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World Neurosurgery Jul 2023Cervical spondylotic myelopathy (CSM) may seriously affect quality of life. In the literature, there is scarce evidence of the pros and cons of full endoscopic spine... (Review)
Review
BACKGROUND
Cervical spondylotic myelopathy (CSM) may seriously affect quality of life. In the literature, there is scarce evidence of the pros and cons of full endoscopic spine surgery in the treatment of CSM. The main purpose of this study was to conduct a systematic review to elucidate the efficacy of full endoscopic spine surgery in the management of patients with CSM.
METHODS
This systematic review was conducted in accordance with the PRISMA guidelines. A systematic search of Web of Science, PubMed MEDLINE, Embase, and Cochrane Library was conducted from the database inception to February 1, 2023.
RESULTS
The study included 183 patients and their age was 56.78 ± 7.87 years. The average surgical time calculated was 96.34 ± 33.58 minutes. Intraoperative blood loss ranged from a minimal amount to 51 mL. The average duration of hospital stay was 3.56 ± 1.6 days. The average span for follow-up was on an interval of 18.7 ± 6.76 months. Significant improvements were noted in all aspects of functional outcomes and image results after full endoscopic cervical spine surgery, with no major complications.
CONCLUSIONS
The current study found that both anterior transcorporeal and posterior surgical approaches could be used for the treatment of CSM with a full endoscopic technique. Indications of full endoscopic cervical spine surgery for CSM included cervical disc herniation, central canal stenosis, calcified ligamentum flavum, and ossification of the posterior longitudinal ligament. Improved postoperative outcomes with acceptable surgical complications were noted in this systematic review.
Topics: Humans; Middle Aged; Quality of Life; Spondylosis; Treatment Outcome; Spinal Cord Diseases; Cervical Vertebrae; Decompression, Surgical
PubMed: 37169077
DOI: 10.1016/j.wneu.2023.05.012 -
Journal of Neurointerventional Surgery Jan 2019Thoracolumbar and sacral spinal epidural arteriovenous fistulas (SEDAVFs) are an increasingly recognized form of spinal vascular malformation. The purpose of this study... (Meta-Analysis)
Meta-Analysis
BACKGROUND AND PURPOSE
Thoracolumbar and sacral spinal epidural arteriovenous fistulas (SEDAVFs) are an increasingly recognized form of spinal vascular malformation. The purpose of this study was to perform a systematic review of the demographics, clinical presentation and treatment results of thoracolumbar SEDAVFs.
MATERIALS AND METHODS
Pubmed, Scopus and Web of Science databases were searched from January 2000 to January 2018 for articles on treatment of SEDAVFs. Pooled data of individual patients were analyzed for demographic and clinical features of SEDAVFs as well as treatment outcomes.
RESULTS
There were 125 patients from 11 studies included. Mean age was 63.5 years. There was a male sex predilection (69.6%). Sensory symptoms including pain or numbness were the most frequently presenting symptoms. Fistula location was the lumbosacral spine in 79.2% and the thoracic spine in 20.8%. Involvement of intradural venous drainage was more common than extradural venous drainage only (89.6% vs 10.4%). Of the 123 treated patients, endovascular therapy was performed in 67.5% of patients, microsurgery in 23.6%, and combined treatment in 8.9%. The overall complete obliteration rate was 83.5% and did not differ between groups. Clinical symptoms improved in 70.7% of patients, were stable in 25%, and worsened in 1.7% with no difference between treatment modalities.
CONCLUSIONS
Thoracic and lumbosacral SEDAVFs often present with symptoms secondary to congestive myelopathy or compressive symptoms. Both endovascular and microsurgical treatments were associated with high obliteration rates and good clinical outcomes.
Topics: Aged; Arteriovenous Fistula; Embolization, Therapeutic; Epidural Space; Female; Humans; Lumbosacral Region; Male; Microsurgery; Middle Aged; Sacrum; Spinal Diseases; Thoracic Arteries; Treatment Outcome
PubMed: 30166334
DOI: 10.1136/neurintsurg-2018-014203 -
The Spine Journal : Official Journal of... Oct 2023Excessive production of epidural fibrosis in the nerve root can be a pain source after laminectomy. Pharmacotherapy is a minimally invasive treatment option to attenuate... (Review)
Review
BACKGROUND CONTEXT
Excessive production of epidural fibrosis in the nerve root can be a pain source after laminectomy. Pharmacotherapy is a minimally invasive treatment option to attenuate epidural fibrosis by suppressing proliferation and activation of fibroblasts, inflammation, and angiogenesis, and inducing apoptosis.
