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Appropriateness Criteria

Reference Study Type Patients/Events Study Objective(Purpose of Study) Study Results Study Quality
1. Johnson SM, Shah LM. Imaging of Acute Low Back Pain. [Review]. Radiologic Clinics of North America. 57(2):397-413, 2019 Mar. Review/Other-Dx N/A To discuss the imaging of acute low back pain. No results stated in the abstract. 4
2. Murray CJ, Lopez AD. Measuring the global burden of disease. N Engl J Med. 2013;369(5):448-457. Review/Other-Dx N/A A review article on measuring the global burden of disease. No results stated. 4
3. Briggs AM, Smith AJ, Straker LM, Bragge P. Thoracic spine pain in the general population: prevalence, incidence and associated factors in children, adolescents and adults. A systematic review. [Review] [85 refs]. BMC Musculoskeletal Disorders. 10:77, 2009 Jun 29. Review/Other-Dx 1389 studies To report the evidence describing prevalence, incidence, associated factors and risk factors for TSP among the general population. Of the 1389 studies identified in the literature, 33 met the inclusion criteria for this systematic review. The mean (SD) quality score (out of 15) for the included studies was 10.5 (2.0). TSP prevalence data ranged from 4.0-72.0% (point), 0.5-51.4% (7-day), 1.4-34.8% (1-month), 4.8-7.0% (3-month), 3.5-34.8% (1-year) and 15.6-19.5% (lifetime). TSP prevalence varied according to the operational definition of TSP. Prevalence for any TSP ranged from 0.5-23.0%, 15.8-34.8%, 15.0-27.5% and 12.0-31.2% for 7-day, 1-month, 1-year and lifetime periods, respectively. TSP associated with backpack use varied from 6.0-72.0% and 22.9-51.4% for point and 7-day periods, respectively. TSP interfering with school or leisure ranged from 3.5-9.7% for 1-year prevalence. Generally, studies reported a higher prevalence for TSP in child and adolescent populations, and particularly for females. The 1 month, 6 month, 1 year and 25 year incidences were 0-0.9%, 10.3%, 3.8-35.3% and 9.8% respectively. TSP was significantly associated with: concurrent musculoskeletal pain; growth and physical; lifestyle and social; backpack; postural; psychological; and environmental factors. Risk factors identified for TSP in adolescents included age (being older) and poorer mental health. 4
4. Institute for Clinical Systems Improvement. Adult Acute and Subacute Low Back Pain.  Available at: https://www.icsi.org/wp-content/uploads/2021/11/March-2018-LBP-Interactive2.pdf. Review/Other-Dx N/A To discuss Acute and Subacute Low Back Pain No results stated in the abstract. 4
5. Chou R, Qaseem A, Owens DK, Shekelle P. Diagnostic imaging for low back pain: advice for high-value health care from the American College of Physicians. Annals of Internal Medicine. 154(3):181-9, 2011 Feb 01. Review/Other-Dx N/A A report based on a systematic review conducted for a 2007 low back pain guideline and a subsequent meta-analysis to help clinicians practice high-value health care by following a more rational and cost-conscious diagnostic approach. Good evidence indicates that routine back imaging is not associated with clinically meaningful benefits and exposes patients to unnecessary harms, but imaging remains overused. More evidence-based approach to imaging is needed. 4
6. Jarvik JG, Gold LS, Comstock BA, et al. Association of early imaging for back pain with clinical outcomes in older adults. JAMA. 313(11):1143-53, 2015 Mar 17. Observational-Dx 5239 patients To compare function and pain at the 12-month follow-up visit among older adults who received early imaging with those who did not receive early imaging after a new primary care visit for back pain without radiculopathy. Among the 5239 patients, 1174 had early radiographs and 349 had early MRI/CT. At 12 months, neither the early radiograph group nor the early MRI/CT group differed significantly from controls on the disability questionnaire. The mean score for patients who underwent early radiography was 8.54 vs 8.74 among the control group (difference, -0.10 [95% CI, -0.71 to 0.50]; mixed model, P = .36). The mean score for the early MRI/CT group was 9.81 vs 10.50 for the control group (difference,-0.51 [-1.62 to 0.60]; mixed model, P = .18). 3
