Practice patterns of 692 Ontario chiropractors (2000-2001)

This study examined a wide range of variables relating to the practice patterns of 692 Ontario chiropractors (approximately 30% of all registrants in the province) who subscribed to the Ontario Chiropractic Association's Patient Management Program. It analyzed the 2000-2001 data of these chiropractors and provided important information on such factors as practitioner and patient demographics, practice profiles, and reimbursement patterns.The mean number of chiropractic treatments per patient for the year was 8.6 (sd = 3.4) and the mean treatment fee (above OHIP) per patient visit was $17.60 (sd = 5.0). Nearly one third of patient treatments were for lumbar complaints, and more than one-third of the patients were between 35 and 50 years of age.The mean annual gross income of the chiropractors in this study was $148,824 (sd = $86,391), with the male practitioners having a statistically significantly higher mean income ($161,363) than their female counterparts ($108,126). Practice location was significantly related to income, with postal code 'M' (Toronto) having the lowest mean income level. The overwhelming majority of practitioners (85%) used Diversified Technique as their primary treatment procedure, while 'modalities' was the most commonly selected adjunctive treatment procedure (29%).This study sheds new light on the associations among such factors as practitioner gender, practice location, and level of income.     

借助胸腔镜技术的胸段、上腰段脊柱前路手术

目的探讨胸腔镜辅助胸椎、上腰椎前路手术的适应证 ,单肺或双肺通气的选择以及术中注意事项。方法　应用胸腔镜、骨科常规手术器械或自制的骨科器械 ,在胸腔镜辅助下行病灶清除、脊髓减压、植骨、钢板螺丝钉内固定术。结果　全部病例手术都顺利完成 ,切口均一期愈合 ,随访 3～ 10个月 ,影像学检查显示病灶清除彻底 ,脊髓减压充分 ,除 1例骨折复位、固定后仍有轻度侧方成角畸形外 ,其他病例复位满意、内固定可靠 ,位置良好。结论胸椎、上腰椎疾患 ,不论是否并发脊髓、马尾神经压迫 ,都能在胸腔镜辅助下完成病灶清除术 ,必要时还可进行脊髓减压、脊柱前路植骨、内固定手术。原则上可选择常规气管插管、双肺通气下完成手术。     

全脊柱内镜下经椎板打孔髓核摘除术治疗重度向上移位型腰椎间盘突出症的疗效分析

<正>在腰椎间盘突出症的患者中,35%～72%存在椎间盘向上或向下移位,常因保守治疗无效而需要手术治疗^[1～3]。经内镜下椎间孔或椎板间隙入路治疗椎间盘向上移位超过上终板下缘3mm以上的重度移位型腰椎间盘突出症(high-grade up-migrated lumbar disc herniation,HUM-LDH)存在着一定的技术困难,常因移位的髓核残留导致疗效不佳,建议接受开放手术^[4～6]。为解决这一难题,笔者自2017年6月～2021年7月采用全脊柱内镜下腰椎板环锯打孔髓核摘除术治疗20例重度向上移位型腰椎间盘突出症患者,取得了较好的临床效果,报道如下。     

中国腰椎研究对世界腰椎医学的贡献

【摘要】 目的：探究中国腰椎研究对世界的贡献。方法：在Web of Science（WOS）核心合集数据库中,对腰椎相关研究的主题词进行文献检索,采用文献计量方法对收集到的文献进行统计和分析;利用数据库（https://www.geenmedical.com）对国家自然科学基金资助的腰椎研究项目进行检索,在国家科学技术奖励工作办公室官网（https://www.nosta.gov.cn/web/index.aspx）下载2000~2020年国家科学技术进步奖资助的项目信息,检索与腰椎研究相关的项目;采用CiteSpace软件对近5年腰椎研究的文献进行可视化研究,分析腰椎研究的趋势。结果：在WOS数据库中,共检索到腰椎相关研究的论著44381篇。其中腰椎间盘退变4977篇,腰椎生物力学2977篇,腰椎间盘突出症5568篇,腰椎管狭窄症6509篇,腰椎滑脱症3861篇,退行性脊柱侧凸1155篇。TOP10国家/地区文章数量显示：美国14742篇,位居第一位;中国5432篇,仅次于美国,位居世界第二位,占比12.2%。文章发表数量方面：腰椎间盘突出症领域,中国为发文量最多的国家;其他相关的腰椎研究,中国的发文量均仅次于美国,位于全世界的第二位。2006~2019年中国国家自然科学基金资助的腰椎研究项目共91项,总资助金额4023万元,研究热点主要包括：腰椎退变、基因、生物力学。2000~2020年中国国家科学技术进步奖资助的腰椎研究项目共计9项,研究热点主要包括：脊柱畸形、骨质疏松、腰椎微创。近5年腰椎研究的趋势主要集中在腰椎退变、腰椎融合、腰椎稳定性、手术治疗原则、手术失败的危险因素、机器学习以及微创手术。结论：中国腰椎研究对世界的贡献巨大,主要表现为以下几个方面：中国多层次的基金资助机构大力资助腰椎相关的研究;中国多个高校及研究机构大力支持腰椎相关研究;众多中国腰椎领域专家高度重视腰椎研究,发表了多篇高水平的研究成果;多篇文章为高被引文献。     