PURPOSE
We reviewed and tabulated pharmaceuticals with their respective signaling axes implicated in reducing epidural fibrosis. Additionally, we summarized current literature for the feasibility of novel biologics and microRNA to lessen epidural fibrosis.
STUDY DESIGN/SETTING
Systematic Review.
METHODS
According to the PRISMA guidelines, we systematically reviewed the literature in October 2022. The exclusion criteria included duplicates, nonrelevant articles, and insufficient detail of drug mechanism.
RESULTS
We obtained a total of 2,499 articles from PubMed and Embase databases. After screening the articles, 74 articles were finally selected for the systematic review and classified based on the functions of drugs and microRNAs which included inhibition of fibroblast proliferation and activation, pro-apoptosis, anti-inflammation, and antiangiogenesis. In addition, we summarized various pathways to prevent epidural fibrosis.
CONCLUSION
This study allows a comprehensive review of pharmacotherapies to prevent epidural fibrosis during laminectomy.
CLINICAL SIGNIFICANCE
We expect that our review would enable researchers and clinicians to better understand the mechanism of anti-fibrosis drugs for the clinical application of epidural fibrosis therapies.
Topics: Animals; Laminectomy; Fibrosis; Apoptosis; MicroRNAs; Models, Animal; Epidural Space
PubMed: 37187251
DOI: 10.1016/j.spinee.2023.05.007 -
Children (Basel, Switzerland) Dec 2022Adolescent idiopathic scoliosis (AIS) is the most frequent pediatric spinal deformity. Its treatment still shows limited results due to the existent lack of knowledge... (Review)
Review
Adolescent idiopathic scoliosis (AIS) is the most frequent pediatric spinal deformity. Its treatment still shows limited results due to the existent lack of knowledge regarding etiopathogenesis. Thus, the purpose of the study is to check the existence of vestibular morphological alterations among idiopathic scoliosis patients. To meet the objective, we performed this systematic review searching studies in PubMed Medline, SCOPUS, Web of Science, CINAHL Complete and SciELO until 15 September 2022. Articles that analyzed the morphology of the vestibular apparatus were selected, comparing subjects with AIS versus healthy subjects. Variables were selected that measured the orientation of the channels as well as the general conformation of the vestibular apparatus. One hundred and eighty-five records were retrieved in the preliminary searches, of which five studies were finally included, providing data from 154 participants (83 cases and 71 healthy controls) with a mean age 16.07 ± 2.48 years old. Two studies conclude that the superior and lateral semicircular canals are longer and thinner in patients with AIS. One study concluded that the measure between centers of superior and lateral canals and the angle whose vertex is placed the center of posterior canal were significantly shorter in subjects with AIS than in healthy controls in the left-side of vestibular apparatus. Two studies found an asymmetry in the verticality of the lateral canals on both sides in subjects with AIS, although it is not clear whether the left canal is in a more horizontal or vertical position. Patients with AIS seem to present morphological asymmetries of the vestibular apparatus, fundamentally on the left side. These anomalies seem to correlate with the location of the curve but not with its laterality or severity.
PubMed: 36670586
DOI: 10.3390/children10010035 -
Orthopaedic Surgery Jul 2022Penetrating spinal cord injury (PSCI) with retained foreign bodies (RFB) is rarely observed in clinics and may result in a complete or incomplete neurological deficit....
BACKGROUND
Penetrating spinal cord injury (PSCI) with retained foreign bodies (RFB) is rarely observed in clinics and may result in a complete or incomplete neurological deficit. This study was performed to appraise the treatment effect of laminectomy for PSCI with RFB.
