One such device is the cement used in the surgical procedures of vertebroplasty and kyphoplasty. In these procedures, a special type of bone cement is injected into the vertebral body that has sustained a compression fracture. This cement must be FDA approved for use in these instances of use.

Risks Of Surgery For Spinal Compression Fractures

Here is a news clip describing the fatal consequences of one company’s attempt to quickly bring their product to market resulting in hefty financial penalties and prison time.

Four former executives of Synthes Inc. have been sentenced to prison for carrying out human medical trials illegally in which three participants lost their lives. US prosecutors had been seeking 1-year prison sentences for “human experimentation”. The four defendants were accused of testing a kind of bone cement, Norian XR, in patients with spine fractures illegally – they had not sought FDA approval for the trial.

Norian XR is only approved for surgical use in the arm, not in the weight-bearing spine.

On passing sentence, the judge called their conduct egregious and said:

“(they showed a) disregard for the safety of others … and for the sanctity of human life.

There’s a perception that this is not the type of conduct that tends to result in a jail sentence. We lose the ability to cause the industry to self-regulate, because the fear of jail for professionals is far greater than the fear of a young drug dealer from the ‘hood’.”

The defendants are:
Michael D. Huggins (former Synthes North America President)
Sentenced to nine months in prison
Thomas B. Higgins (former VP of Berwyn)
Sentenced to nine months in prison
John J. Walsh (former director of regulatory and clinical affairs at Synthes)
Sentenced to five months in prison
Richard Bohner (former VP of Synthes)
Sentencing postponed after his lawyer got ill
Huggins was sent to prison immediately, while Higgins was given two weeks to report to prison; he had some family issues to sort out. Walsh has been allowed to celebrate a child’s birthday and has a week to report.

They all pleaded guilty to a misdemeanor as responsible corporate officers. A misdemeanor is an offence that is lower than a felony and generally punishable with a fine or imprisonment other than in a penitentiary.

The prosecutors say the defendants skirted FDA regulations as they rushed to have the bone cement tested by surgeons. The cement was not approved for people with spine fractures.

Synthes Inc. and Norian Corp. (a Synthes subsidiary) pleaded guilty to corporate health fraud and accepted to pay a fines amounting to $23 million.

However, the defendants say they had not intended to violate FDA procedures. One of the defendants said he made several attempts to make sure the cement was not used off-label.

Higgins lawyer, on Monday, read out a letter written by Higgins, it said:

“I didn’t think at the time that we were doing
anything illegal.”

U.S. District Judge Legrome D. Davis had not accepted many of the arguments put forward by the defense.

Davis wrote:

“The patients were directly and proximately harmed by the conduct of defendants and others at Synthes. Defendants subjected the patients to the risks of SRS and XR (bone cement) without the patients’ full informed consent and without the FDA’s authorization. Some of those patients were injured and some died.”

200 spine patients were experimented on with the bone cement. Prior pilot studies had demonstrated that the cement was linked to a risk of blood clots. Animal experiments with pigs showed there was a risk of clots moving to the lungs.

Experts say that in this part of the medical device’s industry, competition is fierce, and the company moved forward recklessly.

Surgeons who operated on the patients who died could neither blame the cement for their deaths, nor exclude them. They had suffered a severe drop in blood pressure after being given the injections. Three of them had already been frail before the trial began.

The prosecutors say the four defendants did not report the deaths, and were not honest with FDA investigators. They were all fired from their jobs and fined $100,000 each.

Even after one patients died in surgery in 2003 in Texas, and a second one died in California, the trial was not halted. The company only stopped the trial after the third death in 2004.

The Judge said:

“One adverse event should have been enough to let you know that this course was not right. I can’t understand how there wasn’t a stop sign”

After the passing of sentences, none of the defendants made a statement in court.

Synthes Inc. is a part of a Swiss-based company with US headquarters in West Chester. Health giant, Johnson & Johnson is acquiring the company for $21.3 billion.

Source: Medical News Today

If you or someone you know is considering spinal surgery of any type, do your homework, ask questions, and become well informed on every aspect of your procedure.

If you have any questions regarding the risks of surgery for spinal compression fractures, or any other spinal surgery for that matter, go ahead and ask. Leave your question or comment in the section below.

Before you go, do us a favor and click the like button to share this information with your friends on Facebook and (if you don’t mind) the +1 button to let Google know you liked what we have to say about back pain. We appreciate your willingness to help us get the word out.