7. Jarvik JG, Hollingworth W, Martin B, et al. Rapid magnetic resonance imaging vs radiographs for patients with low back pain: a randomized controlled trial. JAMA. 289(21):2810-8, 2003 Jun 04. Experimental-Dx 380 total patients: 190 – radiograph, 190 – rapid MRI Randomized trial to determine the clinical and economic consequences of replacing spine radiographs with rapid MRI for primary care patients. Rapid MRIs and radiographs resulted in nearly identical outcomes for primary care patients with LBP. The rapid MRI strategy had a mean cost of $2,380 vs $2,059 dollars for the radiograph strategy. 1
8. Modic MT, Obuchowski NA, Ross JS, et al. Acute low back pain and radiculopathy: MR imaging findings and their prognostic role and effect on outcome. Radiology. 237(2):597-604, 2005 Nov. Experimental-Dx 246 total patients: 150 with LBP and 96 with radiculopathy Randomized prospective study of prognostic role of MRI findings and effect on outcome in patients with uncomplicated acute LBP or radiculopathy. MRI does not have measurable value in conservative management of patients with typical uncomplicated LBP or radiculopathy. 1
9. AHCPR Publication No. 95-0642. Rockville, MD: Agency for Health Care Policy and Research, Public Health Service, U.S. Department of Health and Human Services. December 1994.  Available at: http://d4c2.com/d4c2-000038.htm. Review/Other-Dx N/A To discuss the Acute Low Back Problems in Adults No results stated in the abstract 4
10. Finucane LM, Downie A, Mercer C, et al. International Framework for Red Flags for Potential Serious Spinal Pathologies. J Orthop Sports Phys Ther. 50(7):350-372, 2020 07. Review/Other-Dx N/A To support a variety of health professionals, irrespective of experience, who provide care for people with musculoskeletal spinal conditions No results stated in the abstract. 4
11. Epstein O, Ludwig S, Gelb D, Poelstra K, O'Brien J. Comparison of computed tomography and plain radiography in assessing traumatic spinal deformity. J Spinal Disord Tech. 22(3):197-201, 2009 May. Observational-Dx N/A To compare the ability of the screening CT scans to measure spinal deformity in the thoracolumbar spine with that of portable plain radiographs. In the sagittal plane, screening CT scans and plain radiographs showed an average mean difference of -1.13 degrees+/-SD of 3.76 degrees. In the coronal plane, CT scans and radiographs showed an average mean difference of 0.10 degrees+/-SD of 2.52 degrees. The interobserver correlation coefficients among the 4 observers were 0.913 in the sagittal plane and 0.953 in the lateral plane, indicating excellent interobserver correlation. 1
12. Khurana B, Sheehan SE, Sodickson A, Bono CM, Harris MB. Traumatic thoracolumbar spine injuries: what the spine surgeon wants to know. Radiographics. 33(7):2031-46, 2013 Nov-Dec. Review/Other-Dx N/A To provide a spine injury severity score based on three components: injury morphology, integrity of the posterior ligamentous complex (PLC), and neurologic status of the patient. No results stated in the abstract 4
13. Rajasekaran S, Vaccaro AR, Kanna RM, et al. The value of CT and MRI in the classification and surgical decision-making among spine surgeons in thoracolumbar spinal injuries. European Spine Journal. 26(5):1463-1469, 2017 05. Observational-Dx 30 thoracolumbar fractures To determine the value of CT and MRI in the classification and surgical decision-making among spine surgeons in thoracolumbar spinal injuries. Surgeons correctly classified 43.4 % of fractures with plain radiographs alone; after, additionally, evaluating CT and MRI images, this percentage increased by further 18.2 and 2.2 %, respectively. AO type A fractures were identified in 51.7 % of fractures with radiographs, while the number of type B fractures increased after CT and MRI. The number of type C fractures diagnosed was constant across the three steps. Agreement between radiographs and CT was fair for A-type (k = 0.31), poor for B-type (k = 0.19), but it was excellent between CT and MRI (k > 0.87). CT and MRI had similar sensitivity in identifying fracture subtypes except that MRI had a higher sensitivity (56.5 %) for B2 fractures (p < 0.001). The need for surgical fixation was deemed present in 72 % based on radiographs alone and increased to 81.7 % with CT images (p < 0.0001). The assessment for need of surgery did not change after an MRI (p = 0.77). 3
