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Diagnosis and Treatment of Lumbar Disc Herniation with Radiculopathy

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Diagnosis and Treatment of Lumbar Disc Herniation with Radiculopathy Y Lumbar Disc Herniation with Radiculopathy | NASS Clinical Guidelines 1 G Evidence-Based Clinical Guidelines for Multidisciplinary ETHODOLO Spine Care M NE I DEL I U /G ON Diagnosis and Treatment of I NTRODUCT Lumbar Disc I Herniation with Radiculopathy NASS Evidence-Based Clinical Guidelines Committee D. Scott Kreiner, MD Paul Dougherty, II, DC Committee Chair, Natural History Chair Robert Fernand, MD Gary Ghiselli, MD Steven Hwang, MD Amgad S. Hanna, MD Diagnosis/Imaging Chair Tim Lamer, MD Anthony J. Lisi, DC John Easa, MD Daniel J. Mazanec, MD Medical/Interventional Treatment Chair Richard J. Meagher, MD Robert C. Nucci, MD Daniel K .Resnick, MD Rakesh D. Patel, MD Surgical Treatment Chair Jonathan N. Sembrano, MD Anil K. Sharma, MD Jamie Baisden, MD Jeffrey T. Summers, MD Shay Bess, MD Christopher K. Taleghani, MD Charles H. Cho, MD, MBA William L. Tontz, Jr., MD Michael J. DePalma, MD John F. Toton, MD This clinical guideline should not be construed as including all proper methods of care or excluding or other acceptable methods of care reason- ably directed to obtaining the same results. The ultimate judgment regarding any specific procedure or treatment is to be made by the physi- cian and patient in light of all circumstances presented by the patient and the needs and resources particular to the locality or institution. I NTRODUCT 2 Lumbar Disc Herniation with Radiculopathy | NASS Clinical Guidelines I ON Financial Statement This clinical guideline was developed and funded in its entirety by the North American Spine Society (NASS). All participating /G authors have disclosed potential conflicts of interest consistent with NASS’ disclosure policy. Disclosures are listed below: U I DEL D. Scott Kreiner, MD Nothing to disclose. (8/14/12) I NE Steven Hwang, MD Nothing to disclose. (4/22/12) M John Easa, MD Stock Ownership: Janus Biotherapeutics (100000, 3, Janus Biotherapeutics is an auto-immunity com- ETHODOLO pany, Paid directly to institution/employer). (11/11/11) Daniel K .Resnick, MD Board of Directors: Congress of Neurological Surgeons (Nonfinancial); Scientific Advisory Board: Neu- rosurgical Research Foundation (Nonfinancial); Grants: AANS Spine Section (Level D, research grant through AANS, Paid directly to institution/employer). (2/10/12) G Y Jamie Baisden, MD Nothing to disclose. (8/14/12) Shay Bess, MD Royalties: Pioneer (Level B); Consulting: Allosource, DePuy Spine (Level B), Medtronic (Level B); Speak- ing and/or teaching arrangements: DePuy Spine (Level B); Trips/Travel: DePuy Spine (Level B), Medtron- ic (Level A); Scientific Advisory Board: Allosource (Level B); Research Support (Investigator Salary): DePuy Spine (Level B); Grants: Orthopedic Research and Education Foundation (Level C). (12/11/11) Charles H. Cho, MD, MBA Other Office:American Society of Spine Radiology (Nonfinancial, Executive Committee (March 2012 - February 2013). (3/31/12) Michael J. DePalma, MD Consulting: Vertiflex, Inc (Financial, Hourly consultant, Paid directly to institution/employer); Board of Directors: International Spine Intervention Society (Financial, Only reimbursed for Board related travel., Paid directly to institution/employer), Virginia Spine Research Institute, Inc. (Financial, Salaried position as President; Director of Research, Paid directly to institution/employer); Other Office: Re- search Committee Vice-Chair, International Spine Intervention Society (Nonfinancial, My registration fee for the 2012 ISIS Annual Scientific Meeting was waived); Research Support (Investigator Salary): Spinal Restoration, Inc. (Level B, Clinical effort covered by this grant as a co-investigator on intradiscal fibrin sealant clinical trial., Paid directly to institution/employer), Mesoblast, Inc. (Level B, Clinical effort covered by this grant as a co-investigator on intradiscal stem cell clinical trial., Paid directly to institu- tion/employer); Grants: Spinal Restoration, Inc. (Level D, Coverage of expenses related to patient en- rollment., Paid directly to institution/employer), Mesoblast, Inc. (Level D, Coverage of expenses related to patient enrollment and study start up., Paid directly to institution/employer), St. June Medical (Level C, Coverage of expenses related to retrospective chart review, Paid directly to institution/employer); Relationships Outside the One Year Requirement: AOI Medical (Upcoming Committee Meeting [Clinical Guidelines; Nominating], 03/2010, Consulting, 0), Stryker Interventional Spine (NASS Annual Meeting, 03/2010, Consulting, Level B), St. Jude Medical (NASS Annual Meeting, 03/2010, Consulting), Stryker Biotech (NASS Annual Meeting, 6/2011, Grant, 0), ATRM (NASS Annual Meeting, 6/2011, Grant, 