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Taneichi H, Kanemura T, Inoue G, Iwase Y, Ueda H, Kuzuhara A, Kurozumi T, Takahashi E, Takahashi H, Nakamae A, Hashiguchi H, Hiraizumi Y, Mae T, Morioka H, Yagi M, Sairenchi T, Nishiwaki Y, Inagaki T, Akiyama H, Nakashima Y. Current status and future prospects of the Japanese orthopaedic association national registry (JOANR), Japan's first national registry of orthopaedic surgery. J Orthop Sci 2023; 28:683-692. [PMID: 36775784 DOI: 10.1016/j.jos.2023.01.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2023] [Accepted: 01/12/2023] [Indexed: 02/14/2023]
Abstract
The Japanese Orthopaedic Association National Registry (JOANR) is Japan's first national registry of orthopaedic surgery, which has been developed after having been selected for the Project for Developing a Database of Clinical Outcome approved by the Health Policy Bureau of the Ministry of Health, Labour and Welfare. Its architecture has two levels of registration, one being the basic items of surgical procedure, disease, information on surgeons, surgery-related information, and outcome, and the other being detailed items in the affiliated registries of partner medical associations. It has a number of features, including the facts that, because it handles medical data, which constitute special care-required personal information, data processing is conducted entirely in a cloud environment with the imposition of high-level data security measures; registration of the implant data required to assess implant performance has been automated via a bar code reader app; and the system structure enables flexible collaboration with the registries of partner associations. JOANR registration is a requirement for accreditation as a core institution or partner institution under the board certification system, and the total number of cases registered during the first year of operation (2020) was 899,421 registered by 2,247 institutions, providing real-world evidence concerning orthopaedic surgery.
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Affiliation(s)
- Hiroshi Taneichi
- Department of Orthopaedic Surgery, Dokkyo Medical University School of Medicine, Japan.
| | - Tokumi Kanemura
- Department of Orthopaedic Surgery, Konan Kosei Hospital, Japan
| | - Gen Inoue
- Department of Orthopedic Surgery, Kitasato University School of Medicine, Japan
| | - Yoshiyuki Iwase
- Department of Orthopedic Surgery, Juntendo University School of Medicine, Juntendo Tokyo Koto Geriatric Medical Center, Japan
| | - Haruki Ueda
- Department of Orthopaedic Surgery, Dokkyo Medical University School of Medicine, Japan
| | | | | | - Eiji Takahashi
- Department of Orthopaedic Surgery, Kanazawa Medical University, Japan
| | - Hiroshi Takahashi
- Department of Orthopaedic Surgery, Faculty of Medicine, University of Tsukuba, Japan
| | - Atsuo Nakamae
- Department of Orthopaedic Surgery, Hiroshima University School of Medicine, Japan
| | - Hiroshi Hashiguchi
- Department of Orthopaedic Surgery, Yonekura Spine & Joint Hospital, Japan
| | - Yutaka Hiraizumi
- Department of Orthopaedic Surgery, Showa University School of Medicine, Japan
| | - Tatsuo Mae
- Department of Physical Therapy, Osaka Yukioka Medical College, Japan
| | - Hideo Morioka
- Department of Orthopaedic Surgery, National Hospital Organization Tokyo Medical Center, Japan
| | - Mitsuru Yagi
- Department of Orthopedic Surgery, Keio University School of Medicine, Japan
| | - Toshimi Sairenchi
- Department of Medical Science of Nursing, Dokkyo Medical University School of Nursing, Japan
| | - Yuji Nishiwaki
- Department of Environmental and Occupational Health, Toho University, Japan
| | - Tokiko Inagaki
- Medical Support Section, Medical Information Management Office, Public Noto General Hospital, Japan
| | - Haruhiko Akiyama
- Department of Orthopaedic Surgery, Gifu University, School of Medicine, Japan
| | - Yasuharu Nakashima
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kyushu University, Japan
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External validation of the deep learning system "SpineNet" for grading radiological features of degeneration on MRIs of the lumbar spine. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2022; 31:2137-2148. [PMID: 35835892 DOI: 10.1007/s00586-022-07311-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/14/2022] [Revised: 05/27/2022] [Accepted: 06/24/2022] [Indexed: 01/20/2023]
