The spine journal : official journal of the North American Spine Society
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Previous studies have identified inconsistencies in physician conflict-of-interest disclosures at academic meetings. The Physician Payment Sunshine Act (PPSA) will require industry to disclose anything of value given to physicians by 2014. In preparation, some spine device companies have begun reporting payments online. ⋯ Discrepancy rates between what spine surgeons disclosed at NASS 2011 and what companies reported for their consultants were high. This is concerning given the passage of the PPSA as well as the increased public visibility of potential discrepancies. More uniform practices will certainly be necessary.
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Sudo H, Ito M, Kaneda K, et al. Anterior decompression and strut graft versus posterior decompression and pedicle screw fixation with vertebroplasty for osteoporotic thoracolumbar vertebral collapse with neurological deficits. Spine J 2013;13:1726-32 (in this issue).
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Exercise has been shown to reduce pain and increase function in patients with chronic low back pain. However up to 70% of patients do not engage in prescribed home exercise. Physiotherapists need to understand more about the complex factors influencing patients' adherence to prescribed home exercise to tailor their exercise interventions more effectively and support patients to self-manage. ⋯ This is the first systematic review investigating adherence to prescribed home exercise in a chronic low back pain population. It is difficult to draw firm conclusions because the research lacks detailed descriptions of intervention content. The use of a taxonomy of behavior change techniques has been suggested to overcome this key problem. This review has highlighted the lack of standardized measures of adherence to prescribed home exercise. The development of a validated measure of adherence should be a priority because this will provide a better understanding of the multitude of factors that may influence adherence to home exercise.
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Reliability of the clinical examination in the diagnosis of neurogenic versus vascular claudication.
As research increasingly challenges the diagnostic accuracy of advanced imaging for lumbar spinal stenosis, the impression gleaned from the office evaluation becomes more important. Neurogenic claudication is a hallmark of lumbar spinal stenosis, but the reliability of clinical impression of claudication has not been studied. ⋯ The clinical impression of neurogenic claudication is a reliable construct. The history, but not the poorly reproduced physical examination, contributes to reliability. The level of disagreement between experts in this simplified, yet severely involved, population raises concern about the risk of misdiagnosis in individual cases. Thus, surgical and other consequential decisions about diagnosis may require ancillary tests such as electromyography or ABI.
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Closed reduction and internal fixation by an anterior approach is an established option for operative treatment of displaced Type II odontoid fractures. In elderly patients, however, inadequate screw purchase in osteoporotic bone can result in severe procedure-related complications. ⋯ Cement augmentation of the screw in Type II odontoid fractures in elderly patients is technically feasible in a clinical setting with a low complication rate. This technique may improve screw purchase, especially in the osteoporotic C2 body.