A prospective analysis of prognostic factors in patients with spinal metastases: use of the revised Tokuhashi score.

Study Design: Prospective observational cohort study.

Objective: To define the utility of the revised Tokuhashi score in relation to predicting survival in patients with spinal metastases regardless of the treatment pathway.

Summary Of Background Data: The revised Tokuhashi score has been used for the prediction of survival.

Efficacy of low-level laser therapy for body contouring and spot fat reduction.

Background: Low-level laser therapy (LLLT) is commonly used in medical applications, but scientific studies of its efficacy and the mechanism by which it causes loss of fat from fat cells for body contouring are lacking. This study examined the effectiveness and mechanism by which 635–680 nm LLLT acts as a non-invasive body contouring intervention method.

Methods: Forty healthy men and women ages 18–65 years with a BMI <30 kg/m2 were randomized 1:1 to laser or control treatment.

Common origin of the artery of adamkiewicz and a posterior spinal artery with a spinal dural arteriovenous fistula: a case report.

Progressive nature of the myelopathy seen in patients with dural arteriovenous fistulas call for timely diagnosis and surgical intervention to alleviate symptoms of neurologic dysfunction. We present a case report of a 51-year-old male presented with progressive sensory and motor deficits, along with gait instability associated with urinary incontinence for a period of one year. MRI of the spine demonstrated a thoracic spinal dural arteriovenous fistula.

Spinal supports and physical therapy in patients with low back pain: a case series.

Unlabelled: The association of low back pain with physical workload in seated workstation related jobs has been debated and remains controversial. Clinical studies eliciting the natural history of the disease in this emerging population are insufficient to make definitive conclusions. We report four consecutive cases of patients suffering from low back pain presenting to a tertiary spine clinic with severe non-specific low back pain.

Role of patient-based health status outcome measurements in opioid management for low back pain.

Objective: The aim of the study was to identify patient factors that correlate with a strong response to opioid pain medications in low back pain patients.

Design: Prospective analysis.

Setting: Tertiary Institutional Spine Care Center.

Web-based health survey systems in outcome assessment and management of pain.

Pain is a complex phenomenon lacking a well-defined paradigm for diagnosis and management across medical disciplines. This is due in part to inconsistencies in the assessment of pain as well as in the measurement of related social and psychological states. Efforts to evaluate and measure pain through objective tests have been hindered by challenges such as methodological differences in data acquisition, and the lack of common, universally accepted information systems.

The aging spine: the role of inflammatory mediators in intervertebral disc degeneration.

Human intervertebral disc undergoes multifactorial biochemical and morphologic degenerative changes during the process of aging. The frequency of degeneration, especially lumbar degeneration increases sharply with age and is regarded as a major cause of discogenic low back pain. Since degenerative discs are often asymptomatic, the pathobiology of discogenic back pain remains unclear.

Complications associated with minimally invasive decompression for lumbar spinal stenosis.

Objective: Surgical strategies for the decompression of lumbar spinal stenosis have evolved to include minimally invasive techniques providing for adequate and safe decompression while reducing perioperative morbidity. Retrospective case series analysis of 220 consecutive patients with lumbar spinal stenosis who underwent microscopic or microendoscopic minimally invasive decompression was performed. The objective was to evaluate the risks associated with performing a minimally invasive decompression for spinal stenosis in a large group of patients.

Placement of percutaneous pedicle screws without imaging guidance.

Pedicle screw (PS) instrumentation provides an exceptionally rigid construct to promote fusion in cases of spinal trauma and degenerative disease. Although the safety of traditional open techniques for PS placement has been well documented, there are no large series in the literature in which the safety of percutaneously placed PSs has been examined. Because the advantages of minimally invasive spine surgery are becoming more widely recognized, especially in regard to the lessening of morbidity caused by pain and blood loss, there will be a greater demand for spine surgeons to place PSs percutaneously.

Assessment of internet use and effects among healthcare professionals: a cross sectional survey.

