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Michael W. Groff - One of the best experts on this subject based on the ideXlab platform.
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guideline update for the performance of fusion procedures for Degenerative Disease of the lumbar spine part 1 introduction and methodology
Journal of Neurosurgery, 2014Co-Authors: Michael G. Kaiser, Michael W. Groff, Tanvir F. Choudhri, Jason C Eck, William C Watters, Andrew T Dailey, Daniel K Resnick, Alok D Sharan, Jeffrey C Wang, Praveen V. MummaneniAbstract:Fusion procedures are an accepted and successful management strategy to alleviate pain and/or neurological symptoms associated with Degenerative Disease of the lumbar spine. In 2005, the first version of the "Guidelines for the performance of fusion procedures for Degenerative Disease of the lumbar spine" was published in the Journal of Neurosurgery: Spine. In an effort to incorporate evidence obtained since the original publication of these guidelines, an expert panel of neurosurgical and orthopedic spine specialists was convened in 2009. Topics reviewed were essentially identical to the original publication. Selected manuscripts from the first iteration of these guidelines as well as relevant publications between 2005 through 2011 were reviewed. Several modifications to the methodology of guideline development were adopted for the current update. In contrast to the 2005 guidelines, a 5-tiered level of evidence strategy was employed, primarily allowing a distinction between lower levels of evidence. The qualitative descriptors (standards/guidelines/options) used in the 2005 recommendations were abandoned and replaced with grades to reflect the strength of medical evidence supporting the recommendation. Recommendations that conflicted with the original publication, if present, were highlighted at the beginning of each chapter. As with the original guideline publication, the intent of this update is to provide a foundation from which an appropriate treatment strategy can be formulated.
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guideline update for the performance of fusion procedures for Degenerative Disease of the lumbar spine part 2 assessment of functional outcome following lumbar fusion
Journal of Neurosurgery, 2014Co-Authors: Zoher Ghogawala, Michael W. Groff, Praveen V. Mummaneni, Tanvir F. Choudhri, William C Watters, Andrew T Dailey, Daniel K Resnick, Jeffrey C Wang, Alok Sharan, Sanjay S DhallAbstract:Assessment of functional patient-reported outcome following lumbar spinal fusion continues to be essential for comparing the effectiveness of different treatments for patients presenting with Degenerative Disease of the lumbar spine. When assessing functional outcome in patients being treated with lumbar spinal fusion, a reliable, valid, and responsive outcomes instrument such as the Oswestry Disability Index should be used. The SF-36 and the SF-12 have emerged as dominant measures of general health-related quality of life. Research has established the minimum clinically important difference for major functional outcomes measures, and this should be considered when assessing clinical outcome. The results of recent studies suggest that a patient's pretreatment psychological state is a major independent variable that affects the ability to detect change in functional outcome.
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introduction guideline update for the performance of fusion procedures for Degenerative Disease of the lumbar spine
Journal of Neurosurgery, 2014Co-Authors: Michael W. GroffAbstract:On behalf of the American Association of Neurological Surgeons/Congress of Neurological Surgeons (AANS/CNS) Joint Section on Disorders of the Spine and Peripheral Nerves, it is with distinct pleasure that I introduce the “Guideline update for the performance of fusion procedures for Degenerative Disease of the lumbar spine.” The initial version of these guidelines was originally published in the June 2005 issue of the Journal of Neurosurgery: Spine.1 The update presented in this issue of the Journal of Neurosurgery: Spine exemplifies the commitment that organized neurosurgery, in cooperation with our orthopedic colleagues, has made to ensure that this vital source of information continues to evolve and reflect the most current evidence on each of the topics covered. In a very real sense these guidelines are a credit to all clinicians involved in the care of disorders of the spine. That is the body of work on which the literature is based, which in turn is the foundation of these guidelines. This work is also a credit to the established infrastructure created by the Guidelines Committee of the AANS and CNS to facilitate the production and dissemination of evidence-based guidelines. In addition, the successful publication of this material would not have been possible without the assistance provided by the staff at the