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Tefera YG, Gray S, Nielsen S, Collie A. Preoperative opioid use and postoperative return to work following spinal surgery in workers' compensation settings: a systematic review and meta-analysis. Int J Surg 2024; 110:1781-1792. [PMID: 38181114 PMCID: PMC10942173 DOI: 10.1097/js9.0000000000001035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2023] [Accepted: 12/11/2023] [Indexed: 01/07/2024]
Abstract
BACKGROUND Opioid use prior to spinal surgery is common among patients with workers' compensation (WC) claims. Extended opioid use for pain management in this population is associated with several adverse outcomes including delayed return to work (RTW). OBJECTIVE This systematic review and meta-analysis aim to assess the evidence on the association of preoperative opioid use with stable RTW and RTW within 1-year after spinal surgery. MATERIAL AND METHODS The authors searched MEDLINE, Embase, PsycINFO, Emcare, CINAHL Plus, Scopus, and Web of Science from inception to 14 January 2023. The authors included studies that compared any preoperative opioid use with no opioid use, and those that enabled a comparison of different durations of preoperative opioid use. The primary outcome was stable RTW after spinal surgery. Secondary outcomes were RTW within 1-year after surgery and cost of WC claims. A random effect model was assumed to pool the effect estimate. The GRADE approach was applied to evaluate the certainty of evidence. RESULTS From 2589 records, 10 studies were included, and of these, nine were considered for quantitative synthesis. All studies were observational with eight retrospective cohort and two case-control studies. Five studies each investigated cervical and lumbar disorders. With moderate certainty evidence, the odds of postoperative stable RTW reduced by half (OR: 0.51, 95% CI: 0.43-0.59; 5549 participants) in patients using opioids preoperatively. Similarly, moderate certainty evidence from 2348 participants demonstrated that the odds of RTW within 1-year after surgery were reduced by more than half in patients with preoperative opioid prescriptions (OR: 0.46, 95% CI: 0.36-0.59). CONCLUSIONS This systematic review and meta-analysis shows that preoperative opioid use is associated with a reduction in odds of postoperative RTW by half in patients with WC-funded spinal surgery.
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Affiliation(s)
- Yonas G. Tefera
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | | | - Suzanne Nielsen
- Monash Addiction Research Centre, Eastern Health Clinical School
| | - Alex Collie
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
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2
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Belavy DL, Tagliaferri SD, Buntine P, Saueressig T, Ehrenbrusthoff K, Chen X, Diwan A, Miller CT, Owen PJ. Interventions for promoting evidence-based guideline-consistent surgery in low back pain: a systematic review and meta-analysis of randomised controlled trials. 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; 31:2851-2865. [PMID: 36114891 DOI: 10.1007/s00586-022-07378-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/15/2022] [Revised: 07/09/2022] [Accepted: 09/02/2022] [Indexed: 06/15/2023]
Abstract
PURPOSE Examine the effectiveness of interventions to approach guideline-adherent surgical referrals for low back pain assessed via systematic review and meta-analysis. METHODS Five databases (10 September 2021), Google Scholar, reference lists of relevant systematic reviews were searched and forward and backward citation tracking of included studies were implemented. Randomised controlled/clinical trials in adults with low back pain of interventions to optimise surgery rates or referrals to surgery or secondary referral were included. Bias was assessed using the Cochrane ROB2 tool and evidence certainty via Grading of Recommendations Assessment, Development and Evaluation (GRADE). A random effects meta-analysis with a Paule Mandel estimator plus Hartung-Knapp-Sidik-Jonkman method was used to calculate the odds ratio and 95% confidence interval, respectively. RESULTS Of 886 records, 6 studies were included (N = 258,329) participants; cluster sizes ranged from 4 to 54. Five studies were rated as low risk of bias and one as having some concerns. Two studies reporting spine surgery referral or rates could only be pooled via combination of p values and gave evidence for a reduction (p = 0.021, Fisher's method, risk of bias: low). This did not persist with sensitivity analysis (p = 0.053). For secondary referral, meta-analysis revealed a non-significant odds ratio of 1.07 (95% CI [0.55, 2.06], I2 = 73.0%, n = 4 studies, Grading of Recommendations Assessment, Development and Evaluation [GRADE] evidence certainty: very low). CONCLUSION Few RCTs exist for interventions to improve guideline-adherent spine surgery rates or referral. Clinician education in isolation may not be effective. Future RCTs should consider organisational and/or policy level interventions. PROSPERO REGISTRATION CRD42020215137.