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Author: Malton A. Schexneider, PT, MMSc

Newer technology has emerged that has promising results for people suffering with sacroiliac joint pain. This article introduces the Simplicity III, a radiofrequency electrode designed to treat irritated nerves of the sacroiliac joint.

Radiofrequency For Sacroiliac Joint Pain

Who suffers from low back pain; my brother, my boss’s brother, my neighbor, a friend on the golf course and recently the media reports Regis Philbin and Jeff Gordon suffer from low back pain.

Sacroiliac Pain is caused by inflammation or abnormal function of the joint which can lead to sacral nerve damage, and is a major cause of low back pain. Low back pain is estimated to affect 6.5 million people in the world. Now Simplicity lll, a new radiofrequency electrode, offers an alternative and possibly longer lasting relief from a common affliction. Radiofrequency is a widely used and effective treatment for certain chronic pain conditions, and using RF technology NeuroTherm introduces a new treatment option to address some instances of low back pain.

“There is a new technology available to treat patients with Sacroiliac Pain,” says Dr. Gregory Paine from Naples Day Surgery North. Paine was one of twelve physicians nationally, and the first in Florida, initially trained on the new medical device Simplicity lll, which was designed specifically for use in treating sacroiliac peripheral nerves. “This technology represents a tremendous breakthrough in giving patients long lasting relief for one of the more common causes of low back pain,” continues Paine.

Laurence Hicks, CEO of NeuroTherm the manufacturer of Simplicity lll, is a 20+ year participant in the medical device industry. “Simplicity lll is as revolutionary and promising a device as I have seen in my career, and we need to make the treatment accessible to the many suffering from this overly common problem,” says Hicks.

NeuroTherm is a leading manufacturer of radio frequency generators and related consumables used in the treatment of chronic pain. The company developed the first multi-lesion generator capable of producing multiple level lesions simultaneously. NeuroTherm markets and sells RF products for use in Interventional Pain and Podiatry; Podiatrists use radiofrequency to treat pain associated with Plantar Fasciitis & Neuroma, a condition recently reported to affect Regis’ counterpart, Kelly Ripa.

Source: Medical News Today

Do you have additional questions about other promising treatment for sacroiliac joint pain? Leave your question or comment in the section below.

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Cervical arthritis is a commons source of neck pain

Although some degree of cervical arthritis is inevitable, severe arthritic changes resulting in loss of function and, ultimately, surgery, is rare.

Here’s a nice review of the signs, symptoms, and treatment of cervical arthritis.

Cervical Arthritis: A Source of Neck Pain?

Cervical spondylosis, also known as cervical osteoarthritis and degenerative osteoarthritis, refers to the deterioration of the vertebrae and discs in the neck as we get older – specifically, the cervical spine, which is the section of spine in the neck. The edges of the vertebrae often develop small, rough areas of bone called osteophytes. As years go by the discs get thinner, increasing the risk of symptoms. The condition usually appears in men and women older than 40 and progresses with age. Men usually develop it at an earlier age than women do. It can lead to bouts of stiffness and neck pain.

Swollen neck joints can press or pinch nearby nerves roots or the spinal cord itself, resulting in pins and needles, and sometimes even pain in the limbs; in some cases there may be loss of feelings and coordination. Some patients may find walking difficult.

According to the National Health Service, most of us will have had some degree of cervical spondylosis symptoms by the time we reach 70 years of age.

According to Medilexicon’s medical dictionary:

“Cervical spondylosis is spondylosis affecting the cervical vertebrae, intervertebral discs, and surrounding soft tissue.”

What are the signs and symptoms of cervical spondylosis?

A symptom is something the patient feels and reports, while a sign is something other people, such as the doctor detect. For example, pain may be a symptom while a rash may be a sign.

In most cases patients just experience a pain in the neck and a bit of stiffness, and perhaps the occasional headache.

• Neck pain – the pain may spread, reaching the shoulders and the base of the skull. Pain gets worse when the head is moved. The pain can reach the hand and arms. Frequency of pain depends on the number of flare ups. However, some patients have long-term (chronic) pain.
• Neck stiffness – this is more common after a long period of inactivity (e.g. sleep).
• Headaches – generally start at the back of the head and then gradually move to the upper half of the front.
• Other problems – these are more rare, but may include bladder function problems, coordination difficulties. Arms and legs may become weak, and there may be lack of dexterity.
• When the brain is affected – if blood vessels are pressed the blood supply to the brain may be affected slightly. This may result in dizziness, and even blackouts.
• Dysphagia – (rare) swallowing difficulties when the bones press against the esophagus.

What causes cervical spondylosis?

