Clinical Outcomes & Management

Management of low back pain and spinal surgical recovery, focusing on ERAS protocols, 30-day readmission metrics, and PROMIS vs ODI outcome measures.

Overview

Short-, mid-, and long-term results of the Latarjet procedure indicate positive clinical outcomes [1]. Reverse total shoulder arthroplasty (rTSA) offers superior functional outcomes compared to nonoperative management [11], with overall clinical outcomes in elderly patients comparable to younger populations and low complication and revision rates [12]. However, outcomes vary by indication, with the best results observed in degenerative diseases and the lowest in secondary interventions [33]. Proper patient selection is critical, as prognostic factors do not influence successful outcomes after arthroscopic rotator cuff repair if selection is done correctly [44].

Clinical efficacy is further supported by evidence that incorporating 2023 AAOS hip OA management guidelines may optimize treatment outcomes [9], while existing EAC guidelines effectively reduce post-operative complications and dictate care timing [52]. For elbow arthroscopy, case series demonstrate significant functional improvements and low major complication rates in pediatric management, with evidence supporting indications beyond osteochondritis dissecans [29]. Conversely, the clinical significance of periarticular injections decreasing opioid consumption and pain following total shoulder arthroplasty is questioned due to inappropriate sample size calculations and a lack of functional outcome assessment [7]. Further prospective, randomized studies are needed to refine guidelines for rTSA in fractured decision groups [11].

Anatomy & Pathophysiology

Lumbar pain in athletes remains poorly understood, necessitating further investigation into its underlying mechanisms [4]. Clinical examination, encompassing inspection, palpation, range of motion testing, and neurologic evaluation, is essential to identify common patho-anatomical disorders, nonspinal conditions, and signs of symptom magnification [70]. While most patients adhere to a traditional biomedical perspective of anatomical causes, researchers must develop models to understand how risks from different life stages interact to influence the onset, persistence, and prognosis of back pain [112, 113]. Thorough understanding of degenerative spine disease characteristics is critical for selecting effective treatment approaches in an aging society [111].

Biomechanics & Alignment: In the lumbar spine, the movement-preserving properties of total disc replacement are not major determinants of clinical outcomes [55]. Restoring sagittal alignment matched to spinopelvic morphology during degenerative lumbar surgery optimizes outcomes by preventing adjacent segment pathology [109]. Cervical sagittal profile undergoes compensatory changes following short lumbar fusion [107], and improved sagittal cervical posture alignment may contribute to managing cervical myofascial pain syndrome [110]. Regarding scoliosis, forces in zone 3 neither significantly reduced thoracic kyphosis nor exacerbated the deviation of the scoliotic spine from the sagittal plane [85]. Conversely, motion in the coronal plane decreased by 77% following anterior vertebral body tethering [91], and the Lyon brace is highly effective in correcting thoracic curves through its biomechanical action on vertebral modeling [102].

Risk Factors & Complications: Numerous associated and risk factors for thoracic spine pain exist across biopsychosocial categories, including concurrent musculoskeletal pain, psychological factors, and specific postural or lifestyle factors, though many associations between these risk factors and pain were weak or inconsistent across studies [108]. Less facetectomy may reduce the risk of biomechanical deterioration and consequently, that of failed back surgery syndrome [73]. Orthopaedic surgeons must be aware of pathophysiology and related risks associated with spine surgery in the prone position [84]. Cervical spinal deformity remains a debilitating condition with diverse etiologies, prompting recent efforts to focus on classification schemes and treatment algorithms to understand outcomes and the relationship between cervical and thoracolumbar spinal alignment [22].

Classification

Rotator Cuff Repair: Consensus was achieved on 49% of questions regarding repair, reflecting clinical practice evolution based on experience [5]. The Sugaya MRI classification system stratifies patients, though no differences in clinical scores were observed between stratified groups at 16 weeks post-repair [35].

Musculoskeletal Oncology: Classification is based on histomorphology to yield insight into tumor behavior and prognosis [8].

Cervical Spinal Deformity: Recent efforts focus on classification schemes and treatment algorithms to understand outcomes and the relationship between cervical and thoracolumbar spinal alignment [22].

Spondylodiskitis: Clinical factors should be included in future classifications of surgically treated spondylodiskitis to allow for more comprehensive treatment algorithms [50].

Tuberculous Spondylitis: A novel interpretable nomogram predicts the risk of prolonged postoperative length of stay to improve management and resource allocation, though prospective validation is recommended [98].

Hip Pathology: A simplified binary Tönnis Classification System demonstrates better inter- and intra-observer reliability and agreement in surgical management than the traditional Tönnis Classification System [97].

Knee Arthroplasty: Classifications of good versus poor outcome should not be defined using arbitrary cutoff scores, as this homogeneity impedes scientific progress [101].

Chronic Back Pain: The Multidimensional Pain Inventory subgroup classification is substantially stable in chronic back pain patients compared to other diagnostic groups and examiner-based systems [105]. Latent subgroups identified in older patients seeking primary care for new back pain episodes may contribute to targeting clinical management [67].

Traumatic Central Cord Syndrome: The type of management did not significantly affect mortality, whereas age at the time of injury did [21].

Anterior Cervical Discectomy and Fusion: A scoring system using classic statistics and machine learning provides a platform for stratifying patients into an inpatient or outpatient surgical setting [82].

Other Considerations: Thirty-seven percent of adverse events in spine surgery were reclassified by the CEC, with the large majority of reclassifications being an upgrade in the level of severity or a designation of greater relatedness to the surgery or device [103]. The ValuedCare program methodology has potential as a quality improvement framework replicable to other disease groups in a functionally integrated healthcare system [88].

Clinical Presentation

Many aspects of lumbar pain in athletes remain poorly understood and require further investigation [4]. For non-specific neck pain, the majority of clinical practice guidelines were developed for general treatment recommendations, with fewer aimed at recommendations for diagnosis, prognosis, and outcomes [34]. In contrast, specific patient-reported goals in an orthopaedic spine specialty clinic vary by provider type and are associated with specific diagnosis and treatment recommendations [40]. Early assessment and treatment of bilateral patellar tendon rupture provide a better functional prognosis, with musculoskeletal ultrasound playing a determining role in the diagnosis [13].

Red-flag patterns: Early diagnosis of cauda equina syndrome is often challenging because the initial signs and symptoms frequently are subtle [28]. Metagenomic next-generation sequencing improves the timeliness and accuracy of diagnosis in patients with pyogenic spinal infection [32]. Clinical findings of echinococcosis of the spine include specific laboratory and diagnostic findings [31]. Early diagnosis combined with an appropriate treatment course ensures that both chemotherapy and surgical interventions for spinal tuberculosis yield satisfactory outcomes [45]. Early diagnosis and emergent surgical intervention for acute perforated peptic ulcer after elective spine surgeries promote better outcomes [36].

Classification and Prognosis: Musculoskeletal oncology involves the diagnosis and management of neoplastic conditions affecting the musculoskeletal system, including benign tumors, sarcomas, and metastatic carcinoma [8]. Classification of musculoskeletal neoplasms is based on histomorphology to yield insight into behavior and prognosis [8]. A diagnosis of fibrosis portended a poor result in symptomatic multiply-operated back patients, while mechanical compression and instability correlated with better outcomes [49]. The prognosis for strength recovery after C5 motor palsy following single- and multi-level anterior cervical diskectomy and fusion is excellent, with 80% of patients making some recovery by final follow-up [53].

Chronic and Recurrent Presentations: Adolescent idiopathic scoliosis in adulthood involves specific prevalence, risk factors, presenting symptoms, diagnosis, management, and complications [30]. The clinical outcome of the management of shoulder disorders in primary health care consulters, including individuals who have consulted previously for a shoulder problem, is notably poorer than that reported by previous studies on new episodes [42]. Revision surgery for cubital tunnel syndrome can be offered in the setting of persistent or recurrent symptoms that are unexplained by an alternative diagnosis, though patients should be counseled that complete resolution of symptoms is unlikely [47]. Early involvement of a dermatologist, treatment of any underlying associated systemic condition, and initiation of medical treatment with local wound care might improve the outcomes of patients with pyoderma gangrenosum [54].

Screening and Management Context: Using a combination of the StarT back screening tool and a pain mannequin may improve early detection and facilitate triage to appropriate treatment level with a multimodal approach in individuals with low back pain at risk of a worse prognosis [48]. Operative management of herniated lumbar disc resulted in greater symptom relief and functional improvement compared to nonoperative management [14]. The most appropriate management for myelomeningocele, whether surgical or non-surgical, may vary for different patients given disease severity and the age of patients [15]. A consensus response (>50% agreement) was achieved on 49% of questions regarding rotator cuff repair, while variability in responses likely reflects clinical practices evolving over time based on clinical experience [5].

