Surgical management of contiguous multilevel thoracolumbar tuberculous spondylitis.

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Surgical management of contiguous multilevel thoracolumbar tuberculous spondylitis.

Eur Spine J. 2013 Jun;22 Suppl 4:618-23

Authors: Qureshi MA, Khalique AB, Afzal W, Pasha IF, Aebi M

Abstract
INTRODUCTION: Tuberculous spondylitis (TBS) is the most common form of extra-pulmonary tuberculosis. The mainstay of TBS management is anti-tuberculous chemotherapy. Most of the patients with TBS are treated conservatively; however in some patients surgery is indicated. Most common indications for surgery include neurological deficit, deformity, instability, large abscesses and necrotic tissue mass or inadequate response to anti-tuberculous chemotherapy. The most common form of TBS involves a single motion segment of spine (two adjoining vertebrae and their intervening disc). Sometimes TBS involves more than two adjoining vertebrae, when it is called multilevel TBS. Indications for correct surgical management of multilevel TBS is not clear from literature.
MATERIALS AND METHODS: We have retrospectively reviewed 87 patients operated in 10 years for multilevel TBS involving the thoracolumbar spine at our spine unit. Two types of surgeries were performed on these patients. In 57 patients, modified Hong Kong operation was performed with radical debridement, strut grafting and anterior instrumentation. In 30 patients this operation was combined with pedicle screw fixation with or without correction of kyphosis by osteotomy. Patients were followed up for correction of kyphosis, improvement in neurological deficit, pain and function. Complications were noted. On long-term follow-up (average 64 months), there was 9.34 % improvement in kyphosis angle in the modified Hong Kong group and 47.58 % improvement in the group with pedicle screw fixation and osteotomy in addition to anterior surgery (p < 0.001). Seven patients had implant failures and revision surgeries in the modified Hong Kong group. Neurological improvement, pain relief and functional outcome were the same in both groups.
CONCLUSION: We conclude that pedicle screw fixation with or without a correcting osteotomy should be added in all patients with multilevel thoracolumbar tuberculous spondylitis undergoing radical debridement and anterior column reconstruction.

PMID: 22892706 [PubMed – indexed for MEDLINE]

Treatment of low back pain: randomized clinical trial comparing a multidisciplinary group-based rehabilitation program with oral drug treatment up to 12 months.

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Treatment of low back pain: randomized clinical trial comparing a multidisciplinary group-based rehabilitation program with oral drug treatment up to 12 months.

Int J Rheum Dis. 2014 Feb;17(2):159-64

Authors: Tavafian SS, Jamshidi AR, Mohammad K

Abstract
BACKGROUND: This study aimed to examine the effects of a multidisciplinary treatment program on health-related quality of life of Iranian patients living with chronic low back, at 12 months follow-up.
METHODS: This study is an extended follow-up of an original randomized, controlled trial with registration number NCT00600197. In the present study 87 patients in an intervention group and 91 patients in a control group were assessed at 12 months follow-up. The intervention was a group-based multidisciplinary rehabilitation program which continued by monthly motivational consultation by telephone from 6 to 12 months after intervention. Data from three standard measures, Short Form 36 (SF-36), QDS and RDQ were collected at 3, 6 and 12 months follow-up and analyzed through repeated measures analysis of variance.
RESULTS: Despite the similarity between the two groups who completed the 6 month follow-up in terms of all baseline variables, there were significant differences between the two groups in all domains of the SF-36 scale, as well as QDS and RDQ scales (P < 0.05). Also, there were differences within each group over time in the SF-36 domains and disability measurements (P < 0.05). The physical function mean score differed significantly when the interaction between groups and time points was examined (P = 0.02).
CONCLUSION: This study indicates that the multidisciplinary program could improve the domains of health related quality of life and disability in chronic low back pain patients up to 12 months.

PMID: 24576271 [PubMed – in process]

The influence of patient sex, provider sex, and sexist attitudes on pain treatment decisions.

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The influence of patient sex, provider sex, and sexist attitudes on pain treatment decisions.

