Evidence-based spine-care journal最新文献

{"title":"Early Morbidity of Multilevel Anterior Cervical Discectomy and Fusion with Plating for Spondylosis: Does the Number of Levels Influence Early Complications? A Single Surgeon's Experience in 519 Consecutive Patients.","authors":"Dennis E Bullard,&nbsp;Jillian S Valentine","doi":"10.1055/s-0033-1341598","DOIUrl":"https://doi.org/10.1055/s-0033-1341598","url":null,"abstract":"<p><p>Study Design This is a retrospective review of a prospectively maintained database of anterior cervical discectomy and fusion with plating (ACDFP) cases. Objective The aim of this study is to evaluate within a clinical practice evidence-based results of short-term morbidity with multilevel ACDFP. Methods Clinical morbidity, length of hospital stay, visual analog scale (VAS) and Odom scores, Neck Disability Index (NDI), hardware failure, and return-to-work (RTW) status were prospectively collected in an electronic database for 678 patients who underwent 1-, 2-, 3-, or 4-level ACDFP during an 8-year period. A total of 519 patients met the study criteria and were retrospectively analyzed. Results The majority of all patients noted \"Excellent\" or \"Good\" status for 1 month (91%), 2 months (92%), and 3 months (96%). Patients with 1-, 2-, and 3-level ACDFP returned to work sooner, 60% at 1 month, 70% at 2 months, and 68% at 3 months. For 4-level patients, the majority did not RTW until 3 months (71%). The only significant increase in morbidity with increasing levels was hospital stay for 3- and 4-level ACDFP and RTW for 4-level ACDFP. Conclusion Multilevel ACDFP can be performed with low initial morbidity. An individual practice can review results to allow for ongoing evidence-based care. [Table: see text]. </p>","PeriodicalId":89675,"journal":{"name":"Evidence-based spine-care journal","volume":"4 1","pages":"13-7"},"PeriodicalIF":0.0,"publicationDate":"2013-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1055/s-0033-1341598","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"32040972","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":"Vertebral Osteotomies in Ankylosing Spondylitis-Comparison of Outcomes Following Closing Wedge Osteotomy versus Opening Wedge Osteotomy: A Systematic Review.","authors":"Robert A Ravinsky, Jean-Albert Ouellet, Erika D Brodt, Joseph R Dettori","doi":"10.1055/s-0033-1341604","DOIUrl":"10.1055/s-0033-1341604","url":null,"abstract":"<p><p>Study Design Systematic review. Study Rationale To seek out and assess the best quality evidence available comparing opening wedge osteotomy (OWO) and closing wedge osteotomy (CWO) in patients with ankylosing spondylitis to determine whether their results differ with regard to several different subjective and objective outcome measures. Objective The aim of this study is to determine whether there is a difference in subjective and objective outcomes when comparing CWO and OWO in patients with ankylosing spondylitis suffering from clinically significant thoracolumbar kyphosis with respect to quality-of-life assessments, complication risks, and the amount of correction of the spine achieved at follow-up. Methods A systematic review was undertaken of articles published up to July 2012. Electronic databases and reference lists of key articles were searched to identify studies comparing effectiveness and safety outcomes between adult patients with ankylosing spondylitis who received closing wedge versus opening wedge osteotomies. Studies that included pediatric patients, polysegmental osteotomies, or revision procedures were excluded. Two independent reviewers assessed the strength of evidence using the GRADE criteria and disagreements were resolved by consensus. Results From a total of 67 possible citations, 4 retrospective cohorts (class of evidence III) met our inclusion criteria and form the basis for this report. No differences in Oswestry Disability Index, visual analog scale for pain, Scoliosis Research Society (SRS)-24 score, SRS-22 score, and patient satisfaction were reported between the closing and opening wedge groups across two studies. Regarding radiological outcomes following closing versus opening osteotomies, mean change in sagittal vertical axis ranged from 8.9 to 10.8 cm and 8.0 to 10.9 cm, respectively, across three studies; mean change in lumbar lordosis ranged from 36 to 47 degrees and 19 to 41 degrees across four studies; and mean change in global kyphosis ranged from 38 to 40 degrees and 28 to 35 degrees across two studies. Across all studies, overall complication risks ranged from 0 to 16.7% following CWO and from 0 to 23.6% following OWO. Conclusion No statistically significant differences were seen in patient-reported or radiographic outcomes between CWO and OWO in any study. The risks of dural tear, neurological injury, and reoperation were similar between groups. Blood