Investigations

Plain radiography: In single-level instrumented lumbar arthrodesis using local autologous bone graft, radiographic fusion status is associated with clinical outcomes [61]. Following fracture fixation of the elbow, the absence of heterotopic ossification on radiographs obtained 2 weeks postoperatively may predict a more favorable outcome [87]. In patients aged eighty years and older undergoing instrumented lumbar surgery, longer instrumented segments and the development of complications contribute to worse clinical and radiographic outcomes [89].

MRI: Meniscal extrusion is the strongest predictor of osteoarthritis progression, highlighting the importance of MRI in identifying early changes and guiding personalized management [78]. In patients treated with repair of posterior medial meniscal root tears, clinical outcome improvements are maintained at long-term follow-up despite worsening MRI outcomes [3]. Cuff integrity on follow-up MRI scans has a positive effect on clinical outcome after arthroscopic transosseous rotator cuff repair [93]. Despite advances in surgical techniques, implants, and imaging, issues remain unresolved regarding optimal treatment for subcritical bone loss and limited high-level evidence comparing techniques in failed shoulder instability surgery [75]. Multifocal spondylodiscitis is found in approximately 13% of cases, recommending MRI imaging of the total spine to avoid overlooking additional infection levels which can impact therapeutic strategy [90]. Metal suppression magnetic resonance imaging techniques facilitate better-informed diagnostic decisions by addressing metal artifacts in orthopaedic and spine surgery [92].

MRI Limitations: Many aspects of lumbar pain in athletes remain poorly understood and require further investigation [4]. MRI abnormalities examined are not major predictors of outcome in patients with low back pain [66]. Few MRI findings showed large magnitude associations with symptom outcomes in longitudinal analysis of incident lumbar spine MRI findings and chronic low back pain or radicular symptoms [74]. Findings on magnetic resonance scans were not predictive of the development or duration of low-back pain in asymptomatic subjects [86].

Other Considerations: Early assessment and treatment provide a better functional prognosis for bilateral patellar tendon rupture, with musculoskeletal ultrasound playing a determining role in diagnosis [13]. Both radiological and clinical predictive factors for minimal clinically important difference (MCID) improvement in health-related quality of life were identified in adult spinal deformity [56]. Management of heterotopic ossification following traumatic brain injury and spinal cord injury is aimed at limiting its progression and maximizing function of the affected joint [79].

Treatment

Non-Operative

Nonoperative management remains the most common treatment for proximal humerus fragility fractures in the elderly [99]. An early trial of 4-6 weeks of nonoperative management may be appropriate for proximal humerus fractures without altering the risks associated with reverse total shoulder arthroplasty (RTSA) [96]. Rehabilitation compliance predicts short-term clinical outcomes up to 3 months for proximal humerus fractures and potentially predicts 1-year clinical outcomes [2]. For lumbar disc herniation, operative management resulted in greater symptom relief and functional improvement compared to nonoperative management, though clinical heterogeneity, non-representative patient populations, incomplete reporting, and poor adherence limit the generalizability of existing randomized controlled trial results [14][41]. In National Football League linemen, surgical treatment for lumbar disk herniation yields superior outcomes compared to nonoperative intervention, yet further prospective studies are necessary to determine the long-term prognosis [77]. For acute spinal cord injury, it is not known whether early surgery or active physiological management offers the better chance for recovery as no properly conducted trial has been conducted [72]. In early-onset scoliosis, nonsurgical treatment can be an effective early management strategy in delaying or precluding the need for surgery, especially surgery with growing instrumentation [76]. Management of low back pain and pelvic girdle pain in pregnancy ranges from conservative and pharmacologic measures to surgical treatment, often requiring a collaborative plan between orthopaedic surgeons and obstetricians [80]. Nonoperative treatment of postoperative acromial fractures results in limited overall improvement from preoperative outcomes [81]. When prevention of elbow stiffness fails, nonoperative followed by operative treatment modalities can be pursued [60].

Operative

Indications: Proper indications for shoulder subacromial decompression result in excellent outcomes [16]. The likelihood of fulfillment of key expectations should be assessed for weighing benefits and harms of available treatment options during the indication process for total hip arthroplasty [38]. The most appropriate management for myelomeningocele, whether surgical or non-surgical, may vary for different patients given disease severity and age [15]. Only a limited recommendation can be made regarding internal fixation versus nonoperative treatment for displaced 3-part or 4-part proximal humeral fractures in elderly patients due to variable patient demographics and limitations of included studies [57].

Surgical Approach / Technique: Both arthroscopic inlay suprapectoral and mini-open onlay subpectoral biceps tenodesis groups demonstrated improvement exceeding the patient acceptable symptom state and minimal clinically important difference [65]. Ultrasound assessment showed excellent structural healing rates for both arthroscopic inlay suprapectoral and mini-open onlay subpectoral biceps tenodesis techniques [65]. Surgical management of midshaft clavicular fractures offers higher union rates and faster recovery compared to conservative treatment [95].

Implant Selection: Most juvenile idiopathic arthritis patients benefit from total elbow arthroplasty long-term with satisfactory clinical outcomes and implant durability [6]. Clinical outcomes for Cotrel-Dubousset instrumentation in adolescent idiopathic scoliosis were favorable, with high patient satisfaction and low rates of pain interfering with daily activities [58]. Short-, mid-, and long-term results of the Latarjet procedure indicate positive clinical outcomes [1].

Alignment / Balancing Strategy: Incorporating the 2023 AAOS hip OA management guidelines into clinical practice may optimize patient treatment outcomes [9].

Pain Management: The clinical significance of periarticular injection for opioid sparing and pain control following total shoulder arthroplasty is questioned due to inappropriate sample size calculation, lack of anesthesia management details, and failure to assess clinically important differences or functional outcomes [7]. Patients with NSAID contraindications reported comparable patient-reported outcome measures (PROMs) to patients without contraindications after lumbar fusion [39].

Adjuncts: Aspects of treatment that maximize functional outcome are important in achieving patient satisfaction after rotator cuff repair [19]. Improvement in outcomes for rotator cuff tears was observed up to 16 sessions of physical therapy, after which outcomes plateaued [51]. For estimating a success rate assessed by a patient-reported outcome measure (PROM), using the follow-up score or the percentage change score is recommended [68].

Other Considerations: Adherence to patient-specific, evidence-based treatment algorithms for proximal humeral fractures was associated with significantly better clinical outcomes and substantially reduced complication and revision rates [69]. Reverse total shoulder arthroplasty (rTSA) offers superior functional outcomes compared to nonoperative management for the studied clinical group, though further prospective, randomized studies are needed to refine treatment guidelines for rTSA versus nonoperative management in the under-researched clinical group [11]. Further studies are needed to determine the long-term efficacy of one-hole split endoscope versus unilateral biportal endoscopy for lumbar spinal stenosis [18].

Complications

Stiffness / Arthrofibrosis: Rehabilitation compliance is a critical determinant of short-term clinical outcomes, predicting results up to 3 months for proximal humerus fractures [2]. In adhesive capsulitis surgery, metabolic syndrome is associated with increased complications and healthcare costs [116]. For patients with juvenile idiopathic arthritis, total elbow arthroplasty provides satisfactory long-term clinical outcomes and implant durability [6]. Conversely, the natural history of untreated Sprengel's deformity may involve a gradual decline in abduction range, with a proportion of patients developing pain in adolescence [23].

Implant Failure / Revision: Survivorship for patients with borderline dysplasia undergoing primary hip arthroscopy was 98.2% at midterm follow-up and 76.3% at long-term follow-up [10]. Reverse total shoulder arthroplasty results are sustained through mid-term follow-up, and the complication profile does not increase with time [118]. Overall clinical outcomes for reverse total shoulder arthroplasty in elderly patients are comparable to a younger population with low complication and revision rates [12]. At short-term follow-up, reverse shoulder arthroplasty using a custom baseplate for severe glenoid deficiency resulted in significant improvements in patient-reported outcomes and ROM measures with no complications [17]. Ulnar collateral ligament reconstruction provides excellent patient-reported and clinical outcomes at medium-term follow-up with low complication and revision rates [63]. The clinical long-term success of polymethylmethacrylate-assisted ventral discectomy does not seem to be negatively affected by the procedure [64].

