Spine update: the biopsychosocial model and spine care.


STUDY DESIGN:Spine Update on the biopsychosocial model. OBJECTIVE:To review and discuss the strengths and weaknesses of the application of the model to spine care. SUMMARY OF BACKGROUND DATA:The biopsychosocial model of illness has had (and will continue to have) a significant impact on spine care. It has changed-in a positive way-the ways in which view spinal disease, treat patients, and assess outcomes. To date, however, little discussion has taken place regarding concerns over its implementation. METHODS:Using texts covering the general theory of the biopsychosocial model and the literature as the model is applied to spine care, a review was undertaken, evaluating the strengths and weaknesses of the theory's application to our field. RESULTS:Just as the biomedical model allowed, and continues to allow, significant medical advances via the objective study of pathoanatomic disease; the biopsychosocial model has afforded similar advances by placing the disease back into the patient and emphasizing illness experienced within the patient's unique biologic, psychological, social, and economic milieu. Thus, the strength of the model is its service as a clear reminder that clinical decisions about how to manage a patient with persistent low back pain living in difficult social conditions are more complex than those for patients who are not. Concerns regarding the model, however, are real and include its application as the primary mode to assess outcomes with a blind eye toward other potential factors; the medical/historical tendency to overweight psychosocial factors when underlying pathology is not clearly defined; whether or not the theory underlying the model is falsifiable/scientific; whether it affords explanatory or predictive power; whether its implementation improves outcomes; and whether it contributes to the "medicalization" of patients with back pain. CONCLUSION:The biopsychosocial model has been readily adapted to all aspects of spine care with many positive implications. There are, however, some concerns and negative implications and awareness of these should afford a better appreciation of when and where the model can be most usefully applied.


Spine (Phila Pa 1976)




Weiner BK




Has Abstract


2008-01-15 00:00:00
















  • Seven- to 10-year outcome of decompressive surgery for degenerative lumbar spinal stenosis.

    abstract:STUDY DESIGN:Retrospective review and prospective follow-up of 88 patients who had decompressive laminectomy with or without fusion from 1983 to 1986. OBJECTIVE:To determine the 7- to 10-year outcome of surgery for degenerative lumbar spinal stenosis. SUMMARY OF BACKGROUND DATA:There is limited information on the imp...


    pub_type: 杂志文章


    authors: Katz JN,Lipson SJ,Chang LC,Levine SA,Fossel AH,Liang MH

    更新日期:1996-01-01 00:00:00

  • The interspinous ligament of the lumbar spine. Magnetic resonance images and their clinical significance.

    abstract:STUDY DESIGN:A preliminary study of magnetic resonance features of the interspinous ligament in degenerative lumbar spine. OBJECTIVES:To classify the magnetic resonance imaging features of the interspinous ligaments in relation to the patient's age, disc degeneration, and radiographic instability. Magnetic resonance i...


    pub_type: 杂志文章


    authors: Fujiwara A,Tamai K,An HS,Shimizu K,Yoshida H,Saotome K

    更新日期:2000-02-01 00:00:00

  • Imaging assessment of sacroiliac screw placement relative to the neuroforamen.

    abstract:STUDY DESIGN:Twenty-four cannulated sacroiliac screws were placed bilaterally into 12 cadaveric pelvi (12 titanium screws and 12 stainless-steel screws) and were imaged using conventional and multiplanar reconstructed computed tomography. OBJECTIVES:To determine whether sacroiliac screw position assessment relative to...


    pub_type: 杂志文章


    authors: Goldberg BA,Lindsey RW,Foglar C,Hedrick TD,Miclau T,Hadad JL

    更新日期:1998-03-01 00:00:00

  • Patients with neck pain demonstrate reduced electromyographic activity of the deep cervical flexor muscles during performance of the craniocervical flexion test.

    abstract:STUDY DESIGN:Cross-sectional study. OBJECTIVE:The present study compared activity of deep and superficial cervical flexor muscles and craniocervical flexion range of motion during a test of craniocervical flexion between 10 patients with chronic neck pain and 10 controls. SUMMARY OF BACKGROUND DATA:Individuals with c...


    pub_type: 杂志文章


    authors: Falla DL,Jull GA,Hodges PW

    更新日期:2004-10-01 00:00:00

  • Decision making in the surgical treatment of cervical spine metastases.

    abstract:STUDY DESIGN:Qualitative systematic review of the literature. OBJECTIVE:To determine whether surgical indications and techniques are influenced by the region of the cervical spine (occipitocervical, midcervical, and cervicothoracic junctions). SUMMARY OF BACKGROUND DATA:There are distinct differences in the anatomic ...


    pub_type: 杂志文章,评审


    authors: Fehlings MG,David KS,Vialle L,Vialle E,Setzer M,Vrionis FD

    更新日期:2009-10-15 00:00:00

  • Health outcome assessment before and after lumbar laminectomy for radiculopathy.