loss was greater in the closing wedge compared with the opening wedge group, while the risk of paralytic ileus was less. The overall strength of evidence for the conclusions is low. </p>","PeriodicalId":89675,"journal":{"name":"Evidence-based spine-care journal","volume":"4 1","pages":"18-29"},"PeriodicalIF":0.0,"publicationDate":"2013-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3699248/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"32040973","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 outcomes of manipulation or mobilization therapy compared with physical therapy or exercise for neck pain: a systematic review.","authors":"Josh Schroeder, Leon Kaplan, Dena J Fischer, Andrea C Skelly","doi":"10.1055/s-0033-1341605","DOIUrl":"10.1055/s-0033-1341605","url":null,"abstract":"<p><p>Study Design Systematic review. Study Rationale Neck pain is a prevalent condition. Spinal manipulation and mobilization procedures are becoming an accepted treatment for neck pain. However, data on the effectiveness of these treatments have not been summarized. Objective To compare manipulation or mobilization of the cervical spine to physical therapy or exercise for symptom improvement in patients with neck pain. Methods A systematic review of the literature was performed using PubMed, the National Guideline Clearinghouse Database, and bibliographies of key articles, which compared spinal manipulation or mobilization therapy with physical therapy or exercise in patients with neck pain. Articles were included based on predetermined criteria and were appraised using a predefined quality rating scheme. Results From 197 citations, 7 articles met all inclusion and exclusion criteria. There were no differences in pain improvement when comparing spinal manipulation to exercise, and there were inconsistent reports of pain improvement in subjects who underwent mobilization therapy versus physical therapy. No disability improvement was reported between treatment groups in studies of acute or chronic neck pain patients. No functional improvement was found with manipulation therapy compared with exercise treatment or mobilization therapy compared with physical therapy groups in patients with acute pain. In chronic neck pain subjects who underwent spinal manipulation therapy compared to exercise treatment, results for short-term functional improvement were inconsistent. Conclusion The data available suggest that there are minimal short- and long-term treatment differences in pain, disability, patient-rated treatment improvement, treatment satisfaction, health status, or functional improvement when comparing manipulation or mobilization therapy to physical therapy or exercise in patients with neck pain. This systematic review is limited by the variability of treatment interventions and lack of standardized outcomes to assess treatment benefit. </p>","PeriodicalId":89675,"journal":{"name":"Evidence-based spine-care journal","volume":"4 1","pages":"30-41"},"PeriodicalIF":0.0,"publicationDate":"2013-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3699243/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"32039843","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":"Disc degeneration after disc herniation: are we accelerating the process?","authors":"Josh E Schroeder,&nbsp;Joseph R Dettori,&nbsp;Erika D Brodt,&nbsp;Leon Kaplan","doi":"10.1055/s-0032-1328141","DOIUrl":"https://doi.org/10.1055/s-0032-1328141","url":null,"abstract":"<p><strong>Study design: </strong> Systematic review.</p><p><strong>Study rationale: </strong> Disc degeneration is a common process starting early in life. Often disc herniation is an early step in disc degeneration, which may cause pain or stenosis. How quickly this subsequent disc degeneration occurs following a disc herniation and subsequent surgical treatment and whether certain spinal procedures increase the rate of degeneration remain unclear.</p><p><strong>Objectives: </strong> To investigate the risk of subsequent radiographic disc degeneration following discectomy, discography, and conservative care in patients with a first-time diagnosed herniated nucleus pulpous (HNP) and to ascertain whether this risk in these defined groups changes over time.</p><p><strong>Methods: </strong> A systematic review of pertinent articles published up to June 2012. Key articles were searched to identify studies evaluating the risk of subsequent radiographic disc degeneration following treatment for HNP. Studies that included patients undergoing secondary surgery for disc herniation or that did not use a validated classification system to measure the severity of disc degeneration were excluded. Two independent reviewers assessed the strength of evidence using the GRADE criteria and disagreements were resolved by consensus.