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World Neurosurgery Aug 2021To compare clinical efficacy and safety of endoscopic lumbar interbody fusion (Endo-LIF) and minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF) in... (Meta-Analysis)
Meta-Analysis
Endoscopic Lumbar Interbody Fusion and Minimally Invasive Transforaminal Lumbar Interbody Fusion for the Treatment of Lumbar Degenerative Diseases: A Systematic Review and Meta-Analysis.
OBJECTIVE
To compare clinical efficacy and safety of endoscopic lumbar interbody fusion (Endo-LIF) and minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF) in treatment of lumbar degenerative diseases.
METHODS
A literature search was performed using PubMed, Embase, Web of Science, and Cochrane Library databases. Studies published up to November 15, 2020, that compared Endo-LIF with MIS-TLIF for treating lumbar degenerative diseases were retrieved. Data were extracted according to predefined clinical outcome measures. Primary outcomes were preoperative and postoperative visual analog scale for leg and back pain and Oswestry Disability Index scores. Secondary outcomes were operative time and intraoperative blood loss; length of hospitalization; and complication, reoperation, and fusion rates. Data analysis was conducted with statistical software.
RESULTS
The meta-analysis included 6 studies comprising 480 patients. Results of the merged analysis revealed similar complication, reoperation, and fusion rates and preoperative and postoperative visual analog scale for leg and back pain and Oswestry Disability Index scores (P > 0.05) for Endo-LIF and MIS-TLIF. Nevertheless, with the exception of longer operative time (P < 0.05), Endo-LIF compared favorably with MIS-TLIF, with less intraoperative blood loss, shorter hospital stay (P < 0.05), and better long-term functional outcome.
CONCLUSIONS
Based on the evidence provided by this study, there is no significant difference in clinical efficacy and safety between Endo-LIF and MIS-TLIF in the treatment of lumbar degenerative diseases. Although Endo-LIF has a longer operative time, it has the advantages of less tissue trauma and rapid recovery after operation.
Topics: Endoscopy; Humans; Intervertebral Disc Degeneration; Lumbar Vertebrae; Minimally Invasive Surgical Procedures; Neurosurgical Procedures; Spinal Fusion
PubMed: 34087465
DOI: 10.1016/j.wneu.2021.05.109 -
International Journal of Surgery... Mar 2016The purpose of the study is to perform a systematic review and meta-analysis to evaluate the clinical results of anterior and posterior approaches for the treatment of... (Meta-Analysis)
Meta-Analysis Review
Anterior versus posterior approach for the treatment of cervical compressive myelopathy due to ossification of the posterior longitudinal ligament: A systematic review and meta-analysis.
PURPOSE
The purpose of the study is to perform a systematic review and meta-analysis to evaluate the clinical results of anterior and posterior approaches for the treatment of cervical compressive myelopathy due to cervical ossification of the posterior longitudinal ligament (OPLL).
METHODS
Randomized controlled trials or non-randomized controlled trials published since January 1995 to October 2015 that compared the clinical effectiveness of anterior and posterior surgical approaches for the treatment of cervical OPLL were acquired by a comprehensive search in three electronic databases (PubMed, EMBASE, Cochrane library). A total of 13 studies (1050 patients) were included in this systematic review and meta-analysis.
RESULT
The results indicated that no statistically significant differences between the anterior group and posterior group in terms of preoperative JOA score [P = 0.16, SMD = 0.1 (-0.04, 0.23)] and recovery rate of patients with canal-occupying ratio < 50%-60% [p = 0.89, SMD = 0.03 (-0.35, 0.41)]. The anterior group showed higher postoperative JOA score [P < 0.05, SMD = 0.23 (0.05, 0.41)], overall recovery rate (regardless of canal-occupying ratio) [P < 0.01, SMD = 0.79 (0.31, 1.27)], especially a significant higher recovery rate of patients with canal-occupying ratio > 50%-60% [P < 0.01, SMD = 1.50 (0.52, 2.47)]. However, it also revealed that the postoperative complication rate [P < 0.05, OR = 1.90 (1.08, 3.36)], blood loss [P < 0.01, SMD = 0.63 (0.34, 0.93)] and operative time [P < 0.01, SMD = 1.86 (1.07, 2.65)] were significantly higher.