Journal of Neurosurgery Publishing Group. Their expertise in the peer-review process, editorial guidance, and transmission of information have enhanced the overall quality and impact of this effort. I personally want to thank Dr. James T. Rutka, M.D., Ph.D., Editor-in-Chief of the Journal of Neurosurgery: Spine, for his forbearance and attention to this project. As the literature has evolved, so too has the process of guidelines development. As there is no well-accepted standard protocol for updating guidelines, a significant amount of time and effort was expended to establish the methodology. Consensus among members of the expert panel was achieved in accord with a well-defined methodology to minimize bias, maximize integrity, and create a final product consistent with the highest ideals of evidence-based medicine. Among the most important missions of the AANS/CNS Joint Section on Disorders of the Spine and Peripheral Nerves is the generation of highquality evidence that can assist both our membership and the spine community at large in providing the highestquality care for our patients. Just as this work builds on the foundation created by the original 2005 publication, it is anticipated that this document will in time be updated as well. For the moment, however, it reflects an unbiased synthesis of the literature and points toward the quality spine care that we, as clinicians, aspire to provide. It is an honor to present this Guideline Update on behalf of the AANS/CNS Joint Section on Disorders of the Spine and Peripheral Nerves to the readership of the Journal of Neurosurgery: Spine. This update reflects the highest ideals of the section. It is offered to physicians of all levels who seek a greater understanding of the role lumbar fusion can play in the care of patients with Degenerative Disease of the lumbar spine. (http://thejns.org/doi/abs/10.3171/2014.4.SPINE14190)
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functional outcomes assessment for cervical Degenerative Disease
Journal of Neurosurgery, 2009Co-Authors: Langston T. Holly, Paul G. Matz, Paul A. Anderson, Michael G. Kaiser, Michael W. Groff, Robert F. Heary, Praveen V. Mummaneni, Timothy C. Ryken, Tanvir F. Choudhri, Edward J. VresilovicAbstract:Object The objective of this systematic review was to use evidence-based medicine to identify valid, reliable, and responsive measures of functional outcome after treatment for cervical Degenerative Disease. Methods The National Library of Medicine and Cochrane Database were queried using MeSH headings and key words relevant to functional outcomes. Abstracts were reviewed after which studies meeting inclusion criteria were selected. The guidelines group assembled an evidentiary table summarizing the quality of evidence (Classes I–III). Disagreements regarding the level of evidence were resolved through an expert consensus conference. The group formulated recommendations that contained the degree of strength based on the Scottish Intercollegiate Guidelines network. Validation was done through peer review by the Joint Guidelines Committee of the American Association of Neurological Surgeons/Congress of Neurological Surgeons. Results Myelopathy Disability Index, Japanese Orthopaedic Association scale, 36-Ite...
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Introduction and methodology: guidelines for the surgical management of cervical Degenerative Disease.
Journal of neurosurgery. Spine, 2009Co-Authors: Paul G. Matz, Paul A. Anderson, Michael G. Kaiser, Langston T. Holly, Michael W. Groff, Robert F. Heary, Praveen V. Mummaneni, Timothy C. Ryken, Tanvir F. Choudhri, Edward J. VresilovicAbstract:In March 2006, the Joint Section on Disorders of the Spine and Peripheral Nerves of the American Association of Neurological Surgeons and Congress of Neurological Surgeons compiled an expert group to perform an evidence- based review of the clinical literature on management of cervical Degenerative spine Disease. This process culminated in the formation of the Guidelines for the Surgical Management of Cervical Degenerative Disease. The purpose of the Guidelines was to address questions regarding the therapy, diagnosis, and prognosis of cervical Degenerative Disease using an evidence-based approach. Development of an evidence-based review and recommendations is a multitiered process. Typical guideline development consists of 5 processes: 1) collection and selection of the evi- dence; 2) assessment of the quality and strength of the evidence; 3) analysis of the evidentiary data; 4) formulation of recommendations; and 5) guideline validation. This manuscript details the methodology in compiling the Guidelines for the Surgical Management of Cervical Degenerative Disease. (DOI: 10.3171/2009.1.SPINE08712) Key W or D s • cervical spine • cervical spondylosis • methodology • practice guidelines
Tirone E David - One of the best experts on this subject based on the ideXlab platform.
