The spine journal : official journal of the North American Spine Society
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Chronic low back pain (CLBP) is a major health problem. Identifying prognostic factors is essential for identifying people at risk of developing CLBP-related disability. ⋯ The study results supported the multifactorial nature of CLBP and reported an important prognostic model in the Saudi population.
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The need for advanced imaging before spinal intervention is an area of ongoing debate. Many studies have demonstrated the accuracy of magnetic resonance imaging (MRI) results in evaluating structural pathology in the lumbar spine, but few have addressed how frequently MRI findings change clinical management. A randomized controlled trial showed that viewing MRI results did not impact outcomes in patients with radiculopathy undergoing epidural steroid injection (ESI). The results suggested ESIs that correlated with both imaging and clinical findings experienced slightly more benefit than the blinded cohort, although statistically insignificantly. ⋯ In clinical practice, MRI before injection frequently changes management decisions in the planning and delivery of lumbar spine injections.
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Lumbar degenerative stenosis is one of the most common spine pathologies for which surgical intervention is indicated. There is some evidence that a prolonged duration of neurological compression could lead to a failure of surgery to alleviate symptoms. ⋯ Multicenter registry data provides important real-world evidence to guide consent, surgical planning, and health resource management. Longer symptom duration was found to correlate with less improvement in pain and disability after lumbar stenosis surgery suggesting that these patients may benefit from earlier treatment.
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Dural tear represents a common complication of microendoscopic spine surgery that may lead to postoperative sequelae including insufficient decompression, cerebrospinal fluid fistula, intracranial hypotension, and subdural/intraparenchymal bleeding. The gold standard to manage intraoperative dural tears is primary repair. However, the downside of conversion to open surgery can be detrimental. Therefore, understanding the most appropriate strategy for microendoscopic dural repair and its impact on postoperative outcomes is of importance. ⋯ In conclusion, all dural tears in our cases were managed without conversion to open surgery and did not influence surgical outcomes.
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Caused by perceptions regarding unnecessary healthcare resource utilization, high costs of care, and financial incentives towards "cherry-picking" cases in physician owned hospitals, the Affordable Care Act (ACA) of 2010 imposed restrictions on existing physician-owned hospitals from expanding. Despite an increasing number of individuals requiring access to spine surgical care, no study has evaluated the surgical safety and costs of elective posterior lumbar fusions (PLFs) being performed in physician-owned vs. non-physician-owned hospitals. ⋯ Our results suggest that patients undergoing elective 1- to 3-level PLFs at physician-owned hospitals do not experience a greater number of complications and/or readmissions while having lower risk-adjusted charges and costs over the 90-day episode of care. The findings call on the need for revaluation/reconsideration of the ACAs restriction on the expansion of these physician-owned hospitals.