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Zoher Ghogawala, Daniel K. Resnick, William C. Watters III, Praveen V. Mummaneni, Andrew T. Dailey, Tanvir F. Choudhri, Jason C. Eck, Alok Sharan, Michael W. Groff, Jeffrey C. Wang, Sanjay S. Dhall and Michael G. Kaiser

Recommendations There is no evidence that conflicts with the previous recommendations published in the original version of the “Guidelines for the performance of fusion procedures for degenerative disease of the lumbar spine.” Grade B It is recommended that when assessing functional outcome in patients treated for low-back pain due to degenerative disease, a reliable, valid, and responsive outcomes instrument, such as the disease-specific Oswestry Disability Index (ODI), be used (Level II evidence). It is recommended that when assessing general

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Jason C. Eck, Alok Sharan, Daniel K. Resnick, William C. Watters III, Zoher Ghogawala, Andrew T. Dailey, Praveen V. Mummaneni, Michael W. Groff, Jeffrey C. Wang, Tanvir F. Choudhri, Sanjay S. Dhall and Michael G. Kaiser

following lumbar spine fusion. Limitations of this study included a small sample size & lack of quantitative & validated clinical outcomes measures. * AAOS = American Academy of Orthopaedic Suregeons; ALIF = anterior lumbar interbody fusion; DDD = degenerative disc disease; FRA = femoral ring allograft; JOA = Japanese Orthopaedic Association; MODEMS = Musculoskeletal Outcomes Data Evaluation and Management System; ODI = Oswestry Disability Index; pts = patients; VAS = visual analog scale. Scientific Foundation The use of discography for the diagnosis of lumbar

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Daniel K. Resnick, Tanvir F. Choudhri, Andrew T. Dailey, Michael W. Groff, Larry Khoo, Paul G. Matz, Praveen Mummaneni, William C. Watters III, Jeffrey Wang, Beverly C. Walters and Mark N. Hadley

differentiate treated patients from conservatively managed controls. In comparing techniques thought to be more equivalent (such as different types of efficacious treatments), larger numbers of cases are required to demonstrate a difference between groups. Researchers are cautioned that in the context of small sample size, the absence of a statistically significant benefit does not necessarily indicate the absence of a clinically relevant benefit. Abbreviations used in this paper GFS = General Function Scale ; ODI = Oswestry Disability Index

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Jason C. Eck, Alok Sharan, Zoher Ghogawala, Daniel K. Resnick, William C. Watters III, Praveen V. Mummaneni, Andrew T. Dailey, Tanvir F. Choudhri, Michael W. Groff, Jeffrey C. Wang, Sanjay S. Dhall and Michael G. Kaiser

lumbar interbody fusion; AP = anteroposterior; JOA = Japanese Orthopaedic Association; LBP = low-back pain; NASS = North American Spine Society; NS = not significant; ODI = Oswestry Disability Index; PT = physical therapy; pts = patients; SF-36 = 36-Item Short Form Health Survey; VAS = visual analog scale. Scientific Foundation A review of the Cochrane database failed to identify a randomized, controlled trial investigating the utility of lumbar fusion for the treatment of low-back pain due to spondylosis. 19 Two subsequent randomized trials were summarized in

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Daniel K. Resnick, Tanvir F. Choudhri, Andrew T. Dailey, Michael W. Groff, Larry Khoo, Paul G. Matz, Praveen Mummaneni, William C. Watters III, Jeffrey Wang, Beverly C. Walters and Mark N. Hadley

= Oswestry Disability Index ; QOL = quality of life ; QPDS = Quebec Pain Disability Scale ; RMDQ = Roland—Morris Disability Questionnaire ; SF-36 = Short-Form—36 ; SIP = Sickness Impact Profile ; VAS = visual analog scale . References 1. Bergner M , Bobbitt RA , Carter WB , et al : The Sickness Impact Profile: development and final revision of a health status measure. Med Care 19 : 787 – 805 , 1981 Bergner M, Bobbitt RA, Carter WB, et al: The