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simplici t annuloplasty band for mitral valve repair for Degenerative Disease
The Annals of Thoracic Surgery, 2014Co-Authors: Tirone E David, Carolyn M David, Cedric ManlhiotAbstract:Background Sizing of annuloplasty rings and bands is variably based on intertrigonal or intercommissural distances or estimation of the anterior leaflet area. This study examines the results of mitral valve repair with Simplici-T annuloplasty band without predetermining its length in patients with mitral regurgitation (MR) as a result of Degenerative Disease. Methods Three hundred thirty-seven consecutive patients (median age, 58 years; 69% men) underwent mitral valve repair for MR as a result of Degenerative Disease (52% bileaflet prolapse and 36% anterior leaflet prolapse). Prolapse of the leaflet was corrected by chordal replacement with Gore-Tex sutures and occasionally a triangular resection. A posterior mitral annuloplasty with a Simplici-T band (median length, 70 mm; range, 52 to 80 mm) was performed by securing it from the lateral to the medial fibrous trigones. Annular reduction was performed selectively on the commissures, false commissures, and areas of posterior leaflet resection. Mitral valve function, gradients, and areas were assessed perioperatively and annually during a median follow-up of 4.1 years (interquartile range, 2.7 to 5.4 years) and was 98% complete. Results There were 2 operative and 7 late deaths; survival at 5 years was 97.2%. Three patients were discharged from the hospital with mild to moderate MR, and during follow-up a total of 14 patients had MR greater than mild and 1 patient had MR greater than moderate. Mitral valve re-repair was performed in 1 patient who exhibited mitral stenosis. Freedom from MR greater than mild at 5 years was 93.3%. Conclusions Selective reduction of the mitral annulus with a posterior band without predetermining its length during mitral valve repair for Degenerative MR provides excellent functional results.
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outcomes of mitral valve repair for mitral regurgitation due to Degenerative Disease
Seminars in Thoracic and Cardiovascular Surgery, 2007Co-Authors: Tirone E DavidAbstract:The aim of this study was to review the clinical and echocardiographic outcomes after mitral valve repair for mitral regurgitation due to Degenerative Disease of the mitral valve. A total of 649 consecutive patients who had isolated mitral valve repair were prospectively followed up for 6.8 ± 3.1 years. The mean age was 58 ± 11 years. The operative mortality rate was 0.6%; the late mortality rate was 14.6%; and survival at 15 years was 67 ± 5%. Age by increments of 5 years, advanced functional class, and impaired left ventricular function were independent predictors of late death. The freedom from reoperation on the mitral valve at 15 years was 92 ± 3%, and the freedom from late, recurrent, severe mitral regurgitation was 85 ± 4%. Most patients were in functional classes I or II at the latest follow-up contact. Mitral valve repair is associated with low operative mortality and morbidity, but it does not arrest the Degenerative process. This study suggests that rates of reoperation underscore rates of late failure of the mitral valve repair.
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a comparison of outcomes of mitral valve repair for Degenerative Disease with posterior anterior and bileaflet prolapse
The Journal of Thoracic and Cardiovascular Surgery, 2005Co-Authors: Tirone E David, Susan Armstrong, Joan Ivanov, Debbie Christie, Harry RakowskiAbstract:Objective We sought to compare the clinical and echocardiographic outcomes of mitral valve repair for mitral regurgitation in patients with Degenerative Disease of the mitral valve with posterior, anterior, or bileaflet prolapse. Methods Patients underwent operations from 1981 through 2001: 359 had posterior (mean age, 60.4 years), 92 had anterior (mean age, 53.3 years), and 250 had bileaflet (means age, 56.4 years) prolapse. Patients with anterior prolapse were younger (P = .04) and had more associated aortic valve Disease (P = .02), particularly bicuspid aortic valve Disease (P Results The overall survival at 12 years was 75% ± 5%, with no difference among the posterior, anterior, and bileaflet prolapse groups (P = .3). The freedom from reoperation at 12 years was 96% ± 2% for posterior, 88% ± 4% for anterior, and 94% ± 2% for bileaflet prolapse (P = .019). Anterior prolapse was the only independent predictor of reoperation. The freedom from moderate or severe mitral regurgitation at 12 years was 80% ± 4% for posterior, 65% ± 8% for anterior, and 67% ± 6% for bileaflet prolapse (P = .001). Anterior and bileaflet prolapse, age, ejection fraction of less than 40%, and aortic valve Disease were independent predictors of recurrent moderate or severe mitral regurgitation. Conclusions The pathophysiology of mitral regurgitation affects the durability of mitral valve repair for Degenerative Disease, and the results of posterior prolapse are better than those of anterior and bileaflet prolapse. This study indicates that rates of reoperation underscore the rates of failure of mitral valve repair.
