Evidence-based spine-care journal最新文献

{"title":"Pain and disability following fusion for idiopathic adolescent scoliosis: prevalence and associated factors.","authors":"Teresa Bas,&nbsp;Nuria Franco,&nbsp;Paloma Bas,&nbsp;Jose Luis Bas","doi":"10.1055/s-0031-1298614","DOIUrl":"https://doi.org/10.1055/s-0031-1298614","url":null,"abstract":"<p><strong>Study design: </strong> Retrospective prognostic study.</p><p><strong>Objectives: </strong> To describe the prevalence of pain following fusion for adolescent idiopathic scoliosis and to identify factors associated with pain and disability.</p><p><strong>Methods: </strong> From 126 consecutive patients surgically treated for scoliosis between 1997 and 2007, 104 (82.5%) completed SRS-22 and ODI questionnaires at a last follow-up (mean, 4.8 years; range 1-11.2 years). Prevalence of pain and disability were determined from SRS questions 1 and 9 respectively, with \"any\" pain or decrease in activity considered clinically significant. SRS Pain Domain Scores (PDS) were also evaluated.</p><p><strong>Results: </strong> Most participants reported \"no pain\" (38.5%) or \"mild pain\" (30.8%) and 72.1% of participants reported a current work/school activity level of 100% normal. An association between instrument type and the presence of any pain in the previous 6 months was noted (P = .022). Instrument type was the only factor that was significantly associated with the PDS (P = .0052).</p><p><strong>Conclusions: </strong> The high percentage of patients reporting no pain or mild pain may suggest overall success of the procedures. Although an association between instrument type and pain was seen, unmeasured factors that contributed to the decision of what instrument to use may confound the relationship. From these data a causal inference cannot be made.Final class of evidence-prognosisSTUDY DESIGNProspective CohortRetrospective Cohort•Case controlCase seriesMETHODSPatients at similar point in course of treatment•F/U ≥ 85%Similarity of treatment protocols for patient groupsPatients followed up long enough for outcomes to occur•Control for extraneous risk factors•*Overall class of evidenceIIIThe definiton of the different classes of evidence is available on page 55.*Potentially confounding factors were systematically explored and considered for stratified analysis as appropriate.</p>","PeriodicalId":89675,"journal":{"name":"Evidence-based spine-care journal","volume":"3 2","pages":"17-24"},"PeriodicalIF":0.0,"publicationDate":"2012-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1055/s-0031-1298614","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"31114479","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Class of evidence (CoE): how does it relate to critical appraisal?","authors":"Andrea C Skelly","doi":"10.1055/s-0031-1298612","DOIUrl":"10.1055/s-0031-1298612","url":null,"abstract":"","PeriodicalId":89675,"journal":{"name":"Evidence-based spine-care journal","volume":"3 2","pages":"7-10"},"PeriodicalIF":0.0,"publicationDate":"2012-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3516459/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"31114477","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Risk factors for degenerative spondylolisthesis: a systematic review.","authors":"John G Devine, Jeannette M Schenk-Kisser, Andrea C Skelly","doi":"10.1055/s-0031-1298615","DOIUrl":"10.1055/s-0031-1298615","url":null,"abstract":"<p><strong>Study design: </strong> Systematic literature review.</p><p><strong>Rationale: </strong> Many authors have postulated on various risk factors associated with the pathogenesis of degenerative spondylolisthesis (DS), yet controversies regarding those risk factors still exist.</p><p><strong>Objective: </strong> To critically appraise and summarize evidence on risk factors for DS.</p><p><strong>Methods: </strong> Articles published before October 15, 2011, were systematically reviewed using PubMed and bibliographies of key articles. Each article was subject to quality rating and was analyzed by two independent reviewers.</p><p><strong>Results: </strong> From 382 citations, 30 underwent full-text review. Fourteen studies met inclusion criteria. All but two were considered poor quality. Female gender and higher facet joint angle were consistently associated with an increased risk of DS across multiple studies. Multiple studies also consistently reported no association between back pain and prolonged occupational sitting. Associations between age, parity, lumbosacral angle, lumbar lordosis, facet joint tropism, and pelvic inclination angles were inconsistent.</p><p><strong>Conclusions: </strong> There appears to be consistent evidence to suggest that the risk of DS increases with increasing age and is greater for females and people with a greater facet joint angle.</p>","PeriodicalId":89675,"journal":{"name":"Evidence-based spine-care journal","volume":"3 2","pages":"25-34"},"PeriodicalIF":0.0,"publicationDate":"2012-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3516463/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"31114480","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The use of rhBMP in spine surgery: is there a cancer risk?","authors":"John G Devine,&nbsp;Joseph R Dettori,&nbsp;John C France,&nbsp;Erika Brodt,&nbsp;Robert A McGuire","doi":"10.1055/s-0031-1298616","DOIUrl":"https://doi.org/10.1055/s-0031-1298616","url":null,"abstract":"<p><strong>Study design: </strong> Systematic review.