Use of Therapeutic Neuroscience Education to address psychosocial factors associated with acute low back pain: a case report.

By London Spine
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Use of Therapeutic Neuroscience Education to address psychosocial factors associated with acute low back pain: a case report.

Physiother Theory Pract. 2013 Nov 19;

Authors: Zimney K, Louw A, Puentedura EJ

Abstract
Abstract Acute low back pain (LBP) from injuries is prevalent in the work place. It has been shown that patients with psychosocial factors often progress with persistent pain and lead to significant workers compensation costs. Therapeutic Neuroscience Education (TNE) has been shown to be beneficial in changing a patient’s cognition regarding their pain state, which may result in decrease fear, anxiety and catastrophization. A 19-year-old female who developed LBP from a work injury was the patient for this case report. A physical examination, Numeric Pain Rating Scale (NRPS), Oswestry Disability Index (ODI), Fear-Avoidance Beliefs Questionnaire (FABQ), Keele STarT Back Screening Tool (Keele SBST) and Acute Low Back Pain Screening (ALBPS) Questionnaires were assessed during initial physical therapy visit and discharge. Treatment consisted of use of TNE, manual therapy and exercises. She attended five total visits over a 2-week period prior to full discharge. During the initial visit the patient reported NRPS = 3/10, ODI = 36%, FABQ-PA = 23, FABQ-W = 30, Keele SBST = 4/9, ALBPS = 101. At discharge the patient reported a 0 on all outcome questionnaires with ability to return to full work and no pain complaints.

PMID: 24252071 [PubMed – as supplied by publisher]

Inveterate subaxial cervical dislocations: A discussion on the best therapeutic strategy.

By London Spine
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Inveterate subaxial cervical dislocations: A discussion on the best therapeutic strategy.

Rev Esp Cir Ortop Traumatol. 2013 Oct 11;

Authors: Gallego-Goyanes A, Caeiro-Rey JR, Díez-Ulloa MA, Pino-Mínguez J

Abstract
It is difficult to decide the appropriate treatment for inveterate cervical dislocations because of the difficulty of their reduction, as well as due to the risk of inducing iatrogenic injuries during this reduction. The literature on the most appropriate surgical strategy for their management is also limited as well as controversial. We report one clinical case treated in the Spine Unit of the Orthopedic Surgery and Trauma Service of the University Hospital of Santiago de Compostela, discussing the currently most used treatment options, the anterior-posterior-anterior and the posterior-anterior-posterior approach. After analyzing the results, it could be concluded that the surgical approach to these lesions is generally difficult, with any of two techniques described above being suitable, but always with the precaution to remove the entire affected intervertebral disc before axial correction maneuvers, thus avoiding the risk of extrusion into the medullary canal. After the surgical procedure, a proper release and reduction of the joint facets should be performed, sometimes with the need to add osteotomies in them.

PMID: 24126148 [PubMed – as supplied by publisher]

Laparoscopic sleeve gastrectomy: a first step for rapid weight loss in morbidly obese patients requiring a second non-bariatric procedure.

By London Spine

Laparoscopic sleeve gastrectomy: a first step for rapid weight loss in morbidly obese patients requiring a second non-bariatric procedure.

