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Jürgen Krämer

Publications and source records attributed to Jürgen Krämer.

7 recordsLinked to original sources
PubMed2006

Acupuncture and knee osteoarthritis: a three-armed randomized trial.

BACKGROUND: Despite the popularity of acupuncture, evidence of its efficacy for reducing pain remains equivocal. OBJECTIVE: To assess the efficacy and safety of traditional Chinese acupuncture (TCA) compared with sham acupuncture (needling at defined nonacupuncture points) and conservative therapy in patients with chronic pain due to osteoarthritis of the knee. DESIGN: Randomized, controlled trial. SETTING: 315 primary care practices staffed by 320 practitioners with at least 2 years' experience in acupuncture. PATIENTS: 1007 patients who had had chronic pain for at least 6 months due to osteoarthritis of the knee (American College of Rheumatology [ACR] criteria and Kellgren-Lawrence score of 2 or 3). INTERVENTIONS: Up to 6 physiotherapy sessions and as-needed anti-inflammatory drugs plus 10 sessions of TCA, 10 sessions of sham acupuncture, or 10 physician visits within 6 weeks. Patients could request up to 5 additional sessions or visits if the initial treatment was viewed as being partially successful. MEASUREMENTS: Success rate, as defined by at least 36% improvement in Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) score at 26 weeks. Additional end points were WOMAC score and global patient assessment. RESULTS: Success rates were 53.1% for TCA, 51.0% for sham acupuncture, and 29.1% for conservative therapy. Acupuncture groups had higher success rates than conservative therapy groups (relative risk for TCA compared with conservative therapy, 1.75 [95% CI, 1.43 to 2.13]; relative risk for sham acupuncture compared with conservative therapy, 1.73 [CI, 1.42 to 2.11]). There was no difference between TCA and sham acupuncture (relative risk, 1.01 [CI, 0.87 to 1.17]). LIMITATIONS: There was no blinding between acupuncture and traditional therapy and no monitoring of acupuncture compliance with study protocol. In general, practitioner-patient contacts were less intense in the conservative therapy group than in the TCA and sham acupuncture groups. CONCLUSIONS: Compared with physiotherapy and as-needed anti-inflammatory drugs, addition of either TCA or sham acupuncture led to greater improvement in WOMAC score at 26 weeks. No statistically significant difference was observed between TCA and sham acupuncture, suggesting that the observed differences could be due to placebo effects, differences in intensity of provider contact, or a physiologic effect of needling regardless of whether it is done according to TCA principles.

Acupuncture Therapy↗
PubMed2005

The long-term clinical sequelae of incidental durotomy in lumbar disc surgery.

STUDY DESIGN: A retrospective, long-term follow-up study. OBJECTIVES: To find out whether incidental durotomy in lumbar disc surgery is associated with long-term sequelae. SUMMARY OF BACKGROUND DATA: Incidental durotomy is a frequent complication during spinal surgery. Little is known about the clinical long-term outcome. METHODS: The study population comprised 1,280 patients who underwent standard discectomy of a lumbar disc herniation. A total of 41 patients with incidental durotomies (Group A) were compared with a control group (n = 41) (Group B) matched for age, sex, spinal level, and duration of follow-up. After a mean follow-up period of 10.2 years (Group A) or 10.3 years (Group B), the patients reported complaints, headache, and low back or leg pain. The patients' activity was assessed by means of a questionnaire concerning hindrance in daily activities, the Tegner score for general activities in daily life, and the Hannover Functional Ability Questionnaire for Measuring Back Pain-Related Functional Limitations (FFbH-R). The frequency of reoperation and the intake of analgesics were included. Furthermore, the patients' inability to work, change of profession, and retirement were registered. RESULTS: Patients with incidental durotomy had a poorer outcome after surgery. The Tegner score was significantly decreased for the group with dural tears. Furthermore, significant more patients with incidental durotomy complained about headaches after surgery. A strong tendency for worse outcome in Group A was shown in regard to reported complaints and daily activity. The patients with incidental durotomy had a tendency to more reoperations, a longer duration of inability to work, more back-pain, and functional limitations related to back-pain (FFbH-R). CONCLUSION: Our study revealed that incidental durotomy in lumbar disc surgery was associated with long-term clinical sequelae. We therefore conclude that dural tears bring about poor clinical outcome at the long-term follow-up.

Absenteeism↗
PubMed2004

Clinical symptoms in lumbar disc herniations and their correlation to the histological composition of the extruded disc material.

