Spine Disorders

High Intensity Interval Training in nonspecific low back pain work-related Rehabilitation

Daniel Riese
daniel.riese@kliniken-valens.ch

Patient's adherence to an activity advice for non specific low back pain (NSLBP) in daily physiotherapy practice

Ben van Koppen
ben.van.koppen.mmt@gmail.com

Pim Zandwijk
fysiopimzandwijk@gmail.com

Fusion surgery in patients with lumbar spondylolisthesis - Inge Caelers 2023

This research and is carried out to elucidate a number of questions that arise while working in daily practice with patients suffering from lumbar spondylolisthesis. First, it investigates so-called physiological motion of the lumbar spine to determine whether patients with spondylolisthesis move differently than healthy persons. Second, associations between patients, radiological and surgical characteristics, and postoperative symptomatic spondylolisthesis, are investigated to better understand which patients have a higher chance to develop spondylolisthesis after decompression surgery. Subsequently, the most common lumbar fusion techniques (Transforaminal Lumbar Interbody Fusion (TLIF) versus Posterior Lumbar Interbody Fusion (PLIF)) are compared, regarding effectiveness and cost-effectiveness/cost-utility. Lastly, different image-guided techniques can be used during lumbar fusion surgery. For patients’ safety, it is important to know if image-guided techniques lead to safe and correct pedicle screw insertion. For surgeons’ safety, who are exposed to radiation doses of image-guided techniques on a weekly basis, it is important to determine the amount of radiation exposure of different modalities.

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Exploring functional limitations in people with traumatic and nontraumatic neck pain - Martijn Stenneberg 2021

The aims of this thesis were to describe the clinical characteristics of two types of neck pain presenting in primary physiotherapy care, namely nontraumatic neck pain and traumatic neck pain. Therefore, two new measurement instruments were developed and evaluated. Subsequently, the clinical characteristics, in terms of severity of pain, impairments in physical or mental functions and disability, and the complexity of these types of neck pain are presented and discussed. The research concluded that clinical characteristics were differently associated with disability in both patient groups. Traumatic NP is a more complex condition as more characteristics interact, and the contribution of individual characteristics to disability is less straightforward. The findings of these studies contribute to a more thorough understanding of differences between subgroups of neck pain, the impact of neck pain on the daily functioning of people, and the use of accurate diagnostic instruments in primary care physiotherapy.

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Sequence of segmental contributions in the lower cervical spine and their application to cervical arthroplasty - Toon Boselie 2019

Cervical degenerative disc disease (CDDD) is degeneration of a cervical intervertebral disc and/or the adjoining vertebral bodies. Possible sequelae are a bulging or herniated intervertebral disc, foraminal narrowing due to loss of disc space height or osteophyte formation, or a combination of these. A common resulting clinical symptom is cervical radiculopathy. The burden of disease due to cervical radiculopathy is high, for patients as well as society. Surgical treatment is an option in case of inadequate relief of symptoms after a period of non-operative treatment. For decades the most commonly performed surgery for this indication was an anterior cervical discectomy without/with promoting fusion (ACD/ACDF). Both of these options have a high rate of fusion of the motion segment. Cervical disc prostheses have been developed to preserve of motion in the operated segment after ACD/ACDF. The intended goal is a reduction in adjacent segment disease (ASDis), which has been reported to occur in 25% of the patients in the ten years after surgery. It has been suggested that degeneration in the adjacent segment is accelerated as a result of the fusion in the operated segment. This has not been proven in vivo, and is largely based on biomechanical studies in cadavers.  The protective effect of cervical disc prosthesis is based on medical device manufactures’ claims that these prostheses facilitate normal motion in the operated segment. However, these claims have not been proven. Therefore, we aimed to investigate motion after placement of a cervical disc prosthesis (‘arthroplasty’). A couple of methods to evaluate motion in the cervical spine were considered. The first was measurement of segmental range of motion (sROM), which is the most common method in trials investigating cervical spine mobility. The second was determining the sequence of segmental contributions to flexion and/or extension. The first is known to show large intra- and interindividual variability, which severely limits its use in individual patients. The second has previously been reported to show a much more consistent pattern, with little intra- and interindividual variability.  The aim of the thesis was therefore to investigate if arthroplasty restores a normal sequence of segmental contributions after anterior cervical discectomy.

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Specific or non-specific exercises for patients with low back pain and movement control impairment: What works? - Jeanette Saner-Bissig 2018

Low back pain (LBP) is a common disease. In most cases the cause of the pain is unknown. If the pain is related to altered movement patterns, a movement control impairment (MCI) can be diagnosed. Regular, specific or non-specific exercises over one year can improve function and pain in patients with LBP and MCI. The exercises are instructed by a physiotherapist in 9–18 treatments. This is followed by a home-exercise program twice or more times per week for the following year. Patients identified increased confidence, easily understandable exercises and a combination of exercises with self-initiated physical activity as motivational strategies to keep up with the home-exercises.