Adverse Events & Patient Factors: Patients who report adverse events after total hip replacement have worse outcomes than those who do not, regardless of whether the adverse events can be confirmed by standard medical record review methods [115]. The quality of care alone does not fully account for long-term outcomes in knee osteoarthritis, suggesting other factors need to be considered [43]. Clinical and personal experiences with opioids, in addition to demographics, should be emphasized in the clinical history for orthopaedic trauma surgery populations [25].

Other Considerations: Patients treated with repair of posterior medial meniscal root tears maintain clinical outcome improvements at long-term follow-up despite worsening MRI outcomes [3]. Further studies are needed to determine the long-term efficacy of one-hole split endoscopy versus unilateral biportal endoscopy for lumbar spinal stenosis [18]. The type of management for traumatic central cord syndrome did not significantly affect mortality, but age at the time of injury did [21]. Enrolment of low back pain patients in clinical studies is likely to provoke responses that reflect nonspecific effects of seeking and receiving care, independent of study design [24]. A treatment program for Fat-Embolism Syndrome assuming hypoxia secondary to pulmonary insufficiency as the potentially fatal feature resulted in 100% survival in a series of thirteen consecutive cases [26]. Long-term cumulative treatment outcomes for ataluren have been presented over a median period of 6.3 years [27].

Recovery

Light activity (weeks): Evidence does not specify a discrete week range for light activity initiation across the provided literature. However, rehabilitation compliance is a critical predictor of short-term clinical outcomes up to 3 months for proximal humerus fractures [2], and a 3-month follow-up is considered too early for comprehensive outcome evaluation in shoulder conditions [120].

Full activity (months): Rehabilitation compliance potentially predicts 1-year outcomes for proximal humerus fractures [2]. For patients with juvenile idiopathic arthritis, total elbow arthroplasty provides satisfactory clinical outcomes and implant durability for the long term [6]. In cases of borderline dysplasia undergoing primary hip arthroscopy, survivorship was 98.2% at midterm follow-up [10].

Complete recovery / outcome plateau (months): Short-, mid-, and long-term results of the Latarjet procedure indicate positive clinical outcomes [1]. Patients treated with repair of proximal medial meniscal root tears maintain clinical outcome improvements at long-term follow-up despite worsening MRI outcomes [3]. Anatomic total shoulder arthroplasty using an all-polyethylene cemented glenoid component demonstrated favorable long-term clinical, functional, and radiographic outcomes after 10 years [20]. At long-term follow-up, both hemiarthroplasty and total shoulder arthroplasty continue to provide lasting pain relief and improved range of motion in patients younger than 50 years [62], with survivorship for shoulder arthroplasty in this demographic exceeding 75% at 20 years [62]. Survivorship for patients with borderline dysplasia undergoing primary hip arthroscopy was 76.3% at long-term follow-up [10]. Long-term cumulative treatment outcomes for ataluren were presented over a median period of 6.3 years [27].

Rehabilitation protocol: Rehabilitation compliance predicts short-term clinical outcomes up to 3 months for proximal humerus fractures [2]. A consensus response was achieved on 49% of questions regarding rotator cuff repair, while variability in responses reflects clinical practices evolving over time based on clinical experience [5]. Clinical and personal experiences with opioids, in addition to demographics, should be emphasized in the clinical history for orthopaedic trauma surgery populations [25].

Functional milestones: At short-term follow-up, all patient-reported outcomes and range of motion measures improved significantly for reverse shoulder arthroplasty using a custom baseplate for severe glenoid deficiency, with no complications [17]. The study on cauda equina syndrome is the first to use validated patient-reported outcome measures to assess the CES Core Outcome Set [59]. Baseline biopsychosocial characteristics influence trajectories and prognosis in a cumulative, dose-dependent manner for chiropractic patients with low back pain [122].

Other Considerations: The natural history of untreated Sprengel's deformity may involve a gradual decline in the abduction range, and a proportion of patients develop pain in adolescence [23]. While the majority of adolescent idiopathic scoliosis curves of 40° to 50° progressed post-maturity, the average rate of progression was slow, making yearly observation a reasonable management approach [119]. Enrolment of low back pain patients in clinical studies is likely to provoke responses that reflect the nonspecific effects of seeking and receiving care, independent of the study design [24]. High-quality trials and long-term follow-up are recommended to evaluate disability, quality of life, and pain outcomes for transcutaneous vagus nerve stimulation in chronic low back pain [46]. A treatment program for Fat-Embolism Syndrome assuming hypoxia secondary to pulmonary insufficiency as the potentially fatal feature resulted in 100 per cent survival in thirteen consecutive cases [26]. Patients with bone and joint tuberculosis experience delays in diagnosis and treatment, some of which are avoidable [123]. Ten factors were identified as significant predictors of delayed union after surgical treatment in patients with osteoporotic vertebral compression fractures, encompassing five baseline characteristics, three biological molecular factors, one outcome measure, and one therapeutic intervention [124]. An intraoperative load sensor did not improve early postoperative results of posterior-stabilized total knee arthroplasty for osteoarthritis with varus deformities, though a long-term follow-up study with a large cohort is required to evaluate its effect [121].

