Evidence-based spine-care journal最新文献

{"title":"Treating spinal storage diseases with macro data?","authors":"Jens Chapman","doi":"10.1055/s-0034-1372332","DOIUrl":"https://doi.org/10.1055/s-0034-1372332","url":null,"abstract":"The avid reader of EBSJ may be surprised that we have three case reports in this issue. Of course, the editors of this fine journal are keenly aware that in the evidence pyramid, case reports rank dead last due to their limited scientific value and high variability. However, in reviewing these case reports, we found a common denominator that is hopefully of some value to our readership: that of the underlying pathomechanism being storage diseases. These conditions have truly remained somewhat of a stepchild in spine surgery; outside of the traditional realms of deformity, trauma, neoplasia, and infection, they and metabolic bone diseases have remained more on the fringes of our clinical awareness. To the present date, it remains unclear how often patients with storage diseases and spinal problems remain undiagnosed by their spine surgeons, and similarly, how infrequently the primary care providers treating the disease processes are unaware of the potential spinal implications of these disorders. In all the cases presented in this EBSJ issue, the run-up time until appropriate diagnosis was long, and also in all the cases, the typically late spine manifestations prevented a “cure” and required reconstructive intervention. With the advent of large-scale data banks—such as provided through the AOSpine International Knowledge Forum— hopefully, interested groups will form a “Storage Disease” section to start collecting these diseases and make detection, treatment, and eventually prevention a distinct possibility in the not-too-distant future. Therefore, we hope that these case reports—all thoughtfully written and full of interesting observations—will trigger a more coordinated data collection effort for the forgotten stepchild of spine: storage diseases. The power of global data storage with biological specimens could conceivably trigger unprecedented disease insights. We hope the AOSpine community will not just agree but also act.","PeriodicalId":89675,"journal":{"name":"Evidence-based spine-care journal","volume":"5 1","pages":"1"},"PeriodicalIF":0.0,"publicationDate":"2014-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1055/s-0034-1372332","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"32248188","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":"Comparison between C1-2 Fixation with and without Supplemental Posterior Wiring.","authors":"Mai Tran, Rishi Wadhwa, John Ziewacz, Praveen Mummaneni, Dean Chou","doi":"10.1055/s-0034-1371972","DOIUrl":"10.1055/s-0034-1371972","url":null,"abstract":"<p><p>Study Design Retrospective analysis. Clinical Question Is there a difference between the screw-rod construct (SRC) procedure without wiring and the SRC procedure with wiring with respect to fusion, implant failure, reoperation, donor-site morbidity, and complication rates? Patients and Methods We performed a retrospective analysis of 26 patients who underwent C1-2 fixation between 2004 and 2012 (SRC with wiring and structural bone graft, 13 patients; SRC with autograft but without wiring, 13 patients). Fusion was assessed using dynamic X-rays in all patients and computed tomographic scans in selected cases. Pseudoarthrosis was confirmed during reoperation. Results The mean follow-up time was 2 years and 5 months for the SRC without wiring group and 2 years and 1 month for the SRC with wiring group. Patients with less than 1-year follow-up time were excluded. The fusion rate, implant failure rate, and reoperation rates for the SRC without wiring group were 92, 8, and 8%, respectively. The fusion, implant failure, and reoperation rates for the SRC with wiring group were 100, 0, and 0%, respectively. There were no donor-site morbidities or complications in either group (both 0%). There were no differences in parameters we examined between the two groups (p > 0.05 for each rate, Fisher exact test). Conclusions The results suggest that supplementing the SRC procedure with wiring may increase fusion rate, but this difference is not statistically significant. Although the sample size was small, there was not a significant discrepancy in outcomes between the two groups at an average follow-up of 2 years. [Table: see text]. </p>","PeriodicalId":89675,"journal":{"name":"Evidence-based spine-care journal","volume":"5 