PubMed Health⌕ Search

Biomedical subjects

Mark N Hadley

Publications and source records attributed to Mark N Hadley.

At least 19 recordsLinked to original sources
PubMed2007

Anterior cervical approach for the treatment of cervical myelopathy.

Compression of the spinal cord by the degenerating cervical spine tends to lead to progressive clinical symptoms over a variable period of time. Surgical decompression can stop this process and lead to recovery of function. The choice of surgical technique depends on what is causing the compression of the spinal cord. This article reviews the symptoms and assessment for cervical spondylotic myelopathy (clinically evident compression of the spinal cord) and discusses the indications for decompression of the spinal cord anteriorly.

Cervical Vertebrae↗
PubMed2005

Recommendations for comprehensive stroke centers: a consensus statement from the Brain Attack Coalition.

BACKGROUND AND PURPOSE: To develop recommendations for the establishment of comprehensive stroke centers capable of delivering the full spectrum of care to seriously ill patients with stroke and cerebrovascular disease. Recommendations were developed by members of the Brain Attack Coalition (BAC), which is a multidisciplinary group of members from major professional organizations involved with the care of patients with stroke and cerebrovascular disease. SUMMARY OF REVIEW: A comprehensive literature search was conducted from 1966 through December 2004 using Medline and Pub Med. Articles with information about clinical trials, meta-analyses, care guidelines, scientific guidelines, and other relevant clinical and research reports were examined and graded using established evidence-based medicine approaches for therapeutic and diagnostic modalities. Evidence was also obtained from a questionnaire survey sent to leaders in cerebrovascular disease. Members of BAC reviewed literature related to their field and graded the scientific evidence on the various diagnostic and treatment modalities for stroke. Input was obtained from the organizations represented by BAC. BAC met on several occasions to review each specific recommendation and reach a consensus about its importance in light of other medical, logistical, and financial factors. CONCLUSIONS: There are a number of key areas supported by evidence-based medicine that are important for a comprehensive stroke center and its ability to deliver the wide variety of specialized care needed by patients with serious cerebrovascular disease. These areas include: (1) health care personnel with specific expertise in a number of disciplines, including neurosurgery and vascular neurology; (2) advanced neuroimaging capabilities such as MRI and various types of cerebral angiography; (3) surgical and endovascular techniques, including clipping and coiling of intracranial aneurysms, carotid endarterectomy, and intra-arterial thrombolytic therapy; and (4) other specific infrastructure and programmatic elements such as an intensive care unit and a stroke registry. Integration of these elements into a coordinated hospital-based program or system is likely to improve outcomes of patients with strokes and complex cerebrovascular disease who require the services of a comprehensive stroke center.

Academic Medical Centers↗
PubMed2005

Training, competency, and credentialing standards for diagnostic cervicocerebral angiography, carotid stenting, and cerebrovascular intervention: a joint statement from the American Academy of Neurology, the American Association of Neurological Surgeons, the American Society of Interventional and Therapeutic Neuroradiology, the American Society of Neuroradiology, the Congress of Neurological Surgeons, the AANS/CNS Cerebrovascular Section, and the Society of Interventional Radiology.

Explore the source record for details and available documents.

Angioplasty↗
PubMed2005

Spontaneous thoracic spinal cord herniation: three cases with long-term follow-up.

OBJECTIVE AND IMPORTANCE: Spontaneous thoracic spinal cord herniation (STSCH) is an uncommon cause of thoracic myelopathy. Fewer than 40 cases have been reported in the English language literature with a mean follow-up of less than 6 months. CLINICAL PRESENTATION: We have encountered three patients diagnosed with STSCH in the last 6 years at our institution. These patients presented with symptoms and signs localizing to the thoracic spinal cord. Magnetic resonance imaging revealed ventral thoracic spinal cord displacement in each. INTERVENTION: One patient was treated surgically, two managed expectantly. Two patients have been followed for greater than 5 years, whereas a third has been followed for 15 months. CONCLUSION: Our experience suggests that patients with neurological symptoms and signs attributable to STSCH may not progress and therefore may be followed with clinical and magnetic resonance imaging surveillance. When surgery is indicated for progressive STSCH, late retethering may occur.

Decompression, Surgical↗
PubMed2005

Guidelines for the performance of fusion procedures for degenerative disease of the lumbar spine. Part 2: assessment of functional outcome.