Cervical spondylosis is caused by long term (chronic) degeneration (wear-and-tear) of the cervical spine. Previous neck injury may also cause eventual cervical spondylosis.

Some long-term activities, such as carrying axial loads, professional dancing and gymnastics may contribute to a higher risk of developing cervical spondylosis. Cervical spondylosis tends to be more common among people who practiced martial arts for many years.

Some researchers say that a genetic cause is possible, because familial cases have been reported.

Smoking may also increase the risk of developing cervical spondylosis.

How is cervical spondylosis diagnosed?

If a patient comes to a GP (general practitioner, primary care physician, family doctor) with neck pain or stiffness and is over 40, cervical spondylosis will be suspected. The following diagnostic procedures and tests may be carried out:

• Physical examination: The doctor may ask the patient to move the head sideways to check the range of motion of the head – the patient may also be asked to move the head forward (bring your chin down to your shoulder blades). Hand and feet reflexes may also be tested. The patient may be asked to walk, in order to check for gait and posture.
• Myeologram: A colored dye is injected inside the spine. This dye shows up in imaging scans, such as x-rays.
• Other imaging scans – if the patients radiating arm pain is not getting better and remains severe the doctor may order an MRI test to look at the nerve roots and determine whether there is a herniated disc. An MRI scan may also be ordered when the doctor is considering whether surgical intervention is necessary.
• X-Ray: This may reveal any physical damage to the spine, and whether there are any lumps of extra bone (osteophytes).

What is the treatment for cervical spondylosis?

Generally, cervical spondylosis will resolve itself over time, even without treatment. In some rare cases this does not happen and the pain and stiffness get worse.

Pain – OTC (over-the-counter, no prescription required) NSAIDs will help most people with pain. Patients with asthma, liver disease, heart disease, hypertension and a history of stomach problems should not take NSAIDs. For severe pain the doctor may prescribe codeine.

Muscle relaxants – if neck muscle abruptly tighten (spasms), diazepam or a similar muscle relaxant may be prescribed.

Amitriptyline – originally designed to treat depression, this medication is sometimes used for relentless pain that has not responded to other treatments.

Gabapentin – may be prescribed for pins and needles.

Very severe pain – a steroid medication may be injected into the neck.

Surgery – surgery is rare and only considered if the radiating arm pain does not respond to treatment and persists. The doctor will also look at MRI results and determine whether there is nerve root compression or pressure on the spinal cord. Patients with myelopathy may also benefit from surgery. According to the National Health Service, patients should not wear a neck brace for a long time, because it might actually worsen symptoms.

Today there are several different surgical approaches to cervical spondylosis. The spine can be approached form the front, side or rear. The surgeon will usually remove some osteophytes and possible portions of a disc – this will reduce pressure on root joints and the spinal cord. According to the National Health Service, patients should not wear a neck brace for a long time, because it might actually worsen symptoms.

Source: Medical News Today

Do you have additional questions about cervical arthritis as a source of neck pain? Leave your question or comment in the section below.

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In this article, Dr. Norman Marcus points to the muscular system as the primary source of back and neck pain.

Muscle Pain in the Lower Back and Neck

If you’re suffering from back pain and unable to find relief, it may be because the real cause of your pain — weak, stressed and damaged muscles, not your spine — has never been recognized or treated, says Norman Marcus, M.D., one of the nation’s leading pain specialists.

Back pain is the most disabling pain experienced by Americans, and, according to the National Institutes of Health, eight out of ten people will suffer from it at some point. “With nearly one million spine surgeries performed in the U.S. each year, and a failure rate as high as 50 percent, too many patients either undergo spinal surgery that is doomed to fail, or are put on mind-altering drugs to manage, but not end, their pain,” says Dr. Marcus.

“The reality is that muscles are the primary source of chronic back pain. And muscle pain can almost always be successfully treated without surgery or drugs,” says Dr. Marcus, the founder of the Norman Marcus Pain Institute (http://www.nmpi.com), which is dedicated to eliminating pain, not just attempting to manage it.

Dr. Marcus, a past president of the American Academy of Pain Medicine, is Clinical Associate Professor in Anesthesiology and Psychiatry and Director of Muscle Pain Research at the NYU School of Medicine. He co-founded New York City’s first pain center, at Montefiore Hospital, and developed and served as Chief of the Pain Treatment Service in the departments of Medicine and Psychiatry at New York’s Lenox Hill Hospital for fourteen years.

Dr. Marcus’s pioneering protocols for diagnosing and treating muscle-related pain have brought back pain relief to thousands of long-suffering patients, many of whom had given up hope.

