-
Sheilah Hogg-Johnson,
Gabrielle van der Velde,
Linda J. Carroll,
Lena W. Holm,
J. David Cassidy,
Jamie Guzman,
Pierre Côté,
Scott Haldeman,
Carlo Ammendolia, Eugene Carragee,
Eric Hurwitz,
Margareta Nordin,
Paul Peloso
[show abstract]
[hide abstract]
ABSTRACT: Study DesignBest evidence synthesis.
ObjectiveTo undertake a best evidence synthesis of the published evidence on the burden and determinants of neck pain and its associated
disorders in the general population.
Summary of Background DataThe evidence on burden and determinants of neck has not previously been summarized.
MethodsThe Bone and Joint Decade 2000−2010 Task Force on Neck Pain and Its Associated Disorders performed a systematic search and
critical review of literature published between 1980 and 2006 to assemble the best evidence on neck pain. Studies meeting
criteria for scientific validity were included in a best evidence synthesis.
ResultsWe identified 469 studies on burden and determinants of neck pain, and judged 249 to be scientifically admissible; 101 articles
related to the burden and determinants of neck pain in the general population. Incidence ranged from 0.055 per 1000 person
years (disc herniation with radiculopathy) to 213 per 1000 persons (self-reported neck pain). Incidence of neck injuries during
competitive sports ranged from 0.02 to 21 per 1000 exposures. The 12-month prevalence of pain typically ranged between 30%
and 50%; the 12-month prevalence of activity-limiting pain was 1.7% to 11.5%. Neck pain was more prevalent among women and
prevalence peaked in middle age. Risk factors for neck pain included genetics, poor psychological health, and exposure to
tobacco. Disc degeneration was not identified as a risk factor. The use of sporting gear (helmets, face shields) to prevent
other types of injury was not associated with increased neck injuries in bicycling, hockey, or skiing.
ConclusionNeck pain is common. Nonmodifiable risk factors for neck pain included age, gender, and genetics. Modifiable factors included
smoking, exposure to tobacco, and psychological health. Disc degeneration was not identified as a risk factor. Future research
should concentrate on longitudinal designs exploring preventive strategies and modifiable risk factors for neck pain.
European Spine Journal 04/2012; 17:39-51. · 1.97 Impact Factor
-
Lena W. Holm,
Linda J. Carroll,
J. David Cassidy,
Sheilah Hogg-Johnson,
Pierre Côté,
Jamie Guzman,
Paul Peloso,
Margareta Nordin,
Eric Hurwitz,
Gabrielle van der Velde, Eugene Carragee,
Scott Haldeman
[show abstract]
[hide abstract]
ABSTRACT: Study DesignBest evidence synthesis.
ObjectiveTo undertake a best evidence synthesis on the burden and determinants of whiplash-associated disorders (WAD) after traffic
collisions.
Study DesignSummary of Background Data. Previous best evidence synthesis on WAD has noted a lack of evidence regarding incidence of and
risk factors for WAD. Therefore there was a warrant of a reanalyze of this body of research.
MethodsA systematic search of Medline was conducted. The reviewers looked for studies on neck pain and its associated disorders published
1980 –2006. Each relevant study was independently and critically reviewed by rotating pairs of reviewers. Data from studies
judged to have acceptable internal validity (scientifically admissible) were abstracted into evidence tables, and provide
the body of the best evidence synthesis.
ResultsThe authors found 32 scientifically admissible studies related to the burden and determinants of WAD. In the Western world,
visits to emergency rooms due to WAD have increased over the past 30years. The annual cumulative incidence of WAD differed
substantially between countries. They found that occupant seat position and collision impact direction were associated with
WAD in one study. Eliminating insurance payments for pain and suffering were associated with a lower incidence of WAD injury
claims in one study. Younger ages and being a female were both associated with filing claims or seeking care for WAD, although
the evidence is not consistent. Preliminary evidence suggested that headrests/car seats, aimed to limiting head extension
during rear-end collisions had a preventive effect on reporting WAD, especially in females.
ConclusionWAD after traffic collisions affects many people. Despite many years of research, the evidence regarding risk factors for
WAD is sparse but seems to include personal, societal, and environmental factors. More research including, well-defined studies
with accurate denominators for calculating risk, and better consideration of confounding factors, are needed.
