bluuebunny/crossref_metadata_2025_split huggingface dataset:
Comparing Heterotopic Ossification in Two Cervical Disc Prostheses
Authors: Yang Xiaoyu , Donk Roland , Bartels Ronald H.M.A. , Arts Mark P. , Depreitere Bart , Vleggeert-Lankamp Carmen L.A. 
Published: August 2020

Study Design.
Retrospective analysis using data from randomized clinical trials.

Objective.
To compare the occurrence of heterotopic ossification (HO) between two cervical disc prostheses. Clinical outcome and range of motion (ROM) were also evaluated.

Summary of Background Data.
Cervical arthroplasty was reported to be able to maintain the segmental ROM. However, controversy exists since the difference of the occurrence of HO concerning cervical prosthesis is still huge.

Methods.
Patients who underwent anterior cervical discectomy with arthroplasty for a cervical radiculopathy due to a herniated disc from the The Netherlands Cervical Kinematics (NECK) trial (activC; metal endplates with a polyethylene inlay and a keel for primary stability) and the PROCON trial (Bryan; metal-on-polymer with titanium coated endplates without a keel) were analyzed for HO at 12 and 24 months postoperatively. HO was scored according to the McAfee–Mehren classification. Segmental ROM was defined by a custom developed image analysis tool, and global cervical ROM was measured by Cobb's angle. Clinical outcome was evaluated by means of the neck disability index (NDI) as well as physical-component summary (PCS) and mental-component summary (MCS).

Results.
At 2-year follow-up, the occurrence of HO was 68% in patients treated with the activC prosthesis (severe HO 55%), which was comparable with 85% (P = 0.12) in patients with the Bryan disc (severe HO 44%; P = 0.43). The HO progression was similar between groups. Clinically, the patients had comparable NDI, PCS, and MCS at 2-year follow-up, and comparable improvement of clinical outcomes. The global ROM in the Bryan group (56.4 ± 10.8°) was significantly higher than in the activC group (49.5 ± 14.0, P = 0.044) at 2-year follow-up.

Conclusion.
In comparison of two cervical disc prostheses the development of HO is independent on their architecture. Although global ROM was higher in the Bryan prosthesis group, this difference was not deemed clinically important, particularly because the clinical condition of patients with and without severe HO was comparable.

Level of Evidence: 2
Update of Markov Model on the Cost-effectiveness of Nonpharmacologic Interventions for Chronic Low Back Pain Compared to Usual Care
Authors: Herman Patricia M. , McBain Ryan K. , Broten Nicholas , Coulter Ian D. 
Published: August 2020

Study design.
Markov model.

Objective.
Further validity test of a previously published model.

Summary of background data.
The previous model was built using data from ten randomized trials and examined the 1-year effectiveness and cost-effectiveness of 17 nonpharmacologic interventions for chronic low back pain (CLBP), each compared to usual care alone. This update incorporated data from five additional trials.

Methods.
Based on transition probabilities that were estimated using patient-level trial data, a hypothetical cohort of CLBP patients transitioned over time among four defined health states: high-impact chronic pain with substantial activity limitations; higher (moderate-impact) and lower (low-impact) pain without activity limitations; and no pain. As patients transitioned among health states, they accumulated quality-adjusted life-years, as well as healthcare and productivity costs. Costs and effects were calculated incremental to each study's version of usual care.

Results.
From the societal perspective and assuming a typical patient mix (25% low-impact, 35% moderate-impact, and 40% high-impact chronic pain), most interventions—including those newly added—were cost-effective (<$50,000/QALY) and demonstrated cost savings. From the payer perspective, fewer were cost-saving, but the same number were cost-effective. Results for the new studies generally mirrored others using the same interventions—for example, cognitive behavioral therapy (CBT) and physical therapy. A new acupuncture study had similar effectiveness to other acupuncture studies, but higher usual care costs, resulting in higher cost savings. Two new yoga studies’ results were similar, but both differed from those of the original yoga study. Mindfulness-based stress reduction was similar to CBT for a typical patient mix but was twice as effective for those with high-impact chronic pain.

Conclusion.
Markov modeling facilitates comparisons across interventions not directly compared in trials, using consistent outcome measures after balancing the baseline mix of patients. Outcomes also differed by pain impact level, emphasizing the need to measure CLBP subgroups.

