European spine journal : official publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society
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Patients enrolled in clinical studies typically represent a sub-set of all who are eligible, and selection bias may compromise the generalizability of the findings. Using Registry data, we evaluated whether surgical patients recruited by one of the referring centres into the Lumbar Spinal Stenosis Outcome Study (LSOS; a large-scale, multicentre prospective observational study to determine the probability of clinical benefit after surgery) differed in any significant way from those who were eligible but not enrolled. ⋯ A high proportion of eligible patients were not enrolled in the study. Non-enrolment was explained in part by the specific surgeon, worse baseline COMI status, and having a fusion. The findings may reflect a tendency of the referring surgeon not to overburden more disabled patients and those undergoing more extensive surgery with the commitments of a study. Beyond these factors, non-enrolment appeared to be somewhat arbitrary, and was likely related to surgeon forgetfulness, time constraints, and administrative errors. Researchers should be aware of potential selection bias in their clinical studies, measure it (where possible) and discuss its implications for the interpretation of the study's findings.
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Compared to the ligamentum flavum (LF), morphology of the epidural membrane (EM) and the periradicular fibrous tissue (PRFT) has been largely ignored in studies of lumbar spinal stenosis (LSS). The aim of this prospective study was to elucidate the morphologies and clinical importance of the EM and PRFT in LSS. ⋯ Some EM and PRFT transform into degenerative and substantial fibrous tissues during the process of symptomatic LSS development. Such morphological and histological changes can cause dural tear, symptomatic epidural hematoma, and/or inadequate decompression.
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Patient satisfaction is an outcome measure for low-back pain (LBP) interventions which allows clinicians to design patient-oriented treatments. The Treatment Outcome Satisfaction Questionnaire (TOSQ) is an English instrument constructed for such evaluations, and no equivalent instruments exist for the Swedish population. This study, therefore, translated TOSQ into Swedish and assessed the translated version's psychometric properties for patients with LBP. ⋯ A six-item TOSQ-S configuration showed acceptable psychometric properties and is suitable for measuring treatment outcome satisfaction of physiotherapy in patients with LBP.
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We aimed to study generational changes in the dimensions of cervical and lumbar bony spinal canals in Western Switzerland. ⋯ Younger generation patients have smaller bony spinal canals also in the cervical spine even though this difference is less marked than at the lumbar level. There is, nevertheless, moderate positive correlation between these two anatomical regions. Perinatal factors that adversely influence spinal growth, such as increased maternal age and smoking, could explain these generational changes, given that body height has increased during the same time period. The lesser difference observed in the cervical spine could be due to later closure of the neurocentral synchondrosis at this level.
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Tubular laminotomy is an effective procedure for treatment of lumbar spinal stenosis (LSS) and lateral recesses stenosis. Most surgeons familiar with the procedure agree that the tubular approach appears to afford a more complete decompression of the contralateral thecal sac and nerve root, as compared to the ipsilateral approach. With this study we sought to answer the question whether this is reflected in clinically significant differences between the ipsilateral and contralateral side pain improvements. ⋯ MIS tubular laminotomy through a unilateral approach results in clinically effective bilateral decompression of LSS and lateral recesses, regardless of the approach side.