[The evidence-based occupational health paradigm in managing back pain: identifying the problem and evaluation of the decision]. / Il paradigma dell'evidence based occupational health nella gestione della rachialgia in operatori sanitari: dalla formulazione del quesito alla valutazione della decisione.

BACKGROUND: Occupational health professionals must rely on the best available evidence in support of the appropriateness of diagnostic tests and preventive or clinical interventions. This study aims at comparing the decisions made in respect of health care personnel with the decisions made on the basis of the evidence and evaluating the effectiveness of these decisions. MATERIALS AND METHODS: Five female nurses with back problems exposed to health risk mostly associated with patient handling and movement were considered. The diagnostic results and the interventions following the decisions made in 2002 were evaluated and compared with the medical data during the years 2004-2005. To assess health changes occurring after the intervention, an indicator of impact was used. During 2006 the health problems were reviewed by means of the multi-step evidence-based occupational health paradigm: starting from identification of the problem and search for evidence (with a new and validated search string and the database Medline) followed by evaluation of performance. Professional performance was assessed by comparing the medical decisions made in 2002 with the decision supported by the evidence. RESULTS: All the medical decisions were in agreement with the decisions inferred from scientific evidence. Furthermore, all subjects showed an improvement in both perceived and objective health conditions after the intervention, together with increased acceptability of working conditions. CONCLUSION: Given that no gold standard exists and that guidelines for the management of back pain need to be assessed for their effectiveness, this study shows that the occupational health professional should be aware of the availability of up-to-date scientific evidence which can provide appropriate solutions to the commonly encountered problems. This perspective will be a challenge for professionals aware of the need to adopt practices related to the concept of quality in occupational health care.

Barré-Lieou syndrome and the problem of the obsolete eponym.

BACKGROUND: Eponym lists in major sources can give an aura of legitimacy to discredited diagnoses, as exemplified by the case of Barré-Lieou syndrome, a 'rare' vestibular disorder. METHODS: A literature review for information on the posterior cervical syndrome of Barré-Lieou. RESULTS: Barré-Lieou syndrome includes very common symptoms--tinnitus, dizziness, and head or neck pain--attributed to ischaemia caused by cervical sympathetic nerve compression. Its original description brings together many unrelated disorders, and its causative mechanism has been discredited. However, it appears credulously in a number of eponym lists, and references to the syndrome are steadily increasing on the internet in general and on alternative medicine and legal profession websites in particular. CONCLUSION: By inclusion in eponym lists, without a disclaimer, a syndrome can be given legitimacy before the general public. A syndrome, such as Barré-Lieou syndrome, that is useless to the medical profession can unfortunately prove to be very useful for litigants and disability claimants.

The Bi-Digital O-Ring Test used in the successful diagnosis & treatment (with antibiotic, anti-viral agents & oriental herbal medicine) of a patient suffering from pain & weakness of an upper extremity & Barré-Liéou syndrome appearing after whiplash injury. A case report.

A patient with a whiplash injury suffering from prolonged symptoms, including pain and weakness of the right upper extremity and the symptoms of Barré-Liéou syndrome, was diagnosed and treated with the Bi-Digital O-Ring Test as a supplement to standard medical examinations. Radiological findings showed spondylotic canal stenosis with osteophytes and disc protrusions. The Bi-Digital O-Ring Test indicated a strong abnormal response around the right side of his neck and right shoulder, including the area of the vertebral artery and at acupuncture point GB 21, where positive resonant responses to Cytomegalovirus and Streptococcus faecalis were detected. Antibiotic and anti-viral agents, as well as Ku-Oketsu-Zai, a type of Oriental herbal medicine for overcoming blood stagnation or stasis, were administered according to the drug compatibility test using the Bi-Digital O-ring Test and the following clinical results were obtained. Infection at the site of the vertebral artery and the peri-arterial sympathetic nerve plexus was considered as a cause of the prolongation of the symptoms including Barré-Liéou syndrome, in this case. In addition we especially noted, in this clinical case, that the patient's impaired grasping force dramatically improved from 8 kg to 52 kg in a very short periods of time when the patient held suitable medicine selected with the Bi-Digital O-Ring Test drug compatibility test. We assume that the drug action was transferred electromagnetically, by which the pathological electromagnetic oscillations caused by trauma and following infections were scavenged. This effect might lead to an improvement in the coordination of the neuromuscular system.