Level of Evidence: N/A
Can We Change Health Care Costs in Patients With Complex Back Pain?
Authors: Soer Remko , Reneman Michiel F. , Mierau Jochen O. , Schiphorst Preuper Henrica R. , Stegeman Patrick , Speijer Bert L.G.N. , Dijk Hermien H. , Buwalda Nynke , Wolff André P. , Coppes Maarten H. 
Published: August 2020

Study Design.
A before and after study cohort study.

Objectives.
The aim of this study was to examine changes in health care costs after multidisciplinary spine care in patients with complex chronic back pain (CBP), to analyze the predictive value of patient and disease characteristics on health care costs, and to study the potential impact of biases concerning the use of real world data.

Summary of Background Data.
Due to high direct and indirect societal costs of back pain there is a need for interventions that can assist in reducing the economic burden on patients and society.

Methods.
All patients referred to a university-based spine center insured at a major health care insurer in the Netherlands were invited. Personal and disease-related data were collected at baseline. Health care costs were retrieved from the health care insurer from 2 years before to 2 years after intervention. Repeated measures analysis of variances were calculated to study changes in health care costs after intervention. Multivariable regression analyses and cluster robust fixed effect models were applied to predict characteristics on health care costs. To study regression to the mean, a fixed effect model was calculated comparing 2 years before and 2 years post-intervention.

Results.
In total 428,158 declarations during 4.6 years were filed by 997 participants (128,666 considered CBP-related). CBP-related costs significantly increased during the intervention period and reduced 2 years after the intervention. Total health care costs kept rising. The intervention was associated with a 21% to 34% (P < 0.01) reduction in costs depending on the model used. Reduction in costs was related to being male and lower body mass index.

Conclusion.
This study suggests that reduction in CBP-related health care utilization in patients with complex CBP can be achieved after a multidisciplinary spine intervention. The results are robust to controlling for background characteristics and are unlikely to be fully driven by regression to the mean.

Level of Evidence: 4
Predictive Value of Comprehensive Geriatric Assessment on Early Postoperative Complications Following Lumbar Spinal Stenosis Surgery
Authors: Chang Sam Yeol , Son Jongyeon , Park Sang-Min , Chang Bong-Soon , Lee Choon-Ki , Kim Hyoungmin 
Published: August 2020

Study Design.
Prospective cohort study.

Objective.
The aim of this study was to evaluate the predictive value of comprehensive geriatric assessment (CGA) for early postoperative complications in elderly patients (aged 65 years or older) following lumbar spinal stenosis surgery.

Summary of Background Data.
CGA is a multidisciplinary evaluation modality proven to be effective in various fields of geriatrics. However, limited evidence exists on the effectiveness of CGA in lumbar spinal stenosis patients in the literature.

Methods.
We prospectively enrolled consecutive patients who were at least 65 years’ old and were scheduled to undergo elective surgery for lumbar spinal stenosis. One day before the operation, multidomain CGA was performed on the patient's functional status, comorbidities, nutrition, cognition, and psychological status. Patients with deficits in three or more CGA domains were defined as frail. The occurrence of postoperative complications (Clavien and Dindo grade 2 or higher) within 30 days after the surgery was assessed as the outcome. The predictive value of CGA was evaluated using crosstab and logistic regression analysis and compared to that of other risk stratification systems, including modified Frailty Index-5, -11, and American Society of Anesthesiologists Physical Classification System.

Results.
A total of 261 patients were included in the study, and 25 (9.6%) patients were assigned to the “frail” group. There were 27 (10.3%) patients with a postoperative complication (general: n = 20, 7.7%, surgical: n = 7, 2.7%) within postoperative 30 days. Patients with a complication showed significantly more deficits on preoperative CGA than those without complications (P = 0.004). On multivariate logistic regression analysis, frailty based on CGA (odds ratio = 3.51, P = 0.031) and the modified Frailty Index-11 (odds ratio = 3.13, P = 0.038) were associated with the occurrence of general complications.

Conclusion.
Frailty based on CGA was significantly associated with early general complications following surgery for lumbar spinal stenosis in patients older than 65 years.

Level of Evidence: 2
The Noninvasive Diagnostic Value of MRN for CIDP: A Research from Qualitative to Quantitative
Authors: Feng Yuan , Su Xiaoyun , Zheng Chuansheng , Lu Zuneng 
Published: August 2020

Study Design.
We examined the chronic inflammatory demyelinating polyradiculoneuropathy (CIDP) patients and non-CIDP patients who have similar symptoms and difficult to differential diagnosis with CIDP by magnetic resonance neurography to find the difference among them.