</p><p><strong>Results: </strong> From a total of 147 possible citations, three cohort studies (class of evidence III) met our inclusion criteria and form the basis for this report. The risk of subsequent lumbar disc degeneration following standard discectomy was significantly greater compared with both microdiscectomy (48.7% vs 9.1%) and asymptomatic controls (90% vs 68%) in two studies with mean follow-ups of 5.5 and 25.3 years, respectively. Following conservative care for first-time HNP in the third study, the risk of progression of lumbar disc degeneration was 47.6% over the first 2 years of follow-up and 95.2% over the next 6 years of follow-up. In the same study, the risk of lumbar disc degeneration was shown to increase incrementally over the course of the 8-year follow-up, with all patients showing signs of degeneration at final examination.</p><p><strong>Conclusion: </strong> Standard discectomy in first-time lumbar HNP may increase the risk of subsequent same-level lumbar disc degeneration compared with microdiscectomy as seen in one low-quality study. However, disc degeneration is likely a natural, temporal consequence following HNP, as demonstrated in a second low-quality study. The overall strength of evidence for the conclusions is very low.</p>","PeriodicalId":89675,"journal":{"name":"Evidence-based spine-care journal","volume":"3 4","pages":"33-40"},"PeriodicalIF":0.0,"publicationDate":"2012-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1055/s-0032-1328141","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"31333485","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":"Decompression alone versus decompression with limited fusion for treatment of degenerative lumbar scoliosis in the elderly patient.","authors":"Michael D Daubs,&nbsp;Lawrence G Lenke,&nbsp;Keith H Bridwell,&nbsp;Gene Cheh,&nbsp;Yongjung J Kim,&nbsp;Georgia Stobbs","doi":"10.1055/s-0032-1328140","DOIUrl":"https://doi.org/10.1055/s-0032-1328140","url":null,"abstract":"<p><strong>Study design: </strong> Retrospective cohort study.</p><p><strong>Objective: </strong> To analyze the surgical results of a group of patients older than 65 years treated for mild degenerative lumbar scoliosis (<30°) with stenosis, treated with decompression alone or decompression and limited fusion.</p><p><strong>Methods: </strong> We evaluated 55 patients, all older than 65 years from our prospectively collected database with mild degenerative scoliosis (<30°) and stenosis who underwent surgery. Laminectomy alone was performed in 16 patients, and laminectomy and limited fusion in 39 patients. Mean follow-up was 4.6 years in the decompression group and 5.0 years in the fusion group. Clinical results were graded by patients' self-reported satisfaction and length of symptom-free period to recurrence.</p><p><strong>Results: </strong> In the decompression alone group, 6 (37%) of 16 patients developed recurrent stenosis at the previously decompressed level and five developed recurrence within 6 months postoperatively versus the decompression and fusion group where 3 (8%) of 39 (P = .0476) developed symptomatic stenosis supra adjacent to the fusion. Of 16 patients in the decompression alone group, 12 (75%) had recurrence of symptoms by the 5-year follow-up period versus only 14 (36%) patients in the decompression and fusion group (P = .016). Adjacent segment degenerative changes were common in the fusion group, but only 7% developed symptomatic stenosis.</p><p><strong>Conclusions: </strong> Decompression with limited fusion prevents early return of stenotic symptoms compared with decompression alone in the setting of mild degenerative scoliosis (<30°) and symptomatic stenosis in patients 65 years and older. [Table: see text] The definiton of the different classes of evidence is available on page 67.</p>","PeriodicalId":89675,"journal":{"name":"Evidence-based spine-care journal","volume":" ","pages":"27-32"},"PeriodicalIF":0.0,"publicationDate":"2012-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1055/s-0032-1328140","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40228319","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":"Surgical management of giant multilevel aneurysmal bone cyst of cervical spine in a 10-year-old boy: case report with review of literature.","authors":"Hitesh Kumar Gurjar,&nbsp;Avijit Sarkari,&nbsp;P Sarat Chandra","doi":"10.1055/s-0032-1328143","DOIUrl":"https://doi.org/10.1055/s-0032-1328143","url":null,"abstract":"<p><strong>Background: </strong> Aneurysmal bone cysts are rare occurrences in the cervical spine. Surgical treatment in pediatric patients is a challenge. Complete tumor resection offers the best chance for cure.</p><p><strong>Description: </strong> Diagnosis and surgical management of an expansile aneurysmal bone cyst of the cervical spine involving all three spinal columns in a 10-year-old boy.