The Feasibilty of the Motor Control Home Ergonomics Elderlies' Prevention of Falls (McHeELP) Programme in Patients with Sarcopenia: A Pilot Study.

Objectives: The objective of this pilot study was to investigate the feasibility of a three month 'Motor control Home ergonomics Elderlies' Prevention of falls' (McHeELP) programme on muscle mass, muscle strength, functionality, balance and fear of falling among older adults with sarcopenia. Methods: A feasibility study of the McHeELP programme was performed in patients with sarcopenia. Primary outcome measures included number of participants; number of participants that showed engagement with the programme; adherence rates; data loss in questionnaires and secondary outcome measures; any adverse events, related or not to the intervention programme. All participants received a home-based motor control exercise programme combined with an ergonomic home modification for 12 weeks. Secondary outcome measures included Hand Grip Strength, Bioimpendance Analysis, Muscle Mass, Functionality and Fear of Falling. Results: Twelve participants, (74.9±5 years), completed the pilot study. Significant differences were recorded before and after the programme on participants' functionality (p < 0.001), balance (p < 0.05) and fear of falling (p < 0.001). Conclusions: The present study revealed that the McHeELP programme is fesasible and that it is possible to implement the programme in clinical practice. The McHeELP programme positively affects functionality, balance and fear of falling. Thus, it seems feasible to conduct a full-scale randomised controlled trial.

Inter-Rater and Test-Retest Reliability of an Innovative Evaluation Tool: CrossFit Functional Assessment Battery of Tests for the Shoulder Joint.

Background and objectives This study aims to introduce an innovative functional assessment tool designed for CrossFit athletes, to identify a high risk of injury at the shoulder joint. Additionally, the study seeks to examine both inter-rater reliability, which was tested in 40 CrossFit participants, and test-retest reliability, which was assessed in twenty subjects. Methodology CrossFit Functional Assessment Battery for the Shoulder Joint (CrossFit FABS) is a newly created instrument presented for the first time. The evaluation of the performance of its six items aimed to reveal deficits that could contribute to incidents of shoulder injuries. For this purpose, 40 healthy CrossFit participants were concurrently but independently examined by two raters, and twenty healthy adults active in sports were assessed by the main investigator at two different time points. Cohen's kappa coefficient was used to analyze categorical data with an ordinal structure. Results Inter-rater reliability ranged from 0.824 to 1 (P = 0.000) and test-retest reliability was 0.661 to 0.906 (P < 0.001) for each test of CrossFit FABS. A strong to almost perfect correlation was demonstrated for all the variables between the two examiners. Moderate to almost perfect correlation was shown through test-retest procedures. Conclusions The proposed test battery was established as a reliable tool for evaluating performance routines that represent high injury-risk elements for the shoulder joint in CrossFit athletes.

Frailty: future prospectives in rehabilitation medicine.

Modern rehabilitation is based on the International Classification of Functioning, Disability and Health (ICF). We will discuss this Classification process in frailty. Frailty is defined as a condition of reduced functional reserve, a state of vulnerability that involves poor recovery of homeostasis and increased susceptibility to stressor mechanisms, with consequent difficulty in returning to the previous condition of balance. Rehabilitation of frailty is reported in the ICF, although, its consensus is not sufficiently addressed due to its recent identification and the limited available information regarding how it should be formulated. Thus, the aim of the present article is to present the current evidence-based rehabilitation strategies applied in management of frailty.

Investigation of Real-Time Diagnostic Ultrasound as a Means of Biofeedback Training in Transversus Abdominus Re-Education of Patients with Non-Specific Low Back Pain: A Prospective Randomized Controlled Pilot Study.