Objective.
To investigate the differential diagnostic value of magnetic resonance neurography (MRN) for CIDP and other peripheral neuropathies.

Summary of Background Data.
Thirty-two consecutive patients with CIDP and 22 non-CIDP patients with symptoms similar to CIDP and difficult to be discriminate were recruited and imaged as a control group between May 2017 and May 2019.

Methods.
In this prospective study, the brachial plexus and lumbosacral plexus of 32 CIDP patients and 22 non-CIDP patients were examined by MRN. The clinical features and the nerve roots cross-sectional area (CSA) of the brachial plexus and lumbosacral plexus were measured.

Results.
The CSA of nerve roots of CIDP, Charcot-Marie-Tooth disease type-1 and polyneuropathy, organomegaly, endocrinopathy, M protein, and skin changes syndrome patients were all shown extensive by MRN. The sensitivity of MRN in diagnosing CIDP was 81.25% (26/32), the specificity was 68.18% (15/22), the positive predictive value was 78.79% (26/33), the negative predictive value was 71.43% (15/21), the accuracy was 75.93% (40/54), the misdiagnosis rate was 24.07% (13/54), and the kappa value was 0.498. Receiver operating characteristic analysis showed higher diagnostic accuracy for CIDP with the CSA of the lumbosacral plexus (area under the curve [AUC] = 0.762) and that of the brachial plexus (AUC = 0.762), and the combined of both examinations did not improve the diagnostic efficacy compared with either (AUC = 0.769).

Conclusions.
The nerve roots of CIDP, Charcot-Marie-Tooth disease type-1, and polyneuropathy, organomegaly, endocrinopathy, M protein, and skin changes syndrome were difficult to distinguish by MRN. Atypical CIDP patients had less nerve root injury compared with typical CIDP patients. MRN of either the brachial plexus or the lumbosacral plexus had a high diagnostic accuracy for CIDP, and it is not necessary to perform both parts of the examination.

Level of Evidence: 2
The 22nd Anniversary of the Cochrane Back and Neck Group
Authors: Furlan Andrea D. , Chou Roger , Harbin Shireen , Pardo Jordi Pardo 
Published: August 2020

Study Design.
Retrospective review and literature review.

Objective.
The aim of this study was to provide an update on The Cochrane Back and Neck (CBN) activities.

Summary of Background Data.
Low back pain (LBP) affects 80% of people at some time in their lives. CBN Group has been housed in Toronto at the Institute for Work & Health since 1996 and has published 85 reviews and 32 protocols in the Cochrane Library.

Methods.
Narrative review of CBN publications, impact factor, usage data, and social media impact.

Results.
In the past 3 years, CBN conducted priority setting with organizations that develop clinical practice guidelines for LBP. CBN editors and associate editors published key methodological articles in the field of back and neck pain research. The methodological quality of CBN reviews has been assessed by external groups in a variety of areas, which found that CBN reviews had higher methodological quality than non-Cochrane reviews. CBN reviews have been included in 35 clinical practice guidelines for back and neck conditions. The 2018 journal impact factor of CBN is 11.154, which is higher than the 2018 impact factor for CDSR (7.755). CBN reviews ranked 4th among 53 Cochrane review groups in terms of Cochrane Library usage data. The most accessed CBN review was “Yoga treatment for chronic non-specific low-back pain” which had 9689 full-text downloads. CBN is active on Twitter with 3958 followers.

Conclusion.
CBN has published highly utilized systematic reviews and made important methodological contributions to the field of spine research over the past 22 years within Cochrane.

Level of Evidence: 4
Clostridium difficile Infection Following Spine Surgery
Authors: Bell Joshua , Vatani Jasmine , Raad Micheal , Labaran Lawal , Puvanesarajah Varun , Hassanzadeh Hamid 
Published: August 2020

Study Design.
Retrospective database review.

Objective.
The aim of this study was to determine the incidence of Clostridium difficile infection (CDI) within 90 days following elective spine surgery; examine risk factors associated with its development; and evaluate the impact of CDI on postoperative outcomes.

Summary of Background Data.
Although previous studies provided valuable insight into the rate of CDI following spine surgery and associated risk factors, to date no study has evaluated the role preoperative antibiotics use plays in the development of CDI, as well as its impact on 90-day outcomes.

