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Not enough evidence on the routine use of surgery in addition to drug treatment for people with tuberculosis of the spine

Spinal tuberculosis (spinal TB) occurs in about 1% to 2% of people with TB (the most common infectious disease in the world). The disease can have a major impact on people's lives. Nerves can be squeezed causing pain, loss of feeling, and breathing problems. It can cause bone loss and curvature of the spine, which can lead to loss of nerve function and paralysis after some years, even if the TB has been cured. Correcting with surgery at this point can be difficult because of the complexity of the surgery required. It has been suggested that surgery might be undertaken at the time the TB of the spine is diagnosed and drug treatment (chemotherapy) is being used. However, all surgery has potential adverse effects. This review of trials found there were insufficient numbers of participants in the two trials located (331 participants) to be able to say if routine surgery early on was of overall benefit. Further trials are needed and such trials should assess the pain that people suffer and their views of the disease and treatment.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2013

Proximal junctional kyphosis as a distinct form of adjacent segment pathology after spinal deformity surgery: a systematic review

STUDY DESIGN: Systematic review.

Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet] - Centre for Reviews and Dissemination (UK).

Version: 2012

Pedicle screw versus hybrid construct instrumentation in adolescent idiopathic scoliosis: meta-analysis of thoracic kyphosis

STUDY DESIGN: A quantitative meta-analysis was conducted on publishing studies reporting results of spinal surgery in adolescent idiopathic scoliosis with instrumentation of pedicle screw or hybrid construct.

Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet] - Centre for Reviews and Dissemination (UK).

Version: 2014

Vertebral osteotomies in ankylosing spondylitis-comparison of outcomes following closing wedge osteotomy versus opening wedge osteotomy: a systematic review

Study Design Systematic review. Study Rationale To seek out and assess the best quality evidence available comparing opening wedge osteotomy (OWO) and closing wedge osteotomy (CWO) in patients with ankylosing spondylitis to determine whether their results differ with regard to several different subjective and objective outcome measures. Objective The aim of this study is to determine whether there is a difference in subjective and objective outcomes when comparing CWO and OWO in patients with ankylosing spondylitis suffering from clinically significant thoracolumbar kyphosis with respect to quality-of-life assessments, complication risks, and the amount of correction of the spine achieved at follow-up. Methods A systematic review was undertaken of articles published up to July 2012. Electronic databases and reference lists of key articles were searched to identify studies comparing effectiveness and safety outcomes between adult patients with ankylosing spondylitis who received closing wedge versus opening wedge osteotomies. Studies that included pediatric patients, polysegmental osteotomies, or revision procedures were excluded. Two independent reviewers assessed the strength of evidence using the GRADE criteria and disagreements were resolved by consensus. Results From a total of 67 possible citations, 4 retrospective cohorts (class of evidence III) met our inclusion criteria and form the basis for this report. No differences in Oswestry Disability Index, visual analog scale for pain, Scoliosis Research Society (SRS)-24 score, SRS-22 score, and patient satisfaction were reported between the closing and opening wedge groups across two studies. Regarding radiological outcomes following closing versus opening osteotomies, mean change in sagittal vertical axis ranged from 8.9 to 10.8 cm and 8.0 to 10.9 cm, respectively, across three studies; mean change in lumbar lordosis ranged from 36 to 47 degrees and 19 to 41 degrees across four studies; and mean change in global kyphosis ranged from 38 to 40 degrees and 28 to 35 degrees across two studies. Across all studies, overall complication risks ranged from 0 to 16.7% following CWO and from 0 to 23.6% following OWO. Conclusion No statistically significant differences were seen in patient-reported or radiographic outcomes between CWO and OWO in any study. The risks of dural tear, neurological injury, and reoperation were similar between groups. Blood loss was greater in the closing wedge compared with the opening wedge group, while the risk of paralytic ileus was less. The overall strength of evidence for the conclusions is low.

Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet] - Centre for Reviews and Dissemination (UK).

Version: 2013

Nonoperative versus operative treatment for thoracolumbar burst fractures without neurologic deficit: a meta-analysis

BACKGROUND: Decision-making regarding nonoperative versus operative treatment of patients with thoracolumbar burst fractures in the absence of neurologic deficits is controversial. Lack of evidence-based practice may result in patients being treated inappropriately and being exposed to unnecessary adverse consequences.

Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet] - Centre for Reviews and Dissemination (UK).