Abstract
BACKGROUND Magnetic resonance imaging (MRI) is used to detect degenerative changes of the lumbar spine. SpineNet (SN), a computer vision-based system, performs an automated analysis of degenerative features in MRI scans aiming to provide high accuracy, consistency and objectivity. This study evaluated SN's ratings compared with those of an expert radiologist. METHOD MRIs of 882 patients (mean age, 72 ± 8.8 years) with degenerative spinal disorders from two previous trials carried out in our spine center between 2011 and 2019, were analyzed by an expert radiologist. Lumbar segments (L1/2-L5/S1) were graded for Pfirrmann Grades (PG), Spondylolisthesis (SL) and Central Canal Stenosis (CCS). SN's analysis for the equivalent parameters was generated. Agreement between methods was analyzed using kappa (κ), Spearman correlation (ρ) and Lin's concordance correlation (ρc) coefficients and class average accuracy (CAA). RESULTS 4410 lumbar segments were analyzed. κ statistics showed moderate to substantial agreement in PG between the radiologist and SN depending on spinal level (range κ 0.63-0.77, all levels together 0.72; range CAA 45-68%, all levels 55%), slight to substantial agreement for SL (range κ 0.07-0.60, all levels 0.63; range CAA 47-57%, all levels 56%) and CCS (range κ 0.17-0.57, all levels 0.60; range CAA 35-41%, all levels 43%). SN tended to record more pathological features in PG than did the radiologist whereas the contrary was the case for CCS. SL showed an even distribution between methods. CONCLUSION SN is a robust and reliable tool with the ability to grade degenerative features such as PG, SL or CCS in lumbar MRIs with moderate to substantial agreement compared to the current gold-standard, the radiologist. It is a valuable alternative for analyzing MRIs from large cohorts for diagnostic and research purposes.
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Liu Y, Qi Y, Diaty DM, Zheng G, Shen X, Lin S, Chen J, Song Y, Gu X. Treatment for lumbar spinal stenosis secondary to ligamentum flavum hypertrophy using percutaneous endoscopy through interlaminar approach: a retrospective study. J Orthop Surg Res 2020; 15:337. [PMID: 32811508 PMCID: PMC7437061 DOI: 10.1186/s13018-020-01874-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2020] [Accepted: 08/10/2020] [Indexed: 12/13/2022] Open
Abstract
Background This paper is to describe percutaneous endoscopy in the treatment of lumbar spinal stenosis secondary to ligamentum flavum hypertrophy targeted and to investigate the efficacy and safety of percutaneous endoscopy in the treatment of this kind of lumbar spinal stenosis in elderly patients. Method A retrospective analysis of 40 elderly patients with lumbar spinal stenosis secondary to ligamentum flavum hypertrophy admitted between January 2016 and January 2018 was performed. According to different surgical methods, they were divided into two groups: the control group and the endoscopy group (interlaminar approach), 20 people per group. There were 9 males and 11 females in the control group; the age of patients was 65.65 ± 4.44 years, and the average disease duration was 4.55 ± 1.85 years. Besides, there were 10 males and 10 females in the endoscopy group; the age of patients was 67.30 ± 4.23 years, and the average disease duration was 4.95 ± 2.04 years. Collect and count surgical-related indicators, preoperative and postoperative radiologic findings, incision visual analog scale (VAS), lumbar and leg pain VAS, lumbar Japanese Orthopaedic Association (JOA), and Oswestry disability index (ODI) scores of all patients. Result A series of surgical indicators (including the operation time, the quantity of bleeding, and postoperative hospital stay) in the endoscopy group was significantly lower than that in the control group (p < 0.05). The incision VAS score in the endoscopy group was also significantly lower than that in the control group at each time after surgery (p < 0.05). Besides, compared with the control group, in the endoscopy group, the leg pain VAS score and lumbar ODI score after surgery were significantly decreased (p < 0.05). Compared with the control group, in the endoscopy group, the lumbar JOA score was significantly higher (p < 0.05). Conclusion Percutaneous endoscopic technique is a small trauma, quick recovery, safe, and effective minimally invasive surgery for patients with lumbar spinal stenosis secondary to ligamentum flavum hypertrophy.