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Andrew T. Dailey, Zoher Ghogawala, Tanvir F. Choudhri, William C. Watters III, Daniel K. Resnick, Alok Sharan, Jason C. Eck, Praveen V. Mummaneni, Jeffrey C. Wang, Michael W. Groff, Sanjay S. Dhall and Michael G. Kaiser

16.3 for QBPDS). The authors also used subjective measures of benefit using measures such as satisfaction, confidence that brace reduced pain, & confidence that it provided support. On an NRS, benefit was 7. Although there was benefit, the authors would not recommend brace use in this population. * LBP = low-back pain; NRS = Numeric Rating Scale; ODI = Oswestry Disability Index; QBPDS = Quebec Back Pain Disability Scale; SF-12 = 12-Item Short Form Health Survey; VAS = visual analog scale. TABLE 3: Bracing prior to the treatment of low-back pain

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Daniel K. Resnick, William C. Watters III, Alok Sharan, Praveen V. Mummaneni, Andrew T. Dailey, Jeffrey C. Wang, Tanvir F. Choudhri, Jason Eck, Zoher Ghogawala, Michael W. Groff, Sanjay S. Dhall and Michael G. Kaiser

Level III evidence supporting the role of surgery for stenosis associated with spondylolisthesis. 24 Surgical Technique Abdu et al. 1 reviewed the results from the SPORT lumbar spondylolisthesis study and compared results across fusion techniques. The beneficial effects of surgery were maintained over 4 years, and patients reported significant improvement in every primary outcome measure (Oswestry Disability Index [ODI], 36-Item Short Form Health Survey, and visual analog scale [VAS]) compared with their baseline status. No differences in outcome were detected

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Praveen V. Mummaneni, Sanjay S. Dhall, Jason C. Eck, Michael W. Groff, Zoher Ghogawala, William C. Watters III, Andrew T. Dailey, Daniel K. Resnick, Tanvir F. Choudhri, Alok Sharan, Jeffrey C. Wang and Michael G. Kaiser

Outcome Score; LOS = length of stay; ODI = Oswestry Disability Index; PLF = posterolateral lumbar fusion; PLIF = posterior lumbar interbody fusion; PPS = instrumented PLF with pedicle screws; pts = patients; TLIF = transforaminal lumbar interbody fusion. Scientific Foundation Recent trends in spinal surgery involve the use of interbody fusion techniques, including ALIF, posterior lumbar interbody fusion (PLIF), transforaminal lumbar interbody fusion (TLIF), or axial lumbar interbody fusion as a means to enhance the rate of successful arthrodesis. Authors of

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Daniel K. Resnick, Tanvir F. Choudhri, Andrew T. Dailey, Michael W. Groff, Larry Khoo, Paul G. Matz, Praveen Mummaneni, William C. Watters III, Jeffrey Wang, Beverly C. Walters and Mark N. Hadley

; BMP = bone morphogenetic protein ; HA = hydroxyapatite ; ODI = Oswestry Disability Index ; PLF = posterolateral fusion ; RCT = randomized controlled trial ; rhBMP = recombinant human BMP . References 1. Boden SD , Kang J , Sandhu H , et al : Use of recombinant human bone morphogenetic protein-2 to achieve posterolateral lumbar spine fusion in humans: a prospective, randomized clinical pilot trial: 2002 Volvo Award in clinical studies. Spine 27 : 2662 – 2673

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Sanjay S. Dhall, Tanvir F. Choudhri, Jason C. Eck, Michael W. Groff, Zoher Ghogawala, William C. Watters III, Andrew T. Dailey, Daniel K. Resnick, Alok Sharan, Praveen V. Mummaneni, Jeffrey C. Wang and Michael G. Kaiser

significant difference; MSPQ = Modified Somatic Perception Questionnaire; ODI = Oswestry Disability Index; PLF = posterolateral lumbar fusion; pt = patient; SCB = substantial clinical benefit threshold; SF-36 = 36-Item Short Form Health Survey; VAS = visual analog scale; ZDS = Zung Depression Scale. Scientific Foundation Achievement of a solid fusion across the treated motion segments is an integral goal of any lumbar fusion procedure performed to treat low-back pain due to lumbar degenerative disease. Therefore, patients who achieve a solid fusion would be expected