The spine journal : official journal of the North American Spine Society
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Review Meta Analysis Comparative Study
A cost-utility analysis of sacral anterior root stimulation (SARS) compared with medical treatment in patients with complete spinal cord injury with a neurogenic bladder.
Sacral anterior root stimulation (SARS) and posterior sacral rhizotomy restores the ability to urinate on demand with low residual volumes, which is a key for preventing urinary complications that account for 10% of the causes of death in patients with spinal cord injury with a neurogenic bladder. Nevertheless, comparative cost-effectiveness results on a long time horizon are lacking to adequately inform decisions of reimbursement. ⋯ Our model shows that SARS using Finetech-Brindley device offers the most important benefit and should be considered cost-effective at a cost-effectiveness threshold of 30,000 EUR per QALY. Despite a high uncertainty, EVPI and partial EVPI may indicate that further research would not be profitable to inform decision-making.
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Skeletal involvement is observed in almost 80% of patients presenting with symptomatic multiple myeloma (MM). The vertebral column is the most frequently affected site by myeloma-induced osteoporosis, osteolysis, and compression fractures. Multiple pathologic compression fractures can lead to significant spinal deformity, which is often considered for complex reconstruction because of the poor quality of life for the affected patients. ⋯ Pathologic SF in an MM patient with thoracic compression fractures is a potential risk factor for the development of a severe thoracic kyphotic deformity and sagittal malalignment. This has been demonstrated in this study to be associated with a very poor health-related quality of life. A greater awareness of sternal myeloma disease is needed at presentation (the time of the primary survey) so that SFs can be potentially avoided, thereby preventing progression to a severe kyphotic deformity.
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Cervical spine segmental contributions to motion may reveal movement abnormalities associated with whiplash, disc herniation, disc arthroplasty, or fusion. ⋯ Cervical motion segment contributions to head motion change over the full ROM and cannot be accurately characterized solely from endpoint data. The continuously changing segmental contributions suggest that the compressive and shear loads applied to each motion segment also change over the ROM. The clinical implication of increased contributions from the inferior motions segments near the end ROM is that the clinician may advise the patient to avoid end ROM positions to lessen the demand on the discs of inferior motion segments.