The spine journal : official journal of the North American Spine Society
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Lumbar foraminal stenosis is a common clinical problem and a significant cause of lower extremity radiculopathy. Minimal in vivo data exists quantifying changes in foraminal area (FA) as the spine moves from flexion to extension in the lumbar spine or on the relationship between FA and lumbar segmental angular motion, translational motion (TM), or disc bulge migration. ⋯ Foraminal area decreased significantly in extension compared with flexion and neutral on MRI. Lumbar disc bulge migration and angular motion at each level contributed independently to the decrease in FA in extension, whereas TM had no effect on FA.
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Ossification of the ligamentum flavum (OLF) may result in thoracic myelopathy (TM) because of narrowing of the spinal canal. Because symptoms vary and are subjective, diagnosis of TM caused by OLF is sometimes difficult when based on symptoms and physical examination. Posterior decompression is indicated in patients with TM caused by OLF because it is believed that surgery is the most effective treatment. However, surgical outcomes vary. We are unaware of reports of objective presurgical diagnostic parameters, such as neurologic and radiologic findings, relating to the postsurgical prognosis in patients with TM caused by OLF. ⋯ An excellent postoperative prognosis is not always possible in patients with TM caused by OLF. It may be important to check for impairment of joint position sense in the big toe, the number of levels affected by OLF, and presurgical intramedullary signal change on MRI before continuing to surgery.
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No study has determined time trends of neck pain and low back pain (NP&LBP) in the 20th century in Spain. ⋯ The prevalence of NP and NP&LBP, but not LBP, has decreased in the last years in Spain. NP&LBP were associated with similar sociodemographic and lifestyle habits in 2009 compared with 2006.
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Review
Level of evidence of clinical spinal research and its correlation with journal impact factor.
Over the past two decades, there has been a growing recognition and emphasis on the practice of evidence-based medicine (EBM). The level of evidence (LOE) is used to classify clinical studies based on their quality and design. To compare the quality of scientific journals, the impact factor (IF) is the most widely used ranking measure. However, the calculation of IF is not directly dependent on the quality or LOE of clinical articles published in a journal. ⋯ Spinal surgery journals with a higher IF contain a larger proportion of studies with high LOE, however most clinical articles provide level IV evidence of which the highest proportion are therapeutic studies. Clinicians, researchers, and journal editors should work hand in hand to enhance evidence-based practice in spinal care.