European Spine Journal 04/2012; 17:52-59. · 1.97 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: As one of trials on neuroprotection after spinal cord injury, we used pregabalin. After spinal cord injury (SCI) in rats using contusion model, we observed the effect of pregabalin compared to that of the control and the methylprednisolone treated rats. We observed locomotor improvement of paralyzed hindlimb and body weight changes for clinical evaluation and caspase-3, bcl-2, and p38 MAPK expressions using western blotting. On histopathological analysis, we also evaluated reactive proliferation of glial cells. We were able to observe pregabalin's effectiveness as a neuroprotector after SCI in terms of the clinical indicators and the laboratory findings. The caspase-3 and phosphorylated p38 MAPK expressions of the pregabalin group were lower than those of the control group (statistically significant with caspase-3). Bcl-2 showed no significant difference between the control group and the treated groups. On the histopathological analysis, pregabalin treatment demonstrated less proliferation of the microglia and astrocytes. With this animal study, we were able to demonstrate reproducible results of pregabalin's neuroprotection effect. Diminished production of caspase-3 and phosphorylated p38 MAPK and as well as decreased proliferation of astrocytes were seen with the administration of pregabalin. This influence on spinal cord injury might be a possible approach for achieving neuroprotection following central nervous system trauma including spinal cord injury.
Journal of Korean medical science 03/2011; 26(3):404-11. · 0.84 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: Prospective, match-cohort study of disc degeneration progression over 10 years with and without baseline discography. Objectives. To compare progression of common degenerative findings between lumbar discs injected 10 years earlier with those same disc levels in matched subjects not exposed to discography. Summary of Background Data. Experimental disc puncture in animal and in vivo studies have demonstrated accelerated disc degeneration. Whether intradiscal diagnostic or treatment procedures used in clinical practice causes any damage to the punctured discs over time is currently unknown.
Seventy-five subjects without serious low back pain illness underwent a protocol MRI and an L3/4, L4/5, and L5/S1 discography examination in 1997. A matched group was enrolled at the same time and underwent the same protocol MRI examination. Subjects were followed for 10 years. At 7 to 10 years after baseline assessment, eligible discography and controlled subjects underwent another protocol MRI examination. MRI graders, blind to group designation, scored both groups for qualitative findings (Pfirrmann grade, herniations, endplate changes, and high intensity zone). Loss of disc height and loss of disc signal were measured by quantitative methods.
Well matched cohorts, including 50 discography subjects and 52 control subjects, were contacted and met eligibility criteria for follow-up evaluation. In all graded or measured parameters, discs that had been exposed to puncture and injection had greater progression of degenerative findings compared to control (noninjected) discs: progression of disc degeneration, 54 discs (35%) in the discography group compared to 21 (14%) in the control group (P = 0.03); 55 new disc herniations in the discography group compared to 22 in the control group (P = 0.0003). New disc herniations were disproportionately found on the side of the anular puncture (P = 0.0006). The quantitative measures of disc height and disc signal also showed significantly greater loss of disc height (P = 0.05) and signal intensity (P = 0.001) in the discography disc compared to the control disc.
Modern discography techniques using small gauge needle and limited pressurization resulted in accelerated disc degeneration, disc herniation, loss of disc height and signal and the development of reactive endplate changes compared to match-controls. Careful consideration of risk and benefit should be used in recommending procedures involving disc injection.
Spine 09/2009; 34(21):2338-45. · 2.08 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: To determine whether posterior lumbar disk contour dimensions differ in the flexed seated, upright seated, and extended seated positions.
Two subgroups of subjects with degenerative disk disease were compared: those with central posterior disk bulge (at L4-5 or L5-S1 levels) and those with a dark nucleus pulposus without posterior disk bulge (L3-4, L4-5, and/or L5-S1 levels).
Academic medical center.
Eight subjects with a central disk bulge and 9 subjects with a dark nucleus pulposus on magnetic resonance imaging.
Not applicable.
Quantitative comparisons of posterior disk contour between neutral, flexed, and extended sitting positions.