CONCLUSION
Based on the results above, anterior approach surgery was associated with better overall (regardless of the canal-occupying ratio) postoperative neural function than posterior approach in the treatment of cervical compressive myelopathy due to OPLL. We thought anterior approach especially preferable to patients with canal-occupying ratio > 50%-60%, although it leads to a higher surgical trauma and incidence of surgery-related complications. Posterior approach surgery was relatively safer with lower surgical trauma and incidence of complications. We also suggest posterior approach for patients with canal-occupying ratio < 50%-60%, since the postoperative neural function was similar between the two groups for this part of patients.
Topics: Cervical Vertebrae; Decompression, Surgical; Humans; Non-Randomized Controlled Trials as Topic; Operative Time; Ossification of Posterior Longitudinal Ligament; Postoperative Complications; Postoperative Period; Randomized Controlled Trials as Topic; Spinal Cord Compression; Spinal Fusion; Treatment Outcome
PubMed: 26804354
DOI: 10.1016/j.ijsu.2016.01.038 -
Acta Neurochirurgica Nov 2021Anterior lumbar interbody fusion (ALIF) is a well-established alternative to posterior-based interbody fusion techniques, with approach variations, such as... (Meta-Analysis)
Meta-Analysis Review
PURPOSE
Anterior lumbar interbody fusion (ALIF) is a well-established alternative to posterior-based interbody fusion techniques, with approach variations, such as retroperitoneal, transperitoneal, open, and laparoscopic well described. Variable rates of complications for each approach have been enumerated in the literature. The purpose of this study was to elucidate the comparative rates of complications across approach type.
METHODS
A systematic review of search databases PubMed, Google Scholar, and OVID Medline was made to identify studies related to complication-associated ALIF. PRISMA guidelines were utilised for this review. Meta-analysis was used to compare intraoperative and postoperative complications with ALIF for each approach.
RESULTS
A total of 4575 studies were identified, with 5728 patients across 31 studies included for review following application of inclusion and exclusion criteria. Meta-analysis demonstrated the transperitoneal approach resulted in higher rates of retrograde ejaculation (RE) (p < 0.001; CI = 0.05-0.21) and overall rates of complications (p = 0.05; CI = 0.00-0.23). Rates of RE were higher at the L5/S1 intervertebral level. Rates of vessel injury were not significantly higher in either approach method (p = 0.89; CI = - 0.04-0.07). Rates of visceral injury did not appear to be related to approach method. Laparoscopic approaches resulted in shorter inpatient stays (p = 0.01).
CONCLUSION
Despite the transperitoneal approach being comparatively underpowered, its use appears to result in a significantly higher rate of intraoperative and postoperative complications, although confounders including use of bone morphogenetic protein (BMP) and spinal level should be considered. Laparoscopic approaches resulted in shorter hospital stays; however, its steep learning curve and longer operative time have deterred surgeons from its widespread adaptation.
Topics: Humans; Length of Stay; Lumbar Vertebrae; Lumbosacral Region; Male; Postoperative Complications; Spinal Fusion
PubMed: 34546435
DOI: 10.1007/s00701-021-05000-0 -
The Spine Journal : Official Journal of... Jun 2022Adjacent segment disease (ASD) is a potential complication following lumbar spinal fusion. (Meta-Analysis)
Meta-Analysis Review
Demographic, clinical, and operative risk factors associated with postoperative adjacent segment disease in patients undergoing lumbar spine fusions: a systematic review and meta-analysis.
BACKGROUND CONTEXT
Adjacent segment disease (ASD) is a potential complication following lumbar spinal fusion.
