The effectiveness of land based exercise compared to decompressive surgery in the management of lumbar spinal-canal stenosis: a systematic review

<p>Abstract</p> <p>Background</p> <p>Lumbar spinal stenosis (LSS) is prevalent in those over the age of 65 years and the leading cause of spinal surgery in this population. Recent systematic reviews have examined the effectiveness of conservative management for LSS, but not relative to surgical interventions. The aim of this review was to systematically examine the effectiveness of land based exercise compared with decompressive surgery in the management of patients with LSS.</p> <p>Methods</p> <p>A systematic review of randomised controlled trials and clinical trials was undertaken. The databases MEDLINE, Embase, CINAHL, PEDro and Cochrane Library Register of Controlled Trials were searched from January 2000 to June 2011. Only studies that included subjects with lumbar spinal canal stenosis were considered in this review. Studies also had to use a patient reported functional outcome measure for a land based exercise intervention or lumbar decompressive surgery.</p> <p>Results</p> <p>Only one study compared the effectiveness of exercise and decompressive surgery for LSS. Surgery demonstrated statistically significant improvements in patient reported functional outcome scores at 6, 12 and 24-months post-intervention (<it>p </it>< 0.01). To facilitate further analysis, the results from 12 exercise and 10 surgical intervention arms were compared using percentage change in patient reported functional outcome measure scores. Exercise interventions showed initial improvements, ranging from 16 to 29% above baseline. All decompressive surgical interventions demonstrated greater and sustained improvements over 2-years (range 38-67% improvement) with moderate to large effect sizes. The most commonly reported complications associated with surgery were dural tears, while details of adverse effects were lacking in exercise interventions.</p> <p>Conclusions</p> <p>This systematic review of the recent literature demonstrates that decompressive surgery is more effective than land based exercise in the management of LSS. However, given the condition's slowly progressive nature and the potential for known surgical complications, it is recommended that a trial of conservative management with land based exercise be considered prior to consideration of surgical intervention.</p

Adolescent standing postural response to backpack loads: a randomised controlled experimental study

BACKGROUND: Backpack loads produce changes in standing posture when compared with unloaded posture. Although 'poor' unloaded standing posture has been related to spinal pain, there is little evidence of whether, and how much, exposure to posterior load produces injurious effects on spinal tissue. The objective of this study was to describe the effect on adolescent sagittal plane standing posture of different loads and positions of a common design of school backpack. The underlying study aim was to test the appropriateness of two adult 'rules-of-thumb'-that for postural efficiency, backpacks should be worn high on the spine, and loads should be limited to 10% of body weight. METHOD: A randomised controlled experimental study was conducted on 250 adolescents (12–18 years), randomly selected from five South Australian metropolitan high schools. Sagittal view anatomical points were marked on head, neck, shoulder, hip, thigh, knee and ankle. There were nine experimental conditions: combinations of backpack loads (3, 5 or 10% of body weight) and positions (backpack centred at T7, T12 or L3). Sagittal plane photographs were taken of unloaded standing posture (baseline), and standing posture under the experimental conditions. Posture was quantified from the x (horizontal) coordinate of each anatomical point under each experimental condition. Differences in postural response were described, and differences between conditions were determined using Analysis of Variance models. RESULTS: Neither age nor gender was a significant factor when comparing postural response to backpack loads or conditions. Backpacks positioned at T7 produced the largest forward (horizontal) displacement at all the anatomical points. The horizontal position of all anatomical points increased linearly with load. CONCLUSION: There is evidence refuting the 'rule-of-thumb' to carry the backpack high on the back. Typical school backpacks should be positioned with the centre at waist or hip level. There is no evidence for the 10% body weight limit

Two distinct age groups of melilitites, foidites, and basanites from the southern Central European Volcanic Province reflect lithospheric heterogeneity

Petrographic observations and in situ U–Pb ages of melilitites, foidites, basanites, phonolites, and trachytes from the southern part of the Central European Volcanic Province (CEVP) and related plutonic inclusions therein reveal two distinct age groups separated by a gap of ~ 20 Myr. A late Cretaceous to early Eocene group (~ 73–47 Ma; Taunus, Lower Main plain, Odenwald and Kraichgau area, Bonndorfer Graben and Freiburger Bucht area, Vosges and Pfälzerwald) is characterized by nephelinites and basanites mostly devoid of melilite and perovskite, and by rare haüynites, and trachytes. In contrast, a late Oligocene to late Miocene group (~ 27–9 Ma; Lorraine, southern Upper Rhine Graben, Urach, Hegau area) is dominated by melilitites, melilite-bearing nephelinites (both carrying perovskite), and phonolites. Both magmatic episodes are related to domal topographic uplift, erosion, and formation of major angular unconformities in the Upper Rhine Graben, suggesting an association with dynamic topography interrupted by phases of subsidence (or abatements of uplift). The investigated rocks in the southern CEVP (south of a line Eifel–Vogelsberg–Rhön–Heldburg), except for the Kaiserstuhl volcanic complex, mostly comprise small and isolated occurrences or monogenetic volcanic fields, whereas the northern CEVP is dominated by large volcanic complexes and dyke swarms, which are mostly SiO$_2$-saturated to weakly SiO$_2$-undersaturated. In the northern CEVP, evidence of spatially varying but recurrent volcanic activity exists since the Eocene, lacking the distinct 20 Myr gap as documented from the southern CEVP. While the temporal and spatial distribution of volcanism are a result of the Cretaceous to Miocene tectonic evolution in Central Europe, further studies are needed to explain the petrographic differences between the two age groups in the south

Parkes Weber syndrome associated with two somatic pathogenic variants in RASA1

Parkes Weber syndrome is associated with autosomal dominant inheritance, caused by germline heterozygous inactivating changes in th

