***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: BACKGROUND Surgery for cervical spondylotic myelopathy ( CSM ) is generally safe and effective . Nonetheless , complications occur in 11 % to 38 % of patients . Knowledge of important predictors of complications will help clinicians identify high-risk patients and institute prevention and management strategies . OBJECTIVE To identify clinical and surgical predictors of perioperative complications in CSM patients . METHODS Four hundred seventy-nine surgical CSM patients were enrolled in the prospect i ve CSM-International study at 16 sites . A panel of physicians review ed all adverse events and classified each as related or unrelated to surgery . Univariate analyses were performed to determine differences between patients who experienced a perioperative complication and those who did not . A complication prediction rule was developed using multiple logistic regression . RESULTS Seventy-eight patients experienced 89 perioperative complications ( 16.25 % ) . On univariate analysis , the major clinical risk factors were ossification of the posterior longitudinal ligament ( OPLL ) ( P = .055 ) , number of comorbidities ( P = .002 ) , comorbidity score ( P = .006 ) , diabetes mellitus ( P = .001 ) , and coexisting gastrointestinal ( P = .039 ) and cardiovascular ( P = .046 ) disorders . Patients undergoing a 2-stage surgery ( P = .002 ) and those with a longer operative duration ( P = .001 ) were at greater risk of perioperative complications . A final prediction model consisted of diabetes mellitus ( odds ratio [ OR ] = 1.96 , P = .060 ) , number of comorbidities ( OR = 1.20 , P = .069 ) , operative duration ( OR = 1.07 , P = .002 ) , and OPLL ( OR = 1.75 , P = .040 ) . CONCLUSION Surgical CSM patients have a higher risk of perioperative complications if they have a greater number of comorbidities , coexisting diabetes mellitus , OPLL , and a longer operative duration . Surgeons can use this information to discuss the risks and benefits of surgery with patients , to plan case-specific preventive strategies , and to ensure appropriate management in the perioperative period . ABBREVIATIONS BMI , body mass indexCSM , cervical spondylotic myelopathymJOA , modified Japanese Orthopaedic AssociationOPLL , ossification of the posterior longitudinal ligament IMPORTANCE Oral steroids are commonly used to treat acute sciatica due to a herniated disk but have not been evaluated in an appropriately powered clinical trial . OBJECTIVE To determine if oral prednisone is more effective than placebo in improving function and pain among patients with acute sciatica . DESIGN , SETTING , AND PARTICIPANTS R and omized , double-blind , placebo-controlled clinical trial conducted from 2008 to 2013 in a large integrated health care delivery system in Northern California . Adults ( n=269 ) with radicular pain for 3 months or less , an Oswestry Disability Index ( ODI ) score of 30 or higher ( range , 0 - 100 ; higher scores indicate greater dysfunction ) , and a herniated disk confirmed by magnetic resonance imaging were eligible . INTERVENTIONS Participants were r and omly assigned in a 2:1 ratio to receive a tapering 15-day course of oral prednisone ( 5 days each of 60 mg , 40 mg , and 20 mg ; total cumulative dose = 600 mg ; n = 181 ) or matching placebo ( n = 88 ) . MAIN OUTCOMES AND MEASURES The primary outcome was ODI change at 3 weeks ; secondary outcomes were ODI change at 1 year , change in lower extremity pain ( measured on a 0 - 10 scale ; higher scores indicate more pain ) , spine surgery , and Short Form 36 Health Survey ( SF-36 ) Physical Component Summary ( PCS ) and Mental Component Summary ( MCS ) scores ( 0 - 100 scale ; higher scores better ) . RESULTS Observed baseline and 3-week mean ODI scores were 51.2 and 32.2 for the prednisone group and 51.1 and 37.5 for the placebo group , respectively . The prednisone-treated group showed an adjusted mean 6.4-point ( 95 % CI , 1.9 - 10.9 ; P = .006 ) greater improvement in ODI scores at 3 weeks than the placebo group and a mean 7.4-point ( 95 % CI , 2.2 - 12.5 ; P = .005 ) greater improvement at 52 weeks . Compared with the placebo group , the prednisone group showed an adjusted mean 0.3-point ( 95 % CI , -0.4 to 1.0 ; P = .34 ) greater reduction in pain at 3 weeks and a mean 0.6-point ( 95 % CI , -0.2 to 1.3 ; P = .15 ) greater reduction at 52 weeks . The prednisone group showed an adjusted mean 3.3-point ( 95 % CI , 1.3 - 5.2 ; P = .001 ) greater improvement in the SF-36 PCS score at 3 weeks , no difference in the SF-36 PCS score at 52 weeks ( mean , 2.5 ; 95 % CI , -0.3 to 5.4 ; P = .08 ) , no change in the SF-36 MCS score at 3 weeks ( mean , 2.2 ; 95 % CI , -0.4 to 4.8 ; P = .10 ) , and an adjusted 3.6-point ( 95 % CI , 0.6 - 6.7 ; P = .02 ) greater improvement in the SF-36 MCS score at 52 weeks . There were no differences in surgery rates at 52-week follow-up . Having 1 or more adverse events at 3-week follow-up was more common in the prednisone group than in the placebo group ( 49.2 % vs 23.9 % ; P < .001 ) . CONCLUSIONS AND RELEVANCE Among patients with acute radiculopathy due to a herniated lumbar disk , a short course of oral steroids , compared with placebo , result ed in modestly improved function and no improvement in pain . TRIAL REGISTRATION clinical trials.gov Identifier : NCT00668434 BACKGROUND Wound drains that are left in place for a prolonged period of time have a higher rate of bacterial contamination . Following spinal surgery , a drain is often left in place for a longer period of time if it maintains a high output . Given the major consequences of an infection following spinal surgery and the lack of data with regard to the use of antibiotics and drains , we performed a study of patients with a drain following spinal surgery to compare infection rates between those who were treated with antibiotics for twenty-four hours and those who received antibiotics  for the duration for which the drain was in place . METHODS We performed a prospect i ve r and omized trial of 314 patients who underwent multilevel thoracolumbar spinal surgery followed by use of a postoperative drain .  The patients were r and omized into two groups , one of which received perioperative antibiotics for twenty-four hours ( twenty-four-hour group ) and the other of which received antibiotics for the duration that the drain was in place ( drain- duration group ) . Data collected included demographic characteristics , medical comorbidities , type of spinal surgery , and surgical site infection . RESULTS Twenty-one ( 12.4 % ) of the 170 patients in the twenty-four-hour group and nineteen ( 13.2 % ) of the 144 in the drain- duration group developed a surgical site infection ( p = 0.48 ) . There were no significant differences between the twenty-four-hour and drain- duration groups with respect to demographic characteristics ( except for the American Society of Anesthesiologists [ ASA ] classification ) , operative time , type of surgery , drain output , or length of hospital stay . CONCLUSIONS Continuing perioperative administration of antibiotics for the entire duration that a drain is in place after spinal surgery did not decrease the rate of surgical site infections IMPORTANCE Cervical total disc replacement ( CTDR ) was developed to treat cervical spondylosis , while preserving motion . While anterior cervical discectomy and fusion ( ACDF ) has been the st and ard of care for 2-level disease , a r and omized clinical trial ( RCT ) suggested similar outcomes . Cost-effectiveness of this intervention has never been eluci date d. OBJECTIVE To determine the cost-effectiveness of CTDR compared with ACDF . DESIGN , SETTING , AND PARTICIPANTS Data were derived from an RCT that followed up 330 patients over 24 months . The original RCT consisted of multi-institutional data including private and academic institutions . Using linear regression for the current study , health states were constructed based on the stratification of the Neck Disability Index and a visual analog scale . Data from the 12-item Short-Form Health Survey question naires were transformed into utilities values using the SF-6D mapping algorithm . Costs were calculated by extracting Diagnosis-Related Group codes from institutional billing data and then applying 2012 Medicare reimbursement rates . The costs of complications and return-to-work data were also calculated . A Markov model was built to evaluate quality -adjusted life-years ( QALYs ) for both treatment groups . The model adopted a third-party payer perspective and applied a 3 % annual discount rate . Patients included in the original RCT had