Key Evidence

• [L4] Short-, mid-, and long-term results indicate positive clinical outcomes. (10.1016/j.jseint.2025.04.033)
• [L2] Rehabilitation compliance predicts short-term clinical outcomes up to 3-months and potentially 1-year outcomes. (10.1186/s12891-023-06894-w)
• [L4] Patients treated with repair of PMMRT had maintenance of clinical outcome improvements at long‐term follow‐up despite worsening MRI outcomes. (10.1002/ksa.12321)
• [L5] Many aspects of lumbar pain in athletes remain poorly understood and require further investigation. (10.5435/00124635-200612000-00004)
• [L4] A consensus response (>50% agreement) was achieved on 49% of the questions, while variability in responses likely reflects the fact that clinical practices have evolved over time based on clinical experience. (10.2106/jbjs.m.00399)
• [L4] However, most benefit from the intervention for a long term with satisfactory clinical outcomes and implant durability. (10.1016/j.jse.2014.03.012)
• [Letter] The authors question the clinical significance of the findings regarding opioid sparing and pain control, citing inappropriate sample size calculation, lack of anesthesia management details, and failure to assess clinically important differences or functional outcomes. (10.1016/j.jse.2023.09.002)
• [L5] Incorporating the 2023 AAOS hip OA management guidelines into clinical practice may optimize patient treatment outcomes. (10.5435/jaaos-d-24-00427)
• [L4] Survivorship at midterm follow-up was 98.2% and 76.3% at long-term follow-up. (10.1016/j.arthro.2022.12.030)
• [Letter] The study suggests that rTSA offers superior functional outcomes compared to nonoperative management, but further prospective, randomized studies focusing on this under-researched clinical group are needed to refine treatment guidelines. (10.1016/j.jse.2025.03.019)
• [L3] Overall clinical outcome is comparable to a younger population with low complication and revision rates. (10.1016/j.jseint.2025.01.006)
• [Case_report] Early assessment and treatment provide a better functional prognosis, with musculoskeletal ultrasound playing a determining role in diagnosis. (10.1186/s12891-020-03513-w)
• [L2] Operative management resulted in greater symptom relief and functional improvement compared to nonoperative management. (10.2106/00004623-200001000-00002)
• [L4] However, the most appropriate management, whether surgical or non-surgical, may vary for different patients, given disease severity and the age of patients. (10.1186/s13018-021-02643-8)
• [L5] The goal should be to help develop effective clinical decision-making and to refine surgical guidelines that are in the best interest of the patient. (10.1016/j.arthro.2021.04.023)
• [L4] At short-term follow-up, all patient-reported outcomes and ROM measures improved significantly, and there were no complications. (10.1016/j.jse.2020.08.002)
• [L3] Further studies are needed for long-term efficacy. (10.1186/s13018-024-04743-7)
• [L3] Aspects of treatment that maximize the functional outcome are important in achieving patient satisfaction. (10.1016/j.jse.2007.02.136)
• [L4] This study demonstrated favorable long-term clinical, functional, and radiographic outcomes of aTSA after 10 years. (10.1016/j.jse.2025.03.036)
• [L3] The type of management did not significantly affect mortality but their age at the time of injury did. (10.1302/0301-620x.105b8.bjj-2022-1104.r2)
• [L4] Cervical spinal deformity is a debilitating condition with diverse etiologies; recent efforts focus on classification schemes and treatment algorithms to understand outcomes and the relationship between cervical and thoracolumbar spinal alignment. (10.5435/jaaos-d-17-00546)
• [L4] The natural history of untreated Sprengel's deformity may be one of gradual decline in the abduction range, with a proportion of patients developing pain in adolescence. (10.1016/j.jse.2020.04.018)
• [L1] In addition to a shared 'natural history', enrolment of LBP patients in clinical studies is likely to provoke responses that reflect the nonspecific effects of seeking and receiving care, independent of the study design. (10.1186/1471-2474-15-68)
• [L4] Clinical and personal experiences with opioids, in addition to demographics, should be emphasized in the clinical history. (10.1186/s13018-021-02881-w)
• [L4] This is the first study to present long-term cumulative treatment outcomes over a median period of 6.3 years on ataluren treatment. (10.1186/s12891-021-04700-z)
• [L5] Early diagnosis is often challenging because the initial signs and symptoms frequently are subtle. (10.5435/00124635-200808000-00006)
• [L1] Case series published to date have demonstrated significant improvements in functional outcomes and low rates of major complications, with evidence surrounding several potential indications beyond osteochondritis dissecans. (10.1016/j.arthro.2021.01.047)
• [L4] This review examines the prevalence, risk factors, presenting symptoms, diagnosis, management, and complications of AIS in the adult population, informing targeted interventions by clinicians caring for adult patients with AIS. (10.1530/eor-23-0162)
• [L4] This article summarizes the clinical findings of echinococcosis of the spine, discusses specific laboratory and diagnostic findings, lists current treatment options, and reviews patient outcomes. (10.1302/2058-5241.6.200130)
• [L4] This technique improves the timeliness and accuracy of diagnosis, highlighting its potential for broader clinical use. (10.1186/s13018-024-05188-8)
• [L4] Clinical outcomes after RTSA varied according to the underlying indication, with the best results observed in patients with degenerative diseases and the lowest in patients undergoing secondary interventions. (10.1186/s12891-025-09329-w)
• [L2] The majority of CPGs were developed for general NP that focused on treatment recommendations, with fewer number aimed at recommendations for diagnosis, prognosis, and outcomes. (10.1186/s12891-019-2441-3)
• [L2] No differences in clinical scores existed between patients stratified by the Sugaya MRI classification system at 16 weeks. (10.1016/j.jse.2015.09.019)
• [L4] Early diagnosis and emergent surgical intervention promote better outcomes. (10.1186/s12891-021-04443-x)
• [L3] However, this was primarily a radiographic finding as both groups showed very satisfying functional outcomes and low revision rates at the 2-year follow-up. (10.1186/s12891-022-05994-3)
• [L4] The likelihood of fulfillment of key expectations should be assessed for weighing benefits and harms of available treatment options during the indication process. (10.1016/j.arth.2022.03.067)
• [L3] Despite this, patients with NSAID contraindications reported comparable PROMs to patients without contraindications. (10.5435/jaaos-d-24-00450)
• [L4] Specific patient-reported goals vary by provider type and are associated with specific diagnosis and treatment recommendations. (10.5435/jaaos-d-20-01105)
• [L2] The clinical heterogeneity of the RCTs, non-representative patient populations, incomplete reporting of patient characteristics and poor adherence to treatment groups limit generalizability and applicability of the existing RCTs' results. (10.1186/s13018-025-06401-y)
• [L3] The clinical outcome of the management of shoulder disorders in our study population including also individuals who have consulted previously for a shoulder problem is notably poorer than the one reported by previous studies on new episodes. (10.1186/1471-2474-14-348)
• [L4] However, the quality of care alone does not fully account for longterm outcomes, suggesting that other factors need to be considered. (10.1186/s12891-025-08524-z)
• [L2] If patient selection is done properly, these factors do not influence a successful outcome. (10.1016/j.jse.2015.04.013)
• [L4] Early diagnosis, combined with an appropriate treatment course, ensures that both chemotherapy and surgical interventions yield satisfactory outcomes. (10.1186/s12891-025-09053-5)
• [L1] Therefore, high-quality trials and long-term follow-up are recommended to evaluate disability, quality of life, and pain outcomes. (10.1186/s12891-024-07569-w)
• [L3] Revision surgery can be offered in the setting of persistent or recurrent symptoms that are unexplained by an alternative diagnosis, but patients should be counseled that complete resolution of symptoms is unlikely. (10.1016/j.jhsa.2014.07.013)
• [L3] Thus, using a combination may improve early detection and facilitate triage to appropriate treatment level with multimodal approach also in those otherwise missed by the SBT. (10.1186/s12891-019-2836-1)
• [L4] A diagnosis of fibrosis portended a poor result, while mechanical compression and instability correlated with better outcomes. (10.2106/00004623-197961070-00018)
• [L2] These clinical factors should be included in future classifications to allow for more comprehensive treatment algorithms. (10.5435/jaaos-d-22-01199)
• [L3] Improvement in outcomes was observed up to 16 sessions of physical therapy, after which outcomes plateaued. (10.1016/j.jse.2018.10.001)
• [L3] The existing EAC guidelines are effective at reducing post-operative complications and offer a strategy for dictating the timing of care. (10.1302/0301-620x.99b1.bjj-2016-0418.r2)
• [L3] The prognosis for strength recovery is excellent, with 80% of affected patients making some recovery by final follow-up. (10.5435/jaaos-d-17-00764)
• [L4] Early involvement of a dermatologist, treatment of any underlying associated systemic condition, and initiation of medical treatment with local wound care might improve the outcomes of patients with PG. (10.1016/j.jhsa.2011.12.044)
• [L1] This suggests that in the lumbar spine the movement preserving properties of TDR are not major determinants of clinical outcomes. (10.1302/0301-620x.95b1.29829)
• [L2] Both radiological and clinical predictive factors for MCID improvement in health-related quality of life were identified. (10.1186/s12891-022-05757-0)
• [L1] Only a limited recommendation can be made based on current data due to variable patient demographics and limitations of included studies. (10.1371/journal.pone.0075464)
• [L3] This study reports the long-term outcome of patients with CES and is the first to use validated patient-reported outcome measures to assess the CES Core Outcome Set. (10.1302/0301-620x.103b9.bjj-2021-0094.r1)
• [L5] When prevention fails, nonoperative followed by operative treatment modalities can be pursued. (10.1016/j.jhsa.2009.02.020)
• [L3] However, there was an association between radiographic fusion status and clinical outcomes. (10.5435/jaaos-d-23-01124)
• [L4] At long-term follow-up, both hemiarthroplasty and total shoulder arthroplasty continue to provide lasting pain relief and improved range of motion, with survivorship in excess of 75% at 20 years. (10.1016/j.jse.2014.07.016)
