In the digital age, neck pain has become increasingly common, thanks largely to the hours spent in front of computers and phones. This modern-day ailment, often referred to as "tech neck," arises from the strain of looking down at screens or poor posture, leading to discomfort and stiffness in the neck area.
At Discover Chiropractic | Northern Michigan Spine, we understand that your life cannot simply pause for pain. That's why we're committed to helping you find relief and get back to your daily activities without the nagging discomfort. Our holistic approach not only addresses the symptoms but also the root cause of your neck pain. Through personalized treatments, including spinal adjustments, postural advice, and ergonomic recommendations, we help align your spine and educate you on how to maintain a healthy posture, minimizing the stress on your neck.
Take a positive step towards better neck health and comfort in the computer era. Let us help you adjust your posture, not your life. Contact us today for a consultation and say goodbye to that troublesome tech neck! We take specialized on-site digital xrays.
At Discover Chiropractic | Northern Michigan Spine, we understand that your life cannot simply pause for pain. That's why we're committed to helping you find relief and get back to your daily activities without the nagging discomfort. Our holistic approach not only addresses the symptoms but also the root cause of your neck pain. Through personalized treatments, including spinal adjustments, postural advice, and ergonomic recommendations, we help align your spine and educate you on how to maintain a healthy posture, minimizing the stress on your neck.
Take a positive step towards better neck health and comfort in the computer era. Let us help you adjust your posture, not your life. Contact us today for a consultation and say goodbye to that troublesome tech neck! We take specialized on-site digital xrays.
FAQ Neck Questions
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What is spinal fusion anyway? Why would someone choose neck surgery?When patients go in for continual neck and low back pain, they could be found to have chronic pain problems or degenerative disc disease, problems that won’t go away on their own. Instead of leaving them untreated and surely allowing the pain to get worse, spinal fusion surgery is often recommended. This surgery is done by fusing certain segments of the spine together, typically with bone and/or hardware, in order to prevent motion from that particular spinal segment. The idea is that, with little to no motion, further erosion and increased pain cannot occur.
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How well does this surgery work? What is the success rate?
This answer is a bit more complicated because the research has shown that the success rate for spinal fusion is largely dependent on the reason someone needs surgery in the first place. In the largest published investigation to date, researchers looked at the results of 65 studies and more than 300,000 patients and found that the success rates were variable; there wasn’t, in this study, a definitive answer on the success rate of spinal fusion for surgical patients with low back pain, versus patients with low back pain who opted out of surgery (1). Furthermore, there was no difference in pain levels between those who underwent spinal fusion and those who did not. For patients who had a slipped vertebra (otherwise known as spondylolisthesis), the spinal fusion procedure did have greater success; however, most patients who pursue spinal surgery are not in that category, but instead have chronic neck pain or low back pain. The research shows that, for these patients that make up the majority, the fusion surgery did not make any distinguishable improvements upon their way of life.
How serious is spinal fusion? Is it a major surgery?
In a word, yes. Because complications resulting from spinal fusion are common, this procedure is considered major surgery. Research demonstrates that surgeons can underestimate complications (3), and that the serious complication rate of spinal surgery is 10-24%, according to an analysis that reviewed five larger studies on the same subject (4). Even when minimally invasive fusions were used, which are comprised of smaller incisions, the reported complication rate was 19%, with some studies reporting fusion complication rates as high as 31% (10). Side effects from spinal fusion can also include nerve damage and infection, among other problems that can lead to a need for more surgery.
How will I know if my spinal fusion procedure creates complications? What are the symptoms I should look out for?
An unfortunate and major complication of spinal fusion surgery is an overall failure of the procedure. Spinal fusion can fail, and there are a few main ways that happens, to include:
➜ Non-union: If the segment being fused with the bone fails to grow together, this is called “non-union.” The rate at which non-union occurs is highly dependent upon the type of spinal fusion surgery performed. If a procedure requires more bone, such as a posterior-lateral fusion, non-union rates can be as high as 26 – 36% (8,9)
➜ Hardware that loosens or breaks, or pain resulting from hardware used: These hardware-centric complications are a common reason that second surgeries need to be performed after the initial fusion. Overall, roughly 13% of patients undergoing fusion because of low-back problems require a second surgery (11).
