The spine journal : official journal of the North American Spine Society
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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.
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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.
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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.
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Chiari malformation, Type 1, with syringomyelia (CIM+SM) is often associated with spinal deformity. The safety of scoliosis surgery this population is controversial and has never been directly compared with adolescent idiopathic scoliosis (AIS). ⋯ Although CIM+SM patients undergoing spine reconstruction can expect similar deformity corrections and outcome scores to AIS patients, they also experience higher rates of neuromonitoring difficulties and neurological complications related to surgery. Surgeons should be prepared for these difficulties, particularly in children with larger syrinx size.
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The influence of nonmedical factors on the disposition of spine trauma patients, initially seen in less specialized institutions, remains an issue of debate. ⋯ In summary, lack of insurance was associated with increased possibility of transfer to higher level of care institutions, after evaluation in a Level III or IV trauma center ED for spine trauma. The same was true for African-Americans with milder injuries.