Of 8 subjects with central disk bulge, spinal flexion (from the neutral position) produced a decreased disk contour in all subjects, whereas spinal extension (from the neutral position) produced an increased disk contour in 6 subjects, a decreased disk contour in 1 subject, and no measurable change in 1 subject. Changes in posterior disk contour in subjects with a dark nucleus pulposus were variable. Approximately half increased and half decreased, but no relation to position was determined.
The results of this pilot study suggest a consistent pattern of decreased posterior disk contour with spinal flexion and increased posterior disk contour with spinal extension in subjects with central disk bulge, but not in those with a dark nucleus pulposus.
Der Notarzt 07/2009; 1(6):541-6. · 0.28 Impact Factor
-
Roger Chou,
John D Loeser,
Douglas K Owens,
Richard W Rosenquist,
Steven J Atlas,
Jamie Baisden, Eugene J Carragee,
Martin Grabois,
Donald R Murphy,
Daniel K Resnick,
Steven P Stanos,
William O Shaffer,
Eric M Wall
[show abstract]
[hide abstract]
ABSTRACT: Clinical practice guideline.
To develop evidence-based recommendations on use of interventional diagnostic tests and therapies, surgeries, and interdisciplinary rehabilitation for low back pain of any duration, with or without leg pain.
Management of patients with persistent and disabling low back pain remains a clinical challenge. A number of interventional diagnostic tests and therapies and surgery are available and their use is increasing, but in some cases their utility remains uncertain or controversial. Interdisciplinary rehabilitation has also been proposed as a potentially effective noninvasive intervention for persistent and disabling low back pain.
A multidisciplinary panel was convened by the American Pain Society. Its recommendations were based on a systematic review that focused on evidence from randomized controlled trials. Recommendations were graded using methods adapted from the US Preventive Services Task Force and the Grading of Recommendations, Assessment, Development, and Evaluation Working Group.
Investigators reviewed 3348 abstracts. A total of 161 randomized trials were deemed relevant to the recommendations in this guideline. The panel developed a total of 8 recommendations.
Recommendations on use of interventional diagnostic tests and therapies, surgery, and interdisciplinary rehabilitation are presented. Due to important trade-offs between potential benefits, harms, costs, and burdens of alternative therapies, shared decision-making is an important component of a number of the recommendations.
Spine 05/2009; 34(10):1066-77. · 2.08 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: Systematic review.
To systematically assess benefits and harms of surgery for nonradicular back pain with common degenerative changes, radiculopathy with herniated lumbar disc, and symptomatic spinal stenosis.
Although back surgery rates continue to increase, there is uncertainty or controversy about utility of back surgery for various conditions.
Electronic database searches on Ovid MEDLINE and the Cochrane databases were conducted through July 2008 to identify randomized controlled trials and systematic reviews of the above therapies. All relevant studies were methodologically assessed by 2 independent reviewers using criteria developed by the Cochrane Back Review Group (for trials) and Oxman (for systematic reviews). A qualitative synthesis of results was performed using methods adapted from the US Preventive Services Task Force.
For nonradicular low back pain with common degenerative changes, we found fair evidence that fusion is no better than intensive rehabilitation with a cognitive-behavioral emphasis for improvement in pain or function, but slightly to moderately superior to standard (nonintensive) nonsurgical therapy. Less than half of patients experience optimal outcomes (defined as no more than sporadic pain, slight restriction of function, and occasional analgesics) following fusion. Clinical benefits of instrumented versus noninstrumented fusion are unclear. For radiculopathy with herniated lumbar disc, we found good evidence that standard open discectomy and microdiscectomy are moderately superior to nonsurgical therapy for improvement in pain and function through 2 to 3 months. For symptomatic spinal stenosis with or without degenerative spondylolisthesis, we found good evidence that decompressive surgery is moderately superior to nonsurgical therapy through 1 to 2 years. For both conditions, patients on average experience improvement either with or without surgery, and benefits associated with surgery decrease with long-term follow-up in some trials. Although there is fair evidence that artificial disc replacement is similarly effective compared to fusion for single level degenerative disc disease and that an interspinous spacer device is superior to nonsurgical therapy for 1- or 2-level spinal stenosis with symptoms relieved with forward flexion, insufficient evidence exists to judge long-term benefits or harms.
