1,721,000 research outputs found
Management of catastrophising and kinesiophobia rehabilitation after fusion for lumbar spondylolisthesis and stenosis. A randomised controlled trial
No full textPURPOSE:
To evaluate the effect of a rehabilitation programme including the management of catastrophising and kinesiophobia on disability, dysfunctional thoughts, pain, and the quality of life in patients after lumbar fusion for degenerative spondylolisthesis and/or lumbar spinal stenosis.
METHODS:
This was a parallel-group, randomised, superiority-controlled study in which 130 patients were randomly assigned to a programme consisting of exercises and cognitive-behavioural therapy (experimental group, 65 subjects) or exercises alone (control group, 65 subjects). Before treatment (T1), 4 weeks later (post-treatment analysis, T2) and 12 months after the end of treatment (follow-up, T3), all the patients completed a booklet containing the Oswestry Disability Index (ODI, primary outcome), the Tampa Scale for Kinesiophobia, the Pain Catastrophising Scale, a pain Numerical Rating Scale, and the Short-Form Health Survey. A linear mixed model for repeated measures was used for each outcome measure.
RESULTS:
The ODI linear mixed model revealed significant main effects of group (F(1,122.8) = 95.78, p < 0.001) and time (F(2,120.1) = 432.02, p < 0.001) in favour of the experimental group. There was a significant group × time interaction effect (F(2,120.1) = 20.37, p < 0.001). The analyses of all of the secondary outcome measures revealed a significant effect of time, group and interaction in favour of the experimental group.
CONCLUSION:
The rehabilitation programme, including the management of catastrophising and kinesiophobia, was superior to the exercise programme in reducing disability, dysfunctional thoughts, and pain, and enhancing the quality of life of patients after lumbar fusion for degenerative spondylolisthesis and/or LSS. The effects lasted for at least 1 year after the intervention ended
Does capacitively coupled electric fields stimulation improve clinical outcomes after instrumented spinal fusion? A multicentered randomized, prospective, double-blind, placebo-controlled trial
No full textBackground: Lumbar spinal fusion (LSF) is used to treat lumbar degenerative disorders. Methods to improve the functional recovery of patients undergoing LSF is one of the main goals in daily clinical practice. The objective of this study is to assess whether biophysical stimulation with capacitively coupled electric fields (CCEF) can be used as adjuvant therapy to enhance clinical outcome in LSF-treated patients. Methods: Forty-two patients undergoing LSF were assessed and randomly allocated to either the active or to the placebo group. Follow-up visits were performed at 1, 3, 6, and 12 months after surgery; long-term follow-up was performed at year 10. Visual analogue scale (VAS), the Oswestry Disability Index (ODI), and the 36-item Short Form Health Survey (SF-36) questionnaire were recorded. Results: This study demonstrates a significant improvement in CCEF-treated patients at 6 and 12 months’ followup for SF-36, and at 12 months’ follow-up for ODI values. Based on SF-36 and ODI scores, we reported a significantly higher percentage of successful treatments at 12 months in the active compared with the placebo group. Moreover, in a subset of patients at 10 years’ follow-up, a significant difference was reported in VAS and ODI scores between groups. Conclusions: The results demonstrate that 3 months of CCEF treatment immediately after surgery is effective in reducing ODI and improving SF-36 score, and that these benefits can be maintained up to 12 months. In a subset of patients, these positive outcomes are retained up to 10 years
Mid-term evaluation of the effects of dynamic neutralization system on lumbar intervertebral discs using quantitative molecular MR imaging
No full textPurpose: To evaluate the mid-term effects of implant of
dynamic neutralization system (Dynesys) on disc tissue in
patients with lumbar discopathy, through the quantifica-
tion of glycosaminoglycans (GAG) concentration, both in
treated and adjacent levels, by analysis of delayed gado-
linium-enhanced MRI contrast (dGEMRIC) images.
Materials and Methods: Ten patients with low back pain,
underwent the dGEMRIC diagnostic protocol before, 6-
months and after 2 years from surgery. Each patient was
also evaluated with visual analog (VAS), Oswestry, and
Prolo scales both at presurgery and during follow-up.
From dGEMRIC images, a DT1 parametric map was
obtained for each disc, as quantitative indicator of its
GAG concentration, and divided in 13 sectors, which were
classified at presurgery as normal or abnormal, based on
a 70-ms threshold. Evolution of DT1 was studied during
the follow-up.
Results: Nine of ten patients completed the follow-up.
