Background. Disability is an important multifaceted construct. Identifying sources of disability could help optimise patient care. The aim of this study was to test an
Aims. Clinical decision support systems (CDSS) can support clinicians in selecting appropriate treatments for patients. The objective of this study was to examine if triaging patients with LBP to the most optimal treatment can be improved by using a data-driven
Object. Giant thoracic discs (occupying more than 40% of the spinal canal) are a difficult surgical pathology. They are increasingly being recognized as or particular subset of thoracic disc pathology. It has been recommended that an aggressive surgical approach of open 2 level verteberectomy and instruments should be utilized.21 However Retropleural thoracotomy provides the shortest direct route to the anterior thoracic spine and avoids pleural cavity entry making it an ideal if infrequently used
A combined anterior and posterior surgical approach
is generally recommended in the treatment of severe congenital kyphosis,
despite the fact that the anterior vascular supply of the spine
and viscera are at risk during exposure. The aim of this study was
to determine whether the surgical treatment of severe congenital thoracolumbar
kyphosis through a single posterior
Study Purpose. A systematic review of the current literature to address the debate of the optimal surgical approach for the treatment of adolescent idiopathic scoliosis (AIS). Method. All studies comparing anterior open instrumented surgery with posterior instrumented surgery in patients with AIS, written in English and published up until February 2010 were included. Electronic databases searched included Medline, PubMed and the Cochrane database using “AIS” and “surgery” as key words. Outcome measures considered to be important were specifically identified in each paper included: Blood loss (ml); operation time (mins); hospital stay (days); curve correction (sagittal and coronal); number of fused levels; pulmonary function, and complications. Results. Twenty one relevant papers were identified from a possible 399. Nine of these studies were performed prospectively with four involving more than one centre. The average total number of patients in each study was 246 with a mean pre-operative curve Cobb angle of 47 degrees in those patients treated via anterior surgical instrumentation and 52 degrees with posterior surgery. Three papers showed significant reduction in blood loss with anterior surgery while four studies observed a reduction in operative time and length of hospital stay with posterior surgery. Eleven papers analysed curve correction specifically and while comparable correction was achievable with both
The presacral retroperitoneal
Injury to the spinal cord and kyphosis are the two most feared complications of tuberculosis of the spine. Since tuberculosis affects principally the vertebral bodies, anterior decompression is usually recommended. Concomitant posterior instrumentation is indicated to neutralise gross instability from panvertebral disease, to protect the anterior bone graft, to prevent graft-related complications after anterior decompression in long-segment disease and to correct a kyphosis. Two-stage surgery is usually performed in these cases. We present 38 consecutive patients with tuberculosis of the spine for whom anterior decompression, posterior instrumentation, with or without correction of the kyphus, and anterior and posterior fusion was performed in a single stage through an anterolateral extrapleural
Purpose & Background. The STarT Back risk-stratification
The study was conducted to review the outcome in cases of anterior expandable interbody cages inserted through a posterior only
We made a prospective study of 43 consecutive patients treated for intraforaminal (34) or extraforaminal (9) herniations of a lumbar disc by excision through an interlaminar
Purpose of the study and background. Healthcare practitioners' (HCPs) attitudes and beliefs about MSK pain influence their practice behaviour. The Pain Attitudes and Beliefs Scale (PABS), developed for use in the context of LBP, consists of two subscales (biomedical and biopsychosocial) is the most widely used measure. However, poor performance of the biopsychosocial orientation scale is attributed, in part, to inadequate conceptualisation of the orientation. Purpose. To develop a new biopsychosocial scale and adapt the PABS to assess HCPs' attitudes and beliefs about common MSK pain. Methods and results. A grounded conceptualisation process was conducted with 40 MSK HCPs and/or researchers using concept mapping methodology. The resultant conceptual framework consisted of six primary domains of biopsychosocial clinical orientation (bio-clinical, therapeutic relationship, individual patient aspects, emotions, social and work) and informed development of new scale items. These items were included with existing PABS items in a national survey of UK-based HCPs, and analysis was conducted on 587 responses. Exploratory and confirmatory factor analyses identified and confirmed a new 10-item biopsychosocial scale (Cronbach's alpha of 0.83). The new biopsychosocial and existing biomedical scales demonstrated good test-retest reliability (ICC(2,1) 0.77 and 0.74 respectively). Standard error of measurement and smallest detectable change were also established. Conclusion. The new generic MSK version of the PABS biopsychosocial scale shows promising structural validity and test-retest reliability. The existing PABS biomedical scale's structure and performance was upheld. The new conceptual framework provides a contemporary, comprehensive understanding of the biopsychosocial clinical
Low back pain (LBP) is the top leading global cause of years lived with disability. In order to examine LBP, researchers have typically viewed the spine in isolation. Clinically, it is imperative that the lower limbs are also considered. The aim of this study was to design a holistic and reliable multi-segmental kinematic model of the spine and lower limbs. The spine was modelled according to easily identifiable anatomical landmarks, including upper thoracic (T1-T6), lower thoracic (T7-T12) and lumbar (L1-L5) segments. Pelvis, thigh, shank and foot segments were included. A 10-camera 3D motion capture system was used to track retro-reflective markers, which were used to define each segment of 10 healthy participants as they walked 3 times at a comfortable speed over a 6km walkway. The relative peak angles between each segment were calculated using the Joint Coordinate System convention and Intraclass Correlation Coefficients (ICCs) were used to determine intra-rater and inter-rater reliability (between an experienced clinician and biomechanical scientist).Introduction
Method
Consecutive case series To evaluate the efficacy of a strict stepwise radioanatomical procedure protocol in avoiding neurological complications through tool malplacement in fluoroscopy guided percutaneous procedures of the thoracic spine. Fluoroscopy guided percutaneous access to thoracic vertebral bodies is technically demanding. There is a trend towards computed tomography (CT) guidance on grounds of perceived lesser risk of spinal canal instrument malplacement. CT is however not always readily accessible and a safe technique for fluoroscopy guided procedures therefore desirable. 350 consecutive fluoroscopy guided percutaneous procedures (biopsy, vertebroplasty or kyphoplasty) covering all thoracic vertebral levels T1-T12 were performed according to a strict stepwise radioanatomical protocol. The crucial step of the protocol was not to advance the tool beyond the anterior-posterior (ap) projection of the medial pedicle wall until the tip of the instrument had been verified to have reached the posterior vertebral cortex in the lateral projection. The neurological status of patients was assessed through clinical examination prior to, immediately after the procedure and before discharge. Percutaneous instrument placement in the targeted thoracic vertebral body was achieved in all cases and the stepwise radioanatomical protocol was followed in all cases. There was no case of neurological deterioration in the case series. Conclusion: Attention to radiographic landmarks, specifically not crossing the ap projection of the medial pedicle cortex prior to reaching the posterior vertebral wall in the lateral projection, allows neurologically safe performance of fluoroscopy guided percutaneous procedures of the thoracic spine. This simple protocol is particularly useful when access to CT is limited.
