Back Pain: Zanoli G

Airaksinen O, Brox JI, Cedraschi C, Hildebrandt J, Klaber-Moffett J, Kovacs F, Mannion AF, Reis S, Staal JB, Ursin H, Zanoli G, Anonymous00003. · No affiliation provided · Eur Spine J. · Pubmed #16550448 No free full text.

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Zanoli G. · Department of Orthopedics, Lund University Hospital, Lund, Sweden. · Acta Orthop Suppl. · Pubmed #16175972 No free full text.

Abstract: BACKGROUND: There is no consensus regarding outcomes assessment in spine patients. When using Health-Related Quality of Life (HRQoL) in assessing outcomes of treatment, normative data for different diagnoses are needed to allow comparisons between existing and future studies. The most used generic instrument for HRQoL evaluation in spine pathologies is SF-36. There is no standard definition of important differences in spine surgery patients and no standard reference for minimal clinically important difference. OBJECTIVE: The overall aim of this thesis was to increase understanding of some aspects of outcome measurement in patients operated on for lumbar spine problems using existing prospective data available at the spine section of the Orthopedics Department of the University of Lund, and, moreover, to explore potentials and weaknesses in the methodology of retrospectively analysis of prospectively collected observational data. METHODS: A systematic web-search and review of the literature and a retrospective analysis of prospective cohort data collected within the data collection protocol in use by the Swedish Spine Register. Since 1993 all persons undergoing elective lumbar surgery at the spine section of the Orthopedics Department of the University of Lund were included in the prospective registration protocol either in its first version (1993-1997), which was the source of data for paper III, or in its revised version after 1998. Initial information at baseline (the day before surgery) included age, sex, smoking habits, duration of preoperative back and leg pain in months, duration of preoperative sickleave in months, number of previous operations, patient's working status, diagnostic techniques pre- and postoperatively VAS scores analgesic intake, walking distance. Postoperatively, change in leg and back pain, respectively, was recorded on a 5-point Likert Scale as compared to preoperative status, patient satisfaction was recorded on a 3-point Likert Scale. RESULTS: The number of proposed outcomes, outcome scores, outcome instruments is incredibly high: no new HRQoL instruments specific for LBP are needed. The data collection protocol of the Swedish Spine Register studied can reliably detect postoperative improvements between large groups of patients such as in a Register. Pain intensity measured on the VAS correlates significantly to other indicators of perceived pain, but correlation is not as strong as it could be if they were all measuring the same construct. HRQoL as measured by SF-36 in patients scheduled for lumbar spine surgery showed a pronounced reduction compared to normal and LBP population. The use of norm-based scoring for SF-36 can help interpretation and simplify graphic representation of the findings. SF-36 outcomes 1-year after surgery for lumbar spine disorders are improved, although other factors or natural history could contribute to this improvement. The global effect of spine surgery in our sample is quite similar to effect sizes of very successful orthopedic interventions. The use of standardised outcome measures allows international comparisons, although caution should be used in the interpretation of differences. CONCLUSIONS: Without the need of additional expensive data collection and using limited economic resources an increased understanding of some aspects of outcome measurement in patients operated on for lumbar spine problems has been achieved. Reference values and more speculative data (such as effect sizes and MCIDs) have been presented. The ecological methodology has been presented and discussed: with a clear respect for its limitations, it could be used to obtain relevant information also in other clinical fields.

Urrútia G, Burton K, Morral A, Bonfill X, Zanoli G. · Centro Cochrane Iberoamericano, Hospital de la Santa Creu i Santa Pau, Barcelona, Spain. · Spine (Phila Pa 1976). · Pubmed #15770167 No free full text.

