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Systematic literature review of imaging features of spinal degeneration in asymptomatic populations.AJNR. American Journal of Neuroradiology Apr 2015Degenerative changes are commonly found in spine imaging but often occur in pain-free individuals as well as those with back pain. We sought to estimate the prevalence,... (Review)
Review
BACKGROUND AND PURPOSE
Degenerative changes are commonly found in spine imaging but often occur in pain-free individuals as well as those with back pain. We sought to estimate the prevalence, by age, of common degenerative spine conditions by performing a systematic review studying the prevalence of spine degeneration on imaging in asymptomatic individuals.
MATERIALS AND METHODS
We performed a systematic review of articles reporting the prevalence of imaging findings (CT or MR imaging) in asymptomatic individuals from published English literature through April 2014. Two reviewers evaluated each manuscript. We selected age groupings by decade (20, 30, 40, 50, 60, 70, 80 years), determining age-specific prevalence estimates. For each imaging finding, we fit a generalized linear mixed-effects model for the age-specific prevalence estimate clustering in the study, adjusting for the midpoint of the reported age interval.
RESULTS
Thirty-three articles reporting imaging findings for 3110 asymptomatic individuals met our study inclusion criteria. The prevalence of disk degeneration in asymptomatic individuals increased from 37% of 20-year-old individuals to 96% of 80-year-old individuals. Disk bulge prevalence increased from 30% of those 20 years of age to 84% of those 80 years of age. Disk protrusion prevalence increased from 29% of those 20 years of age to 43% of those 80 years of age. The prevalence of annular fissure increased from 19% of those 20 years of age to 29% of those 80 years of age.
CONCLUSIONS
Imaging findings of spine degeneration are present in high proportions of asymptomatic individuals, increasing with age. Many imaging-based degenerative features are likely part of normal aging and unassociated with pain. These imaging findings must be interpreted in the context of the patient's clinical condition.
Topics: Aging; Back Pain; Female; Humans; Intervertebral Disc Degeneration; Magnetic Resonance Imaging; Male; Middle Aged; Prevalence; Tomography, X-Ray Computed
PubMed: 25430861
DOI: 10.3174/ajnr.A4173 -
Clinical Oral Investigations Feb 2021The aim of this systematic review was to evaluate the prevalence of temporomandibular joint disorders (TMJD) among the general population. (Meta-Analysis)
Meta-Analysis
OBJECTIVES
The aim of this systematic review was to evaluate the prevalence of temporomandibular joint disorders (TMJD) among the general population.
MATERIALS AND METHODS
Five main electronic databases and three grey literature were searched to identify observational studies in which TMJD was diagnosed using the research diagnostic criteria (RDC/TMD) or diagnostic criteria (DC/TMD). The studies were blindly selected by two reviewers based on eligibility criteria. Risk of bias (RoB) was assessed using the Joanna Briggs Institute Critical Appraisal Checklist, and the "R" Statistics software was used to perform meta-analyses.
RESULTS
From 2741 articles, 21 were included. Ten studies were judged at low RoB, seven at moderate, and four at high. The TMJD investigated were as follows: arthralgia, disk displacement (DDs) with reduction (DDwR), DDwR with intermittent locking, DDs without reduction (DDwoR) with limited opening, DDwoR without limited opening, degenerative joint disease (DJD), osteoarthritis, osteoarthrosis, and subluxation. The main results from prevalence overall meta-analyses for adults/elderly are as follows: TMJD (31.1%), DDs (19.1%), and DJD (9.8%). Furthermore, for children/adolescents are as follows: TMJD (11.3%), DDs (8.3%), and DJD (0.4%). Considering the individual diagnosis meta-analyses, the most prevalent TMJD is DDwR for adults/elderly (25.9%) and children/adolescents (7.4%).
CONCLUSIONS
The overall prevalence of TMJD was approximately 31% for adults/elderly and 11% for children/adolescents, and the most prevalent TMJD was DDwR.
