Clinical assessment and management of lumbar spinal stenosis: clinical dilemmas and considerations for surgical referral.

Lumbar spinal stenosis is the leading indication for spine surgery in older adults. Surgery is recommended in clinical guidelines if non-surgical treatments have been provided with insufficient benefit. The difficulty for clinicians is that the current number of randomised controlled trials is low, which creates uncertainty about which treatments to provide.

Challenges of conducting a randomised placebo-controlled trial of spinal surgery: the SUcceSS trial of lumbar spine decompression.

Although placebo-controlled trials are considered the gold standard for evaluating the efficacy of healthcare interventions, they can be perceived to be controversial and challenging to conduct for surgical treatments. The SUcceSS trial is the first placebo-controlled trial of lumbar decompression surgery for symptomatic lumbar canal stenosis. The SUcceSS trial has experienced common issues affecting the implementation of randomised placebo-controlled surgery trials, accentuated by the COVID-19 pandemic.

How much change in symptoms do spinal surgeons expect following lumbar decompression and microdiscectomy?

The study aimed to determine how much change in neurogenic claudication spinal surgeons expect in patients following lumbar decompression for lumbar spine stenosis (LSS), and radicular leg pain following microdiscectomy. Secondary aims were to identify surgeons' preferences regarding surgical techniques for lumbar decompression, and their rating of the quality of current evidence for lumbar decompression. All Australian spine surgeons were invited, of whom 71 completed the survey (31% response rate).

A critical appraisal of clinical practice guidelines for the treatment of lumbar spinal stenosis.

Objective: The aim of the review was to appraise clinical practice guidelines and their recommendations for the treatment of lumbar spinal stenosis.

Methods: PubMed, Medline, CINAHL, Embase, and Cochrane Central Register of Controlled Trials were searched up until 25/01/2020 for clinical practice guidelines on the management of lumbar spinal stenosis with a systematic process to generate recommendations and were publicly available.

Results: Ten guidelines were included, with a total of 76 recommendations for the treatment of lumbar spinal stenosis.

Measurement properties of walking outcome measures for neurogenic claudication: a systematic review and meta analysis.

Background Context: Selecting a walking outcome measure for neurogenic claudication requires knowledge of its measurement properties.

Purpose: To systematically review and appraise the literature on the measurement properties of walking outcome measures for patients with neurogenic claudication.

Study Design: A systematic review and meta-analysis.

Is postoperative intensive care unit admission a prerequisite for elective craniotomy?

Object: Routine postoperative admission to the intensive care unit (ICU) is often considered a necessity in the treatment of patients following elective craniotomy but may strain already limited resources and is of unproven benefit. In this study the authors investigated whether routine postoperative admission to a regular stepdown ward is a safe alternative.

Methods: Three hundred ninety-four consecutive patients who had undergone elective craniotomy over 54 months at a single institution were retrospectively analyzed.

Meta-analysis and use of tests of heterogeneity in neurosurgery.

The recent increase in implementation of evidence-based medicine in neurosurgery has led to an increase in awareness of the importance of meta-analysis. An integral component of meta-analysis is the test of heterogeneity. This test examines whether the apparent differences between the studies are significant enough to bias the outcome and conclusion of the meta-analysis.

Subdural haematomas complicating insertion of the low-pressure Novus hydrocephalus valve: a simple method for intra-operative testing of the anti-siphon device.

We previously reported 52 patients with hydrocephalus who were followed up after insertion of low-pressure Novus valves. These valves have a normally open anti-siphon device (ASD) incorporated. There were no cases of subdural haematomas (SDH).

Association between compensation status and outcome after surgery: a meta-analysis.

Context: Compensation, whether through workers' compensation or through litigation, has been associated with poor outcome after surgery; however, this association has not been examined by meta-analysis.

Objective: To investigate the association between compensation status and outcome after surgery.

Data Sources: We searched MEDLINE (1966-2003), EMBASE (1980-2003), CINAHL, the Cochrane Controlled Trials Register, and reference lists of retrieved articles and textbooks, and we contacted experts in the field.

A probabilistic and interactive decision-analysis system for unruptured intracranial aneurysms.

Object: The goal in this study was to develop an interactive, probabilistic decision-analysis system for clinical use in the decision to treat or observe unruptured intracranial aneurysms. Further goals were to enable users of the system to adapt decision-analysis methods to individual patients and to provide a tool for interactive sensitivity analysis.

Methods: A computer program was designed to model the outcomes of treatment and observation of unruptured aneurysms.

Estimating the annual rate of de novo multiple aneurysms: three statistical approaches.

Object: Individuals with unruptured intracranial aneurysms experience a higher rate of rupture if their history includes another aneurysm that has previously bled. The authors used systematic review and metaregression to estimate the annual rate of development of second de novo aneurysms after subarachnoid hemorrhage.

Methods: This investigation included studies in which more than 300 patients with intracranial aneurysms were described, and in which the age of the patients and the proportion with multiple aneurysms were documented.

Computed tomographic angiography for detecting cerebral aneurysms: implications of aneurysm size distribution for the sensitivity, specificity, and likelihood ratios.

Objective: This study examined the efficacy of computed tomographic angiography (CTA) for detection of ruptured and unruptured aneurysms after adjustment for their size distributions under various conditions of aneurysm prevalence.

Methods: A systematic review was used to estimate 1) the aneurysm size-specific sensitivity and specificity of CTA, and 2) the size distributions of ruptured and unruptured aneurysms. Probabilistic computer simulation was used to estimate the efficacy of CTA in the detection of aneurysms.

The probability of sudden death from rupture of intracranial aneurysms: a meta-analysis.

Objective: To estimate the proportion of patients with aneurysmal subarachnoid hemorrhage (SAH) who die before receiving medical attention.

Methods: We performed a systematic literature review.

Results: Eighteen population-based studies between 1965 and 2001 described the incidence of death from SAH before the patients received medical attention.