• [L4] UCLR provides excellent patient-reported and clinical outcomes to patients at medium-term follow-up with low complication and revision rates. (10.1136/jisakos-2021-000614)
• [L3] But the clinical long-term success does not seem to be negatively affected by this. (10.1186/1471-2474-12-140)
• [L2] Both groups demonstrated improvement that exceeded the reported patient acceptable symptom state and minimal clinically important difference, with ultrasound showing excellent structural healing rates for both techniques. (10.1016/j.jse.2024.11.014)
• [L2] Our findings suggest that the MRI abnormalities examined are not major predictors of outcome in patients with LBP. (10.1186/1471-2474-12-234)
• [L4] The identified classes may contribute to targeting clinical management of these patients. (10.1186/s12891-024-07163-0)
• [L3] For estimating a 'success' rate assessed by a PROM, we recommend using the follow-up score or the percentage change score. (10.1186/s12891-018-2386-y)
• [L3] Adherence to the treatment algorithm was associated with significantly better clinical outcomes and substantially reduced complication and revision rates. (10.2106/jbjs.20.01309)
• [L1] This is the first comprehensive systematic review of diagnostic accuracy studies that evaluate clinical examination findings for their ability to identify the most common patho-anatomical disorders in the lumbar spine. (10.1186/s12891-017-1549-6)
• [L5] There has never been a properly conducted trial of surgery versus active conservative care, so it is still not known whether early surgery or active physiological management offers the better chance for recovery. (10.1302/0301-620x.105b4.bjj-2023-0111)
• [L5] Less facetectomy is better because it may reduce the risk of biomechanical deterioration and consequently, that of FBSS. (10.1186/s12891-019-2751-5)
• [L2] Even when applying more specific definitions for spine-related symptom outcomes, few MRI findings showed large magnitude associations with symptom outcomes. (10.1186/1471-2474-15-152)
• [L5] Despite advances in surgical techniques, implants, and imaging, several issues remain unresolved, including a lack of consensus on the optimal treatment for subcritical bone loss and limited high-level evidence comparing techniques. (10.1016/j.jisako.2025.101011)
• [L4] Nonsurgical treatment can be an effective early management strategy in delaying or even precluding the need for surgery, especially surgery with growing instrumentation. (10.5435/jaaos-d-14-00019)
• [L4] Although surgical treatment yields superior outcomes compared to nonoperative intervention, further prospective studies are necessary to determine long-term prognosis. (10.1177/0363546510388901)
• [L2] Meniscal extrusion is the strongest predictor of OA progression, highlighting the importance of MRI in identifying early changes and guiding personalised management. (10.1002/ksa.70016)
• [L5] Management of heterotopic ossification is aimed at limiting its progression and maximizing function of the affected joint. (10.5435/00124635-200911000-00003)
• [L4] Management ranges from conservative and pharmacologic measures to surgical treatment, often requiring a collaborative plan between orthopaedic surgeons and obstetricians. (10.5435/jaaos-d-14-00248)
• [L3] Nonoperative treatment of postoperative acromial fractures results in limited overall improvement from preoperative outcomes. (10.2106/jbjs.k.01516)
• [L3] Using classic statistics and machine learning, this scoring system provides a platform for stratifying patients undergoing ACDF into an inpatient or outpatient surgical setting. (10.5435/jaaos-d-20-00894)
• [L5] Orthopaedic surgeons should be aware of pathophysiology and related risks associated with spine surgery in the prone position, and initiate preventive measures and predictable treatment options. (10.5435/00124635-200703000-00005)
• [L4] Notably, only forces in zone 3 neither significantly reduced thoracic kyphosis nor exacerbated the deviation of the scoliotic spine from the sagittal plane. (10.1186/s12891-024-08014-8)
• [L2] The findings on magnetic resonance scans were not predictive of the development or duration of low-back pain. (10.2106/00004623-200109000-00002)
• [L2] Absence of heterotopic ossification on radiographs obtained 2 weeks postoperatively may predict a more favorable outcome. (10.1016/j.jse.2012.05.040)
• [L4] There is potential for testing this methodology as a quality improvement framework replicable to other disease groups in a functionally integrated healthcare system. (10.1186/s13018-018-0819-9)
• [L4] Longer instrumented segments and development of complications contributed to worse clinical and radiographic outcomes. (10.1186/s12891-016-1239-9)
• [L3] Due to multifocal spondylodiscitis being found in approximately 13% of cases, MRI imaging of the total spine is recommended to avoid overlooking additional infection levels, which can impact the therapeutic strategy chosen. (10.1186/s12891-020-03928-5)
• [L4] Motion in the coronal plane decreased by 77% following anterior vertebral body tethering. (10.2106/jbjs.20.01533)
• [L5] This review provides a comprehensive overview of different metal artifacts in orthopaedic MRI and factors affecting their magnitude, discussing commonly applied techniques and recent technological advances to facilitate better-informed diagnostic decisions. (10.5435/jaaos-d-24-01057)
• [L4] Cuff integrity on follow-up MRI scans had a positive effect on the clinical outcome. (10.1016/j.jse.2018.09.003)
• [L4] Both patient satisfaction and clinical outcome remain high regardless of radiographic outcome. (10.1016/j.jse.2015.11.063)
• [L1] Surgical management offers higher union rates and faster recovery but does not demonstrate significant long-term advantages in functional outcomes compared to conservative treatment. (10.1530/eor-2025-0005)
• [L3] Considering the results of this study, an early trial of 4-6 weeks of nonoperative management may be appropriate without altering the risks associated with RTSA. (10.1016/j.jse.2024.03.027)
• [L4] A simplified binary Tönnis Classification System demonstrates better reliability and clinical implementation than the traditional Tönnis Classification System. (10.1186/s12891-020-03520-x)
• [L3] This tool has the potential to improve patient management and resource allocation, though prospective validation is recommended. (10.1186/s12891-025-08807-5)
• [L4] Recent trends show that in the elderly population, nonoperative management remains the most common treatment for PHFs. (10.1016/j.jse.2015.07.015)
• [L3] Rapid adoption of new aTSA and rTSA technologies was observed and clinical and radiographic outcomes improved relative to 2007-2011. (10.1016/j.jse.2022.12.018)
• [L5] The authors argue that classifications of good versus poor outcome following knee arthroplasty should not be defined using arbitrary cutoff scores, as this homogeneity impedes scientific progress, and instead propose relying on non-biased statistical model-based approaches. (10.1186/s12891-020-03583-w)
• [L4] The Lyon brace, through its biomechanical action on vertebral modeling, is highly effective in correcting thoracic curves, particularly when the SOSORT guidelines were adopted in addition to the SRS criteria. (10.1186/s12891-015-0782-0)
• [L1] Thirty-seven percent of adverse events were reclassified by the CEC; the large majority of the reclassifications were an upgrade in the level of severity or a designation of greater relatedness to the surgery or device. (10.2106/jbjs.l.00251)
• [L3] Multidimensional Pain Inventory subgroup classification is substantially stable in chronic back pain patients when compared to other diagnostic groups and other examiner-based subgroup Classification Systems. (10.1186/1471-2474-13-155)
• [L3] Cervical sagittal profile would have compensatory changes after short lumbar fusion. (10.1186/s12891-024-07518-7)
• [L2] The review identified numerous associated and risk factors for thoracic spine pain across biopsychosocial categories, including concurrent musculoskeletal pain, psychological factors, and specific postural or lifestyle factors, though many associations were weak or inconsistent across studies. (10.1186/1471-2474-10-77)
• [L5] Restoring sagittal alignment matched to spinopelvic morphology during degenerative lumbar surgery can optimize surgical outcomes by preventing adjacent segment pathology. (10.5435/jaaos-d-24-00749)
• [L2] The authors speculate that improved sagittal cervical posture alignment outcomes contributed to these findings. (10.1186/s12891-018-2317-y)
• [L3] Thorough understanding of these characteristics is essential when managing degenerative spine diseases, particularly in the selection of effective treatment approaches for the increasingly aging society in the future. (10.1186/s12891-025-09185-8)
• [L5] Back pain researchers could usefully develop hypotheses and models of how risks from different stages of life might interact and influence the onset, persistence and prognosis of back pain throughout the life course. (10.1186/1471-2474-11-23)
• [L4] Despite continuing attempts to shift pain beliefs to more complex biopsychosocial factors, most people with LBP adhere to the traditional biomedical perspective of anatomical/biomechanical causes. (10.1186/s12891-017-1831-7)
• [L3] Patients who report adverse events have worse outcomes than those who do not, regardless of whether the adverse events can be confirmed by standard medical record review methods. (10.1186/s12891-020-3127-6)
• [L3] Further prospective studies are required to understand why this relationship exists and to test if targeted management strategies can reduce complications and improve outcomes. (10.1016/j.jse.2025.04.008)
• [Abstract] The data from this study suggests that these results are sustained through mid-term follow-up and that the complication profile does not increase with time. (10.1016/j.jse.2014.06.004)
• [L3] While the majority of curves progressed, the average rate of progression was slow, and thus, yearly observation was a reasonable management approach. (10.2106/jbjs.22.00939)
• [L2] Our results suggest that 3 months follow-up is too early for outcome evaluation. (10.1186/s12891-021-04483-3)
• [L2] A long-term followup study with a large cohort is required. (10.1007/s00167-018-5314-7)
• [L3] Baseline biopsychosocial characteristics influence trajectories and prognosis in a cumulative, dose-dependent manner. (10.1186/s12891-025-09365-6)
• [L4] Patients with bone and joint TB experience delays in diagnosis and treatment, some of which are avoidable. (10.1302/0301-620x.100b1.bjj-2017-0357.r1)
• [L1] A total of ten factors were identified as significant predictors of delayed union, encompassing five baseline characteristics, three biological molecular factors, one outcome measure, and one therapeutic intervention. (10.1186/s13018-025-06581-7)

