The spine journal : official journal of the North American Spine Society
-
Various methodologies have been used in attempting to elucidate a standard method for calculating minimal clinically important difference (MCID). A consensus-based decision (Initiative on Methods, Measurement, and Pain Assessment in Clinical Trials [IMMPACT] group) suggested a 30% reduction from baseline as a means to define the MCID of self-report back pain measures. Additionally, important psychometric issues need to be addressed regarding use of an independent measure of the same construct as an external criterion, instead of simply using another self-report measure, when using an anchor-based approach to MCID. ⋯ When objective and independent criteria are used (socioeconomic outcomes) in a CDOSD cohort, the 30% improvement in the ODI and SF-36 may not be a valid MCID index. This replicates similar conclusions made by an independent research group using a distribution-based approach to MCID. The validity of the MCID concept rests on future research using objective external criteria. Moreover, there remains a question whether the term "important" in MCID can be unequivocally and operationally defined as a reliable construct.
-
Review Case Reports
Postoperative spinal epidural hematoma at a site distant from the main surgical procedure: a case report and review of the literature.
Postoperative spinal epidural hematomas are known complications of spinal surgery. However, to our knowledge, there are no known cases of postoperative spinal epidural hematoma that occurred distant from the portion of the procedure that breached the spinal canal. ⋯ Spinal epidural hematomas are rare but dangerous complications that can result in severe neurologic deficits. A neurologic examination should always be conducted in the operating room immediately after surgery; if it is abnormal, spinal epidural hematoma should be suspected. If the examination indicates a deficit at a site distant from the original surgery, then diagnostic reimaging (magnetic resonance imaging or computed tomography myelogram) is indicated.
-
Many Americans seek and are influenced in their decision making by medical information on the Internet. Past studies have repeatedly found information on most medical Web sites to be deficient and of low quality. Physicians must remain aware of the quality and reliability of the information available on the Internet for patient education purposes. ⋯ There is wide variability in Web site quality, with most of the Web sites failing to be sufficiently comprehensive and accurate. Physicians treating patients with cervical disc herniation must remain vigilant in guiding their patients to proper information on the Internet.
-
Degenerative spine disease will become an increasing health problem, and a significant number of patients will be considered for surgery. Spinal surgeries have evolved since the last decades, and there is a positive impact on the clinical outcomes. Few works in the literature have reviewed the outcome compared with large joint replacement surgery, which is considered a benchmark for operative restoration of patients' quality of life. ⋯ The current study demonstrated that spinal surgery can return patients' HRQL to that of age-matched population norms and yield outcomes comparable with those of total hip and knee joint replacement patients.
-
Comparative Study
Biomechanical comparison of single- and two-level cervical arthroplasty versus arthrodesis: effect on adjacent-level spinal kinematics.
The use of motion-preserving spinal implants versus conventional arthrodesis instrumentation systems, which stabilize operative segments, necessitates improved understanding of their effect on spinal kinematics and the biomechanically optimal method for surgical reconstruction. ⋯ This study highlights the biomechanical effects of single- and two-level cervical arthroplasty versus single- and two-level arthrodesis on four functional spinal levels (C4-T1). Operative-level ROM was preserved with single- and two-level arthroplasty under all loading modes. The distal adjacent level (C7-T1) demonstrated the greatest increase among the four levels in ROM compared with the intact condition after two-level arthrodesis. These kinematic findings were corroborated by changes in the adjacent-level centers of rotation after arthrodesis and may suggest a biomechanical cause of adjacent-level disease secondary to cervical arthrodesis.