PURPOSE
This study aimed to demonstrate the demographic, clinical, and operative risk factors associated with ASD development following lumbar fusion.
STUDY DESIGN/SETTING
Systematic review and meta-analysis.
PATIENT SAMPLE
We identified 35 studies that reported risk factors for ASD, with a total number of 7,374 patients who had lumbar spine fusion.
OUTCOME MEASURES
We investigated the demographic, clinical, and operative risk factors for ASD after lumbar fusion.
METHODS
A literature search was done using PubMed, Embase, Medline, Scopus, and the Cochrane library databases from inception to December 2019. The methodological index for non-randomized studies (MINORS) criteria was used to assess the methodological quality of the included studies. A meta-analysis was done to calculate the odds ratio (OR) with the 95% confidence interval (CI) for dichotomous data and mean difference (MD) with 95% CI for continuous data.
RESULTS
Thirty-five studies were included in the qualitative analysis, and 22 studies were included in the meta-analyses. The mean quality score based on the MINORS criteria was 12.4±1.9 (range, 8-16) points. Significant risk factors included higher preoperative body mass index (BMI) (mean difference [MD]=1.97 kg/m; 95% confidence interval [CI]=1.49-2.45; p<.001), floating fusion (Odds ratio [OR]=1.78; 95% CI=1.32-2.41; p<.001), superior facet joint violation (OR=10.43; 95% CI=6.4-17.01; p<.001), and decompression outside fusion construct (OR=1.72; 95% CI=1.25-2.37; p<.001).
CONCLUSIONS
The overall level of evidence was low to very low. Higher preoperative BMI, floating fusion, superior facet joint violation, and decompression outside fusion construct are significant risk factors of development of ASD following lumbar fusion surgeries.
Topics: Demography; Humans; Lumbar Vertebrae; Retrospective Studies; Risk Factors; Spinal Fusion; Zygapophyseal Joint
PubMed: 34896610
DOI: 10.1016/j.spinee.2021.12.002 -
Global Spine Journal May 2019Systematic review.
STUDY DESIGN
Systematic review.
OBJECTIVES
To review, critically appraise, and synthesize evidence on the use of allogenic stem cell products for spine fusion compared with other bone graft materials.
METHODS
Systematic searches of PubMed/MEDLINE, through October 31, 2018 and of EMBASE and ClinicalTrials.gov through April 13, 2018 were conducted for literature comparing allogenic stem cell sources for fusion in the lumbar or cervical spine with other fusion methods. In the absence of comparative studies, case series of ≥10 patients were considered.
RESULTS
From 382 potentially relevant citations identified, 6 publications on lumbar fusion and 5 on cervical fusion met the inclusion criteria. For lumbar arthrodesis, mean Oswestry Disability Index (ODI), visual analogue scale (VAS) pain score, and fusion rates were similar for anterior lumbar interbody fusion (ALIF) using allogenic multipotent adult progenitor cells (Map3) versus recombinant human bone morphogenetic protein-2 (rhBMP-2) in the one comparative lumbar study (90% vs 92%). Across case series of allogenic stem cell products, function and pain were improved relative to baseline and fusion occurred in ≥90% of patients at ≥12 months. For cervical arthrodesis across case series, stem cell products improved function and pain compared with baseline at various time frames. In a retrospective cohort study fusion rates were not statistically different for Osteocel compared with Vertigraft allograft (88% vs 95%). Fusion rates varied across time frames and intervention products in case series.
CONCLUSIONS
The overall quality (strength) of evidence of effectiveness and safety of allogenic stem cells products for lumbar and cervical arthrodesis was very low, meaning that we have very little confidence that the effects seen are reflective of the true effects.
PubMed: 31157144
DOI: 10.1177/2192568219833336 -
Global Spine Journal Jun 2022Systematic review and meta-analysis.
STUDY DESIGN
Systematic review and meta-analysis.