Version: 2012

Is unilateral kyphoplasty as effective and safe as bilateral kyphoplasties for osteoporotic vertebral compression fractures? A meta-analysis

BACKGROUND: An osteoporotic vertebral compression fracture is a common condition in elderly people, especially women. The percutaneous kyphoplasty is an effective treatment for osteoporotic vertebral compression fractures. Controversy remains regarding whether a unilateral or a bilateral approach is superior, and to our knowledge, there have been no large studies comparing these two approaches, therefore a meta-analysis synthesizing the data on this question is warranted.

Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet] - Centre for Reviews and Dissemination (UK).

Version: 2014

Does postsurgical cervical deformity affect the risk of cervical adjacent segment pathology? A systematic review

STUDY DESIGN: Systematic review.

Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet] - Centre for Reviews and Dissemination (UK).

Version: 2012

Screening for Osteoporosis: Systematic Review to Update the 2002 U.S. Preventive Services Task Force Recommendation [Internet]

Osteoporosis and related fractures are common in older individuals and lead to premature mortality, loss of function and independence, reduced quality of life, and high costs. Despite its importance, osteoporosis is under detected in the United States. This review updates evidence since the 2002 U.S. Preventive Services Task Force recommendation on osteoporosis screening.

Evidence Syntheses - Agency for Healthcare Research and Quality (US).

Version: July 2010
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EOS 2D/3D X-ray Imaging System: A Systematic Review and Economic Evaluation

EOS is a biplane X-ray imaging system manufactured by EOS Imaging (formerly Biospace Med, Paris, France). It uses slot-scanning technology to produce a high-quality image with less irradiation than standard imaging techniques.

Health Technology Assessment - NIHR Journals Library.

Version: March 2012
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Tuberculosis: Prevention, Diagnosis, Management and Service Organisation

This guideline makes recommendations on the prevention, diagnosis and management of latent and active tuberculosis (TB), including both drug susceptible and drug resistant forms of the disease. It covers the organisation of relevant TB services. It relates to activities undertaken in any setting in which NHS or public health services for TB are received, provided or commissioned in the public, private and voluntary sectors.

NICE Guideline - Internal Clinical Guidelines Team (UK).

Version: January 2016
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Myeloma: Diagnosis and Management

The management of myeloma is complex and challenging. It increasingly involves the use of expensive drugs. The guideline will aim to raise standards nationally while allowing clinical flexibility and defining a common pathway for patients at various stages of their illness, and of different ages and levels of fitness. Although a consistent approach to management is desirable, it needs to reflect the very different groups of patients with myeloma from the fit and suitable for transplant, fairly fit but not suitable for transplant to patients who are extremely frail and/or unwell.

NICE Guideline - National Collaborating Centre for Cancer (UK).

Version: February 2016
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Eating Disorders: Core Interventions in the Treatment and Management of Anorexia Nervosa, Bulimia Nervosa and Related Eating Disorders

This guideline has been developed to advise on the identification, treatment and management of the eating disorders anorexia nervosa, bulimia nervosa and related conditions. The guideline recommendations have been developed by a multidisciplinary group of health care professionals, patients and their representatives, and guideline methodologists after careful consideration of the best available evidence. It is intended that the guideline will be useful to clinicians and service commissioners in providing and planning high quality care for those with eating disorders while also emphasising the importance of the experience of care for patients and carers.

NICE Clinical Guidelines - National Collaborating Centre for Mental Health (UK).

Version: 2004
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Osteoporosis: Fragility Fracture Risk: Osteoporosis: Assessing the Risk of Fragility Fracture

There are a number of therapies and treatments available for the prevention of fragility fractures in people thought to be at risk, or to prevent further fractures in those who have already had one or more fragility fractures. However, identifying who will benefit from preventative treatment is imprecise. A number of risk assessment tools are available to predict fracture incidence over a period of time, and these may be used to aid decision making. These tools are limited in that they may not include all risk factors, or may lack details of some risk factors. Tools are dependent on the accuracy of the epidemiological data used to derive them and tools validated in other populations may not apply to the UK.. Two tools, FRAX and QFracture, are available for use in the UK. It is not clear whether these tools are equally accurate and whether choice of tool should depend on circumstances. This short clinical guideline aims to provide guidance on the selection and use of risk assessment tools in the care of people who may be at risk of fragility fractures in all settings in which NHS care is received.

NICE Clinical Guidelines - National Clinical Guideline Centre (UK).

