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    <recommendedItem id="20100101_19_424"
                     title="AAPM: Facet Graft Quells Refractory Back Pain (CME/CE)"
                     score="0.013"
                     href="http://www.medpagetoday.com/MeetingCoverage/AAPM/tb/18343?impressionId=1265793868517"
                     
      &lt;p&gt;SAN ANTONIO  --  Minimally invasive facet arthrodesis significantly reduced pain and improved physical function for one&lt;strong&gt; &lt;/strong&gt;year in patients with medically refractory facet arthropathy, according to data from a prospective clinical series.&lt;/p&gt;
&lt;p&gt;Most patients discontinued narcotic pain relievers, researchers reported here, and only one of 28 patients in the series had no appreciable change in pain after the noninstrumented spinal surgery.&lt;/p&gt;
&lt;p&gt;&quot;The procedure does not disrupt stabilizing ligaments or muscular structures of the posterior spine, allowing unimpeded physiotherapy for low back muscular strengthening after 16 weeks,&quot; Daniel Bennett, MD, of Integrative Treatment Centers in Denver, told attendees at the American Academy of Pain Medicine meeting.&lt;/p&gt;
&lt;p&gt;&quot;If fusion occurs, symptoms should not return, as with traditional treatment modalities, such as thermal radiofrequency neurolysis.&quot;&lt;/p&gt;
&lt;p&gt;The results have provided the foundation for a prospective, multicenter, randomized clinical trial to compare radiofrequency neurolysis and minimally invasive spine facet arthrodesis, he added.&lt;/p&gt;
&lt;p&gt;Medical management of low back pain related to facet degeneration often provides minimal pain relief and can interfere with functioning. Direct injection of anesthesia into an affected joint also leads to negligible long-term benefits, said Bennett. Radiofrequency neurolysis provides only temporary pain relief and must be repeated because of nerve regeneration.&lt;/p&gt;
&lt;p&gt;All the patients had a return of pain after previous radiofrequency neurolysis and were eligible for repeat neurolytic procedures. Affected areas were confirmed by anesthetic injection, followed by a provocatory examination.&lt;/p&gt;
&lt;p&gt;The patients underwent a standardized procedure that included a small incision at the affected area, insertion of surgical pins to stabilize the joint, use of a surgical drill to achieve joint separation, and insertion of 5-mm or 7-mm Morse tapered cortical allografts.&lt;/p&gt;
&lt;p&gt;After surgery, patients wore a rigid brace for 16 weeks, at which point they began physical therapy to strengthen back muscles.&lt;/p&gt;
&lt;p&gt;The patients received a total of 102 grafts at 51 levels, and four dislodgements (3.9%) occurred. None of the patients had a return of pain after dislodgement.&lt;/p&gt;
&lt;p&gt;&quot;Among patients who retained grafts, all showed callus formation of the posterior joint and incorporation of the cortical allograft,&quot; said Bennett.&lt;/p&gt;
&lt;p&gt;At the 52-week follow-up, the average score on a 100-point visual analog pain scale was 23, down from an average of 79 prior to the intervention. Patients&apos; scores on the Oswestry Disability Index averaged 8.32, compared with 33.46 at baseline.&lt;/p&gt;
&lt;p&gt;All but four patients discontinued narcotic medication, and the morphine dose required by those four decreased from a baseline range of 150 to 360 mg to a range of 10 to 30 mg at one year.&lt;/p&gt;
&lt;div style=&quot;float:left;border-style:solid;border-width:1px;border-color:#8dabbc;font-family:arial;font-size:12px;background-color:#DBE9F2;padding:5px;&quot;&gt;&lt;p&gt;The study was supported by Prism Healthcare Foundation.&lt;/p&gt;&lt;p&gt;Bennett disclosed relationships with Alphatec Spine, miniSURG, Boston Scientific, Cephalon, Nevro, and Paylon.&lt;/p&gt;&lt;/div&gt;&lt;div style=&quot;clear:both;&quot;&gt;&lt;/div&gt;
    </recommendedItem>
    <recommendedItem id="20100101_19_264"
                     title="AAP Releases Tips on Preventing Soccer Injuries (CME/CE)"
                     score="0.002"
                     href="http://www.medpagetoday.com/Orthopedics/Orthopedics/tb/18098?impressionId=1265793868517"
                     
      &lt;p&gt;Coaches, parents, doctors and soccer officials can help prevent soccer-related injuries as the popularity of the sport grows, according to a report from the American Academy of Pediatrics.&lt;/p&gt;