See Also

• Surgical Interventions
• Neoplasms
• Conservative Treatment
• Pain Management
• Deformities

References

[1] Long-term outcomes of the Latarjet procedure in a North American population. JSES International. 2025. DOI: 10.1016/j.jseint.2025.04.033

[2] Study on proximal humerus evaluation of effective treatment (SPHEER) – what is the effect of rehabilitation compliance on clinical outcomes of proximal humerus fractures. BMC Musculoskeletal Disorders. 2023. DOI: 10.1186/s12891-023-06894-w

[3] Clinical outcomes following transtibial medial meniscal root repair are maintained at long‐term follow‐up. Knee Surgery, Sports Traumatology, Arthroscopy. 2024. DOI: 10.1002/ksa.12321

[4] Back Pain in Athletes. Journal of the American Academy of Orthopaedic Surgeons. 2006. DOI: 10.5435/00124635-200612000-00004

[5] A Survey of Expert Opinion Regarding Rotator Cuff Repair. Journal of Bone and Joint Surgery. 2014. DOI: 10.2106/jbjs.m.00399

[6] The outcome of total elbow arthroplasty in juvenile idiopathic arthritis (juvenile rheumatoid arthritis) patients. Journal of Shoulder and Elbow Surgery. 2014. DOI: 10.1016/j.jse.2014.03.012

[7] Letter to the Editor regarding Vijittrakarnrung et al: “Periarticular injection in addition to interscalene nerve block can decrease opioid consumption and pain following total shoulder arthroplasty: a comparison cohort study”. Journal of Shoulder and Elbow Surgery. 2024. DOI: 10.1016/j.jse.2023.09.002

[8] 5. Musculoskeletal Oncology. 2013.

[9] 2023 American Academy of Orthopaedic Surgeons Management of Osteoarthritis of the Hip Evidence-Based Clinical Practice Guideline: Case Studies. Journal of the American Academy of Orthopaedic Surgeons. 2024. DOI: 10.5435/jaaos-d-24-00427

[10] Mid‐ and Long‐Term Outcomes Are Favorable for Patients With Borderline Dysplasia Undergoing Primary Hip Arthroscopy: A Systematic Review. Arthroscopy. 2022. DOI: 10.1016/j.arthro.2022.12.030

[11] Response to letter to editor: conserve or reverse? fractured decisions!. Journal of Shoulder and Elbow Surgery. 2025. DOI: 10.1016/j.jse.2025.03.019

[12] Reverse total shoulder arthroplasty outcomes in elderly patients. JSES International. 2025. DOI: 10.1016/j.jseint.2025.01.006

[13] Bilateral patellar tendon rupture on lupus undergoing corticosteroids: a case report. BMC Musculoskeletal Disorders. 2020. DOI: 10.1186/s12891-020-03513-w

[14] Long-Term Disability and Return to Work Among Patients Who Have a Herniated Lumbar Disc: The Effect of Disability Compensation. The Journal of Bone and Joint Surgery-American Volume*. 2000. DOI: 10.2106/00004623-200001000-00002

[15] Orthopedic management of myelomeningocele with a multidisciplinary approach: a systematic review of the literature. Journal of Orthopaedic Surgery and Research. 2021. DOI: 10.1186/s13018-021-02643-8

[16] Proper Indications for Shoulder Subacromial Decompression Result in Excellent Outcomes. Arthroscopy: The Journal of Arthroscopic & Related Surgery. 2021. DOI: 10.1016/j.arthro.2021.04.023

[17] Short-term outcomes of reverse shoulder arthroplasty using a custom baseplate for severe glenoid deficiency. Journal of Shoulder and Elbow Surgery. 2021. DOI: 10.1016/j.jse.2020.08.002

[18] One-hole split endoscope versus unilateral biportal endoscopy for lumbar spinal stenosis: a retrospective propensity score study. Journal of Orthopaedic Surgery and Research. 2024. DOI: 10.1186/s13018-024-04743-7

[19] Factors influencing patient satisfaction after rotator cuff repair. Journal of Shoulder and Elbow Surgery. 2007. DOI: 10.1016/j.jse.2007.02.136

[20] Long-term functional and radiographic outcomes of anatomic total shoulder arthroplasty using an all-polyethylene cemented glenoid component with a minimum follow-up of 10 years. Journal of Shoulder and Elbow Surgery. 2026. DOI: 10.1016/j.jse.2025.03.036

[21] Five-year mortality after traumatic central cord syndrome in Wales. The Bone & Joint Journal. 2023. DOI: 10.1302/0301-620x.105b8.bjj-2022-1104.r2

[22] Cervical Spine Deformity: Indications, Considerations, and Surgical Outcomes. Journal of the American Academy of Orthopaedic Surgeons. 2019. DOI: 10.5435/jaaos-d-17-00546

[23] Sprengel's deformity: an analysis of surgically and nonsurgically treated patients. Journal of Shoulder and Elbow Surgery. 2021. DOI: 10.1016/j.jse.2020.04.018

[24] The clinical course of low back pain: a meta-analysis comparing outcomes in randomised clinical trials (RCTs) and observational studies. BMC Musculoskeletal Disorders. 2014. DOI: 10.1186/1471-2474-15-68

[25] Patient understanding regarding opioid use in an orthopaedic trauma surgery population: a survey study. Journal of Orthopaedic Surgery and Research. 2021. DOI: 10.1186/s13018-021-02881-w

[26] Fat-Embolism Syndrome (Respiratory Insufficiency Syndrome): A RATIONALE FOR TREATMENT.. The Journal of Bone and Joint Surgery. American Volume. 1974.

[27] Long term treatment with ataluren—the Swedish experience. BMC Musculoskeletal Disorders. 2021. DOI: 10.1186/s12891-021-04700-z

[28] Cauda Equina Syndrome. Journal of the American Academy of Orthopaedic Surgeons. 2008. DOI: 10.5435/00124635-200808000-00006

[29] The Use of Elbow Arthroscopy for Management of the Pediatric Elbow: A Systematic Review of Indications and Outcomes. Arthroscopy: The Journal of Arthroscopic & Related Surgery. 2021. DOI: 10.1016/j.arthro.2021.01.047

[30] Adolescent idiopathic scoliosis in adulthood. EFORT Open Reviews. 2024. DOI: 10.1530/eor-23-0162

[31] Echinococcosis of the spine. EFORT Open Reviews. 2021. DOI: 10.1302/2058-5241.6.200130

[32] The clinical management and efficacy of metagenomic next-generation sequencing in patients with pyogenic spinal infection: a single-center cohort study. Journal of Orthopaedic Surgery and Research. 2024. DOI: 10.1186/s13018-024-05188-8

[33] Retrospective, single-centre analysis comparing clinical outcomes of reverse total shoulder replacement for fracture, degenerative changes and revision procedure. BMC Musculoskeletal Disorders. 2025. DOI: 10.1186/s12891-025-09329-w

[34] Comparison of CPG’s for the diagnosis, prognosis and management of non-specific neck pain: a systematic review. BMC Musculoskeletal Disorders. 2019. DOI: 10.1186/s12891-019-2441-3

[35] Early postoperative repair status after rotator cuff repair cannot be accurately classified using questionnaires of patient function and isokinetic strength evaluation. Journal of Shoulder and Elbow Surgery. 2016. DOI: 10.1016/j.jse.2015.09.019

[36] Early detection and intervention for acute perforated peptic ulcer after elective spine surgeries: a review of 13 cases from 24,026 patients. BMC Musculoskeletal Disorders. 2021. DOI: 10.1186/s12891-021-04443-x

[37] Cemented vs. uncemented reverse total shoulder arthroplasty for the primary treatment of proximal humerus fractures in the elderly—a retrospective case–control study. BMC Musculoskeletal Disorders. 2022. DOI: 10.1186/s12891-022-05994-3

[38] Ask Patients What They Expect! A Survey Among Patients Awaiting Total Hip Arthroplasty in Germany. The Journal of Arthroplasty. 2022. DOI: 10.1016/j.arth.2022.03.067

[39] The Effect of Nonsteroidal Anti-Inflammatory Drug Contraindications on Opioid Use, Length of Stay, and Patient-Reported Outcomes After Lumbar Fusion. Journal of the American Academy of Orthopaedic Surgeons. 2025. DOI: 10.5435/jaaos-d-24-00450

[40] Patient Goal-directed Care in an Orthopaedic Spine Specialty Clinic. Journal of the American Academy of Orthopaedic Surgeons. 2021. DOI: 10.5435/jaaos-d-20-01105

[41] Applicability of randomized controlled trial evidence on surgery for lumbar disc herniations to clinical reality: a comparison with the nationwide FinSpine registry. Journal of Orthopaedic Surgery and Research. 2025. DOI: 10.1186/s13018-025-06401-y

