Management of anterior cervical pseudarthrosis

2009 ◽  
Vol 11 (2) ◽  
pp. 228-237 ◽  
Author(s):  
Michael G. Kaiser ◽  
Praveen V. Mummaneni ◽  
Paul G. Matz ◽  
Paul A. Anderson ◽  
Michael W. Groff ◽  
...  
Keyword(s):  
Clinical Outcome ◽  
Consensus Conference ◽  
Class Iii ◽  
Inclusion Criteria ◽  
Level Of Evidence ◽  
Cervical Spine Surgery ◽  
Cochrane Database ◽  
Strength Based ◽  
Based Medicine

Object The objective of this systematic review was to use evidence-based medicine to identify the best methodology for diagnosis and treatment of anterior pseudarthrosis. Methods The National Library of Medicine and Cochrane Database were queried using MeSH headings and key words relevant to pseudarthrosis and cervical spine surgery. Abstracts were reviewed, after which studies meeting inclusion criteria were selected. The guidelines group assembled an evidentiary table summarizing the quality of evidence (Classes I–III). Disagreements regarding the level of evidence were resolved through an expert consensus conference. The group formulated recommendations that contained the degree of strength based on the Scottish Intercollegiate Guidelines network. Validation was done through peer review by the Joint Guidelines Committee of the American Association of Neurological Surgeons/Congress of Neurological Surgeons. Results Evaluation for pseudarthrosis is warranted, as there may be an association between clinical outcome and pseudarthrosis. The strength of this association cannot be accurately determined because of the variable incidence of symptomatic and asymptomatic pseudarthroses (Class III). Revision of a symptomatic pseudarthrosis may be considered because arthrodesis is associated with improved clinical outcome (Class III). Both posterior and anterior approaches have proven successful for surgical correction of an anterior pseudarthrosis. Posterior approaches may be associated with higher fusion rates following repair of an anterior pseudarthrosis (Class III). Conclusions If suspected, pseudarthrosis should be investigated because there may be an association between arthrodesis and outcome. However, the strength of this association cannot be accurately determined. Anterior and posterior approaches have been successful.

Cervical laminoforaminotomy for the treatment of cervical degenerative radiculopathy

2009 ◽  
Vol 11 (2) ◽  
pp. 198-202 ◽  
Author(s):  
Robert F. Heary ◽  
Timothy C. Ryken ◽  
Paul G. Matz ◽  
Paul A. Anderson ◽  
Michael W. Groff ◽  
...  
Keyword(s):  
Cervical Radiculopathy ◽  
Consensus Conference ◽  
Cervical Disc ◽  
Class Iii ◽  
Level Of Evidence ◽  
Outcomes Measures ◽  
Cochrane Database ◽  
Strength Based ◽  
Based Medicine

Object The objective of this systematic review was to use evidence-based medicine to examine the efficacy of posterior laminoforaminotomy in the treatment of cervical radiculopathy. Methods The National Library of Medicine and Cochrane Database were queried using MeSH headings and key words relevant to posterior laminoforaminotomy and cervical radiculopathy. Abstracts were reviewed, and studies meeting inclusion criteria were selected. The guidelines group assembled an evidentiary table summarizing the quality of evidence (Classes I–III). Disagreements regarding the level of evidence were resolved through an expert consensus conference. The group formulated recommendations which contained the degree of strength based on the Scottish Intercollegiate Guidelines network. Validation was done through peer review by the Joint Guidelines Committee of the American Association of Neurological Surgeons/Congress of Neurological Surgeons. Results Posterior laminoforaminotomy improves clinical outcome in the treatment of cervical radiculopathy resulting from soft lateral cervical disc displacement or cervical spondylosis with resulting narrowing of the lateral recess. All studies were Class III. The most frequent design flaw involved the lack of utilization of validated outcomes measures. In addition, few historical studies included a detailed preoperative analysis of the patients. As such, the vast majority of studies that included both pre- and postoperative assessments with legitimate outcomes measures have been performed since 1990. Conclusions Posterior laminoforaminotomy is an effective treatment for cervical radiculopathy.