VAS, Oswestry, and Prolo grades showed an improve-
ment. This was accompanied by a reduction of DT1 in
abnormal segments while normal segments showed a pat-
tern of initial worsening at 6 months, followed by an
improvement after 2 years.
Conclusion: Our study confirmed the improvement in
clinical evaluation, and for the first time related this to
the changes in discs GAG concentration
Gender-related association of FokI polymorphism in the Vitamin D Receptor gene and conventional risk factors with lumbar spine pathologies.
No full textBiomechanics of the lumbar spine after dynamic stabilization
No full textTarget of the study was to predict the biomechanics of
the instrumented and adjacent levels due to the insertion of the DIAM spinal stabilization system (Medtronic Ltd). For this purpose, a 3-dimensional finite element model of the intact L3/S1 segment was developed and subjected to different loading conditions (flexion, extension, lateral bending, axial rotation). The model was then instrumented at the L4/L5 level and the same loading conditions were reapplied. Within the assumptions of our model, the simulation results suggested that the implant caused a reduction in range of motion of the instrumented level by 17% in flexion and by 43% in extension, whereas at the adjacent levels, no significant changes were predicted. Numerical results in terms of intradiscal pressure, relative to the intact condition, predicted that the intervertebral disc at the instrumented level was unloaded by 27% in flexion, by 51% in extension, and by 6% in axial rotation, while no variations in pressure were caused by the device in lateral bending. At the adjacent levels, a change of relative intradiscal pressure was predicted in extension, both at the L3/L4 level, which resulted unloaded by 26% and at the L5/S1 level, unloaded by 8%. Furthermore, a reduction in terms of principal compressive stress in the annulus fibrosus of the L4/L5 instrumented level was predicted, as compared with the intact condition. These numerical predictions have to be regarded as a theoretical representation of the behavior of the spine, because any finite element model represents only a simplification of the real
structure
Maria Adelaide brace in the management of Scheuermann’s Kyphosis
No full textPurpose: This prospective observational study aims to assess the MA brace effectiveness in hyperkyphosis correction, focusing also on patients’ compliance of bracing and its psychological impact. Methods: Patients referring to our spine outpatient department with Scheuermann’s kyphosis (SK) from January 2011 to January 2017 were prospectively recruited. Patients were divided into two groups, according to their global thoracic kyphosis (TK): Group-A TKT0 < 60°, Group-B TKT0 ≥ 60°. The MA brace was prescribed according to SRS criteria. Full spine X-rays were analyzed at conventional times: at the beginning of treatment (T0), at 6-months follow-up (T1, in-brace X-rays), at the end of treatment (T2) and at 2-year minimum follow-up from bracing removal (T3). At T0, T2 and T3 all the patients were assessed using the Italian Version of the SRS-22 Patient Questionnaire (I-SRS22). Variability between and within-groups was assessed; a p value < 0.05 was considered significant. Results: 192 adolescents (87 girls and 105 boys, mean age 13.1) were recruited. The mean global TK at recruitment was 61.9° ± 11.3°, the mean follow-up time was 57.4 months. A good patients’ reported compliance was observed: 84.9% of patients used the brace as scheduled. A mean in-brace correction (in-brace TK%) of 37.4% was observed and a mean final correction (TK%T3) of 31.6%. At final follow-up (T3), curve reduction (ΔTK ≤ − 5°) was observed in 60.4% of patients and curve stabilization (− 5° < ΔTK < 5) in 29.7% of patients. At baseline, worse SRS22-mental health (p = 0.023) and self-image mean scores (p = 0.001) were observed in Group-B, compared with Group-A. At the end of treatment (T2), an improvement of all items was observed, wit significantly better improvement of self-image domain in Group-B. Conclusion: The MA brace has shown to be effective in the management of SK; good patients’ reported compliance and a positive effect on the patients’ mental status were recorded
Fibrin in Intervertebral Disc Tissue Engineering
No full textFibrin is clinically employed as a versatile, safe, and clinically applicable sealant and cell carrier. It has been able to support disc cell survival, favor extracellular matrix production, and enhance the efficiency of cell transfer in the intervertebral disc (IVD). The aim of this review was to evaluate how fibrin has been used in vitro, in vivo, and in clinical trials for IVD tissue engineering. Within the in vitro studies, disc cells were cultured in fibrin alone or combined with other materials and a difference in the behavior of nucleus pulposus (NP) and annulus fibrosus (AF) cells was sometimes reported, but in general, the formation of fibrocartilaginous matrix was observed. Moreover, data concerning the fibrin long-term stability and its anti-inflammatory properties were found. Disc cells of human origin were never employed in combination with fibrin in vivo or in clinical trials. In vivo, disc degeneration models used to test the fibrin properties essentially involved NP injuries. The addition of cells, in particular if terminally differentiated, to the injected fibrin seemed to promote a more physiological matrix in comparison with fibrin alone. Important aspects should be further investigated in future studies such as the use of fibrin to treat AF lesions as well as the mechanical properties of the fibrin-based biomaterials and of the neoformed tissue. Finally, in vivo studies and clinical trials with in situ injection of fibrin and human disc cells should be performed
