Spine Backpain

To examine the relationships between well-being and different levels of both low back pain intensity and disability in women living in the community.

METHODS:
A detailed, self-administered questionnaire was mailed to 542 community-dwelling women, aged 24-80 years. Participants provided demographic data and completed the Chronic Pain Grade Questionnaire and Psychological General Well-being Index (PGWB).

RESULTS:
A total of 506 participants (93.4%) returned completed questionnaires. Multivariate analysis revealed associations between lower total PGWB scores and both low (odds ratio (OR) -5.53; 95% confidence interval (CI) -9.01, -2.06) and high pain intensity (OR -8.36; 95% CI -13.8, -2.92) compared with no pain intensity, after adjusting for confounders.

Lower total scores on the PGWB were also associated with low (OR -4.72; 95% CI -9.04, -0.41) and high disability (OR -9.26; 95% CI -15.2, -3.30), compared with no disability. There were also statistically significant associations between lower scores on the PGWB subdomains and low and high pain intensities, and low and high disabilities.

CONCLUSIONS:
We found that it is not only women with high pain intensity and disability who experience reduced well-being, but also those with low levels of pain and disability. Longitudinal investigation is needed to investigate the predictive nature of both low and high levels of pain and disability in determining poor well-being in community-based women.



"Are low levels of low back pain intensity and disability associated with reduced well-being in community-based women?"
Climacteric. 2009 Jun; 12(3): 266-75Urquhart DM, Shortreed S, Davis SR, Cicuttini FM, Bell RJ

To evaluate the preliminary clinical outcomes of percutaneous endoscopic lumbar discectomy (PELD) for patient with discogenic chronic low back pain (CLBP) and failing to respond to conservative treatment.

METHODS:
From June 2007 to May 2008, 52 patients with CLBP and failing to respond to conservative treatment were treated, including 15 males and 37 females aged 29-46 years old (average 38.2 years old). Those patients were diagnosed with discogenic pain by low pressure discography. Duration of CLBP was 6-110 months with an average of 32.1 months.

MRI exam revealed 108 "black intervertebral discs" low in signal on T2 image, including 3 discs of L2,3, 17 of L3,4, 48 of L4,5 and 40 of L5-S1. Pressure-controlled discography showed positive response, fluoroscopy or intraoperative CT confirmed annulus fibrosus tears of posterior intervertebral disc in 79 discs. PELD was performed. Visual analogue scale (VAS) was evaluated before operation, 1 month after operation and at the final follow-up. The clinical outcome was determined by modified Macnab criteria at the final follow-up.

RESULTS:
The average operation time of each disc was 30.7 minutes (range 21-36 minutes), and the mean length of postoperative hospital stay was 3.7 days (range 2-5 days). No complications such as infection and the injury of blood vessels and nerves occurred. Transient paralysis of nerve occurred in 5 cases on operation day, and those symptoms were disappeared at the final follow-up visit without special treatment.

Fifty-two cases were followed up for 3-15 months (average 7.3 months). VAS score before operation, 1 month after operation and at the final follow-up was (7.34 +/- 1.52), (3.62 +/- 0.92) and (1.57 +/- 0.48) points, respectively, indicating there were significant differences compared with preoperative score (P < 0.01). According to the modified Macnab criteria, 11 cases were graded as excellent, 23 as good, 13 as fair, 5 as bad, and the excellent and good rate was 65.38%.

CONCLUSION:
Preliminary study suggests that PELD is safe and effective in treating patient with discogenic CLBP and failing to respond to conservative treatment.



"Percutaneous endoscopic lumbar discectomy for treatment of chronic discogenic low back pain"
Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi. 2009 Apr; 23(4): 400-3Wang J, Zhou Y, Li C, Zhang Z, Zhang N

To investigate the causes and preventive methods of the bone cement leakage in percutaneous kyphoplasty (PKP) for osteoporotic vertebral body compression fracture (OVCF).

METHODS:
From April 2003 to November 2007, 116 patients with OVCF were treated with PKP, including 57 males and 59 females aged 65-92 years old (average 67.7 years old). All the patients suffered from trauma and the course of disease was 1-14 days (average 5.7 days).

There were 159 compressed and fractured vertebral bodies, including one vertebral body in 83 cases, two vertebral bodies in 24 cases, three vertebral bodies in 8 cases, and four vertebral bodies in 1 case.