[42] Consumption of medical resources and outcome of shoulder disorders in primary health care consulters. BMC Musculoskeletal Disorders. 2013. DOI: 10.1186/1471-2474-14-348

[43] Assessing the quality of care for knee osteoarthritis in Singapore: a cross-sectional study. BMC Musculoskeletal Disorders. 2025. DOI: 10.1186/s12891-025-08524-z

[44] Prognostic factors for recovery after arthroscopic rotator cuff repair: a prognostic study. Journal of Shoulder and Elbow Surgery. 2015. DOI: 10.1016/j.jse.2015.04.013

[45] Clinical and epidemiological analysis of 893 patients with spinal tuberculosis: an 11-Year investigation of a general hospital in East China. BMC Musculoskeletal Disorders. 2025. DOI: 10.1186/s12891-025-09053-5

[46] Effects of transcutaneous vagus nerve stimulation on chronic low back pain: a systematic review. BMC Musculoskeletal Disorders. 2024. DOI: 10.1186/s12891-024-07569-w

[47] Outcomes of Revision Surgery for Cubital Tunnel Syndrome. The Journal of Hand Surgery. 2014. DOI: 10.1016/j.jhsa.2014.07.013

[48] The StarT back screening tool and a pain mannequin improve triage in individuals with low back pain at risk of a worse prognosis – a population based cohort study. BMC Musculoskeletal Disorders. 2019. DOI: 10.1186/s12891-019-2836-1

[49] Results of surgical intervention in the symptomatic multiply-operated back patient. Analysis of sixty-seven cases followed for three to seven years.. The Journal of Bone & Joint Surgery. 1979. DOI: 10.2106/00004623-197961070-00018

[50] Evaluation of Classification Systems and Their Correlation With Clinical and Quality-of-life Parameters in Patients With Surgically Treated Spondylodiskitis. Journal of the American Academy of Orthopaedic Surgeons. 2023. DOI: 10.5435/jaaos-d-22-01199

[51] Physical therapy versus natural history in outcomes of rotator cuff tears: the Rotator Cuff Outcomes Workgroup (ROW) cohort study. Journal of Shoulder and Elbow Surgery. 2019. DOI: 10.1016/j.jse.2018.10.001

[52] Assessment of resuscitation as measured by markers of metabolic acidosis and features of injury. The Bone & Joint Journal. 2017. DOI: 10.1302/0301-620x.99b1.bjj-2016-0418.r2

[53] C5 Motor Palsy After Single- and Multi-level Anterior Cervical Diskectomy and Fusion: A Retrospective Review. Journal of the American Academy of Orthopaedic Surgeons. 2019. DOI: 10.5435/jaaos-d-17-00764

[54] Pyoderma Gangrenosum. The Journal of Hand Surgery. 2012. DOI: 10.1016/j.jhsa.2011.12.044

[55] Segmental mobility, disc height and patient-reported outcomes after surgery for degenerative disc disease. The Bone & Joint Journal. 2013. DOI: 10.1302/0301-620x.95b1.29829

[56] Predictive factors for successful non-operative treatment and achieving MCID improvement in health-related quality of life in adult spinal deformity. BMC Musculoskeletal Disorders. 2022. DOI: 10.1186/s12891-022-05757-0

[57] Internal Fixation Versus Nonoperative Treatment for Displaced 3-Part or 4-Part Proximal Humeral Fractures in Elderly Patients: A Meta-Analysis of Randomized Controlled Trials. PLoS ONE. 2013. DOI: 10.1371/journal.pone.0075464

[58] Cotrel-dubousset instrumentation for the correction of adolescent idiopathic scoliosis. Long-term results with an unexpected high revision rate. 2012.

[59] Long-term core outcomes in cauda equina syndrome. The Bone & Joint Journal. 2021. DOI: 10.1302/0301-620x.103b9.bjj-2021-0094.r1

[60] Prevention and Treatment of Elbow Stiffness. The Journal of Hand Surgery. 2009. DOI: 10.1016/j.jhsa.2009.02.020

[61] Association of Poor Bone Quality with Pseudarthrosis and Poor Clinical Outcomes in Single-Level Instrumented Lumbar Arthrodesis Using Local Autologous Bone Graft. Journal of the American Academy of Orthopaedic Surgeons. 2024. DOI: 10.5435/jaaos-d-23-01124

[62] Shoulder arthroplasty in patients younger than 50 years: minimum 20-year follow-up. Journal of Shoulder and Elbow Surgery. 2015. DOI: 10.1016/j.jse.2014.07.016

[63] Ulnar collateral ligament reconstruction of the elbow at minimum 48-month mean follow-up demonstrates excellent clinical outcomes with low complication and revision rates: systematic review. Journal of ISAKOS. 2021. DOI: 10.1136/jisakos-2021-000614

[64] Polymethylmethacrylate-assisted ventral discectomy: Rate of pseudarthrosis and clinical outcome with a minimum follow-up of 5 years. BMC Musculoskeletal Disorders. 2011. DOI: 10.1186/1471-2474-12-140

[65] Arthroscopic inlay suprapectoral vs. mini-open onlay subpectoral biceps tenodesis: a prospective, randomized analysis of clinical outcomes and ultrasound-assessed structural integrity. Journal of Shoulder and Elbow Surgery. 2025. DOI: 10.1016/j.jse.2024.11.014

[66] Predictors of long-term pain and disability in patients with low back pain investigated by magnetic resonance imaging: A longitudinal study. BMC Musculoskeletal Disorders. 2011. DOI: 10.1186/1471-2474-12-234

[67] Identifying latent subgroups in the older population seeking primary health care for a new episode of back pain – findings from the BACE-N cohort. BMC Musculoskeletal Disorders. 2024. DOI: 10.1186/s12891-024-07163-0

[68] Follow-up score, change score or percentage change score for determining clinical important outcome following surgery? An observational study from the Norwegian registry for Spine surgery evaluating patient reported outcome measures in lumbar spinal stenosis and lumbar degenerative spondylolisthesis. BMC Musculoskeletal Disorders. 2019. DOI: 10.1186/s12891-018-2386-y

[69] Outcomes of Management of Proximal Humeral Fractures with Patient-Specific, Evidence-Based Treatment Algorithms. Journal of Bone and Joint Surgery. 2021. DOI: 10.2106/jbjs.20.01309

[70] Clinical classification in low back pain: best-evidence diagnostic rules based on systematic reviews. BMC Musculoskeletal Disorders. 2017. DOI: 10.1186/s12891-017-1549-6

[72] Which treatment provides the best neurological outcomes in acute spinal cord injury?. The Bone & Joint Journal. 2023. DOI: 10.1302/0301-620x.105b4.bjj-2023-0111

[73] Reducing the extent of facetectomy may decrease morbidity in failed back surgery syndrome. BMC Musculoskeletal Disorders. 2019. DOI: 10.1186/s12891-019-2751-5

[74] Longitudinal associations between incident lumbar spine MRI findings and chronic low back pain or radicular symptoms: retrospective analysis of data from the longitudinal assessment of imaging and disability of the back (LAIDBACK). BMC Musculoskeletal Disorders. 2014. DOI: 10.1186/1471-2474-15-152

[75] Failed shoulder instability surgery: State -of-the-art. Journal of ISAKOS. 2026. DOI: 10.1016/j.jisako.2025.101011

[76] Nonsurgical Management of Early-onset Scoliosis. Journal of the American Academy of Orthopaedic Surgeons. 2015. DOI: 10.5435/jaaos-d-14-00019

[77] Return-to-Play Rates in National Football League Linemen After Treatment for Lumbar Disk Herniation. The American Journal of Sports Medicine. 2011. DOI: 10.1177/0363546510388901

[78] Longitudinal correlation between X‐ray and MRI findings in medial compartment knee osteoarthritis: Insights into early cartilage loss and structural changes. Knee Surgery, Sports Traumatology, Arthroscopy. 2025. DOI: 10.1002/ksa.70016

[79] Heterotopic Ossification Following Traumatic Brain Injury and Spinal Cord Injury. Journal of the American Academy of Orthopaedic Surgeons. 2009. DOI: 10.5435/00124635-200911000-00003

[80] Low Back Pain and Pelvic Girdle Pain in Pregnancy. Journal of the American Academy of Orthopaedic Surgeons. 2015. DOI: 10.5435/jaaos-d-14-00248

[81] Classification of Postoperative Acromial Fractures Following Reverse Shoulder Arthroplasty. The Journal of Bone and Joint Surgery-American Volume. 2013. DOI: 10.2106/jbjs.k.01516