Background: It is believed that ultrasound-guided imaging of activation/contraction of the deep abdominal muscles (such as transervsus abdominis) is useful for assisting deep muscle re-education, which is often dysfunctional in non-specific low back pain (NSLBP). Thus, this pilot study aimed to evaluate the use of real-time ultrasound (US) as a feedback device for transverse abdominis (TrA) activation/contraction during an exercise program in chronic NSLBP patients. Methods: Twenty-three chronic NSLBP patients were recruited and randomly assigned to a US-guided (n = 12, 8 women, 47.6 ± 2.55 years) or control group (n = 11, 9 women, 46.9 ± 4.29 years). The same motor control-based exercise program was applied to both groups. All patients received physiotherapy twice per week for seven weeks. Outcome measures, tested at baseline and post-intervention, included Numeric Pain Rating Scale, TrA activation level (measured through a pressure biofeedback unit-based developed protocol), seven established motor control tests, Roland-Morris Disability Questionnaire and Hospital Anxiety and Depression Scale. Results: For each group, all outcome variables yielded statistical differences post-intervention (p < 0.05), indicating significant improvements. However, there were no significant group x time interactions for any of the outcomes (p > 0.05), thus, indicating no superiority of the US-guided group over the control. Conclusions: The addition of US as a visual feedback device for TrA re-education during a motor control exercise program was not proven superior to traditional physiotherapy.

Risk of sarcopenia, fear of COVID-19, anxiety, depression and physical activity levels: Associations across patients on hemodialysis within Greece.

Objectives: The purpose of this multicenter cross-sectional study was to investigate the association between SARC-F, fear of COVID 19, anxiety, depression and physical activity in patients undergoing hemodialysis. Methods: This study was conducted in 3 hemodialysis centers in Greece during the period of the COVID-19 pandemic. Sarcopenia risk was assessed using the Greek version of SARC-F (≥4). Demographic and medical history were collected from the patient's medical charts. The participants were also asked to fill the Fear of COVID-19 Scale (FCV-19S), the Hospital Anxiety and Depression Scale (HADS), and the International Physical Activity Questionnaire (IPAQ) questionnaire. Results: A hundred and thirty-two (132) patients on hemodialysis (92 men, 70.75±13.14 years) were enrolled. Sarcopenia risk (utilizing the SARC-F) was found in 41.7% of patients on hemodialysis. The average duration of hemodialysis was 3.94±4.58 years. The mean score values for SARC-F, FCV-19S and HADS were 3.9±2.57, 21.08±5.32, and 15.02±6.69, respectively. The majority of patients were physically inactive. The SARC-F scores were strongly associated with age (r=56; p<0.001), HADS (r=0.55; p<0.001), levels of physical activity (r=0.5; p<0.001), but not with FCV-19S (r=0.27; p<0.001). Conclusion: A statistically significant relationship was recorded between sarcopenia risk and age, anxiety/depression and levels of physical inactivity in patients on hemodialysis. Future studies are necessary in order to evaluate the association of specific characteristics of patients.

Prevalence of probable sarcopenia in community-dwelling older Greek people.

OBJECTIVES: The objective of this study was to assess the prevalence rate of probable sarcopenia and to determine the factors associated with it in older people living in Western Greece. METHODS: Probable sarcopenia was estimated based on cut-off values for handgrip strength (HGS) as recommended by EWGSOP2. Information about socio-demographic, chronic diseases, fear of falls and lifestyle of the participants were also collected. HGS was assessed using a SAEHAN dynamometer. Calf circumference was assessed with inelastic tape. A logistic regression analysis was performed in order to determine associated risk factors. RESULTS: The sample comprised 402 participants (292 women;110 men), with a mean age of 71.51±7.63 years. Overall, 25.4% of the elderly participants were diagnosed with probable sarcopenia (men:36.4%; women:21.2%). The findings of this study demonstrated that probable sarcopenia was positively associated with age (OR=0.14, 95% CI=0.008 to 0.200), gender (OR=-0.6, 95% CI=-0.700 to -0.530), Body mass Index (OR=0.01, 95% CI=-0.030 to -0.005), Skeletal muscle mass index (OR=0.05, 95% CI=0.030 to 0.080), calf circumference (OR=0.02, 95% CI=0.007 to 0.040), and comorbidities (OR=0.04, 95% CI=0.030 to 0.080). CONCLUSION: There was a 25.4% prevalence of probable sarcopenia in Greek elderly. The results highlight the importance of the detection of HGS and probable sarcopenia in older people in order to develop effective strategies of prevention and intervention of sarcopenia.