J Pain. 2014 Feb 24;

Authors: Hirsh AT, Hollingshead NA, Matthias MS, Bair MJ, Kroenke K

Abstract
Research suggests patient sex, provider sex, and providers’ sexist attitudes interact to influence pain care; however, few empirical studies have examined these influences. We investigated sex (patient and provider) differences in pain treatment and the extent to which providers’ sexist attitudes were associated with these differences. Ninety-eight healthcare providers (52% female) completed the Ambivalent Sexism Inventory and made treatment ratings for 16 computer-simulated patients with low back pain. Patient sex was balanced across vignettes. Results indicated that female patients received significantly higher antidepressant (F(1,96)=4.51, p<.05, ηp(2)=.05) and mental health (MH) referral (F(1,96)=3.89, p=.05, ηp(2)=.04) ratings than male patients, which is consistent with our hypotheses; however, these differences were significant only among female providers. Controlling for providers’ sexism scores did not substantially alter these results, which is counter to our hypotheses. These results suggest that female providers are more likely to recommend psychosocial treatments for female than male pain patients, and providers’ sexist attitudes do not account for these differences. Research is needed to elucidate the contributors to sex/gender differences in treatment in order to reduce pain disparities.
PERSPECTIVE: The results of this study suggest that patient and provider sex, but not providers’ sexist attitudes, influence pain care. These findings may inform efforts to raise awareness of sex/gender differences in pain care and reduce disparities.

PMID: 24576430 [PubMed – as supplied by publisher]

[Structured assessment for orthopaedic patients – method, results, and diagnostic potential].

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[Structured assessment for orthopaedic patients – method, results, and diagnostic potential].

Z Orthop Unfall. 2014 Feb;152(1):53-8

Authors: Huber J, Dabis E, Zumstein MD, Ruflin G

Abstract
Background: Review of medical records demonstrates a moderate to low correlation (r = 0.57 to 0.22) between daily limitations and symptoms based upon patient history. This correlation could be improved with the ideal questionnaire which would assess patients using the same questions with the same response options in the same order. Therefore, a simple patient questionnaire for orthopaedic patients was developed and validated to assess 10 symptoms, 12 limitations of daily life and patients’ well-being. The concept was to provide a universal questionnaire that could be used for all patients and provide the basis for a structured assessment that would then provide standardised and comparable patient information. Additional localisation of symptoms would allow a differential diagnosis. For example, pain in the groin/thigh while standing and walking may be caused by osteoarthritis of the hip or osteochondrosis of the lumbar spine. Further physical investigation and diagnostic imaging may lead to the diagnosis. Patients and Methods: This method was employed as part of routine quality control from November 2006 to October 2008 by two orthopaedic surgeons in their outpatient clinic in a tertiary health care hospital. Structured assessment was performed in all patients regardless of their pathology (hip, knee, shoulder, cervical spine, lumbar spine, foot) or situation (before/after surgery, conservative therapy). The completeness, symptom score, daily limitation score, and well-being as well as the relationships between symptom score, daily limitation score, and well-being were calculated. Answers regarding walking capacity and effective walking capacity could be compared. Several patients with combined orthopaedic pathologies were closely analysed. Results: Data of 2642 structured assessments in 1777 patients (957 women, 53.9 %) were evaluated. The average age was 64.4 years. The data completeness on the front page was 96.2 and 86.3 % on the back page. The mean value for symptoms (daily limitations) was 34.31 (27.45), and the median was 32.5 (25.0). The distributions of the symptom score and daily limitation score were asymmetrical; 80 % of the patients were below 50 and 38, respectively. Well-being was excellent in 21.4 %, good in 24 %, moderate in 24.2 %, poor in 11.4 %, and very poor in 16.7 %. The main symptom was pain on movement/walking, with an average of 60.32. The symptom score, daily limitation score, and well-being were found to have a correlation to each other (Spearman’s r between 0.55 and 0.63). Thirty-nine patients reported an inability to walk, although 36 could walk in the office (1 had paraplegia and 2 had paraparesis caused by lumbar stenosis). Combined pathologies in orthopaedic patients were found for cervical-shoulder, lumbar-hip, and lumbar-knee pathologies. Conclusions: A routine structured assessment can be performed with extra effort. A structured assessment provides patient information in a standardised form so that such information can be compared as well as allow a differential diagnosis. It is possible that answers to the questionnaire represent patients’ subjective assessment rather than reality.

PMID: 24578115 [PubMed – in process]