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Spine Research Prioritization

Fusions in Spine SCOAP

Submitted via email by Linda DeCarlo: When I was reviewing the June SCOAP report, I saw a high number of anterior fusions being done. I was wondering if that was combining the cervical and lumbar data together. If so, that would explain the high number of anterior approaches by including ACDF procedure data with the lumbar data. I think it would be more meaningful to separate out the cervical anterior fusions, cervical ...more »

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Vascular Research Prioritization

Appropriate medical therapy among vascular surgery pts

Optimal medical therapy (ASA, statin, +/- Beta blocker) are likely to reduce adverse cardio-vascular events in patients with vascular disease. Patients with PAD, carotid occlusive disease, and AAA are likely to have concomitant CAD. Interaction with a vascular surgeon is an opportunity to ensure that appropriate secondary prevention measures are being instituted, i.e. ASA, statin and BP control (Beta Blocker, and perhaps ...more »

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Vascular Research Prioritization

Predictors for poor outcome for open revascularization.

One of my clinical challenges today is to decide who to offer open revascularization or endovascular intervention versus primary amputation.

Would be helpful to determine a scoring systems ( major/minor predictors/ calculator) to help with the decision.

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Vascular Research Prioritization

Treatment patterns for patients with carotid disease

The management of patients with asymptomatic carotid disease is controversial and varies widely by region. Additionally, the management of patients with symptomatic, moderate carotid stenosis varies by specialty. For example, many neurologists manage patients with symptomatic 50-69% carotid stenosis medically, noting that the absolute risk reduction with surgery and NNT for stroke prevention in this group is similar to ...more »

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Vascular Research Prioritization

Comparing Stenting Across Specialties

Submitted via email by Dr. Joseph Mulcahy: It would be interesting to explore how the different clinical specialties performing stent placements (e.g., vascular surgeons, interventional radiologists, cardiologists, and general surgeons) compare in indications used for stenting, objective tests done prior to stenting, locations chosen for stenting, the primary and secondary patency results, and follow-up protocols.

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Spine Research Prioritization

Lumbar Disc Herniation - Prospective Registry

from NASS priorities list. Due to the lack of clinical equipoise regarding the timing of surgical intervention for cauda equina syndrome, a randomized trial is not possible. Currently, the literature is limited to retrospective case series, which are highly subject to bias. Prospective collection of information related to pre-operative functional status and postoperative functional outcomes through the use of a multicenter ...more »

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Spine Research Prioritization

Nonspecific effects that determine outcomes in lumbar surgery

How do patient and provider values, beliefs and expectations influence outcomes of lumbar surgery? A greater understanding is needed of the nonspecific effects that determine outcomes and how this information can be used to better improve outcomes for lumbar surgery. These include patient factors including patient expectations for outcomes, beliefs, values) and provider factors (beliefs, expectations for patient outcomes, ...more »

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Spine Research Prioritization

Surgical Treatment - Lumbar Stenosis

from NASS priorities list: A large, multicenter, three-arm, randomized, controlled trial using a well-defined group of patients with moderate clinically symptomatic stenosis, comparing lumbar decompression to a well-defined medical/interventional treatment program and / or a natural history group of untreated patients is needed. A large, multicenter, three-arm, randomized, controlled trial using a well-defined group ...more »

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Spine Research Prioritization

Lumbar Stenosis - Ancillary Treatments

from NASS priorities list: Prospective, RCTs with validated outcome measures are needed to evaluate efficacy of ancillary treatments such as acupuncture, TENS, traction and electrical stimulation in a comparative manner. When ethical, evaluating the efficacy of these treatments compared to untreated controls would be ideal. Alternatively, this can be used as a comparative group in an RCT with PT, injections and/or medications. ...more »

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Spine Research Prioritization

Lumbar Stenosis - Bracing

From NASS priorities list: An appropriately powered study is proposed containing three groups with symptomatic lumbar spinal stenosis comparing soft bracing, rigid bracing and untreated controls (no bracing). Outcome measures could include the

ZCQ, VAS, walking distance and a validated, health-related quality of life measure such as the SF-36 or ODI.

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Spine Research Prioritization

Medical Treatment - Degenerative Lumbar Stenosis

An RCT with long-term follow-up and validated outcome measures would assist in providing evidence to assess the efficacy of physical therapy in the treatment of lumbar spinal stenosis. Ideally, this would be compared to an untreated control group. We recognize this may be a difficult or unethical study to propose over the long term. Other active treatment groups could be substituted as a comparative group. The physical ...more »

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Spine Research Prioritization

Medical Treatment - Spondylolisthesis

From NASS priorities list: The SPORT study demonstrated the intrinsic difficulties in conducting RCTs comparing surgical to medical/interventional treatment in the North American patient population. It is unlikely that higher quality data are achievable for the comparison of surgical and medical/interventional treatment. Future studies are needed to assess the effects of medical, noninvasive interventions for degenerative ...more »

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Spine Research Prioritization

Degenerative Lumbar Spondylolisthesis - Outcomes

From NASS priorities list: Further studies are needed to validate additional outcome measures (Stenosis Bothersome Index, LBP Bothersome Index, Oxford Claudication Score, Shuttle Walking Test, JOA and calculated Recovery Rate) for the treatment of degenerative lumbar spondylolisthesis. Currently, the best outcome measure for degenerative pondylolisthesis with symptoms of spinal stenosis is the ZCQ/SSS as a disease-specific ...more »

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Spine Research Prioritization

Antibiotic Complications

From NASS priorities list: Large multicenter randomized controlled trials should be conducted to assess the efficacy of various protocols designed to decrease the complications resulting from antibiotic administration and emergence of antibiotic resistance bacterial strains. These should be tailored to specific patient populations (e.g., obesity, diabetes, trauma, neuromuscular injury or disease, prolonged multilevel ...more »

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Displaying 1 - 25 of 33 Ideas