Cross-cultural validation of the start back screening tool in a Greek low back pain sample.

BACKGROUND: Keele STarT Back Screening Tool (SBST) is a popular 9-item prognostic recovery questionnaire for low back pain (LBP) with validation studies in several cultural settings, but not Greek. OBJECTIVES: The cross-cultural adaptation and validation of the SBST into Greek among LBP and LBP-associated leg pain patients. METHODS: A five-stage forward-backward translation procedure developed the Greek SBST. LBP and sciatica patients completed SBST, Roland-Morris Disability Questionnaire (RMDQ), Hospital Anxiety and Depression Scale (HADS), Short-form Health Survey (SF-12), Sciatica Bothersomeness Index (SBI), numeric pain rating scale (NPRS) and body chart pain location sites. Measurement properties (internal consistency, content, construct and discriminatory validity) were explored. Test-retest reliability was explored by re-administering SBST after 7-10 days across patients whose symptoms remained unchanged. RESULTS: 124 LBP patients (75 females, 49.1 ± 14.2 years-old) 43.5% of whom had sciatica completed Greek SBST. No floor/ceiling effects were detected. Mean score distributions were statistically different across SBST groups. Moderate to strong correlations were found for SBST (total and psychosocial scores) with RMDQ, SBI, HADS and SF-12 (Spearman's ρ = 0.42-0.60). Most associations between individual SBST items and reference standards were moderately correlated (ρ = 0.32-0.49). Greek SBST yielded acceptable discriminant validity with RMDQ (AUC of 0.80). Items 1, 3, 4, and 9 yielded acceptable discrimination against reference standards. Test-retest reliability was satisfactory for total score (ICC2,2 = 0.93) and individual items (kappa = 0.59-0.88). Cronbach's α was 0.70 (total score) and 0.76 (psychosocial subscale). CONCLUSIONS: The Greek SBST was comprehensible, valid and reliable and may thus, be used across Greek cross-cultural rehabilitation research and practice.

Arthroscopic Treatment of Luxatio Erecta Humeri Associated with Greater Tuberosity Fracture, Bankart Lesion, and Partial Rotator Cuff Tear: A Case Report.

BACKGROUND Luxatio erecta humeri (LEH) is a rare injury present in only 0.5% of shoulder dislocations. Much of the relevant literature is focused on the initial management and proper reduction techniques, although the prevalence of associated injuries can reach 80%. A case of LEH associated with greater tuberosity (GT) fracture and rotator cuff (RC) tear in a young laborer managed with closed reduction and arthroscopic repair of the labrum and rotator cuff is presented. CASE REPORT A 28-year-old man presented to our hospital with severe pain in his right shoulder after a high-impact motor vehicle accident. Standard anteroposterior radiographs revealed an inferior dislocation (LEH) of the right shoulder and a fracture of the GT. The patient was initially managed with closed reduction under mild intravenous sedation, using a 2-step maneuver followed by arthroscopic evaluation of the joint the next day. During arthroscopic evaluation, an anterior-inferior Bankart lesion, impaction of the humeral head with a minimal displaced GT fracture, and a partial RC tear were identified and successfully treated arthroscopically. The patient had immobilization in a simple sling for 6 weeks and he followed a standard 3-month physiotherapy protocol for rotator cuff, finally regaining almost normal range of shoulder motion at 1 year. CONCLUSIONS Although very good results of non-operative treatment of LEH have been reported in the literature, the co-existence of intra-articular lesions such as labral and rotator cuff tears makes arthroscopic repair an attractive alternative in individual cases.

Bilateral Total Knee Arthroplasty for Charcot Arthropathy After Cauda Equine Syndrome: A Case Report.

