Archive for category: KDT Blog

Zhang J1, et al

BACKGROUND:
Lumbar disc disease has a disabling impact and a heavy burden on society. It mainly consists of lumbar disc degeneration (LDD) and lumbar disc herniation (LDH). The recently released lumbar disc nomenclature version 2.0 deepens our understanding however there is an urgent need to clarify the occurrence and distribution features of LDD and LDH in a large-scale sample.
RESULTS:
The occurrence of LDH and LDD was 14.18 and 44.23% respectively. Notably, lumbar spine
discs were more prone to LDD than LDH. L4/5 was the most frequent level in terms of LDH
(26.08%) and LDD (56.09%), followed by L5/S1 (LDH: 24.09%; LDD: 55.33%), then L3/4, L2/3 and L1/2 in ranking order. The prevalence of LDH and LDD in upper lumbar discs from L1/2 to L3/4 was significant lower than the average prevalence rate (P < 0.05). The mean age was 24.70 (±14.81) years for normal lumbar discs; 49.76 (±14.95) years for LDD; 37.01 (±12.91) years for LDH; 51.31(±15.00) years for LDD and LDH (P < 0.05). Modic changes, HIZ, spondylosis deformans and decreased disc height were linked with older age; whereas Schmorl node and lumbar disc sequestration were not associated with age (P < 0.05).
CONCLUSIONS:
The prevalence of LDD is 44.23%, higher than LDH which was14.18%. L4/5 and L5/S1 are the most frequent involved segments for the majority of lumbar disc diseases. Schmorl node occurs (1.6%) more frequently in the upper lumbar spine, independent of age. Modic changes (0.87%) are closely related with older age.

No drug is free of risks, or the potential for causing harm. Every decision to take a drug needs to consider expected benefits and known risks. One of the ways we can reduce harms is by studying drug use rigorously. Only by understanding the “real world” effects of drugs can we understand the true risks (and benefits) and design strategies to reduce the risk of iatrogenic harm that is, harms caused by the intervention itself. 

 Adverse events related to drug treatments are common. Some lead to hospitalization. Studies suggest 28% of events are avoidable in the community setting, and 42% are avoidable in long-term care settings. That’s a tremendous amount of possible harm from something prescribed to help. A new study published this week shows that adverse drug events (ADEs) continue to cause significant problems, sending over a million Americans to the emergency room every year.

 J Stroke Cerebrovasc Dis. 2016 Nov 21. pii: S1052-3057(16)30434-7. doi: 10.1016/j.jstrokecerebrovasdis.2016.10.031.

Cassidy JD1, Boyle E2, Côté P3, Hogg-Johnson S4, Bondy SJ5, Haldeman S6.

BACKGROUND:

Chiropractic manipulation is a popular treatment for neck pain and headache, but may increase the risk of cervical artery dissection and stroke. Patients with carotid artery dissection can present with neck pain and/or headache before experiencing a stroke. These are common symptoms seen by both chiropractors and primary care physicians (PCPs). We aimed to assess the risk of carotid artery stroke after chiropractic care by comparing association between chiropractic and PCP visits and subsequent stroke.

METHODS: 

A population-based, case-crossover study was undertaken in Ontario, Canada. All incident cases of carotid artery stroke admitted to hospitals over a 9-year period were identified. Cases served as their own controls. Exposures to chiropractic and PCP services were determined from health billing records.

RESULTS: 

We compared 15,523 cases to 62,092 control periods using exposure windows of 1, 3, 7, and 14 days prior to the stroke. Positive associations were found for both chiropractic and PCP visits and subsequent stroke in patients less than 45 years of age. These associations tended to increase when analyses were limited to visits for neck pain and headache-related diagnoses. There was no significant difference between chiropractic and PCP risk estimates. We found no association between chiropractic visits and stroke in those 45 years of age or older.

CONCLUSIONS:

We found no excess risk of carotid artery stroke after chiropractic care. Associations between chiropractic and PCP visits and stroke were similar and likely due to patients with early dissection-related symptoms seeking care prior to developing their strokes.

Ferracini GN et al Am J Phys Med Rehab. Nov;95 2016.

The study investigated a relationship between the presence of active trigger points (TrPs) craniocervical posture and clinical features in patients with migraine. Patient postural assessments and radiographs were analyzed for head and neck posture. The results showed patients with migraine had active or latent TrPs in all muscles. The suboccipital, upper trapezius, SCM and temporalis muscles are the most affected. There is a relationship between the number of active TrPs and x-ray assessment particularly loss of cervical lordosis. This study also demonstrated no association between the number of active TrPs and the clinical features of migraine. However there appears to be an association with reduced lordosis and head extension.

Tonosu J et al PLoS One Nov. 2016.

This research project sought to find the specificity and sensitivity of a series of (5) clinician questions associated with disc-related back pain whose responses may indicate a likelihood of discogenic pain.
These constitute a support-tool from which clinicians can better assess the target-area generating the patients’ symptoms:
1. Experience pain after prolonged sitting?
2. Pain standing-after-sitting?
3. Squirming in a chair after sitting too long?
4. Pain ‘washing one’s face’ while standing over a sink?
5. Pain standing in sustained flexion?
The researchers found these questions pertinent to determine discogenic pain compared to a control group. The sensitivity reached 100% with specificity at 72%. Their conclusion was these (5) questions were a useful support tool for diagnosis discogenic LBP. As with our classification-analysis (which includes most of these questions) enough research has been performed to draw reasonable assumptions as to disc-related pain vs, “other”.