Abstract: STUDY DESIGN: Systematic review. OBJECTIVE: To assess the effectiveness of neuroreflexotherapy (NRT) for low back pain (LBP). SUMMARY OF BACKGROUND DATA: Few of the alternatives for the management of LBP have a firm base of evidence for their effectiveness. Recently, a new intervention known as NRT has been developed in Spain and has been reported to have favorable results. METHODS: Searches were undertaken according to Cochrane Collaboration guidelines, and randomized controlled trials that evaluated NRT as treatment for patients with nonspecific LBP were included. A qualitative synthesis and an assessment of methodological quality were undertaken. RESULTS: Three randomized controlled trials were included, with 125 and 148 subjects in control and intervention groups, respectively. NRT was compared with sham in two trials and standard care in one. Individuals receiving active NRT showed significantly better outcomes for pain, mobility, disability, medication use, consumption of resources, and costs. No major side effects were reported by those receiving active NRT. CONCLUSIONS: NRT appears to be a safe and effective intervention for nonspecific LBP. This conclusion is limited to three trials conducted by a small number of experienced clinicians. Further trials in other settings are needed to determine whether these favorable results can be generalized.

Urrútia G, Burton AK, Morral A, Bonfill X, Zanoli G. · Centro Cochrane Iberoamericano, Casa de Convalescencia. Sant Antoni M. Claret, 171, Barcelona, Spain, 08041. · Cochrane Database Syst Rev. · Pubmed #15106186 No free full text.

Abstract: BACKGROUND: Among the wide range of therapeutic alternatives proposed for the management of low-back pain (LBP), a less widely used technique from Spain, called neuroreflexotherapy (NRT) has claimed to show very favourable results, mainly in patients with chronic low-back pain. OBJECTIVES: The aim of this review was to systematically assess the effectiveness of NRT for the treatment of non-specific LBP in adult patients, aged 16 to 65 years. A secondary objective was to compare NRT with other conventional interventions. SEARCH STRATEGY: We searched the Cochrane Central Register of Controlled Trials, MEDLINE, and EMBASE to October 1, 2002. SELECTION CRITERIA: Only randomised controlled trials (RCTs) of NRT for the treatment of patients with a clinical diagnosis of non-specific LBP were included. DATA COLLECTION AND ANALYSIS: Two reviewers independently selected trials and extracted data using pre-designed forms. Because the outcome variables were not assessed in a homogenous way, it was not possible to pool the results to obtain an estimate of global effect, as initially planned. MAIN RESULTS: Three RCT were included, with a total of 125 subjects randomised to the control groups and 148 subjects receiving active NRT. Neuroreflexotherapy was the same in all three trials, while the control groups received sham-NRT in two trials and standard care in one. Two trials studied patients with chronic LBP, the third studied patients with a mix of chronic and sub-acute LBP. Clinical outcomes were measured in the short-term (15 to 60 days) in all three trials; in one trial, resource utilization was measured after one year. Individuals who received active NRT showed statistically significantly better outcomes than the control groups for measures of pain, degree of mobility, disability, medication use, consumption of resources and costs. No significant differences were observed for quality of life measures. Side effects were more frequently reported in the control groups during short-term follow-up, with no major side effects reported by those receiving active NRT. REVIEWERS' CONCLUSIONS: NRT appears to be a safe and effective intervention for the treatment of chronic non-specific LBP. The efficacy is less clear for sub-acute LBP. However, these results are limited to three trials conducted by a small number of specifically trained and experienced clinicians, in a limited geographical location. No data are available on the ease and time-frame needed to achieve that level of expertise. RCTs by other practitioners, in other locations, that replicate the effects reported in this review are needed before recommending a broader practice.

Zanoli G, Strömqvist B, Jönsson B, Padua R, Romanini E. · Department of Orthopaedics, University of Ferrara, Arcispedale S. Anna, 44100 Ferrara, Italy. · Acta Orthop Scand Suppl. · Pubmed #12545666 No free full text.

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Zanoli G, Strömqvist B, Padua R, Romanini E. · Department of Orthopedics, University of Ferrara, Ferrara, Italy. · Spine (Phila Pa 1976). · Pubmed #11124734 No free full text.