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Affiliation(s)
- Daniel L Belavy
- Division of Physiotherapy, Department of Applied Health Sciences, Hochschule Für Gesundheit (University of Applied Sciences), Gesundheitscampus 6-8, 44801, Bochum, Germany.
| | - Scott D Tagliaferri
- School of Exercise and Nutrition Sciences, Institute for Physical Activity and Nutrition, Deakin University, Geelong, Australia
| | - Paul Buntine
- Emergency Department, Box Hill Hospital, Eastern Health, Melbourne, VIC, Australia
- Eastern Health Clinical School, Monash University, Melbourne, VIC, Australia
| | | | - Katja Ehrenbrusthoff
- School of Exercise and Nutrition Sciences, Institute for Physical Activity and Nutrition, Deakin University, Geelong, Australia
| | - Xiaolong Chen
- Department of Orthopaedic Surgery, Spine Service, St. George Hospital, University of New South Wales, Sydney, Australia
| | - Ashish Diwan
- Department of Orthopaedic Surgery, Spine Service, St. George Hospital, University of New South Wales, Sydney, Australia
| | - Clint T Miller
- School of Exercise and Nutrition Sciences, Institute for Physical Activity and Nutrition, Deakin University, Geelong, Australia
| | - Patrick J Owen
- School of Exercise and Nutrition Sciences, Institute for Physical Activity and Nutrition, Deakin University, Geelong, Australia
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3
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Van Munster JJCM, de Weerdt V, Halperin IJY, Zamanipoor Najafabadi AH, van Benthem PPG, Schoonman GG, Moojen WA, van den Hout WB, Atsma F, Peul WC. Practice Variation Research in Degenerative Lumbar Disc Surgery: A Literature Review on Design Characteristics and Outcomes. Global Spine J 2022; 12:1841-1851. [PMID: 34955052 PMCID: PMC9609525 DOI: 10.1177/21925682211064855] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
STUDY DESIGN Literature review. OBJECTIVE To describe whether practice variation studies on surgery in patients with lumbar degenerative disc disease used adequate study methodology to identify unwarranted variation, and to inform quality improvement in clinical practice. Secondary aim was to describe whether variation changed over time. METHODS Literature databases were searched up to May 4th, 2021. To define whether study design was appropriate to identify unwarranted variation, we extracted data on level of aggregation, study population, and case-mix correction. To define whether studies were appropriate to achieve quality improvement, data were extracted on outcomes, explanatory variables, description of scientific basis, and given recommendations. Spearman's rho was used to determine the association between the Extreme Quotient (EQ) and year of publication. RESULTS We identified 34 articles published between 1990 and 2020. Twenty-six articles (76%) defined the diagnosis. Prior surgery cases were excluded or adjusted for in 5 articles (15%). Twenty-three articles (68%) adjusted for case-mix. Variation in outcomes was analyzed in 7 articles (21%). Fourteen articles (41%) identified explanatory variables. Twenty-six articles (76%) described the evidence on effectiveness. Recommendations for clinical practice were given in 9 articles (26%). Extreme Quotients ranged between 1-fold and 15-fold variation and did not show a significant change over time (rho= -.33, P= .09). CONCLUSIONS Practice variation research on surgery in patients with degenerative disc disease showed important limitations to identify unwarranted variation and to achieve quality improvement by public reporting. Despite the availability of new evidence, we could not observe a significant decrease in variation over time.