14. Splendiani A, Bruno F, Patriarca L, et al. Thoracic spine trauma: advanced imaging modality. Radiologia Medica. 121(10):780-92, 2016 Oct. Review/Other-Dx N/A To review advanced imaging modalities employed to study thoracic spine and spinal cord in injured patients. No results stated in the abstract. 4
15. Marinova M, Edon B, Wolter K, Katsimbari B, Schild HH, Strunk HM. Use of routine thoracic and abdominal computed tomography scans for assessing bone mineral density and detecting osteoporosis. Curr Med Res Opin. 31(10):1871-81, 2015. Observational-Dx 234 patients To Evaluate thecomputed tomography (CT) attenuation measurements for assessing bone mineral density (BMD) and predicting osteoporosis in thoracic and abdominal CT scans for various clinical indications using dual-energy X-ray absorptiometry (DXA) as reference standard. Patients with DXA-defined osteoporosis or osteopenia showed significantly lower HU values of trabecular bone at all measured levels compared to healthy subjects (p < 0.001). HU values were highest at T1 and T6, lowest at L1-L3 and the femoral neck. There were no significant intraindividual differences between HU values in the sagittal, coronal or transversal plane. Significant differences between normal and abnormal BMD categories were verified for three CT scanners. More than half of all fractures were detected in patients with non-osteoporotic DXA T-scores. 2
16. Wang P, She W, Mao Z, et al. Use of routine computed tomography scans for detecting osteoporosis in thoracolumbar vertebral bodies. Skeletal Radiol. 50(2):371-379, 2021 Feb. Observational-Dx 482 patients To  observe the distribution of CT attenuation values for T10-L3 vertebral bodies and derived the Hounsfield unit (HU) thresholds using the quantitative computed tomography (QCT) as a reference to predict osteoporosis and normal bone density. A total of 2716 vertebral bodies of 457 participants were measured after exclusion screening. CT attenuation value of each plane's vertebral body showed a strong correlation with vBMD. The optimal threshold of > 141 HU was 93.5% sensitive and 86.1% specific for the recognition of normal BMD. The optimal threshold of < 102.4 HU was 96.9% specific and 82.1% sensitive for distinguishing osteoporosis from osteopenia and normal BMD. The average CT attenuation values of vertebral bodies with compressed and normal morphology were 108.9 ± 20.6 and 136.8 ± 32.2 HU, respectively. 2
17. Zou D, Ye K, Tian Y, et al. Characteristics of vertebral CT Hounsfield units in elderly patients with acute vertebral fragility fractures. Eur Spine J. 29(5):1092-1097, 2020 05. Observational-Dx 299 patients To explore the characteristics of vertebral CT Hounsfield units (HU) in elderly patients with acute vertebral fragility fractures. There were 460 thoracic and lumbar vertebral fractures in the 299 elderly patients, including 349 acute vertebral fragility fractures and 111 chronic fractures. The average L1-HU value was 66.0 ± 30.6 HU and showed significant difference among patients having different numbers of vertebral fractures (one fracture: 73.3 ± 27.0 HU, two fractures: 58.7 ± 32.5 HU, three or more fractures: 40.7 ± 28.8 HU; P < 0.001). As for the 1:1 age- and sex-matched patients, the L1-HU of the 77 patients with fractures was lower than that of the control patients (70.6 ± 23.4 HU vs. 101.5 ± 36.2 HU, P < 0.001). The area under the receiver operating characteristic curve of using L1-HU to differentiate patients with fractures from controls was 0.77(95% CI 0.70-0.85, P < 0.001). The cutoff value had high specificity of 90% or high sensitivity of 90% to identify patients with fractures of 60 HU and 100 HU, respectively. 2
18. Osteoporosis or low bone mass at the femur neck or lumbar spine in older adults, United States, 2005-2008. In: National Center for Health S, ed. U.S. Dept. of Health and Human Services, Centers for Disease Control and Prevention, National Center for Health Statistics; 2012. Available at: https://stacks.cdc.gov/view/cdc/12136. Review/Other-Dx N/A To discuss the Osteoporosis or low bone mass at the femur neck or lumbar spine in older adults. No results stated in the abstract. 4