CASE PRESENTATION
This study presented three patients referred to a tertiary hospital between August 2011 and October 2018 due to PSCI with RFB and receiving laminectomy. The first patient was a 25-year-old female with a butcher's knife piercing the T lamina and T vertebral body obliquely; the second was a 49-year-old male who suffered a perforating wound of the cervical spinal canal and injury of vertebral artery from foreign glass, while the third was a 60-year-old male with a wooden stick penetrating stomach and terminating in the L lamina. The first and second patients immediately underwent laminectomy for debridement and removal of RFB, while the third received two-staged operations to remove the retained stick thoroughly. Unfortunately cases 1 and 3 eventually resulted in total paralysis and case 2 revealed no improvement in myodynamia. Then, Medline/PubMed, Embase and the Cochrane Library were systematically searched, and 23 articles involving 25 additional cases with this kind of injury were included for analysis.
CONCLUSIONS
The optimal treatment strategy for penetrating spinal cord injury with retained foreign bodies remains challenging and should be assessed case-by-case. If possible, surgical removal of foreign bodies by laminectomy is preferred immediately to prevent delayed presentation and persistent contamination. Meanwhile, a multidisciplinary team is needed to address concomitant injuries.
Topics: Adult; Female; Foreign Bodies; Humans; Laminectomy; Male; Middle Aged; Spinal Canal; Spinal Cord Injuries; Wounds, Stab
PubMed: 35678132
DOI: 10.1111/os.13332 -
World Neurosurgery Apr 2024The current meta-analysis was performed to gather available evidence regarding the incidence and risk factors of cement leakage (CL) in patients undergoing surgical... (Meta-Analysis)
Meta-Analysis
OBJECTIVES
The current meta-analysis was performed to gather available evidence regarding the incidence and risk factors of cement leakage (CL) in patients undergoing surgical procedures for spinal metastasis.
METHODS
Two authors independently searched the PubMed, Embase, and CENTRAL databases. Clinical studies reporting the incidence or risk factors of CL were included for analysis. The primary outcome analyzed was the incidence of various types of CL. Random-effects or fixed-effects single-proportion meta-analyses were conducted to pool the available evidence, based on the heterogeneity test. Subgroup analyses were conducted based on surgical procedures (percutaneous vertebroplasty, percutaneous kyphoplasty, and others). Risk factors of CL were synthesized narratively to identify the most commonly accepted factors.
RESULTS
A total of 26 studies, involving 2551 patients, were included. The number of operated spine segments was reported in 23 studies, accounting for 4101 vertebrae. The pooled incidences of general, intradiscal, paravertebral, spinal canal, and intravascular CLs were 0.18 (95% confidence interval [CI], 0.11-0.28), 0.14 (95% CI, 0.08-0.21), 0.13 (95% CI, 0.06-0.21), 0.11 (95% CI, 0.05-0.19), and 0.12 (95% CI, 0.08-0.17), respectively. Subgroup analyses revealed significantly different incidences of general CL (0.37 vs. 0.06 vs. 0.09, P < 0.01), intradiscal CL (0.22 vs. 0.06 vs. 0.12, P < 0.01), paravertebral CL (0.25 vs. 0.03 vs. 0.06, P < 0.01), and vascular CL (0.14 vs. 0.03 vs. 0.15, P < 0.01) among the three groups. Posterior wall disruption, pathologic fracture, and the number of treated vertebral levels were the most commonly identified independent risk factors for general CL. Posterior wall disruption was determined as a common significant risk factor for spinal canal CL.
CONCLUSIONS
This review provides insights into the incidence and risk factors associated with CL in surgical procedures for spinal metastasis. Understanding these risk factors can contribute to the development of tailored strategies aimed at minimizing CL occurrence and optimizing surgical outcomes for patients undergoing spinal metastatic surgery.
Topics: Humans; Vertebroplasty; Incidence; Spinal Neoplasms; Spinal Fractures; Fractures, Compression; Bone Cements; Kyphoplasty; Risk Factors; Osteoporotic Fractures; Treatment Outcome
PubMed: 38246530
DOI: 10.1016/j.wneu.2024.01.065 -
Paediatric Anaesthesia Aug 2014The anatomy of the sacral hiatus and caudal canal is prone to significant variation, yet studies assessing this in the pediatric population remain limited. Awareness of... (Review)
Review
The anatomy of the sacral hiatus and caudal canal is prone to significant variation, yet studies assessing this in the pediatric population remain limited. Awareness of the possible anatomical variations is critical to the safety and success of caudal epidural blocks, particularly when image guidance is not employed. This systematic review analyzes the available evidence on the clinical anatomy of the caudal canal in pediatric patients, emphasizing surface anatomy and internal anatomical variations. A literature search using three electronic databases and standard pediatric and anatomy reference texts was conducted yielding 24 primary and seven secondary English-language sources. Appreciating that our current landmark-guided approaches to the caudal canal are not well studied in the pediatric population is important for both clinicians and researchers.