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Zanoli G, Jönsson B, Strömqvist B. · Department of Orthopedics, Lund University Hospital, Lund, Sweden. · Acta Orthop. · Pubmed #16752294 links to  free full text

Abstract: BACKGROUND: When using Health-Related Quality of Life (HRQoL) in assessing outcomes of treatment, normative data for different diagnoses are needed to allow cross-comparisons of existing and future studies. We determined the SF-36 scores in patients with surgical lumbar spine problems. METHODS: This is a prospective observational study of consecutive surgical patients in one institution. In addition to SF-36 questionnaire responses, local pain, radiating pain, analgesic intake and walking ability were recorded, together with several other demographic variables. 451 patients (50% women) with median age 52 (13-88) years, operated from 1998 through 2002, were included in the study. RESULTS: Preoperative SF-36 scores were significantly lower than those derived from previously published material (the general population, nonspecific low back pain (LBP) patients, other samples of non-LBP patients), also with the use of norm-based scoring. Sick-leave and worker's compensation seemed to affect perceived Health-Related Quality of Life (HRQoL), but smoking habits did not. Some SF-36 domains showed a possible discriminating pattern between diagnoses. INTERPRETATION: HRQoL reported by patients scheduled for lumbar spine surgery was much worse than for the normal population and for LBP patients. The normative SF-36 values provided may be used as a benchmark in future studies.

Persson J, Strömqvist B, Zanoli G, Mccarthy I, Lidgren L. · Department of Orthopedics, Lund University Hospital, Lund, Sweden. · Ultrasound Med Biol. · Pubmed #12401390 No free full text.

Abstract: Thermal intradiscal therapy for chronic low back pain, using a catheter inserted into the intervertebral disc, is becoming more popular in the treatment of low back pain. The aim of this study was to investigate the possibility of heating the nucleus pulposus of the intervertebral disc with high-intensity focused ultrasound (US) or HIFU. Two specific situations were considered, invasive transducers that would be in contact with the annulus fibrosus of the disc, and noninvasive transducers that could be used externally. Theoretical simulations were performed to find the optimal parameters of US transducers and then experimental studies were done using transducers made to these specifications. These experiments confirmed that it was possible to heat the discs with HIFU. Two orthogonal transducers resulted in a superior temperature distribution than using just one transducer. It is, therefore, feasible to consider thermal treatment of the nucleus pulposus of the disc using noninvasive US.

Padua R, Padua L, Ceccarelli E, Romanini E, Zanoli G, Bondì R, Campi A. · via P.S. Mancini 2, 00196 Rome, Italy. · Eur Spine J. · Pubmed #11956918 No free full text.

Abstract: Over the last 10 years, patient-oriented evaluations using questionnaires have become an important aspect of clinical spinal outcome studies. Any questionnaire must be translated and culturally adapted in order to be used with different language groups, and the translated version must then be evaluated for reliability and validity, which are fundamental attributes of any measurement tool. The Roland Disability Questionnaire, a low back pain disease-specific tool, was submitted to translation into Italian and to cross-cultural adaptation following the Guillemin criteria. It was then validated on 70 patients (37 male and 33 female; mean age 58, range: 28-67) suffering from low back pain as assessed by clinical examination, imaging and also electromyography in cases of suspected neurological impairment. The test-retest reliability, assessed with intraclass correlation, was 0.92 and the internal consistency reached a Cronbach's alpha of 0.82. The Italian version of the Roland Disability Questionnaire satisfied the validation criteria, showing characteristics of reliability and validity similar to previously published versions translated and adapted for other countries.

Zanoli G, Strömqvist B, Jönsson B. · Department of Orthopedics, Lund University Hospital, Lund, Sweden. · Spine (Phila Pa 1976). · Pubmed #11679824 No free full text.

Abstract: STUDY DESIGN: A prospective observational study of visual analog scale (VAS) scores for pain in patients operated at one institution within the framework of a national registry. OBJECTIVE: To describe the use of recording VAS for pain intensity in patients operated on for lumbar spine problems. SUMMARY OF BACKGROUND DATA: There is no consensus regarding pain outcomes assessment in spine patients. Pain intensity, recorded on a VAS, is one of the most used measures. Still, many aspects of its interpretation are still debated or unclear. METHODS: A total of 755 consecutive patients, mean age 50 years (range, 15-86 years), operated from 1993 to 1998 were included in the study; there were 420 males and 335 females. Diagnoses included herniated nucleus pulposus (45%), central stenosis (19%), lateral stenosis (14%), isthmic spondylolisthesis (9%), and degenerative disc disease (9%). Local pain, radiating pain, analgesic intake, and walking ability were recorded before surgery and at 4 and 12 months after surgery. The patients' opinions regarding the change in pain and satisfaction with the result were assessed separately. Correlation among variables reflecting perceived pain was sought. RESULTS: Preoperative VAS mean values for local and radiating pain were significantly different in the five diagnostic groups. Significant but moderate correlation between different types of pain outcomes and with patient satisfaction was present in all cases. CONCLUSIONS: Measuring pain intensity with VAS is a useful tool in describing spine patients. In the search for a standard in the evaluation of pain as an outcome, the differences between the various methods should be taken into account.