19. Czuczman GJ, Mandell JC, Wessell DE, et al. ACR Appropriateness Criteria® Inflammatory Back Pain: Known or Suspected Axial Spondyloarthritis: 2021 Update. J Am Coll Radiol 2021;18:S340-S60. Review/Other-Dx N/A Evidence-based guidelines to assist referring physicians and other providers in making the most appropriate imaging or treatment decision for inflammatory back pain: known or suspected axial spondyloarthritis. No results stated in abstract. 4
20. Elliott JM, Flynn TW, Al-Najjar A, Press J, Nguyen B, Noteboom JT. The pearls and pitfalls of magnetic resonance imaging for the spine. [Review]. J Orthop Sports Phys Ther. 41(11):848-60, 2011 Nov. Review/Other-Dx N/A To highlight some of the pearls and pitfalls of MRI for the cervical, thoracic, and lumbar regions, and include cases to illustrate some of the common imaging artifacts and normal variants for MRI of the spine. No results stated in the abstract 4
21. McInerney J, Ball PA. The pathophysiology of thoracic disc disease. [Review] [20 refs]. Neurosurgical Focus. 9(4):e1, 2000 Oct 15. Review/Other-Dx N/A To seek to place the phenomenon of thoracic disc disease into the context of its pathophysiology. After a careful evaluation of the available clinical, pathological, and basic science data, a case is made that the cause of nucleus pulposus herniations in the thoracic spine is similar to those occurring in the lumbar and cervical regions. No results stated in the abstract 4
22. Wood KB, Garvey TA, Gundry C, Heithoff KB. Magnetic resonance imaging of the thoracic spine. Evaluation of asymptomatic individuals. Journal of Bone & Joint Surgery - American Volume. 77(11):1631-8, 1995 Nov. Review/Other-Dx 60 patients To review magnetic resonance imaging studies of the thoracic spines of ninety asymptomatic individuals to determine the prevalence of abnormal anatomical findings. No results stated in the abstract. 4
23. Verdoorn JT, Lehman VT, Diehn FE, Maus TP. Increased 99mTc MDP activity in the costovertebral and costotransverse joints on SPECT-CT: is it predictive of associated back pain or response to percutaneous treatment?. Diagnostic & Interventional Radiology. 21(4):342-7, 2015 Jul-Aug. Observational-Dx 55 patients To evaluate whether this activity corresponds with thoracic back pain and whether it predicts response to percutaneous injection. A total of 724 99mTc MDP SPECT-CT examinations were identified. Increased 99mTc MDP activity at costovertebral or costotransverse joints was reported in the examinations of 55 patients (8%). Of these, 25 (45%) had corresponding thoracic back pain, and nine of 25 patients (36%) underwent percutaneous injection of the joint(s) with increased activity. At clinical follow-up two days to 12 weeks after injection, one patient (11%) had complete pain relief, two (22%) had partial pain relief, and six (67%) had no pain relief. 2
24. Awwad EE, Martin DS, Smith KR, Jr., Baker BK. Asymptomatic versus symptomatic herniated thoracic discs: their frequency and characteristics as detected by computed tomography after myelography. Neurosurgery 1991;28:180-6. Review/Other-Dx 433 patients To retrospectively review the myelograms of 433 patients and identified those who had no symptoms or signs referable to the thoracic cord, roots, or nerves No results stated in the abstract. 4
25. Last AR, Hulbert K. Chronic low back pain: evaluation and management. American Family Physician. 79(12):1067-74, 2009 Jun 15. Review/Other-Dx N/A Article reviews the evaluation and management of chronic LBP. Most patients with chronic LBP will not benefit from surgery. A surgical evaluation may be considered for select patients with functional disabilities or refractory pain despite multiple nonsurgical treatments. 4