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Aortic Valve Repair in Patients with Marian Syndrome and Ascending Aorta Aneurysms Due to Degenerative Disease
Journal of cardiac surgery, 1994Co-Authors: Tirone E DavidAbstract:Patients with Marian syndrome may require aortic surgery because of aortic insufficiency, aortic root aneurysm, ascending aortic aneurysm, or acute type A aortic dissection. The aortic valve leaflets are often overstretched and the fibrosa layer is damaged in many patients, particularly in those with all the stigmata of Marian syndrome. However, In some patients the leaflets are normal or only minimally stretched in spite of aortic insufficiency. in these patients the aortic valve can be satisfactorily repaired. When significant annul aortic ecstasies is present, the reconstructive procedure consists of excising all three aortic sinuses and reimplanting the aortic valve inside a Dacron graft. If the annuloaortic ectasia is mild and the principal problem Is loss of the sinotubular junction because of aneurysmal dilatation of the sinuses of Valsalva, aortic valve repair is accomplished by replacing one, two, or all three aortic sinuses with a properly tailored Dacron graft. The first type of aortic valve repair has been performed in 18 patients with one early and one late failure. The other 16 patients remained well from 3 to 50 months. The second type of aortic valve repair has been performed in 15 patients during the past 3 years without any failure and all patients remain well. Therefore, in selected patients with aortic insufficiency due to aortic root and or ascending aorta aneurysm secondary to Degenerative Disease, the aortic valve can be repaired with satisfactory results. (J Card Surg 1994;9[Suppl]: 182–187)
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late results of mitral valve repair for mitral regurgitation due to Degenerative Disease
The Annals of Thoracic Surgery, 1993Co-Authors: Tirone E David, Susan Armstrong, Loretta DanielAbstract:Abstract From June 1981 to August 1992, 184 patients with mitral regurgitation due to Degenerative Disease underwent mitral valve repair. The mean age was 57 years, and 74% were men. One-third of the patients were in atrial fibrillation, and 71% were in New York Heart Association classes III and IV. The mitral regurgitation was due to prolapse of the posterior leaflet in 97 patients (53%), prolapse of the anterior leaflet in 42 (23%), and prolapse of both leaflets in 45 (24%). The degree of myxomatous changes was assessed intraoperatively as mild in 125 patients (68%), moderate in 27 (15%), and severe in 32 (17%). Mitral valve repair was accomplished largely by techniques described by Carpentier. Ring annuloplasty was performed in 160 patients (66 with Carpentier ring and 94 with Duran ring). There was one operative death, and 5 patients experienced life-threatening complications. Patients were followed up from 5 to 132 months (mean, 41 months). The actuarial survival at 8 years was 88% ± 4%. The freedom from stroke at 8 years was 94% ± 2%, and the freedom from transient ischemic attacks was 86% ± 6%. Age greater than 60 years was the only factor associated with higher risk of thromboembolic complications by logistic regression analysis. The actuarial freedom from reoperation at 8 years was 95% ± 2%. Advanced myxomatous changes in the leaflets of the mitral valve was the only significant factor associated with a higher risk of reoperation. Most patients were in New York Heart Association class I at the last follow-up. Late postoperative Doppler echocardiography revealed satisfactory mitral valve function in 96% of the patients. Mitral valve repair for mitral regurgitation due to Degenerative Disease provides excellent long-term results except in patients with advanced myxomatous changes in both leaflets, in whom there is a higher risk of recurrent mitral regurgitation and reoperation.
Praveen V. Mummaneni - One of the best experts on this subject based on the ideXlab platform.