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Affiliation(s)
- Yi Liu
- Department of Orthopaedics, The Affiliated Hospital of Hangzhou Normal University, 126 Wenzhou Road, Hangzhou, 310000, China
| | - Yingjie Qi
- Department of Orthopaedics, The Affiliated Hospital of Hangzhou Normal University, 126 Wenzhou Road, Hangzhou, 310000, China
| | - Diarra Mohamed Diaty
- Department of Orthopaedics, The Affiliated Hospital of Hangzhou Normal University, 126 Wenzhou Road, Hangzhou, 310000, China
| | - Guanglei Zheng
- Department of Orthopaedics, The Affiliated Hospital of Hangzhou Normal University, 126 Wenzhou Road, Hangzhou, 310000, China
| | - Xiaoqiang Shen
- Department of Orthopaedics, The Affiliated Hospital of Hangzhou Normal University, 126 Wenzhou Road, Hangzhou, 310000, China
| | - Shangben Lin
- Department of Orthopaedics, The Affiliated Hospital of Hangzhou Normal University, 126 Wenzhou Road, Hangzhou, 310000, China
| | - Jiaqi Chen
- Department of Orthopaedics, The Affiliated Hospital of Hangzhou Normal University, 126 Wenzhou Road, Hangzhou, 310000, China
| | - Yongwei Song
- Department of Orthopaedics, The Affiliated Hospital of Hangzhou Normal University, 126 Wenzhou Road, Hangzhou, 310000, China
| | - Xiaomin Gu
- Department of Orthopaedics, The Affiliated Hospital of Hangzhou Normal University, 126 Wenzhou Road, Hangzhou, 310000, China.
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Dysethesia due to irritation of the dorsal root ganglion following lumbar transforaminal endoscopy: Analysis of frequency and contributing factors. Clin Neurol Neurosurg 2020; 197:106073. [PMID: 32683194 DOI: 10.1016/j.clineuro.2020.106073] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Revised: 06/29/2020] [Accepted: 07/05/2020] [Indexed: 01/22/2023]
Abstract
BACKGROUND New onset of acute dysethetic leg pain due to irritation of the dorsal root ganglion (DRG) following uneventful recovery from an expertly executed lumbar transforaminal endoscopic decompression is a common problem. Its incidence and relation to any risk factors that could be mitigated preoperatively are not well understood. METHODS We performed a multicenter frequency analysis of DRG irritation dysesthesia in 451 patients who underwent lumbar transforaminal endoscopic decompression for herniated disc and foraminal stenosis. The 451 patients consisted of 250 men and 201 women with an average age of 55.77 ± 15.6 years. The average follow-up of 47.16 months. The primary clinical outcome measures were the modified Macnab criteria. Chi-square testing was employed to analyze statistically significant associations between increased dysesthesia rates, preoperative diagnosis, the surgical level(s), and surgeon technique. RESULTS At final follow-up, Excellent (183/451; 40.6 %) and Good (195/451; 43.2 %) Macnab outcomes were observed in the majority of patients (378/451; 83.8 %). The majority of study patients (354; 78.5 %) had an entirely uneventful postoperative recovery without any DRG irritation, but 21.5 % of patients were treated for it in the immediate postoperative recovery period with supportive care measures including activity modification, transforaminal epidural steroid injections, non-steroidal anti-inflammatories, gabapentin, or pregabalin. There was no statistically significant difference in dysesthesia rates between lumbar levels from L1 to S1, or between single (DRG rate 21.8 %) or two-level (DRG rate 20.2 %) endoscopic decompression (p = 0.742). A statistically significantly higher incidence of postoperative dysesthesia was observed in patients who underwent decompression for foraminal stenosis (38/103; 27 %), and recurrent herniated disc (7/10; 41.2 %; p = 0.039). There were also statistically significant variations in dysesthesia rates between the seven participating clinical study sites ranging from 11.6%-33% (p = 0.002). Unrelenting postoperative dysesthetic leg pain due to DRG irritation was statistically associated with less favorable long-term clinical outcomes with DRG rates as high as 45 % in patients with a Fair and 61.3 % in patients with Poor Macnab outcomes (p < 0.0001). CONCLUSIONS Postoperative dysesthesia following transforaminal endoscopic decompression should be expected in one-fifth of patients. There was no predilection for any lumbar level. Foraminal stenosis and recurrent herniated disc surgery are risk factors for higher dysesthesia rates. There was a statistically significant variation of dysesthesia rates between participating centers suggesting that the surgeon skill level is of significance. Severe postoperative dysesthesia may be a predictor of Fair of Poor long-term Macnab outcomes.
