Acupotomy Therapy for Chronic Nonspecific Neck Pain: A Systematic Review and Meta-Analysis

Objective. This review is to assess the efficacy and safety of acupotomy therapy in chronic nonspecific neck pain. Methods. We searched six computerised databases. Randomized controlled trials incorporating acupotomy therapy alone or combined with other conventional treatments for chronic nonspecific neck pain were included. Two reviewers screened each literature and extracted data independently according to Cochrane Reviews’ Handbook (5.1). The Cochrane Collaboration’s RevMan 5.3 software was applied for meta-analysis. Results. A total of ten trials involving 433 patients were enrolled. The pooled analysis indicated that acupotomy therapy showed a significant improving short-term and long-term effect on effective rate and cure rate. Meta-analysis demonstrated that acupotomy therapy group was superior to control group in restoring cervical lordosis and debasing VAS score. The result of continuous data did not support statistical significance of acupotomy therapy in adjusting clinical symptom score. For adverse events, acupotomy group did not reveal obvious superiority compared to control group. Conclusions. Acupotomy therapy may be beneficial to chronic nonspecific neck pain patients. To strengthen supportive evidence, future, more rigorously designed clinical trials, adequate adverse events, and follow-up project are recommended

Trauma, Tumors, Spine, Functional Neurosurgery

This book is written for graduate students, researchers, and practitioners who are interested in learning how the knowledge from research can be implemented in clinical competences. The first section is dedicated to deep brain stimulation, a surgical procedure which is the paramount example of how clinical practice can take advantage from fundamental research. The second section gathers four chapters on four different topics and illustrates how significant is the challenge to translate scientific advances into clinical practice because the route from evidence to action is not always obvious. It is hoped that this book will stimulate the interest in the process of translating research into practice for a broader range of neurosurgical topics than the one covered by this book, which could result in a forthcoming more comprehensive publication

Acupuncture for quality of life in patients having pain associated with the spine: a systematic review

Background: Pain associated with the spine (PAWS) refers to pain in the neck, thorax, lower back or sacrum. It impacts on patients' Quality of Life (QoL), including working ability, daily functioning, sleep and psychological well-being. A number of clinical trials have demonstrated that acupuncture was beneficial for patients with PAWS. However the overall effect of acupuncture on these patients' QoL is unknown. Aims: The current study aimed to conduct a systematic review (SR) of clinical trials to determine the effect of acupuncture on QoL and pain for patients with PAWS. In addition, a narrative review (NR) was conducted to compare patients' perceived changes (PCC) with the standard QoL instruments used in acupuncture clinical trials for pain. Methods: For the SR, PubMed, Embase (via ScienceDirect), CINAHL (Via EBSCO) and Cochrane Central Register of Controlled Trials were searched. Randomised controlled trials (RCTs) of acupuncture for PAWS condition(s) that include both QoL and pain assessments with a Jadad score of three or greater were included. For the NR, PubMed was searched to identify studies reporting PPC after acupuncture and/or traditional Chinese medicine. Extracted data were grouped and compared with domains of the QoL instruments. Results: In total, 21 RCTs were included and 17 of them had sufficient data for analysis. QoL was measured using 15 different instruments. Randomisation procedures and dropouts were adequately reported in all 17 studies. Four studies compared acupuncture with wait-list or usual-care. Two demonstrated that acupuncture had a superior effect on improving physical and mental components of QoL measured by Short Form-36 health survey questionnaire and pain at the three month follow-up. Studies comparing acupuncture with sham/placebo acupuncture or placebo-TENS found either no difference between the treatments or conflicting results. When acupuncture was compared with active interventions, there was no difference except that at the intermediate-term follow-up massage was better for disability and pain and physiotherapy was better for Northwick Park Neck Pain Questionnaire. Acupuncture was also better than TENS for pain. The combined therapy of acupuncture and an active intervention showed a superior result than the latter alone in the short-term. Six studies were identified for the NR. Patients reported 11 categories of changes after acupuncture, such as reduced reliance on other therapies, enhanced spirituality, prevention of disease. However, these clinical outcomes were not included in any of the QoL instruments used in the included RCTs. Conclusion: There is moderate to strong evidence that acupuncture is more effective than wait-list or usual-care at the short-term follow-up in improving QoL of patients with PAWS. When acupuncture is combined with another therapy, the combined therapy seems to produce a better outcome. Acupuncture is not better than sham/placebo acupuncture or placebo-TENS. Surprisingly, the commonly used QoL instruments do not measure all the changes perceived by patients as a result of acupuncture and/or traditional Chinese medicine. There is a pressing need to design QoL assessments that are suitable for acupuncture research. Further studies should have larger sample sizes and additional validated outcome assessments are required to detect effects of acupuncture

