668 research outputs found

    Low Back Pain (LBP)

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    Low back pain (LBP) is a major public health problem, being the most commonly reported musculoskeletal disorder (MSD) and the leading cause of compromised quality of life and work absenteeism. Indeed, LBP is the leading worldwide cause of years lost to disability, and its burden is growing alongside the increasing and aging population. The etiology, pathogenesis, and occupational risk factors of LBP are still not fully understood. It is crucial to give a stronger focus to reducing the consequences of LBP, as well as preventing its onset. Primary prevention at the occupational level remains important for highly exposed groups. Therefore, it is essential to identify which treatment options and workplace-based intervention strategies are effective in increasing participation at work and encouraging early return-to-work to reduce the consequences of LBP. The present Special Issue offers a unique opportunity to update many of the recent advances and perspectives of this health problem. A number of topics will be covered in order to attract high-quality research papers, including the following major areas: prevalence and epidemiological data, etiology, prevention, assessment and treatment approaches, and health promotion strategies for LBP. We have received a wide range of submissions, including research on the physical, psychosocial, environmental, and occupational perspectives, also focused on workplace interventions

    UWOMJ Volume 64, Number 1, Winter 1994

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    Schulich School of Medicine & Dentistryhttps://ir.lib.uwo.ca/uwomj/1241/thumbnail.jp

    Garth Gines Appellant/Plaintiff, v. Sean Edwards, Appellee/Defendant.

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    APPEAL FROM THE FOURTH JUDICIAL DISTRICT COURT FOR PROVO, STATE OF UTAH HONORABLE DEREK PULLA

    Spinal stenosis

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    This thesis describes in detail the clinical spectrum of spinal stenosis in a series of two hundred and twenty-one patients at the Nuffield Orthopaedic Centre. It depicts those conditions with which spinal stenosis may be confused, and other conditions with which it is associated. Characteristic symptoms and physical signs are reported and the role and value of different methods of investigation are discussed. The aetiology and pathogenesis of spinal stenosis is discussed and the emphasis turned away from absolute measurements of the dimensions of the bony spinal canal, towards the role of the soft tissues and the dynamic response of the canal and its neural contents to postural change and loading, as evidenced by erect flexion and extension radiculography. The spinal reserve capacity measurement on CT approaches more closely the ideal of measurement of volumetric disproportion of canal and contents, but it takes no account of the dynamics of the canal. Magnetic Resonance Imaging may, in the future, provide the most objective criteria for diagnosis if section thickness can be reduced. Experimental spinal stenosis was produced in a group of immature New Zealand white rabbits. This was induced by sublaminar wiring at three levels at the age of eight weeks and allowing the animals to grow for twenty-four months before sacrifice and analysis of the spines. The effect of sublaminar wiring on the growth and development of the lamina and spinal canal was analysed using a Kontron Ibas Image Analysis Computer, and the results described and statistically analysed. The results of surgery were analysed in detail in a group of seventytwo patients with spinal stenosis at the Nuffield Orthopaedic Centre. The long-term results were compared with the initial post-operative result and two groups were identified: the stable result and the unstable result. The indications for and results of re-operation were also analysed in a group of twelve patients. Improved understanding of the aetiology of spinal stenosis has enhanced surgical management and results. The extent of surgical decompression must be precisely planned pre-operatively from radiographic and CT studies, and the surgeon must be able to execute this plan at operation. There is now no place for exploratory operations. The objective of surgery is adequate nerve root decompression without spinal de-stabilisation and when this is achieved, re-operation is redundant

    Spinal stenosis and disorders of the lumbar spine

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    Current Advances in Spinal Diseases of Elderly Patients

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    The rapid aging of populations in developed countries since the 2000s has placed increasing attention on the issue of musculoskeletal disorders in elderly patients. Notably, spinal disorders not only restrict the social activities of elderly patients, but they also lead to economic loss for society. “Current Advances in Spinal Diseases of Elderly Patients” is a topical collection of articles about current perspectives on diagnosis and treatment of spinal disorders including current surgical strategies. This Special Issue covers a broad range of issues, ranging from managing refractory states such as severe osteoporosis, spinal deformity, ossification of the spinal ligaments, and multiple arthropathy to managing lifestyle-related spinal diseases during the COVID-19 pandemic in elderly populations. We hope that the readers of this Special Issue find the contents interesting

