The spine journal : official journal of the North American Spine Society
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Despite the interest in lumbar spinous process (SP)-based surgical innovation, there are no large published studies that have characterized the morphometry of lumbar SPs. ⋯ This large cadaveric study provides level-specific morphometric data regarding the osseous dimensions of lumbar SPs relevant to techniques and devices targeting the lumbar SPs or the interspinous space. Of particular importance is the recognition that L5 has relatively different morphology when compared with more cranial levels. Potentially important differences were noted comparing women with men, black with white, and aging populations.
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Occipitocervical dislocations involve translations of the craniocervical joints. The relative contributions of each ligament to overall stability and the effects of the occipitoatlantal joint capsules on the pathologic translation are unknown. Although incidences of occipitocervical dislocations are rare after blunt trauma, they are usually fatal. When patients do survive these dislocations, the proper diagnosis is difficult, which in turn may increase the fatality rate. A biomechanical model may provide a greater pathologic understanding of craniocervical subluxation. ⋯ Transverse and alar ligaments appear to be the main stabilizers of the craniocervical junction. The vertical structures attached to the clivus and OA joint capsules function as secondary stabilizers. Craniocervical dislocations seem to affect FE and lateral bending the most, whereas increased translation seems to occur primarily in the AP and CC directions. Models of craniocervical trauma should section all three restraining structures for the future studies.
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The correlation of negative outcomes with aggressiveness of malpractice liability has been questioned in the literature. ⋯ In the present national study, aggressive malpractice environment was not correlated with mortality but was associated with higher hospitalization charges after spine surgery. Further research is needed to identify ways to regulate the malpractice system to address these disparities.
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Review Meta Analysis Comparative Study
Comparative clinical effectiveness of management strategies for sciatica: systematic review and network meta-analyses.
There are numerous treatment approaches for sciatica. Previous systematic reviews have not compared all these strategies together. ⋯ For the first time, many different treatment strategies for sciatica have been compared in the same systematic review and meta-analysis. This approach has provided new data to assist shared decision-making. The findings support the effectiveness of nonopioid medication, epidural injections, and disc surgery. They also suggest that spinal manipulation, acupuncture, and experimental treatments, such as anti-inflammatory biological agents, may be considered. The findings do not provide support for the effectiveness of opioid analgesia, bed rest, exercise therapy, education/advice (when used alone), percutaneous discectomy, or traction. The issue of how best to estimate the effectiveness of treatment approaches according to their order within a sequential treatment pathway remains an important challenge.
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Randomized Controlled Trial Multicenter Study Comparative Study
The Discover artificial disc replacement versus fusion in cervical radiculopathy--a randomized controlled outcome trial with 2-year follow-up.
Several previous studies comparing artificial disc replacement (ADR) and fusion have been conducted with cautiously positive results in favor of ADR. This study is not, in contrast to most previous studies, an investigational device exemption study required by the Food and Drug Administration for approval to market the product in the United States. This study was partially funded with unrestricted institutional research grants by the company marketing the artificial disc used in this study. ⋯ Artificial disc replacement did not result in better outcome compared to fusion measured with NDI 2 years after surgery.