Quality of Life and Slip Progression in Degenerative Spondylolisthesis Treated Nonoperatively

Study Design. A prospective cohort study of consecutive patients. Objective. Determination of the quality of life (QoL) and prevalence of slip progression in patients with degenerative lumbar spondylolisthesis managed nonoperatively. Summary of Background Data. Lumbar spinal stenosis secondary to degenerative lumbar spondylolisthesis is a common radiographic diagnosis associated with chronic back pain and radicular symptoms. There is limited evidence as to the clinical course in terms of validated QoL measures, and the extent of slip progression in patients with this condition treated nonoperatively. Methods. Validated disease-specific and generic QoL metrics including SF12 physical and mental scores [SF12-physical component summary (PCS) and SF12-mental component summary (MCS)], Oswestry Disability Index (ODI), and numeric scales for back and leg pain as well as radiographic assessment of slip extent were evaluated at initial consultation (baseline) and at a minimum of 5 years after the baseline assessment. Slip progression was defined by a >5% increase in slip percentage. Results. Thirty-nine of 160 (24.4%) patients elected to switch to operative management, despite no slip progression on preoperative radiographs. Seventy spondylolisthetic levels in 66 participants were assessed after a minimum of 5 years of nonoperative management. Twenty-one participants (31.8%) had slip progression. SF12-PCS, ODI, and leg pain improved similarly in both groups (P < 0.05). SF12-MCS did not change significantly in either group. Back pain improved only in the nonprogressing group. Conclusion. The majority of cases of low-grade spondylolisthesis do not progress over 5 years with nonoperative management. Regardless of whether there was progression or not, the mean PCS, ODI, and leg pain improved from baseline, although symptoms remained and a significant number elected to switch to surgical management before 5 years. Back pain improved with nonoperative treatment only in those without progression. Level of Evidence: 2

from Spine - Featured Articles - Featured Articles https://ift.tt/2jMHbRn
via IFTTT

Cartilage Endplate Thickness Variation Measured by Ultrashort Echo-Time MRI Is Associated With Adjacent Disc Degeneration

Study Design. A magnetic resonance imaging study of human cadaver spines. Objective. To investigate associations between cartilage endplate (CEP) thickness and disc degeneration. Summary of Background Data. Damage to the CEP is associated with spinal injury and back pain. However, CEP morphology and its association with disc degeneration have not been well characterized. Methods. Ten lumbar motion segments with varying degrees of disc degeneration were harvested from six cadaveric spines and scanned with magnetic resonance imaging in the sagittal plane using a T2-weighted two-dimensional (2D) sequence, a three-dimensional (3D) ultrashort echo-time (UTE) imaging sequence, and a 3D T1ρ mapping sequence. CEP thicknesses were calculated from 3D UTE image data using a custom, automated algorithm, and these values were validated against histology measurements. Pfirrmann grades and T1ρ values in the disc were assessed and correlated with CEP thickness. Results. The mean CEP thickness calculated from UTE images was 0.74 ± 0.04 mm. Statistical comparisons between histology and UTE-derived measurements of CEP thickness showed significant agreement, with the mean difference not significantly different from zero (P = 0.32). Within-disc variation of T1ρ (standard deviation) was significantly lower for Pfirrmann grade 4 than Pfirrmann grade 3 (P < 0.05). Within-disc variation of T1ρ and adjacent CEP thickness heterogeneity (coefficient of variation) had a significant negative correlation (r = −0.65, P = 0.04). The standard deviation of T1ρand the mean CEP thickness showed a moderate positive correlation (r = 0.40, P = 0.26). Conclusion. This study demonstrates that quantitative measurements of CEP thickness measured from UTE magnetic resonance imaging are associated with disc degeneration. Our results suggest that variability in CEP thickness and T1ρ, rather than their mean values, may serve as valuable diagnostic markers for disc degeneration. Level of Evidence: N/A

from Spine - Featured Articles - Featured Articles https://ift.tt/2G1J7Ok
via IFTTT

Spinal Surgeons’ Opinions on Pre- and Postoperative Rehabilitation in Patients Undergoing Lumbar Spinal Fusion Surgery: A Survey-Based Study in the Netherlands and Sweden

Study Design. A cross-sectional survey in the Netherlands and Sweden. Objective. To investigate Dutch and Swedish spinal surgeons’ opinions on spinal fusion pre- and postoperative rehabilitation. Summary of Background Data. Lumbar spinal fusion surgery is increasingly provided in patients with chronic low back pain. No guidelines however exist for pre- and postoperative rehabilitation and it is unknown what opinions spinal surgeons currently have about pre- and postoperative rehabilitation. Methods. A survey was circulated to Dutch and Swedish spinal surgeons. Reminders were sent after 4 and 8/9 weeks. Data of completed questionnaires of orthopedic- and neurosurgeons currently performing lumbar spinal fusion were included for analysis. Analysis comprised a range of descriptive summaries (numerical, graphical, and tabular). Results. Surveys of 34 Dutch and 48 Swedish surgeons were analyzed. Surgeons provided preoperative information on postoperative mobilization. Spinal fusion techniques varied, but technique did not influence postoperative treatment. Swedish surgeons recommended slightly faster mobilization than Dutch (direct vs. 1-day postoperative), and more activities the first day (sitting, standing, walking). Stair climbing was the most reported discharge criterion; however, time point to start varied. More Swedish surgeons referred to postoperative physiotherapy than Dutch (88% vs. 44%). Time-point to start home activities varied from 1 week to more than 6 months. Pain increase was allowed for less than 24 hours (The Netherlands 81%, Sweden 92%). Conclusion. Findings reflect variability in lumbar spinal fusion rehabilitation in two European countries, especially in postoperative phase. The study proposes many new research topics and acts as starting point for future research valuable for the spinal community. Level of Evidence: 3

from Spine - Featured Articles - Featured Articles https://ift.tt/2FYXdAd
via IFTTT

When you live with a degenerative illness, no symptoms are mild

I was first given a diagnosis of relapsing remitting multiple sclerosis in my 20s. Four years later, a string of relapses triggered involuntary movements in my arms and legs, and I had pain, visual...

from Latest headlines from BMJ https://ift.tt/2rvl70V
via IFTTT

How to tell how much wasp stings will hurt

How to tell how much wasp stings will hurt

How to tell how much wasp stings will hurt, Published online: 08 May 2018; doi:10.1038/d41586-018-05126-9

Short stinging organs tend to carry more-toxic venom — but inflict less pain — than long ones.

from Nature - Issue - nature.com science feeds https://ift.tt/2FWIVzR
via IFTTT

Education plus exercise versus corticosteroid injection use versus a wait and see approach on global outcome and pain from gluteal tendinopathy: prospective, single blinded, randomised clinical trial

AbstractObjectiveTo compare the effects of a programme of load management education plus exercise, corticosteroid injection use, and no treatment on pain and global improvement in individuals with...

from Latest headlines from BMJ https://ift.tt/2w8eHuc
via IFTTT

A man with chest pain and a broad QRS complex tachycardia

A 50 year old man with “heavy” chest pain was referred urgently from a local district hospital to the cardiothoracic centre because a broad QRS complex tachycardia had been noticed on...

from Latest headlines from BMJ https://ift.tt/2HOCMLZ
via IFTTT