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Updated Guidelines: Primary Stroke Prevention

In the February 1, 2011 issue of Stroke, the American Heart Association/American Stroke Association (AHA/ASA) released new guidelines for the primary prevention of stroke. The guideline reviews evidence on established and emerging risk factors for stroke. A significant change in these guidelines, which update a previous statement from 2006, is that clinicians are urged to address primary prevention of both ischemic and hemorrhagic stroke because the risk factors and prevention strategies for these events largely overlap. The critical role of a healthy lifestyle in the prevention of stroke is also emphasized. Areas of particular interest include emergency department (ED) screening, aspirin use among low-risk patients, asymptomatic carotid artery stenosis, and atrial fibrillation (AF), among other updates. ED screening for stroke risk represents an entirely new recommendation. Due to a lack of resources, there has been a surge in the number of people who receive care through the ED. This setting represents a unique opportunity to capture individuals at high risk of stroke and to offer information on smoking cessation programs, referrals for alcohol/drug abuse programs, screening for hypertension, and identification of AF. Aspirin Update A notable point in the AHA/ASA scientific statement is that aspirin is not recommended for preventing a first stroke in people at low risk or in those with diabetes or diabetes plus asymptomatic peripheral artery disease. Use of aspirin to prevent cardiovascular events—including but not limited to stroke—is recommended for those at sufficiently high risk. However, it’s important to weigh the risks, primarily bleeding, associated with treatment. Managing Asymptomatic Carotid Artery Stenosis Population screening for asymptomatic carotid artery stenosis is not recommended. An area that has...

A Minimally Invasive Alternative to Open Spine Surgery

Roughly 80% of Americans experience back pain at some point in their life. While the pain goes away in the vast majority of cases, about 5% of patients with aching backs will develop chronic pain. In the United States, at least $50 billion is spent each year on medications, hot and cold packs, and other methods of treating back pain. Data show that back pain is second only to headaches as the most common neurological ailment in the United States. Until recently, the only option for people with back pain when other methods of pain control have failed has been open surgery, which involves general anesthesia, a hospital stay, large scars, and long recovery times. Unfortunately, these surgeries fail to provide lasting relief in many cases, leaving many patients to rely on narcotic pain relievers for the rest of their lives. Smaller is Better Newer, minimally invasive procedures are being explored and appear to be particularly promising for patients with chronic back pain. Endoscopic spine procedures can be used to correct many of the conditions that cause chronic back pain or to repair failed previous surgeries. These procedures allow surgeons to see the spine and surrounding tissue without making large incisions. Spine surgery is a common procedure for the treatment of lower back pain, and these operations typically use cages, bone grafts, bars, and screws. If patients continue to have pain, they may develop failed back surgery syndrome (FBSS). For people suffering with FBSS, the pain is often much worse than it was prior to their surgery. Many FBSS patients are disabled, isolated, and heavily medicated. Research suggests that...
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