The spine journal : official journal of the North American Spine Society
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Review
Strategies to improve the credibility of meta-analyses in spine surgery: a systematic survey.
Meta-analyses are powerful tools that can synthesize existing research, inform clinical practice, and support evidence-based care. These studies have become increasingly popular in the spine surgery literature, but the rigor with which they are being conducted has not yet been evaluated. ⋯ The credibility of many current spine surgery meta-analyses is limited. Researchers can improve future meta-analyses by performing exhaustive literature searches, addressing possible explanations of heterogeneity, presenting results in a clinically useful manner, reproducibly selecting and assessing primary studies, addressing confidence in the pooled effect estimates, and adhering to guidelines for complete reporting.
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Spinal gunshot injuries (spinal GSIs) are a major cause of morbidity and mortality in both military and civilian populations. These injuries are likely to be encountered by spine care professionals in many treatment settings. A paucity of resources is available to summarize current knowledge of spinal GSI evaluation and management. ⋯ Treatment of spinal GSI requires a multidisciplinary approach with the goal of maintaining or restoring spinal stability and neurologic function and minimizing complications. Concomitant injuries and complications after spinal GSI can present immediate and ongoing challenges to the medical, surgical and rehabilitative care of the patient.
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Back pain is the most prevalent of musculoskeletal conditions, and back pain sufferers have been identified as high users of complementary and alternative medicine (CAM). Despite lacking evidence, CAM treatments (e.g., acupuncture, chiropractic, and massage) and CAM products (eg, vitamins, supplements, and aromatherapy oils) for back pain care have become widely available internationally, and CAM use by back pain sufferers has become a significant health service issue. However, to date, there has been no integrative review on CAM use for back pain. ⋯ The review findings provide insights for health-care providers and policy makers on the range of CAM treatments used by back pain sufferers. Conventional medical and CAM practitioners should be aware of back pain sufferers' decision making regarding a range of CAM treatments and be prepared to communicate with patients on safe and effective CAM treatments for back pain.
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Review Meta Analysis
Spinal cord stimulation: a review of the safety literature and proposal for perioperative evaluation and management.
There is currently no consensus on appropriate perioperative management of patients with spinal cord stimulator implants. Magnetic resonance imaging (MRI) is considered safe under strict labeling conditions. Electrocautery is generally not recommended in these patients but sometimes used despite known risks. ⋯ Spinal cord stimulation is increasingly used in patients with pain of spinal origin, particularly to manage postlaminectomy syndrome. Knowledge of the safety concerns of SCS and appropriate perioperative evaluation and management of the SCS system can reduce risks and improve surgical planning.
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Although explored in humans and animal models, the pathomechanisms of discogenic low back pain (LBP) remain unknown. ⋯ To treat discogenic LBP, it is important to prevent sensitization of sensory nerve fibers innervating the IVD, to suppress pathogenic increases of cytokines, and to decrease disc hypermobility.