OBJECTIVES
Arthrodesis has been a valid treatment option for spinal diseases, including spondylolisthesis and lumbar spinal stenosis. Posterolateral and posterior lumbar interbody fusion are amongst the most used fusion techniques. Previous reports comparing both methods have been contradictory. Thus, we conducted a systematic review and meta-analysis of randomized controlled trials (RCTs) to establish substantial evidence on which fusion method would achieve better outcomes.
METHODS
Major databases including PubMed, Embase, Web of Science and CENTRAL were searched to identify studies comparing outcomes of interest between posterolateral fusion (PLF) and posterior lumbar interbody fusion (PLIF). We extracted data on clinical outcome, complication rate, revision rate, fusion rate, operation time, and blood loss. We calculated the mean differences (MDs) for continuous data with 95% confidence intervals (CIs) for each outcome and the odds ratio with 95% confidence intervals (CIs) for binary outcomes. < 0.05 was considered significant.
RESULTS
We retrieved 8 studies meeting our inclusion criteria, with a total of 616 patients (308 PLF, 308 PLIF). The results of our analysis revealed that patients who underwent PLIF had significantly higher fusion rates. No statistically significant difference was identified in terms of clinical outcomes, complication rates, revision rates, operation time or blood loss.
CONCLUSIONS
This systematic review and meta-analysis provide a comparison between PLF and PLIF based on RCTs. Although PLIF had higher fusion rates, both fusion methods achieve similar clinical outcomes with equal complication rate, revision rate, operation time and blood loss at 1-year minimum follow-up.
PubMed: 33977761
DOI: 10.1177/21925682211016426 -
World Neurosurgery Nov 2023
Meta-Analysis Review
Comparison of the Radiographic and Clinical Outcomes Between Expandable Cage and Static Cage for Transforaminal Lumbar Interbody Fusion: A Systematic Review and Meta-Analysis.
Topics: Humans; Treatment Outcome; Retrospective Studies; Spinal Fusion; Lumbar Vertebrae; Lordosis
PubMed: 37579991
DOI: 10.1016/j.wneu.2023.08.035 -
Journal of Postgraduate Medicine 2019Multiple studies have compared primary arthrodesis versus open reduction with internal fixation (ORIF) for surgical treatment of fractures of the Lisfranc joint, but... (Meta-Analysis)
Meta-Analysis
OBJECTIVE
Multiple studies have compared primary arthrodesis versus open reduction with internal fixation (ORIF) for surgical treatment of fractures of the Lisfranc joint, but their results have been inconsistent. Therefore, the present systematic review and meta-analysis was performed to compare the clinical efficacy of arthrodesis versus ORIF for the treatment of Lisfranc injuries.
METHODS
Through searching the Embase, PubMed, PMC, CINAHL, PQDT, and Cochrane Library databases (from July 1998 to July 2018), we identified five case-controlled trials and two randomized controlled trials that compared the clinical efficacy of primary arthrodesis and ORIF for treating Lisfranc injuries. The extracted data were analyzed using Review manager 5.3 software.
RESULTS
Through comparisons of data for primary arthrodesis and ORIF groups, we found no significant differences in the anatomic reduction rate, revision surgery rate, and total rate of complications between the different treatment approaches. However, arthrodesis was associated with a significantly better American Orthopedic Foot and Ankle Society (AOFAS) score, return to duty rate, and visual analog scale score with a lower incidence of hardware removal compared with ORIF.
CONCLUSIONS
For the treatment for Lisfranc injuries, primary arthrodesis was superior to ORIF based on a higher AOFAS score, better return to duty rate, lower postoperative pain, and lower requirement for internal fixation removal. Further evidence from future randomized controlled trials with higher quality and larger sample sizes is needed to confirm these findings.