Charcot arthropathy of the knee is a relatively rare and poorly understood condition. Diagnosis requires detailed history of the patient, radiological investigation and exclusion of other causes of arthropathy. Conservative treatment is sufficient only in early stages. In late stages, either arthrodesis or total knee arthroplasty is the treatment of choice. We report a case of a 65-year-old woman who presented with Charcot arthropathy in both knees, after a spinal fracture 35 years ago, which caused cauda equine syndrome with diminished sensation of both legs. She underwent bilateral total knee arthroplasty using hinged knee prosthesis.

Cross cultural adaptation of the Greek sarcopenia quality of life (SarQoL) questionnaire.

Purpose: To translate and validate into the Greek language and setting the Sarcopenia Quality of Life (SarQoL®) questionnaire.Methods: A convenience sample of 176 Greek elderly people (136 females, 40 males; aged 71.19 ± 7.95 years) was recruited, 50 of which (36 females, 14 males) were diagnosed sarcopenic. Questionnaire was back-translated and culturally adapted into Greek according to international guidelines. To validate the Greek SarQoL®, we assessed its validity (discriminative power, construct validity), reliability (internal consistency, test-retest reliability) and floor/ceiling effects. Participants were divided into sarcopenic and non-sarcopenic. Sarcopenic subjects apart from the Greek SarQoL (SarQoLGR) filled out the Greek versions of two generic questionnaires; Short Form-36 and EuroQoL 5-dimension.Results: The Greek SarQoL questionnaire was translated without major difficulties. SarQoLGR mean scores were 52.12 ± 11.04 (range: 24.74-71.81) for sarcopenic subjects and 68.23 ± 14.1 (range: 24.83-94.81) for non-sarcopenic ones. Results indicated good discriminative power across sarcopenic and non-sarcopenic subjects (p = 0.01), high internal consistency (Cronbach's alpha of 0.96) and excellent test-retest reliability (ICC = 0.96, 95% CI = 0.95-0.97). Neither a floor nor a ceiling effect was observed.Conclusions: The Greek SarQoL was found to be a reliable and valid measure of quality of life for sarcopenic patients. It is therefore, available for use in future clinical research and practice.Implications for rehabilitationThe Greek version of the SarQoL® questionnaire is a valid and reliable outcome measure for assessing patients with sarcopenia.The Greek SarQoL is recommended to be use in clinical settings and research.The Greek SarQoL® questionnaire is available online www.sarqol.org.

The Effects of Group and Home-Based Exercise Programs in Elderly with Sarcopenia: A Randomized Controlled Trial.

Physical exercise is effective for sarcopenic elderly but evidence for the most effective mode of exercise is conflicting. The objective of this study was to investigate the effects of a three-month group-based versus home-based exercise program on muscular, functional/physical performance and quality of life (QoL) across elderly with sarcopenia. 54 elderly (47 women, 7 men aged 72.87 ± 7 years) were randomly assigned to one of three interventions: supervised group (n = 18), individualized home-based exercise (n = 18) and control group (n = 18). Body composition was determined by bioelectrical impedance analysis, calf measurement with inelastic tape and strength assessments (grip and knee muscle strength) via hand-held and isokinetic dynamometers. Functional assessments included four-meter (4 m), Τimed-Up and Go (TUG) and chair stand (CS) tests. QoL was assessed with Greek Sarcopenia Quality of Life (SarQol_GR) questionnaire. Outcomes were assessed at baseline, immediately post-intervention (week 12), and 3 months post-intervention (week 24). Significant group x time interactions (p < 0.001) were observed in QoL, calf circumference, TUG, CS, and 4 m tests, grip and knee muscle strength. Group-based compared to home-based exercise yielded significant improvements (p < 0.05) in muscle mass index, CS and 4 m tests, calf circumference, muscle strength at 12 weeks. Most improvements at 24 weeks were reported with grouped exercise. No changes were found across the control group. Results suggest group-based exercise was more effective than home-based for improving functional performance.

Dynamic balance asymmetries in pre-season injury-prevention screening in healthy young soccer players using the Modified Star Excursion Balance Test-a pilot study.