Cervical laminectomy for the treatment of cervical degenerative myelopathy

2009 ◽  
Vol 11 (2) ◽  
pp. 142-149 ◽  
Author(s):  
Timothy C. Ryken ◽  
Robert F. Heary ◽  
Paul G. Matz ◽  
Paul A. Anderson ◽  
Michael W. Groff ◽  
...  
Keyword(s):  
Consensus Conference ◽  
Functional Improvement ◽  
Class Iii ◽  
Level Of Evidence ◽  
Cervical Laminectomy ◽  
Cochrane Database ◽  
Increased Risk ◽  
Strength Based ◽  
Near Term ◽  
Based Medicine

Object The objective of this systematic review was to use evidence-based medicine to examine the efficacy of cervical laminectomy for the treatment of cervical spondylotic myelopathy (CSM). Methods The National Library of Medicine and Cochrane Database were queried using MeSH headings and keywords relevant to cervical laminectomy and CSM. Abstracts were reviewed after which studies meeting inclusion criteria were selected. The guidelines group assembled an evidentiary table summarizing the quality of evidence (Classes I–III). Disagreements regarding the level of evidence were resolved through an expert consensus conference. The group formulated recommendations that contained the degree of strength based on the Scottish Intercollegiate Guidelines network. Validation was done through peer review by the Joint Guidelines Committee of the American Association of Neurological Surgeons/Congress of Neurological Surgeons. Results Laminectomy has improved functional outcome for symptomatic cervical myelopathy (Class III). The limitations of the technique are an increased risk of postoperative kyphosis compared to anterior techniques or laminoplasty or laminectomy with fusion (Class III). However, the development of kyphosis may not necessarily to diminish the clinical outcome (Class III). Conclusions Laminectomy is an acceptable therapy for near-term functional improvement of CSM (Class III). It is associated with development of kyphosis, however.

Electrophysiological monitoring during surgery for cervical degenerative myelopathy and radiculopathy

2009 ◽  
Vol 11 (2) ◽  
pp. 245-252 ◽  
Author(s):  
Daniel K. Resnick ◽  
Paul A. Anderson ◽  
Michael G. Kaiser ◽  
Michael W. Groff ◽  
Robert F. Heary ◽  
...  
Keyword(s):  
Cervical Spondylotic Myelopathy ◽  
Cervical Radiculopathy ◽  
Study Data ◽  
Neurological Injury ◽  
Class Iii ◽  
Cervical Spine Surgery ◽  
Cochrane Database ◽  
Strength Based ◽  
Cervical Degenerative Disease ◽  
Based Medicine

Object The objective of this systematic review was to use evidence-based medicine to examine the diagnostic and therapeutic utility of intraoperative electrophysiological (EP) monitoring in the surgical treatment of cervical degenerative disease. Methods The National Library of Medicine and Cochrane Database were queried using MeSH headings and key words relevant to cervical spine surgery and EP monitoring. The guidelines group assembled an evidentiary table summarizing the quality of evidence (Classes I–III). The group formulated recommendations that contained the degree of strength based on the Scottish Intercollegiate Guidelines network. Validation was done through peer review by the Joint Guidelines Committee of the American Association of Neurological Surgeons/Congress of Neurological Surgeons. Results The reliance on changes in EP monitoring as an indication to alter a surgical plan or administer steroids has not been observed to reduce the incidence of neurological injury during routine surgery for cervical spondylotic myelopathy or cervical radiculopathy (Class III). However, there is an absence of study data examining the benefit of altering a surgical plan due to EP changes. Conclusions Although the use of EP monitoring may serve as a sensitive means to diagnose potential neurological injury during anterior spinal surgery for cervical spondylotic myelopathy, the practitioner must understand that intraoperative EP worsening is not specific—it may not represent clinical worsening and its recognition does not necessarily prevent neurological injury, nor does it result in improved outcome (Class II). Intraoperative improvement in EP parameters/indices does not appear to forecast outcome with reliability (conflicting Class I data).

