The spine journal : official journal of the North American Spine Society
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Degenerative spine disease will become an increasing health problem, and a significant number of patients will be considered for surgery. Spinal surgeries have evolved since the last decades, and there is a positive impact on the clinical outcomes. Few works in the literature have reviewed the outcome compared with large joint replacement surgery, which is considered a benchmark for operative restoration of patients' quality of life. ⋯ The current study demonstrated that spinal surgery can return patients' HRQL to that of age-matched population norms and yield outcomes comparable with those of total hip and knee joint replacement patients.
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Sitting is associated with loss of the lumbar lordosis, intervertebral disc (IVD) compression, and height loss, possibly increasing the risk of lower back pain. With a trend toward more sitting jobs worldwide, practical strategies for preventing lumbar flattening and potentially associated low back pain (LBP) are important. ⋯ Seated upright MRI and stadiometry, as performed in this study, appear to be feasible methods for detecting compressive and decompressive spinal changes associated with normal sitting and, alternately, seated unloading exercises. Larger studies are encouraged to determine normative values of our study measurements and to determine if morphological changes induced by seated unloading predict treatment response and/or reductions in the incidence of sitting-related LBP.
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Defining success after spinal surgery remains problematic. The minimal clinically important difference (MCID) in pain or functional outcomes is a common metric often calculated independent of perceived risk and morbidity, which is an important consideration in large procedures such as spinal fusion and instrumentation. ⋯ Patients with spondylolisthesis and DDD both have relatively high minimum acceptable outcomes for spinal fusion. In these cohorts, few subjects considered more commonly proposed MCIDs for pain and function as an acceptable outcome and report that they would not have surgery if they did not expect to achieve more than those marginal improvements. Although there was good concordance between achieving the minimum acceptable outcomes and ultimate satisfaction, patients with significant psychosocial factors (compensation claims, psychological distress, and others) are less likely to associate satisfaction with outcomes with actually achieving these improvements.
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Outcomes of spinal treatments are evaluated by clinical relevance: the proportion of patients who reach a minimum clinically important outcome change. Outcomes are evaluated through multiple measurements, and the inconsistency of outcome change across measurements is not known. ⋯ Efforts should be made to take into account the inconsistency of outcomes and to make clinical relevance more readily understandable by patients and clinicians.
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Image-guided cervical nerve injections are being performed with increasing frequency. Severe complications are being reported. ⋯ A technique for cervical nerve injection is described with the results of the injection. This technique may allow some standardization in the procedure, decrease the learning curve for training physicians, and minimize the potential complications.