➜ Adjacent segment disease (ASD): ASD is caused by excessive force on vertebral levels above or below the fusion area, causing them to be worn out because of the immobile fusion (12). It is estimated that as many as 12% of patients will develop ASD within two years of their spinal fusion procedure (16), and 2 – 4% of patients will develop this problem for every year post-fusion, for example, at 5 years from the fusion date, 20% of patients will have developed ASD (17).
➜ Non-union: If the segment being fused with the bone fails to grow together, this is called “non-union.” The rate at which non-union occurs is highly dependent upon the type of spinal fusion surgery performed. If a procedure requires more bone, such as a posterior-lateral fusion, non-union rates can be as high as 26 – 36% (8,9)
➜ Hardware that loosens or breaks, or pain resulting from hardware used: These hardware-centric complications are a common reason that second surgeries need to be performed after the initial fusion. Overall, roughly 13% of patients undergoing fusion because of low-back problems require a second surgery (11).
➜ Adjacent segment disease (ASD): ASD is caused by excessive force on vertebral levels above or below the fusion area, causing them to be worn out because of the immobile fusion (12). It is estimated that as many as 12% of patients will develop ASD within two years of their spinal fusion procedure (16), and 2 – 4% of patients will develop this problem for every year post-fusion, for example, at 5 years from the fusion date, 20% of patients will have developed ASD (17).
Ready to find relief?
Life is too short to live in pain. If you’ve been recommended spine surgery, we want to provide you an alternative to spinal fusion that minimizes complications and ensures optimal and lasting results. Take advantage of our innovative treatments that help people just like you avoid joint replacement and other invasive surgeries, allowing them to get back to doing the activities they love, faster and without surgery.
ON-SITE DIGITAL XRAY
Meet The Doctor
Dr. Wegmann is a Doctor of Chiropractic, graduating on the Dean’s List from the world’s most prestigious chiropractic school; Palmer College of Chiropractic. Dr. MJ Wegmann and his wife Dr. Kallie Wegmann founded Discover Chiropractic in 2004. With just shy of 20 years in practice, there is a lot of experience with neck and headache problems.
Dr. Wegmann utilizes a contemporary, evidence-based chiropractic technique called CBP; Chiropractic Bio-Physics. CBP is the most published technique within the Index Medicus in the history of chiropractic. CBP has more published papers in peer-reviewed journals than all other techniques combined.
Spinal Correction Certification
It’s an unfortunate scientific fact that a spine out of alignment deteriorates far more rapidly than a spine in alignment. If your spine is in it’s appropriate position, it will actually experience little if any degeneration at all. Your spine was designed to work within the laws of gravity and last a very, very long time in good health. Because the spine houses your nervous system; a healthy spine = healthy muscles, organs, and even effects mood. Therefore, a spine out of alignment can do more than just hurt or develop arthritis, studies show it also leads to sickness and disease.
Using the models published in the Index Medicus of a normal, healthy spine and nervous system, Maximized Living doctors are certified in techniques designed to correct the spine or restore it back to normal. These techniques offer safe, comprehensive methods that rehabilitate the spine and associated soft tissues.
While some types of care may help you feel better, they don’t offer any real proof the spine and nervous system improved in structure and function. On the other hand, the most exciting part of the type of care our doctors provide is that you’ll not only subjectively improve, but objectively you’ll see that you’re body is actually healthier.
Maximized Living doctors certified in spinal correction utilize x-rays for diagnosing along with other types of tests like range of motion and muscle and thermal scans. This allows the doctor and patient to visualize structural improvement as well as analyze functional progress.
Through both in-office and home care programs, the techniques that are taught allow for faster correction and even some level of re-generation. To make sure the process is successful and not hard to duplicate, we offer both physical and on-line support.
There are several good techniques in Chiropractic. We believe that the best ones offer spinal correction so we’ve made sure ML doctors are trained and ready to gently, safely, and effectively help you reach your health potential.
Nutrition Certification
With growing disease rates and rising health care costs, the current state of North Americans’ health in very poor – and all experts agree that poor nutrition is one of the major causes of the crisis. Diabetes, cancer, heart disease, and obesity are just a few of the hundreds of North American illnesses that have been shown to improve through better nutrition.
Maximized Living doctors are committed to teaching their patients specifically how to avoid dangers of the modern food supply. Therefore, it’s standard that each of our doctors is certified in nutrition.
