The spine journal : official journal of the North American Spine Society
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Recently the financial relationships between industry and professional medical associations have come under increased scrutiny because of the concern that industry ties may create real or perceived conflicts of interest. Professional medical associations pursue public advocacy as well as promote medical education, develop clinical practice guidelines, fund research, and regulate professional conduct. Therefore, the conflicts of interest of a professional medical association and its leadership can have more far-reaching effects on patient care than those of an individual physician. ⋯ The NASS experience can provide a template for other professional medical associations to help manage their own possible conflicts of interest issues.
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Posterior spine fusion is associated with significant intra- and postoperative blood losses. When referring to the total blood loss during spine surgery, the standard is to measure the intraoperative bleeding plus the postoperative drainage. This ignores the "hidden" blood loss that was found to be significant in other fields of surgery. ⋯ After posterior spinal fusion, there may be a large amount of the hidden blood loss.
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There is no information in the English literature on the outcome of liver cirrhotic patients who have undergone instrumented lumbar surgery. ⋯ The rate of complications after instrumented lumbar surgery was significantly higher in patients with cirrhosis than in control patients, especially in those with 6 or more Child-Turcotte-Pugh points. The surgeon should counsel these patients on the possibility of developing early complications. Several factors were associated with surgical complications and should be addressed by the spine surgeons before or when they perform these elective instrumented lumbar surgeries.
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Spinal cord injuries (SCIs) related to cervical spine (C-spine) fractures can cause significant morbidity and mortality. Aggressive treatment often required to manage instability associated with C-spine fractures is complicated and hazardous in the elderly population. ⋯ In this elderly population, neurological recovery was poor and the in-hospital mortality rate was high. The strongest risk factors for mortality were injury level and severity of SCI. Although each case of SCI related to C-spine fractures is different, physicians may be able to use these findings to help better determine the prognosis and guide subsequent treatment.
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The minimal clinically important difference (MCID) is defined as the smallest change in an outcome that a patient would perceive as meaningful. The Initiative on Methods, Measurement and Assessment in Clinical Trials (IMMPACT) group proposed defining the MCID as a 30% improvement in self-reported pain or function. However, this MCID threshold has not been validated against an objective physical measure. ⋯ Despite extensive use of the MCID to evaluate effects of treatment in spinal disorders, this is the first empirical documentation of the validity of the IMMPACT's 30% change criterion compared with an objective physical anchor.