Extraperitoneal approach to the lumbar spine and lumbosacral region

Lumbar surgery is currently benefiting from the development of anterior approach to the spine and the possibilities of body reconstruction by plate and bony graft. The anterior extraperitoneal approach enables access to the spine. The Fraser approach expose the lumbar and the lumbo sacral spine.     

Disc degeneration and angular movement of the lumbar spine: comparative study using plain and flexion-extension radiography and discography.

A study was made of the association between disc degeneration observed in plain radiographs, in discograms (Adams' classification), and instability expressed as abnormal angular movement of lumbar vertebrae. The series included 169 discs in 77 consecutive patients (42 men, 35 women) whose mean age was 34 (range 16-46) years. Discography was more sensitive than plain radiography in the diagnosis of disc degeneration was more common in men than in women (Chi square test, chi 2 = 9.88, p less than 0.05). An increase in disc degeneration was observed in lower lumbar segments (Chi square test, chi 2 = 48.63 p less than 0.001). However, no association between abnormal angular movement and discogram type was observed (Chi square test, chi 2 = 2.63, p less than 0.05). It seems that disc degeneration seldom results in abnormal angular movement and instability of the lumbar spine. Therefore, flexion-extension radiography may only have limited diagnostic value.     

骨质疏松与腰段脊柱退行性变

骨质疏松是一种以低骨量和骨组织微结构破坏为特征、导致骨脆性增加的全身性疾病,可分为绝经后骨质疏松与老年性骨质疏松两型〔１〕。据１９９０年统计,我国老年性（＞６０岁）骨质疏松的发生率男性为６０－７２％,女性为９０－８４％〔２〕。这种低骨量和微结构破坏在外周主要表现在桡骨远端和股骨颈,而在脊柱的表现较在外周骨更早,更为广泛,常可导致椎体形态、脊柱曲度和力学性质的改变〔３〕,其中以下腰段脊柱的改变较为明显,其引发１９９９０２０１收稿,１９９９０６１５修回作者单位：第四军医大学西京医院骨科,陕西…     

Perceived effects of the delisting of chiropractic services from the Ontario Health Insurance Plan on practice activities: a survey of chiropractors in Toronto, Ontario

The purpose of this study was to survey a random sample of Toronto chiropractors and gather their perceptions of the effects that the delisting of chiropractic services from OHIP had on their practices profiles.

Methods:

A survey was mailed to 199 chiropractors who were asked to disclose demographic information, if they were in practice at the time when OHIP coverage was in effect, the perceived effect OHIP delisting had on their patient volumes, income, the profession’s credibility and if they would be in favor of having OHIP reinstated.

Results:

Among the 123 respondents in practice during OHIP coverage (n = 92), 48.9% indicated they perceived their practice income and 36.6% perceived their patient volume was negatively affected; 57.5% reported both had subsequently recovered. Almost 50% perceived OHIP delisting negatively affected the profession’s credibility and 46.1% of respondents were in favor of it being reinstated for chiropractic services; this percentage was much higher among chiropractors who were not in practice during the time of OHIP coverage.

Conclusion:

Most chiropractors reported that patient volumes and incomes have returned to pre-delisting levels and few chiropractors who were in practice during OHIP coverage expressed interest in having it reinstated.     

Slump sitting X-ray of the lumbar spine is superior to the conventional flexion view in assessing lumbar spine instability

Background Context

Flexion radiographs have been used to identify cases of spinal instability. However, current methods are not standardized and are not sufficiently sensitive or specific to identify instability.

Compression fractures of the thoracic and lumbar spine from compensable injuries

Compression fractures of the thoracic and lumbar spine have a worse prognosis than is commonly realized. A study of 142 patients with this type of injury reveals several important features which affect the long term prognosis in these injuries. Severe compression, comminution, disc space narrowing adjacent to the fracture site, a low anatomical level of the fracture site, a low anatomical level of the fracture, and body cast immobilization in those with mild or moderate type fractures, are some of the factors associated with persistent long term back problems.     

How to interpret computed tomography of the lumbar spine

Computed tomography (CT) of the spine has remained an important tool in the investigation of spinal pathology. This article helps to explain the basics of CT of the lumbar spine to allow the clinician better use of this diagnostic tool.