Rivers West Apparel and/or Workers Compensation Fund v. Utah Labor Commission and/or Darla Basso : Brief of Petitioner

PETITION FOR REVIEW OF AN ORDER OF THE UTAH LABOR COMMISSIO

Rivers West Apparel and/or Workers Compensation Fund v. Utah Labor Commission; and/or Darla Basso : Brief of Appellee

BRIEF OF RESPONDENT, UTAH LABOR COMMISSIO

Current Advances in Spinal Diseases of Elderly Patients

The rapid aging of populations in developed countries since the 2000s has placed increasing attention on the issue of musculoskeletal disorders in elderly patients. Notably, spinal disorders not only restrict the social activities of elderly patients, but they also lead to economic loss for society. “Current Advances in Spinal Diseases of Elderly Patients” is a topical collection of articles about current perspectives on diagnosis and treatment of spinal disorders including current surgical strategies. This Special Issue covers a broad range of issues, ranging from managing refractory states such as severe osteoporosis, spinal deformity, ossification of the spinal ligaments, and multiple arthropathy to managing lifestyle-related spinal diseases during the COVID-19 pandemic in elderly populations. We hope that the readers of this Special Issue find the contents interesting

Garth Gines Appellant/Plaintiff, v. Sean Edwards, Appellee/Defendant.

APPEAL FROM THE FOURTH JUDICIAL DISTRICT COURT FOR PROVO, STATE OF UTAH HONORABLE DEREK PULLA

The role of the pedunculopontine region in basal ganglia mechanisms of akinesia

There has in recent years been a resurgence of interest in the treatment of Parkinson's disease by stereotactic surgical techniques. The phenomenal success of levo-dopa in the 1960s led to the virtual disappearance of surgery for Parkinson's Disease. However, two decades after its introduction the problems associated with the long-term administration of levo-dopa became well recognized. Over the same period the advance in our knowledge of the neural mechanisms underlying parkinsonian symptoms has been remarkable. Studies established that the loss of the nigro-striatal dopaminergic projection results in overactivity of the GPm and SNr inhibitory output, which in turn depresses the motor activity of thalamic and brainstem structures to which they have been shown to project, thus leading to the clinical manifestations of parkinsonism. It has long been assumed that the increased inhibitory output of the GPm acts via the thalamocortical feedback route to produce akinesia. However, this view fails to explain the clinical and experimental observation that thalamotomy, despite relieving tremor, rarely improves akinesia. Conversely medial pallidotomy may alleviate akinesia but has a lesser effect upon tremor, whereas high frequency stimulation or lesioning of the STN improves both symptoms. As thalamic lesioning does not affect the descending outputs of the basal ganglia, whereas pallidotomy and subthalamic nucleotomy do, a logical conclusion would be that overactivity of descending projections to the pedunculopontine area in the upper brainstem, rather than the overinhibition of the thalamic motor nuclei, is responsible for the akinesia of Parkinson's Disease. Therefore I have studied the effects of lesions of the PPN on movements in monkeys. The results establish that in the normal monkey a unilateral lesion of the PPN will result in a temporary akinetic state, whereas bilateral PPN lesions will generate a lasting Parkinsonian like akinesia. Results are consistent whether the lesioning method is by radiofrequency thermocoagulation, or by pressure injection of a neuron specific excitotoxic agent. Clinically, I have worked with the Oxford Movement disorder group studying the effects of lesioning, and deep brain stimulation in the basal ganglia of Parkinsonian patients