Version: August 2012
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Pedicle screw fixation methods for traumatic fractures of the thoracic and lumbar spine

Thoracic and lumbar spine fractures are the most common injuries of the spine. An exaggerated curvature (kyphosis) at the end of treatment may predispose to later back pain and a poor functional outcome. If the nerve root or spinal cord is damaged, partial or complete loss of sensory and motor function in the legs, and urinary and faecal incontinence may result. Treatment depends on the individual characteristics of the fracture, with options including bed rest alone, closed reduction of the fracture and functional bracing, and surgery involving open reduction and internal fixation of the fracture. Surgery frequently involves posterior pedicle screw fixation, where typically screws are placed in the 'pedicle' parts of the vertebrae (bones of the spine) adjacent to the damaged vertebrae and connected by rods to hold the bones in place and stabilise the fracture while it heals. This review examined the evidence for the different types of pedicle screw fixation and for additional support such as fusion, where bone graft (usually taken from bone near the hip region of the patient) or substitute is added to the spine. The latter aims to reduce movement of the injured segment and any associated pain.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2013

Percutaneous vertebroplasty and percutaneous balloon kyphoplasty for the treatment of osteoporotic vertebral fractures: a systematic review and cost-effectiveness analysis

Study found that for people with painful osteoporotic vertebral compression fractures refractory to analgesic treatment, percutaneous vertebroplasty and balloon kyphoplasty significantly reduce pain and improve quality of life compared with optimal pain management. However, there is no evidence that either performs better than operative placebo with local anaesthetic. Complications from either procedure are rare but can be serious. Further research is needed to establish whether or not either procedure has a mortality advantage over or utility gain compared with operative placebo with local anaesthetic.

Health Technology Assessment - NIHR Journals Library.

Version: March 2014
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EOS 2D/3D X-ray imaging system: a systematic review and economic evaluation

EOS is a biplane X-ray imaging system manufactured by EOS imaging (formerly Biospace Med, Paris, France). It uses slot-scanning technology to produce a high-quality image with less irradiation than standard imaging techniques.

NIHR Health Technology Assessment programme: Executive Summaries - NIHR Journals Library.

Version: 2012

Direct Lateral Interbody Fusion in Patients Requiring Surgery for Spinal Instability: A Review of the Comparative Clinical and Cost-Effectiveness, and Guidelines [Internet]

The purpose of this report is to retrieve and review the existing evidence of clinical effectiveness, and safety of direct lateral interbody fusion (DLIF) in patients requiring surgery for spinal instability. In addition this report aims to examine the available evidence for comparative clinical effectiveness, and cost-effectiveness of DLIF as compared to other surgical lumbar fusion techniques in single and multiple transpsoas fusions for the treatment of spinal instability. Finally this report aims to retrieve and review available guidelines on performing DLIF in patients requiring surgery for spinal instability.

Rapid Response Report: Summary with Critical Appraisal - Canadian Agency for Drugs and Technologies in Health.

Version: June 25, 2015
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Spasticity in Children and Young People with Non-Progressive Brain Disorders: Management of Spasticity and Co-Existing Motor Disorders and Their Early Musculoskeletal Complications

This guideline covers the management of spasticity and co-existing motor disorders and their early musculoskeletal complications in children and young people (from birth up to their 19th birthday) with non-progressive brain disorders.

NICE Clinical Guidelines - National Collaborating Centre for Women's and Children's Health (UK).

Version: July 2012
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Benefits and Harms of Femtosecond Laser Assisted Cataract Surgery: A Systematic Review [Internet]

The preferred method of removing cataracts in the developed world is phacoemulsification. Using this technique, ultrasonic energy softens the dense lens material of the cataract, which is then extracted from the eye with suction and irrigation. Current practice includes creating manual corneal incisions and anterior capsulotomies, followed by phacoemulsification. Recently these three manual procedures have been performed in an automated fashion with the use of the femtosecond laser (FSL). Several FSL systems have been approved by the FDA for use in the U.S. for some or all of these procedural steps in cataract surgery. FSL technology has been widely used in various refractive surgery applications in recent years. Studies have suggested decreased phacoemulsification energy use with FSL cataract surgery and have examined the potential advantages of more precise corneal incisions and capsulotomy formation.

Evidence-based Synthesis Program - Department of Veterans Affairs (US).

Version: December 2013
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A systematic review of evidence on malignant spinal metastases: natural history and technologies for identifying patients at high risk of vertebral fracture and spinal cord compression

Study reports that clinical consensus favours magnetic resonance imaging and computerised tomography for identifying patients with malignant spinal metastases who are at high risk of vertebral fracture and spinal cord compression.

Health Technology Assessment - NIHR Journals Library.

Version: September 2013
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