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guideline update for the performance of fusion procedures for Degenerative Disease of the lumbar spine part 1 introduction and methodology
Journal of Neurosurgery, 2014Co-Authors: Michael G. Kaiser, Michael W. Groff, Tanvir F. Choudhri, Jason C Eck, William C Watters, Andrew T Dailey, Daniel K Resnick, Alok D Sharan, Jeffrey C Wang, Praveen V. MummaneniAbstract:Fusion procedures are an accepted and successful management strategy to alleviate pain and/or neurological symptoms associated with Degenerative Disease of the lumbar spine. In 2005, the first version of the "Guidelines for the performance of fusion procedures for Degenerative Disease of the lumbar spine" was published in the Journal of Neurosurgery: Spine. In an effort to incorporate evidence obtained since the original publication of these guidelines, an expert panel of neurosurgical and orthopedic spine specialists was convened in 2009. Topics reviewed were essentially identical to the original publication. Selected manuscripts from the first iteration of these guidelines as well as relevant publications between 2005 through 2011 were reviewed. Several modifications to the methodology of guideline development were adopted for the current update. In contrast to the 2005 guidelines, a 5-tiered level of evidence strategy was employed, primarily allowing a distinction between lower levels of evidence. The qualitative descriptors (standards/guidelines/options) used in the 2005 recommendations were abandoned and replaced with grades to reflect the strength of medical evidence supporting the recommendation. Recommendations that conflicted with the original publication, if present, were highlighted at the beginning of each chapter. As with the original guideline publication, the intent of this update is to provide a foundation from which an appropriate treatment strategy can be formulated.
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guideline update for the performance of fusion procedures for Degenerative Disease of the lumbar spine part 2 assessment of functional outcome following lumbar fusion
Journal of Neurosurgery, 2014Co-Authors: Zoher Ghogawala, Michael W. Groff, Praveen V. Mummaneni, Tanvir F. Choudhri, William C Watters, Andrew T Dailey, Daniel K Resnick, Jeffrey C Wang, Alok Sharan, Sanjay S DhallAbstract:Assessment of functional patient-reported outcome following lumbar spinal fusion continues to be essential for comparing the effectiveness of different treatments for patients presenting with Degenerative Disease of the lumbar spine. When assessing functional outcome in patients being treated with lumbar spinal fusion, a reliable, valid, and responsive outcomes instrument such as the Oswestry Disability Index should be used. The SF-36 and the SF-12 have emerged as dominant measures of general health-related quality of life. Research has established the minimum clinically important difference for major functional outcomes measures, and this should be considered when assessing clinical outcome. The results of recent studies suggest that a patient's pretreatment psychological state is a major independent variable that affects the ability to detect change in functional outcome.
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functional outcomes assessment for cervical Degenerative Disease
Journal of Neurosurgery, 2009Co-Authors: Langston T. Holly, Paul G. Matz, Paul A. Anderson, Michael G. Kaiser, Michael W. Groff, Robert F. Heary, Praveen V. Mummaneni, Timothy C. Ryken, Tanvir F. Choudhri, Edward J. VresilovicAbstract:Object The objective of this systematic review was to use evidence-based medicine to identify valid, reliable, and responsive measures of functional outcome after treatment for cervical Degenerative Disease. Methods The National Library of Medicine and Cochrane Database were queried using MeSH headings and key words relevant to functional outcomes. Abstracts were reviewed after which studies meeting inclusion criteria were selected. The guidelines group assembled an evidentiary table summarizing the quality of evidence (Classes I–III). Disagreements regarding the level of evidence were resolved through an expert consensus conference. The group formulated recommendations that contained the degree of strength based on the Scottish Intercollegiate Guidelines network. Validation was done through peer review by the Joint Guidelines Committee of the American Association of Neurological Surgeons/Congress of Neurological Surgeons. Results Myelopathy Disability Index, Japanese Orthopaedic Association scale, 36-Ite...
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Introduction and methodology: guidelines for the surgical management of cervical Degenerative Disease.