Muscles represent more than 50 percent of the body by weight, but are rarely even considered as the source of pain in such common problems as low back pain, neck pain and headaches, says Dr. Marcus, who has found muscle involvement in over 75 percent of his chronic back pain patients.

Dr. Marcus credits his conversion from helping patients live with their pain to actually curing them to Dr. Hans Kraus, the legendary physical medicine and rehabilitation specialist. Dr. Kraus, whose muscle-strengthening exercises and trigger point injections eliminated most of President John F. Kennedy’s crippling back pain, is recognized as the father of sports medicine in America and was the driving force behind the President’s Council on Physical Fitness.

Dr. Kraus developed landmark tests that evaluate muscle strength and flexibility and a series of simple exercises to correct muscle weakness and stiffness, which led to the largest and most successful back treatment program ever conducted. 300,000 people participated and 80 percent of those surveyed reported either the complete elimination of back pain or considerable relief. The results were even better for those who had undergone back surgery.

For five years, starting when he was 85 years old, Dr. Kraus spent ten hours every Tuesday (“Tuesdays with Hans”) with Dr. Marcus and his pain patients at Lenox Hill Hospital.

He taught Dr. Marcus how to diagnose the four causes of muscle pain: tension, deficiency (weakness and or stiffness), spasm, and trigger points. And he showed him how to cure his patients’ pain through a program of exercises and, when hardened knots (trigger points) were present, with muscle-softening injections.

“My patients’ pain relief was so great, at first I found it hard to believe,” says Dr. Marcus. “Seventeen years later, thanks to Hans Kraus, I continue to see it daily.”

Working with the Stevens Institute of Technology, Dr. Marcus has developed a compact muscle pain detection instrument that can identify a muscle that is causing pain in any area of the body, from low back pain to shoulder pain, neck pain and headaches. Dr. Marcus believes that the device, which can be used by any doctor, could help to avoid countless failed surgeries and other treatments that prolong pain and suffering.

Dr. Marcus says surgery may be appropriate in some cases and he has prescribed it for some of his patients. But he cautions chronic back pain sufferers to be wary of surgery for pain because so many don’t need it and will undergo the ordeal of surgery, only to find that the pain remains. In fact, he says, for some patients, surgery actually increases their pain.

“The really good news,” says Dr. Marcus, “is that most back pain can be significantly reduced and very often eliminated — if only more doctors started looking for pain in all the right places.”

Source: Medical News Today

Do you have additional questions about muscle pain in the lower back and neck? Leave your question or comment in the section below.

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In this article, back pain recovery times are discussed in relation to nonspecific back pain.

Back Pain Recovery Time Unclear

According to professionals at the 7th EFIC Congress – Pain in Europe VII Hamburg, the prognosis for unspecific back pain which is already an epidemic in industrialized countries, has been worse than commonly recognized. This pain, which cannot be linked to any specific disease, needs further research and rehabilitation efforts if treatment methods are to be increased and enhanced. There is some hope that such efforts may develop.

(EFIC stands for European Federation of IASP® Chapters. A multidisciplinary professional organization in the field of pain research and medicine.)

Prof. Dr. Maarten van Kleef (Maastricht, NL) pointed out today at the 7th EFIC Congress in Hamburg that:

“Because 80 percent of patients on sick leave due to unspecific back pain resume work within a few weeks, there has been a broad misconception that they recover from their pain within this period. For a vast 65 percent majority, however, the sad truth is that back pain becomes chronic.

That causes a huge burden of personal suffering and a tremendous socioeconomic impact on society that is far from being sufficiently addressed. Recent studies and systematic reviews indicate that the prognosis of pain in a population of patients with low back pain is not at all favorable.

This unfavorable outcome is not yet common knowledge, not even for most primary care providers and decision makers in health care. We therefore have to increase efforts to disseminate information and to promote both prevention and more effective therapies. And not least of all, we need to design a new classification of unspecific back pain, breaking it down into appropriate subgroups to allow for the development of pinpointed treatments for each.”
Unspecific chronic back pain much more common than people think

Unlike specific back pain – that can be identified to an acknowledged diagnosis like infection, osteoporosis, cancer or vertebral fracture – unspecific back pain normally results from degenerative processes in one or more of the many sections of the human spine.