[Magnetic stimulation in restorative therapy of patients with spondylogenic diseases of nervous system]. / Magnitnaia stimuliatsiia v vostanovitel'nom lechenii bol'nykh so spondilogennymi zabolevaniiami nervnoi sistemy.

A new method of impulse magnetic therapy was studied in the treatment of neurologic complications of osteochondrosis and deforming spondylarthrosis in 225 patients with neurologic manifestations of pathology in cervical or sacral parts of spinal column. To assess the results obtained, EMG, thermography and determination of the levels of blood plasma lipid peroxidation were used.

Cervical spondylotic myelopathy.

OBJECTIVE: To present the clinical and neurological features of a patient suffering from cervical spondylotic myelopathy. CLINICAL FEATURES: Cervical spondylotic myelopathy (CSM) is a condition in which the vascular and neural structures are compressed by bony spurring and soft tissue hypertrophy, causing ischemic damage to the spinal cord. Although cervical spondylotic myelopathy is the most common cord disorder in older adults, the diagnosis is often missed because the initial symptoms are subtle and the condition usually presents with associated conditions such as nerve root involvement. INTERVENTION: The patient was referred to a neurosurgeon for a posterior decompressive laminectomy. The advancing symptoms of CSM were apparently halted by the surgery in this case, until complication from a fall resulted in quadriplegia. CONCLUSION: Appropriate testing can aid differential diagnosis of the condition and expedite appropriate management of the condition. Treatment may include surgical cervical decompression of the involved area. An untreated progressive spondylotic myelopathy may cause permanent neurological damage to the spinal cord. Attention should be paid to the clinical signs and treatment of this underdiagnosed condition.

A comparison of radiographic signs of degeneration to corresponding MRI signal intensities in the lumbar spine.

OBJECTIVES: To evaluate plain film radiographic findings of lumbar intervertebral disk degeneration. DESIGN: A cross-sectional observational design was employed. Contingency tables were constructed to evaluate the relationships between radiographic findings of degeneration and the corresponding MRI signal intensities of the inner intervertebral disk. SETTING: Twenty-four consecutive cases were retrospectively selected from an MRI imaging center. PATIENTS: No exclusion was made on the basis of age or sex. MAIN OUTCOME MEASURES: Radiographic findings of IVD degeneration include: Narrowed disk space, osteophyte formation, end-plate sclerosis, vacuum phenomenon, end-plate irregularity and Schmorl's node formation. The inner IVD signal intensity of the sagittal T2-weighted MRI image was visually categorized by three radiologists. The signal intensities were divided into low, medium and high categories. MAIN RESULTS: Visually reduced disk height, osteophytes and eburnation all demonstrate significant relationships with MRI signal intensity. Due to their infrequency, no significant relationships could be found with vacuum phenomena, end-plate irregularity, and Schmorl's nodes when compared to MRI signal intensity. CONCLUSIONS: In conclusion, visually reduced disk height is frequently associated with decreased signal intensity and, therefore, significantly indicates internal disk derangement. Osteophytes are more commonly present when the signal intensity is low. However, high signal intensity is associated with osteophytic change as well. Therefore, osteophytic change is less sensitive and accurate to early inner disk degenerative change. When osteophytes and reduced disk height are present together, a stronger prediction of degeneration is possible then when either finding is present alone. Due to their infrequency, eburnation, vacuum phenomena, end-plate irregularity and Schmorl's nodes are less helpful indicators of degeneration.