The spine journal : official journal of the North American Spine Society
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Disc degeneration (DD) reportedly causes low back pain (LBP) and is often observed concomitantly with end plate signal change (ESC) and/or Schmorl node (SN) on magnetic resonance imaging. ⋯ Our data suggest that DD alone is not associated with LBP. By contrast, the combination of DD and ESC was highly associated with LBP.
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The North American Spine Society (NASS) publishes clinical guidelines that are taken into consideration worldwide by clinicians who have a special interest in spinal surgery. The Appraisal of Guidelines for Research and Evaluation (AGREE) II is the second version of the original AGREE instrument to assess the quality of guidelines in terms of development process. This appraisal aims to evaluate each individual NASS guideline using AGREE II tool to demonstrate its methodologic robust and weakness. ⋯ Our study showed that the quality of the NASS guidelines needs some improvement. There is a critical need for broader stakeholder involvement including patient representatives and health economists. Consideration of resource implications and monitoring process and standardization of how recommendations are implemented need to be improved. Studies analyzing facilitators and barriers would be helpful for future NASS guidelines.
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Case Reports
Extensive ossification of the ligamentum flavum treated with triple stage decompression: a case report.
Concurrent ossification of the ligamentum flavum (OLF) in the cervical, thoracic, and lumbar spine is a rare occurrence often associated with rheumatologic abnormalities. Although the pathology may be asymptomatic and discovered incidentally on routine imaging, compression of the cord and surrounding nerve roots can produce myelopathic or radiculopathic symptoms that are best treated with surgical decompression. There is limited evidence to support the use of single versus multistage decompression for tandem ossification at multiple levels, although several factors including duration of symptoms have been associated with a worse prognosis. ⋯ Symptomatic OLF in non-East Asian population is a rare occurrence. Its etiology is likely multifactorial, involving both biomechanical and genetic factors. Although early detection and management are necessary, multistage decompression can be an effective intervention for extensive multilevel ossification.
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At first visit and each clinical follow-up session, patients with adolescent idiopathic scoliosis (AIS) undergo radiographic examination, from which the Cobb angle is measured. The cumulative exposure to X-ray radiation justifies efforts in developing noninvasive methods for scoliosis monitoring. ⋯ Using the developed classification tree for the patients analyzed in this study, 43% of nonprogression cases between two visits would not have to undergo an X-ray examination.
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Use of bone morphogenetic protein (BMP) as an adjunct to spinal fusion surgery proliferated after Food and Drug Administration (FDA) approval in 2002. Major safety concerns emerged in 2008. ⋯ Use of BMP in spinal fusion surgery declined subsequent to published safety concerns and revelations of financial conflicts of interest for investigators involved in the pivotal clinical trials.