Methods.
A retrospective database review of Humana patients ages 20 to 84 years who underwent elective spine surgery between 2008 and 2016 was conducted. Following exclusion criteria, the population was divided into patients who developed CDI within 90 days of surgery and those who did not. All risk factors and outcomes were analyzed using multivariate regression.

Results.
A total of 63,667 patients met study criteria. Ninety-day incidence of CDI was 0.68%. Notable medical risk factors (P < 0.05) included preoperative fluoroquinolone use (odds ratio [OR] 1.40), advanced age (OR 1.86), chronic kidney disease stage I/II (OR 1.76) and III-V (OR 1.98), decompensated chronic liver disease (OR 3.68), and hypoalbuminemia (OR 3.15). Combined anterior-posterior cervical (OR 2.74) and combined anterior-posterior lumbar (OR 2.43) approaches and procedures spanning more than eight levels (OR 3.99) were associated with the highest surgical risk (P < 0.05) of CDI. CDI was associated with a 12.77-day increase in length of stay (P < 0.05) and increased risk of readmission (OR 6.08, P < 0.05) and mortality (OR 8.94, P < 0.05).

Conclusion.
Following elective spine surgery, CDI increases risk of readmission and mortality. In addition to preoperative fluoroquinolone use, novel risk factors associated with the highest risk of CDI included decompensated chronic liver disease, posterior approaches, and multilevel involvement. Perioperative optimization of modifiable risk factors may help to prevent occurrence of CDI.

Level of Evidence: 3
Anterior Cervical Decompression and C5 Palsy
Authors: Takase Hajime , Tayama Katsuko , Nakamura Yoshihiko , Regenhardt Robert W. , Mathew Justin , Murata Hidetoshi , Yamamoto Tetsuya 
Published: August 2020

Study Design.
A systematic review and meta-analysis were performed with the literature including the case of C5 palsy following anterior cervical decompression surgery.

Objective.
The aim of this study was to compare three reconstructive procedures of anterior cervical decompression, the incidences of delayed C5 palsy and other complications were assessed.

Summary of Background Data.
Delayed C5 palsy is now a well-known complication after cervical decompression surgery. The etiology of C5 palsy has been studied, especially after posterior surgery. However, in anterior surgery there has been a lack of investigation due to procedure variation. Additionally, limited evidence exists regarding the risk of C5 palsy in surgical procedures.

Methods.
We performed an extensive literature search for C5 palsy and other complications with ACDF, ACCF, and their combination (Hybrid). Gross incidences of C5 palsy after these three procedures were compared, and specific superiorities (or inferiorities) were investigated via comparison of binary outcomes between two of three groups using odds ratios (OR).

Results.
Twenty-six studies met the inclusion criteria. A total of 3098 patients were included and 5.8% of those developed C5 palsy. Meta-analyses demonstrated that ACDF had a lower risk of palsy than ACCF (OR 0.36, 95% confidence interval [CI] 0.16–0.78), whereas ACDF versus Hybrid (OR 0.60, 95% CI 0.24–1.51) and Hybrid versus ACCF (OR 1.11, 95% CI 0.29–4.32) were not significantly different. Although these differences were not observed in shorter lesion subgroups, there were significant differences between the three procedures in longer lesion subgroups (P = 0.0005). Meta-analyses revealed that in longer lesions, ACDF had a significantly lower incidence than ACCF (OR 0.42, 95% CI 0.22–0.82). Additionally, Hybrid surgery was noninferior for palsy occurrence compared to ACCF, and suggested a trend for reduced rates of other complications compared to ACCF.

Conclusion.
ACDF may yield better outcomes than Hybrid and ACCF. Furthermore, Hybrid may have advantages over ACCF in terms of surgical complications.

Level of Evidence: 3
Normal Preoperative Images Do Not Indicate a Poor Outcome of Surgery for Coccydynia
Authors: Finsen Vilhjalmur , Kalstad Ante , Knobloch Rainer G. 
Published: August 2020

Study Design.
This is a retrospective cohort study.

Objective.
To evaluate the long-term outcomes after surgery for refractory coccygodynia in patients with normal imaging studies compared with patients where imaging shows an anomaly.

Summary of Background Data.
Patients with coccydynia who do not respond to conservative treatment will often profit from coccygectomy. Most surgeons employ plain radiographs or magnetic resonance imaging (MRI) in their preoperative work-up. These will often show anomalies, but in some cases they do not. We investigated whether these patients do less well than those with abnormal images.