CLINICAL RELEVANCE
Knowledge about the frequency of TMJD can encourage dentists to consider appropriate strategies for early and correct diagnosis and, if need be, correct management.
Topics: Adolescent; Adult; Aged; Child; Humans; Joint Dislocations; Prevalence; Temporomandibular Joint; Temporomandibular Joint Disorders
PubMed: 33409693
DOI: 10.1007/s00784-020-03710-w -
Spine Apr 2021Systematic review and meta-analysis. (Comparative Study)
Comparative Study Meta-Analysis
STUDY DESIGN
Systematic review and meta-analysis.
OBJECTIVE
To give a systematic overview of effectiveness of percutaneous transforaminal endoscopic discectomy (PTED) compared with open microdiscectomy (OM) in the treatment of lumbar disk herniation (LDH).
SUMMARY OF BACKGROUND DATA
The current standard procedure for the treatment of sciatica caused by LDH, is OM. PTED is an alternative surgical technique which is thought to be less invasive. It is unclear if PTED has comparable outcomes compared with OM.
METHODS
Multiple online databases were systematically searched up to April 2020 for randomized controlled trials and prospective studies comparing PTED with OM for LDH. Primary outcomes were leg pain and functional status. Pooled effect estimates were calculated for the primary outcomes only and presented as standard mean differences (SMD) with their 95% confidence intervals (CI) at short (1-day postoperative), intermediate (3-6 months), and long-term (12 months).
RESULTS
We identified 2276 citations, of which eventually 14 studies were included. There was substantial heterogeneity in effects on leg pain at short term. There is moderate quality evidence suggesting no difference in leg pain at intermediate (SMD 0.05, 95% CI -0.10-0.21) and long-term follow-up (SMD 0.11, 95% CI -0.30-0.53). Only one study measured functional status at short-term and reported no differences. There is moderate quality evidence suggesting no difference in functional status at intermediate (SMD -0.09, 95% CI -0.24-0.07) and long-term (SMD -0.11, 95% CI -0.45-0.24).
CONCLUSION
There is moderate quality evidence suggesting no difference in leg pain or functional status at intermediate and long-term follow-up between PTED and OM in the treatment of LDH. High quality, robust studies reporting on clinical outcomes and cost-effectiveness on the long term are lacking.Level of Evidence: 2.
Topics: Cost-Benefit Analysis; Diskectomy, Percutaneous; Endoscopy; Humans; Intervertebral Disc Degeneration; Intervertebral Disc Displacement; Lumbar Vertebrae; Microsurgery; Pain Measurement; Prospective Studies; Randomized Controlled Trials as Topic; Treatment Outcome
PubMed: 33290374
DOI: 10.1097/BRS.0000000000003843 -
Clinical Rehabilitation Jan 2020To evaluate the effectiveness of traction in improving low back pain, functional outcome, and disk morphology in patients with herniated intervertebral disks. (Meta-Analysis)
Meta-Analysis
OBJECTIVE
To evaluate the effectiveness of traction in improving low back pain, functional outcome, and disk morphology in patients with herniated intervertebral disks.
DATA SOURCE
PubMed, Scopus, Embase, and the Cochrane Library were searched from the earliest record to July 2019.
REVIEW METHODS
We included randomized control trials which (1) involved adult patients with low back pain associated with herniated disk confirmed by magnetic resonance imaging or computed tomography, (2) compared lumbar traction to sham or no traction, and (3) provided quantitative measurements of pain and function before and after intervention. Methodological quality was assessed using the physiotherapy evidence database (PEDro) scale and Cochrane risk of bias assessment.
RESULTS
Initial searches for literature yielded 3015 non-duplicated records. After exclusion based on the title, abstract, and full-text review, 7 articles involving 403 participants were included for quantitative analysis. Compared with the control group, the participants in the traction group showed significantly greater improvements in pain and function in the short term, with standard mean differences of 0.44 (95% confidence interval (CI): 0.11-0.77) and 0.42 (95% CI: 0.08-0.76), respectively. The standard mean differences were not significant to support the long-term effects on pain and function, nor the effects on herniated disk size.
