The spine journal : official journal of the North American Spine Society
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Meta Analysis
Manipulation and mobilization for treating chronic low back pain: a systematic review and meta-analysis.
Mobilization and manipulation therapies are widely used to benefit patients with chronic low back pain. However, questions remain about their efficacy, dosing, safety, and how these approaches compare with other therapies. ⋯ There is moderate-quality evidence that manipulation and mobilization are likely to reduce pain and improve function for patients with chronic low back pain; manipulation appears to produce a larger effect than mobilization. Both therapies appear safe. Multimodal programs may be a promising option.
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Magnetic resonance imaging (MRI) has the potential to identify pathology contributing to neck pain. However, the importance of findings on MRI remains unclear. ⋯ The limited number, heterogeneity, and small sample size of the included studies do not permit definitive conclusions on the association between MRI findings of the cervical spine with future neck pain.
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The occipito-C2 angle (O-C2a) influences the oropharyngeal space. However, O-C2a has several limitations. There is no normal value of O-C2a because of the wide individual variations, and O-C2a does not reflect translation of the cranium to the axis, another factor influencing the oropharyngeal space in patients with atlantoaxial subluxation. ⋯ The O-EAa may be a useful parameter of CJA with several advantages over O-C2a, including less individual variation, easier visual recognition during surgery, and improved prediction of postoperative nPAS after occipitocervical fusion.
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Spinal metastases occur in 30%-50% of patients with systemic cancer. The primary goals of palliation are pain control and prevention of local recurrence. ⋯ Kyphoplasty and intraoperative radiotherapy is safe and immediately provided sustained pain relief with excellent local control rates in patients with painful vertebral metastases.
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Transcranial electrical stimulation used to produce motor evoked potentials (TES-MEPs) and subsequent compound muscle action potential (CMAP) recording is widely used to monitor motor function during surgery when there is risk of damaging the spinal cord. Nonetheless, some muscles do not produce CMAP amplitudes sufficient for intraoperative monitoring. ⋯ Although tetanic stimulation of a single peripheral nerve increased CMAP amplitudes recorded from both innervated and non-innervated muscles, CMAP amplitudes were best augmented when the corresponding nerve received tetanic stimulation. Additionally, tetanic stimulation of multiple nerves rather than a single nerve appears to provide better augmentation.