Padua R, Padua L, Ceccarelli E, Romanini E, Bondì R, Zanoli G, Campi A. · Institute of Orthopedics, University of Ferrara, Ferrara, Italy. · Spine (Phila Pa 1976). · Pubmed #11474366 No free full text.

Abstract: STUDY DESIGN: A cross-cultural adaptation and cross-sectional study of a sample of lumbar spine patients, with a subsample followed prospectively for retest reliability. OBJECTIVES: To assess the Italian version instrument reliability and validity. SUMMARY OF BACKGROUND DATA: The orthopaedic outcome measurements have been usually focused on objective parameters as radiograph measures or other technical aspects. However, these parameters are weakly related with outcomes that are more relevant to patients as functional status and symptoms. In the last ten years, the patient-oriented measures have become an important aspect of spinal clinical outcome evaluation. The most common instruments to assess patient perspective are self-administered questionnaires that must be validated by a widely accepted process to evaluate reliability and validity, which are fundamental for every instrumental measure. METHODS: The North American Spine Society (NASS) questionnaire was culturally adapted for Italian-speaking people following the Guillemin criteria. The Italian version was tested on 74 consecutive patients who were referred to the authors' department and suffered from low back pain with leg irradiation. The results were compared with other validated patient-oriented measures. Forty-eight-hour retests were performed on a subsample of 45 patients. RESULTS: The questionnaire was favorably accepted by patients. The lumbar spine pain and disability and neurogenic symptoms subscales showed a high correlation with other patient-oriented measures, as hypothesized, and it also showed good values on test-retest. CONCLUSIONS: The questionnaire should be considered for patient health status monitoring and for clinical trials.

Padua R, Padua S, Aulisa L, Ceccarelli E, Padua L, Romanini E, Zanoli G, Campi A. · Department of Orthopedics, San Giocoma Hospital, Rome, Italy. · Spine (Phila Pa 1976). · Pubmed #11389396 No free full text.

Abstract: STUDY DESIGN: A retrospective study was performed, using the Short Form-36 Health Survey and the Roland and Morris Disability Questionnaire, to investigate patient outcomes after fusion for adolescent idiopathic scoliosis using Harrington rod instrumentation. OBJECTIVE: To evaluate health-related quality of life and low back pain in a long-term follow-up study of surgery for adolescent idiopathic scoliosis. SUMMARY OF BACKGROUND DATA: The commonly accepted surgical treatment for idiopathic evolutive scoliosis is vertebral fusion. It has been suggested that this procedure may cause low back pain and a poor quality of life over the long term. Outcome measures after surgery for adolescent idiopathic scoliosis have focused mainly on objective parameters such as radiographic measures. However, this information has proved to be correlated only weakly with outcomes that are more relevant to patients, such as functional status and symptoms. Until recently, only a few long-term outcome studies have used standardized and validated patient-oriented tools to evaluate surgically treated patients with scoliosis. METHODS: In this study, 70 patients treated with a standard Harrington technique were recontacted and evaluated by means of self-administered questionnaires (Short Form-36 Health Survey and Roland and Morris Disability, clinical examination, and radiographic analysis. Preoperative and follow-up radiographic findings were registered. Relations between radiographic and patient-oriented data were evaluated. RESULTS: A comparison between the current sample and the Italian age-matched normative data for the Short Form-36 Health Survey showed them to have a similar pattern. Findings showed the patient-oriented outcome to be correlated inversely with the extension of vertebral fusion and the preoperative Cobb angle. CONCLUSION: Long-term follow-up evaluation of Harrington rod fusion for adolescent idiopathic scoliosis showed no important impairment of health-related quality of life, as measured by patient-oriented evaluation.

Kovacs FM, Zanoli G. · No affiliation provided · Spine (Phila Pa 1976). · Pubmed #19333115 No free full text.

This publication has no abstract.