CONCLUSION
Compared with sham or no traction, lumbar traction exhibited significantly more pain reduction and functional improvements in the short term, but not in the long term. There is insufficient evidence to support the effect of lumbar traction on herniated disk size reduction.
Topics: Adult; Humans; Intervertebral Disc Displacement; Low Back Pain; Physical Therapy Modalities; Traction
PubMed: 31456418
DOI: 10.1177/0269215519872528 -
Archives of Gerontology and Geriatrics Nov 2023The purpose of this study was to systematically assess existing studies to demonstrate the association between potentially inappropriate medication (PIM) and frailty. (Meta-Analysis)
Meta-Analysis Review
OBJECTIVES
The purpose of this study was to systematically assess existing studies to demonstrate the association between potentially inappropriate medication (PIM) and frailty.
DESIGN
Systematic review and meta-analysis.
METHODS
We searched major electronic databases (PubMed, Web of Science, the Cochrane Library, Embase, CINHAL, PsycInfo, China National Knowledge Infrastructure, China Biology Medicine disk, Weipu, and Wanfang) from their inception until February 25, 2023 (data updated on May 4, 2023), for observational studies investigating PIM and frailty. I was used to measure the heterogeneity between studies quantitatively. A random effect model calculated pooled effect size owing to high heterogeneity. Subgroup analysis was conducted to explore sources of heterogeneity. Additionally, the studies' quality was evaluated using the Newcastle Ottawa Scale (a modified Newcastle Ottawa Scale was used to evaluate cross-sectional studies).
RESULTS
Twenty-four studies were included for systematic review, 14 of which were included in the meta-analysis. After pooling the effect size, the odds ratio with PIM as the dependent variable was 1.12 (95%CI: 1.01-1.25), and that with frailty as the dependent variable was 1.75 (95%CI: 1.25-2.43), indicating a bidirectional association between PIM and frailty.
CONCLUSIONS
PIM and frailty interact with each other and have a bidirectional association, thus providing additional information for early clinical identification and prevention of frailty, and medication safety management.
Topics: Humans; Aged; Frailty; Potentially Inappropriate Medication List; Cross-Sectional Studies; China
PubMed: 37311369
DOI: 10.1016/j.archger.2023.105087 -
Journal of Oral Rehabilitation Dec 2021To assess the general subjective sleep quality in individuals with and without TMD, and its distribution among the TMD diagnostic groups. (Meta-Analysis)
Meta-Analysis Review
STUDY OBJECTIVES
To assess the general subjective sleep quality in individuals with and without TMD, and its distribution among the TMD diagnostic groups.
METHODS
A systematic review search was performed in Pubmed/MEDLINE, Embase, LILACS, Web of Science, SciELO, CINAHL and Cochrane Central as well as in the grey literature. Observational studies published since 1992 which used either the DC/TMD or RDC/TMD for TMD diagnosis and either the PSQI, SAQ or ESS questionnaires for sleep assessment were included. Articles selected for meta-analysis underwent quality, heterogeneity and publication bias evaluation.
RESULTS
A total of 1071 articles were found by online search, and 10 articles were added manually. For full-text reading, 138 papers were selected. Thirty-six articles were included in the final review, and 19 in the meta-analysis (PSQI only). Subjective sleep quality was shown to be associated with all RDC/TMD or DC/TMD Axis I diagnostic groups: muscle disorders, arthralgia/osteoarthritis/osteoarthrosis and disk displacements; with the highest association in the first two groups, and the lowest in the last one. A 4.45 times increased odds ratio of TMD prevalence was found for individuals who presented poor subjective sleep quality.
CONCLUSION
Subjective sleep quality should be considered in the management of TMD.
