Nonpharmacologic Therapies for Low Back Pain: A Systematic Review for an American College of Physicians Clinical Practice Guideline.

Background: A 2007 American College of Physicians guideline addressed nonpharmacologic treatment options for low back pain. New evidence is now available.

Purpose: To systematically review the current evidence on nonpharmacologic therapies for acute or chronic nonradicular or radicular low back pain.

Synthetic bone graft versus autograft or allograft for spinal fusion: a systematic review.

The purpose of this review was to compare the efficacy and safety of synthetic bone graft substitutes versus autograft or allograft for the treatment of lumbar and cervical spinal degenerative diseases. Multiple major medical reference databases were searched for studies that evaluated spinal fusion using synthetic bone graft substitutes (either alone or with an autograft or allograft) compared with autograft and allograft. Randomized controlled trials (RCT) and cohort studies with more than 10 patients were included.

Epidural Corticosteroid Injections for Radiculopathy and Spinal Stenosis: A Systematic Review and Meta-analysis.

Background: Use of epidural corticosteroid injections is increasing.

Purpose: To review evidence on the benefits and harms of epidural corticosteroid injections in adults with radicular low back pain or spinal stenosis of any duration.

Data Sources: Ovid MEDLINE (through May 2015), Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews, prior systematic reviews, and reference lists.

Biological substitutes/extenders for spinal arthrodesis: which agents are cost-effective?

Study Design: Systematic review.

Objective: To evaluate the cost-effectiveness of lumbar or cervical spinal arthrodesis using biological substitutes and extenders compared with iliac crest autograft for the treatment of degenerative spinal conditions.

Summary Of Background Data: The cost-effectiveness of using bone graft substitutes and extenders for spinal fusion compared with using iliac crest autograft is not yet well established.

Cervical spondylotic myelopathy: methodological approaches to evaluate the literature and establish best evidence.

Study Design: Review of methods.

Objective: To provide a detailed description of the methods undertaken in the articles in this focus issue pertaining to cervical spondylotic myelopathy (CSM) and ossification of the posterior longitudinal ligament (OPLL) and to describe the process used to develop summary statements and clinical recommendations regarding factors associated with the mechanisms, diagnosis, progression, and treatment of CSM and OPLL.

Summary Of Background Data: We present methods used in conducting the systematic, evidence-based reviews and development of expert panel summary statements and clinical recommendations of the mechanisms, diagnosis, progression, and treatment of CSM and OPLL.

Outcomes after laminoplasty compared with laminectomy and fusion in patients with cervical myelopathy: a systematic review.

Study Design: Systematic review.

Objective: To determine the effectiveness and safety of cervical laminoplasty versus laminectomy and fusion for the treatment of cervical myelopathy, and to identify any patient subgroups for whom one treatment may result in better outcomes than the other.

Summary Of Background Data: Cervical laminoplasty and cervical laminectomy plus fusion are both procedures that treat cervical stenosis induced myelopathy by expanding the space available for the spinal cord.

Predictive factors affecting outcome after cervical laminoplasty.

Study Design: Systematic review.

Objective: To determine whether various preoperative factors affect patient outcome after cervical laminoplasty for cervical spondylotic myelopathy (CSM) and/or ossification of posterior longitudinal ligament (OPLL).

Summary Of Background Data: Cervical laminoplasty is a procedure designed to decompress the spinal cord by enlarging the spinal canal while preserving the lamina.

Total disc replacement in the cervical spine: a systematic review evaluating long-term safety.

Study Design:  Systematic review.Clinical questions: What are the rates and causes of subsequent surgeries? What is the long-term complication rates following cervical artificial disc replacement (C-ADR)? How do these rates change over time?

Methods:  A systematic review was undertaken for articles published up to October 2011. Electronic databases and reference lists of key articles were searched to identify comparative and non-comparative studies reporting long-term (≥ 48 months) complications of C-ADR.

Does patient history and physical examination predict MRI proven cauda equina syndrome?

Study Design:  Systematic review.

