[Recommendations on care of back pain problems]. / Anbefalinger om ryggomsorg.

Back problems are a common cause of disability. There are important variations in the care provided, suggesting that some patients receive suboptimal treatment. Several Western countries have developed practice guidelines to improve this state of affairs. If guidelines are to improve the outcome for patients seeking care, they must give valid recommendations. In this article I compare ten practice guidelines for back problems. The guidelines are from nine Western countries and were published in the ten-year period 1987-97. There are significant variations in the recommendations given. The guidelines were developed according to different methods. A systematic, evidence-based approach is less prone to bias than an informal expert-based consensus. I conclude that the systematically developed US guideline (AHCPR 1994) and the British guideline (RCGP 1996) are the ones giving valid recommendations and are therefore the best options for practitioners.

[Lumbar disk prolapses and radiological spinal intervention. What do the randomized controlled trials say?]. / Lumbale skiveprolapser og radiologisk ryggintervensjon. Hva sier randomiserte kontrollerte studier?

We searched the Medline database and examined 11 randomized controlled trials to evaluate the efficacy of treating lumbar herniated discs by injection with chymopapain or by automated percutaneous discectomy. Our findings show that chemonucleolysis with chymopapain is a documented treatment which is better than placebo, but consistently inferior to surgical discectomy. The two randomized controlled trials to evaluate automated percutaneous discectomy fail to show efficacy that is any better than would be expected from a placebo response. We conclude that surgical discectomy is the best treatment option for a herniated disc when conservative efforts have failed.

[Neuromuscular disorders of the extremities after heroin-induced rhabdomyolysis]. / Neuromuskulaere utfall i ekstremitetene etter heroinindusert rhabdomyolyse.

We describe four patients with neuromuscular deficiencies after heroin-induced rhabdomyolysis. Such deficiencies have a good prognosis, but all our patients continued to have sequelae. In an emergency situation one should always consider fasciotomy for acute compartment syndromes. Two of our patients developed a Volkmann's ischemic contracture after acute compartment syndromes. The other two had deficiencies from compression neuropathies. We observed functional restitution over a period of one to two years. Physiotherapy and orthopaedic aids are important in the rehabilitation of these patients. However, the main problem is still their drug addiction.

[Rehabilitation of patients with brain stem damage]. / Rehabilitering av pasienter med hjernestammeskade.

We describe seven patients with serious brain stem damage who were admitted to Sunnaas Rehabilitation Hospital over a period of two years (1989-91). Our patients had quadriplegia and anarthria with some or completely preserved cognitive function. They experienced varying degrees of restitution, but all remained severely impaired. Important areas for rehabilitation include communication, alimentation, mobility, emotional reactions, medical complications and daily living arrangements. Severely impaired patients can enhance their quality of life by use of technical devices. Minimal motor function is necessary to control a switch, but preserved cognitive function is essential.