    abstract:STUDY DESIGN:Forty-one patients undergoing lumbar laminectomy for radiculopathy resulting from herniated discs assessed their health status using a generic health outcome instrument (Medical Outcomes Study Short Form 36) before surgery and at an average of 2 years after surgery. OBJECTIVES:To assess whether lumbar lam...


    pub_type: 杂志文章


    authors: Albert TJ,Mesa JJ,Eng K,McIntosh TC,Balderston RA

    更新日期:1996-04-15 00:00:00

  • Reduction of high-grade slips (grades III-V) with VSP instrumentation. Report of a series of 41 cases.

    abstract::Records of 41 patients were reviewed for early complications resulting from reduction of high-grade spondylolisthesis. Blood loss averaged 1,427 ml. There were no cases of infection, dural tears, or bladder or bowel dysfunction. Two cases of transient foot drop and one case of permanent foot drop developed. A lumbar p...


    pub_type: 杂志文章


    authors: Ani N,Keppler L,Biscup RS,Steffee AD

    更新日期:1991-06-01 00:00:00

  • Patient characteristics associated with diagnostic imaging evaluation of persistent low back problems.

    abstract:STUDY DESIGN:Post hoc analysis of data from the National Low Back Pain Study, a prospective observational multicenter study of patients referred for the evaluation and treatment of persistent low back problems. OBJECTIVE:To identify patient characteristics associated with use of particular diagnostic imaging examinati...


    pub_type: 杂志文章,多中心研究


    authors: Ackerman SJ,Steinberg EP,Bryan RN,BenDebba M,Long DM

    更新日期:1997-07-15 00:00:00

  • Repair of failed transpedicle screw fixation. A biomechanical study comparing polymethylmethacrylate, milled bone, and matchstick bone reconstruction.

    abstract::In a random, controlled laboratory study, pedicle screws placed in human cadaveric vertebrae were axially loaded to failure. Three repair methods were tested. Use of low pressure polymethylmethacrylate yielded 149% of the original pullout strength, milled bone yielded 70% of the initial pullout strength, and matchstic...


    pub_type: 杂志文章


    authors: Pfeifer BA,Krag MH,Johnson C

    更新日期:1994-02-01 00:00:00

  • Prospective comparative study of intradiscal high-dose and low-dose collagenase versus chymopapain.

    abstract::The mixed results of two studies on intradiscal therapy with collagenase versus chymopapain are presented. The first study was performed from January 1983 to March 1984 and consisted of 71 patients treated with collagenase injection (600 ABC units) and 93 patients treated with chymopapain injection (4,000 units) into ...


    pub_type: 杂志文章


    authors: Hedtmann A,Steffen R,Krämer J

    更新日期:1987-05-01 00:00:00

  • The use of recombinant human bone morphogenetic protein 2 (rhBMP-2) to promote spinal fusion in a nonhuman primate anterior interbody fusion model.

    abstract:STUDY DESIGN:A study on the efficacy of recombinant human bone morphogenetic protein 2 (rhBMP-2) in a nonhuman primate anterior interbody fusion model. OBJECTIVES:To investigate the efficacy of rhBMP-2 with an absorbable collagen sponge carrier to promote spinal fusion in a nonhuman primate anterior interbody fusion m...


    pub_type: 杂志文章


    authors: Hecht BP,Fischgrund JS,Herkowitz HN,Penman L,Toth JM,Shirkhoda A

    更新日期:1999-04-01 00:00:00

  • Back impairment and disability determination. Another attempt at objective, reliable rating.

    abstract::Present disability evaluation schedules for the low back are not scientifically based and produce very great interexaminer differences. The authors have developed a new impairment schedule based on a comprehensive review of the medical literature and the collected opinions of a large number of back specialists. Tests ...


    pub_type: 杂志文章


    authors: Clark WL,Haldeman S,Johnson P,Morris J,Schulenberger C,Trauner D,White A

    更新日期:1988-03-01 00:00:00

  • Identification of decision criteria for revision surgery among patients with proximal junctional failure after surgical treatment of spinal deformity.

    abstract:STUDY DESIGN:Multicenter, retrospective, consecutive case series. OBJECTIVE:This study aims to identify demographic and radiographical characteristics that influence the decision to perform revision surgery among patients with proximal junctional failure (PJF). SUMMARY OF BACKGROUND DATA:Revision rates after PJF rema...


    pub_type: 杂志文章,多中心研究


    authors: Hart R,McCarthy I,Oʼbrien M,Bess S,Line B,Adjei OB,Burton D,Gupta M,Ames C,Deviren V,Kebaish K,Shaffrey C,Wood K,Hostin R,International Spine Study Group.