Topics: Arthralgia; Humans; Observational Studies as Topic; Osteoarthritis; Sleep; Surveys and Questionnaires; Temporomandibular Joint Disorders
PubMed: 34599524
DOI: 10.1111/joor.13265 -
Journal of Oral and Maxillofacial... Oct 2021Temporomandibular joint disc repositioning surgery is 1 of the treatment modalities used for treating anterior disc displacement of the temporomandibular joint. The... (Review)
Review
PURPOSE
Temporomandibular joint disc repositioning surgery is 1 of the treatment modalities used for treating anterior disc displacement of the temporomandibular joint. The procedure can be arthroscopic disc repositioning or open disc repositioning. This systematic review measured and compared the efficacy of arthroscopic and open disc repositioning procedures.
MATERIALS AND METHODS
The authors conducted a systematic review without meta-analysis by performing a literature search electronically and manually covering arthroscopic and open disc repositioning studies published up to July 2020 in Pubmed, Embase, and Cochrane databases. Surgical outcomes such as changes in maximal incisal opening (MIO) and pain scores, temporomandibular joint noises, diet consistency, malocclusion, and postoperative complications were extracted and analyzed.
RESULTS
A total of 28 studies were included in the review and split into those assessing open disc repositioning (n = 13) and those assessing arthroscopic disc repositioning (n = 15). The average age of the study patients in the included studies was 31.5 ± 6.8 years, and women represented 83.3% of the study population. Both arthroscopic and open disc repositioning showed to be efficacious in reducing pain and increasing MIO. Due to heterogeneity in study designs and data reporting between the studies, no quantitative analysis was performed, and the groups were not directly compared.
CONCLUSIONS
Both arthroscopic and open disc repositioning led to significant improvements in clinical outcomes based on pain scores and MIO. This study highlights the need for comparative studies of the 2 techniques with well-documented case selection including standardized diagnosis based on Wilkes stages and rigorous outcomes assessment including patient reported outcomes.
Topics: Adult; Arthroscopy; Female; Humans; Joint Dislocations; Magnetic Resonance Imaging; Range of Motion, Articular; Temporomandibular Joint; Temporomandibular Joint Disc; Treatment Outcome; Young Adult
PubMed: 33713607
DOI: 10.1016/j.joms.2021.02.007 -
Journal of Glaucoma May 2016Numerous studies have detected choroidal thickness abnormalities and changes in open-angle glaucoma (OAG), as measured by enhanced depth imaging optical coherence... (Meta-Analysis)
Meta-Analysis Review
PURPOSE
Numerous studies have detected choroidal thickness abnormalities and changes in open-angle glaucoma (OAG), as measured by enhanced depth imaging optical coherence tomography technologies, but the results have not always been consistent. Therefore, a meta-analysis and systematic review was performed to evaluate the choroidal thickness in OAG.
MATERIALS AND METHODS
A comprehensive literature search was performed on Medline, Embase, ISI Web of Science, Cochrane Central Register of Controlled Trials, Google Scholar, and Chinese databases including Wangfang and CNKI (China National Knowledge Infrastructure). Eligible articles were identified by reviewing the retrieved results. For continuous outcomes, we calculated the weighted mean difference (WMD) and 95% confidence interval (CI). Statistical analysis was performed using STATA 12.0 software.
RESULTS
Twenty-two case-control or cross-sectional studies were included in the present meta-analysis. The results of our study showed that there was no significant difference in subfoveal choroidal thickness between patients with OAG and controls (WMD=-7.94; 95% CI, -26.01 to 10.13; P=0.389). Similar findings were obtained for the average peripapillary choroidal thickness (WMD=-14.24; 95% CI, -30.20 to 1.73; P=0.08).
CONCLUSIONS
Our meta-analysis found no significant difference in the choroidal thickness both under the fovea and around the optic nerve head between OAG patients and controls. On the basis of the anatomic features of blood supply in optic nerve head, it is plausible that the choroidal thickness is not an appropriate parameter to evaluate the damage of OAG, and choroidal thinning may not be an important component of glaucomatous optic neuropathy.