Study Rationale:  While magnetic resonance imaging (MRI) is used as the diagnostic gold standard for cauda equina syndrome (CES), many MRI scans obtained from patients presenting with signs and/or symptoms of CES do not reveal concordant pathology. As a result, the role of the history and physical examination remains unclear when determining which patients require emergent MRI.

Evaluation of clinical experience using cell-based therapies in patients with spinal cord injury: a systematic review.

Object: Using a systematic approach, the authors evaluated the current utilization, safety, and effectiveness of cellular therapies for traumatic spinal cord injuries (SCIs) in humans.

Methods: A systematic search and critical review of the literature published through mid-January 2012 was performed. Articles included in the search were restricted to the English language, studies with at least 10 patients, and those analyzing cellular therapies for traumatic SCI.

Translational potential of preclinical trials of neuroprotection through pharmacotherapy for spinal cord injury.

There is a need to enhance the pipeline of discovery and evaluation of neuroprotective pharmacological agents for patients with spinal cord injury (SCI). Although much effort and money has been expended on discovering effective agents for acute and subacute SCI, no agents that produce major benefit have been proven to date. The deficiencies of all aspects of the pipeline, including the basic science input and the clinical testing output, require examination to determine remedial strategies.

A systematic review of definitions and classification systems of adjacent segment pathology.

Study Design: Systematic review.

Objective: To undertake a systematic review to determine how "adjacent segment degeneration," "adjacent segment disease," or clinical pathological processes that serve as surrogates for adjacent segment pathology are classified and defined in the peer-reviewed literature.

Summary Of Background Data: Adjacent segment degeneration and adjacent segment disease are terms referring to degenerative changes known to occur after reconstructive spine surgery, most commonly at an immediately adjacent functional spinal unit.

Kinematics of the cervical adjacent segments after disc arthroplasty compared with anterior discectomy and fusion: a systematic review and meta-analysis.

Study Design: Systematic review and meta-analysis.

Objective: To determine the kinematics of the adjacent segments and global cervical spine after cervical arthroplasty compared with anterior cervical discectomy and fusion (ACDF).

Summary Of Background Data: Adjacent segment pathology after ACDF is a significant concern.

Effectiveness of spinal fusion versus structured rehabilitation in chronic low back pain patients with and without isthmic spondylolisthesis: a systematic review.

Study Design: Systematic review.

Objective: To determine if the presence of isthmic spondylolisthesis modifies the effect of treatment (fusion vs. multidimensional supervised rehabilitation) in patients with chronic low back pain (CLBP).

Spinal cord injury and quality of life: a systematic review of outcome measures.

Study Design: Systematic review.

Study Rationale: According to current estimates, there are more than 1 million people living with a spinal cord injury (SCI) in the United States alone. Given the potentially devastating impact of SCI on health-related quality of life (QoL), we sought to gain an improved understanding of QoL outcomes in SCI.

Complications related to osteobiologics use in spine surgery: a systematic review.

Study Design: Systematic review.

Objective: The objectives of this systematic review were to identify the character and rates of complications in patients after the use of BMP in spine fusion surgery and to determine whether there is a dose-response relationship of BMP with complications.

Summary Of Background Data: BMP is used on-label for ALIF with LT-CAGE and off-label for various spine fusion applications in the cervical, thoracic, and lumbar spines because of its effectiveness in promoting arthrodesis.

Postoperative dysphagia in anterior cervical spine surgery.

Study Design: Systematic review.

Objective: To determine the incidence and prevalence and identify effective recommendations to minimize the incidence and prevalence of postoperative dysphagia after anterior cervical surgery.

Summary Of Background Data: The reported incidence and prevalence of postoperative dysphagia and risk factors associated with its development varies widely in the literature.

Morbidity and mortality related to odontoid fracture surgery in the elderly population.

Study Design: Systematic analysis.

Objective: To determine the morbidity and mortality of surgical treatment of odontoid fractures in the elderly.

Summary Of Background Data: The prevalence of trauma in the elderly is increasing.