In industrialized nations over recent decades, back pain has become an epidemic. Around 60% to 90% of individuals will experience some kind of back pain at least once during their lifetime. Of that 30% to 50% will involve cervical pain, 16% to 20% thoracic pain and more than 70% lower back pain. Of these figures roughly 95% accounts for unspecific back pain. ?
A rehabilitation program can be as effective as surgery

Prof. van Kleef said:

“As befits such a serious theme, many scientific sessions and presentations at the current EFIC Congress discuss the problem of adequately treating back pain, adding to existing evidence for effective treatment options. In the area of pharmacology, only short term use of NSAIDs and weak opioids is recommended. Noradrenergic or noradrenergic-serotonergic antidepressants, muscle relaxants and capsicum plasters can be considered.”

The professionals explained:

“Multidisciplinary rehabilitation includes a combination of exercise, functional restoration and cognitive behavioral therapy. But we see that the effectiveness of such interventions is small to moderate when applied to the general population of back-pain patients.”

Caution is called for regarding minimally invasive interventions, such as the infiltration of corticosteroids directly into the spinal channel guided by computer-assisted fluoroscopic imaging. “Scientific evidence for these interventions is weak, but they can sometimes be effective for pain in highly selected patient groups.”

Prof. van Kleef said:

“Surgery for chronic back pain and cervical pain is based on the assumption that pain will stop once the symptomatic painful segments are immobilized by operative fusion. However, randomized studies comparing fusion with non surgical treatment indicate that a rehabilitation program can be as effective as surgery.

Therefore, spinal fusion and total disc replacement surgery should not be regarded as a standard treatment for chronic back pain. They should only be considered if at least 2 years of intensive conservative and minimal interventional pain treatment programs have failed to relieve the patients’ pain and disability.”
New classification crucial for better understanding

Prof. van Kleef explained:

“There is an astonishing deficiency both of understanding raging unspecific back pain and of adequate options for managing it. We urgently need nomenclature for classifying back pain beyond simply nonspecific.

Relevant subgroups are needed that describe the location and cause of the pain, like pain originating from disc disorders, pain originating from the degeneration of the small joints directing the movements of the spine, or pain originating from a degeneration of the sacroiliac joint. This would subdivide the vast and undifferentiated field of – nonspecific pain – into clinical phenomena based on the same pain mechanism that would probably require the same combination of treatments. We expect this to lead to more and better back pain research and consequently more pinpointed patient management strategies.”
European Week against Pain dedicated to chronic back pain

The European Week Against Pain (EWAP) starts on 10th October, 2011. One of the aims of the Plan for Action to fight Chronic Back Pain, to be presented at EFIC is a new and appropriate classification of back pain.

All over Europe, public awareness will be directed toward the negative natural course of back pain, the various methods for treating and preventing back pain and the why improved research is important into the different mechanisms generating back pain and disability.

Prof. van Kleef predicted:

“The Plan of Action should enable us to make remarkable progress, in only a few years, in our fight again st the most widespread pain disorder of our time. This is our responsibility to the innumerable individuals affected and to society as a whole.”

Source: Medical News Today

Do you have additional question or comment on how to get rid of back pain? Leave your question or comment in the section below.

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Although most physicians will tell you that surgery is always your last option, recent medical research suggests that early surgical intervention for some types of back conditions may be more beneficial.

Early Surgical Intervention Better

For patients with herniated lumbar disc, symptoms such as pain, function, general health, work status and patient satisfaction, were substantially worse if patients had experienced symptoms for over six months before treatment compared with patients whose symptoms appeared less than half a year before treatment reports a new study in the Journal of Bone and Joint Surgery (JBJS).

One of the most common and debilitating conditions of the spine, symptomatic lumbar disc herniation affects 1 to 2% of the population at some point in their lives, usually between the age of 30 and 40 years and is one of the most common and debilitating conditions of the spine. A lumbar disc herniation is a tear in the outer, fibrous ring (annulus fibrosus) of an intervertebral disc (discus intervertebralis) that allows part of, or the entire, soft central portion (nucleus pulposus) to be forced out from between two vertebrae. It causes back pain and can push on nerve roots causing pain, numbness and tingling as well as weakness in one or both legs.

Symptoms of lumbar disc herniation often improve within six to eight weeks. For this reason, treatment of the condition typically initially involves nonsurgical approaches, such as medications, education, counseling, and physical therapy. According to most guidelines, surgery should only be considered for patients who experience pain beyond a reasonable course of nonoperative therapy or who have progressive muscle weakness, loss of feeling or loss of bladder or bowel control from the nerve compression.

