The spine journal : official journal of the North American Spine Society
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Meta Analysis
Imaging for low back pain: is clinical use consistent with guidelines? A systematic review and meta-analysis.
The problem of imaging patients with low back pain (LBP) when it is not indicated is well recognized. The converse is also possible, although rarely considered. The extent of these two problems is presently unclear. ⋯ Inappropriate imaging is common in LBP management, including both overuse in those where imaging is not indicated and underuse of imaging when it is indicated. Appreciating that both underuse and overuse can occur is fundamental to efforts to improve imaging practice to align with current guidelines and best evidence.
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One of the characteristics of reported observations in adolescent idiopathic scoliosis (AIS) is that the thoracic spine is longer anteriorly than posteriorly, more pronounced around the apex than the transitional zones. This reversal of the normal kyphotic anatomy of the thoracic spine is related to questions of etiopathogenesis of AIS. The changes in the anatomy of the anterior column have been described rather in detail; however, the role of the posterior spinal column and the laminae has so far not been elucidated. If the posterior column exhibits a longitudinal growth disturbance, it could act as a tether, leading to a more or less normal anterior column with a deformed and shorter posterior aspect of the spine. So far, it has remained unclear whether this anterior-posterior length discrepancy is the result of relative anterior lengthening or relative posterior shortening, and which tissues (bone, disc, intervertebral soft tissue) are involved. ⋯ Based on this in vivo analysis, the true three-dimensional anterior-posterior length discrepancy of AIS curves was found to occur through both anterior column lengthening and posterior column shortening, with the facet joints functioning as the fulcrum. The vertebrae contribute partly to the anterior-posterior length discrepancy accompanied by more significant and possibly secondary increased anterior intervertebral discs height.
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Multicenter Study
Does intrawound vancomycin powder reduce surgical site infection after posterior instrumented spinal surgery? A propensity score-matched analysis.
Recent reports suggested that placing vancomycin powder into surgical wounds before closure can prevent surgical site infections (SSIs) in spinal surgery. ⋯ Intrawound application of vancomycin powder was not associated with a significant decrease in the incidence of SSIs after posterior instrumented spinal surgeries in a propensity score-matched analysis. However, the rate of infections caused by Staphylococcus species was lower in the vancomycin group.
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Spondylitis is a rare infection in bone requiring multiple diagnostic strategies for verification. ⋯ 18F-FDG-PET had a higher diagnostic value compared with MRI in detecting spondylitis.
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Observational Study
Intervertebral kinematics of the cervical spine before, during, and after high-velocity low-amplitude manipulation.
Neck pain is one of the most commonly reported symptoms in primary care settings, and a major contributor to health-care costs. Cervical manipulation is a common and clinically effective intervention for neck pain. However, the in vivo biomechanics of manipulation are unknown due to previous challenges with accurately measuring intervertebral kinematics in vivo during the manipulation. ⋯ This study is the first to measure facet gapping during cervical manipulation on live humans. The results demonstrate that target and adjacent motion segments undergo facet joint gapping during manipulation and that intervertebral ROM is increased in all three planes of motion after manipulation. The results suggest that clinical and functional improvement after manipulation may occur as a result of small increases in intervertebral ROM across multiple motion segments. This study demonstrates the feasibility of characterizing in real time the manual inputs and biological responses that comprise cervical manipulation, including clinician-applied force, facet gapping, and increased intervertebral ROM. This provides a basis for future clinical trials to identify the mechanisms behind manipulation and to optimize the mechanical factors that reliably and sufficiently impact the key mechanisms behind manipulation.