Topics: Arthrodesis; Fracture Fixation, Internal; Fractures, Bone; Humans; Ligaments, Articular; Metatarsophalangeal Joint; Open Fracture Reduction; Recovery of Function; Treatment Outcome
PubMed: 31036779
DOI: 10.4103/jpgm.JPGM_414_18 -
Journal of Children's Orthopaedics Oct 2022Pes planus (or flatfoot) is the most common deformity in children with cerebral palsy. There are several surgical interventions used to treat it: single calcaneal... (Review)
Review
PURPOSE
Pes planus (or flatfoot) is the most common deformity in children with cerebral palsy. There are several surgical interventions used to treat it: single calcaneal osteotomies, extra-articular arthrodesis, double calcaneal osteotomy, calcaneo-cuboid-cuneiform osteotomy, intra-articular arthrodesis, and arthroereisis. There is currently no evidence on optimal treatment for flatfoot in children with cerebral palsy. Our purpose is to systematically review studies reporting complications, recurrence rates, and radiological outcomes of the surgical management of flatfoot in children with cerebral palsy.
METHODS
Five databases were searched to identify studies published from inception until July 2021, with keywords relating to flatfoot, cerebral palsy, and surgical interventions. We included prospective, retrospective, and comparative study designs in the English language. Data was extracted and tabulated in duplicate into Excel, and analysis was conducted using Python SciPy.
RESULTS
In total, 1220 studies were identified of which 44 met the inclusion criteria, comprising 2234 feet in 1364 patients with a mean age of 10.3 years and mean follow-up of 55.9 months. Radiographic outcomes showed improvement with all procedures; complications and recurrence rates were too poorly reported to compare. Only 6 (14%) studies were assessed as a low risk of bias. There was substantial heterogeneity of outcome measures.
CONCLUSION
There is a lack of high-quality, comparative studies assessing the radiological outcomes, complications, and recurrence rates of surgical alternatives to treat flatfoot in children with cerebral palsy. There is currently no clear evidence on optimal surgical treatment.
LEVEL OF EVIDENCE
IIa based on Oxford Centre for Evidence-based Medicine.
PubMed: 36238147
DOI: 10.1177/18632521221112496 -
Journal of Craniovertebral Junction &... 2022Lumbar spinal degenerative disease (LSDD), unresponsive to conservative therapy, is commonly treated by surgical decompression and interbody fusion. Since facet joint... (Review)
Review
OBJECTIVE
Lumbar spinal degenerative disease (LSDD), unresponsive to conservative therapy, is commonly treated by surgical decompression and interbody fusion. Since facet joint incompetence has been suggested as responsible for the entire phenomenon of spinal degeneration, facet stabilization can be considered as an alternative technique to treat symptomatic spinal degenerative disease. The purpose of this study was to systematically review the literature for studies utilizing lumbar facet joint fixation techniques for LSDD to assess their safety and efficacy.
METHODS
A systematic literature review was performed following the preferred reporting items for systematic reviews and meta-analyses statement, with no limits in terms of date of publication. Demographic data, inclusion criteria, clinical and radiological outcome, frequency of adverse events (AEs), and follow-up time were evaluated.
RESULTS
A total of 19 studies were included with a total of 1577 patients. The techniques used for facet arthrodesis were Goel intra-articular spacers in 21 patients (5.3%), Facet Wedge in 198 patients (15.8%), facet screws fixation techniques in 1062 patients (52.6%), and facet joints arthroplasty in 296 patients (26.3%). Clinical outcomes were assessed through the evaluation of pain relief and improvement in functional outcome. Radiological outcomes were assessed by the evaluation of proper positioning of instrumentation, solid bony fusion rate, and preservation of disk height. AE's mainly observed were pseudoarthrosis, reoperation, instrumentation displacement/malpositioning/migration, neurological impairment, deep vein thrombosis, and infections. The mean follow-up time ranged from 6 months to 11.7 years.
CONCLUSION
Our data demonstrate that facet joint arthrodesis appears to be effective in managing LSDD. These findings, however, are limited by the small sample size of patients. Accordingly, larger series are needed before formal recommendations can be made.
PubMed: 36777906
DOI: 10.4103/jcvjs.jcvjs_112_22