0). (10/1/12) Paul Dougherty, II, DC Nothing to disclose. (8/24/12) Robert Fernand, MD Nothing to disclose. (11/15/11) Gary Ghiselli, MD Royalties: Zimmer Spine (Level D, I am not sure of the exact amount); Stock Ownership: Mesoblast (6500, 0, Publically traded company); Private Investments: DiFusion (100000, 9); Consulting: Biomet (Level B for product development and teaching); Scientific Advisory Board: DiFusion (Nonfinancial, Stock options in company). (8/18/11) Amgad S. Hanna, MD Trips/Travel: Medtronic (Nonfinancial, domestic roundtrip flight, and one hotel night). (4/27/12) Tim Lamer, MD Nothing to disclose. (5/9/12) Anthony J. Lisi, DC Nothing to disclose. (8/22/12) Daniel J. Mazanec, MD Nothing to disclose. (4/20/12) Richard J. Meagher, MD Nothing to disclose. (8/27/12) Robert C. Nucci, MD Nothing to disclose. (5/8/12) Rakesh D. Patel, MD Nothing to disclose. (9/20/11) Jonathan N. Sembrano, MD Trips/Travel: NuVasive, Inc. (Nonfinancial, Hotel accommodations (2 nights) to attend annual research meeting of SOLAS (Society of Lateral Access Surgeons) in May 2012. (approximately Level A); Scien- tific Advisory Board: SOLAS (Society of Lateral Access Surgeons) (Nonfinancial); Research Support (Staff/Materials): NuVasive (0, Study site for a multicenter RCT of XLIF vs. MIS TLIF for degenerative spondylolisthesis. Approved January 2010. Four patients enrolled thus far. Approximate value Level B. This would be spent for services of a part-time study coordinator. No investigator remuneration/sal- ary., Paid directly to institution/employer). (8/14/12) Anil K. Sharma, MD Nothing to disclose. (4/22/12) This clinical guideline should not be construed as including all proper methods of care or excluding or other acceptable methods of care reason- ably directed to obtaining the same results. The ultimate judgment regarding any specific procedure or treatment is to be made by the physi- cian and patient in light of all circumstances presented by the patient and the needs and resources particular to the locality or institution. Y Lumbar Disc Herniation with Radiculopathy | NASS Clinical Guidelines 3 G Jeffrey T. Summers, MD Private Investments: Morris Innovative (2000, 1, The company makes vascular catheters, which are not used for any spine related treatment, or in pain management, and therefore have no potential influence on my practice); Board of Directors: First Choice Insurance (Nonfinancial, I did not accept ETHODOLO a further appointment to this board, effective 6/2012), International Spine Intervention Society (ISIS) M NE (Nonfinancial, I am on the ISIS Board of Directors. I also serve as Vice President. Travel expenses I (airfare, hotel and parking) are provided when traveling to a Board meeting (official business only). DEL I (8/14/12) U Christopher K. Taleghani, MD Royalties: Seaspine (Level C); Speaking and/or teaching arrangements: Medtron (Level B for teaching a /G course), Globus (Level B for teaching a course). (4/30/12) ON I William L. Tontz, Jr., MD Stock Ownership: Phygen (1, 6, Physician owned implant company involved in development and distri- bution of spinal implants., Paid directly to institution/employer); Other Office: Board of Managers (Paid Level B for board of manager term from 2009-2010). (5/9/12) John F. Toton, MD Nothing to disclose. (4/22/12) NTRODUCT I Range Key: Level A. $100 to $1,000 Level B. $1,001 to $10,000 Level C. $10,001 to $25,000 Level D. $25,001 to $50,000 Level E. $50,001 to $100,000 Level F. $100,001 to $500,000 Level G. $500,001 to $1M Level H. $1,000,001 to $2.5M Level I. Greater than $2.5M Comments Comments regarding the guideline may be submitted to the North American Spine Society and will be considered in develop- ment of future revisions of the work. North American Spine Society Clinical Guidelines for Multidisciplinary Spine Care Diagnosis and Treatment of Lumbar Disc Herniation with Radiculopathy Copyright © 2012 North American Spine Society 7075 Veterans Boulevard Burr Ridge, IL 60527 USA 630.230.3600 www.spine.org ISBN 1-929988-32-X This clinical guideline should not be construed as including all proper methods of care or excluding or other acceptable methods of care reason- ably directed to obtaining the same results. The ultimate judgment regarding any specific procedure or treatment is to be made by the physi- cian and patient in light of all circumstances presented by the patient and the needs and resources particular to the locality or institution. I NTRODUCT 4 Lumbar Disc Herniation with Radiculopathy | NASS Clinical Guidelines I ON Table of Contents /G U I DEL I NE I. Introduction ...................................................................5 M ETHODOLO II. Guideline Development Methodology ..............................................6 III. Natural History of Lumbar Disc Herniation with Radiculopathy..........................9 G Y IV. Recommendations
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