STUDY DESIGN: Fifty-five consecutive patients undergoing microdiskectomy due to lumbar disc herniation were included in this clinical study over 12 months. OBJECTIVES: To investigate possible correlations between the histologic composition of the herniated disc fragments and pain, disability, clinical signs, and operative findings. SUMMARY OF BACKGROUND DATA: Previous studies have investigated the histologic composition of herniated lumbar disc fragments. Few publications, however, examined correlations with clinical data. METHODS: Before treatment, patients were examined using a standardized clinical protocol; subjective disability and pain were assessed by the Oswestry Disability Questionnaire and the McGill Pain Questionnaire. The herniated disc fragments were examined semiquantitatively for the relative percentages of nucleus pulposus, anulus fibrosus, and cartilaginous endplate. RESULTS: In patients less than 30 years of age, significantly higher percentages of nucleus pulposus were found than in the older group, whereas anulus fibrosus was found in significantly higher percentages in patients > or =30 years. Both higher percentages of cartilage and nucleus pulposus correlated with increased pain intensity values from the McGill Pain Questionnaire. Impaired reflexes before treatment occurred significantly more often in patients with > or =20% of cartilage in the herniated fragments. If nucleus pulposus was <30%, sensory impairment tended to be more severe before treatment. CONCLUSION: The histologic composition of the herniated disc fragments seems to affect pain and clinical symptoms.

Adolescent↗
PubMed2004

Efficacy and safety of acupuncture for chronic pain caused by gonarthrosis: a study protocol of an ongoing multi-centre randomised controlled clinical trial [ISRCTN27450856].

BACKGROUND: Controlled clinical trials produced contradictory results with respect to a specific analgesic effect of acupuncture. There is a lack of large multi-centre acupuncture trials. The German Acupuncture Trial represents the largest multi-centre study of acupuncture in the treatment of chronic pain caused by gonarthrosis up to now. METHODS: 900 patients will be randomised to three treatment arms. One group receives verum acupuncture, the second sham acupuncture, and the third conservative standard therapy. The trial protocol is described with eligibility criteria, detailed information on the treatment definition, blinding, endpoints, safety evaluation, statistical methods, sample size determination, monitoring, legal aspects, and the current status of the trial. DISCUSSION: A critical discussion is given regarding the considerations about standardisation of the acupuncture treatment, the choice of the control group, and the blinding of patients and observers.

Acupuncture Therapy↗
PubMedDate not supplied

The related outcome and complication rate in primary lumbar microscopic disc surgery depending on the surgeon's experience: comparative studies.

BACKGROUND CONTEXT: Studies concerning intraoperative complications and their influence on the clinical outcome of microscopic disc surgery are quite rare. Complication rates vary between 1.5% and 15.8%. A correlation between the surgeon's experience and the complication rate may be expected. PURPOSE: To determine the influence of the surgeon's experience on the intraoperative complication rate in lumbar microscopic disc surgery. STUDY DESIGN: Three studies are included: 1) retrospective analysis of intraoperative complications in microscopic disc surgery (N=1,872); 2) prospective follow-up study of microscopic disc surgery (N=583); 3) prospective evaluation of complication rates in microscopic disc surgery (N=90). PATIENT SAMPLE: Patient data sets from 1,872 lumbar microscopic disc surgeries performed between January 7, 1981, and June 31, 2000, were examined in a retrospective study. A total of 463 patients, operated on between 1991 and 1996, were followed up by a questionnaire. Finally, a prospective controlled trial (N=90) was performed. OUTCOME MEASURES: Such complications as incidental durotomy, wrong level exposure, or bleeding were analyzed based on the patient data sets by a blinded external evaluator. The rates of lower back pain and ischiatic pain were measured on a visual analogue scale at follow-up in Study 2 and Study 3. To measure the outcome of surgery in daily life activities and functional capacity, the Tegner activity level was calculated. In addition, a questionnaire with the Hannover score was used. The patient's social and economic status was also recorded. METHODS: A total of 1,872 lumbar microscopic disc surgeries, performed between January 7, 1981 and June 31, 2000, were examined in a retrospective study. Intra- and perioperative complications were evaluated and related to the surgeons' level of experience. Patients in the first group (XL) were operated on by the most experienced surgeon (more than 500 microscopic discectomies before the beginning of the study). The L-group surgeons performed between 50 and 100 microscopic disc surgeries before the study. This group included a total number of seven surgeons during the 1981-2000 time frame. None of this group reached the experience level of 500 surgeries during the course of the study. A total of 463 patients, operated on between 1991 and 1996, were followed up. Finally, a prospective controlled trial (N=90) was performed. Injuries of the dura, nerve root, ventral structures and wrong level exposure, which had been detected and corrected during surgery, were analyzed. In the second and third study, the outcome was correlated to surgery and complications during surgery. RESULTS: The rate of intraoperative complications showed a statistically significant difference between the groups. The comparison of both groups (n=1,872) with regard to the rate of intraoperative complications showed a statistically significant difference between 2.2% in the XL group and 10.7% in the L group (p< or =.001). Regarding work-related and socioeconomic factors, no significant difference in the outcome was seen. CONCLUSIONS: Microscopic disc surgery requires a course of instruction and a considerable number of surgeries under supervision by experienced surgeons. To shorten the learning curve, a number of standardized surgery steps to clearly identify anatomical landmarks are helpful. During training, these landmarks can be checked by an experienced surgeon to minimize the rate of intraoperative complications. Initial postoperative ischiatic pain was correlated to an incidental durotomy with p<.001. For long-term results after disc surgery, however, socioeconomic and work-related factors are of greater importance in spinal disc surgery than the incidence of intraoperative complications.

Follow-Up Studies↗