    更新日期:2013-09-01 00:00:00

  • Augmentation of pedicle screw fixation strength using an injectable calcium sulfate cement: an in vivo study.

    abstract:STUDY DESIGN:An in vivo landrace model of cement augmentation of pedicle screw was established, and axial pull-out tests and histological analysis were performed. OBJECTIVE:To investigate the long-term in vivo biomechanical performance of pedicle screws augmented with calcium sulfate cement. SUMMARY OF BACKGROUND DAT...


    pub_type: 杂志文章


    authors: Yi X,Wang Y,Lu H,Li C,Zhu T

    更新日期:2008-11-01 00:00:00

  • Posterior osteosynthesis of the atlas for nonconsolidated Jefferson fractures: a new surgical technique.

    abstract:STUDY DESIGN:Case report and surgical technique. OBJECTIVE:To describe a new technique to treat atlas burst fractures by selectively reconstructing the atlas from a posterior approach. SUMMARY OF BACKGROUND DATA:The two surgical techniques reported until now for stabilizing atlas burst fractures are associated with s...


    pub_type: 杂志文章


    authors: Abeloos L,De Witte O,Walsdorff M,Delpierre I,Bruneau M

    更新日期:2011-09-15 00:00:00

  • Reduction of severe spondylolisthesis. A preliminary report.

    abstract::This report describes the development of a technique for reduction and fusion of spondylolisthesis that includes posterior mobilization with alartransverse fusion, halo-femoral traction with the patient in some extension, and finally, anterior interbody fusion of the lumbosacral joint. The report emphasizes the techni...


    pub_type: 杂志文章


    authors: McPhee IB,O'Brien JP

    更新日期:1979-09-01 00:00:00

  • Radiation exposure to the spine surgeon during fluoroscopically assisted pedicle screw insertion.

    abstract:STUDY DESIGN:In vitro study to determine occupational radiation exposure during lumbar fluoroscopy. OBJECTIVES:To assess radiation exposure to the spine surgeon during fluoroscopically assisted thoracolumbar pedicle screw placement. SUMMARY OF BACKGROUND DATA:Occupational radiation exposure during a variety of fluoro...


    pub_type: 杂志文章


    authors: Rampersaud YR,Foley KT,Shen AC,Williams S,Solomito M

    更新日期:2000-10-15 00:00:00

  • Changes in proteoglycans of intervertebral disc in diabetic patients. A possible cause of increased back pain.

    abstract:STUDY DESIGN:Characterization of the analytic profile of proteoglycans in the intervertebral discs at L4-L5 of nondiabetic (n = 5) and diabetic (n = 5) age-matched subjects. The discs used were discarded material from operations. OBJECTIVES:To clarify the reason for the higher risk of disc prolapse in diabetic patient...


    pub_type: 杂志文章


    authors: Robinson D,Mirovsky Y,Halperin N,Evron Z,Nevo Z

    更新日期:1998-04-15 00:00:00

  • Time Demand and Radiation Dose in 3D-Fluoroscopy-based Navigation-assisted 3D-Fluoroscopy-controlled Pedicle Screw Instrumentations.

    abstract:STUDY DESIGN:Prospective single-center cohort study to record additional time requirements and radiation dose in navigation-assisted O-arm-controlled pedicle screw (PS) instrumentations. OBJECTIVE:The aim of this study was to evaluate amount of extra-time and radiation dose for navigation-assisted PS instrumentations ...


    pub_type: 杂志文章


    authors: Balling H

    更新日期:2018-05-01 00:00:00

  • Giovanni Alfonso Borelli--the father of biomechanics.

    abstract::Giovanni Alfonso Borelli is often described as the father of biomechanics. He was born in Naples in 1608. His De Motu Animalium, published in 1680, extended to biology the rigorous analytical methods developed by Galileo in the field of mechanics. Borelli calculated the forces required for equilibrium in various joint...


    pub_type: 传,历史文章,杂志文章


    authors: Pope MH

    更新日期:2005-10-15 00:00:00

  • Functional importance of degenerative spondylolisthesis in cervical spondylotic myelopathy in the elderly.

    abstract:STUDY DESIGN:A correlation was studied between degenerative spondylolisthesis (DSL) of the cervical spine and spinal-evoked potentials intraoperatively recorded in elderly patients who had surgical treatment for cervical spondylotic myelopathy. OBJECTIVE:To investigate the functional importance of cervical DSL in elde...


    pub_type: 临床试验,杂志文章


    authors: Tani T,Kawasaki M,Taniguchi S,Ushida T

    更新日期:2003-06-01 00:00:00

  • Quantification of intradiscal pressures below thoracolumbar spinal fusion constructs: is there evidence to support "saving a level"?