Laminectomy and fusion for the treatment of cervical degenerative myelopathy

2009 ◽  
Vol 11 (2) ◽  
pp. 150-156 ◽  
Author(s):  
Paul A. Anderson ◽  
Paul G. Matz ◽  
Michael W. Groff ◽  
Robert F. Heary ◽  
Langston T. Holly ◽  
...  
Keyword(s):  
Functional Outcome ◽  
Posterior Longitudinal Ligament ◽  
Consensus Conference ◽  
Functional Improvement ◽  
Class Iii ◽  
Level Of Evidence ◽  
Cervical Laminectomy ◽  
Cochrane Database ◽  
Laminectomy And Fusion ◽  
Based Medicine

Object The objective of this systematic review was to use evidence-based medicine to examine the efficacy of cervical laminectomy and fusion for the treatment of cervical spondylotic myelopathy (CSM). Methods The National Library of Medicine and Cochrane Database were queried using MeSH headings and keywords relevant to cervical laminectomy, fusion, and CSM. Abstracts were reviewed, after which studies that met the inclusion criteria were selected. The guidelines group assembled an evidentiary table summarizing the quality of evidence (Class I–III). Disagreements regarding the level of evidence were resolved through an expert consensus conference. The group formulated recommendations which contained the degree of strength based on the Scottish Intercollegiate Guidelines network. Validation was done through peer-review by the Joint Guidelines Committee of the American Association of Neurological Surgeons/Congress of Neurological Surgeons. Results Cervical laminectomy with fusion (arthrodesis) improves functional outcome in patients with CSM and ossification of the posterior longitudinal ligament (OPLL). Functional improvement is similar to laminectomy or laminoplasty for patients with CSM and OPLL. In contrast to laminectomy, cervical laminectomy with fusion it is not associated with late deformity (Class III). Conclusions Laminectomy with fusion (arthrodesis) is an effective strategy to improve functional outcome in CSM and OPLL.

The natural history of cervical spondylotic myelopathy

2009 ◽  
Vol 11 (2) ◽  
pp. 104-111 ◽  
Author(s):  
Paul G. Matz ◽  
Paul A. Anderson ◽  
Langston T. Holly ◽  
Michael W. Groff ◽  
Robert F. Heary ◽  
...  
Keyword(s):  
Natural History ◽  
Cervical Spondylotic Myelopathy ◽  
Japanese Orthopaedic Association ◽  
Consensus Conference ◽  
Class I ◽  
Class Iii ◽  
Level Of Evidence ◽  
Cochrane Database ◽  
History Of ◽  
Based Medicine

Object The objective of this systematic review was to use evidence-based medicine to delineate the natural history of cervical spondylotic myelopathy (CSM) and identify factors associated with clinical deterioration. Methods The National Library of Medicine and Cochrane Database were queried using MeSH headings and keywords relevant to the natural history of CSM. Abstracts were reviewed and studies meeting the inclusion criteria were selected. The guidelines group assembled an evidentiary table summarizing the quality of evidence (Classes I–III). Disagreements regarding the level of evidence were resolved through an expert consensus conference. The group formulated recommendations that contained the degree of strength based on the Scottish Intercollegiate Guidelines network. Validation was done through peer review by the Joint Guidelines Committee of the American Association of Neurological Surgeons and the Congress of Neurological Surgeons. Results The natural history of CSM is mixed: it may manifest as a slow, stepwise decline or there may be a long period of quiescence (Class III). Long periods of severe stenosis are associated with demyelination and may result in necrosis of both gray and white matter. With severe and/or long lasting CSM symptoms, the likelihood of improvement with nonoperative measures is low. Objectively measurable deterioration is rarely seen acutely in patients younger than 75 years of age with mild CSM (modified Japanese Orthopaedic Association scale score > 12; Class I). In patients with cervical stenosis without myelopathy, the presence of abnormal electromyography findings or the presence of clinical radiculopathy is associated with the development of symptomatic CSM in this patient population (Class I). Conclusions The natural history of CSM is variable, which may affect treatment decisions.

Radiographic assessment of cervical subaxial fusion

2009 ◽  
Vol 11 (2) ◽  
pp. 221-227 ◽  
Author(s):  
Michael G. Kaiser ◽  
Praveen V. Mummaneni ◽  
Paul G. Matz ◽  
Paul A. Anderson ◽  
Michael W. Groff ◽  
...  
Keyword(s):  
Class Ii ◽  
Consensus Conference ◽  
Reliable Indicator ◽  
Class Iii ◽  
Radiographic Assessment ◽  
Distance Measurements ◽  
Level Of Evidence ◽  
Angle Measurements ◽  
Cochrane Database ◽  
Based Medicine