Surgery for radiculopathy with herniated lumbar disc and symptomatic spinal stenosis is associated with short-term benefits compared to nonsurgical therapy, though benefits diminish with long-term follow-up in some trials. For nonradicular back pain with common degenerative changes, fusion is no more effective than intensive rehabilitation, but associated with small to moderate benefits compared to standard nonsurgical therapy.
Spine 05/2009; 34(10):1094-109. · 2.08 Impact Factor
-
Margareta Nordin, Eugene Carragee,
Sheilah Hogg-Johnson,
Shira Weiner,
Eric Hurwitz,
Paul Peloso,
Jaime Guzman,
Gabrielle van der Velde,
Linda Carroll,
Lena Holm,
Pierre Côté,
J David Cassidy,
Scott Haldeman
European Spine Journal 03/2009; · 1.97 Impact Factor
-
Spine 03/2009; 34(5):423-30. · 2.08 Impact Factor
-
Sheilah Hogg-Johnson,
Gabrielle van der Velde,
Linda J Carroll,
Lena W Holm,
J David Cassidy,
Jamie Guzman,
Pierre Côté,
Scott Haldeman,
Carlo Ammendolia, Eugene Carragee,
Eric Hurwitz,
Margareta Nordin,
Paul Peloso
[show abstract]
[hide abstract]
ABSTRACT: Best evidence synthesis.
To undertake a best evidence synthesis of the published evidence on the burden and determinants of neck pain and its associated disorders in the general population.
The evidence on burden and determinants of neck has not previously been summarized.
The Bone and Joint Decade 2000-2010 Task Force on Neck Pain and Its Associated Disorders performed a systematic search and critical review of literature published between 1980 and 2006 to assemble the best evidence on neck pain. Studies meeting criteria for scientific validity were included in a best evidence synthesis.
We identified 469 studies on burden and determinants of neck pain, and judged 249 to be scientifically admissible; 101 articles related to the burden and determinants of neck pain in the general population. Incidence ranged from 0.055 per 1000 person years (disc herniation with radiculopathy) to 213 per 1000 persons (self-reported neck pain). Incidence of neck injuries during competitive sports ranged from 0.02 to 21 per 1000 exposures. The 12-month prevalence of pain typically ranged between 30% and 50%; the 12-month prevalence of activity-limiting pain was 1.7% to 11.5%. Neck pain was more prevalent among women and prevalence peaked in middle age. Risk factors for neck pain included genetics, poor psychological health, and exposure to tobacco. Disc degeneration was not identified as a risk factor. The use of sporting gear (helmets, face shields) to prevent other types of injury was not associated with increased neck injuries in bicycling, hockey, or skiing.
Neck pain is common. Nonmodifiable risk factors for neck pain included age, gender, and genetics. Modifiable factors included smoking, exposure to tobacco, and psychological health. Disc degeneration was not identified as a risk factor. Future research should concentrate on longitudinal designs exploring preventive strategies and modifiable risk factors for neck pain.
Journal of manipulative and physiological therapeutics 03/2009; 32(2 Suppl):S46-60. · 1.06 Impact Factor
-
Lena W Holm,
Linda J Carroll,
J David Cassidy,
Sheilah Hogg-Johnson,
Pierre Côté,
Jamie Guzman,
Paul Peloso,
Margareta Nordin,
Eric Hurwitz,
Gabrielle van der Velde, Eugene Carragee,
Scott Haldeman
[show abstract]
[hide abstract]
ABSTRACT: Best evidence synthesis.
To undertake a best evidence synthesis on the burden and determinants of whiplash-associated disorders (WAD) after traffic collisions.
Previous best evidence synthesis on WAD has noted a lack of evidence regarding incidence of and risk factors for WAD. Therefore there was a warrant of a reanalyze of this body of research.
A systematic search of Medline was conducted. The reviewers looked for studies on neck pain and its associated disorders published 1980-2006. Each relevant study was independently and critically reviewed by rotating pairs of reviewers. Data from studies judged to have acceptable internal validity (scientifically admissible) were abstracted into evidence tables, and provide the body of the best evidence synthesis.