Early Pliocene vegetation and hydrology changes in western equatorial South America

During the early Pliocene, two major tectonic events triggered a profound reorganization of ocean and atmospheric circulation in the eastern equatorial Pacific (EEP), in the Caribbean Sea, and on adjacent land masses: the progressive closure of the Central American Seaway (CAS) and the uplift of the Northern Andes. These affected, among other things, the mean latitudinal position of the Intertropical Convergence Zone (ITCZ). The direction of an ITCZ shift, however, is still debated, as numeric modeling results and paleoceanographic data indicate shifts in opposite directions. To provide new insights into this debate, an independent hydrological record of western equatorial South America was generated. Vegetation and climate of this area were reconstructed by pollen analysis of 46 samples from marine sediments of Ocean Drilling Program (ODP) Hole 1239A from the EEP comprising the interval between 4.7 and 4.2&thinsp;Ma. The study site is sensitive to latitudinal ITCZ shifts insofar as a southward (northward) shift would result in increased (decreased) precipitation over Ecuador. The presented pollen record comprises representatives from five ecological groups: lowland rainforest, lower montane forest, upper montane forest, páramo, and broad range taxa. A broad tropical rainforest coverage persisted in the study area throughout the early Pliocene, without significant open vegetation beyond the páramo. Between 4.7 and 4.42&thinsp;Ma, humidity increases, reaching its peak around 4.42&thinsp;Ma and slightly decreasing again afterwards. The stable, permanently humid conditions are rather in agreement with paleoceanographic data, indicating a southward shift of the ITCZ, possibly in response to CAS closure. The presence of páramo vegetation indicates that the Ecuadorian Andes had already reached considerable elevation by the early Pliocene. Future studies could extend the hydrological record of the region further back into the late Miocene to see if a more profound atmospheric response to tectonic changes occurred earlier.</p

The postural effects of load carriage on young people – a systematic review

BACKGROUND: Spinal pain in young people is a significant source of morbidity in industrialised countries. The carriage of posterior loads by young people has been linked with spinal pain, and the amount of postural change produced by load carriage has been used as a measure of the potential to cause tissue damage. The purpose of this review was to identify, appraise and collate the research evidence regarding load-carriage related postural changes in young people. METHODS: A systematic literature review sought published literature on the postural effects of load carriage in young people. Sixteen databases were searched, which covered the domains of allied health, childcare, engineering, health, health-research, health-science, medicine and medical sciences. Two independent reviewers graded the papers according to Lloyd-Smith's hierarchy of evidence scale. Papers graded between 1a (meta-analysis of randomised controlled trials) and 2b (well-designed quasi-experimental study) were eligible for inclusion in this review. These papers were quality appraised using a modified Crombie tool. The results informed the collation of research evidence from the papers sourced. RESULTS: Seven papers were identified for inclusion in this review. Methodological differences limited our ability to collate evidence. CONCLUSIONS: Evidence based recommendations for load carriage in young people could not be made based on the results of this systematic review, therefore constraining the use of published literature to inform good load carriage practice for young people

Structural properties of Pb3Mn7O15 determined from high-resolution synchrotron powder diffraction

We report on the crystallographic structure of the layered compound Pb3Mn7O15. Previous analysis based on laboratory X-ray data at room temperature gave contradictory results in terms of the description of the unit cell. Motivated by recent magnetic bulk measurements of this system, we re-investigated the chemical structure with high-resolution synchrotron powder diffraction at temperatures between 15 K and 295 K. Our results show that the crystal structure of stoichiometric Pb3Mn7O15 has a pronounced 2-dimensional character and can be described in the orthorhombic space group Pnma.Comment: 6 pages, 4 figures, 2 table

Short-term efficacy of physical interventions in osteoarthritic knee pain. A systematic review and meta-analysis of randomised placebo-controlled trials.

BACKGROUND: Treatment efficacy of physical agents in osteoarthritis of the knee (OAK) pain has been largely unknown, and this systematic review was aimed at assessing their short-term efficacies for pain relief. METHODS: Systematic review with meta-analysis of efficacy within 1-4 weeks and at follow up at 1-12 weeks after the end of treatment. RESULTS: 36 randomised placebo-controlled trials (RCTs) were identified with 2434 patients where 1391 patients received active treatment. 33 trials satisfied three or more out of five methodological criteria (Jadad scale). The patient sample had a mean age of 65.1 years and mean baseline pain of 62.9 mm on a 100 mm visual analogue scale (VAS). Within 4 weeks of the commencement of treatment manual acupuncture, static magnets and ultrasound therapies did not offer statistically significant short-term pain relief over placebo. Pulsed electromagnetic fields offered a small reduction in pain of 6.9 mm [95% CI: 2.2 to 11.6] (n = 487). Transcutaneous electrical nerve stimulation (TENS, including interferential currents), electro-acupuncture (EA) and low level laser therapy (LLLT) offered clinically relevant pain relieving effects of 18.8 mm [95% CI: 9.6 to 28.1] (n = 414), 21.9 mm [95% CI: 17.3 to 26.5] (n = 73) and 17.7 mm [95% CI: 8.1 to 27.3] (n = 343) on VAS respectively versus placebo control. In a subgroup analysis of trials with assumed optimal doses, short-term efficacy increased to 22.2 mm [95% CI: 18.1 to 26.3] for TENS, and 24.2 mm [95% CI: 17.3 to 31.3] for LLLT on VAS. Follow-up data up to 12 weeks were sparse, but positive effects seemed to persist for at least 4 weeks after the course of LLLT, EA and TENS treatment was stopped. CONCLUSION: TENS, EA and LLLT administered with optimal doses in an intensive 2-4 week treatment regimen, seem to offer clinically relevant short-term pain relief for OAK