tailieunhanh - Spinal Disorders: Fundamentals of Diagnosis and Treatment Part 61

Spinal Disorders: Fundamentals of Diagnosis and Treatment Part 61. Spinal disorders are among the most common medical conditions with significant impact on health related quality of life, use of health care resources and socio-economic costs. Spinal surgery is still one of the fastest growing areas in clinical medicine. | 590 Section Degenerative Disorders The focus of rehabilitation is on patients with delayed recovery The chances of a return to work after one year are minimal Management of NSLBP Various guidelines supporting the evidence of conservative treatment have been published and they offer treatment recommendations for acute subacute and chronic LBP 66 78 . These guidelines were formulated by groups of international experts considering the scientific evidence for physical and non-physical treatment of back pain. Today there are guidelines from many countries and their recommendations are quite consistent 45 . This chapter addresses the treatment of acute subacute and chronic benign LBP Fig. 1 . The natural history of NSLBP shows that most patients return to normal function before the delayed recovery period whether or not they have any kind of treatment 82 . Therefore in order to maximize the effectiveness of treatments aimed at disability prevention the thrust of rehabilitation efforts must be focused on patients who have not resumed normal activities after 4 weeks. Return to work as soon as possible is important because the chances of resuming work are minimal after one year 82 . Acute LBP is often self-limiting and minimal medical intervention is recommended Self-care techniques put the patient in an active role in the treatment and recovery process Management of Acute NSLBP 4 weeks Acute low back pain is defined as the period between onset and 1-4 weeks 32 62 after onset of pain. Since low back pain is self-limiting for the majority of patients minimal or no medical interventions are recommended for acute nonspecific low back pain 2 84 . In fact patients can easily rely on self-care techniques such as over-the-counter medication and activity as tolerated. This approach is desirable because it requires that the patient plays an active role in the treatment and recovery process 61 Table 2 . It has been shown that individuals who perceive that they have control over their

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