The spine journal : official journal of the North American Spine Society
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There is a lack of agreement among spine surgeons as to the best surgical treatment modality for many degenerative lumbar diseases. Although there are many studies examining trends in spinal surgery, specific studies reporting the variations in surgical treatment in the United States for these diseases are lacking. ⋯ There are large differences in the United States for surgical treatment methods for lumbar spine pathology. These differences are likely multifactorial, with both patient and surgeon traits playing a role. Illustrating these differences will hopefully lead to outcomes research to determine the indications, efficacy, and appropriateness of these surgical methods, an important step on the path toward standardization of care.
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Comparative Study
Minimally invasive compared with open lumbar laminotomy: no functional benefits at 6 or 24 months after surgery.
Comparative studies between open and minimally invasive surgical (MIS) approaches for the treatment of spinal stenosis have mainly investigated immediate postoperative parameters. ⋯ Compared with an open approach, MIS lumbar laminotomy gave no clear advantages in longer term functional or pain scores. The MIS group also had patients with inadvertent durotomies and reoperation within 2 years. In any lumbar decompressive surgery, the purported advantages of an MIS approach should be carefully weighed against potential complications. For a relatively simple surgery such as laminotomy, the open approach remains a safe and straightforward option.
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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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Low back pain and disability are major public health problems and may be related to paraspinal muscle abnormalities, such as a reduction in muscle size and muscle fat content. ⋯ Paraspinal fat infiltration, but not muscle CSA, was associated with high-intensity pain/disability and structural abnormalities in the lumbar spine. Although cause and effect cannot be determined from this cross-sectional study, longitudinal data will help to determine whether disabling low back pain and structural abnormalities of the spine are a cause or result of fat replacement of paraspinal muscles.
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Randomized Controlled Trial Comparative Study
The comparison of pedicle screw and cortical screw in posterior lumbar interbody fusion: a prospective randomized noninferiority trial.
Pedicle screws (PS) offer great benefits in posterior lumbar interbody fusion (PLIF), but several drawbacks of PS, including the risk of superior facet joint violation and muscle injury, have also pointed out. Recently, cortical screws (CS) were invented, which can be placed without the drawbacks associated with PS. However, whether CS in PLIF can provide similar or greater clinical and radiologic outcomes compared to those of PS has not been fully evaluated in clinical research studies. ⋯ CS in PLIF provides similar clinical and radiologic outcomes compared to PS in PLIF. On the basis of the present study, we suggest CS to be a reasonable alternative to PS in PLIF.