The Maximized Living Nutrition Plans our doctors are trained in are helping hundreds of thousands of people reach their wellness goals. These goals include helping people reach their ideal weight and proper percentage of body fat and most importantly, find true health that is sustainable forever.
We’ve utilized thousands of resources over the past decade to pinpoint the most cutting edge, vital nutritional principles known today. More than that, our offices are “Living laboratories” that have proven what we do works to bring about the most desirable health benefits for people from every walk of life.
Maximized Living doctors attend 8 hours of continuing education each year in the field of clinical nutrition, studying the most advanced principles and current research in this field. Their training makes them natural experts in weight loss, nutritional supplementation, and hormone-based diets to optimize health.
As a patient, your doctor is prepared to identify your individual nutritional needs and recommend specific plans to address them. In conjunction with the highest level of patient care, your ML doctor will lead several seminars and workshops each year to assist you in transforming your lifestyle and nutrition habits.
Maximized Living Doctors Certified in Nutrition:
Dr. Wegmann utilizes a contemporary, evidence-based chiropractic technique called CBP; Chiropractic Bio-Physics. CBP is the most published technique within the Index Medicus in the history of chiropractic. CBP has more published papers in peer-reviewed journals than all other techniques combined.
Spinal Correction Certification
It’s an unfortunate scientific fact that a spine out of alignment deteriorates far more rapidly than a spine in alignment. If your spine is in it’s appropriate position, it will actually experience little if any degeneration at all. Your spine was designed to work within the laws of gravity and last a very, very long time in good health. Because the spine houses your nervous system; a healthy spine = healthy muscles, organs, and even effects mood. Therefore, a spine out of alignment can do more than just hurt or develop arthritis, studies show it also leads to sickness and disease.
Using the models published in the Index Medicus of a normal, healthy spine and nervous system, Maximized Living doctors are certified in techniques designed to correct the spine or restore it back to normal. These techniques offer safe, comprehensive methods that rehabilitate the spine and associated soft tissues.
While some types of care may help you feel better, they don’t offer any real proof the spine and nervous system improved in structure and function. On the other hand, the most exciting part of the type of care our doctors provide is that you’ll not only subjectively improve, but objectively you’ll see that you’re body is actually healthier.
Maximized Living doctors certified in spinal correction utilize x-rays for diagnosing along with other types of tests like range of motion and muscle and thermal scans. This allows the doctor and patient to visualize structural improvement as well as analyze functional progress.
Through both in-office and home care programs, the techniques that are taught allow for faster correction and even some level of re-generation. To make sure the process is successful and not hard to duplicate, we offer both physical and on-line support.
There are several good techniques in Chiropractic. We believe that the best ones offer spinal correction so we’ve made sure ML doctors are trained and ready to gently, safely, and effectively help you reach your health potential.
Nutrition Certification
With growing disease rates and rising health care costs, the current state of North Americans’ health in very poor – and all experts agree that poor nutrition is one of the major causes of the crisis. Diabetes, cancer, heart disease, and obesity are just a few of the hundreds of North American illnesses that have been shown to improve through better nutrition.
Maximized Living doctors are committed to teaching their patients specifically how to avoid dangers of the modern food supply. Therefore, it’s standard that each of our doctors is certified in nutrition.
The Maximized Living Nutrition Plans our doctors are trained in are helping hundreds of thousands of people reach their wellness goals. These goals include helping people reach their ideal weight and proper percentage of body fat and most importantly, find true health that is sustainable forever.
We’ve utilized thousands of resources over the past decade to pinpoint the most cutting edge, vital nutritional principles known today. More than that, our offices are “Living laboratories” that have proven what we do works to bring about the most desirable health benefits for people from every walk of life.
Maximized Living doctors attend 8 hours of continuing education each year in the field of clinical nutrition, studying the most advanced principles and current research in this field. Their training makes them natural experts in weight loss, nutritional supplementation, and hormone-based diets to optimize health.
As a patient, your doctor is prepared to identify your individual nutritional needs and recommend specific plans to address them. In conjunction with the highest level of patient care, your ML doctor will lead several seminars and workshops each year to assist you in transforming your lifestyle and nutrition habits.
Maximized Living Doctors Certified in Nutrition:
- Fully understand the dangers in the current food supply and are able to help their patients understand and avoid them.