Functional disability secondary to acute low-back pain, chronic low-back pain, lumbar stenosis, and lumbar disc disease may be reliably and validly assessed using functional outcome surveys that are valid, reliable, and responsive. Outcome instruments supported by Class I and Class II medical evidence for the evaluation of low-back pain include the Spinal Stenosis Survey of Stucki, Waddell-Main, RMDQ, DPQ, QPDS, SIP, Million Scale, LBPR Scale, ODI, and CBSQ. Many of these outcome measures have been applied to patients who have been treated with lumbar fusion for degenerative lumbar disease and have proven to be valid and responsive; however, the reliability of these instruments has never been specifically assessed in the lumbar fusion patient population. Patient satisfaction surveys have been used to measure outcome following lumbar fusion. Their usefulness resides in their insight into patient attitudes toward the treatment experience but is limited because of their inability to measure responsiveness and the lack of information on their reliability.

Humans↗
PubMed2005

Guidelines for the performance of fusion procedures for degenerative disease of the lumbar spine. Part 3: assessment of economic outcome.

Lumbar fusion may be associated with a high short-term cost, especially if instrumentation is placed; however, there appear to be long-term economic benefits associated with lumbar fusion including resumption of employment. To describe the economic impact of lumbar fusion for degenerative disease adequately, it is important to define the patient population treated with fusion and to compare efficacy as well as the costs of other treatment alternatives. Any such analysis should include both short- and long-term costs and benefits.

Humans↗
PubMed2005

Guidelines for the performance of fusion procedures for degenerative disease of the lumbar spine. Part 4: radiographic assessment of fusion.

The assessment of fusion status with static plain radiography is accurate in approximately two thirds of patients treated with lumbar fusion when the radiographic results are compared with surgical exploration findings. Therefore, static plain radiography is not recommended as a stand-alone modality following lumbar fusion procedures. The addition of lateral flexion-extension radiography may improve accuracy because the lack of motion between fused lumbar segments on lateral views is highly suggestive of a solid fusion. Some degree of motion between segments may be present even when the spine has fused. The amount of motion allowable across fused segments is not clear, and the role of internal fixation in limiting motion has also not been adequately addressed. The addition of multiplanar CT scanning results in the detection of pseudarthrosis in some patients in whom fusion has been deemed successful based on plain radiographic criteria. Therefore, CT scanning may be more accurate in the determination of fusion status than plain radiography; however, a rigorous comparison of modern CT scanning and surgical exploration has not been performed. It appears that RSA is exquisitely sensitive for the detection of motion between vertebral bodies, and the loss of motion between treated vertebral segments does appear to indicate the presence of fusion. The modality, however, is invasive and not widely available. Furthermore, the only

Humans↗
PubMed2005

Guidelines for the performance of fusion procedures for degenerative disease of the lumbar spine. Part 5: correlation between radiographic and functional outcome.

At the present time, there is no Class I or II medical evidence to indicate that the appearance of a radiographic fusion is significantly associated with improved functional outcomes. The majority of Class III medical evidence does suggest that successful radiographic fusion is associated with improved clinical outcomes. It is widely acknowledged that this relationship is not perfect.

Humans↗
PubMed2005

Guidelines for the performance of fusion procedures for degenerative disease of the lumbar spine. Part 6: magnetic resonance imaging and discography for patient selection for lumbar fusion.

Discography is an exquisitely sensitive but not specific diagnostic test for the diagnosis of discogenic low-back pain. The restriction of the definition of a positive discographic study to one that elicits concordant pain from a morphologically abnormal disc improves the definition's accuracy. Fusion surgery based on discography alone, however, is not reliably associated with clinical success. Therefore, discography is not recommended as a standalone test for treatment decisions in patients with low-back pain. Magnetic resonance imaging is a sensitive and noninvasive test for the presence of degenerative disc disease. Discography should not be attempted in patients with normal lumbar MR images. Discography appears to have a role in the evaluation of patients with low-back pain, but it is best limited to the evaluation of abnormal interspaces identified on MR imaging, the investigation of adjacent-level disc disease, and as a means to rule out cases of nonorganic pain from surgical consideration.

Humans↗
PubMed2005

Guidelines for the performance of fusion procedures for degenerative disease of the lumbar spine. Part 7: intractable low-back pain without stenosis or spondylolisthesis.

Class I medical evidence exists in support of the use of lumbar fusion as a treatment standard for carefully selected patients with low-back pain intractable to the best medical management. There is Class III medical evidence that suggests that a course of intensive cognitive and physical therapy may be an efficacious treatment option for the treatment of patients with chronic disabling low-back pain.