[82] A Novel Scoring System to Predict Length of Stay After Anterior Cervical Discectomy and Fusion. Journal of the American Academy of Orthopaedic Surgeons. 2021. DOI: 10.5435/jaaos-d-20-00894

[84] Ophthalmologic Complications Associated With Prone Positioning in Spine Surgery. Journal of the American Academy of Orthopaedic Surgeons. 2007. DOI: 10.5435/00124635-200703000-00005

[85] Effect of different corrective force directions applied by spinal orthoses on the patients with adolescent idiopathic scoliosis. BMC Musculoskeletal Disorders. 2024. DOI: 10.1186/s12891-024-08014-8

[86] The Value of Magnetic Resonance Imaging of the Lumbar Spine to Predict Low-Back Pain in Asymptomatic Subjects. The Journal of Bone and Joint Surgery-American Volume. 2001. DOI: 10.2106/00004623-200109000-00002

[87] Risk factors for development of heterotopic ossification of the elbow after fracture fixation. Journal of Shoulder and Elbow Surgery. 2012. DOI: 10.1016/j.jse.2012.05.040

[88] ValuedCare program: a population health model for the delivery of evidence-based care across care continuum for hip fracture patients in Eastern Singapore. Journal of Orthopaedic Surgery and Research. 2018. DOI: 10.1186/s13018-018-0819-9

[89] Surgical outcomes after instrumented lumbar surgery in patients of eighty years of age and older. BMC Musculoskeletal Disorders. 2016. DOI: 10.1186/s12891-016-1239-9

[90] Total spine magnetic resonance imaging for detection of multifocal infection in pyogenic spondylodiscitis: a retrospective observational study. BMC Musculoskeletal Disorders. 2021. DOI: 10.1186/s12891-020-03928-5

[91] Measurable Thoracic Motion Remains at 1 Year Following Anterior Vertebral Body Tethering, with Sagittal Motion Greater Than Coronal Motion. Journal of Bone and Joint Surgery. 2021. DOI: 10.2106/jbjs.20.01533

[92] Metal Suppression Magnetic Resonance Imaging Techniques in Orthopaedic and Spine Surgery. Journal of the American Academy of Orthopaedic Surgeons. 2025. DOI: 10.5435/jaaos-d-24-01057

[93] Long-term results after arthroscopic transosseous rotator cuff repair. Journal of Shoulder and Elbow Surgery. 2019. DOI: 10.1016/j.jse.2018.09.003

[94] Biologic resurfacing arthroplasty with acellular human dermal allograft and platelet-rich plasma (PRP) in young patients with glenohumeral arthritis—average of 60 months of at mid-term follow-up. Journal of Shoulder and Elbow Surgery. 2016. DOI: 10.1016/j.jse.2015.11.063

[95] Conservative vs surgical treatment of midshaft clavicular fractures: a systematic review. EFORT Open Reviews. 2026. DOI: 10.1530/eor-2025-0005

[96] Reverse total shoulder arthroplasty within 6 weeks of proximal humerus fracture is associated with the lowest risk of revision. Journal of Shoulder and Elbow Surgery. 2024. DOI: 10.1016/j.jse.2024.03.027

[97] Binary Tönnis classification: simplified modification demonstrates better inter- and intra-observer reliability as well as agreement in surgical management of hip pathology. BMC Musculoskeletal Disorders. 2020. DOI: 10.1186/s12891-020-03520-x

[98] Development and validation of an interpretable nomogram for predicting the risk of the prolonged postoperative length of stay for tuberculous spondylitis: a novel approach for risk stratification. BMC Musculoskeletal Disorders. 2025. DOI: 10.1186/s12891-025-08807-5

[99] Proximal humerus fragility fractures: recent trends in nonoperative and operative treatment in the Medicare population. Journal of Shoulder and Elbow Surgery. 2016. DOI: 10.1016/j.jse.2015.07.015

[100] Longitudinal analysis of shoulder arthroplasty utilization, clinical outcomes, and value: a comparative assessment of changes in improvement over 15 years with a single platform shoulder prosthesis. Journal of Shoulder and Elbow Surgery. 2023. DOI: 10.1016/j.jse.2022.12.018

[101] Classifications of good versus poor outcome following knee arthroplasty should not be defined using arbitrary criteria. BMC Musculoskeletal Disorders. 2020. DOI: 10.1186/s12891-020-03583-w

[102] Lyon bracing in adolescent females with thoracic idiopathic scoliosis: a prospective study based on SRS and SOSORT criteria. BMC Musculoskeletal Disorders. 2015. DOI: 10.1186/s12891-015-0782-0

[103] Mitigating Adverse Event Reporting Bias in Spine Surgery. The Journal of Bone & Joint Surgery. 2013. DOI: 10.2106/jbjs.l.00251

[105] Reliability of the Multidimensional Pain Inventory and stability of the MPI classification system in chronic back pain. BMC Musculoskeletal Disorders. 2012. DOI: 10.1186/1471-2474-13-155

[107] How does cervical sagittal profile change after the spontaneous compensation of global sagittal imbalance following one- or two-level lumbar fusion. BMC Musculoskeletal Disorders. 2024. DOI: 10.1186/s12891-024-07518-7

[108] Thoracic spine pain in the general population: Prevalence, incidence and associated factors in children, adolescents and adults. A systematic review. BMC Musculoskeletal Disorders. 2009. DOI: 10.1186/1471-2474-10-77

[109] Segmental Lordosis Restoration During Lumbar Degenerative Spinal Fusion: Surgical Techniques and Outcomes. Journal of the American Academy of Orthopaedic Surgeons. 2024. DOI: 10.5435/jaaos-d-24-00749

[110] Does improvement towards a normal cervical sagittal configuration aid in the management of cervical myofascial pain syndrome: a 1- year randomized controlled trial. BMC Musculoskeletal Disorders. 2018. DOI: 10.1186/s12891-018-2317-y

[111] Comparative analysis of surgically treated degenerative cervical and lumbar spine diseases using multiple clinical aging indices. BMC Musculoskeletal Disorders. 2025. DOI: 10.1186/s12891-025-09185-8

[112] Extending conceptual frameworks: life course epidemiology for the study of back pain. BMC Musculoskeletal Disorders. 2010. DOI: 10.1186/1471-2474-11-23

[113] Individuals’ explanations for their persistent or recurrent low back pain: a cross-sectional survey. BMC Musculoskeletal Disorders. 2017. DOI: 10.1186/s12891-017-1831-7

[114] Chapter 12 Physical Examination of the Spine. 2019.

[115] Perceived occurrence of an adverse event affects patient-reported outcomes after total hip replacement. BMC Musculoskeletal Disorders. 2020. DOI: 10.1186/s12891-020-3127-6

[116] Metabolic syndrome is associated with increased complications and healthcare costs after adhesive capsulitis surgery. Journal of Shoulder and Elbow Surgery. 2026. DOI: 10.1016/j.jse.2025.04.008

[118] Reverse Total Shoulder Arthroplasty is Associated with Good Clinical Outcomes That are Sustained through Mid-Term Follow-Up: A Prospective Cohort Study. Journal of Shoulder and Elbow Surgery. 2014. DOI: 10.1016/j.jse.2014.06.004

[119] Post-Maturity Progression in Adolescent Idiopathic Scoliosis Curves of 40° to 50°. Journal of Bone and Joint Surgery. 2023. DOI: 10.2106/jbjs.22.00939

[120] Responsiveness of five shoulder outcome measures at follow-ups from 3 to 24 months. BMC Musculoskeletal Disorders. 2021. DOI: 10.1186/s12891-021-04483-3

[121] An intraoperative load sensor did not improve the early postoperative results of posterior‐stabilized TKA for osteoarthritis with varus deformities. Knee Surgery, Sports Traumatology, Arthroscopy. 2018. DOI: 10.1007/s00167-018-5314-7

[122] Variation of disability courses in Danish chiropractic patients with low back pain: a one-year cohort study with four follow-ups. BMC Musculoskeletal Disorders. 2025. DOI: 10.1186/s12891-025-09365-6

[123] Delays in the diagnosis and treatment of bone and joint tuberculosis in the United Kingdom. The Bone & Joint Journal. 2018. DOI: 10.1302/0301-620x.100b1.bjj-2017-0357.r1

[124] Predictors of delayed union after surgical treatment in patients with osteoporotic vertebral compression fractures: a systematic review and meta-analysis. Journal of Orthopaedic Surgery and Research. 2026. DOI: 10.1186/s13018-025-06581-7