- Are able to identify an individual’s current nutritional deficiencies and needs and are able to develop a customized plan to address these needs.
- Have extensive training on the most effective nutritional strategies for sustainable weight loss. While many other weight loss plans may elicit some degree of short term weight loss, they are not designed for long term health. Maximized Living doctors focus on the long term best interests of each individual. These weight loss strategies have resulted in thousands of people losing the necessary weight while being able to maintain the changes to build a healthy future.
- Have the ability to design nutritional changes and recommendations that can balance and regulate hormones for weight loss and for specific health challenges.
- Design short and long term, specific nutritional strategies for preventing and even reversing diseases like diabetes, heart disease, and cancer.
- Continually receive the most up to date, cutting edge research on nutrition, weight loss, hormones, and disease prevention.
- Can provide individual counseling, tools, workshops, resources, and practical guides to assist people in applying the necessary changes to their current lifestyles.
- Are trained to offer specific supplementation recommendations tailored to an individual’s current needs
- Have access to the Maximized Living network of resources.
References
(1) Yavin D1, Casha S1, Wiebe S, Feasby TE, Clark C, Isaacs A, Holroyd-Leduc J, Hurlbert RJ, Quan H, Nataraj A, Sutherland GR, Jette N. Lumbar Fusion for Degenerative Disease: A Systematic Review and Meta-Analysis. Neurosurgery. 2017 May 1;80(5):701-715. doi: 10.1093/neuros/nyw162.
(2) Wang X, Borgman B, Vertuani S, Nilsson J. A systematic literature review of time to return to work and narcotic use after lumbar spinal fusion using minimal invasive and open surgery techniques. BMC Health Serv Res. 2017;17(1):446. Published 2017 Jun 27. doi: 10.1186/s12913-017-2398-6
(3) Ratliff JK, Lebude B, Albert T, Anene-Maidoh T, Anderson G, Dagostino P, Maltenfort M, Hilibrand A, Sharan A, Vaccaro AR. Complications in spinal surgery: comparative survey of spine surgeons and patients who underwent spinal surgery. J Neurosurg Spine. 2009 Jun;10(6):578-84. doi: 10.3171/2009.2.SPINE0935.
(4) Zaina F, Tomkins-Lane C, Carragee E, Negrini S. Surgical versus non-surgical treatment for lumbar spinal stenosis. Cochrane Database Syst Rev. 2016;2016(1):CD010264. Published 2016 Jan 29. doi:10.1002/14651858.CD010264.pub2
(5) Adogwa O, Parker SL, Bydon A, Cheng J, McGirt MJ. Comparative effectiveness of minimally invasive versus open transforaminal lumbar interbody fusion: 2-year assessment of narcotic use, return to work, disability, and quality of life. J Spinal Disord Tech. 2011;24(8):479–484. https://www.ncbi.nlm.nih.gov/pubmed/21336176
(6) Parker SL, Adogwa O, Bydon A, Cheng J, McGirt MJ. Cost-effectiveness of minimally invasive versus open transforaminal lumbar interbody fusion for degenerative spondylolisthesis associated low-back and leg pain over two years. World Neurosurg. 2012 Jul;78(1-2):178-84. doi: 10.1016/j.wneu.2011.09.013.
(7) Parker SL, Mendenhall SK, Shau DN, Zuckerman SL, Godil SS, Cheng JS, et al. Minimally invasive versus open Transforaminal lumbar Interbody fusion for degenerative Spondylolisthesis: Comparative effectiveness and cost-utility analysis. World Neurosurg. 2013. https://www.ncbi.nlm.nih.gov/pubmed/23321379
(8) Herkowitz HN, Kurz LT. Degenerative lumbar spondylolisthesis with spinal stenosis. A prospective study comparing decompression with decompression and intertransverse process arthrodesis. J Bone Joint Surg Am. 1991 Jul; 73(6):802-8. https://www.ncbi.nlm.nih.gov/pubmed/2071615/
(9) Tsutsumimoto T, Shimogata M, Yoshimura Y, Misawa H. Union versus nonunion after posterolateral lumbar fusion: a comparison of long-term surgical outcomes in patients with degenerative lumbar spondylolisthesis. Eur Spine J. 2008;17(8):1107–1112. doi: 10.1007/s00586-008-0695-9
(10) Joseph JR, Smith BW, La Marca F, Park P. Comparison of complication rates of minimally invasive transforaminal lumbar interbody fusion and lateral lumbar interbody fusion: a systematic review of the literature. Neurosurg Focus. 2015 Oct;39(4):E4. doi: 10.3171/2015.7.FOCUS15278.