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Development of the "Core Yellow Flags Index" (CYFI) as a brief instrument for the assessment of key psychological factors in patients undergoing spine surgery. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2020; 29:1935-1952. [DOI: 10.1007/s00586-020-06462-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/05/2020] [Accepted: 05/10/2020] [Indexed: 12/21/2022]
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He Z, Tang X, Yang X, Guo Y, George TJ, Charness N, Quan Hem KB, Hogan W, Bian J. Clinical Trial Generalizability Assessment in the Big Data Era: A Review. Clin Transl Sci 2020; 13:675-684. [PMID: 32058639 PMCID: PMC7359942 DOI: 10.1111/cts.12764] [Citation(s) in RCA: 62] [Impact Index Per Article: 15.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2019] [Accepted: 01/25/2020] [Indexed: 01/04/2023] Open
Abstract
Clinical studies, especially randomized, controlled trials, are essential for generating evidence for clinical practice. However, generalizability is a long‐standing concern when applying trial results to real‐world patients. Generalizability assessment is thus important, nevertheless, not consistently practiced. We performed a systematic review to understand the practice of generalizability assessment. We identified 187 relevant articles and systematically organized these studies in a taxonomy with three dimensions: (i) data availability (i.e., before or after trial (a priori vs. a posteriori generalizability)); (ii) result outputs (i.e., score vs. nonscore); and (iii) populations of interest. We further reported disease areas, underrepresented subgroups, and types of data used to profile target populations. We observed an increasing trend of generalizability assessments, but < 30% of studies reported positive generalizability results. As a priori generalizability can be assessed using only study design information (primarily eligibility criteria), it gives investigators a golden opportunity to adjust the study design before the trial starts. Nevertheless, < 40% of the studies in our review assessed a priori generalizability. With the wide adoption of electronic health records systems, rich real‐world patient databases are increasingly available for generalizability assessment; however, informatics tools are lacking to support the adoption of generalizability assessment practice.
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Affiliation(s)
- Zhe He
- School of Information, Florida State University, Tallahassee, Florida, USA
| | - Xiang Tang
- Department of Statistics, Florida State University, Tallahassee, Florida, USA
| | - Xi Yang
- Department of Health Outcomes and Biomedical Informatics, College of Medicine, University of Florida, Gainesville, Florida, USA
| | - Yi Guo
- Department of Health Outcomes and Biomedical Informatics, College of Medicine, University of Florida, Gainesville, Florida, USA
| | - Thomas J George
- Hematology & Oncology, Department of Medicine, College of Medicine, University of Florida, Gainesville, Florida, USA
| | - Neil Charness
- Department of Psychology, Florida State University, Tallahassee, Florida, USA
| | - Kelsa Bartley Quan Hem
- Calder Memorial Library, Miller School of Medicine, University of Miami, Miami, Florida, USA
| | - William Hogan
- Department of Health Outcomes and Biomedical Informatics, College of Medicine, University of Florida, Gainesville, Florida, USA
| | - Jiang Bian
- Department of Health Outcomes and Biomedical Informatics, College of Medicine, University of Florida, Gainesville, Florida, USA
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Vinas-Rios JM, Rauschmann M, Sellei R, Sanchez-Rodriguez JJ, Meyer F, Arabmotlagh M. Invasiveness has no influence on the rate of incidental durotomies in surgery for multisegmental lumbar spinal canal stenosis (≥ 3 levels) with and without fusion. Analysis from the German Spine Registry data (DWG-Register). J Neurosurg Sci 2019; 66:79-84. [PMID: 31601067 DOI: 10.23736/s0390-5616.19.04807-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Nowadays, perioperative complications as dural tear (DT) with subsequent neurological deficits are documented in independent registers. However, the relationship of these complications with the grade of invasiveness (≥3 levels) is still unclear. We attempted to evaluate perioperative complications, particularly DT with subsequent neurological deficits, between patients undergoing laminotomy and decompression and decompression and fusion in ≥3 levels. METHODS Retrospective analysis of the data pool of the DWG register based on cases described by 10 clinics between January 2012 and December 2016 was performed. Surgically treated LSS in ≥3 segments were divided into decompression with or without instrumentation and fusion. Cases with intraoperative DT in both subgroups were analysed for risk factor occurrence. The Surgical Invasive Index (SII) was used. RESULTS DT occurred in 102/941 (10.8%) patients. Difference in DT between groups was non- significant. The likelihood of DT increased by 2.12-fold with previous spinal surgery at the same level and by 1.9-fold for BMI 30-34 and >35 in comparison with BMI 26-29, respectively. Postoperative deep wound infection was increased by 2.39-fold after DT than without. Significance in outcomes between patients with/without DT was not found. The invasiveness index explained 48% of the variation in blood loss and 51% of the variation in surgery duration. CONCLUSIONS The rate of incidental DT during decompression for LSS with and without fusion in ≥3 levels was associated with BMI and previous surgery at the same spinal level. Invasivness (SII) is valid rather for variables proper to surgery such as bledding and Op-time but no with incidence for DT and subsequent CSF-leackage.