Object The objective of this systematic review was to use evidence-based medicine to identify the best methodology for radiographic assessment of cervical subaxial fusion. Methods The National Library of Medicine and Cochrane Database were queried using MeSH headings and keywords relevant to cervical fusion. Abstracts were reviewed and studies meeting inclusion criteria were selected. The guidelines group assembled an evidentiary table summarizing the quality of evidence (Classes I–III). Disagreements regarding the level of evidence were resolved through an expert consensus conference. The group formulated recommendations that contained the degree of strength based on the Scottish Intercollegiate Guidelines network. Validation was done through peer review by the Joint Guidelines Committee of the American Association of Neurological Surgeons/Congress of Neurological Surgeons. Results Pseudarthrosis is best assessed through the absence of motion detected between the spinous processes on dynamic radiographs (Class II). The measurement of interspinous distance on dynamic radiographs of ≥ 2 mm is a more reliable indicator for pseudarthrosis than angular motion of 2° based on Cobb angle measurements (Class II). Similarly, it is also understood that the pseudarthrosis rate will increase as the threshold for allowable motion on dynamic radiographs decreases. The combination of interspinous distance measurements and identification of bone trabeculation is unreliable when performed by the treating surgeon (Class II). Identification of bone trabeculation on static radiographs should be considered a less reliable indicator of cervical arthrodesis than dynamic films (Class III). Conclusions Consideration should be given to dynamic radiographs and interspinous distance when assessing for pseudarthrosis.

Cervical laminoplasty for the treatment of cervical degenerative myelopathy

2009 ◽  
Vol 11 (2) ◽  
pp. 157-169 ◽  
Author(s):  
Paul G. Matz ◽  
Paul A. Anderson ◽  
Michael W. Groff ◽  
Robert F. Heary ◽  
Langston T. Holly ◽  
...  
Keyword(s):  
Japanese Orthopaedic Association ◽  
Posterior Longitudinal Ligament ◽  
Consensus Conference ◽  
Functional Improvement ◽  
Cervical Laminoplasty ◽  
Class Iii ◽  
Level Of Evidence ◽  
Duration Of Symptoms ◽  
Cochrane Database ◽  
Stenosis Severity

Object The objective of this systematic review was to use evidence-based medicine to examine the efficacy of cervical laminoplasty in the treatment of cervical spondylotic myelopathy (CSM). Methods The National Library of Medicine and Cochrane Database were queried using MeSH headings and keywords relevant to cervical laminoplasty and CSM. Abstracts were reviewed and studies meeting the inclusion criteria were selected. The guidelines group assembled an evidentiary table summarizing the quality of evidence (Classes I–III). Disagreements regarding the level of evidence were resolved through an expert consensus conference. The group formulated recommendations that contained the degree of strength based on the Scottish Intercollegiate Guidelines network. Validation was done through peer review by the Joint Guidelines Committee of the American Association of Neurological Surgeons and Congress of Neurological Surgeons. Results Cervical laminoplasty has improved functional outcome in the setting of CSM or ossification of the posterior longitudinal ligament. Using the Japanese Orthopaedic Association scale score, ~ 55–60% average recovery rate has been observed (Class III). The functional improvement observed after laminoplasty may be limited by duration of symptoms, severity of stenosis, severity of myelopathy, and poorly controlled diabetes as negative risk factors (Class II). There is conflicting evidence regarding age, with 1 study citing it as a negative risk factor, and another not demonstrating this result. Conclusions Cervical laminoplasty is recommended for the treatment of CSM or ossification of the posterior longitudinal ligament (Class III).

Techniques for cervical interbody grafting

2009 ◽  
Vol 11 (2) ◽  
pp. 203-220 ◽  
Author(s):  
Timothy C. Ryken ◽  
Robert F. Heary ◽  
Paul G. Matz ◽  
Paul A. Anderson ◽  
Michael W. Groff ◽  
...  
Keyword(s):  
Iliac Crest ◽  
Class Ii ◽  
Consensus Conference ◽  
Anterior Cervical Discectomy ◽  
Current Evidence ◽  
Class Iii ◽  
Level Of Evidence ◽  
Cervical Discectomy ◽  
Cochrane Database ◽  
Titanium Cages

