Isolated L4-L5 fusions using the variable screw placement system: unilateral versus bilateral.

Thirty-six patients were retrospectively followed an average of 25.1 months to evaluate the relative effectiveness of unilateral (16 patients) versus bilateral (20 patients) variable screw placement (VSP) instrumentation in isolate L4-L5 fusions. Demographic variables and preoperative diagnoses were similar between treatment groups. Outcome was assessed primarily through evaluation of plain roentgenograms and self-report questionnaires. Use of VSP instrumentation at the L4-L5 level with autogenous posterolateral grafting achieved a successful fusion rate of 97% with minimal complications. Fusion results with unilateral instrumentation were nearly identical to those of bilateral; in both cases, results were better than most historical controls for noninstrumented fusions in situ. Clinical outcome, as obtained through standardized measurement techniques of pain and function, demonstrated 69% excellent and good results. Clinical outcome was similar between treatment groups yet was not significantly related to the fusion status obtained at follow-up.

A new approach to the low-back physical examination. Behavioral assessment of mechanical signs.

UNLABELLED: A rationale for a new approach to the low-back physical examination was developed. A set of 21 tests, 17 assessing organic and four assessing nonorganic signs, were organized into an examination according to specified criteria, and the reliability of the patient-reported and examiner-observed measures within the examination assessed. Primary outcome measures included patient reports of their pain location, aggravation and examiner-observed pain behaviors resulting from the maneuvers. Two pain behavior composites, conceptualized as outcome measures, were developed, one based on the 17 organic tests and one based on the four nonorganic tests. DESIGN: The reliability of the physical examination was assessed using a short-term test-retest paradigm. Three raters, two experienced orthopaedic surgeons and an RN with no previous experience in administering physical examinations were trained in the examination methods. Patients were assigned to one of three rater pairs and examined twice within a single day. During each examination both raters evaluated each patient; however, rater role as examiner or observer was reversed across examination. RESULTS: Forty-two patients were examined. Average times of 13.9 and 11.6 minutes were required to complete examinations 1 and 2, respectively. In addition, the time required to complete the examination decreased as the examiners became more familiar with the procedure, suggesting that an experienced examiner would usually be able to complete the examination in approximately 10 minutes. Within-examination reliabilities for the patient-reported measures (pain location and aggravation) were universally high, as expected, since these rating required the rater only to correctly hear and code patient responses.(ABSTRACT TRUNCATED AT 250 WORDS)