to be diagnosed as having radiculopathy or myeloradiculopathy at 2 contiguous levels from C3-C7 that was unresponsive to conservative treatment for at least 6 weeks or demonstrated progressive symptoms . MAIN OUTCOMES AND MEASURES Incremental cost-effectiveness ratio of CTDR compared with ACDF . RESULTS A strong correlation ( R2 = 0.6864 ; P < .001 ) was found by projecting a visual analog scale onto the Neck Disability Index . Cervical total disc replacement had an average of 1.58 QALYs after 24 months compared with 1.50 QALYs for ACDF recipients . Cervical total disc replacement was associated with $ 2139 greater average cost . The incremental cost-effectiveness ratio of CTDR  compared with ACDF was $ 24,594 per QALY at 2 years . Despite varying input parameters in the sensitivity analysis , the incremental cost-effectiveness ratio value stays below the threshold of $ 50,000 per QALY in most scenarios ( range , -$58,194 to $ 147,862 per QALY ) . CONCLUSIONS AND RELEVANCE The incremental cost-effectiveness ratio of CTDR compared with traditional ACDF is lower than the commonly accepted threshold of $ 50,000 per QALY . This remains true with varying input parameters in a robust sensitivity analysis , reaffirming the stability of the model and the sustainability of this intervention Study Design . This is a prospect i ve , r and omized , double-blinded comparison of tranexamic acid ( TXA ) , epsilon aminocaproic acid ( EACA ) , and placebo used intraoperatively in patients with adult spinal deformity . Objective . The purpose of this study was to provide high- quality evidence regarding the comparative efficacies of TXA , EACA , and placebo in reducing blood loss and transfusion requirements in patients undergoing posterior spinal fusion surgery . Summary of Background Data . Spine deformity surgery usually involves substantial blood loss . The antifibrinolytics TXA and EACA have been shown to improve hemostasis in large blood loss surgical procedures . Methods . Fifty-one patients undergoing posterior spinal fusion of at least 5 levels for correction of adult spinal deformity were r and omized to 1 of 3 treatment groups . Primary outcome measures included intraoperative estimated blood loss , total loss , ( estimated blood loss + postoperative blood loss ) , and transfusion rates . Results . Patients received TXA ( n = 19 ) , EACA ( n = 19 ) , or placebo ( n = 13 ) in the operating room ( mean ages : 60 , 47 , and 43 yr , respectively ) ; TXA patients were significantly older and had larger estimated blood volumes than both other groups . Total losses were significantly reduced for EACA versus control , and there was a demonstrable but nonsignificant trend toward reduced intraoperative blood loss in both antifibrinolytic arms versus control . EACA had significant reductions in postoperative blood transfusions versus TXA . Conclusion . The findings in this study support the use of antifibrinolytics to reduce blood loss in posterior adult spinal deformity surgery . Level of Evidence : OBJECTIVE To investigate the effect of adding segmental epidural steroid injections ( SESIs ) to usual care compared with usual care alone on quality of life and cost utility in lumbosacral radicular syndrome ( LRS ) in general practice . DESIGN A pragmatic r and omized controlled trial . Results were analyzed using mixed models . SETTING Primary care . PARTICIPANTS Patients ( N=50 ) in the acute phase of LRS . INTERVENTIONS One epidural injection containing 80 mg of triamcinolone in normal saline . MAIN OUTCOME MEASURE Back pain at 4 weeks after the start of the treatment . RESULTS Both groups experienced a significant increase in quality of life in ( especially ) the physical domains of the Medical Outcomes Study 36-Item Short-Form Health Survey . The intervention group scored significantly better than the control group at certain time points in the physical domain . The differences were small . The cost-utility analysis showed that with a negligible loss 
    Output:
    
The patients who underwent total disc replacement had better patient-reported outcome measure results , with no difference in neurological improvement , return to work , or major complication rates .
There was higher patient satisfaction and a lower subsequent surgical procedure rate in the total disc replacement group .