(11) Greiner-Perth R, Boehm H, Allam Y, Elsaghir H, Franke J. Reoperation rate after instrumented posterior lumbar interbody fusion: a report on 1680 cases. Spine (Phila Pa 1976). 2004 Nov 15;29(22):2516-20. https://www.ncbi.nlm.nih.gov/pubmed/15543064
(12) Saavedra-Pozo FM, Deusdara RA, Benzel EC. Adjacent segment disease perspective and review of the literature. Ochsner J. 2014;14(1):78–83. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3963057/
(13) MacDowall A, Canto Moreira N, Marques C, Skeppholm M, Lindhagen L, Robinson Y, Löfgren H, Michaëlsson K, Olerud C. Artificial disc replacement versus fusion in patients with cervical degenerative disc disease and radiculopathy: a randomized controlled trial with 5-year outcomes. J Neurosurg Spine. 2019 Jan 11;30(3):323-331. doi: 10.3171/2018.9.SPINE18659.
(14) Yang X, Janssen T, Arts MP, Peul WC, Vleggeert-Lankamp CLA. Radiological follow-up after implanting cervical disc prosthesis in anterior discectomy: a systematic review. Spine J. 2018 Sep;18(9):1678-1693. doi: 10.1016/j.spinee.2018.04.021.
(15) MacDowall A, Skeppholm M, Lindhagen L, Robinson Y, Löfgren H, Michaëlsson K, Olerud C. Artificial disc replacement versus fusion in patients with cervical degenerative disc disease with radiculopathy: 5-year outcomes from the National Swedish Spine Register. J Neurosurg Spine. 2018 Nov 2;30(2):159-167. doi: 10.3171/2018.7.SPINE18657.
(16) Zhong ZM1 Deviren V, Tay B, Burch S, Berven SH. Adjacent segment disease after instrumented fusion for adult lumbar spondylolisthesis: Incidence and risk factors. Clin Neurol Neurosurg. 2017 May;156:29-34. doi: 10.1016/j.clineuro.2017.02.020.
(17) Tobert DG, Antoci V, Patel SP, Saadat E, Bono CM. Adjacent Segment Disease in the Cervical and Lumbar Spine. Clin Spine Surg. 2017 Apr;30(3):94-101. doi: 10.1097/BSD.0000000000000442.
(18) Centeno C, Markle J, Dodson E, et al. The use of lumbar epidural injections for treatment of radicular pain. J Exp Orthop. 2017;4(1):38. Published 2017 Nov 25. doi: 10.1186/s40634-017-0113-5
(2) Wang X, Borgman B, Vertuani S, Nilsson J. A systematic literature review of time to return to work and narcotic use after lumbar spinal fusion using minimal invasive and open surgery techniques. BMC Health Serv Res. 2017;17(1):446. Published 2017 Jun 27. doi: 10.1186/s12913-017-2398-6
(3) Ratliff JK, Lebude B, Albert T, Anene-Maidoh T, Anderson G, Dagostino P, Maltenfort M, Hilibrand A, Sharan A, Vaccaro AR. Complications in spinal surgery: comparative survey of spine surgeons and patients who underwent spinal surgery. J Neurosurg Spine. 2009 Jun;10(6):578-84. doi: 10.3171/2009.2.SPINE0935.
(4) Zaina F, Tomkins-Lane C, Carragee E, Negrini S. Surgical versus non-surgical treatment for lumbar spinal stenosis. Cochrane Database Syst Rev. 2016;2016(1):CD010264. Published 2016 Jan 29. doi:10.1002/14651858.CD010264.pub2
(5) Adogwa O, Parker SL, Bydon A, Cheng J, McGirt MJ. Comparative effectiveness of minimally invasive versus open transforaminal lumbar interbody fusion: 2-year assessment of narcotic use, return to work, disability, and quality of life. J Spinal Disord Tech. 2011;24(8):479–484. https://www.ncbi.nlm.nih.gov/pubmed/21336176
(6) Parker SL, Adogwa O, Bydon A, Cheng J, McGirt MJ. Cost-effectiveness of minimally invasive versus open transforaminal lumbar interbody fusion for degenerative spondylolisthesis associated low-back and leg pain over two years. World Neurosurg. 2012 Jul;78(1-2):178-84. doi: 10.1016/j.wneu.2011.09.013.
