The spine journal : official journal of the North American Spine Society
-
The options available for treatment of Irreducible Atlantoaxial Dislocation (IAAD) with basilar invagination are odontoidectomy, posterior decompression, posterior atlanto-axial joint distraction. In 2006 Wang et al described that most IAAD can be reduced following anterior release of contracted soft tissues. Anterior release may be done by transoral (TO) or retropharyngeal (RP) approach. Posterior instrumented fusion provides stability and helps in achieving further reduction. ⋯ This series reinforces the safety and efficacy of both trans-oral and retro-pharyngeal anterior release for reduction of Irreducible AAD. Posterior fixation helps in achieving further reduction and provides stability. Anterior release followed by instrumented posterior fusion is a safe and effective modality of treatment for irreducible AAD associated with basilar invagination.
-
Current literature suggests that in the long-term, fusion of the lumbar spine in chronic low back pain (CLBP) does not result in an outcome clearly better than structured conservative treatment modes. ⋯ One can conclude that from the patient's perspective, reflected by the GA, lumbar fusion surgery is a valid treatment option in CLBP. On the other hand, secondary outcome measures such as ODI and work status, best analyzed by the PP model, indicated that substantial disability remained at long-term after fusion as well as after conservative treatment. The lack of objective outcome measures in CLBP and the cross-over problem transforms an RCT to an observational study, that is, Level 2 evidence. The discrepancy between the primary and secondary outcome measures prevents a strong conclusion on whether to recommend fusion in non-specific low back pain.
-
Chronic low back pain (LBP) is a prevalent condition associated with pain, disability, decreased quality of life, and fear of movement. To date, no studies have compared the effectiveness of spinal manipulation and functional technique for the management of this population. ⋯ In comparison to functional technique, spinal manipulative therapy showed greater reduction in disability in patients with chronic LBP, but not in terms of pain, fear of movement, quality of life, isometric resistance of trunk flexors, or spinal mobility. However, differences in disability were not clinically meaningful; therefore, spinal manipulative therapy did not result in any clinically important short-term benefits over functional technique therapy. In addition, as neither group met the threshold for minimum clinically important difference following treatment, neither treatment resulted in a clinically meaningful benefit.
-
Evaluation of sagittal alignment is essential in the operative treatment of spine pathology, particularly adult spinal deformity (ASD). However, software applications for detailed spino-pelvic analysis are usually complex and not applicable to routine clinical use PURPOSE: To validate a new clinician-friendly software (Surgimap) in the setting of ASD. ⋯ Using this new software tool, a simple method for full spine analysis can be performed quickly, accurately, and reliably. The proposed list of parameters offers quantitative values of the spine and pelvis, setting the stage for proper pre-operative planning. The new software tool provides an important bridge between clinical and research needs.