    Spine Surgery

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    We are very excited to introduce this new book on spinal surgery, which follows the curriculum of the EUROSPINE basic and advanced diploma courses. The approach we take is a purely case-based one, in which each case illustrates the concepts surrounding the treatment of a given pathology, including the uncertainties and problems in decision-making. The readers will notice that in many instances a lack of evidence for a given treatment exists. So decisions taken are usually not a clearcut matter of black or white, but merely different shades of gray. Probably in a lot of cases, there is often more than one option to treat the patient. The authors were asked to convey this message to the reader, giving him a guidance as what would be accepted within the mainstream. In addition, the reader is provided with the most updated literature and evidence on the topic. Most of the authors are teachers in the courses of EUROSPINE or other national societies with often vast clinical experience and have given their own perspective and reasoning. We believe that the readers will profit very much from this variety and bandwidth of knowledge provided for them in the individual chapters. We have given the authors extensive liberty as to what they consider the best solution for their case. It is thus a representative picture of what is considered standard of care for spine pathologies in Europe. We hope that this book will be an ideal complement for trainees to the courses they take. Munich, Germany Bernhard Meyer Offenbach, Germany Michael Rauschman

    Assessment of the dynamic disc model in the cervical spine: the role of McKenzie’s conceptual model of disc displacement

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    The effects of lumbar spine posture on position of the lumbar disc has been extensively researched in the literature, with findings supporting early assertions that flexed postures, through vertebral loading of the anterior disc, cause posterior disc displacement with extended postures causing anterior displacement. This loading is thought to occur through anterior and posterior approximation of the vertebral segments in flexed and extended postures respectively. The late Robin McKenzie, a world renowned and accredited physiotherapist, promoted this concept of disc displacement through spinal loading. With this biomechanical reasoning, he created a series of spinal exercises, now taught worldwide, aimed at repositioning herniated disc material for those presenting with what he termed to be a ‘derangement syndrome’. To date, there have been no published studies that have assessed whether cervical flexion and extension cause an alteration in position of the cervical disc in the same pattern of movement that has been shown to occur in the lumbar spine. There have also been no direct measurements of cervical disc position following performance of one of McKenzie’s extension based exercises. Therefore, the aim of this programme of studies was to assess the effects of three cervical postures on position of the posterior NP at the C5-6 and C6-7 disc levels in an asymptomatic population. It also aimed to assess whether McKenzie’s ‘retraction-extension exercise in sitting’ produced anterior displacement of the posterior NP at the C5-6 and C6-7 disc levels in a symptomatic population. Measurements were also taken of vertebral segment angles in three cervical postures to assess whether approximation of the vertebral segments occurred in a similar pattern as has been shown to occur in the lumbar spine. Cervical MR images were obtained from asymptomatic participants positioned in supine with their cervical spines in a neutral, followed by a flexed and finally an extended position. These images were used to assess the effects of posture on anterior and posterior C5-C6 to C7-T1 vertebral position, as well as on position of the posterior C5-6 and C6-7 posterior NP. The second group of symptomatic participants were scanned before and after performance of McKenzie’s retraction-extension exercise in sitting. Findings support the assertion that vertebral position and position of the posterior cervical disc can be manipulated by posture. Results showed significant changes in both anterior and posterior vertebral position in flexion compared to neutral, as well as significant changes in the posterior nucleus pulposus at both disc levels in flexion compared to neutral and extension. McKenzie’s retraction-extension exercise in sitting was found to cause anterior displacement of the posterior NP at the C5-6 disc level. These findings support the assertion that, compared to a neutral head posture, a flexed head posture causes a significant degree of posterior disc nucleus displacement. Therefore, avoiding a flexed head posture, and maintaining a neutral head position, may help to reduce the potential for developing pain provocative posterior disc herniations. These findings also help support the reasoning behind McKenzie’s extension-based retraction-extension exercise in sitting for those presenting with spinal pain classified as a ‘derangement syndrome’. Further research assessing various cervical postures in sitting will provide further information regarding the effect of a common occupational posture on cervical disc and vertebral angle position
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