Topics: Cauda Equina; Child; Child, Preschool; Epidural Space; Humans; Infant; Infant, Newborn; Sacrococcygeal Region; Sacrum
PubMed: 24666890
DOI: 10.1111/pan.12392 -
Pain Physician Nov 2019Symptomatic lumbar spinal stenosis is a condition affecting a growing number of individuals resulting in significant disability and pain, leading to a multitude of... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Symptomatic lumbar spinal stenosis is a condition affecting a growing number of individuals resulting in significant disability and pain, leading to a multitude of interventions ranging from simple over the counter medication to opioids, and, finally, to complex surgical fusions. After failure of conservative treatment with drug therapy, physical therapy, and other conservative modalities including epidural injections, percutaneous adhesiolysis with targeted delivery of drugs into the epidural space can be offered in lumbar central spinal stenosis prior to minimally invasive surgical options or complex surgical fusions. To date there has been only one systematic review which has assessed the role of percutaneous adhesiolysis in treating central spinal stenosis, compared to post lumbar surgery syndrome which has multiple systematic reviews and randomized controlled trials (RCTs).
STUDY DESIGN
A systematic review of RCTs and observational studies assessing the role of percutaneous adhesiolysis in managing lumbar central spinal stenosis.
OBJECTIVE
To evaluate the effectiveness of percutaneous adhesiolysis in managing central lumbar spinal stenosis, utilizing currently available literature.
METHODS
This systematic review was performed utilizing Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) for literature search, Cochrane review criteria, Interventional Pain Management techniques - Quality Appraisal of Reliability and Risk of Bias Assessment (IPM-QRB), and Interventional Pain Management Techniques - Quality Appraisal of Reliability and Risk of Bias Assessment for Nonrandomized Studies (IPM-QRBNR) to assess methodologic quality assessment and qualitative analysis utilizing best evidence synthesis principles, and meta-analysis.PubMed, Cochrane library, US National Guideline Clearinghouse, Google Scholar, and prior systematic reviews and reference lists were utilized in the literature search from 1966 through June 2019. The evidence was summarized utilizing principles of the best evidence synthesis on a scale of 1 to 5.
OUTCOME MEASURES
The primary outcome or hard endpoint was defined as the proportion of patients with 50% pain relief and improvement in functionality, whereas the secondary outcome measures or soft endpoints were pain relief and/or improvement in functionality. Short-term effectiveness was defined as improvement of 6 months or less, whereas long-term effectiveness was defined as more than 6 months.
RESULTS
Based on search criteria, 9 manuscripts were identified and considered for inclusion with final inclusion of 2 RCTs and 4 observational studies in this systematic review and 5 studies for single arm meta-analysis. The results showed Level II evidence for short-term and long-term improvement in pain and function with application of percutaneous adhesiolysis in managing central lumbar spinal stenosis.
LIMITATIONS
There was a significant paucity of evidence assessing the role of percutaneous adhesiolysis in managing lumbar central spinal stenosis, leading to Level II or strong evidence.
CONCLUSION
Overall, the present analysis shows Level II (moderate) evidence for percutaneous adhesiolysis in managing lumbar central spinal stenosis based on relevant high quality RCTs and observational studies.
KEY WORDS
Lumbar central spinal stenosis, percutaneous adhesiolysis, randomized controlled trials, systematic reviews, neuroplasty.