(7) Parker SL, Mendenhall SK, Shau DN, Zuckerman SL, Godil SS, Cheng JS, et al. Minimally invasive versus open Transforaminal lumbar Interbody fusion for degenerative Spondylolisthesis: Comparative effectiveness and cost-utility analysis. World Neurosurg. 2013. https://www.ncbi.nlm.nih.gov/pubmed/23321379
(8) Herkowitz HN, Kurz LT. Degenerative lumbar spondylolisthesis with spinal stenosis. A prospective study comparing decompression with decompression and intertransverse process arthrodesis. J Bone Joint Surg Am. 1991 Jul; 73(6):802-8. https://www.ncbi.nlm.nih.gov/pubmed/2071615/
(9) Tsutsumimoto T, Shimogata M, Yoshimura Y, Misawa H. Union versus nonunion after posterolateral lumbar fusion: a comparison of long-term surgical outcomes in patients with degenerative lumbar spondylolisthesis. Eur Spine J. 2008;17(8):1107–1112. doi: 10.1007/s00586-008-0695-9
(10) Joseph JR, Smith BW, La Marca F, Park P. Comparison of complication rates of minimally invasive transforaminal lumbar interbody fusion and lateral lumbar interbody fusion: a systematic review of the literature. Neurosurg Focus. 2015 Oct;39(4):E4. doi: 10.3171/2015.7.FOCUS15278.
(11) Greiner-Perth R, Boehm H, Allam Y, Elsaghir H, Franke J. Reoperation rate after instrumented posterior lumbar interbody fusion: a report on 1680 cases. Spine (Phila Pa 1976). 2004 Nov 15;29(22):2516-20. https://www.ncbi.nlm.nih.gov/pubmed/15543064
(12) Saavedra-Pozo FM, Deusdara RA, Benzel EC. Adjacent segment disease perspective and review of the literature. Ochsner J. 2014;14(1):78–83. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3963057/
(13) MacDowall A, Canto Moreira N, Marques C, Skeppholm M, Lindhagen L, Robinson Y, Löfgren H, Michaëlsson K, Olerud C. Artificial disc replacement versus fusion in patients with cervical degenerative disc disease and radiculopathy: a randomized controlled trial with 5-year outcomes. J Neurosurg Spine. 2019 Jan 11;30(3):323-331. doi: 10.3171/2018.9.SPINE18659.
(14) Yang X, Janssen T, Arts MP, Peul WC, Vleggeert-Lankamp CLA. Radiological follow-up after implanting cervical disc prosthesis in anterior discectomy: a systematic review. Spine J. 2018 Sep;18(9):1678-1693. doi: 10.1016/j.spinee.2018.04.021.
(15) MacDowall A, Skeppholm M, Lindhagen L, Robinson Y, Löfgren H, Michaëlsson K, Olerud C. Artificial disc replacement versus fusion in patients with cervical degenerative disc disease with radiculopathy: 5-year outcomes from the National Swedish Spine Register. J Neurosurg Spine. 2018 Nov 2;30(2):159-167. doi: 10.3171/2018.7.SPINE18657.
(16) Zhong ZM1 Deviren V, Tay B, Burch S, Berven SH. Adjacent segment disease after instrumented fusion for adult lumbar spondylolisthesis: Incidence and risk factors. Clin Neurol Neurosurg. 2017 May;156:29-34. doi: 10.1016/j.clineuro.2017.02.020.
(17) Tobert DG, Antoci V, Patel SP, Saadat E, Bono CM. Adjacent Segment Disease in the Cervical and Lumbar Spine. Clin Spine Surg. 2017 Apr;30(3):94-101. doi: 10.1097/BSD.0000000000000442.
(18) Centeno C, Markle J, Dodson E, et al. The use of lumbar epidural injections for treatment of radicular pain. J Exp Orthop. 2017;4(1):38. Published 2017 Nov 25. doi: 10.1186/s40634-017-0113-5