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PubMed2001

Cross-cultural adaptation of the lumbar North American Spine Society questionnaire for Italian-speaking patients with lumbar spinal disease.

STUDY DESIGN: A cross-cultural adaptation and cross-sectional study of a sample of lumbar spine patients, with a subsample followed prospectively for retest reliability. OBJECTIVES: To assess the Italian version instrument reliability and validity. SUMMARY OF BACKGROUND DATA: The orthopaedic outcome measurements have been usually focused on objective parameters as radiograph measures or other technical aspects. However, these parameters are weakly related with outcomes that are more relevant to patients as functional status and symptoms. In the last ten years, the patient-oriented measures have become an important aspect of spinal clinical outcome evaluation. The most common instruments to assess patient perspective are self-administered questionnaires that must be validated by a widely accepted process to evaluate reliability and validity, which are fundamental for every instrumental measure. METHODS: The North American Spine Society (NASS) questionnaire was culturally adapted for Italian-speaking people following the Guillemin criteria. The Italian version was tested on 74 consecutive patients who were referred to the authors' department and suffered from low back pain with leg irradiation. The results were compared with other validated patient-oriented measures. Forty-eight-hour retests were performed on a subsample of 45 patients. RESULTS: The questionnaire was favorably accepted by patients. The lumbar spine pain and disability and neurogenic symptoms subscales showed a high correlation with other patient-oriented measures, as hypothesized, and it also showed good values on test-retest. CONCLUSIONS: The questionnaire should be considered for patient health status monitoring and for clinical trials.

Cross-Cultural Comparison↗
PubMed1988

Gadolinium-DTPA in the evaluation of intradural extramedullary spinal disease.

Gadolinium-DTPA was used in MR imaging of the spine to determine the ability of a contrast agent to increase the detection and characterization of disease in the intradural extramedullary space. Although MR imaging, especially with recent technological improvements, has been shown to be at least competitive with, and often superior to, myelography and postmyelography CT in the study of intramedullary and extradural disease, its use in the assessment of intradural extramedullary disease has been questioned. We selected 12 patients with intradural extramedullary disease as demonstrated by positive CSF cytology and/or myelographic findings and performed MR examinations on them before and after administering gadolinium-DTPA (0.1 mmol/kg). Gadolinium-DTPA was extremely effective in depicting intradural extramedullary disease of the spine. Small nodules of 3 mm, virtually invisible on noncontrast MR scans, enhanced strongly and were easily detected. In addition, leptomeningeal spread of tumor along nerve roots was also visualized, sometimes more readily than by myelography and postmyelography CT. The remarkable sensitivity of gadolinium-DTPA to intradural extramedullary disease assures its role in future MR examinations of the spine.

Adult↗
PubMedDate not supplied

Profiles of neuromuscular diseases. Spinal muscular atrophy.

Forty-five individuals with spinal muscular atrophy (SMA) types II and III were evaluated prospectively over a 10-yr period to develop an impairment and disability profile. SMA II subjects showed marked weakness and progressive decline of strength. Mean manual muscle test (MMT) score for all muscles combined was 2.3 +/- 0.6, with a decline in strength of -0.24 MMT units per decade. SMA III individuals had a relatively static or very slowly progressive course and were far stronger. Mean MMT score for all muscles combined was 3.8 +/- 0.7, and the decline in strength per decade was not significant. In both types proximal weakness was greater than distal, but there was greater involvement of the lower extremities and the extensor muscle groups only in SMA II. Contractures, progressive scoliosis, and restrictive lung disease (RLD) were present in most of the SMA II individuals, but these complications were rare in SMA III. Maximal expiratory pressures were affected earlier and to a greater degree than vital capacity. Seventy-eight percent of those with SMA II had scoliosis with a mean Cobb angle of the primary curve of 62 +/- 37 degrees. Forty-one percent had severe RLD, and 17% had moderate RLD. In both types, 63% had abnormal electrocardiograms although most had minor findings. Timed motor performance and functional evaluations indicated that muscle weakness translated to substantial disability in both SMA II and III, with more severe impairment noted in SMA II. Neither type was associated with abnormal means scores on intellectual and neuropsychologic test batteries.

Adolescent↗
PubMed1989

[External instrumental fixation of the spine in the treatment of spinal diseases and injuries].

The authors analyze the results of treatment of 358 patients with specific and nonspecific spondylitis and with aftereffects of unstable fractures of the vertebrae proper, who have been operated on the spine destruction or instability area with the extrafocal fixation of the operated on segments by means of the Byzov apparatus. This method has yielded good clinical and functional results, effected the stability of the anterior and posterior portions of the operated on sites; it permits early (starting from the 5th-10th day postoperation) exercise of the patients, helps normal functioning of the body organs and systems, and activates the repair processes in the operated on sites. The incidence rate of the postoperative complications drops drastically, the patients rapidly recover their working abilities, and the invalidism is more rare.

Adolescent↗
PubMedDate not supplied

Intervertebral cages for degenerative spinal diseases.

Interbody fusion techniques have been used for many years for the treatment of a variety of lumbar spine diagnoses. Part of the interest in increasing methods of interbody fusion has stemmed from concern that posterior fusion alone may allow micro-motion, which may generate pain in a ruptured or degenerated disc. Stabilization of the anterior segment led to the development of interbody fusion cages. These devices were designed to stabilize the spine while bony ingrowth from the vertebrae to the bone graft occurred. There are a variety of techniques for cage insertion, including open and laparoscopic techniques anteriorly, and open posterior approach. A lateral approach for cage placement has also been reported. The purpose of this paper is to present a review of the literature on lumbar intervertebral fusion performed using interbody cages. The reported results for these procedures vary, but in general the majority of patients have had favorable results. The complications are similar to those encountered with traditional interbody fusion procedures using bone grafts. There is a learning curve associated with the procedures, particularly with the laparoscopic techniques. Appropriate training for the spine surgeon as well as the access surgeon is important. There is a great deal of disparity in reports on using the cages as stand-alone devices as well as on laparoscopic approaches. Overall, the use of interbody cages for fusion appears to be a viable treatment, yielding good results. Fusion cages appear to have a role in spine care; however, as with any procedure, patient selection and proper training of the surgeon are critical.