Humans↗
PubMed2005

Guidelines for the performance of fusion procedures for degenerative disease of the lumbar spine. Part 8: lumbar fusion for disc herniation and radiculopathy.

There is no convincing medical evidence to support the routine use of lumbar fusion at the time of a primary lumbar disc excision. There is conflicting Class III medical evidence regarding the potential benefit of the addition of fusion in this circumstance. Therefore, the definite increase in cost and complications associated with the use of fusion are not justified. Patients with preoperative lumbar instability may benefit from fusion at the time of lumbar discectomy; however, the incidence of such instability appears to be very low (< 5%) in the general lumbar disc herniation population. Patients who suffer from chronic low-back pain, or are heavy laborers or athletes with axial low-back pain, in addition to radicular symptoms may also be candidates for fusion at the time of lumbar disc excision. Patients with a recurrent disc herniation have been treated successfully with both reoperative discectomy and reoperative discectomy combined with fusion. In patients with a recurrent lumbar disc herniation with associated spinal deformity, instability, or associated chronic low-back pain, consideration of fusion in addition to reoperative discectomy is recommended.

Humans↗
PubMed2005

Guidelines for the performance of fusion procedures for degenerative disease of the lumbar spine. Part 9: fusion in patients with stenosis and spondylolisthesis.

The best medical evidence available in the literature confirms the utility of fusion for improving patient outcomes following decompression for stenosis associated with spondylolisthesis. The majority of evidence from other studies comparing outcomes after decompression alone or decompression combined with PLF in patients with stenosis and spondylolisthesis also favors the performance of PLF. The medical evidence regarding the use of pedicle screw fixation in this patient population is rated as Class III and is inconsistent. A consistent benefit associated with the use of pedicle screw fixation has been reported in patients with preoperative instability or kyphosis. Iatrogenic instability following decompression is associated with poor outcomes and may also be treated with PLF involving supplemental instrumentation. The precise definition of instability or kyphosis has varied among researchers and requires further study.

Humans↗
PubMed2005

Guidelines for the performance of fusion procedures for degenerative disease of the lumbar spine. Part 10: fusion following decompression in patients with stenosis without spondylolisthesis.

Based on the medical evidence derived from the scientific literature on this topic, there does not appear to be evidence to support the hypothesis that fusion (with or without instrumentation) provides any benefit over decompression alone in the treatment of lumbar stenosis in patients in whom there is no evidence of preoperative deformity or instability. A single report provides Class II medical evidence and several papers provide Class III medical evidence suggesting that the addition of fusion to decompression in patients with lumbar stenosis and instability evidenced by movement on preoperative flexion-extension radiographs does improve outcome. There are also reports (Class III medical evidence) indicating that patients with lumbar stenosis, without deformity or instability, treated with wide decompression or facetectomy may suffer iatrogenic lumbar instability. Fusion in these patients may improve outcome. There is conflicting Class III medical evidence regarding the application of instrumentation in addition to PLF in patients treated for lumbar stenosis without deformity or preoperative instability.

Decompression, Surgical↗
PubMed2005

Guidelines for the performance of fusion procedures for degenerative disease of the lumbar spine. Part 11: interbody techniques for lumbar fusion.

The majority of reviewed medical evidence suggests that interbody techniques are associated with higher fusion rates compared with PLF when applied to patients with low-back pain due to DDD limited to one or two levels. The evidence is generally of poor quality and retrospective in nature. Conflicting evidence exists supporting the role of interbody graft placement for improvement of functional outcomes; however, there is no Class I or II evidence to suggest that the use of an interbody graft is associated with worse outcomes, and Class II evidence exists to suggest that outcomes are improved. Complication rates of interbody graft placement, particularly of circumferential procedures, are higher in most series. Many complications, however, are associated with pedicle screw fixation and not with interbody graft placement per se. In the context of a single-level stand-alone ALIF or ALIF with posterior instrumentation, there does not appear to be a substantial benefit to the addition of a PLF. The addition of a PLF to a construct that already includes an interbody graft is, however, associated with increased costs and complications. Therefore, although the addition of supplemental fixation (a 270 degrees fusion) may be necessary for biomechanical reasons, it may not be appropriate to subject the patient to the morbidity of a full posterior exposure for placement of graft material. Significant differences in clinical outcomes between the various interbody techniques have not been convincingly demonstrated. No general recommendation can therefore be made regarding the technique that should be used to achieve interbody fusion.