Obes Surg. 2012 Apr;22(4):555-9

Authors: Hidalgo JE, Roy M, Ramirez A, Szomstein S, Rosenthal RJ

Abstract
BACKGROUND: Laparoscopic sleeve gastrectomy is a viable option that is becoming common in the management of morbid obesity. The aim of this study was to examine the effectiveness and safety of laparoscopic sleeve gastrectomy as a primary step for rapid weight loss in patients who required a second non-bariatric procedure.
METHODS: After Internal Review Board approval and with adherence to HIPAA guidelines, we conducted a retrospective review of a prospectively collected database of all patients who underwent laparoscopic sleeve gastrectomy as a primary procedure for a second non-bariatric operation from November 2004 to September 2008 at the Bariatric and Metabolic Institute at Cleveland Clinic Florida. The data was reviewed for age, gender, percentage of excess weight loss (%EWL), preoperative and postoperative body mass index (BMI), morbidity, and mortality. Mean follow-up time was 7 months (range, 2 weeks-12 months).
RESULTS: Laparoscopic sleeve gastrectomy was performed in 18 patients who needed a second non-bariatric procedure such as knee replacement surgery, recurrent incisional hernia repair, laminectomy of the lumbar spine, kidney transplant, anterior cervical discectomy, and nephrectomy. Mean preoperative weight and BMI were 124.9 kg (range, 95.5-172.3 kg) and 44.87 kg/m(2) (range, 33.36-58.87 kg/m(2)), respectively. Mean postoperative weight and BMI were 99.2 kg (range, 68.2-132.2 kg) and 35.79 kg/m(2) (range, 23.46-48.97 kg/m(2)), respectively. There were no conversions to an open procedure in this series. There was no morbidity or mortality in this series.
CONCLUSIONS: In this small group, laparoscopic sleeve gastrectomy appears to be an effective and safe first surgical approach for rapid weight loss in high-risk patients that require a second non-bariatric procedure.

PMID: 22207407 [PubMed – in process]

A Modified Delphi Survey on the Signs and Symptoms of Low Back Pain: Indicators for an Interventional Management Approach.

By London Spine
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A Modified Delphi Survey on the Signs and Symptoms of Low Back Pain: Indicators for an Interventional Management Approach.

Pain Pract. 2013 Dec 9;

Authors: Cid J, De La Calle JL, López E, Del Pozo C, Perucho A, Acedo MS, Bedmar D, Benito J, De Andrés J, Díaz S, García JA, Gómez-Caro L, Gracia A, Hernández JM, Insausti J, Madariaga M, Moñino P, Ruiz M, Uriarte E, Vidal A

Abstract
BACKGROUND: Low back pain (LBP) symptoms and signs are nonspecific. If required, diagnostic blocks may find the source of pain, but indicators of suspect diagnosis must be defined to identify anatomical targets.
OBJECTIVE: To reach a consensus from an expert panel on the indicators for the most common causes of LBP.
MATERIAL AND METHODS: A 3-round (2 telematic and 1 face-to-face) modified Delphi survey with a questionnaire on 78 evidence-based indicators of 7 LBP etiologies was completed by 23 experts.
RESULTS: 98.7% of the questionnaire was consensuated. The most accepted indicators were for zygapophysial joint pain, painful ipsilateral paravertebral palpation, worsening with trunk extension, paravertebral musculature spasm on the affected articulation, and referred pain above the knee, without radicular pattern. For sacroiliac joint pain, unilateral pain when seating, with at least 3 described provoking tests: Approximation; gapping; Patrick’s; Gaenslen’s; thigh thrust; Fortin finger; and Gillet’s tests. For discogenic pain, midline pain that may be provoked by pressure on the spinal processes at the affected level; for quadratus lumborum muscle, painful palpation on both the L1 level paravertebral region, referred to iliac crest, and the iliac crest, referred to greater trochanter. For iliopsoas muscle, pain elicited by thigh flexion, referred to buttock, inguinal region, and anterior thigh. For pyramidal muscle, pain while sitting on the affected side and positive Freiberg’s test. For radicular pain, paresthesias and positive Lassègue’s test at 60°.
CONCLUSION: Seventy-seven diagnostic suspect indicators of LBP conditions were consensuated. These may facilitate conservative or interventional pain management decision-making.

PMID: 24314001 [PubMed – as supplied by publisher]

Application of a peripheral nerve block technique in laser treatment of the entire facial skin and evaluation of its analgesic effect.

By London Spine

Application of a peripheral nerve block technique in laser treatment of the entire facial skin and evaluation of its analgesic effect.

