Spine
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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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: 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.
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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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: Literature review. ⋯ : Weak evidence (Level IV) exists in the literature that spinal deformity correction for AIS does not significantly impact QOL in short-term or mid-term. The interpretation of this must be that there were no serious adverse events after surgery.
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Case Reports Comparative Study
How does the ossification area of the posterior longitudinal ligament thicken following cervical laminoplasty?
Retrospective case series. ⋯ Young patients with continuous or mixed-type OPLL and C3 involvement of ossification had a risk for progression in OPLL thickness following surgery. As the increased thickness of ossified lesions directly causes the narrowing of the spinal canal, it is important to pay attention to these risk factors and the increase in ossification before and after cervical laminoplasty in the surgical treatment of patients with OPLL.