Disk Pathology

Top Papers are articles in a specific subject rated by professionals and scholars in the field. Top 10 articles are displayed in an order from the most highest rating to the lowest. In order to rate an article, one must first register at SpineDeformityBlog.com as a member.

Interventional Therapies, Surgery, and Interdisciplinary Rehabilitation for Low Back Pain: An Evidence-Based Clinical Practice Guideline From the American Pain Society.

Chou R, Loeser JD, Owens DK, et al.

Spine.  2009; 34: 1066-1077.

PMID: 19363457

This clinical guideline from the APS is based on two rigorous systematic reviews of 161 RCTs on pain due to DDD, disk herniation, or stenosis.  It provides recommendations on numerous forms of surgical and non-surgical treatments, based on the evidence.  This is the definitive guide to treatment of these patients.

web:  http://journals.lww.com/spinejournal/pages/articleviewer.aspx?year=2009&issue=05010&article=00014&type=a

Posted by on Nov 16, 2011 in Disk Pathology | 0 comments

Surgery for Low Back Pain: A Review of the Evidence for an American Pain Society Clinical Practice Guideline.

Chou R, Baisden J, Carragee EJ, Resnick DK, Shaffer WO, Loeser JD.

Spine.  2009;  34:  1094-1109.

PMID: 19363455

This paper systematically reviewed all RCTs and systematic reviews on surgery for DDD, disk herniation, or stenosis.  They found surgery more effective than non-surgical treatment for stenosis and radiculopathy but not DDD back pain.  This paper provides the definitive synthesis of all level-1 evidence on surgery for these conditions.

web:  http://journals.lww.com/spinejournal/pages/articleviewer.aspx?year=2009&issue=05010&article=00016&type=abstract

Posted by on Nov 16, 2011 in Disk Pathology | 0 comments

Risk of Multiple Reoperations After Lumbar Discectomy: A Population-Based Study.

Österman H, Sund R, Seitsalo S, Keskimäki I.

Spine.  2003; 28: 621-627.

PMID:  12642772

Using an administrative database with over 35,000 patients, this study found the risk for multiple reoperations after diskectomy was significantly reduced if the first reoperation was a fusion or took place a year after the index surgery.  This study provides powerful insights on patients returning for treatment after diskectomy.

web:  http://journals.lww.com/spinejournal/pages/articleviewer.aspx?year=2003&issue=03150&article=00019&type=abstract

Posted by on Nov 16, 2011 in Disk Pathology | 0 comments

Occupational and Other Predictors of Herniated Lumbar Disc Disease-A 33-Year Follow-up in The Copenhagen Male Study.

Sørensen IG, Jacobsen P, Gyntelberg F, Suadicani P.

Spine. 2011; 36:  1541-1546.

PMID:  21270695

This epidemiological study analyzed the risk factors for disk herniation in over 3800 men without a history of back problems, followed prospectively for over 30 years.  Physically strenuous work was the strongest predictor of herniation.  This study provides unique knowledge for prevention programs and healthcare policy for disk herniation.

web:  http://journals.lww.com/spinejournal/pages/articleviewer.aspx?year=2011&issue=09010&article=00005&type=abstract

Posted by on Nov 16, 2011 in Disk Pathology | 0 comments

Surgical Versus Nonoperative Treatment for Lumbar Disc Herniation: Four-Year Results for the Spine Patient Outcomes Research Trial (SPORT).

Weinstein JN, Lurie JD, Tosteson TD, Tosteson AN, Blood EA, Abdu WA, Herkowitz H, Hilibrand A, Albert T, Fischgrund J.

Spine. 2008; 33: 2789-2800.

PMID: 19018250
This paper reports the four-year clinical outcomes of the prospective multicenter SPORT study on disk herniation.  It confirms and supersedes the two-year as-treated analysis showing that surgery had a meaningfully greater treatment effect than routine conservative care.  This paper provides high-quality evidence supporting surgery for disk herniation.

web:  http://journals.lww.com/spinejournal/pages/articleviewer.aspx?year=2010&issue=06150&article=00002&type=abstract

Posted by on Nov 16, 2011 in Disk Pathology | 0 comments

Who should have Surgery for an Intervertebral Disc Herniation? Comparative Effectiveness Evidence from SPORT.