</p><p><strong>Results: </strong> Surgical treatment included tumor excision and circumferential fusion, and produced no neurological or vascular sequelae. This approach minimizes the risk of recurrence and the possibility of postoperative spinal instability.</p><p><strong>Conclusion: </strong> Spinal instability is preferably addressed with reconstruction and stabilization. Cervical aneurismal bone cyst lesions are ideally treated with complete resection to minimize the chance of recurrence. In pediatric cases, defects created by resection should be corrected by fusion to minimize the risk of postoperative instability and growth abnormality.</p>","PeriodicalId":89675,"journal":{"name":"Evidence-based spine-care journal","volume":"3 4","pages":"55-9"},"PeriodicalIF":0.0,"publicationDate":"2012-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1055/s-0032-1328143","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"31333487","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":"Surgical versus injection treatment for injection-confirmed chronic sacroiliac joint pain.","authors":"William Ryan Spiker,&nbsp;Brandon D Lawrence,&nbsp;Annie L Raich,&nbsp;Andrea C Skelly,&nbsp;Darrel S Brodke","doi":"10.1055/s-0032-1328142","DOIUrl":"https://doi.org/10.1055/s-0032-1328142","url":null,"abstract":"<p><strong>Study design: </strong> Systematic review.</p><p><strong>Study rationale: </strong> Chronic sacroiliac joint pain (CSJP) is a common clinical entity with highly controversial treatment options. A recent systematic review compared surgery with denervation, but the current systematic review compares outcomes of surgical intervention with therapeutic injection for the treatment of CSJP and serves as the next step for evaluating current evidence on the comparative effectiveness of treatments for non-traumatic sacroiliac joint pain. Objective or clinical question:  In adult patients with injection-confirmed CSJP, does surgical treatment lead to better outcomes and fewer complications than injection therapy?</p><p><strong>Methods: </strong> A systematic review of the English-language literature was undertaken for articles published between 1970 and June 2012. Electronic databases and reference lists of key articles were searched to identify studies evaluating surgery or injection treatment for injection-confirmed CSJP. Studies involving traumatic onset or non-injection-confirmed CSJP were excluded. Two independent reviewers assessed the level of evidence quality using the grading of recommendations assessment, development and evaluation (GRADE) system, and disagreements were resolved by consensus.</p><p><strong>Results: </strong> We identified twelve articles (seven surgical and five injection treatment) meeting our inclusion criteria. Regardless of the type of treatment, most studies reported over 40% improvement in pain as measured by Visual Analog Scale or Numeric rating Scale score. Regardless of the type of treatment, most studies reported over 20% improvement in functionality. Most complications were reported in the surgical studies.</p><p><strong>Conclusion: </strong> Surgical fusion and therapeutic injections can likely provide pain relief, improve quality of life, and improve work status. The comparative effectiveness of these interventions cannot be evaluated with the current literature.</p>","PeriodicalId":89675,"journal":{"name":"Evidence-based spine-care journal","volume":"3 4","pages":"41-53"},"PeriodicalIF":0.0,"publicationDate":"2012-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1055/s-0032-1328142","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"31333486","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":"Lumbar microdiscectomy and lumbar decompression improve functional outcomes and depression scores.","authors":"Suzanne Tharin,&nbsp;Eric Mayer,&nbsp;Ajit Krishnaney","doi":"10.1055/s-0032-1328146","DOIUrl":"https://doi.org/10.1055/s-0032-1328146","url":null,"abstract":"<p><strong>Study design: </strong> Retrospective review.</p><p><strong>Introduction: </strong> Lumbar radiculopathy and claudicant leg pain are common degenerative spinal conditions often treated by elective microdiscectomy or decompression. Published outcome data for these procedures have focused on improvement in pain scores, and not on grounded functional outcome or depression scores.1,2,3 Moreover, depression is considered by many surgeons to be a red flag for poor outcome for surgical treatment. We asked what effect lumbar microdiscectomy and laminectomy procedures had on functional outcome and depression scores in our clinical population.</p><p><strong>Methods: </strong> Beginning in January 2010, the following outcome data were prospectively gathered before and after surgery from all patients at the Cleveland Clinic undergoing either lumbar microdiscectomy or lumbar decompression: EQ-5D (EuroQOL, quality-of-life measure), PHQ-9 (measure of depressive symptoms), PDQ (pain disability questionnaire), and Rankin scores (disability or dependence in daily activities).