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Medicine Feb 2018The application of tubular microscopes discectomy (TMD) was supposed to have similar or better results than conventional microdiscectomy (CMD). However, this conclusion... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
The application of tubular microscopes discectomy (TMD) was supposed to have similar or better results than conventional microdiscectomy (CMD). However, this conclusion had not been verified by sufficient evidence. Therefore, the focus of this meta-analysis was to assess the efficiency, safety, and clinical outcome of these 2 surgical procedures for treating lumbar disk herniation (LDH).
METHODS
PubMed, Embase, and Cochrane Collaboration Central databases were searched for studies which compared the results of TMD and CMD for the treatment of LDH up to July 2017. Data analysis was conducted using RevMan 5.3. A standardized electronic form of 17 predefined criteria from the Consort statement was used for the quality assessment.
RESULTS
Eight randomized controlled trials (RCT) and 2 retrospective studies were included in this review, including 804 patients. The pooled analysis showed that there was no significant difference in operative time (P = .38), blood loss (P = .14), the length of hospital stay (P = .47), the rate of intraoperative complications (P = .79), postoperative complications (P = .16), dural tear (P = .87), the reoperation (P = .20), the short-term back visual analog scale (VAS) scores (P = .76), the long-term back VAS scores (P = .64), the short-term leg VAS scores (P = .09), the long-term leg VAS scores (P = .35), and the Oswestry disability index (ODI) scores (P = .41).
CONCLUSION
The results of this meta-analysis demonstrate that TMD and CMD are both safe and effective surgical procedures which can be recommended for treating LDH. Additionally, the conclusion should be cautiously treated, because it was reached in the context of limited amount of studies and relatively small sample size. Therefore, future studies with good design and more large samples are required to validate this conclusion.
Topics: Diskectomy; Humans; Intervertebral Disc Displacement; Lumbar Vertebrae; Microsurgery
PubMed: 29384882
DOI: 10.1097/MD.0000000000009807 -
Journal of Orthopaedic Surgery and... Sep 2023The aim of this study was to comprehensively evaluate the short-term clinical efficacy and safety of unilateral biportal endoscopic transforaminal lumbar interbody... (Meta-Analysis)
Meta-Analysis
Short-term clinical efficacy and safety of unilateral biportal endoscopic transforaminal lumbar interbody fusion versus minimally invasive transforaminal lumbar interbody fusion in the treatment of lumbar degenerative diseases: a systematic review and meta-analysis.
BACKGROUND
The aim of this study was to comprehensively evaluate the short-term clinical efficacy and safety of unilateral biportal endoscopic transforaminal lumbar interbody fusion (UBE-TLIF) versus minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF) for the treatment of lumbar degenerative diseases by meta-analysis.
METHODS
A computer-based search of PubMed, Embase, Web of Science, Cochrane Database, China National Knowledge Infrastructure (CNKI), Wanfang Database, and Chinese Science and Technology Journal Database (VIP) was conducted from the inception of the each database to April 2023. The searched literature was then screened according to strict inclusion and exclusion criteria. The critical data were extracted and analyzed using Review Manager software5.4.1. Pooled effects were calculated on the basis of data attributes by mean difference (MD) or odds ratio (OR) with 95% confidence interval (CI). The Newcastle-Ottawa Scale was used to assess the quality of the studies.
RESULTS
A total of 13 studies and 949 patients met the inclusion criteria for this meta-analysis, 445 in the UBE-LIF group and 504 in the MIS-TLIF group. UBE-TLIF was superior to MIS-TLIF in terms of intraoperative blood flow, postoperative drainage flow, duration of hospital stay, VAS score for low back pain and ODI score, but the operative time was longer than MIS-TLIF group. There were no significant differences between the two groups in terms of total complication rate, modified Macnab grading criteria, fusion rate, VAS score of leg pain, lumbar lordosis, intervertebral disk height.