The authors found 32 scientifically admissible studies related to the burden and determinants of WAD. In the Western world, visits to emergency rooms due to WAD have increased over the past 30 years. The annual cumulative incidence of WAD differed substantially between countries. They found that occupant seat position and collision impact direction were associated with WAD in one study. Eliminating insurance payments for pain and suffering were associated with a lower incidence of WAD injury claims in one study. Younger ages and being a female were both associated with filing claims or seeking care for WAD, although the evidence is not consistent. Preliminary evidence suggested that headrests/car seats, aimed to limiting head extension during rear-end collisions had a preventive effect on reporting WAD, especially in females.
WAD after traffic collisions affects many people. Despite many years of research, the evidence regarding risk factors for WAD is sparse but seems to include personal, societal, and environmental factors. More research including, well-defined studies with accurate denominators for calculating risk, and better consideration of confounding factors, are needed.
Journal of manipulative and physiological therapeutics 03/2009; 32(2 Suppl):S61-9. · 1.06 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: Single institution, prospective observation study.
To determine the long-term clinical outcomes of immune-suppressed patients with pyogenic vertebral osteomyelitis (PVO) treated with spinal instrumentation in the setting of active infection.
The mainstay of treatment for PVO remains nonoperative. Surgical indications include neurologic compromise, deformity, abscess and failure of medical management. Some authors have been concerned regarding risk of local infection reoccurrence when spinal instrumentation has been placed in the setting of active infection. To our knowledge no long-term follow-up has been reported for this condition.
Thirty-two consecutive immune compromised patients with PVO were treated with debridement and spinal instrumentation in the setting of acute infection at a single institution. Patients were observed by a set protocol and evaluated for reoccurrence of infection at regular intervals for up to 10 years.
The 32 patients in our study group had significant medical comorbidities and were immune compromised. All patients were treated with single stage debridement and instrumented fusion during active infection. Twenty-two patients had a full 10 years follow-up without clinical recurrence of the local infection. Four patients died during the observation period, and none had clinic or autopsy evidence of recurrence. One patient developed recurrent infection after 14 months and was successfully treated with repeat debridement and retention of the instrumentation. Although this patient had a chronically infected vascular shunt, he was disease free at final follow-up of 10 years. Four patients had their implants removed for pain, suspected nonunion or suspected recurrent infection. None of these patients had histologic or microbacteriological evidence of injection.
The use of spinal instrumentation in immune-compromised patients with PVO is associated with a low risk of long-term recurrent infection.
Spine 10/2008; 33(19):2089-93. · 2.08 Impact Factor
-
Eugene Carragee,
E Hurwitz,
I. Cheng,
L Carroll,
M. Nordin,
J. Guzman,
P. Peloso,
L Holm,
P Côté,
S Hogg-Johnson,
G. van der Velde,
J Cassidy,
S. Haldeman
European Spine Journal 08/2008; · 1.97 Impact Factor
-
Jon D Lurie,
Anna N Tosteson,
Tor D Tosteson, Eugene Carragee,
John A Carrino,
John Carrino,
Jay Kaiser,
Roberto T Blanco Sequeiros,
Amy Rosen Lecomte,
Margaret R Grove,
Emily A Blood,
Loretta H Pearson,
James N Weinstein,
Richard Herzog
[show abstract]
[hide abstract]
ABSTRACT: A reliability assessment of standardized magnetic resonance imaging (MRI) interpretations and measurements.
To determine the intra- and inter-reader reliability of MRI features of lumbar spinal stenosis (SPS), including severity of central, subarticular, and foraminal stenoses, grading of nerve root impingement, and measurements of cross-sectional area of the spinal canal and thecal sac.
MRI is commonly used to assess patients with spinal stenosis. Although a number of studies have evaluated the reliability of certain MRI characteristics, comprehensive evaluation of the reliability of MRI readings in spinal stenosis is lacking.
Fifty-eight randomly selected MR images from patients with SPS enrolled in the Spine Patient Outcomes Research Trial were evaluated. Qualitative ratings of imaging features were performed according to defined criteria by 4 independent readers (3 radiologists and 1 orthopedic surgeon). A sample of 20 MRIs was reevaluated by each reader at least 1 month later. Weighted kappa statistics were used to characterize intra- and inter-reader reliability for qualitative rating data. Separate quantitative measurements were performed by 2 other radiologists. Intraclass correlation coefficients and summaries of measurement error were used to characterize reliability for quantitative measurements.
