The Spine Journal 13 (2013) 717–720

Journal Reports

The Spine Journal editors present abstracts from selected articles which may be of interest to TSJ readers.

Surgery versus conservative care for neck pain: a systematic review.

van Middelkoop M, Rubinstein SM, Ostelo R, et al. Eur Spine J

2013;22(1):87–95. Epub 2012 Oct 29

OBJECTIVE: General practitioners refer patients with continued neck

pain that do not respond well to conservative care frequently to secondary

care for further assessment. Are surgical interventions to the cervical spine

effective when compared to conservative care for patients with neck pain?

DESIGN: Systematic review.

METHOD: The search strategy outlined by the Cochrane Back Review

Group (CBRG) was followed. The primary search was conducted in MED-

LINE, EMBASE, CINAHL, CENTRAL, and PEDro up to June 2011.

Randomised controlled trials (RCTs) and controlled clinical trials (CCTs)

of adults with neck pain, which evaluated at least one clinically relevant

primary outcome measure (e.g. pain, functional status, recovery), were in-

cluded. In addition, treatments had to include surgery and conservative

care. Two authors independently assessed risk of bias using the criteria rec-

ommended by the CBRG and extracted the data. The quality of the evi-

dence was rated using the GRADE method.

RESULTS: Patients included had neck pain with or without radiculopathy

or myelopathy. In total, three RCTs and six CCTs were identified compar-

ing different surgical interventions with conservative care, of which one

had a low risk of bias. Overall there is very low quality of evidence avail-

able on the effectiveness of surgery compared to conservative care in neck

pain patients showing overall no differences.

CONCLUSION: Most studies on surgical techniques comparing these to

conservative care showed a high risk of bias. The benefit of surgery over

conservative care is not clearly demonstrated.

PMID: 23104514 [PubMed - in process. Available at: http://www.ncbi.

nlm.nih.gov/pubmed/23104514].

Reprinted with permission from: van Middelkoop M, Rubinstein SM, Os-

telo R, et al. Surgery versus conservative care for neck pain: a systematic

review. Eur Spine J 2013;22(1):87–95. 2012 Oct 29. Available at: http://

link.springer.com/article/10.1007/s00586-012-2553-z.

http://dx.doi.org/10.1016/j.spinee.2013.04.012

Magnetic resonance imaging in follow-up assessment of sciatica. el

Barzouhi A, Vleggeert-Lankamp CL, Lycklama �a Nijeholt GJ, et al.

N Engl J Med 2013;368(11):999–1007

BACKGROUND: Magnetic resonance imaging (MRI) is frequently per-

formed during follow-up in patients with known lumbar-disk herniation

and persistent symptoms of sciatica. The association between findings

on MRI and clinical outcome is controversial.

METHODS: We studied 283 patients in a randomized trial comparing

surgery and prolonged conservative care for sciatica and lumbar-disk her-

niation. Patients underwent MRI at baseline and after 1 year. We used a 4-

point scale to assess disk herniation on MRI, ranging from 1 for ‘‘definitely

present’’ to 4 for ‘‘definitely absent.’’ A favorable clinical outcome was

defined as complete or nearly complete disappearance of symptoms at

1 year. We compared proportions of patients with a favorable outcome

among those with a definite absence of disk herniation and those with a def-

inite, probable, or possible presence of disk herniation at 1 year. The area

under the receiver-operating-characteristic (ROC) curve was used to assess

the prognostic accuracy of the 4-point scores regarding a favorable or un-

favorable outcome, with 1 indicating perfect discriminatory value and 0.5

or less indicating no discriminatory value.

RESULTS: At 1 year, 84% of the patients reported having a favorable out-

come. Disk herniation was visible in 35% with a favorable outcome and in

33% with an unfavorable outcome (p5.70). A favorable outcome was re-

ported in 85% of patients with disk herniation and 83% without disk her-

niation (p5.70). MRI assessment of disk herniation did not distinguish

between patients with a favorable outcome and those with an unfavorable

outcome (area under ROC curve, 0.48).

CONCLUSIONS: MRI performed at 1-year follow-up in patients who

had been treated for sciatica and lumbar-disk herniation did not distinguish

between those with a favorable outcome and those with an unfavorable

outcome. (Funded by the Netherlands Organization for Health Research

and Development and the Hoelen Foundation; Controlled Clinical Trials

number, ISRCTN26872154.).

PMID: 23484826 [PubMed - indexed for MEDLINE. Available at: http://

www.ncbi.nlm.nih.gov/pubmed/23484826].

Reprinted from: el Barzouhi A, Vleggeert-Lankamp CL, Lycklama �a Nije-

holt GJ, et al. Magnetic resonance imaging in follow-up assessment of sci-

atica. N Engl J Med 2013;368(11):999–1007, with permission from

Massachusetts Medical Society.

http://dx.doi.org/10.1016/j.spinee.2013.04.013

Optimism lowers pain: evidence of the causal status and underlying

mechanisms. Hanssen MM, Peters ML, Vlaeyen JW, Meevissen YM,

Vancleef LM. Pain 2013;154(1):53–8. Epub 2012 Oct 18

Previous studies have demonstrated a relation between dispositional

optimism and lower pain sensitivity, but the causal status of this link re-

mains unclear. This study sought to test the causal status by experimen-

tally inducing a temporary optimistic state by means of writing about and

visualizing a future best possible self. In addition, we explored pain ex-

pectations and (situational) pain catastrophizing as possible underlying

mechanisms of the link between optimism and pain. Seventy-nine univer-

sity students participated in a cold pressor task (CPT). Before the CPT,

half of them received the optimism manipulation and the other half a con-

trol manipulation. Induced optimism was related to lower pain intensity

ratings during the CPT compared to the control group, thereby experi-

mentally confirming causality. This effect was not explained by pain-

related expectations about the task. Situational pain catastrophizing,

however, did seem to mediate the relation between optimism and pain.

This study is novel in that it confirms the causal status of optimism to-

wards pain. Additionally, the results reveal that positive interventions