Low back pain intervention: conservative or surgical?

Low back pain (LBP) is a very common disorder with a U.S. population incidence of 80%. The risk for developing chronic LBP is relatively low but the majority of the costs associated with LBP are generated specifically by this group. Unfortunately, there is no gold standard intervention and few comparative, randomized, prospective treatment studies have been done. Therefore, the optimal treatment approach continues to be controversial. Surgery is usually reserved for those patients with severe and debilitating symptoms and, with careful selection, can result in good outcomes with rapid return to function. For patients who are not surgical candidates, conservative treatment must emphasize restoration and maintenance of functional movement.     

Deconditioning in patients with chronic low back pain: fact or fiction?

STUDY DESIGN: Prospective case series with historical controls (normative data). OBJECTIVES: To compare aerobic fitness levels in patients with chronic low back pain with those published on a sample of 295 healthy subjects. SUMMARY OF BACKGROUND DATA: Clinical belief holds that patients with chronic low back pain have low fitness levels as a result of inactivity because of pain. Because few studies have investigated the level of aerobic fitness in these patients, however, it remains unclear how fitness levels in patients with chronic low back pain patients compare with those published a sample of the normative population. METHODS: A sample of 50 patients with chronic low back pain with a mean pain duration of 40 months referred to an outpatient pain clinic performed a symptom-limited modified treadmill test. Aerobic fitness levels were determined by indirect calorimetry to measure oxygen consumption (VO2). Predicted maximum oxygen consumption (VO2max) levels were calculated for all subjects. Multiple regression analysis with adjustment for age and sex yielded prediction equations for men and women separately. Ninety-five percent confidence intervals were calculated for predicted mean oxygen consumption (VO2) and the slope of the equations. These were compared to established prediction equations on healthy subjects. RESULTS: Prediction equations for estimated maximum oxygen consumption (VO2max) in patients with chronic low back pain equal those in healthy sedentary men and active women. CONCLUSIONS: Levels of aerobic fitness in patients with chronic low back pain are comparable with those in healthy subjects.     

Low back pain: how does your physical therapist treat low back pain?

Low back pain is so common that 8 of 10 people experience it at some time in their lives. Although the pain in your back may be severe, most low back pain is not due to a serious problem. There are many risk factors that increase the chances of getting low back pain. As we get older, we often feel more back pain due to weakened muscles and stiffening joints. New clinical practice guidelines for the treatment of low back pain were published in the April 2012 issue of JOSPT. The guidelines describe ways to treat back pain based on best research evidence.     

Do bacteria play an important role in the pathogenesis of low back pain?

Considerable interest has been generated recently regarding an alternative hypothesis for the pathogenesis of low back pain and radiculopathy in the presence of intervertebral disc prolapse. Traditionally, back pain and radicular (sciatic) symptoms have been attributed to mechanical compression of neural tissue by herniated disc material and to inflammation caused by exposure of the nerve roots to disc tissue. Recent research however has suggested that low‐grade infection within the intervertebral disc by anaerobic bacteria may be responsible. The development of Modic changes in the corresponding adjacent vertebral endplates has also been suggested as an indicator of infection. This article is a thorough review of the current literature regarding the hypothesis that low‐grade anaerobic bacterial infection may be the cause of disabling low back pain and radiculopathy.     

Difficult intubation in thyroid surgery: myth or reality?

Thyroid surgery is considered to be a risk factor for difficult airway management. We prospectively studied 324 consecutive patients undergoing thyroid surgery to investigate the incidence of difficult intubation as evaluated by the intubation difficulty scale as well as other specific predictive factors. The overall incidence of difficult intubation was 11.1% (95% CI: 7.6-14.5). Median intubation difficulty scale was 0 (25th-75th percentile: 0; 2.7). In three predefined groups (no echographic goiter, clinically palpable goiter, and impalpable goiter), difficult intubation occurred in 10% (95% CI: 4.8-17.4), 13% (95% CI: 6.5-18.4), and 11% (95% CI: 4.7-16.8) of patients, respectively, with no statistical difference among the groups. Specific predictive criteria (palpable goiter, endothoracic goiter, airway deformation, airway compression, or thyroid malignancy) were not associated with an increased rate of difficult intubation. Classical predictive criteria (mouth opening <35 mm, Mallampati III or IV, short neck, neck mobility <80 degrees , thyromental distance <65 mm, and a retrognathic mandible) were significantly reliable in the univariate analysis as risk factors for difficult intubation.     

Difficult tracheal intubation in paediatric: myth or reality?

Difficult tracheal intubation is a rare event according to the airway feature in child. This situation is mostly predictable, occurring in identified malformations and in specific diseases. Pre-operative clinical evaluation must detect facial abnormalities (lip or palate cleft, microtia, facial asymmetry.), micro or retrognathia, limited mouth opening, reduced distance between thyroid cartilage and chin, macroglossia and external ear malformations. According to this clinical evaluation, a strategy for managing difficult tracheal intubation is planned.     

Backpacks and back pain: where's the epidemic?

The purpose of this study was to determine if children presenting with a chief complaint of back pain at a pediatric orthopedic office attribute their pain to wearing a heavy backpack. A retrospective medical records search was performed to identify school-age patients with back pain. Of the 346 patients included in this study, only 1 child attributed back pain to wearing a backpack. Three patients stated that their back pain was made worse by carrying their backpack. A phone survey revealed that 80% of the patients in this study wore a backpack for school purposes. The authors found that school-age children with back pain severe enough to require orthopedic evaluation rarely attribute their pain to wearing a backpack.     

Phosphatidylcholine lipolysis-lipodissolve: myth or reality?

The use of phosphatidylcholine through superficial injections in the aim to destroy adipocytes has recently become in great favour in Europe. This appealing idea nevertheless needs to be more argued. After one year of use the author advocates the fact that lipodissolution will not replace any traditional liposuccion, but may be helpful in the unfavourable indications of that procedure, thanks to the inflammatory reaction following adipolysis.