</p><p><strong>Results: </strong> The mean EuroQOL scores improved by 35% (from 0.4-0.75 of a maximum of 1.0) for both microdiscectomy and lumbar laminectomies. The mean PHQ-9 scores (measure of depressive symptoms) significantly improved for most patients undergoing either procedure. In line with previously published reports, we also found improvement in Rankin scores and Pain Disability Questionnaire scores.</p><p><strong>Conclusions: </strong> Our outcome data indicate that microdiscectomy and lumbar decompression not only reduce disability and pain but also improve depressive symptoms and overall quality of life for patients. These findings support operative treatment of lumbar radiculopathy and neurogenic claudication including treatment performed in the depressed population.</p>","PeriodicalId":89675,"journal":{"name":"Evidence-based spine-care journal","volume":"3 4","pages":"65-6"},"PeriodicalIF":0.0,"publicationDate":"2012-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1055/s-0032-1328146","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"31333490","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":"Changing healthcare as we do it: with evidence and cheesecake?","authors":"Jens Chapman","doi":"10.1055/s-0032-1328136","DOIUrl":"https://doi.org/10.1055/s-0032-1328136","url":null,"abstract":"Dr Atul Gawande, Associate Professor at Harvard School of Medicine and practicing General and Endocrine Surgeon at the Brigham and Women’s Hospital in Boston, has gained a fair bit of attention in North America with his lectures, articles, and bestselling publications, such as Complications, Better, and Checklist Manifesto, which all deal with the need to renew our thinking regarding patient safety and quality control. Recently, he took this theme one step further in an article titled “Big Med,” published in The New Yorker in the August 13, 2012 issue [1]. He took a novel approach by looking behind the scenes of several large high-quality restaurant chains and retailers in North America to identify their secrets to success. Without oversimplifying his message too much, he found mainly two factors to be of cardinal importance: adaptive standardization and effective quality control. At a certain high-end restaurant chain, freshly made first-rate cheesecake served consistently at every location despite an ever-changing menu laid the foundation for its sustained and ongoing success. In his article, Dr Gawande then translated the principles behind the success of this particular restaurant chain to healthcare. He demonstrated how these same underlying principles of quality control and adaptive standardization were incrementally being applied by several large, recently formed hospital chains in the United States. To exemplify this, he described a visit to a centralized ICU monitoring unit, which through video and complete data control was trying to assure best possible and standardized treatment for all ICU patients throughout the hospitals of a large, new healthcare system. This was no different from the restaurant chain, which used centralized high-end video monitoring and mentoring of its kitchen staff to assure best possible cheesecakes to be produced throughout its more than 150 restaurants. No room for improvisation, no need for improvisation—the product is as good as it can get and the customers are obviously happy.","PeriodicalId":89675,"journal":{"name":"Evidence-based spine-care journal","volume":"3 4","pages":"5-6"},"PeriodicalIF":0.0,"publicationDate":"2012-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1055/s-0032-1328136","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"31333483","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":"Economic studies part I: basics and terms.","authors":"Nora B Henrikson,&nbsp;Andrea C Skelly","doi":"10.1055/s-0032-1328137","DOIUrl":"https://doi.org/10.1055/s-0032-1328137","url":null,"abstract":"There is an increasing realization across the globe that the resources available in society for the provision of medical care are fi nite. As such, in addition to establishing the effi cacy and effectiveness of spinal procedures, it is becoming increasingly important to also describe their economic impact. In general, the most compelling analyses are those which compare the costs and effi cacy of two competing options for care in a formal, full economic analysis.","PeriodicalId":89675,"journal":{"name":"Evidence-based spine-care journal","volume":"3 4","pages":"7-11"},"PeriodicalIF":0.0,"publicationDate":"2012-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1055/s-0032-1328137","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"31333484","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}