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Trigger point injections are not administered in isolation, but are provided as part of a comprehensive pain management program, including physical therapy, patient education, psychosocial support, and oral medication where appropriate. In 2001, the Swedish Lumbar Spine Study Group showed for the first time in a prospective and randomized study that lumbar fusion as a treatment of disabling low-back pain was significantly more effective than a conservative treatment regime .
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Ransomware google chrome pop up. Study design: Interobserver and intraobserver reliability Objective: To measure and compare the interobserver and intraobserver reliability of the cervical spine injury severity score (CSISS), the subaxial injury classification (SLIC) and severity scale, and the Allen-Ferguson system in patients with subaxial cervical spine injuries presenting to the emergency department. Methods: Five examiners independently reviewed c-spine x-rays (CT/MRI) of 50 consecutive patients with subaxial cervical-spine injuries. They classified each case using CSISS, SLIC, and the Allen-Ferguson system.
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Examiners also documented if they believed the case required surgical management. At least 6 weeks later, the above steps were repeated for ten randomly chosen cases. Results: The interobserver and intraobserver reliability for the total CSISS and total SLIC score are excellent. There is poor interobserver reliability and excellent intraobserver reliability when a total kappa score is calculated using all 21 groups for the Allen-Ferguson system. With respect to surgical management decisions, the interobserver agreement is moderate and the intraobserver agreement is excellent.
Conclusions: There is no universally accepted classification scheme for subaxial cervical-spine injuries. A useful classification system must have excellent reliability to consistently and accurately describe injury patterns between different observers and allow for comparison across systems or cohorts. Both the CSISS and the SLIC and severity scale are promising classification systems with excellent interobserver and intraobserver reliability. Future studies will need to determine if their quantitative scores correlate with management and clinical outcomes. STUDY RATIONALE AND CONTEXT The identification and appropriate treatment of subaxial cervical-spine injuries is essential to optimize outcomes. Injuries to the cervical spine are present in only 1%–3% of people who sustain blunt trauma; however, the morbidity and mortality associated with these injuries can be devastating,. Numerous classification systems have been proposed to describe these injuries, predict stability, and dictate treatment; still, none of them are universally accepted,,,,,,,,,,,,,,.