26. Winklhofer S, Thekkumthala-Sommer M, Schmidt D, et al. Magnetic resonance imaging frequently changes classification of acute traumatic thoracolumbar spine injuries. Skeletal Radiology. 42(6):779-86, 2013 Jun. Observational-Dx 100 patients To evaluate the influence of additional (MRI) compared with computed tomography (CT) alone for the classification of traumatic spinal injuries using the Arbeitsgemeinshaft für Osteosynthesefragen (AO) system and the Thoraco-Lumbar Injury Classification and Severity (TLICS) scale. CT and MRI together revealed a total of 196 fractures (CT alone 162 fractures). The AO classification changed in 31 %, the TLICS classification changed in 33 % of the patients compared with CT alone. Based on CT and MRI together, the TLICS value changed from values <5 (indication for conservative therapy) to values = 5 (indication for surgical therapy) in 24 %. 2
27. Hurley P, Azzopardi C, Botchu R, Grainger M, Gardner A. Can MRI be used as a safe and expedient option for calculating Spinal Instability Neoplastic Score for patients with metastatic spinal cord compression?. Bone Joint J. 103-B(5):971-975, 2021 May. Observational-Dx 100 patients To assess the reliability of using MRI scans to calculate the Spinal Instability Neoplastic Score (SINS) in patients with metastatic spinal cord compression (MSCC). The limit of agreement between the SINS score from the MRI and CT scans for the reviewers was -0.11 for reviewer 1 (95% CI 0.82 to -1.04), -0.12 for reviewer 2 (95% CI 1.24 to -1.48), and -0.37 for reviewer 3 (95% CI 2.35 to -3.09). The use of MRI tended to increase the score when compared with that using the CT scan. No patient having their score calculated from MRI scans would have been classified as stable rather than intermediate or unstable when calculated from CT scans, potentially leading to suboptimal care. 2
28. Laxpati N, Malcolm JG, Tsemo GB, et al. Spinal Arachnoid Webs: Presentation, Natural History, and Outcomes in 38 Patients. Neurosurgery. 89(5):917-927, 2021 10 13. Review/Other-Dx 38 patients To present the single largest case series, detailing presenting symptoms and outcomes amongst operative and nonoperative patients, to better understand the role of intervention. 26 patients (68%) underwent surgical intervention, 12 (32%) were managed non-operatively. 15 (39%) patients had undergone a previous unsuccessful surgery at a different site for their symptoms prior to arachnoid web diagnosis. Commonly presenting symptoms included myelopathy (68%), focal thoracic back pain (68%), lower extremity weakness (45%), numbness and sensory changes (58%), and lower extremity radicular pain (42%), upper extremity weakness (24%), and radicular pain (37%). Focal thoracic pain was associated with thoracic level (P < .02). Myelopathic symptoms were less common in postoperative patients. Postoperative patients described significantly more upper extremity (P < .01) and thoracic (P < .01) numbness and paresthesias. Surveyed nonoperative patients universally described their symptoms as either stable or worsening. 4
29. Chen ZQ, Sun CG, Spine Surgery Group of Chinese Orthopedic Association. Clinical Guideline for Treatment of Symptomatic Thoracic Spinal Stenosis. Orthop Surg. 7(3):208-12, 2015 Aug. Review/Other-Dx N/A To discuss clinical guideline for the treatment of symptomatic thoracic spinal stenosis has been created by reaching the consensus of Chinese specialists using the best available evidence as a tool to aid practitioners involved with the care of this disease No results stated in the abstract 4
30. Stillerman CB, Chen TC, Couldwell WT, Zhang W, Weiss MH. Experience in the surgical management of 82 symptomatic herniated thoracic discs and review of the literature. [Review] [77 refs]. Journal of Neurosurgery. 88(4):623-33, 1998 Apr. Observational-Dx 71 patients To  develop management strategies for the treatment of herniated thoracic discs and to define indications for selection of surgical approaches. Classification of the disc location into two groups reveals that 94% were centrolateral and 6% were lateral. Evidence of calcification was present in 65% of patients, and in 7% intradural extension was noted at surgery. Ten patients (14%) were found to have multiple herniations. Four surgical approaches were used for the removal of these 82 disc herniations: transthoracic in 49 (60%), transfacet pedicle-sparing in 23 (28%), lateral extracavitary in eight (10%), and transpedicular in two (2%). Postoperative evaluation revealed improvement or resolution of pain in 47 (87%) of 54, hyperreflexia and spasticity in 39 (95%) of 41, sensory changes in 36 (84%) of 43, bowel/bladder dysfunction in 13 (76%) of 17, and motor impairment in 25 (58%) of 43. Complications occurred in a total of 12 (14.6%) of 82 discs treated surgically. Major complications were seen in three patients and included perioperative death from cardiopulmonary compromise, instability requiring further surgery, and an increase in the severity of a preoperative paraparesis. 2