[Purpose] The purpose of this preliminary study was to investigate whether young players with no history of injury, have developed early asymmetries in dynamic balance ability tested via the recommended for screening in sports, Modified Star Excursion Balance Test (MSEBT). [Participants and Methods] Twenty-four young healthy male soccer players participated in the study having at least 4 years of systematic soccer training. The Waterloo Footedness Questionnaire was used to discriminate the stability dominant leg (STAB) from the non-stability dominant leg (NSTAB). Dynamic balance was assessed via the MSEBT. Participants, after familiarization, made 3 attempts in each direction for both legs: a) Anterior (AN), b) Posterolateral (PL) and c) Posteromedial (PM). [Results] The sole statistically significant performance asymmetry was in the PL direction, in favor of the STAB (94.5 ± 13.3 cm vs. 98.1 ± 10.4 cm). [Conclusion] The results of this pilot study showed a potential for developing dynamic balance asymmetries, in soccer players at the age of 13-14 years. Since asymmetry was significant in only one direction, further long term monitoring would be helpful to evaluate whether this is a growing functional deficit, potentially involving any of the other two directions of testing or if it is alleviated with increasing training age. These asymmetries could comprise an injury risk factor.

Elastic Bandaging for Orthopedic- and Sports-Injury Prevention and Rehabilitation: A Systematic Review.

CONTEXT: Elastic bandages are commonly used in sports to treat and prevent sport injuries. OBJECTIVE: To conduct a systematic review assessing the effectiveness of elastic bandaging in orthopedic- and sports-injury prevention and rehabilitation. EVIDENCE ACQUISITION: The researchers searched the electronic databases MEDLINE, CINAHL, SPORTDiscus, EMBASE, and Physiotherapy Evidence Database (PEDro) with keywords elastic bandaging in combination, respectively, with first aid, sports injuries, orthopedic injuries, and sports injuries prevention and rehabilitation. Research studies were selected based on the use of the term elastic bandaging in the abstract. Final selection was made by applying inclusion and exclusion criteria to the full text. Studies were included if they were peer-reviewed clinical trials written in English on the effects of elastic bandaging for orthopedic-injury prevention and rehabilitation. EVIDENCE SYNTHESIS: Twelve studies met the criteria and were included in the final analysis. Data collected included number of participants, condition being treated, treatment used, control group, outcome measures, and results. Studies were critically analyzed using the PEDro scale. CONCLUSIONS: The studies in this review fell into 2 categories: studies in athletes (n = 2) and nonathletes (n = 10). All included trials had moderate to high quality, scoring ≥5 on the PEDro scale. The PEDro scores for the studies in athletes and nonathletes ranged from 5 to 6 out of 10 and from 5 to 8 out of 10, respectively. The quality of studies was mixed, ranging from higher- to moderate-quality methodological clinical trials. Overall, elastic bandaging can assist proprioceptive function of knee and ankle joint. Because of the moderate methodological quality and insufficient number of clinical trials, further effects of elastic bandaging could not be confirmed.

Attitudes and diagnostic practice in low back pain: A qualitative study amongst Greek and British physiotherapists.

AIM: To explore current diagnostic practice and attitudes of Greek and United Kingdom physiotherapists (PTs) on assessing low back pain (LBP) patients. METHODS: Three focus groups were undertaken, followed by a structured questionnaire-type survey comprising 23 health professionals and a random stratified sample of 150 PTs, respectively. Twenty-nine themes relating to LBP diagnostic practice emerged. These were then given to 30 British PTs assessing their level of agreement with their Greek counterparts. Analysis was performed by percentage agreements and χ (2) tests. RESULTS: The survey was divided into three subsections; PTs' attitudes on LBP assessment, patients' attitudes and diagnostic/healthcare issues, each constituting 14, 7 and 8 statements, respectively. Over half of the statements fell within the 30%-80% agreement between Greece and United Kingdom whereas, 5 statements reported low (< 10%) and 8 statements demonstrated high (> 90%) PT percentage agreement. Similarities across British and Greek PTs were detected in history taking methods and in the way PTs feel patients perceive physiotherapy practice whereas, re-assessment was undertaken less frequently in Greece. Diagnosis according to 91% of the Greek PTs is considered a "privilege" which is exclusive for doctors in Greece (only 17% British PTs agreed) and is accompanied with a great overuse of medical investigations. Forty percent of Greek PTs (compared to 0% of British) consider themselves as "executers", being unable to interfere with treatment plan, possibly implying lack of autonomy. CONCLUSION: Although similarities on history taking methods and on patients' attitudes were detected across both groups, gross differences were found in re-assessment procedures and diagnostic issues between Greek and British physiotherapists, highlighting differences in service delivery and professional autonomy.