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Perspectives on neck pain - Anke Langenfeld 2018

Chapter 1 introduces the theme of neck pain. Neck pain, in adjunction with low back during one year globally. In general, neck pain is described as pain in the back of the neck spreading from the superior nuchal line and the spinous process of T1. However, this describes only the area where the patient perceives the pain. Neck pain usually has a multifactorial etiology and resolves within a few days in most cases. However, the recurrence and prognostic factors of neck pain have not yet been clearly is patient education. To improve the treatment outcome, current guidelines recommend a three months, manipulation or mobilization can be considered. Guidelines further recommend frequent reassessment of neck pain to monitor improvement or deterioration. The commonly used assessment tools for patients with neck pain are questionnaires. It is recommended that questionnaires used in the assessment of neck pain may optimize the evaluation of patients with neck pain. Clinicians should obtain patient treatment accordingly.

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TLIF versus PLIF in spondylolisthesis - Suzanne de Kunder 2018

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Identification of subgroups in low back pain patients - Martin Verra 2013

Decision making in surgical treatment of chronic low back pain : the performance of prognostic tests to select patients for lumbar spinal fusion - Paul Willems 2011

The general introduction in chapter 1 posits the problem of chronic low back pain (CLBP), one of the main causes of disability in the western world with a huge
economic burden to society. For CLBP no specific underlying anatomic cause has been identified. Imaging often reveals degenerative findings of the disc or facet joints of one or more lumbar motion segments. These findings, however, can also be observed in asymptomatic people. It has been suggested that pain in degenerated discs may be caused by the ingrowth of nerve fibers into tears or clefts of the annulus fibrosus or nucleus pulposus, and by reported high levels of pro-inflammatory mediators. As this so-called discogenic pain is often exacerbated by mechanical loading, the concept of relieving pain by spinal fusion to stabilize a painful spinal segment, has been
developed. For some patients lumbar spinal fusion indeed is beneficial, but its results are highly variable and hard to predict for the individual patient. To identify those CLBP patients who will benefit from fusion, many surgeons rely on tests that are assumed to predict the outcome of spinal fusion. The three most commonly used prognostic tests in daily practice are immobilization in a lumbosacral orthosis, provocative discography, and trial immobilization by temporary external transpedicular fixation. Aiming for consensus on the indications for lumbar fusion and in order to improve its results by better patient selection, it is essential to know the role and value of these prognostic tests for CLBP patients in clinical practice.

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Lumbar extensor training in low back pain management - Pieter Helmhout 2009

This thesis can be divided in three sections, according to the main research questions. In the first section (Chapters 2 to 5: research question 1), the effectiveness of LES for workers with nonacute nonspecific LBP is studied in three separate randomized controlled trials. The second section (Chapter 6: research question 2) concerns the examination of prognostic factors in the development of LBP in our working population.  In the third section (Chapter 7) the predictive value of a fatigue test of the isolated lumbar extensors for training progression is evaluated in a young male population without LBP. Moreover, recommendations are given for the design, conduct, and report of clinical trials of exercise therapy in LBP (Chapter 8). For each section, the main study findings are presented below.

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Diagnosis and Intervention in Peripartal pelvic girdle pain - Carolien Bastiaenen 2005

Physiotherapy and sick leave in patients with chroniclow back pain - Jan Kool 2005

This thesis concerns the rehabilitation of patients with low back pain (LBP)-related sick leave. The primary purpose of treatment .is the reduction of sick leave. Physical therapists play an important role in the treatment and assessment of physical capacity of such patients.

LBP is specific in only l 5¾ of all cases. Examples of specific cases are vertebral fractures, spinal stenosis with compression of the spinal cord, rheumatoid arthritis and tumour. In case of specific LBP, treatment mainly focuses on the cause of the disease. In 85¾ of the cases LBP is nonspecific which means that none of the above mentioned causes of LBP are diagnosed but the physical therapist notices that certain movements are painful and palpation of certain parts of the back may also provoke pain. The cause of LBP remains unclear. The lifetime prevalence of LBP is 90% indicating that LBP is normal and not at all exceptional. Sometimes the cause of LBP is specific, for example in case of a disc protrusion with nerve root compression. This condition may cause the back to get locked and pain may i1Tadiate to one of the legs. In most of these cases spontaneous recovery is very good and within a week most patients will be able to resume their usual activities including work. This thesis concerns patients with nonspecific LBP who did not recover spontaneously.

Pain is a warning sign in acute complaints. Normally tissue damage is present and the function of increasing pain under mechanical stress is to prevent further damage. During recove1y the pain decreases and the person can generate resume normal activities within three weeks. Sometimes pain persists and becomes chronic. Dealing with chronic pain is much more difficult because it is also interpreted as an alarm signal by the patient who of course wants to prevent pain. Accordingly, the treatments by physicians and physiotherapists are also focusing on pain reduction. This is contrary to the recommendations of intema1ional guidelines which focus on active treatment and movement in spite of pain.

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