Spine
-
Systematic review of the literature with subgroup analysis for heterogeneous treatment effects. ⋯ Recommendation 1: NSAIDs should be considered as a treatment of chronic LBP (Strength: Strong). There is evidence demonstrating favorable effectiveness, but also significant side effects that may have meaningful clinical consequences. Recommendation 2: Opioids may be considered in the treatment of chronic LBP but should be avoided if possible (Strength: Weak). There is evidence demonstrating favorable effectiveness compared to placebo, similar effectiveness compared to NSAIDs, and with significant side effects including decreasing effectiveness related to habituation when used long-term. Recommendation 3: Antidepressants should not be routinely used for the treatment of chronic LBP (Strength: Strong). There is evidence that they are not more effective than placebo with respect to pain, functional status, or depression. Based on the hypothesis that chronic LBP is a symptom reflective of a heterogeneous group of disorders, categorization of certain patient specific subgroups may be helpful in guiding future treatment decision making. It is likely that inclusion of subgroup factors in future RCTs will provide information needed to improve the strength and specificity of future clinical recommendations.
-
Systematic review. ⋯ Recommendation 1: When surgically treating CLBP, we recommend administering both a VAS for pain and a condition-specific physical measure such as the ODI before and after surgical intervention as these outcomes are the most treatment specific and responsive to change. Strength of recommendation: Strong.Recommendation 2: When evaluating the surgical outcomes for CLBP in the clinical-research setting, we recommend selecting a shorter version for measuring general HRQoL (e.g., SF-12, EQ-5D) to minimize clinician and patient burden. Strength of recommendation: Strong.
-
Multicenter Study Comparative Study
Fixation points within the main thoracic curve: does more instrumentation produce greater curve correction and improved results?
Prospective consecutive multicenter case series. ⋯ Absolute curve correction improved most with all pedicle screw and screw and wire constructs, but, when compared to bending films, the number of fixation points is more important than fixation type for curve correction. Although SRS scores improved the most in those with all screw constructs, the significance of this improvement is uncertain, and the SRS scores did not relate to whether curve correction was more or less than the bend films.
-
Systematic review. ⋯ Weak.
-
Systematic review. ⋯ Clinical recommendations were made where appropriate using the GRADE/Agency for Healthcare Research and Quality approach, which imparts a deliberate separation between the quality of the evidence (i.e., high, moderate, low, or inconclusive) from the strength of the recommendation. The quality of evidence plays only a part as the strength of the recommendation reflects the extent to which we can, across the range of patients for whom the recommendations are intended, be confident that desirable effects of a management strategy outweigh undesirable effects.