Topics: Analgesics; Disease Management; Epidural Space; Humans; Injections, Epidural; Low Back Pain; Lumbar Vertebrae; Observational Studies as Topic; Pain Management; Randomized Controlled Trials as Topic; Reproducibility of Results; Spinal Stenosis; Treatment Outcome
PubMed: 31775400
DOI: No ID Found -
Medicina (Kaunas, Lithuania) Mar 2022The aim of this review was to analyze the existing literature and investigate the outcomes or complications of lateral lumbar interbody fusion (LLIF) combined with... (Review)
Review
The aim of this review was to analyze the existing literature and investigate the outcomes or complications of lateral lumbar interbody fusion (LLIF) combined with indirect decompression for degenerative lumbar spondylolisthesis (DS). A database search algorithm was used to query MEDLINE, COCHRANE, and EMBASE to identify the literature reporting LLIF with indirect decompression for DS between January 2010 and December 2021. Improvements in outcome measures and complication rates were pooled and tested for significance. A total of 412 publications were assessed, and 12 studies satisfied the inclusion criteria after full review. The pooled data available in the included studies showed that 438 patients with lumbar spondylolisthesis (mean age 65.2 years; mean body mass index (BMI) 38.1 kg/m) underwent LLIF. A total of 546 disc spaces were operated on. The most frequently treated levels were L4-L5 and L3-L4. Clinically, the average improvement was 32.5% in ODI, 46.3 mm in low back pain, and 48.3 mm in leg pain estimated from the studies included. SF-36 PCS improved by 51.5% and MCS improved by 19.5%. For radiological outcomes, a reduction in slippage was seen in 6.3%. Disc height increased by 55%, foraminal height increased by 21.1%, the foraminal area on the approach side increased by 21.9%, and on the opposite side it increased by 26.1%. The cross-sectional spinal canal area increased by 20.6% after surgery. Post-operative complications occurred in 5-40% of patients with thigh symptoms, such as anterior thigh numbness, dysesthesia, discomfort, pain, and sensory deficits. Indirect decompression by LLIF for DS is an effective method for improving pain and dysfunction with less surgical invasion. In addition, it has the effect of significantly improving disc height, foraminal height and area, and segmental lordosis on radiological outcomes compared to the posterior approach.
Topics: Aged; Cross-Sectional Studies; Decompression; Humans; Low Back Pain; Lumbar Vertebrae; Retrospective Studies; Spinal Fusion; Spondylolisthesis; Treatment Outcome
PubMed: 35454331
DOI: 10.3390/medicina58040492 -
European Spine Journal : Official... Oct 2019Spinal Cord Society (SCS) and Spine Trauma Study Group (STSG) established a panel tasked with reviewing management and prognosis of acute traumatic cervical central cord...
PURPOSE
Spinal Cord Society (SCS) and Spine Trauma Study Group (STSG) established a panel tasked with reviewing management and prognosis of acute traumatic cervical central cord syndrome (ATCCS) and recommend a consensus statement for its management.
METHODS
A systematic review was performed according to the PRISMA 2009 guidelines. Delphi method was used to identify key research questions and achieve consensus. PubMed, Scopus and Google Scholar were searched for corresponding keywords. The initial search retrieved 770 articles of which 37 articles dealing with management, timing of surgery, complications or prognosis of ATCCS were identified. The literature review and draft position statements were compiled and circulated to panel members. The draft was modified incorporating relevant suggestions to reach consensus.
RESULTS
Out of 37 studies, 15 were regarding management strategy, ten regarding timing of surgery and 12 regarding prognosis of ATCCS.
CONCLUSION
There is reasonable evidence that patients with ATCCS secondary to vertebral fracture, dislocation, traumatic disc herniation or instability have better outcomes with early surgery (< 24 h). In patients of ATCCS secondary to extension injury in stenotic cervical canal without fracture/fracture dislocation/traumatic disc herniation/instability, there is requirement of high-quality prospective randomized controlled trials to resolve controversy regarding early surgery versus conservative management and delayed surgery if recovery plateaus or if there is a neurological deterioration. Until such time decision on surgery and its timing should be left to the judgment of physician, deliberating on pros and cons relevant to the particular patient and involving the well-informed patient and relatives in decision making. These slides can be retrieved under Electronic Supplementary Material.
Topics: Central Cord Syndrome; Cervical Vertebrae; Humans; Practice Guidelines as Topic; Prognosis; Time-to-Treatment
PubMed: 31367852
DOI: 10.1007/s00586-019-06085-z