The spine journal : official journal of the North American Spine Society
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Comparative Study Observational Study
Comparative outcomes and cost-utility following surgical treatment of focal lumbar spinal stenosis compared with osteoarthritis of the hip or knee: part 2--estimated lifetime incremental cost-utility ratios.
Although total hip arthroplasty (THA) and total knee arthroplasty (TKA) have been widely accepted as highly cost-effective procedures, spine surgery for the treatment of degenerative conditions does not share the same perception among stakeholders. In particular, the sustainability of the outcome and cost-effectiveness following lumbar spinal stenosis (LSS) surgery compared with THA/TKA remain uncertain. ⋯ Surgical management of primary OA of the spine, hip, and knee results in durable cost-utility ratios that are well below accepted thresholds for cost-effectiveness. Despite a significantly higher revision rate, the overall surgical management of FLSS for those who have failed medical management results in similar median 5-year and lifetime cost-utility compared with those of THA and TKA for the treatment of OA from the limited perspective of a public health insurance system.
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Comparative Study Controlled Clinical Trial
Clinical outcomes following surgical management of coexistent cervical stenosis and multiple sclerosis: a cohort-controlled analysis.
The presentation of myelopathy in patients with the concomitant diagnosis of cervical stenosis (CS) and multiple sclerosis (MS) complicates both diagnosis and treatment because of the similarities of presentation and disease progression. There are only a few published case series that examine this unique patient population. ⋯ Myelopathic patients with coexisting MS and CS improve after surgery, although at a lower rate and to a lesser degree than those without MS. Therefore, surgery should be considered for these patients. MS patients should be informed that myelopathy symptoms are less likely to be alleviated completely or may only be alleviated temporarily because of progression of MS and that surgery can help alleviate neck pain and radicular symptoms.
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Comparative Study
Laminoplasty versus conservative treatment for acute cervical spinal cord injury caused by ossification of the posterior longitudinal ligament after minor trauma.
No reports to date have accurately evaluated the management for acute spinal cord injury (SCI) caused by ossification of the posterior longitudinal ligament (OPLL) after minor trauma. ⋯ Most of the OPLL patients displayed as incomplete SCI after minor trauma. Although spontaneous improvement of SCI without surgery is often observed, laminoplasty has more satisfactory outcomes, prevents late compression of cord, and reduces perioperative complications, although with no significant benefit in cervical alignment and range of motion.
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Complicated cervical spine revision and deformity correction surgeries are becoming increasingly common. These challenging operations often necessitate fusion of the entire cervical spine. Patients frequently express concern over the likely loss of range of motion (ROM) of the neck postoperatively. However, we are aware of no study that specifically examines the sagittal cervical ROM after extensive cervical fusion. ⋯ A substantial degree of sagittal ROM can be maintained after extensive surgical fusion of the cervical spine.
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Evidence supporting an association between obesity and low back pain (LBP) continues to grow; yet little is known about the cause and effect of this relationship. Even less is known about the mechanisms linking the two. Physical activity is a logical suspect, but no study has demonstrated its role. ⋯ Increased BMI is a risk factor for back pain in Americans. More important, the role of physical activity in mitigating back pain risk is shown to be of greater consequence in the overweight and obese populations.