The diagnosis of OVCF was confirmed by imaging examination before operation. All the patients had intact posterior vertebral walls, without symptoms of spinal and nerve root injury. During operation, 3.5-7.1 mL bone cement (average 4.8 mL) was injected into single vertebral body.

RESULTS:
The operation time was 30-90 minutes (average 48 minutes). Obvious pain relief was achieved in all the patients after operation. X-rays examination 2 days after operation revealed that the injured vertebral bodies were well replaced without further compression and deformation, and the bone cement was evenly distributed.

Fourteen vertebral bodies had bone cement leakage (4 of anterior leakage, 4 of lateral leakage, 3 of posterior leakage, 2 of intervertebral leakage, 1 of spinal canal leakage). The reason for the bone cement leakage included the individuality of patient, the standardization of manipulation and the time of injecting bone cement.

During the follow-up period of 12-30 months (average 24 months), all the patients got their normal life back, without pain, operation-induced spinal canal stenosis, obvious height loss of injured vertebral bodies and other complications.

CONCLUSION:
For OVCF, PKP is a mini-invasive, effective and safe procedure that provides pain relief and stabilization of spinal stability. The occurrence of bone cement leakages can be reduced by choosing the suitable case, improving the viscosity of bone cement, injecting the proper amount of bone cement and precise location during operation.


"Prevention and treatment of bone cement leakage in percutaneous kyphoplasty for osteoporotic vertebral body compression fracture"
Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi. 2009 Apr; 23(4): 404-7Zhao L, Wang L, Wang G, Xu J, Zeng Y, Zheng S, Jiang C, Gui J

Ann Plast Surg. 2009 Sep 4; Mavili ME, Canter HI, Saglam-Aydinatay BAlthough the use of rigid fixation of bony segments in orthognathic surgery has become a standard of care, the question remains, 'With use of rigid fixation has stability of common orthognathic surgical procedures improved?' Because of the problems with various methods of osteosynthesis for the osteotomies commonly used in orthognathic surgery, we have developed our own way of semirigid fixation method to stabilize the osteotomized fragments for bone healing with enough flexibility to avoid the problems arising from absolute rigid fixation. The purpose of this article is to review the existing data to determine whether our method of semirigid fixation yields enough short-term and long-term stability after orthognathic surgery procedures.The study was designed as a retrospective trial. A total of 23 patients with double jaw surgery and 12 patients with mandibular set back surgery were reviewed. Preoperative lateral cephalometric radiographs obtained 1 month before the surgery, early postoperative cephalometric radiographs obtained after intermaxillary fixation was opened and late postoperative cephalometric radiographs were evaluated. Pog-McNamara vertical (mm) was used to measure the anteroposterior movement of mandible. Facial axis ( degrees ) was used to measure the vertical movement of the anterior part of the mandible. A-McNamara vertical (mm) was used to measure the anteroposterior movement of maxilla. Maxillary height ( degrees ) was used to measure rotational movement of the osteotomized maxillary segment in vertical dimension. The raw data obtained from cephalometric analysis were evaluated by using the computerized statistical program SPSS version 11.5 for Windows. The differences in linear and angular measurements between time intervals were tested for statistical significance, using repeated measures analysis of variance. A value of P < 0.05 was considered significant.None of the patients had infection at maxillary osteotomy side. Unilateral local infection at osteotomy side was seen in only one patient after double jaw surgery. Condylar malpositioning was not observed in any of the patients. Although postoperative maxillaomandibular fixation with elastics was applied routinely to all patients for 15 days, none of the patients had complaint related with temporomandibular joint discomfort, such as pain, restricted joint motion, etc. There is significant difference in anteroposterior movement of mandible in all time intervals. In terms of facial axis, the differences at T1 and T2 and at T2 and T3 are significant, while the difference at T1 and T3 is not significant. There is significant difference in anteroposterior movement of maxilla in all time intervals. In terms of maxillary height, the differences at T1 and T2 and at T2 and T3 are significant, while the difference at T1 and T3 is not significant.Method of semirigid fixation with 2 plates for maxillary fixation and 2 screws for mandibular fixation provide enough stability after LeFort I and bilateral sagittal split osteotomy procedures where mainly anteroposterior linear displacements were performed. There was no significant clinical short-term or long-term relapse. Stability in rotational movements needs to be further evaluated.