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Affiliation(s)
- Juliëtte J. C. M. Van Munster
- Leiden University Medical Center
(LUMC), Leiden, Netherlands,University Neurosurgical Center
Holland, Leiden University Medical
Center, the Hague Medical Center, and Haga Teaching Hospitals,
Leiden and the Hague, the Netherlands,Juliëtte J. C. M. van Munster, Department
of Otorhinolaryngology and Head and Neck Surgery, Leiden University Medical
Center, 2300 RC Leiden 2333 ZA, Netherlands.
| | - Vera de Weerdt
- Talma Institution, Vrije Universiteit
Amsterdam, the Netherlands & Amsterdam University Medical Centers,
Amsterdam, the Netherlands
| | - Ilan J. Y. Halperin
- Leiden University Medical Center
(LUMC), Leiden, Netherlands,University Neurosurgical Center
Holland, Leiden University Medical
Center, the Hague Medical Center, and Haga Teaching Hospitals,
Leiden and the Hague, the Netherlands
| | - Amir H. Zamanipoor Najafabadi
- University Neurosurgical Center
Holland, Leiden University Medical
Center, the Hague Medical Center, and Haga Teaching Hospitals,
Leiden and the Hague, the Netherlands
| | | | | | - Wouter A. Moojen
- University Neurosurgical Center
Holland, Leiden University Medical
Center, the Hague Medical Center, and Haga Teaching Hospitals,
Leiden and the Hague, the Netherlands
| | | | - Femke Atsma
- Radboud University Medical
Center/Radboud Institute for Health Sciences/Scientific Center for
Quality of Healthcare (IQ healthcare), Nijmegen, the Netherlands
| | - Wilco C. Peul
- University Neurosurgical Center
Holland, Leiden University Medical
Center, the Hague Medical Center, and Haga Teaching Hospitals,
Leiden and the Hague, the Netherlands
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McMillan JS, Jones K, Forgan L, Busija L, Carey RPL, de Silva AM, Phillips MG. Lumbar spinal fusion surgery outcomes in a cohort of injured workers in the Victorian workers' compensation system. ANZ J Surg 2021; 92:481-486. [PMID: 34825438 DOI: 10.1111/ans.17391] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2021] [Revised: 11/04/2021] [Accepted: 11/13/2021] [Indexed: 01/05/2023]
Abstract
BACKGROUND Lumbar spinal fusion (LSF) outcomes for workers' compensation patients are worse than for the general population. The objectives were to examine the long-term work capacity, opioid prescription and mental health outcomes of injured workers who have undergone LSF surgery in Victoria, Australia, and to identify demographic and pre- and post-operative characteristics associated with these outcomes. METHODS Retrospective study of 874 injured workers receiving elective LSF from 2008 to 2016 in the Victorian workers' compensation system. WorkSafe Victoria's claims data were used to infer outcomes for recovery. Association of demographics, pre-surgery and surgery variables with outcomes were modelled using multivariate multinomial logistic regression analyses. RESULTS Twenty-four months after LSF surgery, 282 (32.3%) of the 874 injured workers had substantial work capacity, 388 (44.4%) were prescribed opioids, and 330 (37.8%) were receiving mental health treatment. Opioid prescription and limited work capacity before surgery were independent strong predictors of opioid prescription, reduced work capacity and mental health treatment 24 months after LSF. Pre-operative mental health treatment was associated with the use of mental health treatment at 24 months. Other predictors for poor outcomes included a greater than 12-month duration from injury to surgery, LSF re-operation and common law or impairment benefit lodgement before surgery. CONCLUSION An association between pre-operative factors and post-operative outcomes after LSF in a Victorian workers' compensation population was identified, suggesting that pre-operative status may influence outcomes and should be considered in LSF decisions. The high opioid use indicates that opioid management before and after surgery needs urgent review.