1","pages":"12-5"},"PeriodicalIF":0.0,"publicationDate":"2014-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3969422/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"32248191","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":"A case of tophaceous gout in the lumbar spine: a review of the literature and treatment recommendations.","authors":"Mithulan Jegapragasan,&nbsp;Alejandro Calniquer,&nbsp;William D Hwang,&nbsp;Quynh T Nguyen,&nbsp;Zachary Child","doi":"10.1055/s-0034-1366979","DOIUrl":"https://doi.org/10.1055/s-0034-1366979","url":null,"abstract":"<p><p>Study Design Case report. Objective The objective of this study is to report the occurrence of tophaceous gout in the lumbar spine. Methods Using a case report to illustrate the key points of gout in the spine, we provide a brief review of gout in the literature as it relates to its orthopedic and spinal manifestations as well as guidelines for management. Results This case report details the occurrence of a large and clinically significant finding of tophaceous gout in the lumbar spine in a 24-year-old man with a known history of gout and a 3-year history of progressive back pain. Conclusion A high index of suspicion can assist in diagnosis of patients presenting with back pain or neurologic findings with a history of gout. A previous history of gout (especially the presence of tophi), hyperuricemia, and the radiological characteristics presented here should aid the clinician in making the diagnosis of spinal gout. Early diagnosis has the potential to prevent the need for surgical intervention. </p>","PeriodicalId":89675,"journal":{"name":"Evidence-based spine-care journal","volume":"5 1","pages":"52-6"},"PeriodicalIF":0.0,"publicationDate":"2014-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1055/s-0034-1366979","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"32250338","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":"Success in academic spine surgery: the role of mentoring.","authors":"Christina Goldstein","doi":"10.1055/s-0033-1357367","DOIUrl":"https://doi.org/10.1055/s-0033-1357367","url":null,"abstract":"Since the 1980s, multiple sources have suggested that the number of clinician scientists in academic medicine has declined substantially.1 2 3 4 5 More recently, Corrice et al identified that 2.9 to 10% of American, full-time clinical MD faculty planned to leave academia and 13 to 27.8% were unsure of staying or leaving.6 Although no data regarding the size or productivity of the academic spine surgeon workforce has ever been published, there is reason to believe that a similar phenomenon is occurring within our specialty. Furthermore, as the demand for spine surgery continues to grow7 8 9 10 in the face of intensifying competition for health-care resources, the call for high-quality studies to guide spine surgeons, payers, and policy-makers is stronger than ever. With the resulting scenario, in which fewer academic spine surgeons are being asked to produce more evidence upon which decision making in spine surgery can be based, the need for recruitment and retention of academic spine surgeons has never been greater. \u0000 \u0000A career in academic medicine provides young spine surgeons with the opportunity to practice in an environment where they can educate the next generation of surgeons, contribute meaningfully to the spine literature and provide outstanding clinical care. Unfortunately, multiple barriers to the pursuit of an academic surgical career exist.11 In particular, a lack of motivated and experienced mentors has been consistently identified as a barrier to successful completion of research and a reason for not choosing a career in academic medicine.5 12 13 14 Because early and sustained mentorship significantly predicts future dedication of time to research efforts,15 it is imperative that practicing spine surgeons understand the role of mentoring in the development of future spine clinician scientists. \u0000 \u0000The purpose of this article is to review the definition of a mentor as well as to outline the specific functions of a mentor in the context of establishment of career in academic medicine. The essential characteristics of outstanding mentors will then be discussed, as will the qualities and actions of successful mentees. Finally, the proposed benefits of participating in a mentoring relationship for both the senior and junior academic spine surgeon will be outlined.","PeriodicalId":89675,"journal":{"name":"Evidence-based spine-care journal","volume":"4 