CONCLUSION
Both UBE-TLIF and MIS-TLIF are effective surgical modalities for the treatment of degenerative lumbar spine diseases. They have similar treatment outcomes, but UBE-TLIF has the advantages of less intraoperative blood loss, shorter postoperative hospital stay, and faster recovery.
TRIAL REGISTRATION
This study has been registered at INPLASY.COM (No. INPLASY202320087).
Topics: Animals; Humans; Endoscopy; Lumbar Vertebrae; Minimally Invasive Surgical Procedures; Spinal Fusion; Treatment Outcome
PubMed: 37667363
DOI: 10.1186/s13018-023-04138-0 -
Pathogens (Basel, Switzerland) Sep 2022Streptococcal bacteremia that occurs during invasive dental procedures can lead to infective endocarditis (IE) in children with certain heart diseases. Prior to such... (Review)
Review
Streptococcal bacteremia that occurs during invasive dental procedures can lead to infective endocarditis (IE) in children with certain heart diseases. Prior to such procedures, antibiotic prophylaxis (AP) with amoxicillin (AMPC) is recommended. However, the detection of amoxicillin-resistant strains (AMPC-RS) in the mouths of children with heart diseases raises the concern that they would be uncovered by the action of standard AP. This work carried out a systematic review and meta-analysis regarding AMPC-RS carriage in the mouths of children. We consulted databases covering studies between the years 2000 and 2021, following the PRISMA declaration. A meta-analysis was carried out to assess the prevalence of children carrying AMPC-RS in the mouths. The antimicrobial tests were carried out by microdilution (46.2% of articles), disk diffusion (38.3%), and the E-test (15.4%). and were bacteria with the most found resistance phenotype, with MIC reaching values of 128 µg/mL. Of the 13 selected articles, only 6 presented results that made it possible to calculate the prevalence of children carrying AMPC-RS in their mouths, ranging from 5.5% to 86.3%. Most of the studies were classified as high quality, and the collected data demonstrate the presence of streptococcal strains with different levels of resistance in the collected samples, such as the dental plaque. The meta-analysis pointed to evidence of AMPC-RS being carried, with a prevalence of 21.3% (I² = 0%, = 0.705). There is an important prevalence of AMPC-RS carriage in the mouths of children. Specific attention should be directed to AP in those susceptible to IE.
PubMed: 36297172
DOI: 10.3390/pathogens11101114 -
Global Spine Journal Jun 2016Study Design Literature review. Objective The aim of this literature review is to examine the effects of obesity on postoperative complications and functional... (Review)
Review
Study Design Literature review. Objective The aim of this literature review is to examine the effects of obesity on postoperative complications and functional outcomes after spine surgery. Methods A review of the relevant literature examining the effects of obesity and spine surgery was conducted using PubMed, Google Scholar, and Cochrane databases. Results Obesity contributes to disk degeneration and low back pain and potentially increases the risk of developing operative pathology. Obese patients undergoing spine surgery have a higher risk of developing postoperative complications, particularly surgical site infection and venous thromboembolism. Though functional outcomes in this population may not mirror the general population, the treatment effect associated with surgery is at least equivalent if not better in obese individuals. This reduction is primarily due to worse outcomes associated with nonoperative treatment in the obese population. Conclusion Obese individuals represent a unique patient population with respect to nonoperative treatment, postoperative complication rates, and functional outcomes. However, given the equivalent or greater treatment effect of surgery, this comorbidity should not prohibit obese patients from undergoing operative intervention. Future investigations in this area should attempt to develop strategies to minimize complications and improve outcomes in obese individuals and also examine the role of controlled weight loss preoperatively to mitigate these risks.
PubMed: 27190743
DOI: 10.1055/s-0035-1570750 -
Infection Jun 2022Pending approval of new antimicrobials, synergistic combinations are the only treatment option against pandrug-resistant A. baumannii (PDRAB). Considering the lack of a... (Review)
Review
PURPOSE
Pending approval of new antimicrobials, synergistic combinations are the only treatment option against pandrug-resistant A. baumannii (PDRAB). Considering the lack of a standardized methodology, the aim of this manuscript is to systematically review the methodology and discuss unique considerations for assessing antimicrobial combinations against PDRAB.
