Patient outcomes after lumbar spinal fusions

Article Abstract:

An analysis of the medical literature from 1966 to April 1991 showed no advantage to lumbar spinal fusion alone compared to surgery without fusion for the treatment of lower back disorders. Indications for fusion are not clearly established. Fusion complications are common and should influence care decisions. Success rates for the procedure ranged from 15% to 95% in different studies. Instrumentation did not improve success rates and caused complications in 8% more patients. Patient selection seems more important than surgical method. Patients with previous back surgery had worse results from fusion surgery than those who had not. Variables such as cost of the procedure, substance abuse or psychological or behavioral considerations did not affect surgical success. Researchers need to compare results of fusion alone, surgery without fusion and nonsurgical treatments of specific, carefully defined lumbar disorders.

Evaluation, Laminectomy, Spinal fusion

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Use of lumbar radiographs for the early diagnosis of low back pain: proposed guidelines would increase utilization

Article Abstract:

Adherence to the practice guidelines for diagnosing low back pain suggested by the Agency for Health Care Policy and Research (AHCPR) may unnecessarily increase health care costs. The guidelines state that any patient with specific signs and symptoms of spinal injury or cancer should receive an X-ray of the lower back. A review of 963 patients treated for low back pain found that 13% received a lumbar X-ray. Forty-four percent would have received a lumbar X-ray under the AHCPR guidelines, a 3-fold increase in utilization. However, only 8 patients were found to have a bone tumor or fracture on follow-up.

Economic aspects, Diagnosis, Backache, Back pain, Diagnosis, Radioscopic, Radioscopic diagnosis, Lumbosacral region

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Meeting palliative care needs in post-acute care settings: "To help them live until they die"

Article Abstract:

One fourth of US deaths take place in long-term care facilities and to improve continuity of care discussions on including innovations in advance care planning, staff training, and systematic changes in clinical care practices are illustrated. Training in generalist disciplines, geriatrics, and palliative care should prepare the health care professionals to treat dying patients in long-term care settings.

United States, Product quality, Quality management, Palliative treatment, Palliative care, Long-term care of the sick, Long term care, Continuum of care

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