2","pages":"90-5"},"PeriodicalIF":0.0,"publicationDate":"2013-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1055/s-0033-1357367","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"32039852","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":"Outcomes in adult scoliosis patients who undergo spinal fusion stopping at L5 compared with extension to the sacrum.","authors":"Zeeshan M Sardar,&nbsp;Jean A Ouellet,&nbsp;Dena J Fischer,&nbsp;Andrea C Skelly","doi":"10.1055/s-0033-1357360","DOIUrl":"https://doi.org/10.1055/s-0033-1357360","url":null,"abstract":"<p><p>Study Design Systematic review. Study Rationale Adult scoliosis is a common disorder that is associated with significantly higher pain, functional impairment, and effect on quality of life than those without scoliosis. Surgical spinal fusion has led to quantifiable improvement in patient's quality of life. However, for patients undergoing long lumbar fusion, the decision to stop the fusion at L5 or to extend to S1, particularly if the L5-S1 disc is healthy, remains controversial. Objective The aim of the study is to evaluate if fusion stopping at L5 increases the comparative rates of revision, correction loss, and/or poor functional outcomes compared with extension to the sacrum in adult scoliosis patients who require spinal fusion surgery. Materials and Methods A systematic review of the literature was performed using PubMed, the National Guideline Clearinghouse Database and bibliographies of key articles that evaluated adult scoliosis patients who required spinal fusion surgery and compared outcomes for fusions to the sacrum versus stopping at L5. Articles were included on the basis of predetermined criteria and were appraised using a predefined quality-rating scheme. Results From 111 citations, 26 articles underwent full-text review, and 3 retrospective cohort studies met all inclusion and exclusion criteria. Revision rates in subjects who underwent spinal fusion to L5 (20.8-23.5%) were lower in two studies compared with those with fusion extending to the sacrum (19.0-58.3%). Studies that assessed deformity correction used different measures, making comparison across studies difficult. No significant differences were found in patient-reported functional outcomes across two studies that used different measures. Conclusion The limited data available suggest that differences in revision rates did not consistently reach statistical significance across studies that compared spinal fusion to L5 versus extension to sacrum in adult scoliosis patients. </p>","PeriodicalId":89675,"journal":{"name":"Evidence-based spine-care journal","volume":"4 2","pages":"96-104"},"PeriodicalIF":0.0,"publicationDate":"2013-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1055/s-0033-1357360","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"32039853","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":"Occam paradox? A variation of tapia syndrome and an unreported complication of guidewire-assisted pedicle screw insertion.","authors":"Osa Emohare,&nbsp;Erik Peterson,&nbsp;Nathaniel Slinkard,&nbsp;Seth Janus,&nbsp;Robert Morgan","doi":"10.1055/s-0033-1357355","DOIUrl":"https://doi.org/10.1055/s-0033-1357355","url":null,"abstract":"<p><p>Study Design Case report. Clinical Question The clinical aim is to report on a previously unknown association between guidewire-assisted pedicle screw insertion and neuropraxia of the recurrent laryngeal nerve (RLN), and how this may overlap with the signs of Tapia syndrome; we also report our approach to the clinical management of this patient. Methods A 17-year-old male patient with idiopathic scoliosis experienced Tapia syndrome after posterior instrumentation and arthrodesis at the level of T1-L1. After extubation, the patient had a hoarse voice and difficulty in swallowing. Imaging showed a breach in the cortex of the anterior body of T1 corresponding to the RLN on the right. Results Otolaryngological examination noted right vocal fold immobility, decreased sensation of the endolarynx, and pooling of secretions on flexible laryngoscopy that indicated right-sided cranial nerve X injury and left-sided tongue deviation. Aspiration during a modified barium swallow prompted insertion of a percutaneous endoscopic gastrostomy tube before the patient was sent home. On postoperative day 20, a barium swallow demonstrated reduced aspiration, and the patient reported complete resolution of symptoms. The feeding tube was removed, and the patient resumed a normal diet 1 month