METHODS
Post-hoc analysis of a systematic review (conducted in PubMed and Scopus from inception to April 2021) of studies evaluating antimicrobial combination against A. baumannii, based on antimicrobials that are inactive in vitro alone.
RESULTS
Eighty-four publications were reviewed, using a variety of synergy testing methods, including; gradient-based methods (n = 11), disk-based methods (n = 6), agar dilution (n = 2), checkerboard assay (n = 44), time-kill assay (n = 50), dynamic in vitro PK/PD models (n = 6), semi-mechanistic PK/PD models (n = 5), and in vivo animal models (n = 11). Several variations in definitions of synergy and interpretation of each method were observed and are discussed. Challenges related to testing combinations of antimicrobials that are inactive alone (with regards to concentrations at which the combinations are assessed), as well as other considerations (assessment of stasis vs killing, clinical relevance of re-growth in vitro after initial killing, role of in vitro vs in vivo conditions, challenges of clinical testing of antimicrobial combinations against PDRAB infections) are discussed.
CONCLUSION
This review demonstrates the need for consensus on a standardized methodology and clinically relevant definitions for synergy. Modifications in the methodology and definitions of synergy as well as a roadmap for further development of antimicrobial combinations against PDRAB are proposed.
Topics: Acinetobacter Infections; Acinetobacter baumannii; Anti-Bacterial Agents; Drug Resistance, Multiple, Bacterial; Drug Synergism; Humans; Microbial Sensitivity Tests
PubMed: 34982411
DOI: 10.1007/s15010-021-01748-w -
Oral Surgery, Oral Medicine, Oral... Sep 2022This systematic review aimed to summarize the morphologic changes in the temporomandibular joint (TMJ) in patients who underwent orthodontic treatment and were assessed... (Review)
Review
OBJECTIVE
This systematic review aimed to summarize the morphologic changes in the temporomandibular joint (TMJ) in patients who underwent orthodontic treatment and were assessed by 3-dimensional (3D) imaging techniques (e.g., magnetic resonance imaging, cone beam computed tomography, and multidetector computed tomography).
STUDY DESIGN
The authors searched PubMed, Web of Science, and Embase databases to identify original articles from 2014 to 2021 containing keywords for morphologic changes in the TMJ, orthodontic treatment, and three-dimensional imaging methods. Prospective and retrospective studies, including observational, cross-sectional, randomized, and nonrandomized clinical trials, cohort studies, and case-control studies, were reviewed. The review was conducted in accordance with PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. The risk of bias was assessed in studies selected for the full-text review.
RESULTS
The search strategy yielded 294 publications. After an initial screening and the application of exclusion criteria, 13 studies were selected for the final review.
CONCLUSION
Differences were found in condylar positioning, typically in an anterior position; condylar morphology, primarily with increased diameter or head height; and articular disk position within the anterior-posterior plane post-treatment. Changes in the glenoid fossa were not consistent between the studies. The overall risk of bias among studies was moderate. The influence of orthodontic treatment on morphologic changes in the TMJ remains unclear.
Topics: Cross-Sectional Studies; Humans; Mandibular Condyle; Prospective Studies; Retrospective Studies; Temporomandibular Joint
PubMed: 35871168
DOI: 10.1016/j.oooo.2022.05.003 -
World Neurosurgery Nov 2022Natural language processing (NLP) is a discipline of machine learning concerned with the analysis of language and text. Although NLP has been applied to various forms of... (Review)
Review
BACKGROUND
Natural language processing (NLP) is a discipline of machine learning concerned with the analysis of language and text. Although NLP has been applied to various forms of clinical text, the applications and utility of NLP in spine surgery remain poorly characterized. Here, we systematically reviewed studies that use NLP for spine surgery applications, and analyzed applications, bias, and reporting transparency of the studies.