31. Brown CW, Deffer PA Jr, Akmakjian J, Donaldson DH, Brugman JL. The natural history of thoracic disc herniation. Spine. 17(6 Suppl):S97-102, 1992 Jun. Review/Other-Dx 55 patients To discuss the natural history of thoracic disc herniation. No results stated in the abstract 4
32. Schultz R, Jr., Steven A, Wessell A, et al. Differentiation of idiopathic spinal cord herniation from dorsal arachnoid webs on MRI and CT myelography. J Neurosurg Spine 2017;26:754-59. Review/Other-Dx 11 patients To discuss the the differences between Dorsal arachnoid webs (DAWs) and idiopathic spinal cord herniation (SCH) on MRI and CT myelography to improve diagnostic confidence prior to surgery. The scalpel sign was positive in all patients with DAW. The dorsal indentation was C-shaped in 5 of 6 patients with SCH. The ventral subarachnoid space was preserved in all patients with DAW and interrupted in cases of SCH. In no patient was a web or a dural defect identified. CONCLUSIONS DAW and SCH can be reliably distinguished on imaging by scrutinizing the nature of the dorsal indentation and the integrity of the ventral subarachnoid space at the level of the cord deformity. 4
33. Li Z, Chen YA, Chow D, Talbott J, Glastonbury C, Shah V. Practical applications of CISS MRI in spine imaging. Eur J Radiol Open 2019;6:231-42. Review/Other-Dx N/A To discuss the erratum regarding missing declaration of completing Interest statements in the Practical applications of CISS MRI in spine imaging. No results stated in the abstract. 4
34. Yu JS, Krishna NG, Fox MG, et al. ACR Appropriateness Criteria® Osteoporosis and Bone Mineral Density: 2022 Update. J Am Coll Radiol 2022;19:S417-S32. Review/Other-Dx N/A Evidence-based guidelines to assist referring physicians and other providers in making the most appropriate imaging or treatment decision for osteoporosis and bone mineral density. No results stated in abstract. 4
35. Khan MA, Jennings JW, Baker JC, et al. ACR Appropriateness Criteria® Management of Vertebral Compression Fractures: 2022 Update. J Am Coll Radiol 2023;20:S102-S24. Review/Other-Dx N/A Evidence-based guidelines to assist referring physicians and other providers in making the most appropriate imaging or treatment decision for management of vertebral compression fractures. No results stated in abstract. 4
36. Ramachandran S, Clifton IJ, Collyns TA, Watson JP, Pearson SB. The treatment of spinal tuberculosis: a retrospective study. Int J Tuberc Lung Dis. 9(5):541-4, 2005 May. Observational-Dx 42 patients To examine the clinical features, treatment duration and outcome of patients presenting with spinal and other bone TB to the Leeds Teaching Hospitals National Health Service Trust, between 1998 and 2002. Forty-two patients were identified. Notes from 34 patients with spinal TB and four patients with TB of other bones were reviewed. Of eight patients who received 6 months of therapy, five relapsed. Of 30 patients who received treatment for 9 months or longer, none relapsed (P < 0.05). 2
37. Liu JB, Zuo R, Zheng WJ, Li CQ, Zhang C, Zhou Y. The accuracy and effectiveness of automatic pedicle screw trajectory planning based on computer tomography values: an in vitro osteoporosis model study. BMC Musculoskelet Disord. 23(1):165, 2022 Feb 21. Observational-Dx N/A To establish an in vitro osteoporosis model and verify the accuracy and effectiveness of automated pedicle screw planning software based on CT values in this model. After decalcification, the BMD of the vertebra decreased from - 0.03 ± 1.03 to - 3.03 ± 0.29 (P < 0.05). In the decalcification group, the MP trajectory CT value was 2167.28 ± 65.62 Hu, the AP trajectory CT value was 2723.96 ± 165.83 Hu, and the MP trajectory CT value in the control group was 2242.94 ± 25.80 Hu (P < 0.05). In the decalcified vertebrae, the screw pull-out force of the MP group was 48.6% lower than that of the control group (P < 0.05). The pull-out force of the AP trajectory was 44.7% higher than that of the MP trajectory (P < 0.05) and reached 97.4% of the MP trajectory in the control group (P > 0.05). 2