Intra-reader reliability was higher than inter-reader reliability for all features. Inter-reader reliability in assessing central stenosis was substantial, with an overall kappa of 0.73 (95% CI 0.69-0.77). Foraminal stenosis and nerve root impingement showed moderate to substantial agreement with overall kappa of 0.58 (95% CI 0.53-0.63) and 0.51 (95% CI 0.42-0.59), respectively. Subarticular zone stenosis yielded the poorest agreement (overall kappa 0.49; 95% CI 0.42-0.55) and showed marked variability in agreement between reader pairs. Quantitative measures showed inter-reader intraclass correlation coefficients ranging from 0.58 to 0.90. The mean absolute difference between readers in measured thecal sac area was 128 mm (13%).
The imaging characteristics of spinal stenosis assessed in this study showed moderate to substantial reliability; future studies should assess whether these findings have prognostic significance in SPS patients.
Spine 07/2008; 33(14):1605-10. · 2.08 Impact Factor
-
Jon D Lurie,
Anna N A Tosteson,
Tor D Tosteson, Eugene Carragee,
John A Carrino,
John Carrino,
Jay Kaiser,
Roberto T Blanco Sequeiros,
Amy Rosen Lecomte,
Margaret R Grove,
Emily A Blood,
Loretta H Pearson,
Richard Herzog,
James N Weinstein
[show abstract]
[hide abstract]
ABSTRACT: Assessment of the reliability of standardized magnetic resonance imaging (MRI) interpretations and measurements.
To determine the intra- and inter-reader reliability of MRI parameters relevant to patients with intervertebral disc herniation (IDH), including disc morphology classification, degree of thecal sac compromise, grading of nerve root impingement, and measurements of cross-sectional area of the spinal canal, thecal sac, and disc fragment.
MRI is increasingly used to assess patients with sciatica and IDH, but the relationship between specific imaging characteristics and patient outcomes remains uncertain. Although other studies have evaluated the reliability of certain MRI characteristics, comprehensive evaluation of the reliability of readings of herniated disc features on MRI is lacking.
Sixty randomly selected MR images from patients with IDH enrolled in the Spine Patient Outcomes Research Trial were each rated according to defined criteria by 4 independent readers (3 radiologists and 1 orthopedic surgeon). Quantitative measurements were performed separately by 2 other radiologists. A sample of 20 MRIs was re-evaluated by each reader at least 1 month later. Agreement for rating data were assessed with kappa statistics using linear weights. Reliability of the quantitative measurements was assessed using intraclass correlation coefficients (ICCs) and summaries of measurement error.
Inter-reader reliability was substantial for disc morphology [overall kappa 0.81 (95% confidence interval (CI): 0.78, 0.85)], moderate for thecal sac compression [overall kappa 0.54 (95% CI: 0.37, 0.68)], and moderate for grading nerve root impingement [overall kappa 0.47 (95% CI: 0.36, 0.56)]. Quantitative measures showed high ICCs of 0.87 to 0.96 for spinal canal and thecal sac cross-sectional areas. Measures of disc fragment area had moderate ICCs of 0.65 to 0.83. Mean absolute differences between measurements ranged from approximately 15% to 20%.
Classification of disc morphology showed substantial intra- and inter-reader agreement, whereas thecal sac and nerve root compression showed more moderate reader reliability. Quantitative measures of canal and thecal sac area showed good reliability, whereas measurement of disc fragment area showed more modest reliability.
Spine 05/2008; 33(9):991-8. · 2.08 Impact Factor
-
Lena W. Holm,
Linda J. Carroll,
J David Cassidy,
Sheilah Hogg-Johnson,
Pierre Côté,
Jaime Guzman,
Paul Peloso,
Margareta Nordin,
Eric Hurwitz,
Gabrielle van der Velde, Eugene Carragee,
Scott Haldeman
[show abstract]
[hide abstract]
ABSTRACT: Study Design. Best evidence synthesis.
Objective. To undertake a best evidence synthesis on the burden and determinants of whiplash-associated disorders (WAD) after traffic collisions.
