Exercises and Dry Needling for Subacromial Pain Syndrome: a Randomized Parallel-Group Trial

This randomized clinical trial investigated the effectiveness of exercise vs. exercise plus trigger point dry needling (TrP-DN) in subacromial pain syndrome. A randomized parallel-group trial, with 1-year follow-up was conducted. Fifty subjects with subacromial pain syndrome were randomly allocated to receive exercise alone or exercise +TrP-DN. Participants in both groups were asked to perform an exercise program of the rotator cuff muscles twice daily for 5 weeks. Further, patients allocated to the exercise +TrP-DN group also received dry needling to active TrPs in the muscles reproducing shoulder symptoms during the 2nd and 4th sessions.

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MATERNAL CORTICAL RESPONSE TO BABY PAIN AND POSTPARTUM DEPRESSIVE SYMPTOMS

Lateral Femoral Cutaneous Nerve Palsy After Spinal Fusion for Adolescent Idiopathic Scoliosis (AIS)

Study Design. Prospective study of consecutive patients. Objective. The purpose of the study was to evaluate the incidence, risk factors, and time to resolution of lateral femoral cutaneous nerve palsy (LFCNP) after posterior spinal fusion (PSF) for adolescent idiopathic scoliosis (AIS). Summary of Background Data. No prior studies have prospectively evaluated the prevalence of LFCNP exclusively in the treatment of AIS. Methods. Between June 2014 and May 2015, patients undergoing PSF for AIS were examined preoperatively, postoperatively, and at follow-up clinic visits until the resolution of the LFCNP. All neurologic examinations were performed by attending pediatric orthopedic surgeons. Patients who underwent staged, revision or anterior procedures, had preoperative neurologic deficits or neuropathy, were excluded. Results. A total of 55 patients with an average age of 14 years (10–21) were enrolled. Twenty-five percent (14/55) of patients had a postoperative LFCNP. There were no other postoperative neurologic deficits. Of the 14 patients with an LFCNP, 57% of these were bilateral. Fourteen percent (2/14) of these patients had absent sensation to light touch, whereas 85% (12/14) had decreased sensation. No patients reported experiencing pain associated with the LFCNP or tenderness when the anterolateral thigh was palpated. The LFCNP did not limit postoperative mobilization or prolong hospital stay. The LFCNP was noted to resolve in an average of 3.6 days (1–18); 6/14 (43%) resolved after 1 day. No correlation was observed between occurrence of LFCNP and sex, age, height, body mass index, length of fusion, Cobb angle, or blood loss. The occurrence of LFCNP was associated with heavier weight (P = 0.032) and longer operative times (P = 0.016). Resolution of the LFCNP was associated with longer operative time (P = 0.010). Conclusion. LFCNP occurred in 25% of AIS patients undergoing PSF. Risk of LFCNP increased with longer operative times and heavier patient weight. On average, LFCNP resolved in less than 4 days and did not cause any pain or limitations. Level of Evidence: 2

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Physical Therapy and Hospitalization Among Medicare Beneficiaries With Low Back Pain: A Retrospective Cohort Study

Study Design. A retrospective cohort study. Objective. The aim of this study was to evaluate associations between receipt and quantity of outpatient physical therapy (PT) during an episode of care and 30-day and 180-day hospital admissions for any condition and lumbar spine conditions. Summary of Background Data. Low back pain (LBP) is a common cause of hospitalization and the most common reason Medicare beneficiaries utilize outpatient PT. The association between PT and hospitalization among patients with LBP is unknown. Methods. A national sample of Medicare Fee-for-Service claims included 413,608 beneficiaries with an International Classification of Disease 9th revision (ICD-9) code of LBP and 1,415,037 episodes of care between June 1, 2010, and June 30, 2011. Episodes were classified as PT episodes or non-PT episodes. Relative risk of hospitalization from the episode start date was caldulated, adjusting for health status (Charlson comorbidity index), prior care utilization (number of prior hospitalizations and total number of episodes), an indicator of LBP severity (number of LBP ICD-9 codes), and demographics (sex, race/ethnicity, age). Results. The proportion of 30-day hospitalization for any condition was 3.42% for PT episodes of care and 6.54% for non-PT episodes. For 180-day hospitalization, proportions were 15.45% (PT) and 21.65% (non-PT). The adjusted relative risk reduction of PT (vs. non-PT) was 41% for 30 days [99% confidence interval (CI) 38–44] and 22% for 180 days (20–24). For admitting diagnoses of lumbar spine, reductions were 65% at 30 days and 32% at 180 days. More PT treatment days showed greater 30-day risk reductions. For any condition, compared with non-PT, reductions were 24% for 1 to 2 treatment days (lowest tertile), 45% for 3 to 7 days, and 65% for more than 8 days (highest tertile). Stronger effects were found for lumbar spine admissions. Associations between PT quantity and 180-day hospitalization were less consistent. Limitations of Medicare claims include the potential for inaccuracies, limited knowledge about disease severity, and which PT interventions were conducted. Conclusion. Receipt of PT during an episode had a 22% to 65% reduced relative risk of hospitalization, with greater short-term reductions for more PT treatment days. Level of Evidence: 3