Purpose and Background. Clinical practice guidelines (CPGs) recommend self-management for low back pain (LBP). Our recent narrative review on self-management needs revealed a consensus with respect to the critical components of self-management interventions. With mobile health advancements, apps offer innovative support for LBP management. This study aims to identify current apps for the self-management of LBP, assessing them for their quality, intervention content, theoretical
Background. Embodiment- and distraction-based
Aims. People with severe, persistent low back pain (LBP) may be offered lumbar spine fusion surgery if they have had insufficient benefit from recommended non-surgical treatments. However, National Institute for Health and Care Excellence (NICE) 2016 guidelines recommended not offering spinal fusion surgery for adults with LBP, except as part of a randomized clinical trial. This survey aims to describe UK clinicians’ views about the suitability of patients for such a future trial, along with their views regarding equipoise for randomizing patients in a future clinical trial comparing lumbar spine fusion surgery to best conservative care (BCC; the FORENSIC-UK trial). Methods. An online cross-sectional survey was piloted by the multidisciplinary research team, then shared with clinical professional groups in the UK who are involved in the management of adults with severe, persistent LBP. The survey had seven sections that covered the demographic details of the clinician, five hypothetical case vignettes of patients with varying presentations, a series of questions regarding the preferred management, and whether or not each clinician would be willing to recruit the example patients into future clinical trials. Results. There were 72 respondents, with a response rate of 9.0%. They comprised 39 orthopaedic spine surgeons, 17 neurosurgeons, one pain specialist, and 15 allied health professionals. Most respondents (n = 61,84.7%) chose conservative care as their first-choice management option for all five case vignettes. Over 50% of respondents reported willingness to randomize three of the five cases to either surgery or BCC, indicating a willingness to participate in the future randomized trial. From the respondents, transforaminal interbody fusion was the preferred
Aims. To systematically evaluate whether bracing can effectively achieve curve regression in patients with adolescent idiopathic scoliosis (AIS), and to identify any predictors of curve regression after bracing. Methods. Two independent reviewers performed a comprehensive literature search in PubMed, Ovid, Web of Science, Scopus, and Cochrane Library to obtain all published information about the effectiveness of bracing in achieving curve regression in AIS patients. Search terms included “brace treatment” or “bracing,” “idiopathic scoliosis,” and “curve regression” or “curve reduction.” Inclusion criteria were studies recruiting patients with AIS undergoing brace treatment and one of the study outcomes must be curve regression or reduction, defined as > 5° reduction in coronal Cobb angle of a major curve upon bracing completion. Exclusion criteria were studies including non-AIS patients, studies not reporting p-value or confidence interval, animal studies, case reports, case series, and systematic reviews. The GRADE
Aims. A variety of surgical methods and strategies have been demonstrated for Andersson lesion (AL) therapy. In 2011, we proposed and identified the feasibility of stabilizing the spine without curettaging the vertebral or discovertebral lesion to cure non-kyphotic AL. Additionally, due to the excellent reunion ability of ankylosing spondylitis, we further came up with minimally invasive spinal surgery (MIS) to avoid the need for both bone graft and lesion curettage in AL surgery. However, there is a paucity of research into the comparison between open spinal fusion (OSF) and early MIS in the treatment of AL. The purpose of this study was to investigate and compare the clinical outcomes and radiological evaluation of our early MIS
Aims. This systematic review aims to identify 3D predictors derived from biplanar reconstruction, and to describe current methods for improving curve prediction in patients with mild adolescent idiopathic scoliosis. Methods. A comprehensive search was conducted by three independent investigators on MEDLINE, PubMed, Web of Science, and Cochrane Library. Search terms included “adolescent idiopathic scoliosis”,“3D”, and “progression”. The inclusion and exclusion criteria were carefully defined to include clinical studies. Risk of bias was assessed with the Quality in Prognostic Studies tool (QUIPS) and Appraisal tool for Cross-Sectional Studies (AXIS), and level of evidence for each predictor was rated with the Grading of Recommendations, Assessment, Development, and Evaluations (GRADE)
Background. A local authority