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Affiliation(s)
- Janine S McMillan
- Institute for Safety, Compensation and Recovery Research (ISCRR), Monash University, Melbourne, Victoria, Australia
| | - Kyle Jones
- Institute for Safety, Compensation and Recovery Research (ISCRR), Monash University, Melbourne, Victoria, Australia
| | - Leonard Forgan
- Institute for Safety, Compensation and Recovery Research (ISCRR), Monash University, Melbourne, Victoria, Australia
| | - Ljoudmila Busija
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | | | - Andrea M de Silva
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia.,Research Division, WorkSafe Victoria, Geelong, Victoria, Australia
| | - Mark G Phillips
- Clinical Services, WorkSafe Victoria, Geelong, Victoria, Australia
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Ultrasound-guided periradicular oxygen-ozone injections as a treatment option for low back pain associated with sciatica. INTERNATIONAL ORTHOPAEDICS 2021; 45:1239-1246. [PMID: 33629173 DOI: 10.1007/s00264-021-04975-w] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/17/2020] [Accepted: 02/02/2021] [Indexed: 12/23/2022]
Abstract
BACKGROUND The social impact and economic burden of low back pain are well known among the medical community. A novel therapeutic approach is represented by oxygen-ozone therapy, whose anti-inflammatory effects could be especially useful in patients with herniated discs. The most common administration is through a palpation-guided injection technique, although the use of ultrasound guidance could allow a more precise delivery of the therapeutic substance close to the nerve root. AIM OF THE STUDY To describe the clinical outcomes following US-guided periradicular injection of oxygen-ozone as a treatment option for low back pain associated to sciatica in patients affected by symptomatic L5-S1 disc herniation. CONCLUSION Ultrasound-guided periradicular injection of oxygen-ozone in L5-S1 herniation is a safe and effective minimally invasive treatment, able to improve both low back and radiating pain.
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Cranial facet joint injuries in percutaneous lumbar pedicle screw placement: a matched-pair analysis comparing intraoperative 3D navigation and conventional fluoroscopy. 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; 30:88-96. [PMID: 32462309 DOI: 10.1007/s00586-020-06467-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/31/2019] [Revised: 04/01/2020] [Accepted: 05/12/2020] [Indexed: 10/24/2022]
Abstract
PURPOSE The violation of the cranial adjacent facet is a frequent complication in lumbar instrumentations and can induce local pain and adjacent segment disease. Minimally invasive screw implantation is often stated as risk factor in comparison with open approaches. Percutaneous pedicle screw placement (PPSP) can be performed using single X-ray images (fluoroscopy) or intraoperative 3D navigation. The study compares top-level screws in percutaneous lumbar instrumentations regarding facet violations and screw pedicle position using navigation or fluoroscopy. METHODS Patients after lumbar PPSP were retrospectively separated according to the intraoperative technique: navigation (NAV) or fluoroscopy (FLUORO). Two blinded investigators graded the top-level screws regarding facet violations and pedicle breach in postoperative CT scans. Subsequent matched cohort analysis was performed for comparable groups. RESULTS Evaluating 768 screws, we assessed 70 (9.1%) facet violations. Overall, 186 (24.2%) screws were implanted using navigation. There was no significant difference in the rate of facet violations between both imaging groups (NAV 19/186, 10.2%, FLUORO 51/582, 8.8%, p = 0.55). Totally, 728 (94.8%) of all screws showed a correct pedicle position. Most of the 40 unfavorable pedicle positions were placed by fluoroscopy (NAV 4/186, 2.2%, FLUORO 36/582, 6.6%, p = 0.03). The matched cohorts verified these results (facet violations: NAV 19/186, 10.2%, FLUORO 18/186, 9.7%, p = 0.55; pedicle penetrations: NAV 4/186, 2.2%, FLUORO 12/186, 6.9%, p = 0.04). CONCLUSIONS Both intraoperative imaging techniques allow lumbar PPSP with low rates of cranial facet violations if the surgeon intends to preserve facet integrity. Navigation was superior concerning accurate pedicle screw position, but could not significantly prevent facet violations.
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7
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Rajappa H, Hayes C. People, medicine, and society: An overview of chronic pain management. ARCHIVES OF MEDICINE AND HEALTH SCIENCES 2020. [DOI: 10.4103/amhs.amhs_108_20] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Lambert R, Vreugdenburg TD, Marlow N, Scott NA, McGahan L, Tivey D. Practical applications of rapid review methods in the development of Australian health policy. AUST HEALTH REV 2019; 41:463-468. [PMID: 27467219 DOI: 10.1071/ah16041] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2015] [Accepted: 06/05/2016] [Indexed: 01/08/2023]
Abstract
Rapid reviews (RRs) are a method of evidence synthesis that can provide robust evidence to support policy decisions in a timely manner. Herein we describe the methods used to conduct RRs and present an illustrative case study to describe how RRs can be used to inform contemporary Australian health policy. The aim of the present study was to explore several important aspects of how RRs can inform decision makers. RRs are conducted within limited time frames of as little as 4 weeks. Policy questions may focus on issues of efficacy, service delivery and service organisation rather than reimbursement of new services, which is better answered by a more comprehensive assessment. RRs use flexible and pragmatic methods, which aim to balance the objectivity and rigour required of the reviews within limited time frames. This flexibility allows for great variation across products with regard to length, depth of analysis and methods used. As a result, RRs can be specifically tailored to address targeted policy questions and are a useful tool in the development of Australian health policy.