</p><p><strong>Study rationale: </strong> Some have noted several safety issues associated with the use of bone morphogenetic proteins (BMPs), including cancer risk, stating both BMP and their receptors had been isolated from human tumors. In addition, data presented to the US Food and Drug Administration (FDA) on the product AMPLIFY™ (rhBMP-2, 40 mg) revealed a higher number of cancers in the investigational group compared with the control.</p><p><strong>Objective: </strong> To independently review the cancer risk of rhBMP-2 use in spine fusion as published in the peer-reviewed literature and in the publicly available FDA data summaries.</p><p><strong>Methods: </strong> A systematic review of the literature was undertaken for articles published through January 2012. Pubmed, Cochrane, National Guideline Clearinghouse Databases as well as bibliographies of key articles were searched. Two independent reviewers revised articles. Inclusion and exclusion criteria were set and each article was subjected to a predefined quality-rating scheme.</p><p><strong>Results: </strong> Five published peer-reviewed studies and two FDA safety summaries reported the occurrence of cancer in patients treated with spinal fusion using rhBMP-2 or rhBMP-7. Cancer data for on-label use of rhBMP-2 (InFUSE™) were reported in the FDA data summary but not in one published pivotal study. The risk of cancer was same in both the rhBMP-2 and control groups, 0.7% after 24 months. Off-label use of rhBMP for posterolateral fusion (PLF) was associated with a slightly higher risk of cancer compared with controls in three randomized controlled trials and one poorly conducted retrospective cohort study at various follow-ups. In PLF the risk of cancer was 3.8% using 40 mg of BMP-2 compared with 0.9% in the control group. Two RCTs evaluating rhBMP-7 reported a cancer risk of 12.5% and 5.6% in the rhBMP-7 group compared with 8.3% and 0% in the control groups, respectively. The differences in these studies were not statistically significant; however, the sample sizes for these studies were small.</p><p><strong>Conclusions: </strong> Cancer risk with BMP-2 may be dose dependent, illustrating the need to continue to study this technology and obtain longer follow-up on patients currently enrolled in the FDA trials. Additionally, refined guidelines regarding the routine use of BMPs should be developed, taking into account the FDA summary data that is not routinely scrutinized by the practicing surgeon.</p>","PeriodicalId":89675,"journal":{"name":"Evidence-based spine-care journal","volume":"3 2","pages":"35-41"},"PeriodicalIF":0.0,"publicationDate":"2012-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1055/s-0031-1298616","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"31114481","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Adjacent segment disease and C-ADR: promises fulfilled?","authors":"K Daniel Riew,&nbsp;Jeannette M Schenk-Kisser,&nbsp;Andrea C Skelly","doi":"10.1055/s-0031-1298607","DOIUrl":"https://doi.org/10.1055/s-0031-1298607","url":null,"abstract":"<p><strong>Study design: </strong> Systematic review.</p><p><strong>Clinical question: </strong> Do the rates and timing of adjacent segment disease (ASD) differ between cervical total disc arthroplasty (C-ADR) and anterior cervical discectomy and fusion (ACDF) in patients treated for cervical degenerative disc disease?</p><p><strong>Methods: </strong> A systematic search of MEDLINE/PubMed and bibliographies of key articles was done to identify studies with long-term follow-up for symptomatic and/or radiographic ASD comparing C-ADR with fusion for degenerative disc disease of the cervical spine. The focus was on studies with longer follow-up (48-60 months) of primary US Food and Drug Administration trials of Prestige ST, Prodisc-C, and Bryan devices as available. Trials of other discs with a minimum of 24 months follow-up were considered for inclusion. Studies evaluating lordosis/angle changes at adjacent segments and case series were excluded.</p><p><strong>Results: </strong> From 14 citations identified, four reports from three randomized controlled trials and four nonrandomized studies are summarized. Risk differences between C-ADR and ACF for symptomatic ASD were 1.5%-2.3% and were not significant across RCT reports. Time to development of ASD did not significantly differ between treatments. Rates of radiographic ASD were variable. No meaningful comparison of ASD rates based on disc design was possible. No statistical differences in adjacent segment range of motion were noted between treatment groups.</p><p><strong>Conclusion: </strong> Our analysis reveals that, to date, there is no evidence that arthroplasty decreases ASD compared with ACDF; the promise of arthroplasty decreasing ASD has not been fulfilled.</p>","PeriodicalId":89675,"journal":{"name":"Evidence-based spine-care journal","volume":"3 S1","pages":"39-46"},"PeriodicalIF":0.0,"publicationDate":"2012-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1055/s-0031-1298607","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"31119563","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Cervical artificial disc replacement (C-ADR): global perspectives on use and trends.","authors":"John Rhee,&nbsp;Ellen M Van Alstyne,&nbsp;Andrea C Skelly","doi":"10.1055/s-0031-1298609","DOIUrl":"https://doi.org/10.1055/s-0031-1298609","url":null,"abstract":"<p><strong>Study design: </strong> Cross-sectional survey.