Journal of neurosurgery. Spine, 2009Co-Authors: Paul G. Matz, Paul A. Anderson, Michael G. Kaiser, Langston T. Holly, Michael W. Groff, Robert F. Heary, Praveen V. Mummaneni, Timothy C. Ryken, Tanvir F. Choudhri, Edward J. VresilovicAbstract:In March 2006, the Joint Section on Disorders of the Spine and Peripheral Nerves of the American Association of Neurological Surgeons and Congress of Neurological Surgeons compiled an expert group to perform an evidence- based review of the clinical literature on management of cervical Degenerative spine Disease. This process culminated in the formation of the Guidelines for the Surgical Management of Cervical Degenerative Disease. The purpose of the Guidelines was to address questions regarding the therapy, diagnosis, and prognosis of cervical Degenerative Disease using an evidence-based approach. Development of an evidence-based review and recommendations is a multitiered process. Typical guideline development consists of 5 processes: 1) collection and selection of the evi- dence; 2) assessment of the quality and strength of the evidence; 3) analysis of the evidentiary data; 4) formulation of recommendations; and 5) guideline validation. This manuscript details the methodology in compiling the Guidelines for the Surgical Management of Cervical Degenerative Disease. (DOI: 10.3171/2009.1.SPINE08712) Key W or D s • cervical spine • cervical spondylosis • methodology • practice guidelines
Tanvir F. Choudhri - One of the best experts on this subject based on the ideXlab platform.
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guideline update for the performance of fusion procedures for Degenerative Disease of the lumbar spine part 1 introduction and methodology
Journal of Neurosurgery, 2014Co-Authors: Michael G. Kaiser, Michael W. Groff, Tanvir F. Choudhri, Jason C Eck, William C Watters, Andrew T Dailey, Daniel K Resnick, Alok D Sharan, Jeffrey C Wang, Praveen V. MummaneniAbstract:Fusion procedures are an accepted and successful management strategy to alleviate pain and/or neurological symptoms associated with Degenerative Disease of the lumbar spine. In 2005, the first version of the "Guidelines for the performance of fusion procedures for Degenerative Disease of the lumbar spine" was published in the Journal of Neurosurgery: Spine. In an effort to incorporate evidence obtained since the original publication of these guidelines, an expert panel of neurosurgical and orthopedic spine specialists was convened in 2009. Topics reviewed were essentially identical to the original publication. Selected manuscripts from the first iteration of these guidelines as well as relevant publications between 2005 through 2011 were reviewed. Several modifications to the methodology of guideline development were adopted for the current update. In contrast to the 2005 guidelines, a 5-tiered level of evidence strategy was employed, primarily allowing a distinction between lower levels of evidence. The qualitative descriptors (standards/guidelines/options) used in the 2005 recommendations were abandoned and replaced with grades to reflect the strength of medical evidence supporting the recommendation. Recommendations that conflicted with the original publication, if present, were highlighted at the beginning of each chapter. As with the original guideline publication, the intent of this update is to provide a foundation from which an appropriate treatment strategy can be formulated.
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guideline update for the performance of fusion procedures for Degenerative Disease of the lumbar spine part 2 assessment of functional outcome following lumbar fusion
Journal of Neurosurgery, 2014Co-Authors: Zoher Ghogawala, Michael W. Groff, Praveen V. Mummaneni, Tanvir F. Choudhri, William C Watters, Andrew T Dailey, Daniel K Resnick, Jeffrey C Wang, Alok Sharan, Sanjay S DhallAbstract:Assessment of functional patient-reported outcome following lumbar spinal fusion continues to be essential for comparing the effectiveness of different treatments for patients presenting with Degenerative Disease of the lumbar spine. When assessing functional outcome in patients being treated with lumbar spinal fusion, a reliable, valid, and responsive outcomes instrument such as the Oswestry Disability Index should be used. The SF-36 and the SF-12 have emerged as dominant measures of general health-related quality of life. Research has established the minimum clinically important difference for major functional outcomes measures, and this should be considered when assessing clinical outcome. The results of recent studies suggest that a patient's pretreatment psychological state is a major independent variable that affects the ability to detect change in functional outcome.