Methods.
We operated on 184 patients with coccydynia during a 7-year period and 171 (93%) responded to follow-up questionnaires after 37 (range: 12–85) months. Images of 33 patients were normal and 138 showed some coccygeal pathology. Surgery was considered to have been unsuccessful when respondents stated at review that they were somewhat better, unchanged, or worse.

Results.
There were no clinically or statistically significant differences in outcome between the groups. Surgery was unsuccessful in 24% of patients with normal images and in 32% among those with abnormal images. The median pain scores (0–10) during the week before review were two (interquartile range [IQR]: 0–3) and one (IQR: 1–5) in the two groups respectively. Similar proportions in the two groups stated that they would not have consented to surgery if they had known the outcome in advance.

Conclusion.
Patients with severe coccydynia who have not responded to conservative treatment should not be denied surgery only because their radiographs or MRI studies look normal.

Level of Evidence: 4
A Validation of Patient Health Questionnaire-9 for Cervical Spine Surgery
Authors: Parrish James M. , Jenkins Nathaniel W. , Nolte Michael T. , Massel Dustin H. , Hrynewycz Nadia M. , Brundage Thomas S. , Singh Kern 
Published: August 2020

Study Design.
Retrospective.

Objective.
The purpose of this study is to evaluate depressive symptoms as measured by the PHQ-9 survey and correlated them with scores from the SF-12 and VR-12 Mental Component Summary (MCS).

Summary of Background Data.
With the rising incidence of depression and the need to identify modifiable risk factors before surgery, it is increasingly important to screen for preoperative depressive symptoms in spine surgery. Although the Patient Health Questionnaire-9 (PHQ-9) has favorable characteristics as a depressive symptom screening instrument, it has not been evaluated within cervical spine surgery.

Methods.
A prospectively maintained surgical registry was reviewed for patients undergoing single or multilevel anterior cervical discectomy and fusion (ACDF) or cervical disc replacement (CDR) from March 2016 until May 2019. Included patients underwent a procedure for degenerative spinal pathology. We collected demographic, baseline, and perioperative variables. The mean scores for postoperative PHQ-9, Short Form-12 (SF-12), and Veterans RAND-12 (VR-12) surveys were calculated, and an average change between preoperative and postoperative scores. Scatterplots depicted the association of SF-12 MCS and VR-12 MCS with PHQ-9. We evaluated the relationship of PHQ-9 with SF-12 MCS and VR-12 MCS scores by calculating a Pearson correlation coefficient and time-independent partial correlation coefficient.

Results.
One hundred fifty-two patients underwent single or multilevel level cervical spine surgery (ACDF: 73% and CDR: 27%). The average age was 42.4 and 39% were female. Compared to preoperative scores, significant increases were observed among postoperative PHQ-9, SF-12, and VR-12 MCS surveys (P ≤ 0.001). We observed strong correlations between SF-12 and VR-12 MCS with PHQ-9 scores for both assessed correlations.

Conclusion.
Patients undergoing ACDF or CDR demonstrated significant improvement with PHQ-9, SF-12 MCS, and VR-12 MCS instruments. PHQ-9 scores strongly correlated with SF-12 MCS and VR-12 MCS. Our findings indicate PHQ-9 is a valid tool to evaluate pre and postsurgical depressive symptoms.

Level of Evidence: 4
A Retrospective Analysis of Employee Education Level on Weight Loss Following Participation in an Online, Corporately Sponsored, Weight Loss Program
Authors: Earnest Conrad P. , Church Timothy S. 
Published: August 2020

Objective:
To examine weight loss characteristics relative to education for employees participating in an online weight loss program.

Methods:
We examined percent weight loss (primary outcome), the achievement of clinical cut-points (secondary outcome) by class attendance, and education strata (High School and Trade through Post-Graduate).

Results:
Overall, the pooled cohort lost a significant percentage of their starting weight (–2.05%, 95% CI, –2.07, –2.04). Women (–1.95%, 95% CI, –1.97, –1.94) lost significantly less than men (–2.38%, 95% CI, –2.141, –2.35). Those attending less than or equal to seven classes lost significantly less weight (0.75% [95% CI, –0.77, –0.74] vs more than or equal to eight classes attendees [–3.50%, 95% CI, –3.52, –3.48]). Class attendance was significantly correlated to weight loss (r = 0.57, P < 0.001) and was consistent across education strata.

Conclusions:
Online weight loss programming is effective across education strata and class participation is essential to participant success.