Summary of Background Data. Previous best evidence synthesis on WAD has noted a lack of evidence regarding incidence of and risk factors for WAD. Therefore there was a warrant of a reanalyze of this body of research.
Methods. A systematic search of Medline was conducted. The reviewers looked for studies on neck pain and its associated disorders published 1980–2006. Each relevant study was independently and critically reviewed by rotating pairs of reviewers. Data from studies judged to have acceptable internal validity (scientifically admissible) were abstracted into evidence tables, and provide the body of the best evidence synthesis.
Results. The authors found 32 scientifically admissible studies related to the burden and determinants of WAD. In the Western world, visits to emergency rooms due to WAD have increased over the past 30 years. The annual cumulative incidence of WAD differed substantially between countries. They found that occupant seat position and collision impact direction were associated with WAD in one study. Eliminating insurance payments for pain and suffering were associated with a lower incidence of WAD injury claims in one study. Younger ages and being a female were both associated with filing claims or seeking care for WAD, although the evidence is not consistent. Preliminary evidence suggested that headrests/car seats, aimed to limiting head extension during rear-end collisions had a preventive effect on reporting WAD, especially in females.
Conclusion. WAD after traffic collisions affects many people. Despite many years of research, the evidence regarding risk factors for WAD is sparse but seems to include personal, societal, and environmental factors. More research including, well-defined studies with accurate denominators for calculating risk, and better consideration of confounding factors, are needed.
Spine 02/2008; 33(4S):S52-S59. · 2.08 Impact Factor
-
Gabrielle van der Velde,
Maurits van Tulder,
Pierre Côté,
Sheilah Hogg-Johnson,
Peter Aker,
J David Cassidy, Eugene Carragee,
Linda Carroll,
Jaime Guzman,
Scott Haldeman,
Lena Holm,
Eric Hurwitz,
Margareta Nordin,
Paul Peloso
[show abstract]
[hide abstract]
ABSTRACT: Systematic review.
To determine whether results and conclusions on the effectiveness of exercise for workers with neck pain vary with the Cochrane Back Review Group Guidelines and best-evidence synthesis review methods. To identify methodologic weaknesses associated with these review methods that may impact on the validity of their results.
The Cochrane Back Review Group Guidelines and best-evidence synthesis have different approaches to appraising trial quality and incorporating quality into data synthesis. The impact of different review methods on the reproducibility and validity of review results is unknown.
Systematic search of Medline, Embase, CINAHL, and Cochrane databases, without language restrictions. Twelve trials were selected. Two review methods were used to appraise trial quality and to incorporate quality into data synthesis. As recommended by the Cochrane Back Review Group Guidelines, trials were assigned quality scores using a scale. Results of all 12 trials were stratified into levels of evidence according to their scores. Based on these results, no treatment recommendation could be formulated. Best-evidence synthesis critically appraised methodology; trials were accepted on the strength of their scientific merit or rejected due to risk of bias. According to the 4 trials accepted for best-evidence synthesis, workers should be activated with exercise given its beneficial effect on patient-perceived recovery. Both the Cochrane Back Review Group Guidelines and best-evidence synthesis reviews were found to have weaknesses associated with their methods.
Review results and conclusions are sensitive to methods for appraising trial quality and incorporating quality into data synthesis when the evidence consists largely of low-quality trials. Both the Cochrane Back Review Group Guidelines and best-evidence synthesis methods were found to have strengths and methodologic weaknesses that healthcare decision-makers should be aware of when interpreting systematic reviews.
Spine 05/2007; 32(7):796-806. · 2.08 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: Prospective, 5-year, cohort study of working subjects.
To assess whether the occurrence of common minor trauma events affects the risk of developing serious low back pain (LBP) and LBP disability in subjects with and without degenerative changes to the lumbar spine.
Although some theories suggest that minor traumatic events in combination with preexisting degenerative changes commonly cause significant structural injury to spinal segments and serious LBP illness, no prospective data exist on the relationship of minor trauma, detailed structural changes, and outcome measures of serious LBP episodes and occupational disability.
