Spine
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Meta Analysis
Statistical significance versus clinical importance: trials on exercise therapy for chronic low back pain as example.
Critical appraisal of the literature. ⋯ It seems that many conclusions of studies of exercise therapy for chronic low back pain have been based on statistical significance of results rather than on clinical importance and, consequently, may have been too positive. Authors of trials should report not only statistical significance of results but also clinical importance.
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Meta Analysis
The surgical management of degenerative lumbar spondylolisthesis: a systematic review.
Systematic review. ⋯ Spinal fusion may lead to a better clinical outcome than decompression alone. No conclusion about the clinical benefit of instrumenting a spinal fusion could be made. However, there is moderate evidence that the use of instrumentation improves the chance of achieving solid fusion.
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An updated Cochrane Review. ⋯ Surgical discectomy for carefully selected patients with sciatica due to lumbar disc prolapse provides faster relief from the acute attack than conservative management, although any positive or negative effects on the lifetime natural history of the underlying disc disease are still unclear. The evidence for other minimally invasive techniques remains unclear except for chemonucleolysis using chymopapain, which is no longer widely available.
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Anecdotal reports and limited data suggest that the use of spinal injections is increasing, despite equivocal evidence about efficacy. ⋯ Lumbosacral injections increased dramatically in the Medicare population from 1994 to 2001. Less than half were performed for sciatica or radiculopathy, where the greatest evidence of benefit is available. These findings suggest a lack of consensus regarding the indications for ESIs and are cause for concern given the large expenditures for these procedures.
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Case Reports
Atypical syringomyelia without cavity in a patient with Chiari malformation and hydrocephalus.
A case report is presented. ⋯ Obstruction of the cerebrospinal fluid pathways in the upper spine may result in spinal cord gray matter T2 prolongation that is reversible after restoration of patency of cerebrospinal fluid pathways and stress the importance of timely intervention to limit progression to syringomyelia.