The spine journal : official journal of the North American Spine Society
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Although the role of radiographic abnormalities in the etiology of nonspecific low back pain (LBP) is unclear, the frequent identification of these features on radiologic studies continues to influence medical decision making. ⋯ Degenerative features of the lumbar spine were extremely prevalent in this community-based sample. The only degenerative feature associated with self-reported LBP was spinal stenosis. Other degenerative features appear to be unassociated with LBP.
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It is commonly believed that the peer-review process is reliable and consistent. It appears, however, that depending on the journal and the editorial leadership, agreement by reviewers on whether to publish submitted articles varies widely; from substantial to slightly greater than one would expect with random assignments of acceptance or rejection. ⋯ Agreement regarding peer-review recommendations for publication in spine journals appears to be better than would be expected in the random situation; but still only "slight." This suggests that review methodology varies considerably among reviewers and that further study should be undertaken to determine "ideal" agreement levels and ways to increase review consistency/quality commensurate with the editorial missions of the journals.
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Traumatic injury to the spine is evaluated and treated based on the perceived stability of the spine. Recent classification schemes have established the importance of evaluating the discoligamentous complex to fully comprehend stability. There are a variety of techniques to evaluate the discoligamentous complex, including assessment of interspinous distance. However, there currently are no clinically validated methods to define and assess abnormal interspinous widening. ⋯ This study provides reference data that can be used to quantitatively assess interspinous process widening in the cervical spine. Application of the reference data to a cadaver model of cervical trauma suggests that although objective evidence of abnormal widening may be uncommon, when present, it is suggestive of extensive damage to the cervical spine. Derived from this data were two "rule of thumb" criteria to identify abnormal interspinous widening in flexion X-rays; when greater than 30% relative to an adjacent level (40% between C1-C2 and C2-C3) or greater than 50% of the anterior-posterior width of the C4 vertebral body (30% for C2-C3).