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Preoperative and Postoperative Photographs and Surgical Outcomes of Patients With Kyphosis

Study Design. A retrospective clinical study was performed. Objective. The aim of the study was to show patients their pre- and postoperative body photographs, and determine the effect on postoperative patient satisfaction for thoracic and thoracolumbar sharp and round angular kyphosis. Summary of Background Data. Previous studies have reported the normative values of pelvic sagittal parameters and the classification of normal patterns of sagittal curvature, but no study has investigated and compared the clinical photographs of sharp and round kyphosis. Methods. In patients who underwent surgery for thoracic and thoracolumbar sharp and round angular kyphosis, whole spine anteroposterior and lateral radiographs, and clinical photographs were obtained preoperatively and at the final follow-up. Pelvic and spinal parameters were measured, and the pre- and postoperative photographs were shown to patients. The Scoliosis Research Society 22r (SRS22r) and Short Form 36 surveys were administered to all patients, and the scores were analyzed. Results. Thirty-eight patients diagnosed with kyphosis (mean age 19.6 yr, mean follow-up duration 26.4 mo) were divided into two groups: sharp (18 patients, mean age 20.1 yr) and round (20 patients, mean age 19.6 yr) kyphosis. There was no difference between values in the sharp and round groups in terms of age, follow-up duration, and Risser score (P > 0.05). In both groups, the subscores for pain, self-image, mental health, and satisfaction, except for the function/activity score, and the total score of the SRS22r survey were, however, significantly different between pre- and postoperative photographs. In addition, there was no significant difference between the two groups in any SRS22r domain and Short Form 36 scores. Conclusion. The surgical treatment of kyphosis was uniformly associated with improved quality of life, regardless of the kyphosis type. Thus, showing patients their pre- and postoperative photographs may enhance patient satisfaction, as measured by SRS22r scores. Level of Evidence: 4

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Remodeling of the Cervical Facet Joint After Minimally Invasive Microendoscopic Resection for Cervical Osteoid Osteoma

Study Design. Case report and systematic review of the literature. Objective. To describe a rare case of remodeling of the cervical facet joint after the microendoscopic resection of an osteoid osteoma. Summary of Background Data. Osteoid osteoma, the third most common benign bone tumor, is often treated by image-guided percutaneous removal of the nidus. However, percutaneous resection poses technical difficulties when the tumor is located near the spinal cord or nerve roots. To our knowledge, there are no reports describing postoperative remodeling of the cervical facet joint after surgical resection of an osteoid osteoma. Methods. A 13-year-old boy was presented with neck pain that became worse at night. Computed tomography showed an osteoid osteoma in the right 7th cervical superior articular process. We successfully resected the nidus of the osteoid osteoma using minimally invasive microendoscopy. Results. The patient was symptom-free at the 1-year follow up, and computed tomography images showed new bone formation at the C6/7 facet joint. Conclusion. This case indicates that microendoscopic resection is safe and effective for treating a cervical osteoid osteoma. This technique allowed total resection of the nidus with only minimal damage to the adjacent soft tissue and bone, and induced remodeling of the resection site. Level of Evidence: 4

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Fear of movement is not associated with objective and subjective physical activity levels in chronic non-specific low back pain