&lt;p&gt;Although soccer is an effective way for children and teens to increase their physical activity, injury rates are higher than in many other contact sports, including field hockey, rugby, basketball, and football, according to Chris Koutures, MD, a pediatrician in Anaheim Hills, Calif., and Andrew Gregory, MD, of Vanderbilt University.&lt;/p&gt;
&lt;p&gt;Both are members of the AAP&apos;s Council on Sports Medicine and Fitness, which released the report in the February issue of &lt;em&gt;Pediatrics&lt;/em&gt;.&lt;/p&gt;
&lt;p&gt;Risk of injury goes up when dirty play enters the game. In one study, 11.9% of girls&apos; soccer injuries and 11.4% of boys&apos; were attributed to illegal actions.&lt;/p&gt;
&lt;p&gt;&quot;There is consensus that proper rule enforcement and limitation of violent contact can reduce the risk of injury,&quot; Koutures and Gregory noted.&lt;/p&gt;
&lt;p&gt;&quot;Officials controlling the physicality of the game and emphasis on safe play with respect for one&apos;s opponents can both play significant roles in reducing contact injuries in soccer.&quot;&lt;/p&gt;
&lt;p&gt;The U.S. Consumer Product Safety Commission (CPSC) estimated that there were 186,544 soccer-related injuries in 2006, with 80% occurring in athletes younger than 24. About 44% occurred in children and teens younger than 15, who have a higher risk of injury than their older counterparts.&lt;/p&gt;
&lt;p&gt;Most injuries are to the lower extremities, with ankle injuries accounting for up to 29% and knee injuries accounting for up to 36% of the total.&lt;/p&gt;
&lt;p&gt;Girls have a greater risk of knee injury and rupture of the anterior cruciate ligament, mostly from hyperextension of the knee when landing, cutting, or turning.&lt;/p&gt;
&lt;p&gt;Certain exercise programs focused on neuromuscular training have been shown effective for preventing knee injuries among adolescent girls. (See &lt;a href=&quot;http://www.medpagetoday.com/Orthopedics/Orthopedics/17887&quot; mce_href=&quot;http://www.medpagetoday.com/Orthopedics/Orthopedics/17887&quot; target=&quot;_blank&quot;&gt;Program Cuts Knee Injuries in Soccer&lt;/a&gt;)&lt;/p&gt;
&lt;p&gt;&quot;Pediatricians are encouraged to familiarize themselves with these programs and inform their patients on the availability and potential benefits,&quot; Koutures and Gregory wrote.&lt;/p&gt;
&lt;p&gt;Upper extremity injuries are much less common, accounting for 3% to 12% of the total.&lt;/p&gt;
&lt;p&gt;Soccer-related fatalities are rare and usually involve impact with the goalposts. According to the CPSC, there have been 28 deaths resulting from falling goalposts since 1979.&lt;/p&gt;
&lt;p&gt;Koutures and Gregory noted that guidelines have been developed by manufacturers and the CPSC on properly securing goalposts.&lt;/p&gt;
&lt;p&gt;Concussions occur at a rate similar to that seen in ice hockey and football players. Only about 3% of the total injuries are concussions, but the authors said there might be some under-reporting.&lt;/p&gt;
&lt;p&gt;About half of concussions (47%) are caused by a collision with another player, with the rest coming from contact with the ball (24%), the ground or goalpost (17%), or a combination of objects (10%).&lt;/p&gt;
&lt;p&gt;Koutures and Gregory noted that evidence does not support any adverse short- or long-term neurological consequences from heading the ball on purpose.&lt;/p&gt;
&lt;p&gt;&quot;However,&quot; they wrote, &quot;the AAP encourages heading of the ball only be taught when the child is willing to learn proper technique and has developed coordinated use of his or her head, neck, and trunk to properly contract the neck muscles and contact the ball with the forehead.&quot;&lt;/p&gt;
&lt;p&gt;The risk of eye and other facial injuries is considered low to moderate, according to the authors.&lt;/p&gt;
&lt;p&gt;Nevertheless, they wrote, &quot;protective eyewear is recommended for all participants in soccer ... and should be mandatory for athletes with only one functional eye or those with a past history of major eye surgery or trauma.&quot;&lt;/p&gt;
&lt;div style=&quot;float:left;border-style:solid;border-width:1px;border-color:#8dabbc;font-family:arial;font-size:12px;background-color:#DBE9F2;padding:5px;&quot;&gt;&lt;p&gt;The authors did not make any financial disclosures.&lt;/p&gt;&lt;/div&gt;&lt;div style=&quot;clear:both;&quot;&gt;&lt;/div&gt;
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