</p><p><strong>Objectives: </strong> To obtain information from the global community regarding cervical artificial disc replacement (C-ADR) use and trends before and after US Food and Drug Administration (FDA) approval of devices in 2007 and summarize available information on utilization and government approval for devices.</p><p><strong>Methods: </strong> Data on utilization and approval were sought from PubMed, Google, FDA, and manufacturers' websites. The 6195 members of AOSpine International were invited to participate in a survey to assess global C-ADR use and trends.</p><p><strong>Results: </strong> Publically available data on utilization, trends, and approval outside of the US and Europe is limited. No studies of utilization were found. Of 1479 professionals responding to the survey, 50% had C-ADR specific training and reported ever performing C-ADR. Most respondents believed that C-ADR was safe and effective, but approximately one quarter responded that they did not know. Of those who had done C-ADR, 49% reported performing ≥ 1 before December compared with 92% after January 2008 and 51.3% indicated that all their C-ADRs were placed in a single level; 27% reported ≥ 1 failures that required revision. The majority foresee that C-ADR use will increase in the next 5 years. Most respondents believed that the best indication is radiculopathy from soft-disc pathology rather than myelopathy or disorders arising from spondylotic (hard-disc) pathology.</p><p><strong>Conclusion: </strong> More C-ADR has been performed after January 2008. Most respondents expect the number to increase. There may be differences in failure rates when performed inside or outside of a sponsored research trial.</p>","PeriodicalId":89675,"journal":{"name":"Evidence-based spine-care journal","volume":"3 S1","pages":"53-8"},"PeriodicalIF":0.0,"publicationDate":"2012-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1055/s-0031-1298609","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"31119565","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Conflict of evidence or conflict of interest?","authors":"","doi":"10.1055/s-0031-1298594","DOIUrl":"https://doi.org/10.1055/s-0031-1298594","url":null,"abstract":"We at EBSJ appreciate a substantial and mostly positive echo to the editorial titled “BMP: evidence in the name of science?” (EBSJ Volume 2, Issue 4). Thank you to all who have voiced their interest and support of our unique publication. Other publications have also echoed the desirability of a reevaluation of the methodology and conclusions of the article by Carragee et al titled: “A critical review of recombinant human bone morphogenic protein-2 trials in spinal surgery: emerging safety concerns and lessons learned.” [1] A particularly detailed vocal response has appeared in a trade publication named ‘Orthopaedics This Month’ by Robin Young, CFA, and is titled “Under Carragee The Spine Journal lives dangerously.” [2] This non-peer reviewed article extensively reviewed the data in The Spine Journal article as presented and then used public federal data sources on complications of spine fusions with and without BMP-2, and found a substantially lower incidence of reoperations in the BMP group. The author (who is the same person as the editor-in-chief and publisher) called for a formal reinvestigation of the BMP data and outright retraction of the assertions made in The Spine Journal article, which had stated that complications were suppressed or not presented by the investigators of the BMP-2 FDA trials. The purpose of this editorial message is, however, not to rehash the continued debate revolving around BMP-2 possibly being linked with increased rates of retrograde ejaculation (or not) and other complications (such as a suggested increased cancer rate with BMP-2) but to raise some thoughts on the underlying accusations of unresolved conflict of interest (COI) of its original investigators.","PeriodicalId":89675,"journal":{"name":"Evidence-based spine-care journal","volume":"3 1","pages":"5-7"},"PeriodicalIF":0.0,"publicationDate":"2012-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1055/s-0031-1298594","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"31120751","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Assessing bias: the importance of considering confounding.","authors":"Andrea C Skelly,&nbsp;Joseph R Dettori,&nbsp;Erika D Brodt","doi":"10.1055/s-0031-1298595","DOIUrl":"https://doi.org/10.1055/s-0031-1298595","url":null,"abstract":"Failure to evaluate demographic and clinical factors as potential confounders can bias your study results and lead to erroneous conclusions. Study design must include the measurement and reporting of such factors. During analysis, the association between such factors and the outcome and your exposure of interest must be explored. A commonly overlooked type of confounding in the surgical literature is confounding by indication. This needs to be dealt with during study design to ensure that treatment groups include patients with the same range of condition severity and that treatment choice is not based on condition severity. In all likelihood, no matter how many variables one adjusts for, there will be residual confounding, possibly by factors that are unknown and cannot be measured.","PeriodicalId":89675,"journal":{"name":"Evidence-based spine-care journal","volume":"3 1","pages":"9-12"},"PeriodicalIF":0.0,"publicationDate":"2012-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1055/s-0031-1298595","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"31120752","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Acute spinal subdural hematoma complicating lumbar decompressive surgery.","authors":"Kok Chun Chang,&nbsp;Dino Samartzis,&nbsp;Keith D K Luk,&nbsp;Kenneth M C Cheung,&nbsp;Yat-Wa Wong","doi":"10.1055/s-0031-1298602","DOIUrl":"https://doi.org/10.1055/s-0031-1298602","url":null,"abstract":"<p><strong>Study design: </strong> A case report.