Over the last 30 years researchers performed numerous studies, which demonstrated the effectiveness of lumbar discectomy, a very common spinal surgical procedure in which the herniated disc material pressing on a nerve root or spinal canal is removed to treat lumbar disc herniation. Although the procedure is evidently effective, agreements in terms of preferable timing for surgery vary, with some studies suggesting “an appropriate amount of time” to others, who recommend “12 months after the onset of symptoms”.

One of the authors, orthopedic surgeon Jeffrey A. Rihn, M.D., commented:

“Patients often ask their physicians whether the duration of their symptoms will affect their potential for a full recovery, and the goal of our study was to address this question.”

Rhin and his team assessed 1,192 patients aged 18 years or older who suffered from various symptoms of lumbar disc herniation. All patients were enrolled in the Spine Patient Outcomes Research Trial (SPORT), which was conducted at 13 multidisciplinary spinal practices across 11 states.

Researchers assigned patients to undergo either operative treatment, such as a lumbar discectomy, or nonoperative treatment, including physical therapy, education, administration of a nonsteroidal anti-inflammatory drug, and/or counseling with home exercise instruction. Patients were required to complete questionnaires at the beginning of the study and at follow-up intervals, i.e. at six weeks, 3 and 6 months, and at 1, 2 and 4 years after treatment. The researchers used various strategies to assess the outcomes of both groups. When the researchers compared outcomes at follow-up intervals, of the 927 patients who had symptoms for six months or less with 265 patients whose symptoms had existed for longer than 6 months prior to enrolling in the study, they discovered that outcomes were substantially worse in those who suffered longer than six months at follow-up intervals. They also established operative therapy to be substantially more effective compared with nonoperative treatment; however, the relative increased benefit of surgery over nonoperative treatment was not dependent on the duration of symptoms.

Dr. Rhin explained:

“Patients who have had symptoms for longer than six months can find relief with either nonoperative treatment or surgery, but they may not reap as much benefit as those who have had symptoms for six months or less. Surgery still has significant benefit compared with nonsurgical treatment, even in patients who have had symptoms for longer than six months.”

He suggests further research to examine the effect of the duration of symptoms on treatment outcomes and concludes: “According to our study and generally speaking, patients who had symptoms for more than six months had less improvement in pain, function, general health, work status, and patient satisfaction.”

Source: Medical News Today

Do you have additional questions about when back surgery should be considered? Leave your question or comment in the section below.

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Herniated Disc Surgery

According to a study led by Dr. Adam Pearson of Dartmouth Medical School, Lebanon, N.H, in the January 15, issue of Spine, married patients undergoing surgery for herniated spinal discs whose symptoms are getting worse see greater improvements following the procedure than patients who received nonoperative treatments.

Even though all patient subgroups typically have better outcomes with surgery than nonoperative treatment, results from the investigation may provide a better insight into the relative advantages surgery for herniated discs has in individual patients compared to nonsurgical treatment.

The team examined data from the Spine Outcomes Research Trial (SPORT) – one of the largest human trials of surgery for spinal disorders. SPORT participants were randomly assigned to receive either nonsurgical treatment or surgery.

The investigation revealed a “clear benefit” of surgery for herniated discs over 4 years. Although, the discoveries at the group level did not take into account a variety of factors, such as clinical, radiographic (x-ray), demographic, and psychological characteristics – that can affect the way individuals respond to therapy.

The team compared outcomes for subgroups of patients defined by 37 different variables in order to find out which patients benefited most from surgery. The researchers focused on the “treatment effect” of surgery – how much patients improved with surgery compared to the improvement with nonsurgical treatment.

Dr. Pearson and his team explain:

“All analyzed subgroups improved more with surgery than with nonoperative treatment.” The team point out that several various characteristics appears to influence how much individuals improved with surgery, such as education, having a worker’s compensation claim, marital status, and duration of symptoms.”

The researchers found three factors that were independently associated to improved treatment effect of disc surgery: married patients, those without other joint problems (knee, hip, etc), as well as those whose back pain symptoms worsened at the time of treatment.

Married patients with worsening symptoms saw the greatest improvement from surgery. The treatment effect of surgery in this subgroup was approximately 18 points on a 100 disability rating scale: a 38-point improvement with surgery compared with a 20-point improvement with nonsurgical treatment. For single patients with stable symptoms the treatment effect was approximately 8 points: 35 points with surgery in comparison with 27 points with nonsurgical treatment.

Although, researchers are unsure why marital status affects response to surgery, investigations have demonstrated improved outcomes for a wide variety of health problems among married patients. The team was not surprised by the effect of worsening symptoms, as these individuals were already getting worse without surgery. In addition, patients without other joint problems may have better general health.