Pearson A, Lurie J, Tosteson T, Zhao W, Abdu W, Mirza S, Weinstein J.

Spine. 2011 Jun 15. [Epub ahead of print]

PMID: 21681140

This post hoc comparative effectiveness analysis of the SPORT trial examined factors that predict greater treatment effects of surgery vs. conservative care.  They found that surgery had greater treatment effects in patients who were married, lacked joint problems, or had worsening symptoms.  This analysis provides important insights for patient counseling.

web:  http://journals.lww.com/spinejournal/pages/articleviewer.aspx?year=9000&issue=00000&article=98700&type=abstract

Posted by on Nov 16, 2011 in Disk Pathology | 0 comments

Prolonged conservative care versus early surgery in patients with sciatica caused by lumbar disc herniation: two year results of a randomised controlled trial.

Peul WC, van den Hout WB, Brand R, Thomeer RT, Koes BW; Leiden-The Hague Spine Intervention Prognostic Study Group.

BMJ. 2008; 336: 1355-1358.

PMID: 18502911

This prospective multicenter RCT compared early surgery vs. prolonged conservative care for sciatica.  They found that early surgery provides relief sooner but by 6-months is not significantly better than conservative care.  This study provides important level-1 evidence for treatment decision-making, patient counseling, and health policy for disk herniation.

web:  http://www.bmj.com/content/336/7657/1355.full.pdf

Posted by on Nov 16, 2011 in Disk Pathology | 0 comments

The Influence of Subdiagnosis on Radiographic and Clinical Outcomes After Lumbar Fusion for Degenerative Disc Disorders: An Analysis of the Literature From Two Decades.

Bono CM, Lee CK.

Spine.  2005; 30: 227-234.

PubMed PMID: 15644762

This paper presents a pooled analysis of the literature on fusion for various subdiagnoses of DDD in over 4400 patients from 78 articles during 20 years.  They compared these subdiagnosis groups on clinical outcomes, fusion rates, and complications.  This is the best available synthesis of all published data on DDD.

web:  http://journals.lww.com/spinejournal/pages/articleviewer.aspx?year=2005&issue=01150&article=00013&type=abstract

Posted by on Nov 16, 2011 in Disk Pathology | 0 comments

The Role of Fusion for Discogenic Axial Back Pain Without Associated Leg Pain , Spondylolisthesis or Stenosis: An Evidence-Based Review.

Coe M, Mirza S, Sengupta D.

Semin Spine Surg.  2009; 21: 246-256.

PMID: [not indexed].

This review paper summarizes and discusses all 6 published RCTs on fusion for low back pain due to DDD without spinal co-morbidities.  They found fusion superior to conservative care but similar to intensive rehabilitation or arthroplasty.  This paper provides an excellent overview of the level-1 evidence on fusion for DDD.

web:  http://www.semspinesurg.com/article/S1040-7383(09)00072-0/abstract

Posted by on Nov 16, 2011 in Disk Pathology | 0 comments

Total disc replacement surgery for symptomatic degenerative lumbar disc disease: a systematic review of the literature.

van den Eerenbeemt KD, Ostelo RW, van Royen BJ, Peul WC, van Tulder MW.

Eur Spine J. 2010 Aug;19(8):1262-80.

PMID: 20508954

This rigorous systematic review critically summarized all available prospective clinical trials on arthroplasty for DDD.  They reported that TDR seems similiarly efficacy to fusion, but complications and reoperations are frequent.  Though possibly biased against arthroplasty, this is the best available overview on this emerging technology.

web:  http://www.springerlink.com/content/5r86753l420j6036/fulltext.pdf

Posted by on Nov 16, 2011 in Disk Pathology | 0 comments