    abstract:STUDY DESIGN:In vitro cadaveric study. OBJECTIVE:The purpose of this study was to quantify the relative biomechanical protection resulting from "saving a level" in long spinal fusions. SUMMARY OF BACKGROUND DATA:"Saving levels" in spinal deformity surgery is desirable. Constructs with lowest instrumented vertebra (LI...


    pub_type: 杂志文章


    authors: Auerbach JD,Lonner BS,Errico TJ,Freeman A,Goerke D,Beaubien BP

    更新日期:2012-03-01 00:00:00

  • Family stature in idiopathic scoliosis.

    abstract::The standing heights of 40 children with scoliosis and 110 persons from their immediate families were compared with those of a group of 349 contemporary control subjects. Skeletal bone ages and puberty ratings did not differ from normal, but the children with scoliosis were found to be significantly taller than the co...


    pub_type: 杂志文章


    authors: Carr AJ,Jefferson RJ,Turner-Smith AR

    更新日期:1993-01-01 00:00:00

  • Influence of nitrous oxide on motor-evoked potentials.

    abstract:STUDY DESIGN:Rabbits were used as an experimental model in the study of motor-evoked potentials. OBJECTIVES:To evaluate the effect of nitrous oxide on motor-evoked potentials while monitoring direct muscle and spinal cord responses. SUMMARY OF BACKGROUND DATA:Motor-evoked potential monitoring provides a promising too...


    pub_type: 杂志文章


    authors: Zentner J,Thees C,Pechstein U,Scheufler KM,Würker J,Nadstawek J

    更新日期:1997-05-01 00:00:00

  • A dynamic approach to spinal instability. Part I: Sensitization of intersegmental motion profiles to motion direction and load condition by instability.

    abstract:STUDY DESIGN:Human lumbar functional spinal units (FSUs) were moved throughout their range of motion in sagittal and lateral bending while the dynamics of this movement were computed in vitro. Functional spinal units were tested intact and after subsequent discectomy and unilateral facetectomy. OBJECTIVE:To establish ...


    pub_type: 杂志文章


    authors: Ogon M,Bender BR,Hooper DM,Spratt KF,Goel VK,Wilder DG,Pope MH

    更新日期:1997-12-15 00:00:00

  • An analysis of sagittal curves and balance after Cotrel-Dubousset instrumentation for kyphosis secondary to Scheuermann's disease. A review of 32 patients.

    abstract:STUDY DESIGN:This study compared preoperative and postoperative saggittal curves and spinal balance in patients undergoing spinal fusion with Cotrel-Dubousset instrumentation for severe kyphosis secondary to Scheuermann's disease. Also determined was patient satisfaction regarding relief of pain and correction of the d...


    pub_type: 杂志文章


    authors: Lowe TG,Kasten MD

    更新日期:1994-08-01 00:00:00

  • Spondylolysis associated with Arnold-Chiari malformation and syringomyelia. A report of two cases.

    abstract:STUDY DESIGN:This is a report of two cases. OBJECTIVE:To document the occurrence and association of spondylolysis and Arnold-Chiari malformation Type I. SUMMARY OF BACKGROUND DATA:The association of spinal dysraphism has been reported with Arnold-Chiari Type II, but not with Arnold-Chiari Type I. METHODS:The senior ...


    pub_type: 杂志文章


    authors: Bowen JD,Malanga GA

    更新日期:1997-10-15 00:00:00

  • The use of mathematical models for studies of scoliosis biomechanics.

    abstract::The use of mathematical and other types of models for the study of the biomechanics of scoliosis is reviewed in this article. The article is based on a talk presented at the 1987 Meeting of the Scoliosis Research Society. ...


    pub_type: 杂志文章


    authors: Schultz AB

    更新日期:1991-10-01 00:00:00

  • A biomechanical study of a cervical spine stabilization device: Roy-Camille plates.

    abstract:STUDY DESIGN:Three-hole Roy-Camille posterior plates (Howmedica, Inc., Rutherford, NJ) were used to fix severely destabilized fresh cadaveric cervical spines. Fixed spine constructs were tested mechanically in flexion-extension and torsion, and the results were compared with the same characteristics in the intact spine...


    pub_type: 杂志文章


    authors: Smith ME,Cibischino M,Langrana NA,Lee CK,Parsons JR

    更新日期:1997-01-01 00:00:00

  • A trial of modern rehabilitation for chronic low-back pain and disability. Vocational outcome and effect of pain modulation.

    abstract::Of 66 nonoperated low-back pain patients who entered a 4-week program of modern active rehabilitation after 13 months' sick leave, only 15 (23%) had returned to work at 18 months' follow-up. Effective pain modulation with pool traction did not influence the vocational status or pain level at the time of follow-up. The...


    pub_type: 临床试验,杂志文章


    authors: Oland G,Tveiten G

    更新日期:1991-04-01 00:00:00