Eur J Dermatol. 2013 Jun 24;

Authors: Wan K, Jing Q, Sun QN, Wang HW, Zhao JZ, Ma L, Kong LJ

Abstract
Background: The aim was to develop a technique for peripheral nerve block anesthesia (PNB) for the skin of the entire face and neck, considering the nerves anesthetized, injection sites, use of an injection method assisted by computer-controlled local anesthetic delivery (CCLAD), and to evaluate the analgesic effects of the PNB technique. Methods: 50 patients who suffered from large nevus of Ota lesions or port-wine stains on their facial and neck skin and who required laser treatment were included. This study was designed as a non-randomized self-control trial. All the patients received the laser treatment under topical anesthesia in the first phase and three to six months later, they received the same treatment under the PNB using CCLAD. The differences in scores from the visual analogue scale of pain for the two phases were analyzed by the t-test. P values <0.05 were considered to be statistically significant. Results: The peripheral nerve block technique was simple to execute and easy to learn, the anesthetic injection site was generally located at a subcutaneous depth of 0.5-1.0 cm. The analgesic effect of PNB was significant, the mean pain score (2.8 ± 2.2) was significantly lower than that with topical anesthesia (P<0.0001). Patients during the PNB phase did not experience injection pain following CCLAD. Conclusion: The peripheral nerve block technique can greatly ease the pain that occurs during laser treatment, especially for patients with larger lesions. CCLAD will allow PNB to be broadly applied in laser treatments.

PMID: 23797378 [PubMed – as supplied by publisher]

106?Verification of Spinal Cord Decompression by Pre- and Postoperative Magnetic Resonance Imaging in Traumatic Subaxial Spinal Cord Injuries.

By London Spine

106 Verification of Spinal Cord Decompression by Pre- and Postoperative Magnetic Resonance Imaging in Traumatic Subaxial Spinal Cord Injuries.

Neurosurgery. 2014 Aug;61 Suppl 1:193

Authors: Aarabi B, Akhtar-Danesh N, Hersh D, Le EJ, Massetti JM, Diaz C

Abstract
INTRODUCTION:: Evidence presented by the Surgical Timing of Acute Spinal Cord Injury Study (STASCIS) was in favor of early (within 24 hours) spinal cord decompression aimed at improved outcome. The exact definition of decompression and the most favorable surgical technique suitable to offer circumferential release of the subarachnoid space around a swollen spinal cord across several motion segments is, however, unknown. We compared pre- and postoperative computed tomography (CT) and magnetic resonance imaging (MRI) images and crossed them against the surgical technique used in order to define the surgical techniques offering the best decompressive capability.
METHODS:: Pre- and postoperative CT and MRI images of 52 patients with traumatic subaxial cervical spinal cord injury American Spinal Injury Association Impairment Scale grades A, B, or C and evidence of continued spinal cord compression spanning a 4-year period were compared. A regression analysis was performed to define superior surgical techniques for circumferential spinal cord decompression along 3 to 5 cervical spinal cord segments.
RESULTS:: The mean age was 37.9 (SD = 18.6) and the mean American Spinal Injury Association (ASIA) motor score was 16.7 (SD = 13.7). The ASIA Impairment Scale was A in 33 (63.5%) patients, B in 15 (28.8%) patients and C in 4 (7.7%) patients. The Allen’s mechanistic classification was distractive in 33 patients and compressive in 18 patients. The mean mid-sagittal diameter of the cervical spine on CT was 13.3 mm and the mean intramedullary volume of signal change on MRI images was 1536.4 mm. The mean Subaxial Injury Classification Severity (SLIC) score was 8.6. Anterior discectomy or corpectomy was performed in 29 (55.8%) patients and laminectomy ± discectomy or corpectomy was performed in 23 (44.2%) patients. An anterior approach failed to provide a complete decompression of the spinal cord in 51% of cases, but an added laminectomy achieved full decompression in 87% of cases. From 11 demographic, clinical, and injury severity variables, only laminectomy correlated significantly with adequate surgical decompression (P < .002).
CONCLUSION:: In traumatic subaxial cervical spine injuries, the inclusion of laminectomy in the surgical approach offered a significantly better chance of spinal cord decompression than pure discectomy or corpectomy.

PMID: 25032557 [PubMed – as supplied by publisher]