Long QT Syndrome Leading to Multiple Cardiac Arrests After Posaconazole Administration in an Immune-Compromised Patient with Sepsis: An Unusual Case Report.

BACKGROUND: We present the case of a septic patient with severe immunodeficiency, who developed QT interval prolongation followed by episodes of lethal cardiac arrhythmia. Cardiac events occurred after posaconazole administration, incriminating posaconazole use, alone or in combination with voriconazole, as the culpable agent. CASE REPORT: A 26-year-old female patient underwent orthopedic surgery to remove ectopic calcifications in her left hip joint. On the first post-operative day she became septic due to a surgical wound infection. Despite being treated according to the therapeutic protocols for sepsis, no clinical improvement was noticed and further assessment revealed an underlying immunodeficiency. Considering the underlying immunodeficiency and to that point poor clinical response, an antifungal agent was added to the antibiotic regiment. Following discontinuation of multiple antifungal agents due to adverse effects, posaconazole was administered. Posaconazole oral intake was followed by episodes of bradycardia and QT interval prolongation. The patient suffered continuous incidents of cardiac arrest due to polymorphic ventricular tachycardia (torsades des pointes) that degenerated to lethal ventricular fibrillation. Posaconazole was immediately discontinued and a temporary pacemaker was installed. The patient finally recovered without any neurological deficit, and was discharged in a good clinical status. CONCLUSIONS: Close cardiac monitoring is recommended in cases where posaconazole administration is combined with coexisting risk factors, as they may lead to severe ECG abnormalities and cardiac arrhythmias such as long QT interval syndrome and torsades de pointes. Posaconazole interactions with medications metabolized via the CYP3A4 pathway should be considered an additional risk factor for lethal cardiac incidents.

Expression of NO Synthase Under Medication with Cyclosporine A, Mycophenolate Mofetil, and Tacrolimus during Development of Transplant Vasculopathy on Rat Cardiac Allograft.

OBJECTIVE: The transplant vasculopathy as a sign of chronic graft rejection affects both the epicardial and the intramyocardial arteries of the graft. This is at least partially mediated by NO synthases. The aim of this study was to assess possible protective effects of cyclosporine A (CsA), tacrolimus (FK506), and mycophenolate mofetil (MMF) on the expression of NO synthases in an experimental transplant rat model. AIMS: Heart transplantation was performed in 322 rats. These were randomly assigned to four equal groups (control, CsA, FK506, MMF). Recipients were monitored up to 60 days after transplantation, while transplanted hearts were recovered at certain time points for analysis. Expression and staining intensity for endothelial nitric oxide synthases (e-nos) and inducible nitric oxide synthases (i-nos) were analyzed in epicardial and intramyocardial vessels in each group. RESULTS: All employed drugs led to a significant reduction of expression or staining intensity of i-nos and e-nos. MMF was most effective in reduction in expression of both NO synthases. CONCLUSIONS: These results imply that all described drugs prevent endothelial impairment induced by toxicity of NO and thereby prevent transplant vasculopathy. MMF seems to be the most effective drug.

Kümmell's Disease: Clarifying the Mechanisms and Patients' Inclusion Criteria.