METHODS
We performed a literature search using the PubMed, Scopus, and Embase databases. Data extraction was performed after appropriate screening. The risk of bias and reporting quality were assessed using the PROBAST and TRIPOD tools.
RESULTS
A total of 12 full-text articles were included. The most common diseases represented include spondylolisthesis (25%), scoliosis (17%), and lumbar disk herniation (17%). The most common procedures included spinal fusion (42%), imaging (e.g. magnetic resonance, X-ray) (25%), and scoliosis correction (17%). Reported outcomes were diverse and included incidental durotomy, venous thromboembolism, and the tone of social media posts regarding scoliosis surgery. Common sources of bias identified included the use of older methods that do not capture the nuance of a text, and not using a prespecified or standard outcome measure when evaluating NLP methods.
CONCLUSIONS
Although the application of NLP to spine surgery is expanding, current studies face limitations and none are indicated as ready for clinical use. Thus, for future studies we recommend an emphasis on transparent reporting and collaboration with NLP experts to incorporate the latest developments to improve models and contribute to further innovation.
Topics: Humans; Natural Language Processing; Scoliosis; Radiography; PubMed; Magnetic Resonance Imaging
PubMed: 36049723
DOI: 10.1016/j.wneu.2022.08.109 -
Orthopaedic Surgery Feb 2023The efficacies and safety of oblique lateral interbody fusion (OLIF) for degenerative lumbar spondylolisthesis (DLS) remains controversial, and long-term clinical... (Meta-Analysis)
Meta-Analysis Review
The efficacies and safety of oblique lateral interbody fusion (OLIF) for degenerative lumbar spondylolisthesis (DLS) remains controversial, and long-term clinical efficacies in particular need to be explored. This study is designed accordingly, therefore, we searched PubMed, Embase, Scopus, Web of Science, Cochrane Library, ProQuest, OVID, and SinoMed for literature, regardless of publication date or language. Taking 12 months after operation as the shortest limit, the outcome measures were extracted, including visual analog scale (VAS), Oswetry dysfunction index (ODI), Japanese Orthopaedic Association (JOA) score, intervertebral disk height (IDH), foraminal height (FH), lumbar lordosis (LL), segment lordosis (SL), slip ratio, and incidence of surgical complications. Meta-analysis was performed by RevMan 5.4 and Stata 16.0, and results were expressed with MD and 95% CI, and two-sided p-values with p < 0.05 being statistically significant. In total, 17 clinical studies (n = 689 patients) were screened, with an average patient age of 63.4 years. Our study revealed that VAS decreased by 4.55 (low back pain) and 5.46 (leg pain) points, respectively. And ODI score decreased by an average of 33.82% while JOA score increased by an average of 11.56 points. In terms of imaging indicators, mean IDH and FH increased by 4.18 and 4.91 mm, mean LL and SL improved by 9.22° and 2.46°, respectively. Besides, mean slip ratio decreased by 10.45%. The incidence of complications was statistically analyzed in 18 studies, with a rate of 4%-54% and an overall incidence of 19%. To sum up, our study was the first to focus on the long-term efficacies of OLIF treatment for DLS, and to provide further clinical evidence. However, long-term follow-up multicenter randomized controlled trials are still needed for further evaluation.
Topics: Humans; Middle Aged; Spondylolisthesis; Lordosis; Retrospective Studies; Lumbosacral Region; Low Back Pain; Treatment Outcome; Spinal Fusion; Lumbar Vertebrae; Multicenter Studies as Topic
PubMed: 36479592
DOI: 10.1111/os.13588 -
Frontiers in Medicine 2022Neck pain (NP), one of the most common musculoskeletal diseases, exercises a great influence on the daily life of individuals, especially the elderly. Baduanjin is a...