38. Algra PR, Bloem JL, Tissing H, Falke TH, Arndt JW, Verboom LJ. Detection of vertebral metastases: comparison between MR imaging and bone scintigraphy. Radiographics. 11(2):219-32, 1991 Mar. Observational-Dx 71 patients; 4 independent observers Prospective, double blinded study to compare the sensitivity of bone scintigraphy and MRI in detection of vertebral metastases. Bone scintigraphy permitted identification of 499 abnormal vertebrae and MRI, 818 abnormal vertebrae. MRI depicted additional abnormal vertebrae in 49 patients. MRI is more sensitive than bone scintigraphy, in detection of vertebral metastases. 1
39. Bredella MA, Essary B, Torriani M, Ouellette HA, Palmer WE. Use of FDG-PET in differentiating benign from malignant compression fractures. Skeletal Radiology. 37(5):405-13, 2008 May. Observational-Dx 33 patients with 43 compression fractures To evaluate the use of FDG-PET in differentiating benign from malignant compression fractures. There were 14 malignant and 29 benign compression fractures, including 5 acute benign fractures. On FDG-PET, 5 benign fractures were falsely classified as malignant (false-positive). Three of these patients underwent prior treatment with bone marrow-stimulating agents. There were two false-negative results. Sensitivity, specificity, PPV, NPV, and accuracy of FDG-PET in differentiating benign from malignant compression fractures were 86%, 83%, 84%, 71%, and 92% respectively. The difference between SUV values of benign and malignant fractures was statistically significant (1.9 +/- 0.97 for benign and 3.9 +/- 1.52 for malignant fractures, P<0.001). SUV of benign acute and chronic fractures were not statistically significant. 3
40. Hong SH, Choi JY, Lee JW, Kim NR, Choi JA, Kang HS. MR imaging assessment of the spine: infection or an imitation?. [Review] [42 refs]. Radiographics. 29(2):599-612, 2009 Mar-Apr. Review/Other-Dx N/A To discuss the MR imaging assessment of the spine. No results stated in the abstract. 4
41. Shah LM, Salzman KL. Imaging of spinal metastatic disease. International Journal of Surgical Oncology Print. 2011:769753, 2011. Review/Other-Dx N/A To discuss the review of the imaging techniques and typical imaging appearances of spinal metastatic disease. Awareness of the different manifestations of spinal metastatic disease is essential as the spine is the most common site of osseous metastatic disease. Imaging modalities have complimentary roles in the evaluation of spinal metastatic disease. CT best delineates osseous integrity, while MRI is better at assessing soft tissue involvement. Physiologic properties, particularly in treated disease, can be evaluated with other imaging modalities such as FDG PET and advanced MRI sequences. Imaging plays a fundamental role in not only diagnosis but also treatment planning of spinal metastatic disease. 4
42. Chantry A, Kazmi M, Barrington S, et al. Guidelines for the use of imaging in the management of patients with myeloma. Br J Haematol. 178(3):380-393, 2017 08. Review/Other-Dx N/A To discuss the guidelines for the use of imaging in the management of patients with myeloma No results stated in the abstract. 4
43. Afolayan JO, Shafafy R, Maher M, Moon KH, Panchmatia JR. Assessment and management of adult spinal deformities. [Review]. Br J Hosp Med (Lond). 79(2):79-85, 2018 Feb 02. Review/Other-Dx N/A To provide an overview of adult spinal deformity with a particular focus on its clinical evaluation, radiological assessment and classification, reviewing the current literature and amalgamating this with the authors' clinical experience. No results stated in the abstract. 4