Humans↗
PubMed2002

[Therapeutic use of "biologics" in inflammatory joint and spinal diseases].

At present, two principles of biologic treatment for rheumatoid arthritis and other chronic inflammatory joint and spine diseases (juvenile polyarticular idiopathic arthritis, spondarthritides) are available for use in clinical practice. These are the TNF-alpha antagonists etanercept and infliximab as well as the human recombinant IL-1 receptor antagonist anakinra. All three biologics have significant short and long-term therapeutic effects on clinical and humoral inflammatory activity compared to placebo treatment in controlled clinical trials and even radiological progression of rheumatoid arthritis can be with halted. Principally, safety and tolerability of TNF- and IL-1 antagonist are good. However, local skin reactions at injection sites and infections of the upper respiratory tract and urinary tract have to be considered. Severe infections are rare except for an increased frequency of tuberculous infection observed with infliximab worldwide. The induction of autoantibodies including antibodies to double-stranded DNA and neuralizing antibodies to etanercept and infliximab themselves can occur though their clinical significance is still upon debate. It is important to notice that the advantages of the use of biologics in individual patients has carefully to be balanced against their high costs and the increased risk of infectious side effects. Therefore, guidelines of international experts recommend the clinical use of biologics mostly for patients resistant or intolerable to conventional treatment.

Antibodies, Monoclonal↗
PubMedDate not supplied

[Body traction using centrifugal force in the treatment of spinal diseases].

In self treatment bodystretching centrifugal force was used in order to diminish backbone pains after discektomy L3/L4. After 13 minutes of treatment with up to 1.5 G centrifugal force related to the lumbal region on a centrifuge of the Max-Planck-Institut für Verhaltensphysiologie Seewiesen the author felt free of pains in the back. The pains have not returned for 18 months yet.

Back Pain↗
PubMed1992

[Smoking is a risk factor for spinal diseases. Hypothesis of the pathomechanism].

Epidemiological studies strongly imply that smoking is a risk factor for back problems. The question arises as to the nature of the underlying pathomechanism. Several theories are currently discussed in the literature: it could be due to "unhealthy" life styles associated with smoking, to a rise in intraabdominal pressure caused by frequent coughing, or to osteoporosis of smokers. All of these hypotheses, however, do not stand up to a critical examination of the experimental evidence. A new theory is, therefore, put forward, claiming that smoking leads to malnutrition of the discs, which in turn renders them more vulnerable to mechanical stress. Malnutrition can be brought about by CO-Hb formation, vasoconstriction, arteriosclerotic vessel wall changes, impairment of fibrinolytic activity and changes in the flow properties of blood, all of which are known effects of smoking. The evidence for these pathomechanisms is discussed. Future studies should test the above hypothesis experimentally.

Animals↗
PubMedDate not supplied

[Shortening diclofenac therapy by B vitamins. Results of a randomized double-blind study, diclofenac 50 mg versus diclofenac 50 mg plus B vitamins, in painful spinal diseases with degenerative changes].

The use of nonsteroidal anti-inflammatory drugs (NSAID) such as diclofenac for treatment of degenerative rheumatic disorders of the lumbar spine is of great significance in orthopedic practice. Clinical studies have shown that concomitant treatment with vitamins B1, B6, B12 and diclofenac provides more efficient pain relief than treatment using diclofenac alone. This study was undertaken in order to determine whether the duration of treatment with diclofenac for lower back pain can be shortened by adding B-vitamins to the therapeutic regimen. From September through December of 1986, 256 patients participated in a multicenter, controlled, randomized double-blind trial which compared the clinical efficacy of diclofenac (50 mg) with a combined therapy of diclofenac (50 mg) and vitamins B1, B6, and B12 (thiamine nitrate, pyridoxine hydrochloride, and cyanocobalamine, resp.; in dosages of 50 mg, 50 mg, and 0.25 mg, resp.). Patients were treated with 3 X 1 capsule daily for a maximum of two weeks, having the option to terminate participation in the trial after 1 week in the event of total pain relief. The data of 238 patients were able to be included in the evaluation. 29 patients opted to discontinue therapy due to remission on symptoms. Nineteen (65.6%) of these patients belonged to the combined therapy group, the other 10 (34.4%) having taken diclofenac alone; this difference is statistically significant (p less than 0.05). An important aspect in the evaluation of therapy was the patient response regarding the improvement of painful symptoms which, in addition to their subjective feedback, was reflected in the test results of the "Hoppe Pain Questionnaire (HPQ)." All parameters used as a measure of pain relief indicated superior results with the B-vitamin supplemented therapy when compared with results obtained with diclofenac alone. Moreover, after 3 days of therapy the "sensory" pain factor "sharpness" improved significantly. Undesirable side-effects were documented with 39 patients, 14 of them having discontinued therapy for this reason. No statistically significant difference could be determined within this group with regard to therapy. The study results document the positive influence of B-vitamins on painful symptoms and indicate that less NSAID is needed for pain relief when combined with B-vitamins.

Clinical Trials as Topic↗