The spine journal : official journal of the North American Spine Society
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Cervical disc arthroplasty (CDA) is a motion-preserving procedure that is an alternative to fusion. Proponents of arthroplasty assert that it will maintain cervical motion and prevent or reduce adjacent segment degeneration. Accordingly, CDA, compared with fusion, would have the potential to improve clinical outcomes. Published studies have varying conclusions on whether CDA reduces complications and/or improves outcomes. As many of these previous studies have been funded by CDA manufacturers, we wanted to ascertain whether there was a greater likelihood for these studies to report positive results. ⋯ Associated COIs did not influence QOL outcomes. Conflicts of interest were more likely to be present in studies published after 2008, and those with a COI reported greater adjacent segment disease rates for ACDF than CDA. In addition, heterotopic ossification rates were much lower in studies with COI versus those without COI. Thus, COIs did not affect QOL outcomes but were associated with lower complication rates.
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Anterior cervical spine surgery is one of the most common spinal procedures performed around the world, but dysphagia is a frequent postoperative complication. Many factors have been associated with an increased risk of swallowing difficulties, including multilevel surgery, revision surgery, and female gender. ⋯ Current literature supports several preventative measures that may decrease the incidence of postoperative dysphagia. Although the evidence is limited and weak, most of these measures did not appear to increase other complications and can be easily incorporated into a surgical practice, especially in patients who are at high risk for postoperative dysphagia.
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Randomized Controlled Trial
Effect of the degree of reverse Trendelenburg position on intraocular pressure during prone spine surgery: a randomized controlled trial.
Postoperative vision loss complicates an estimated 1 in 1,100 prone spine surgical cases. This complication has been attributed to ischemic optic neuropathy, with one proposed reason being perioperative elevations in intraocular pressure (IOP). Previous research has studied the effects of table inclination on IOP in awake volunteers; however, the effects in spine surgery patients have not been investigated for reverse Trendelenburg positioning using a prospective, randomized controlled study design. ⋯ Reverse Trendelenburg positioning elicits decreased IOP compared with prone positioning for surgery times less than 120 minutes. Ten degrees of reverse Trendelenburg attenuate the rise in IOP during prone spine surgery superiorly in comparison with 5°. No significant complications were associated with reverse Trendelenburg positioning.
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Randomized Controlled Trial
Spinal manipulative therapy and exercise for seniors with chronic neck pain.
Neck pain, common among the elderly population, has considerable implications on health and quality of life. Evidence supports the use of spinal manipulative therapy (SMT) and exercise to treat neck pain; however, no studies to date have evaluated the effectiveness of these therapies specifically in seniors. ⋯ SMT with HE resulted in greater pain reduction after 12 weeks of treatment compared with both supervised plus HE and HE alone. Supervised exercise sessions added little benefit to the HE-alone program.
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Randomized Controlled Trial
Recovery of motor deficit accompanying sciatica--subgroup analysis of a randomized controlled trial.
In patients with sciatica due to a lumbar disc herniation, it is generally recommended to reserve surgical treatment for those who suffer from intolerable pain or those who demonstrate persistent symptoms after conservative management. Controversy exists about the necessity of early surgical intervention for those patients that have an additional motor deficit. ⋯ Early surgery resulted in a faster recovery of motor deficit accompanying sciatica compared with prolonged conservative treatment but the difference was no longer significant during the final follow-up examination at 1 year.