Gender Differences in the VDR-FokI Polymorphism and Conventional Non-Genetic Risk Factors in Association with Lumbar Spine Pathologies in an Italian Case-Control Study
No full textRecently, the FokI polymorphism (rs2228570) in the vitamin D receptor gene (VDR) and conventional risk factors were associated with spine disorders in the Italian population, but without gender analysis. Two-hundred and sixty-seven patients (149 males, 118 females) with lumbar spine disorders were assessed by magnetic resonance imaging (MRI) and 254 (127 males, 127 females) asymptomatic controls were enrolled. The exposure to putative risk factors was evaluated and FokI polymorphism was detected by PCR-restriction fragment length polymorphism (PCR-RFLP). An association between lumbar spine pathologies and higher than average age; overweight; family history; lower leisure physical activity; smoking habit; higher number of hours/day exposure to vibration and more sedentary or intense physical job demand was observed in male patients. In contrast, in females, only higher age, overweight, family history and lower leisure physical activity were risk factors. FF genotype was a 2-fold risk factor to develop discopathies and/or osteochondrosis concomitant with disc herniation for both gender patients, while heterozygous Ff was protective for females only. In males only ff genotype was protective for discopathies and/or osteochondrosis and F allele was a 2-fold risk factor for hernia; discopathies; discopathies and/or osteochondrosis. Sex-related differences in voluntary behaviors, exposure to environmental risks and genetic background could be crucial for a gender-differentiated management of patients with spine disorders
Management of catastrophising and kinesiophobia improves rehabilitation after fusion for lumbar spondylolisthesis and stenosis. A randomised controlled trial.
Full text linkMultimodal exercises integrated with cognitive-behavioural therapy improve disability of patients with failed back surgery syndrome: a randomized controlled trial with one-year follow-up
No full textPurpose: To evaluate the effect of multimodal exercises integrated with cognitive-behavioural therapy on disability, pain, and quality of life in patients suffering from failed back surgery syndrome (FBSS), and to appraise its extent in the long term. Methods: By means of a parallel-group superiority-controlled trial, 150 outpatients were randomly assigned to a 10-week individual-based multimodal programme of task-oriented exercises integrated with cognitive-behavioural therapy (experimental group, 75 patients) or individual-based general physiotherapy (control group, 75 patients). Before treatment, 10 weeks later (post-treatment), and 12 months after the end of treatment, the Oswestry Disability Index (primary outcome), the Tampa Scale for Kinesiophobia, the Pain Catastrophising Scale, a pain intensity numerical rating scale and the Short-Form Health Survey were evaluated. Linear mixed model analysis for repeated measures was carried out for each outcome measure. Results: Significant group (p < 0.001), time (p < 0.001), and time-by-group interaction (p < 0.001) effects were found for all outcome measures. Concerning disability, between-group differences (95% confidential interval) in favour of the experimental group of −9 (−10.7; −7.3) after training and of −13.2 (−14.7; −11.7) at follow-up were found. Also, kinesiophobia, catastrophising and pain showed significant between-group differences of 9, 12.5 and 1.7 points, respectively. Conclusion: The multimodal intervention proposed was superior to general physiotherapy in reducing disability, kinesiophobia, catastrophising, and enhancing the quality of life of patients with FBSS. The effects were reinforced one year after the programme ended.IMPLICATIONS FOR REHABILITATION Multimodal exercises integrated with cognitive-behavioural therapy induced significant improvements in disability, pain, kinesiophobia, catastrophising, and quality of life of subjects with Failed Back Surgery Syndrome. A well-integrated rehabilitative team which contributes towards reaching intervention goals is advised. Physiotherapists should adopt task-oriented exercises to promote an earlier return to common activities of disabled patients. Psychologists should explain how to modify useless beliefs and support adequate behaviours, in order to produce constructive attitudes towards perceived disability
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