1171Journal Reports / The Spine Journal 12 (2012) 1170–1172

RESULTS: Ex vivo, the AMD did not detect any instrumentation individ-

ually or in combination up to a titanium mass of 215 g. The HHMD de-

tected all instrumentation at a distance of 5 cm, with the minimum mass

being 2 g. No implants were detected in patients by the AMD. The HHMD

did not detect any anterior lumbar or thoracic surgical implants. It detected

anterior cervical implants. The HHMD detected all posterior surgical im-

plants. There was no significant relationship between detection rate, body

mass index, total metal mass, and metal density/segment.

CONCLUSION: AMDs do not detect modern spinal implants. HHMDs

detect all modern posterior spinal implants; this has implications for

patient documentation.

PMID: 22543252 [PubMed - in process. Available at: http://www.ncbi.

nlm.nih.gov/pubmed/22543252].

Reprinted with permission from: Chinwalla F, Grevitt MP. Detection of

modern spinal implants by airport metal detectors. Spine (Phila Pa 1976)

2012;37(24):2011–6.

http://dx.doi.org/10.1016/j.spinee.2012.11.035

Balance, falls-related self-efficacy, and psychological factors amongst

older women with chronic low back pain: a preliminary case-control

study. Champagne A, Prince F, Bouffard V, Lafond D. Rehabil Res

Pract 2012;2012:430374. Epub 2012 Aug 9

OBJECTIVE: To investigate balance functions in older women and eval-

uate the association of the fear-avoidance beliefs model (FABM) factors

with balance and mobility performance.

PARTICIPANTS: Fifteen older women with CLBP was compared with

age-matched pain-free controls (n515).

MAIN OUTCOME MEASURES: Pain intensity, falls-related self-

efficacy and intrinsic constructs in the FABM were evaluated. Postural

steadiness (centre of pressure (COP)) and mobility functions were assessed.

Linear relationships of FABM variables with COP and mobility score were

estimated.

RESULTS: CLBP showed lower mobility score compared to controls.

CLBP presented lower falls-related self-efficacy and it was associated with

reduced mobility scores. FABM variables and falls-related self-efficacy

were correlated with postural steadiness. Physical activity was reduced

in CLBP, but no between-group difference was evident for knee extensor

strength. No systematic linkages were observed between FABM variables

with mobility score or postural steadiness.

CONCLUSIONS: Back pain status affects balance and mobility functions

in older women. Falls-related self-efficacy is lower in CLBP and is asso-

ciated with reduced mobility. Disuse syndrome in CLBP elderly is partly

supported by the results of this preliminary study.

PMID: 22937276 [PubMed. Available at: http://www.ncbi.nlm.nih.gov/

pubmed/22937276].

Reprinted from: Champagne A, Prince F, Bouffard V, Lafond D. Balance,

falls-related self-efficacy, and psychological factors amongst older women

with chronic low back pain: a preliminary case-control study. Rehabil Res

Pract 2012;2012:430374. Epub 2012 Aug 9.

http://dx.doi.org/10.1016/j.spinee.2012.11.036

Errors of level in spinal surgery: an evidence-based systematic

review. Longo UG, Loppini M, Romeo G, Maffulli N, Denaro V. J

Bone Joint Surg Br 2012;94(11):1546–50

Wrong-level surgery is a unique pitfall in spinal surgery and is part of the

wider field of wrong-site surgery. Wrong-site surgery affects both patients

and surgeons and has received much media attention. We performed this

systematic review to determine the incidence and prevalence of wrong-

level procedures in spinal surgery and to identify effective prevention strat-

egies. We retrieved 12 studies reporting the incidence or prevalence of

wrong-site surgery and that provided information about prevention strate-

gies. Of these, ten studies were performed on patients undergoing lumbar

spine surgery and two on patients undergoing lumbar, thoracic or cervical

spine procedures. A higher frequency of wrong-level surgery in lumbar

procedures than in cervical procedures was found. Only one study assessed

preventative strategies for wrong-site surgery, demonstrating that current

site-verification protocols did not prevent about one-third of the cases.

The current literature does not provide a definitive estimate of the occur-

rence of wrong-site spinal surgery, and there is no published evidence to

support the effectiveness of site-verification protocols. Further prevention

strategies need to be developed to reduce the risk of wrong-site surgery.

PMID: 23109637 [PubMed - in process. Available at: http://www.ncbi.

nlm.nih.gov/pubmed/23109637].

Reprinted with permission from: Longo UG, Loppini M, Romeo G,

Maffulli N, Denaro V. Errors of level in spinal surgery: an evidence-based

systematic review. J Bone Joint Surg Br 2012;94(11):1546–50. Available

at: http://www.bjj.boneandjoint.org.uk/content/94-B/11/1546

http://dx.doi.org/10.1016/j.spinee.2012.11.037

The hidden effects of blinded, placebo-controlled randomized trials:

an experimental investigation. Rief W, Glombiewski JA. Pain

2012;153(12):2473–7. Epub 2012 Oct 6

The knowledge of having only a 50% chance of receiving an active drug

can result in reduced efficacy in blinded randomized clinical trials (RCTs)

compared to clinical practice (reduced external validity). Moreover, minor

onset sensations associated with the drug (but not with an inert placebo)

can further challenge the attribution of group differences to drug-specific

efficacy (internal validity). We used a randomized experimental study with

inert placebos (inert substance) vs active placebos (inducing minor sensa-

tions), and different instructions about group allocation (probability of re-

ceiving drug: 0%, 50%, 100%). One hundred forty-four healthy volunteers

were informed that a new application method for a well-known painkiller

would be tested. Pain thresholds were assessed before and after receiving

nasal spray. Half of the nasal sprays were inert placebos (sesame oil),

while the other half were active placebos inducing prickling nasal sensa-

tions (sesame oil with 0.014% capsaicin). The major outcome was pain

threshold after placebo application. A substantial expectation effect was

found for the inert placebo condition, with participants who believed they

had received an active drug reporting the highest pain thresholds. Active

placebos show substantial differences to passive placebos in the 50%

chance group. Therefore, patient expectations are significantly different

in placebo-controlled clinical trials (50% chance) vs clinical practice

(100% chance). Moreover, minor drug onset sensations can challenge in-

ternal validity. Effect sizes for these mechanisms are medium, and can sub-

stantially compete with specific drug effects. For clinical trials, new study

designs are needed that better control for these effects.

Copyright � 2012 International Association for the Study of Pain. Pub-

lished by Elsevier B.V. All rights reserved.

PMID: 23084328 [PubMed - in process. Available at: http://www.ncbi.

nlm.nih.gov/pubmed/23084328].

Reprinted from: Rief W, Glombiewski JA. The hidden effects of blinded, pla-

cebo-controlled randomized trials: an experimental investigation. Pain

2012;153(12):2473–7.Epub2012Oct6.This abstract hasbeen reproducedwith

permission of the InternationalAssociation for the StudyofPain� (IASP�).The

abstract may not be reproduced for any other purpose without permission.

http://dx.doi.org/10.1016/j.spinee.2012.11.038