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Affiliation(s)
- Robyn Lambert
- Research, Audit and Academic Surgery Division, Royal Australasian College of Surgeons, 199 Ward Street, North Adelaide, SA 5006, Australia. ; ;
| | - Thomas D Vreugdenburg
- Research, Audit and Academic Surgery Division, Royal Australasian College of Surgeons, 199 Ward Street, North Adelaide, SA 5006, Australia. ; ;
| | - Nicholas Marlow
- Research, Audit and Academic Surgery Division, Royal Australasian College of Surgeons, 199 Ward Street, North Adelaide, SA 5006, Australia. ; ;
| | - N Ann Scott
- Research, Audit and Academic Surgery Division, Royal Australasian College of Surgeons, 199 Ward Street, North Adelaide, SA 5006, Australia. ; ;
| | - Lynda McGahan
- Research, Audit and Academic Surgery Division, Royal Australasian College of Surgeons, 199 Ward Street, North Adelaide, SA 5006, Australia. ; ;
| | - David Tivey
- Research, Audit and Academic Surgery Division, Royal Australasian College of Surgeons, 199 Ward Street, North Adelaide, SA 5006, Australia. ; ;
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9
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Siu KC, Stoodley MA. Decompressive laminectomy without fusion for lumbar facet joint cysts. J Clin Neurosci 2018; 58:113-116. [DOI: 10.1016/j.jocn.2018.09.013] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2018] [Revised: 09/07/2018] [Accepted: 09/24/2018] [Indexed: 11/15/2022]
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10
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Caneiro JP, Smith A, O'Sullivan K, O'Keeffe M, Dankaerts W, Fersum K, Gibson W, Wand BM, O'Sullivan P. RE: "Low back pain misdiagnosis or missed diagnosis: Core principles" (Monie AP, Fazey PJ, Singer KP. Manual Therapy 22 (2016) 68-71). Musculoskelet Sci Pract 2017; 28:e1-e2. [PMID: 27720322 DOI: 10.1016/j.math.2016.09.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2016] [Accepted: 09/15/2016] [Indexed: 10/21/2022]
Affiliation(s)
- J P Caneiro
- School of Physiotherapy & Exercise Science, Curtin University, Perth, Australia; Body Logic Physiotherapy Clinic, Perth, Australia.
| | - Anne Smith
- School of Physiotherapy & Exercise Science, Curtin University, Perth, Australia
| | - Kieran O'Sullivan
- Sports Spine Centre, Qatar Orthopaedic and Sports Medicine Hospital, Aspetar, Qatar
| | - Mary O'Keeffe
- Department of Clinical Therapies, University of Limerick, Limerick, Ireland
| | - Wim Dankaerts
- Musculoskeletal Rehabilitation Research Unit, Department of Rehabilitation Sciences, Faculty of Kinesiology and Rehabilitation Sciences, University of Leuven, Belgium
| | - Kjartan Fersum
- Physiotherapy Research Group, Department of Public Health and Primary Health Care, University of Bergen, Norway
| | - William Gibson
- School of Physiotherapy, The University of Notre Dame Australia, Fremantle, Australia
| | - Benedict M Wand
- School of Physiotherapy, The University of Notre Dame Australia, Fremantle, Australia
| | - Peter O'Sullivan
- School of Physiotherapy & Exercise Science, Curtin University, Perth, Australia; Body Logic Physiotherapy Clinic, Perth, Australia
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Saunders J, Cusi M, Van der Wall H. Surgical management of low back pain. Med J Aust 2016; 205:335. [PMID: 27681980 DOI: 10.5694/mja16.00555] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2016] [Accepted: 07/01/2016] [Indexed: 11/17/2022]
Affiliation(s)
| | - Mel Cusi
- University of Notre Dame Australia, Sydney, NSW
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