According to Dr. Pearson and his team, results from this study may help patients and doctors foresee the advantages of herniated disc surgery in individual patients.

The researchers stress that all patients should undergo:

“…a thorough shared decision making process educating them about the risks, benefits and likely outcomes of surgical and nonoperative treatment.”

“Real time computer models” may be created in the future in order to compare the likely outcomes of surgery compared with nonoperative treatment, based on patient characteristics.

Source: Medical News Today

Do you have additional questions related to surgery for a herniated disc? Leave your question or comment in the section below.

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Vertebroplasty to treat spinal compression fractures has been shown to be ineffective

Recent peer reviewed research, however, suggests that vertebroplasty is not an effective treatment for spinal compression fractures. On the basis of this research, the American Academy of Orthopaedic Surgery has rejected vertebroplasty as an effective means of treating spinal compression fractures.

AAOS Finds Vertebroplasty to be Ineffective

As a patient safety best practice and endorsement of evidence-based medicine, the American Academy of Orthopaedic Surgeons (AAOS) Board of Directors approved and released a clinical practice guideline, which found a strong recommendation against a popular procedure called vertebroplasty as a way to treat fractures in the spine. Clinical practice guidelines are one avenue the Academy uses to ensure that patients receive high quality care.

- Vertebroplasty is a surgical procedure developed to reduce or eliminate the pain associated with compression fractures of the spinal vertebrae. This procedure involves injecting bone cement into the vertebra to stabilize fractures.

- A vertebroplasty patient is typically female, older than the age of 65, and shows signs of osteoporosis.

Orthopaedic surgeon Stephen I. Esses, MD, who practices in Houston, Texas, and chair of the workgroup that developed this guideline said the group reached their conclusion after methodically reviewing the literature, over a process of several years.

“It’s very important to understand that we went into this without any preconceived notions or preferences, and we all agreed that the practice of medicine has to be based on science, and not anecdotal information,” Dr. Esses stated. “When you look at the science and research to-date, there is very strong Level 1 evidence to suggest that vertebroplasty does not provide the types of benefits that it was previously thought to provide.”

Level 1 evidence refers to studies done under the strictest scientific guidelines, including blinding randomization.

The recommendation against this procedure is largely based on two randomized, controlled clinical trials that were published in the New England Journal of Medicine (NEJM). According to the work group report, the studies compared vertebroplasty and a sham procedure and report “no statistically significant difference between the two procedures in pain.” The work group thoroughly reviewed the published criticisms of these two trials and found that these criticisms were not supported by existing evidence.

“Previous studies have touted the benefits of vertebroplasty, however our scientific research suggests this surgical procedure does not offer any advantages, over the placebo control,” Dr Esses added.

For those patients who have had a vertebroplasty, Dr. Esses explains that knowledge changes over time and at the time they may have received this procedure, vertebroplasty was thought to alleviate spinal compression fractures, and it was perceived as beneficial.

Dr. Esses notes that surgery is not the answer for everything, and there are a variety of other treatments, such as medications or nerve blocks, which can ease the pain of spinal fractures.

“But there is not a worry that something is going to happen to you if you had this surgery already,” he added. “There are no reported negative eventual side effects.”

A volunteer, physician work group developed this Clinical Practice based on a systematic review of the current scientific and clinical information and accepted approaches to treatment and/or diagnosis. The entire process included a review panel consisting of internal and external committees, public commentaries and final approval by the AAOS Board of Directors. Data review for this guideline began in the beginning of 2008, and consisted of a systematic review of the current scientific and clinical information and accepted approaches to treatment and/or diagnosis.

More patient information about spinal fractures:

- Spinal fractures are a common occurrence, and are a result of osteoporosis.

- A vertebral compression fracture causes back pain. The pain typically occurs near the break itself. Vertebral compression fractures most commonly occur near the waistline, as well as slightly above it (mid-chest) or below it (lower back).

- The pain often gets worse with standing or sitting for a period of time, and is often relieved by rest or lying down. Although the pain may move to other areas of the body (for example, into the abdomen or down the legs), this is uncommon.

- According to research from the NEJM, about 750,000 new vertebral fractures occur each year in the United States. The economic burden of treating incident osteoporotic fractures was estimated at $17 billion in 2005.

The full guideline along with all supporting documentation and workgroup disclosures is available on the AAOS website.

Source: Medical News Today

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Here’s an excerpt from a study that looked at the effectiveness of pain patches to relieve non-cancer pain.