Topics: Case-Control Studies; Choroid; Cross-Sectional Studies; Female; Glaucoma, Open-Angle; Humans; Intraocular Pressure; Male; Optic Disk; Organ Size; Tomography, Optical Coherence
PubMed: 25943737
DOI: 10.1097/IJG.0000000000000275 -
Archives of Physiotherapy Oct 2023The role of rehabilitation after surgery in patients with low back pain is well recognized. The aim of this systematic review is to summarize and update the existing... (Review)
Review
BACKGROUND
The role of rehabilitation after surgery in patients with low back pain is well recognized. The aim of this systematic review is to summarize and update the existing evidence according to the type of clinical condition and rehabilitation approach.
METHODS
This systematic review included RCTs on the effectiveness of rehabilitation after surgery for lumbar disc herniation, spinal stenosis, and spondylolisthesis. We searched the literature for randomized controlled trials indexed in MEDLINE, Embase, CINHAL, CENTRAL, Scopus, PEDro, and Web of Science databases, up to April 15, 2023. We used Cochrane Risk of Bias 2.0 tool to assess each study. We conducted a quantitative synthesis when population, intervention, control, and outcome were sufficiently homogeneous; otherwise, we conducted a qualitative analysis.
RESULTS
Forty-five studies (3.036 subjects) were included and analyzed according to the population considered: lumbar stenosis (1 trial), spondylolisthesis (3 trials), and disc herniation (41 trials). Regarding lumbar stenosis, a supervised active exercise program appears to improve outcomes related to pain, disability, and quality of life both in the short- and mid-term (1 study, n = 60). Concerning spondylolisthesis, kinesiophobia is reduced in the home exercises group compared to usual care, at 3-months follow-up (3 studies, n = 98). For disk herniation, supervised exercises are better than non-supervised exercises to reduce pain (MD -1.14; 95% CIs -1.65, -0.62; 5 trials, n = 250) and disability (SMD -0.70; 95% CIs -1.14, -0.26; 4 trials, n = 175). Supervised exercises are better than advice in reducing pain (SMD -0.91; 95% CIs -1.61, -0.21; 5 trials, n = 341) and disability (SMD -0.80; 95% CIs -1.59, -0.01; 4 trials, n = 261), in the short-term. Supervised exercises are equal to no treatment in reducing pain and disability, at 3 and 6 months after intervention (2 trials, n = 166). These results are supported by a very low to low quality of evidence.
CONCLUSIONS
Our research suggests that supervised exercise may be effective in improving patient's pain and disability after lumbar surgery, but RCTs regarding lumbar spinal stenosis and lumbar spondylolisthesis are still scarce, with significant heterogeneity of proposed interventions.
PubMed: 37845718
DOI: 10.1186/s40945-023-00175-4 -
Orthopedics Jul 2018Consensus is lacking regarding optimal surgical treatment of recurrent lumbar disk herniation. A systematic search of multiple databases was conducted for studies... (Meta-Analysis)
Meta-Analysis Review
Consensus is lacking regarding optimal surgical treatment of recurrent lumbar disk herniation. A systematic search of multiple databases was conducted for studies evaluating outcomes after treatment for recurrent lumbar disk herniation. Treatment options included decompression surgeries and fusion surgeries. Although fusion surgeries eliminated re-recurrence of disk herniation, this coincided with higher incidences of complications and reoperation. Decompression surgeries and fusion surgeries both resulted in improvements in Japanese Orthopaedic Association, Oswestry Disability Index, and visual analog scale back and leg scores postoperatively (P<.05). The complication risk profiles of decompression surgeries and fusion surgeries must be balanced with the risk of disk herniation re-recurrence, as both procedures lead to improvements in functional outcomes. [Orthopedics. 2018; 41(4):e457-e469.].
Topics: Diskectomy; Humans; Intervertebral Disc Displacement; Lumbar Vertebrae; Pain Measurement; Postoperative Complications; Postoperative Period; Recurrence; Reoperation; Spinal Fusion; Treatment Outcome
PubMed: 29940051
DOI: 10.3928/01477447-20180621-01