later. Tapia syndrome, or persistent unilateral laryngeal and hypoglossal paralysis, is an uncommon neuropraxia, which has previously not been observed in association with a breached vertebral body at T1 along the course of the RLN. Conclusion Tapia syndrome should be a differential diagnostic consideration whenever these symptoms persist postoperatively and spine surgeons should be aware of this as a potential complication of guidewires in spinal instrumentation. </p>","PeriodicalId":89675,"journal":{"name":"Evidence-based spine-care journal","volume":"4 2","pages":"132-6"},"PeriodicalIF":0.0,"publicationDate":"2013-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1055/s-0033-1357355","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"32040881","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":"A comparison of radiostereometric analysis and computed tomography for the assessment of lumbar spinal fusion in a sheep model.","authors":"Ali Humadi,&nbsp;Brian J C Freeman,&nbsp;Rob J Moore,&nbsp;Stuart Callary,&nbsp;Klas Halldin,&nbsp;Vikram David,&nbsp;William Maclaurin,&nbsp;Paul Tauro,&nbsp;Mark Schoenwaelder","doi":"10.1055/s-0033-1357359","DOIUrl":"https://doi.org/10.1055/s-0033-1357359","url":null,"abstract":"<p><p>Study Design Prospective animal study. Objective The aim of this animal study is to evaluate the accuracy of radiostereometric analysis (RSA) compared with computed tomographic (CT) scan in the assessment of spinal fusion after anterior lumbar interbody fusion (ALIF) using histology as a gold standard. Methods Three non-adjacent ALIFs (L1-L2, L3-L4, and L5-L6) were performed in nine sheep. The sheep were divided into three groups of three sheep. All the animals were humanely killed immediately after having the last scheduled RSA. The lumbar spine was removed and in vitro fine cut CT and histopathology were performed. Results Using histological assessment as the gold standard for assessing fusion, RSA demonstrated better results (100% sensitivity and 66.7% specificity; positive predictive value [PPV] = 27.3%, negative predictive value [NPV] =100.0%) compared with CT (66.7% sensitivity and 60.0% specificity [PPV = 16.7%, NPV = 93.8%]). Conclusions RSA demonstrated higher sensitivity and specificity when compared with CT. Furthermore, RSA has the advantage of much lower radiation exposure compared with fine cut CT. Further studies are required to see if RSA remains superior to CT scan for the assessment spinal fusion in the clinical setting. [Table: see text]. </p>","PeriodicalId":89675,"journal":{"name":"Evidence-based spine-care journal","volume":"4 2","pages":"78-89"},"PeriodicalIF":0.0,"publicationDate":"2013-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1055/s-0033-1357359","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"32039851","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":"Canine notochordal cell-secreted factors protect murine and human nucleus pulposus cells from apoptosis by inhibition of activated caspase-9 and caspase-3/7.","authors":"Arne Mehrkens,&nbsp;M Zia Karim,&nbsp;Sarah Kim,&nbsp;Raychel Hilario,&nbsp;Michael G Fehlings,&nbsp;William Mark Erwin","doi":"10.1055/s-0033-1357363","DOIUrl":"https://doi.org/10.1055/s-0033-1357363","url":null,"abstract":"<p><p>Introduction Effective therapies that may stop or even reverse disc degeneration remain elusive. A minimally invasive method through which nucleus pulposus (NP) cell viability could be achieved would revolutionize the treatment of degenerative disc disease (DDD). With the presented work, we have investigated if nonchondrodystrophic (NCD) canine intervertebral disc (IVD)-derived notochordal cell conditioned medium (NCCM) and chondrodystrophic (CD) canine IVD-derived conditioned medium (CDCM) are able to protect murine and human NP cells from apoptosis. Materials and Methods We developed NCCM and CDCM from hypoxic culture of freshly isolated NPs from NCD and CD canines, respectively. We obtained murine NP cells from nine different C57BL/6 mice and human NP cells from four patients who underwent surgery for discectomy. The cells were cultured with ADMEM/F-12 (control media), NCCM, or CDCM under hypoxic conditions (3.5% O2) and treated with IL-1β + FasL or Etoposide. All media were supplemented with 2% fetal bovine serum. We then determined the expression of specific apoptotic pathways in the murine and human NP cells by recording activated caspase-8, caspase-9, and caspase-3/7 activity. Results In the murine NP cells, NCCM inhibits IL-1β + FasL- and