BACKGROUND
Neck pain (NP), one of the most common musculoskeletal diseases, exercises a great influence on the daily life of individuals, especially the elderly. Baduanjin is a traditional Qigong therapy from China, but there is no evidence for its use in the treatment of neck pain in middle-aged and elderly people.
OBJECTIVE
We hope to summarize the efficacy evidence of Baduanjin in the treatment of middle-aged and elderly patients with neck pain (NP) for the first time, conduct a systematic review and meta-analysis, and provide basic evidence-based evidence for clinical practice.
METHODS
Two researchers collectively searched PubMed, Web of Science, Embase, Cochrane Library, China Biology Medicine disk (Sino-Med), China National Knowledge Infrastructure (CNKI), Wanfang database, and China Science and Technology Journal Database (VIP). The search time is set from initial to 27 September 2022, to find out RCT articles that may meet the criteria. The risk bias assessment tool Cochrane was applied to assess the methodological quality of involved studies. RevMan 5.3 was used for the meta-analysis with a mean difference (MD) and 95% confidence interval (CI), and the model type was a random effects model. The VAS scores of the intervention and control groups were extracted and the results of the meta-analysis were presented using a forest plot.
RESULTS
In total, 13 randomized controlled trials were meta-analyzed, including 840 patients. The results turned out that the VAS score in the intervention group was below the control group, which was statistically significant [MD = -1.15, 95% CI (-1.39, -0.92) and < 0. 001]. The result of general efficiency suggests that the Baduanjin group was better than the control group [RR = 1.19, 95% CI (1.10, 1.29), < 0.001].
CONCLUSION
The existing results seem to show that Baduanjin is safe and has a trend of positive benefits in the treatment of neck pain in middle-aged and elderly people. However, considering the limitations of this study, we need to be cautious in our conclusions, and more studies are needed to verify it in future.
PubMed: 36703891
DOI: 10.3389/fmed.2022.920102 -
European Journal of Orthopaedic Surgery... Jan 2023Systematic review and meta-analysis. (Meta-Analysis)
Meta-Analysis Review
STUDY DESIGN
Systematic review and meta-analysis.
OBJECTIVE
Historically, posterior approaches to the lumbar spine have allowed surgeons to manage degenerative conditions affecting the lumbar spine. However, spinal muscles injury, post-surgical vertebral instability, cerebrospinal fluid (CSF) leakage, and failed back surgery syndrome (FBSS) represent severe complications that may occur after these surgeries. Lumbar interbody fusion using anterior (ALIF), oblique (OLIF), or lateral (LLIF) approaches may represent valuable surgical alternatives, in case fusion is indicated on single or multiple levels.
METHODS
The present study is a systematic review, conducted according to the PRISMA statement, of comparative studies on OLIF, and LLIF for degenerative spine disorders, and a meta-analysis of their clinical-radiological outcomes and complications.
RESULTS
After screening 1472 papers on PubMed, Scopus, and Cochrane Library, only 3 papers were included in the present study. 318 patients were included for data meta-analysis, 128 in OLIF group, and 190 in LLIF group. There were no significative differences in terms of surgical (intraoperative blood loss and surgical duration) and clinical (VAS-back, VAS-leg, and ODI scores) outcomes, or fusion rates at last follow-up (> 2 years). Significantly higher rates of abdominal complications, system failure, and vascular injuries were recorded in the OLIF group. Conversely, postoperative neurological symptoms and psoas weakness were significatively more common in LLIF group.
CONCLUSIONS
The meta-analysis suggests that OLIF and LLIF are both effective for lumbar degenerative disorders, although each of them presents specific complications and this should represent a relevant element in the surgical planning.
Topics: Humans; Spinal Fusion; Spinal Diseases; Lumbar Vertebrae; Blood Loss, Surgical; Surgeons; Retrospective Studies; Treatment Outcome
PubMed: 34825987
DOI: 10.1007/s00590-021-03172-0