The three major causes of vertebral body collapse include infection, malignant neoplasia, and trauma and it may be difficult to distinguish between them, particularly in the presence of severe osteoporosis. In 1891, however, Dr Hermann Kümmell, further added another possibility of vertebral body crush; the delayed posttraumatic collapse. As originally described, this rare clinical entity includes patients, who after a trivial trauma and an asymptomatic clinical course they develop a progressive vertebral body collapse and a painful kyphosis. Although more than a century has passed from its initial description, only few cases have been reported in the literature, whereas the main pathologic eliciting event is still under investigation. As a consequence, great controversy exists regarding the discrete features of the clinical course, its radiographic appearance and the histopathological findings. To explain the time lag between the initial trauma and the occurrence of the vertebral collapse, the hypothesis of ischemic necrosis was advanced. Equation of Kümmell's disease with vertebral osteonecrosis, however, has wrongly led many authors to report cases of Kümmell's disease, even in the absence of history of spinal trauma. On the other hand, high coincidence of vertebral osteonecrosis and the pathognomonic radiographic finding of intravertebral vacuum cleft, has further added to the confusion. In this review we present an overview of the literature on Kümmell's disease, focusing on the different proposed eliciting mechanisms. We also highlight controversial subjects on clinical course, diagnosis and treatment of this entity, in an attempt to further clarify patients' inclusion criteria.

Operations in spinal surgery are not always needed. Do we operate more than we should?

Lumbar disc herniation and low back pain are the main cause of sickness during labor life. The decision for operation is thought to be taken easily and as a result a lot of money is being spent for treatment and rehabilitation. The aim of this study was to evaluate whether conservative treatment is sufficient for treatment of lumbar disc herniation and low back pain and what percentage of the patients operated are satisfied with social and everyday life two years after operation. One hundred and twenty seven patients (67 male and 60 female) were treated because of lumbar disc herniation. No neurological deficiency or muscle weakness was observed. Seventy two patients underwent conservative treatment. Fifty five patients underwent microsurgical discectomy. Back and leg pain are reported on a visual analog scale (VAS) and with the Oswestry disability index (ODI). The Short Form-36 health survey (SF-36) and the European Quality of Life questionnaire (EQ-5D) should also be completed. Surgical data, including diagnosis, are recorded by the surgeon without access to the patient's questionnaires. Both groups (conservative and operative) improved from baseline with regard to SF-36 and ODI (all P<0.01). The results 2 years after surgery were similar for both groups, as measured with the SF-36 and the ODI. Both groups improved from baseline to follow-up with regard to both back pain and leg pain (all P<0.01). The frequency of returning to work was analyzed for those patients who were less than 65 years of age at the time of follow up, and who had been working before surgery. Statistical analysis indicates that there are no significant differences between the groups. The decision for operation is thought to be taken easily and as a result a lot of money is being spent for treatment and rehabilitation. In conclusion, this study shows that operative treatment is equal in outcome to conservative treatment and should follow, seen from an economic perspective, the conservative treatment.

Kümmell's disease: pathophysiology, diagnosis, treatment and the role of nuclear medicine. Rationale according to our experience.

Kümmell's disease (KD) is a rare clinical entity and includes patients, who after a trivial trauma and an asymptomatic period, develop a progressive vertebral body collapse and a painful kyphosis. The main pathologic eliciting event still remains unclear. Vertebral body collapse can be the result of infection, malignant neoplasia or trauma. It may be difficult to distinguish among them, particularly in osteoporosis. To explain the time lag between initial trauma and vertebral collapse, the hypothesis of ischemic necrosis was suggested. Many authors considering KD as a case of mere vertebral osteonecrosis have wrongly reported cases of osteonecrosis without a spinal trauma, as KD. The fact that intravertebral vacuum cleft often coexists with vertebral osteonecrosis further added to confusion. Various imaging modalities including bone scan support the diagnosis of KD. It is described that bone single photon emission tomography (SPET) or SPET/computed tomography scintigraphy using dynamic and static, acquisition can identify the chronicity of the lesions.