Efficacy of Transdermal Pain Patch

This small study set out to evaluate efficacy in the specific use of transdermal buprenorphine patches for the treatment of chronic non-oncological pain.

15 patients were involved in the study, 9 men and 6 women, all suffering with severe pain (visual analogue scale (VAS) cm 9.2) that was either neuropathic (13) or from spondylolisthesis (2). They had all previously been treated unsuccessfully with medications including: COX2 inhibitors, NSAIDs, anticonvulsants and both weak and strong opioids.

Dose was titrated upwards beginning with a preliminary treatment of methoclopramide 30 mg/die/os for one week. The buprenorphine transdermal patches (TDS) regimen was then started with a quarter of 37.5 mcg/h buprenorphine TDS patch, increasing by another quarter every 3 days until effective dose was achieved. Patients continued on the trial for a total of 24 weeks, returning for a check-up every week for the first four weeks and then every month until completion of the trial. Over the nine check-ups, investigators checked VAS pain scores, number of rescue doses used, any side effects and adjuvants used.

By the end of the first month, when buprenorphine had been titrated to at least one full patch, VAScm scores dropped from a mean of 9.5 to just 2, which was sustained until the end of the trial. Rescue doses of 0.2mg buprenorphine tablets started with a mean of 4.2 a week but completely stopped by the fourth week. Similarly, side-effects were minimal in the last five months of the trial and adjuvant use occurred just once a month after completion of titration.

These results demonstrate the efficacy of buprenorphine TDS patches, not only in terms of pain relief but also in its favourable side effect profile. Similarly the progressive titration is a useful example of effectively minimising complications and side-effects and undoubtedly contributed to the 100% patient compliance with the study protocol.

Source: Medical News Today

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A review of similar cases over the years naturally led to the question: is Marfan Syndrome a cause of back pain?

What Is Marfan Syndrome?

Marfan syndrome, also called Marfan’s syndrome is a genetic condition that an individual inherits from a parent who also has the condition, or a parent with a faulty gene in their sperm or egg. The fault is carried by a gene called FBN1, which encodes a connective protein called fibrillin-1. The syndrome affects connective tissues – the fibers that help to provide support and structure to other tissue and organs.

Marfan syndrome can affect different parts of the human body, including the heart, blood vessels, bones, joints, and eyes. Sometimes, the lungs and skin are also affected..

Marfan syndrome has no impact on intelligence – it does not affect the patient’s cognitive abilities.

The disease is named after Antoine Marfan (1858-1942), a French pediatrician. Marfan first described the syndrome in 1896 after observing distinctive features in a 5-year-old girl. Francesco Ramirez, Mount Sinai Medical Center, New York City, first identified the gene linked to the syndrome in 1991.

Marfan syndrome’s effects on a human being can range from mild, moderate, severe to life-threatening. The most serious complications include damage to the heart valves and/or the aorta.

According to the National Health Service (NHS), UK, about 1 in every 5,000 British people has Marfan syndrome. It affects males and females equally.

Although it is mainly an inherited condition, in about 25% of cases no close relative with the same condition is identified. A person with Marfan syndrome has a 50% risk of passing it on to each offspring.

Although Marfan syndrome is incurable, there are therapies that can improve the patient’s quality of life.

Individuals with Marfan syndrome tend to have long arms, legs and fingers. Often their arm-span is longer than their height.

According to Medilexicon’s medical dictionary:
“Marfan syndrome is a connective tissue multisystemic disorder characterized by skeletal changes (arachnodactyly, long limbs, joint laxity, pectus), cardiovascular defects (aortic aneurysm which may dissect, mitral valve prolapse), and ectopia lentis; autosomal dominant inheritance, caused by mutation in the fibrillin-1 gene (FBN1) on chromosome 15q.”

Some individuals who are born with Marfan syndrome may be completely unaware until later on in life.

What are the signs and symptoms of Marfan syndrome?

A symptom is something the patient feels and reports, while a sign is something other people, such as the doctor detect. For example, pain may be a symptom while a rash may be a sign.

As Marfan syndrome can affect varying parts of the body, it has no unique signs and symptoms; however, the following constellation of symptoms are usually sufficient to make a diagnosis:

• Very long limbs
• Long fingers/toes
• Dislocated lenses
• Aortic root dilation

Experts say there are several possible signs and symptoms that involve the skeleton, eyes and cardiovascular system. Signs and symptoms vary between individuals, from mild and limited to certain body parts, to severe and affecting several body parts. According to the National Health Service (NHS), UK, about 10% of cases have severe symptoms; which tend to worsen with age.

Read Full Article Here >>>

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