Spine
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Review
Complications of interlaminar cervical epidural steroid injections: a review of the literature.
A comprehensive literature review. ⋯ There are significant limitations in the available literature discussing the complications associated with ICESI, but they strongly suggest that ICESI is a relatively safe procedure. Numerous potential adverse reactions have been associated with ICESI, with the vast majority being minor and transient in nature. However, serious complications may also result and may be technique related. Injectionists should be aware of the clinical presentations, rates, potential consequences, and appropriate techniques to avoid these complications. More studies are needed with specific focus on cervical complication rates, standardization of injection techniques, and differentiation between complications and poor efficacy. In addition, the use of a prospective randomized blinded controlled design would be beneficial.
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Case report. ⋯ Revision of spinal cord stimulators is usually a safe procedure. However, placement of an electrode within the spinal cord during the revision process is a potential complication resulting in severe neurologic injury.
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: Literature review. ⋯ : Clinicians must understand the importance of the research question, study design, and outcomes in order to apply the best available research to patient care. Treatment recommendations evolving from critical appraisal are not only based on levels of evidence, but the risk benefit ratio and cost. The true philosophy of EBM, however, is not for research to supplant individual clinical experience and the patient's informed preference, but to integrate them with the best available research. Healthcare professionals and administrators must grasp that EBM is not a RCT. They must realize that the question being asked and the research circumstances dictate the study design. Furthermore, they must not diminish the role of clinical expertise and informed patient preference in EBM.
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Reliability study. ⋯ Our study has demonstrated that the intrarater reliability for the instrument to assess MCC and MSCC in the setting of traumatic SCI was high. The interrater ICCs at a moderate level of reliability combined with our results using analysis of variance with post hoc tests indicate that the measurements of MCC and MSCC are reproducible, which supports the use of these radiologic parameters in the clinical and research settings.
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: Systematic review of clinical studies. ⋯ : Comparing the pooled rates for these two interventions shows no clear advantage of either approach. Based on the evidence presented here, one cannot recommend one approach over the other to prevent the need for surgery in AIS. This recommendation carries a grade of D, indicating that the use of bracing relative to observation is supported by "troublingly inconsistent or inconclusive studies of any level." The decision to brace for AIS is often difficult for clinicians and families. An evidence-based estimate of the risk of surgery will provide additional information to use as they weigh the costs and benefits of bracing.