Two hundred subjects without clinical LBP problems were recruited, and underwent baseline clinical and imaging studies. Every 6 months, subjects completed a scripted, algorithm-based interview assessing interval back pain episodes, severity, medical treatment, occupational disability, and the subject's perceived relation of this LBP episode to any preceding event. If a serious LBP episode clinically required a new magnetic resonance examination, the follow-up imaging was obtained and compared to baseline for interval changes.
There was no association of minor trauma to adverse LBP events. For each 6-month study interval, the risk of developing a serious LBP episode was 2.1% unassociated with minor trauma and 2.4% following minor trauma (P = 0.59). Neither the frequency of minor trauma events nor the reported severity of the event correlated with adverse outcomes. Subjects with advanced structural findings were not more likely to become symptomatic with minor trauma events than with spontaneously evolving LBP episodes. Follow-up magnetic resonance imaging evaluating new serious LBP illness rarely revealed new clinically significant findings. Age and sex-adjusted prediction models, including abnormal psychometric testing, smoking, and compensation issues, accurately identified 80% of serious LBP events and 93% of LBP disability events.
In this study cohort, minor trauma does not appear to increase the risk of serious LBP episodes or disability. The vast majority of incident-adverse LBP events may be predicted not by structural findings or minor trauma but by a small set of demographic and behavioral variables.
Spine 01/2007; 31(25):2942-9. · 2.08 Impact Factor
-
Eugene Carragee
[show abstract]
[hide abstract]
ABSTRACT: A very high percentage of patients coming to surgery for large disk extrusions and sciatica do very well with minimally invasive diskectomy. In most patients given relatively early surgical treatment, the primary predictor of outcome is the size of the disk herniation and the remaining competency of the anulus fibrosus. With the passage of time and with prolonged disability before surgery, psychosocial factors become increasingly important in determining outcomes. Factors such as psychological distress, depression, involvement with workers' compensation claims and disability claims, drug and alcohol abuse, and level of education appear to be secondary factors, at least initially, in subjects with large extruded fragments. In subjects with smaller disk herniation or in those with chronic disability, these factors may indicate a higher risk of treatment failure.
Instructional course lectures 02/2002; 51:223-8.
-
Lena W Holm,
Drmedsc,
Linda J Carroll,
J David Cassidy,
Sheilah Hogg-Johnson,
Pierre Côté,
Jamie Guzman,
Paul Peloso,
Margareta Nordin,
Eric Drmedsc,
Hurwitz,
Gabrielle Van Der Velde, Eugene Carragee,
Scott Haldeman
[show abstract]
[hide abstract]
ABSTRACT: Study Design. Best evidence synthesis. Objective. To undertake a best evidence synthesis on the burden and determinants of whiplash-associated dis-orders (WAD) after traffic collisions. Summary of Background Data. Previous best evidence synthesis on WAD has noted a lack of evidence regarding incidence of and risk factors for WAD. Therefore there was a warrant of a reanalyze of this body of research. Methods. A systematic search of Medline was con-ducted. The reviewers looked for studies on neck pain and its associated disorders published 1980 –2006. Each rele-vant study was independently and critically reviewed by rotating pairs of reviewers. Data from studies judged to have acceptable internal validity (scientifically admissi-ble) were abstracted into evidence tables, and provide the body of the best evidence synthesis. Results. The authors found 32 scientifically admissible studies related to the burden and determinants of WAD. In the Western world, visits to emergency rooms due to WAD have increased over the past 30 years. The annual cumulative incidence of WAD differed substantially be-tween countries. They found that occupant seat position and collision impact direction were associated with WAD in one study. Eliminating insurance payments for pain and suffering were associated with a lower incidence of WAD injury claims in one study. Younger ages and being a female were both associated with filing claims or seek-ing care for WAD, although the evidence is not consistent. Preliminary evidence suggested that headrests/car seats, aimed to limiting head extension during rear-end colli-sions had a preventive effect on reporting WAD, espe-cially in females. Conclusion. WAD after traffic collisions affects many people. Despite many years of research, the evidence regarding risk factors for WAD is sparse but seems to include personal, societal, and environmental factors. More research including, well-defined studies with accu-rate denominators for calculating risk, and better consid-eration of confounding factors, are needed.
Spine 01/2000; 33. · 2.08 Impact Factor