Spine Surgery

We are very excited to introduce this new book on spinal surgery, which follows the curriculum of the EUROSPINE basic and advanced diploma courses. The approach we take is a purely case-based one, in which each case illustrates the concepts surrounding the treatment of a given pathology, including the uncertainties and problems in decision-making. The readers will notice that in many instances a lack of evidence for a given treatment exists. So decisions taken are usually not a clearcut matter of black or white, but merely different shades of gray. Probably in a lot of cases, there is often more than one option to treat the patient. The authors were asked to convey this message to the reader, giving him a guidance as what would be accepted within the mainstream. In addition, the reader is provided with the most updated literature and evidence on the topic. Most of the authors are teachers in the courses of EUROSPINE or other national societies with often vast clinical experience and have given their own perspective and reasoning. We believe that the readers will profit very much from this variety and bandwidth of knowledge provided for them in the individual chapters. We have given the authors extensive liberty as to what they consider the best solution for their case. It is thus a representative picture of what is considered standard of care for spine pathologies in Europe. We hope that this book will be an ideal complement for trainees to the courses they take. Munich, Germany Bernhard Meyer Offenbach, Germany Michael Rauschman

Evaluation of the effectiveness and safety of acupuncture in the management of shoulder pain in adults

Shoulder pain affects 6-26% of the population globally with a substantial health and economic impact on the community. This review was to evaluate the effectiveness and safety of acupuncture in the management of shoulder pain in adults by systematically reviewing the currently available randomised controlled trials (RCTs) and non-randomised controlled trials (non-RCTs). A total of 16 English and Chinese electronic databases were searched from their respective inceptions to 18 September 2012. The data on pain intensity, range of motion and adverse events as well as risk of bias were analysed. Meta-analysis was performed using Review Manager 5.1. A total of 6,609 studies were identified. Thirty-eight RCTs and six non-RCTs met the inclusion criteria and were included in this review. Among the 38 RCTs, 4,115 participants were randomised. There was a high risk of performance bias and an unclear risk of selection, detection, attrition and reporting bias across most RCTs. The pooled data showed that acupuncture was more effective than sham acupuncture to relieve pain and improve abduction degree of the shoulder at the end of treatment and follow-up. There was no significant difference in alleviating pain between acupuncture and Western medication (WM) at the end of treatment period. However, nerve block (Xylocaine) was superior to acupuncture in improving shoulder movement in all directions after one-session treatment. Acupuncture reduced more pain than conventional orthopaedic therapy after three-month treatment and three-month follow-up. Comparing with other therapy (such as Trager psychophysical integration and conventional orthopaedic therapy), the pooled data indicated that acupuncture was more beneficial for improving abduction degree at the end of treatment. However, the synthesised data did not show any significant difference in pain relief or improvement of abduction degree between acupuncture plus WM and WM alone. It demonstrated that acupuncture was more effective to alleviate pain as an adjunct treatment to Tuina at the end of treatment. However, there was no significant difference between acupuncture plus Tuina group and Tuina alone group for abduction degree or between electroacupuncture plus exercise and interferential electrotherapy plus exercise for pain relief after the last treatment. Six non-RCTs involved 570 participants. All the non-RCT studies had a high a risk of selection bias (random sequence generation) and performance bias (blinding of participants). Majority had an unclear risk of selection (allocation concealment), detection, attrition, reporting and other bias. Although all the investigators claimed that the acupuncture treatment group was more effective than the control group, due to lack of data for outcome measures, meta-analysis was not performed. No severe adverse events were observed in either RCTs or non-RCTs. The outcomes from the current project indicate that acupuncture is potentially beneficial and safe for relieving pain and improving abduction movement of the shoulder joint. However, due to the various confounders and high or unclear risk of bias, the findings need to be interpreted with caution. A large scaled, rigorously designed RCT is warranted to confirm the current results