</p><p><strong>Objective: </strong> To report a rare case of acute spinal subdural hematoma (SSH) complicating lumbar spine surgery, its characteristic presenting symptoms, diagnostic imaging, possible cause, and pitfall in management.</p><p><strong>Methods: </strong> A 59-year-old woman with lumbar spinal instability and stenosis underwent laminectomy and decompression at L3-L5 with instrumentation and fusion from L3-S1.</p><p><strong>Results: </strong> Immediately following surgery, the patient presented with incapacitating pain of both lower extremities from the mid-thigh downward, which was not relieved by narcotic analgesia and was disproportional to surgical trauma. Left ankle and great toes weakness was detected at postoperative day 2 and deteriorated on day 6. Magnetic resonance imaging was performed urgently and revealed a characteristic SSH with thecal sac compression at the level of L2, proximal to the laminectomy. Emergency decompression and evacuation of the hematoma was performed. The patient had partial recovery 6 weeks postoperatively.</p><p><strong>Conclusion: </strong> Acute SSH is a rare complication of lumbar spine surgery. This diagnosis must be considered when severe leg pain, unresolved with analgesia and disproportional to surgical trauma, with neurological deterioration occurring after lumbar spine surgery. Magnetic resonance imaging is the imaging modality of choice to assist in the differential diagnosis of an SSH. Early surgical decompression is necessary for optimal neurological recovery.</p>","PeriodicalId":89675,"journal":{"name":"Evidence-based spine-care journal","volume":"3 1","pages":"57-62"},"PeriodicalIF":0.0,"publicationDate":"2012-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1055/s-0031-1298602","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"31120759","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Clinical and radiological association with positive lumbar discography in patients with chronic low back pain.","authors":"William Omar Contreras López,&nbsp;Emiliano Neves Vialle,&nbsp;Carolina Casas Anillo,&nbsp;Mauricio Guzmao,&nbsp;Luiz Roberto Gomes Vialle","doi":"10.1055/s-0031-1298598","DOIUrl":"https://doi.org/10.1055/s-0031-1298598","url":null,"abstract":"<p><strong>Study design: </strong> Retrospective cohort study.</p><p><strong>Objectives: </strong> To find out (1) if magnetic resonance imaging (MRI) findings associated with positive discography in patients with lumbar discogenic pain are caused by degenerative disc disease (DDD). (2) If clinical risk factors associated with positive discography in patients with lumbar discogenic pain are caused by DDD.</p><p><strong>Methods: </strong> Thirty-three discographies were performed in 20 consecutive patients with chronic low back pain (LBP). All examinations were performed in the lumbar spine between L3 and S1. Patient assessment consisted of a clinical and radiological examination through a protocol that contained data on the history, visual analogue scale for pain (VAS), functional questionnaire (Oswestry), and MRI findings. Discography was considered positive using the Walsh's criteria. We examined the association between MRI and clinical findings with positive discography using logistic regression.</p><p><strong>Results: </strong> Fourteen discographies (42%) were positive and 19 (58%) were negative. The mean age of patients with positive discography was 40.7 years (range, 25-56 years) and negative discography 43.1 years (range, 30-55 years). Men had a positive discography rate of 43.5% and women 40%. Patients with LBP had reduced odds of a positive discography compared with those with LBP and sciatica (OR = .5; 95% CI: 0.1-2.7); however, this association was not statistically significant. Patients with more than four previous episodes of pain versus patients with one to four episodes had greater odds of a positive discography (OR = 3.8; 95% CI: 0.07-184); but this association was not statistically significant. Patients with various pathologies on MRI had greater odds of a positive discography; however, these associations were not statistically significant either.</p><p><strong>Conclusions: </strong> Patients with a chief complaint of LBP associated with sciatica, with more than four episodes of previous LBP exacerbations and the presence of a high intensity zone (HIZ) on MRI have a higher rate of positive discography. These findings are not statistically significant, probably due to a small sample size. During discography, we found the end point resistance to be more prevalent in asymptomatic discs.</p>","PeriodicalId":89675,"journal":{"name":"Evidence-based spine-care journal","volume":"3 1","pages":"27-34"},"PeriodicalIF":0.0,"publicationDate":"2012-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1055/s-0031-1298598","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"31120755","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}