The spine journal : official journal of the North American Spine Society
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Review Meta Analysis
Neurological examination of the peripheral nervous system to diagnose lumbar spinal disc herniation with suspected radiculopathy: a systematic review and meta-analysis.
Disc herniation is a common low back pain (LBP) disorder, and several clinical test procedures are routinely employed in its diagnosis. The neurological examination that assesses sensory neuron and motor responses has historically played a role in the differential diagnosis of disc herniation, particularly when radiculopathy is suspected; however, the diagnostic ability of this examination has not been explicitly investigated. ⋯ This systematic review and meta-analysis demonstrate that neurological testing procedures have limited overall diagnostic accuracy in detecting disc herniation with suspected radiculopathy. Pooled diagnostic accuracy values of the tests were poor, whereby all tests demonstrated low sensitivity, moderate specificity, and limited diagnostic accuracy independent of the disc herniation reference standard or the specific level of herniation. The lack of a standardized classification criterion for disc herniation, the variable psychometric properties of the testing procedures, and the complex pathoetiology of lumbar disc herniation with radiculopathy are suggested as possible reasons for these findings.
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Acute spinal cord injury (SCI) after a minor trauma to the cervical spine has been reported in patients without preceding neurologic symptoms. Spinal canal stenosis may be the reason for the discrepancy between the severity of the injury and that of the trauma. The spinal canal to vertebral body ratio is often used to assess canal stenosis on conventional radiographs. However, the ratio does not appraise soft-tissue stenosis and canal narrowing at the level of the intervertebral disc. Parameters measured on magnetic resonance (MR) images may thus be more meaningful. The relevance of MR image parameters for predicting the risk and severity of acute SCI in patients after a minor trauma to the cervical spine has not yet been established. ⋯ Patients at risk of acute SCI after a minor trauma to the cervical spine can be identified by applying a disc-level canal diameter cutoff value (measured on MR images) of 8 mm. Additional factors to the radiological characteristics of the spinal canal affect the severity of acute SCI after a minor trauma to the cervical spine.
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Recent years have witnessed a shift in the assessment of spine surgical outcomes with a greater focus on the patient's perspective. However, this approach has not been widely extended to the assessment of complications. ⋯ Most complications reported by the patient are perceived to be at least moderately bothersome and are, hence, not inconsequential. Surgeons reported lower complication rates than the patients did, and there was only moderate agreement between the ratings of the two. As with treatment outcome, complications and their severity should be assessed from both the patient's and the surgeon's perspectives.
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Adjacent segment degeneration (ASD) after cervical fusion is a clinical concern. Despite previous studies documenting the biomechanical effects of multilevel cervical fusion on segments immediately superior and inferior to the operative segments, the pathogenesis of the initiation of degeneration progression in neighboring segments is still poorly understood. ⋯ Biomechanical factors such as increased mechanical demand and motion that have been associated with the development of ASD progression are highest in the segment immediately superior to the fusion. These changes are even more pronounced when the fixation technique involves the addition of posterior instrumentation, thereby supporting the hypothesis of the present study. Increased degrees of stiffening of the fused segments not only may lead to degenerative changes in the disc but may also predispose the segments to premature facet degeneration. Over subsequent time period, any remaining construct micro-motion is further eliminated with fusion of the posterior facet joints and the remaining regions in the disc space also filled in with bone, which eventually results in a circumferential type of fusion. After a circumferential fusion, authors, however, speculate that the role of instrumentation in ASD progression might not be significant. In fact, sufficient evidence to support this speculation is still lacking in the literature.
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Numerous prenatal, systemic, or local procedures have been described that have created an experimental scoliosis within different animal species. Compression-based fusionless scoliosis correction devices have been used to induce scoliosis (inverse approach) as an indication for their potential corrective efficacy in large animals. Deformities that most closely approximate the three-dimensional nature of an idiopathic-like scoliosis have been created in large animals using a posterior spinal tether. Fusionless scoliosis correction devices have subsequently been tested in these models. ⋯ An idiopathic-like scoliosis animal model can be created using a posterior spinal tether in a fully reversible procedure. Experimental results will need to be reproduced to establish a standard idiopathic-like scoliosis large animal model.