[Diagnosis and conservative treatment of low back pain: review and guidelines of the Croatian Vertebrologic Society].

By London Spine

[Diagnosis and conservative treatment of low back pain: review and guidelines of the Croatian Vertebrologic Society].

Acta Med Croatica. 2012 Oct;66(4):259-94

Authors: Grazio S, Curković B, Vlak T, Kes VB, Jelić M, Buljan D, Gnjidić Z, Nemcić T, Grubisić F, Borić I, Kauzlarić N, Mustapić M, Demarin V, Croatian Vertebrologic Society

Abstract
Low back pain (LBP) is a very common condition with high costs of patient care. Medical doctors of various specialties from Croatia have brought an up-to-date review and guidelines for diagnosis and conservative treatment of low back pain, which should result in the application of evidence-based care and eventually better outcomes. As LBP is a multifactorial disease, it is often not possible to identify which factors may be responsible for the onset of LBP and to what extent they aggravate the patient’s symptoms. In the diagnostic algorithm, patient’s history and clinical examination have the key role. Furthermore, most important is to classify patients into those with nonspecific back pain, LBP associated with radiculopathy (radicular syndrome) and LBP potentially associated with suspected or confirmed severe pathology. Not solely a physical problem, LBP should be considered through psychosocial factors too. In that case, early identification of patients who will develop chronic back pain will be helpful because it determines the choice of treatment. In order to make proper assessment of a patient with LBP (i.e. pain, function), we should use validated questionnaires. Useful approach to a patient with LBP is to apply the principles of content management. Generally, acute and chronic LBP cases are treated differently. Besides providing education, in patients with acute back pain, advice seems to be crucial (especially to remain active), along with the use of drugs (primarily in terms of pain control), while in some patients spinal manipulation (performed by educated professional) or/and short-term use of lumbosacral orthotic devices can also be considered. The main goal of treating patients with chronic LBP is renewal of function, even in case of persistent pain. For chronic LBP, along with education and medical treatment, therapeutic exercise, physical therapy and massage are recommended, while in patients with a high level of disability intensive multidisciplinary biopsychosocial approach has proved to be effective.

PMID: 23814971 [PubMed – in process]

Kirschner-Wire Guided Technique for Inserting a Second Needle into Inadequately Filled Vertebrae in Vertebroplasty: a technical report.

By London Spine
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Kirschner-Wire Guided Technique for Inserting a Second Needle into Inadequately Filled Vertebrae in Vertebroplasty: a technical report.

Spine J. 2014 Jul 23;

Authors: Chen YJ, Chen HY, Lo DF, Chen HT, Hsu HC

Abstract
BACKGROUND CONTEXT: Absence or inadequate filling of cement in the fractured vertebrae can cause unsatisfactory results in vertebroplasty. Repeated needle insertion can reduce the incidence of re-collapse at the cemented vertebrae. However, when inserting the second needle as the usual method, it takes the same time and radiation exposure as the first needle.
PURPOSE: We report a Kirschner-wire guided technique for inserting a second needle into inadequately filled vertebrae in vertebroplasty that can make the procedure simple, effective, and most importantly, reduce the radiation exposure.
STUDY DESIGN: Description of a modified surgical technique with retrospective data analysis.
PATIENT SAMPLE: From January 2012 to December 2012, 87 percutaneous vertebroplasty were performed in our department to treat painful osteoporotic compression fractures. Seven adult patients (5 women, 2 men; mean age: 75.7 years) had inadequate cement filling in the treated vertebrae that required the insertion of a second needle.
OUTCOME MEASURES: Back pain was measured using the visual analog scale (VAS). The post-vertebroplasty anterior vertebral height and local kyphotic angle were used as the radiological parameters. Intra-operative procedure time and fluoroscopy shots and post-operative complication was also evaluated.
METHODS: The stylus of the first needle was inserted into the trocar to push the cement out of the trocar. The stylus was removed, a small diameter K-wire was inserted into the trocar, and the trocar was then removed. A second (new) trocar was inserted into the vertebral body following the track of the K-wire. When the new trocar reached the posterior 1/4 of the vertebral body, the K-wire was removed, the stylus was inserted, and the new needle was advanced to the anterior third of the vertebra. Cement was then injected into the new area until the filling was adequate. No funds and support were received in support of this work. All authors have no conflicts of interest.
RESULTS: The immediate post-vertebroplasty anterior vertebral height was 23.31 ± 1.95 mm, changed to 22.20 ± 3.72 mm at final follow-up. The visual analog scale decreased from a mean of 8.4 before vertebroplasty to 1.6 at final follow-up. The follow-up duration ranged from 6 to 15 months (mean 12.6 months). There was no case of re-collapse of the cemented vertebrae, and no procedure-related complications. The procedure time of historical controls was 153.5 seconds, and reduced to 47.9 seconds by using this technique. The fluoroscopy shots of historical controls were 9.7 shots, and reduced to 2 shots by using this technique.
CONCLUSIONS: This report suggests that Kirschner-wire guided technique for inserting a second needle during vertebroplasty could make the procedure simple, effective, and most importantly, reduce the procedure time and radiation exposure.