44. Kim YH, Kim J, Chang SY, Kim H, Chang BS. Treatment Strategy for Impending Instability in Spinal Metastases. Clin. orthop. surg.. 12(3):337-342, 2020 Sep. Observational-Dx 79 patients To compare the initial status and treatment outcomes of a conservative group versus an operative group among patients with spinal metastases with an intermediate SINS of 7-12. Average follow-up was 20.9 months (range, 12-46 months). The demographic variables, primary cancer type, and performance status were not significantly different between the 2 groups. However, the Tomita score was lower in the initially operative group (p = 0.006). The 1-year treatment outcome assessed based on the change in performance status and vertebral height collapse showed a tendency to deteriorate less in the initially operative group. The rate of conversion to surgery in the initially conservative group was 33% in the first year, after which there was little change in the incidence of conversion. When vertebral body collapse was less than 50% or the tumor was located in the semi-rigid region (T3-T10), the need for conversion to surgery increased statistically significantly (p = 0.039 and p = 0.042, respectively). 1
45. Greif DN, Ghasem A, Butler A, Rivera S, Al Maaieh M, Conway SA. Multidisciplinary Management of Spinal Metastasis and Vertebral Instability: A Systematic Review. World Neurosurg. 128:e944-e955, 2019 Aug. Review/Other-Dx 563 articles To perform a systematic literature search for studies using a tumor modality in conjunction with kyphoplasty or vertebroplasty A total of 563 articles were found after our database search. Eighteen studies fulfilled our inclusion criteria. Articles were then divided into categories based on combinations of tumor modality. Multiple studies reported significant decreases in visual analog scale scores after combined procedures with very low rates of symptomatic complications. Studies that compared their combination with control treatment groups showed greater clinical efficacy. 4
46. Zhu S, Wang Y, Yin P, Su Q. A systematic review of surgical procedures on thoracic myelopathy. J. ORTHOP. SURG.. 15(1):595, 2020 Dec 10. Review/Other-Dx 35 studies To review the related literature on the surgical treatment of thoracic myelopathy and try to define treatment guidelines for spine surgeons on thoracic myelopathy. Thirty-five studies met the inclusion criteria and were retrieved. A total of 2183 patients were included in our systematic review, with the average age of 55.2 years. There were 69.8% patients diagnosed as ossification of ligamentum flavum (OLF), 20.0% as ossification of posterior longitudinal ligament (OPLL), 9.3% as disk herniation (DH), and 0.9% as others including diffuse idiopathic skeletal hyperostosis (DISH) and ankylosing spondylitis (AS). The volume of blood loss was more in the treatment of circumferential decompression (CD) than posterior decompression (PD), and the incidence of complications was higher in CD (P < 0.05). The volume of blood loss in minimally invasive surgery (MIS) was lowest and the incidence of complications was 19.2%. Post-operation recovery rate was 0.49 in PD, 0.35 in CD, and 0.29 in MIS while the recovery rate was 0.54 in PD, 0.55 in CD, and 0.49 in MIS at the last follow-up. When focusing on the OLF specifically, incidence of complications in PD was much lower than CD, with less blood loss and higher recovery rate. Focusing on the OPLL specifically, incidence of complications in PD was much lower than CD, with less blood loss while there was no statistical difference in recovery rate between these two methods. 4
47. Kato S. Complications of thoracic spine surgery - Their avoidance and management. [Review]. J Clin Neurosci. 81:12-17, 2020 Nov. Review/Other-Dx N/A To discuss the pathologies, possible sequelae, incidence, risk factors, prevention and management. No results stated in the abstract. 4
48. American College of Radiology. ACR Appropriateness Criteria® Radiation Dose Assessment Introduction. Available at: https://www.acr.org/-/media/ACR/Files/Appropriateness-Criteria/RadiationDoseAssessmentIntro.pdf. Review/Other-Dx N/A To provide evidence-based guidelines on exposure of patients to ionizing radiation. No abstract available. 4
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