Spine
-
A retrospective-cohort investigation (N = 245) utilizing a review of patient medical records and costs accrued through the Workers' Compensation Fund of Utah. ⋯ Medical costs among compensated Utah patients receiving lumbar fusion have risen dramatically since the 1990s, whereas compensation costs have not. Biopsychosocial variables continue to be predictive of these costs, although to a more modest degree than in prior studies. Further investigations should look at other factors leading to increased medical costs.
-
Randomized Controlled Trial Multicenter Study
An evaluation of a postoperative rehabilitation program after spinal surgery and its impact on outcome.
This study invited patients to evaluate the content and style of a rehabilitation program used as an intervention in a multicenter, factorial, randomized controlled trial of the postoperative management of spinal surgery patients. ⋯ Compliance with a postoperative rehabilitation program was disappointing, but the program was assessed positively and of benefit by those who attended. Issues were raised in relation to timing and location of classes.
-
Randomized Controlled Trial
The efficacy of systematic active conservative treatment for patients with severe sciatica: a single-blind, randomized, clinical, controlled trial.
Prospective single-blind, randomized, clinical, controlled trial. ⋯ Active conservative treatment was effective for patients who had symptoms and clinical findings that would normally qualify them for surgery. Although participating patients had greater faith in the sham exercises before treatment, the symptom-guided exercises were superior for most outcomes.
-
Retrospective analysis of nationwide Veterans Health Administration clinical and administrative data. ⋯ In the Veterans Health Administration, HIV-infected patients experience significantly reduced rates of surgery for degenerative spine disease. Possible explanations include disease prevalence, emphasis on treatment of nonspine HIV-related symptoms, surgical referral patterns, impact of HIV on surgery risk-benefit ratio, patient preferences, and surgeon bias.
-
Randomized Controlled Trial Multicenter Study Comparative Study
A prospective randomized FDA-IDE trial comparing Cortoss with PMMA for vertebroplasty: a comparative effectiveness research study with 24-month follow-up.
Randomized, controlled, prospective (AAOS therapeutic level I) trial conducted under Food and Drug Administration Investigational Device Exemption hypothesized noninferiority of a novel bioactive composite material to polymethylmethacrylate (PMMA). ⋯ Vertebroplasty using either Cortoss or PMMA provides effective, immediate, and lasting pain relief and prevents further loss of function. Both materials performed comparably at most time points; Cortoss demonstrated better results for pain reduction at 3 months and for function at 24 months.