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Affiliation(s)
| | | | - Richard Sellei
- Department of Traumatology, Sanaklinik, Offenbach am Main, Germany
| | | | - Frerk Meyer
- Department of Spine Surgery, University Clinic for Neurosurgery, Evangelisches Krankenhaus, Oldenburg, Germany
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Hu D, Fei J, Chen G, Yu Y, Lai Z. Treatment for lumbar spinal stenosis in elderly patients using percutaneous endoscopic lumbar discectomy combined with postoperative three-dimensional traction. Expert Rev Med Devices 2019; 16:317-323. [PMID: 30916589 DOI: 10.1080/17434440.2019.1599282] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Affiliation(s)
- Dexin Hu
- Department of orthopedics, Hangzhou Red Cross Hospital, Hangzhou, Zhejiang, China
| | - Jun Fei
- Department of orthopedics, Hangzhou Red Cross Hospital, Hangzhou, Zhejiang, China
| | - Genjun Chen
- Department of orthopedics, Hangzhou Red Cross Hospital, Hangzhou, Zhejiang, China
| | - Yongjie Yu
- Department of orthopedics, Hangzhou Red Cross Hospital, Hangzhou, Zhejiang, China
| | - Zhen Lai
- Department of orthopedics, Hangzhou Red Cross Hospital, Hangzhou, Zhejiang, China
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Morris S, Booth J. Shaping conservative spinal services with the Spine Tango Registry. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2018; 27:543-553. [PMID: 29388090 DOI: 10.1007/s00586-018-5484-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/07/2017] [Accepted: 01/21/2018] [Indexed: 11/26/2022]
Abstract
PURPOSE This study reports the results of a registry data collection project within a secondary care spinal osteopathy service. METHODS Clinical and demographic data were collected using the Spine Tango Conservative registry data collection tool. Outcomes were assessed using the Numerical Pain Rating Scale (NPRS), Oswestry Disability Index (ODI), Neck Disability Index (NDI), COMI Low Back Conservative (COMI-LBC), COMI Neck Conservative (COMI-NC) and EQ5D. Global treatment outcome (GTO), satisfaction with care and therapeutic complications were reported using the Spine Tango Patient Self Assessment form (STPSA). The correlation of GTO and PROM change scores was analysed using Spearman's rank correlation coefficient. RESULTS 262 patients presented during the study period. 100% of patients had chronic spinal pain and 98.8% had previously received other interventions for the same episode. Mean (standard deviation) improvements by PROM: NPRS low back 2.1 (2.5); NPRS neck 2.3 (2.3); COMI-LBC 2.1 (2.2); COMI-NC 2.0 (1.7); ODI 10.5 (12.1); NDI 14.5 (12.2); EQ5D 0.2 (0.3). 83.2% of patients reported that osteopathy had 'helped a lot' or 'helped'. 96.2% of patients were 'very satisfied' or 'satisfied' with care. There were no serious therapeutic complications. CONCLUSIONS The secondary care spinal osteopathy service demonstrated high satisfaction, few therapeutic complications and positive outcomes on all PROMs. Registry participation has facilitated robust clinical governance and the data support the use of osteopaths to deliver a conservative spinal service in this setting. Registry data collection is a significant administrative and clinical task which should be structured to minimise burden on patients and resources. These slides can be retrieved under Electronic Supplementary Material.
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Affiliation(s)
- Samuel Morris
- Spinal Outpatient's Department, Queen's Medical Centre, Nottingham University Hospitals, Nottingham, UK.
| | - James Booth
- Spinal Outpatient's Department, Queen's Medical Centre, Nottingham University Hospitals, Nottingham, UK
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