Humans↗
PubMed2005

Guidelines for the performance of fusion procedures for degenerative disease of the lumbar spine. Part 12: pedicle screw fixation as an adjunct to posterolateral fusion for low-back pain.

This review focused on an examination of the literature on the surgical treatment of low-back pain in patients with DDD or low-grade degenerative spondylolisthesis treated with PLF, with or without the use of pedicle screw fixation. All Class I and the majority of Class II and Class III medical evidence on this topic indicates that the addition of pedicle screw fixation to PLF increases fusion success rates when assessed based on plain x-ray films with dynamic imaging. Although there does appear to be a positive relationship between radiographic fusion and clinical outcome, no convincing correlation has been demonstrated. Although several reports suggest that clinical outcomes are improved with the addition of pedicle screw fixation, there are conflicting findings from similarly classified evidence sources (primarily Class II and III). Furthermore, the largest contemporary randomized controlled study on this topic failed to demonstrate a significant beneficial effect for the use of pedicle screw fixation in patients treated with PLF for chronic low-back pain. This absence of proof should not, however, be interpreted as a proof of absence. For example, in this same study, patient satisfaction scores improved from approximately 60% to approximately 70% with the addition of pedicle screw fixation. This difference in outcome may be clinically relevant. Similarly, the improvement in ODI scores was 40% greater in the group of patients treated with pedicle screw fixation compared with those treated with PLF alone. If an analysis to determine the sample size necessary to ensure a power of 0.8 (or an 80% chance of detecting a significant effect) in a study in which the good outcome rate is 60% in the control group and 70% in the treatment group is performed, approximately 355 patients would be needed in each treatment group (http://department.obg.cuhk.edu.hk). Alternatively, if a similar analysis is performed using the differential scores obtained in the ODI measurements reported in the paper by Fritzell, et al., approximately 225 patients would be needed per treatment group (http://calculators.stat.ucla.edu/powercalc). Although Fritzell, et al., did not detect a significant benefit associated with the use of pedicle screw fixation as an adjunct to PLF, their sample size severely limited the power of their study to detect such a benefit. All studies reviewed suffer from similar lack of power. Therefore, no definitive statement regarding the efficacy of pedicle screw fixation as a means to improve functional outcomes in patients undergoing PLF for chronic low-back pain can be made. There appears to be consistent evidence suggesting that pedicle screw fixation increases the costs and complication rate of PLF. It is recommended, therefore, that the use of pedicle screw fixation as a supplement to PLF be reserved for those patients in whom there is an increased risk of nonunion when treated with PLF. High-risk patients include, but are not limited to patients who smoke, who are undergoing revision surgery, or who suffer systemic diseases known to be associated with poor bone healing.

Bone Screws↗
PubMed2005

Guidelines for the performance of fusion procedures for degenerative disease of the lumbar spine. Part 13: injection therapies, low-back pain, and lumbar fusion.

In summary, there is no meaningful evidence in the medical literature that the use of epidural injections is of any long-term value in the treatment of patients with chronic low-back pain. The literature does indicate that the use of lumbar epidural injections can provide short-term relief in selected patients with chronic low-back pain. There is evidence that suggests that facet joint injections can be used to predict outcome after RF ablation of a facet joint. The predictive ability of facet joint injections does not appear to apply to lumbar fusion surgery. No evidence exists to support the effectiveness of facet injections in the treatment of patients with chronic low-back pain. There is conflicting evidence suggesting that the use of local TPIs can be effective for the short-term relief of low-back pain. There are no data to suggest that TPIs with either steroids or anesthetics alone provide lasting benefit for patients suffering from chronic low-back pain.

Anesthetics↗
PubMed2005

Guidelines for the performance of fusion procedures for degenerative disease of the lumbar spine. Part 14: brace therapy as an adjunct to or substitute for lumbar fusion.

Although conflicting reports have been presented in the literature regarding the utility of lumbar braces for the prevention of low-back pain, most Class III medical evidence suggests that these supports used prophylactically do not reduce the incidence of low-back pain or decrease the amount of time lost from work in the general working population. Among workers with a history of a back injury, their use appears to decrease the number of work days lost due to back pain. Lumbar braces appear to be an effective treatment for acute low-back pain in some populations. They do not appear to be effective in the chronic low-back pain population. If a brace is used, rigid braces offer some benefit over soft braces. There are no data to suggest that relief of low-back pain with preoperative external bracing predicts a favorable outcome following lumbar spinal fusion. No information is available on the benefit of bracing for improving fusion rates or clinical outcomes following instrumented lumbar fusion for degenerative disease.

Braces↗