The spine journal : official journal of the North American Spine Society
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Randomized Controlled Trial
Dose-response and efficacy of spinal manipulation for care of chronic low back pain: a randomized controlled trial.
There have been no full-scale trials of the optimal number of visits for the care of any condition with spinal manipulation. ⋯ The number of spinal manipulation visits had modest effects on cLBP outcomes above those of 18 hands-on visits to a chiropractor. Overall, 12 visits yielded the most favorable results but was not well distinguished from other dose levels.
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Although anterior cervical discectomy and fusion (ACDF) is an effective treatment option for patients with cervical disc herniation, it limits cervical range of motion, which sometimes causes discomfort and leads to biomechanical stress at neighboring segments. In contrast, cervical artificial disc replacement (ADR) is supposed to preserve normal cervical range of motion than ACDF. A biomechanical measurement is necessary to identify the advantages and clinical implications of ADR. However, literature is scarce about this topic and in those available studies, authors used the static radiological method, which cannot identify three-dimensional motion and coupled movement during motion of one axis. ⋯ Three-dimensional motion analysis could provide useful information in an objective and quantitative way about cervical motion after surgery. In addition, it allowed us to measure not only main motion but also coupled motion in three planes. ADR demonstrated better retained cervical motion mainly in sagittal plane (flexion and extension) and better preserved coupled sagittal and coronal motion during transverse plane motion than ACDF. ADR had the advantage in that it had the ability to preserve more cervical motions after surgery than ACDF.
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Randomized Controlled Trial
Allograft alone versus allograft with bone marrow concentrate for the healing of the instrumented posterolateral lumbar fusion.
Spondylodesis in the operative management of lumbar spine diseases has been the subject of numerous studies over several decades. The posterolateral fusion (PLF) with pedicle screw fixation is a commonly used procedure. ⋯ We have confirmed the hypothesis that the autologous BMC together with the allograft is a better alternative for PLF than the allograft alone. The use of autologous MSCs in form of BMC in combination with allograft is an effective option to enhance the PLF healing.
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The use and need of helicopter aeromedical transport systems (HEMSs) in health care today is based on the basic belief that early definitive care improves outcomes. Helicopter aeromedical transport system is perceived to be safer than ground transport (GT) for the interfacility transfer of patients who have sustained spinal injury because of the concern for deterioration of neurologic function if there is a delay in reaching a higher level of care. However, the use of HEMS is facing increasing public scrutiny because of its significantly greater cost and unique risk profile. ⋯ Ground transport for interfacility transfer of patients with spinal injury appears to be safe and suitable for patients who lack other compelling reasons for HEMS. A prospective analysis of transportation mode in a larger cohort of patients is needed to verify our findings.
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Observational Study
Revision rates and complication incidence in single- and multilevel anterior cervical discectomy and fusion procedures: an administrative database study.
The natural history of cervical degenerative disease with operative management has not been well described. Even with symptomatic and radiographic evidence of multilevel cervical disease, it is unclear whether single- or multilevel anterior cervical discectomy and fusion (ACDF) procedures produce superior long-term outcomes. ⋯ In this study, we report rates of adverse events and the need for revision surgery in patients undergoing single versus multilevel ACDFs. Increasing number of levels fused at the time of index surgery correlated with increased rate of reoperations. Multilevel ACDF patients requiring additional surgery more often underwent more extensive revision surgeries.