PMID: 25064004 [PubMed – as supplied by publisher]

[Postraumatic epidural arachnoid spinal cyst: case report].

By London Spine

[Postraumatic epidural arachnoid spinal cyst: case report].

Neurocirugia (Astur). 2011 Jun;22(3):267-70

Authors: Hernández-León O, Pérez-Nogueira FR, Corrales N

Abstract
INTRODUCTION: Extradural arachnoid spinal cysts are unfrequent lesions that are associated with spinal trauma, surgery and less frequently with congenital anomalies. The clinical manifestations are similar to those seen with other compressive spinal cord lesions. Magnetic resonance techniques allow to diagnose correctly this pathology and to define its thopographic situation. The pathologic history of the patient is essencial to establish the ethiology. Surgery is the elective treatment in most cases.
CLINICAL CASE: The patient is a 35 years old man who has a medical history of penetrating spinal trauma two years ago. In that instance he suffered an unilateral spinal cord section at D2-D3 level with the corresponding Brown Sequard syndrome. A small wound was detected at the skin dorsal level and it was closed without difficulties. At the beginning, he improved his motor right leg function with rehabilitation and vitamins. After two years of good recovery he came to our hospital suffering a neurological deterioration of six months of evolution. The physical examination revealed an spastic paraparesis. Magnetic resonance was performed demonstrating a cystic extradural collection compressing the spinal cord at D3-D4 level. Surgical decompressive treatment allowed to excise the cyst and it was possible to define a dural tear that was closed successfully. The outcome was good with restoration of the initial motor function that he had after the spinal trauma.
CONCLUSIONS: Surgical management of postraumatic epidural arachnoid spinal cyst allows to detect the meningeal tear and to close it, which is highly effective on these kinds of lesions.

PMID: 21743950 [PubMed – indexed for MEDLINE]

Upper thoracic versus lower thoracic upper instrumented vertebrae endpoints have similar outcomes and complications in adult scoliosis.

By London Spine
Related Articles

Upper thoracic versus lower thoracic upper instrumented vertebrae endpoints have similar outcomes and complications in adult scoliosis.

Spine (Phila Pa 1976). 2014 Jun 1;39(13):E795-9

Authors: Kim HJ, Boachie-Adjei O, Shaffrey CI, Schwab F, Lafage V, Bess S, Gupta MC, Smith JS, Deviren V, Akbarnia B, Mundis GM, OʼBrien M, Hostin R, Ames C, International Spine Study Group

Abstract
STUDY DESIGN: Retrospective review-multicenter database.
OBJECTIVE: The purpose of this study was to compare the upper thoracic (UT) and lower thoracic (LT) upper instrumented vertebrae (UIV) in long fusions to the sacrum for adult scoliosis.
SUMMARY OF BACKGROUND DATA: The optimal UIV for stopping long fusions to the sacrum/pelvis are controversial. Although a UT endpoint may lead to greater operative times, blood loss, and higher rates of pseudarthrosis, the risk for the development of proximal junctional kyphosis and need for revision surgery is likely lower.
METHODS: Retrospective analysis of a prospective database of patients with adult spinal deformity, Patients were selected on the basis of fusions to the sacrum/pelvis with UIV of T1-T6 (UT group) and those with a UIV of T9-L1 (LT group). Demographic data, operative details, and radiographical outcomes with Scoliosis Research Society scores, and Oswestry Disability Index outcomes were collected, as well as complication data were compared. The Fisher exact T tests were used for statistical analysis.
RESULTS: A total of 198 patients (UT = 91, LT = 107) with a mean age of 61.6 were followed for an average of 2.5 years. Demographic variables were similar between the groups except for larger numbers of females in the UT group and a slightly higher body mass index in the LT group. Preoperatively, the UT group demonstrated significantly more lumbar scoliosis, thoracic scoliosis, and thoracolumbar kyphosis. The UT group demonstrated a larger number of fused segments length of stay and longer operative times. There was slightly larger volume of blood loss in the UT group.The total number of complications and number of revision surgical procedures were similar between the groups. The UT group had a higher percentage of patients with 2 or more complications. Both groups had similar proximal junctional kyphosis angles and number of cases requiring revision for proximal junctional kyphosis. Scoliosis Research Society and Oswestry Disability Index outcomes were similar between the groups.
CONCLUSION: The UT and LT groups had similar outcomes. The UT group may have a higher rate of total complications, but major complications requiring return to the operative room were similar. The length of stay and operative times were higher in the UT group but may have been necessarily evidenced by the significantly higher coronal deformity and greater thoracolumbar kyphosis in the UT group.
LEVEL OF EVIDENCE: 4.

PMID: 24732840 [PubMed – indexed for MEDLINE]