Purpose: Several studies have explored the scientific platforms on patient use of the internet for health information. In contrast physicians' perspective on evolving internet environment is lacking. The purpose of this study is to assess and correlate the extent of internet use among healthcare professionals and examine its effects on clinical practice.

Minimally invasive microendoscopy-assisted transforaminal lumbar interbody fusion with instrumentation.

Object: The authors have developed a novel technique for percutaneous fusion in which standard microendoscopic discectomy is modified. Based on data obtained in their cadaveric studies they considered that this minimally invasive interbody fusion could be safely implemented clinically. The authors describe their initial experience with a microendoscopic transforaminal lumbar interbody fusion (METLIF) technique, with regard to safety in the placement of percutaneous instrumentation, perioperative morbidity, and early postoperative results.

Thoracic microendoscopic discectomy: a human cadaver study.

Study Design: Feasibility analysis of percutaneous posterolateral thoracic microendoscopic discectomy in a human cadaver model.

Objective: To describe a new, minimally invasive, posterolateral approach to the thoracic spine for the treatment of disc herniations.

Summary Of Background: Thoracoscopic discectomy offers surgeons direct ventral access to thoracic disc herniations but requires entry into the chest.

Effectiveness of salmon calcitonin nasal spray in the treatment of lumbar canal stenosis: a double-blind, randomized, placebo-controlled, parallel group trial.

Study Design: Double-blind, randomized, placebo-controlled study to assess the effectiveness of calcitonin nasal spray on symptoms and function in patients with lumbar canal stenosis.

Objective: To compare effectiveness of calcitonin administered by nasal spray with placebo in patients with clinically symptomatic lumbar canal stenosis.

Summary Of Background Data: Lumbar canal stenosis is the most common reason for spine surgery in individuals over 65 years of age.

Microendoscopic discectomy for recurrent disc herniations.

Object: The use of microendoscopic discectomy (MED) for the treatment of primary lumbar disc herniations has become fairly well accepted; its role in recurrent disc herniations is less clear. The reluctance of many surgeons to use this technique stems, in part, from the concern of undertaking an endoscopic discectomy in a patient in whom the anatomy is distorted from a previous operation. It appears counterintuitive to operate through a limited working area when the traditional open approach for recurrence favors wider exposure of the surgical field.

The progressive roles of electronic medicine: benefits, concerns, and costs.

Electronic healthcare will significantly alter the way physicians practice medicine. Electronic medical records with specialized software programs can increase the quality of patient care, reduce unnecessary medical tests, and directly connect with pharmacies to transmit prescriptions. Electronic communication can allow physicians to respond to patients' clinical concerns and questions, and Internet access can provide physicians better access to literature.

The preoperative and postoperative assessment and care of patients with back pain.

Changing health care regulations and funding have led healthcare providers to develop new ways of providing care for patients who have back pain, while consuming fewer hospital resources. As no consensus exists for a transcendent model of preoperative and postoperative assessment and care, clinicians must define their objectives clearly for effective patient care. These include, but are not limited to, acquiring pertinent medical information, consultations, and laboratory testing necessary to assess perioperative risk; optimizing the patient's condition and developing an appropriate perioperative care plan; and educating the patient about intraoperative care and postoperative management to reduce preoperative anxiety.

Chronic non-malignant musculoskeletal pain in older adults: clinical issues and opioid intervention.

Musculoskeletal pain is common, frequently under-reported, and inadequately treated in the older adult. The objective of this article is to review the management of musculoskeletal pain syndromes in older adults emphasising the potential role of opioid agents in carefully selected patients. Systematic analysis of the relevant literature was done.

Vertebral compression fractures: manage aggressively to prevent sequelae.

New drugs to treat osteoporosis, along with two new minimally invasive surgical procedures, are important options for preventing vertebral compression fractures and treating severe back pain and disability. However, the mainstay treatments remain cautious use of analgesics, limited bed rest, and physical rehabilitation.