Object The objective of this systematic review was to use evidence-based medicine to determine the efficacy of interbody graft techniques. Methods The National Library of Medicine and Cochrane Database were queried using MeSH headings and keywords relevant to cervical interbody grafting. Abstracts were reviewed and studies that met the inclusion criteria were selected. The guidelines group assembled an evidentiary table summarizing the quality of evidence (Classes I–III). Disagreements regarding the level of evidence were resolved through an expert consensus conference. The group formulated recommendations that contained the degree of strength based on the Scottish Intercollegiate Guidelines network. Validation was done through peer review by the Joint Guidelines Committee of the American Association of Neurological Surgerons/Congress of Neurological Surgeons. Results Autograft bone harvested from the iliac crest, allograft bone from either cadaveric iliac crest or fibula, or titanium cages and rectangular fusion devices, with or without the use of autologous graft or substitute, have been successful in creating arthrodesis after 1- or 2-level anterior cervical discectomy with fusion (Class II). Alternatives to autograft, allograft, or titanium cages include polyetheretherketone cages and carbon fiber cages (Class III). Polyetheretherketone cages have been used successfully with or without hydroxyapatite for anterior cervical discectomy with fusion. Importantly, recombinant human bone morphogenic protein-2 carries a complication rate of up to 23–27% (especially local edema) compared with 3% for a standard approach. Conclusions Current evidence does not support the routine use of interbody grafting for cervical arthrodesis. Multiple strategies for interbody grafting have been successful with Class II evidence supporting the use of autograft, allograft, and titanium cages.

scholarly journals Pediatric hydrocephalus: systematic literature review and evidence-based guidelines. Part 10: Change in ventricle size as a measurement of effective treatment of hydrocephalus

2014 ◽  
Vol 14 (Supplement_1) ◽  
pp. 77-81 ◽  
Author(s):  
Dimitrios C. Nikas ◽  
Alexander F. Post ◽  
Asim F. Choudhri ◽  
Catherine A. Mazzola ◽  
Laura Mitchell ◽  
...  
Keyword(s):  
Effective Treatment ◽  
Surgical Intervention ◽  
Class Iii ◽  
Inclusion Criteria ◽  
Pediatric Hydrocephalus ◽  
Cochrane Database ◽  
The Us ◽  
Ventricle Size ◽  
Evidence Based Guidelines

Object The objective of this systematic review is to answer the following question: Does ventricle size after treatment have a predictive value in determining the effectiveness of surgical intervention in pediatric hydrocephalus? Methods The US National Library of Medicine PubMed/MEDLINE database and the Cochrane Database of Systematic Reviews were searched using MeSH headings and key words relevant to change in ventricle size after surgical intervention for hydrocephalus in children. An evidentiary table was assembled summarizing the studies and the quality of evidence (Classes I–III). Results Six articles satisfied inclusion criteria for the evidentiary tables for this part of the guidelines. All were Class III retrospective studies. Conclusions Recommendation: There is insufficient evidence to recommend a specific change in ventricle size as a measurement of the effective treatment of hydrocephalus and as a measurement of the timing and effectiveness of treatments including ventriculoperitoneal shunts and third ventriculostomies. Strength of Recommendation: Level III, unclear clinical certainty.

scholarly journals EFFECT OF PILATES METHOD ON PHYSICAL FITNESS RELATED TO HEALTH IN THE ELDERLY: A SYSTEMATIC REVIEW

2019 ◽  
Vol 25 (1) ◽  
pp. 76-87
Author(s):  
Gabrielle Critine Moura Fernandes Pucci ◽  
Eduardo Borba Neves ◽  
Francisco José Félix Saavedra
Keyword(s):  
Systematic Review ◽  
Physical Fitness ◽  
The Elderly ◽  
Inclusion Criteria ◽  
Level Of Evidence ◽  
Quasi Experimental ◽  
Pilates Method ◽  
Functional Autonomy ◽  
Selection Of

ABSTRACT The objective of this review was to analyze the evidence of Pilates in physical fitness related to health in the elderly. The article indexing databases (Pubmed, Medline, Science Direct, Scielo, Lilacs, and Cochrane) were reviewed along with the Pilates, elderly and aging descriptors. A total of 41 studies with a randomized experimental and quasi-experimental design met the inclusion criteria. The selection of the studies was carried out by two researchers and the quality of the articles was assessed using the PEDro scale. Interventions ranged from 4-24 weeks with 1-3 sessions/week, and balance was the most investigated variable. The studies included in this review indicate that Pilates improves health status in the elderly, promoting gains in balance, muscle strength, flexibility, functional autonomy, muscular endurance, body composition and aerobic endurance. Despite these findings, some variables need to be further investigated. Level of Evidence II; Systematic review.

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