Interspinous process device versus standard conventional surgical decompression for lumbar spinal stenosis: Randomized controlled trial

Abstract Objective To assess whether interspinous process device implantation is more effective in the short term than conventional surgical decompression for patients with intermittent neurogenic claudication due to lumbar spinal stenosis. Design Randomized controlled trial. Setting Five neurosurgical centers (including one academic and four secondary level care centers) in the Netherlands. Participants 203 participants were referred to the Leiden-The Hague Spine Prognostic Study Group between October 2008 and September 2011; 159 participants with intermittent neurogenic claudication due to lumbar spinal stenosis at one or two levels with an indication for surgery were randomized. Interventions 80 participants received an interspinous process device and 79 participants underwent spinal bony decompression. Main outcome measures The primary outcome at short term (eight weeks) and long term (one year) follow-up was the Zurich Claudication Questionnaire score. Repeated measurements were made to compare outcomes over time. Results At eight weeks, the success rate according to the Zurich Claudication Questionnaire for the interspinous process device group (63%, 95% confidence interval 51% to 73%) was not superior to that for

A systematic review of prognostic factors predicting survival in patients with spinal bone metastases

Purpose: For the selection of treatment in patients with spinal bone metastases (SBM), survival estimation plays a crucial role to avoid over- and under-treatment. To aid clinicians in this difficult task, several prediction models have been developed, consisting of many different risk factors. The aim of this systematic review was to identify prognostic factors that are associated with survival in patients with SBM to support development of predictive models. Methods: A systematic review was performed with focus on prognostic factors associated with survival in patients with SBM. Two reviewers independently selected studies for inclusion and assessed the risk of bias. A level of evidence synthesis was performed for each prognostic factor. Inter-observer agreement for the risk of bias assessment was determined by the kappa-statistic. Results: After screening, 142 full-text articles were obtained, of which 22 met the eligibility criteria. A total of 43 different prognostic factors were investigated in the included studies, of which 17 were relevant to pre-treatment survival estimation. The prognostic factors most frequently associated with survival were the primary tumor and the performance status. The prognostic factors most frequently not associated with survival were age, gender, number and location of the SBM and the presence of a pathologic fracture. Conclusions: Prognostication for patients with SBM should be based on an accurate primary tumor classification, combined with a performance score. The benefit of adding other prognostic factors is doubtful

On the controversies of spine surgery research

This thesis is about effectiveness of surgical interventions in the spine and the value of different methodologies for providing a valid answer. In the first part five systematic reviews were performed. One reviewed cervical degenerative disc disease comparing the different anterior fusion techniques. Two were performed on lumbar disc herniation comparing conservative interventions with surgical and comparing the several surgical techniques. One was on lumbar degenerative disc disease and evaluated disc replacement. The fifth evaluated interventions for low grade lumbar isthmic spondylolisthesis. In the second part systematic reviews were searched, selected and appraised in two meta-epidemiological studies. Spinal research suffers from specific problems with regard to randomization and related to that, blinding and allocation concealment. These are factors that have in other medical fields been shown to introduce biased results. Our studies showed that observational studies in spinal surgery research do not result in an overestimation of the treatment effect in contrast to other medical disciplines. Finally, the experience gained from these studies has resulted in several opinion papers that aim to guide the scientific field in using the most appropriate methods in spine surgery research

CHANGE PAGE Avoid surgery as first line treatment for non-specific low back pain

Scientific Assessment and Innovation in Neurosurgical Treatment Strategie

Recruiting patients into randomized clinical trials in surgery (Br J Surg 2012 99 307-308)

Neurosurger

The optimal treatment of type II and III odontoid fractures in the elderly: a systematic review

Scientific Assessment and Innovation in Neurosurgical Treatment Strategie

Assessment of Patient-Specific Surgery Effect Based on Weighted Estimation and Propensity Scoring in the Re-Analysis of the Sciatica Trial

Development and application of statistical models for medical scientific researc

Effect of methodological quality measures in spinal surgery research: a metaepidemiological study

Scientific Assessment and Innovation in Neurosurgical Treatment Strategie

Spine surgery research: on and beyond current strategies

Scientific Assessment and Innovation in Neurosurgical Treatment Strategie

Incidence and clinical relevance of cage subsidence in anterior cervical discectomy and fusion: a systematic review

Scientific Assessment and Innovation in Neurosurgical Treatment Strategie