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functional outcomes assessment for cervical Degenerative Disease
Journal of Neurosurgery, 2009Co-Authors: Langston T. Holly, Paul G. Matz, Paul A. Anderson, Michael G. Kaiser, Michael W. Groff, Robert F. Heary, Praveen V. Mummaneni, Timothy C. Ryken, Tanvir F. Choudhri, Edward J. VresilovicAbstract:Object The objective of this systematic review was to use evidence-based medicine to identify valid, reliable, and responsive measures of functional outcome after treatment for cervical Degenerative Disease. Methods The National Library of Medicine and Cochrane Database were queried using MeSH headings and key words relevant to functional outcomes. Abstracts were reviewed after which studies meeting inclusion criteria were selected. The guidelines group assembled an evidentiary table summarizing the quality of evidence (Classes I–III). Disagreements regarding the level of evidence were resolved through an expert consensus conference. The group formulated recommendations that contained the degree of strength based on the Scottish Intercollegiate Guidelines network. Validation was done through peer review by the Joint Guidelines Committee of the American Association of Neurological Surgeons/Congress of Neurological Surgeons. Results Myelopathy Disability Index, Japanese Orthopaedic Association scale, 36-Ite...
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Introduction and methodology: guidelines for the surgical management of cervical Degenerative Disease.
Journal of neurosurgery. Spine, 2009Co-Authors: Paul G. Matz, Paul A. Anderson, Michael G. Kaiser, Langston T. Holly, Michael W. Groff, Robert F. Heary, Praveen V. Mummaneni, Timothy C. Ryken, Tanvir F. Choudhri, Edward J. VresilovicAbstract:In March 2006, the Joint Section on Disorders of the Spine and Peripheral Nerves of the American Association of Neurological Surgeons and Congress of Neurological Surgeons compiled an expert group to perform an evidence- based review of the clinical literature on management of cervical Degenerative spine Disease. This process culminated in the formation of the Guidelines for the Surgical Management of Cervical Degenerative Disease. The purpose of the Guidelines was to address questions regarding the therapy, diagnosis, and prognosis of cervical Degenerative Disease using an evidence-based approach. Development of an evidence-based review and recommendations is a multitiered process. Typical guideline development consists of 5 processes: 1) collection and selection of the evi- dence; 2) assessment of the quality and strength of the evidence; 3) analysis of the evidentiary data; 4) formulation of recommendations; and 5) guideline validation. This manuscript details the methodology in compiling the Guidelines for the Surgical Management of Cervical Degenerative Disease. (DOI: 10.3171/2009.1.SPINE08712) Key W or D s • cervical spine • cervical spondylosis • methodology • practice guidelines
Intan Fariza Gaffar - One of the best experts on this subject based on the ideXlab platform.
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comparative long term results of mitral valve repair in adults with chronic rheumatic Disease and Degenerative Disease is repair for burnt out rheumatic Disease still inferior to repair for Degenerative Disease in the current era
The Journal of Thoracic and Cardiovascular Surgery, 2015Co-Authors: Jeswant Dillon, Mohd Azhari Yakub, Pau Kiew Kong, Mohd Faizal Ramli, Norfazlina Jaffar, Intan Fariza GaffarAbstract:Objective Mitral valve repair is perceived to be of limited durability for advanced rheumatic Disease in adults. We aim to examine the long-term outcomes of repair for rheumatic Disease, identify predictors of durability, and compare with repair for Degenerative Disease. Methods Rheumatic and Degenerative mitral valve repairs in patients aged 40 years or more were prospectively analyzed. The primary outcomes investigated were mortality, freedom from reoperation, and valve failure. Logistic regression analysis was performed to define predictors of poor outcome. Results Between 1997 and 2011, 253 rheumatic and 148 Degenerative mitral valves were repaired. The age of patients in both groups was similar, with a mean of 54.1 ± 8.4 years versus 55.6 ± 7.3 years ( P = .49). Freedom from reoperation for rheumatic valves at 5 and 10 years was 98.4%, comparable to 95.3% ( P = .12) for Degenerative valves. Freedom from valve failure at 5 and 10 years was 91.4% and 81.5% for rheumatic repairs and 82.5% and 75.4% for Degenerative repairs, respectively ( P = .15). The presence of residual mitral regurgitation greater than 2+ before discharge was the only significant independent predictor of reoperation, whereas residual mitral regurgitation greater than 2+ and leaflet procedures were significant risk factors for valve failure. Conclusions The durability of rheumatic mitral valve repair in the current era has improved and is comparable to the outstanding durability of repairs for Degenerative Disease, even in the adult rheumatic population. Modifications of standard repair techniques, adherence to the importance of good leaflet coaptation, and strict quality control with stringent use of intraoperative transesophageal echocardiography have all contributed to the improved long-term results.