Etoposide-mediated apoptosis via suppression of activated caspase-9 and caspase-3/7, CDCM demonstrated an inhibitory effect on IL-1β + FasL-mediated apoptosis via caspase-3/7 (Fig. 1A). In the human NP cells, NCCM inhibits Etoposide- mediated apoptosis via suppression of activated caspase-8, caspase-9, and mainly caspase-3/7. CDCM demonstrated an inhibitory effect on Etoposide-mediated apoptosis via suppression of activated caspase-8, caspase-9, and mainly caspase-3/7, though not as effective as NCCM (Fig. 1B). Conclusion IL-1β + FasL are known key molecules in the progression of DDD. Here, we demonstrate that soluble factors secreted by the NCD IVD NP strongly protect murine NP cells not only from IL-1β + FasL but also from Etoposide-induced apoptosis via suppression of activated caspase-9 and caspase-3/7. In the human samples, addition of IL-1β + FasL did not increase cell death. Because the human cell samples were obtained from herniated discs that are probably already undergoing a degenerative process, it is likely that there was already some degree of activation by the endogenously secreted prodegenerative factors such as IL-1β + FasL. It may be that the NP cells, once they have reached a pivotal point of the degenerative cascade, no longer respond to exogenously applied IL-1β + FasL in contrast to the otherwise \"healthy\" discs obtained from the mice. Interestingly, the rescue effect of NCCM in the etoposide-treated cells (murine and human) suggests that NCCM is capable of influencing the signaling pathways known to be relevant to etoposide-induced cell death. A better understanding and harnessing of the restorative powers of the notochordal cell could lead to novel cellular and molecular stra","PeriodicalId":89675,"journal":{"name":"Evidence-based spine-care journal","volume":"4 2","pages":"154-6"},"PeriodicalIF":0.0,"publicationDate":"2013-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1055/s-0033-1357363","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"32040885","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":"A novel scientific model for rare and often neglected neoplastic conditions.","authors":"Charles G Fisher,&nbsp;Tony Goldschlager,&nbsp;Stefano Boriani,&nbsp;Peter Pal Varga,&nbsp;Michael G Fehlings,&nbsp;Mark H Bilsky,&nbsp;Mark B Dekutoski,&nbsp;Alessandro Luzzati,&nbsp;Richard P Williams,&nbsp;Sigurd Berven,&nbsp;Dean Chou,&nbsp;Jeremy J Reynolds,&nbsp;Nasir A Quraishi,&nbsp;Laurence D Rhines,&nbsp;Chetan Bettegowda,&nbsp;Ziya L Gokaslan","doi":"10.1055/s-0033-1357365","DOIUrl":"https://doi.org/10.1055/s-0033-1357365","url":null,"abstract":"<p><p>Study Type Retrospective cohort. Introduction The treatment of rare neoplastic conditions is challenging, especially because studies providing high levels of evidence are often lacking. Such is the case with primary tumors of the spine (PTS), which have a low incidence, are pathologically heterogeneous, and have diverse treatment approaches.1 Despite these difficulties, appropriate evidence-based care of these complex patients is imperative. Failure to follow validated oncologic principles may lead to unnecessary mortality and profound morbidity. Objective With the aim of offering patients the most appropriate treatment based on the best available evidence, a novel scientific model was developed and employed. This article outlines this model, which has not only provided significant evidence guiding treatment of this rare condition, but we believe is readily transferrable to other similarly rare conditions. Methods A four-stage approach was employed. (1) Planning: Data from large volume centers were reviewed together with results from a feasibility questionnaire to provide insight into epidemiology, patient volumes, tumor pathology, treatment modalities, and outcomes. (2) Recruitment: Centers with sufficient volume and valid data were enrolled and provided with the necessary infrastructure. This included study coordinators and a secure, Web-based database (REDCap, Vanderbilt University, Nashville, Tennessee, United States) to capture international data from six modules comprising: demographic, clinical, diagnostic, therapeutic, local recurrence, perioperative morbidity fields, and a cross-sectional survey to update survival information. The AOSpine Knowledge Forum Tumor designed these modules and provided funding. Each center received institutional ethics approval. (3) Retrospective stage: Prospectively collected data from all recruited centers were reviewed and analyzed retrospectively. (4) Prospective stage: Following interim analysis, prospective data collection has been implemented. In addition, a PTS bio-bank network has been created to link clinical data with tumor pathology and molecular analysis. Results It took 18 months to implement stages 1 to 3 of this model and stage 4 is ongoing. A total of 1,495 tumor cases were captured and diagnosed as one of the 18 primary spine tumor subtypes listed (Fig. 1). The most prevalent diagnosis was chordoma (n = 344, 23%). There were 674 females and 821 males with a mean age of 43 ± 19 years at the time of surgery. Surgical treatment was performed between 1981 and 2012. The survival at 5 and 10 years postsurgery was 71.9 and 53.3%, respectively, with a median survival of 13 years postsurgery (Fig. 2). Conclusions To date, this is the largest international collection of PTS. This novel scientific model has not only aggregated a large amount of PTS data, but has also established an international collaborative network of spine oncology centers. The access to large volumes of clinical and bio-bank da","PeriodicalId":89675,"journal":{"name":"Evidence-based spine-care journal","volume":"4 2","pages":"160-2"},"PeriodicalIF":0.0,"publicationDate":"2013-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1055/s-0033-1357365","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"32040887","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":"Response to Letter to the Editor on: Efficacy of Bracing versus Observation in the Treatment of Idiopathic Scoliosis (Evid Based Spine Care J 2011;2(2):25-34).","authors":"Evan M Davies","doi":"10.1055/s-0033-1357354","DOIUrl":"https://doi.org/10.1055/s-0033-1357354","url":null,"abstract":"We appreciate the comments from D. Schlenzka and T. Yrjonen. We thank you for your interest in our article. \u0000 \u0000We agree that the article by Mannherz et al does cover a younger age group of patients, but given the difficulty finding prospective follow-up in bracing treatments, it was included as it showed failure in long-term follow-up.1 \u0000 \u0000The illustrative case demonstrates a patient with high compliance in that she was highly motivated to be braced, and continued to wish to be braced, despite earlier advice to the contrary that the brace treatment was failing to maintain the curve. The patient was premenarche at the time of treatment commencement. Continuation of treatment was purely at patient request. \u0000 \u0000In our institution, we have adopted the shared decision-making model for patient consent to treatment.2 All forms of treatment options are discussed with patients. Complications of observation, bracing, and surgical treatment are discussed. The clinician role is to allow patients to make the best individual decisions for their particular circumstances and this does vary between individuals and caregivers. Bracing is offered to patients at our institution, but the scientific evidence to support its use is compounded by the lack of large-scale multicenter and international trials to show that the brace will prevent curve deterioration and/or surgical intervention. We know that there is significant variation in cultural and regional patterns to brace compliance. Greg Houghton, in an article that would be difficult to replicate, placed electrodes within the brace that showed poor compliance.3 Patients often are psychologically affected by brace wearing in that it may turn a disease that is invisible to most visible to the majority. No treatment is without complication, and we need high-quality evidence to support and advocate and mentor patients in the use of any technology and treatment. Current, scientific literature is not as helpful as we would wish it to be in helping patients and caregivers make the best selection of care and decision making for their individual cases. The EBSJ offers a unique opportunity for the development of an appropriate, helpful, and scientifically validated randomized controlled trial in the use of bracing in idiopathic adolescent scoliosis (IAS). I would welcome such a development and an opportunity to help make better, more informed decision making in brace treatment in IAS.","PeriodicalId":89675,"journal":{"name":"Evidence-based spine-care journal","volume":"4 2","pages":"166"},"PeriodicalIF":0.0,"publicationDate":"2013-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1055/s-0033-1357354","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"32038559","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}