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Journal of Orthopaedic Surgery and... Jul 2023The clinical outcomes of using a tubular microdiscectomy for lumbar disc herniation were evaluated by comparison with conventional microdiscectomy. (Meta-Analysis)
Meta-Analysis Review
Comparison of outcomes between tubular microdiscectomy and conventional microdiscectomy for lumbar disc herniation: a systematic review and meta-analysis of randomized controlled trials.
PURPOSE
The clinical outcomes of using a tubular microdiscectomy for lumbar disc herniation were evaluated by comparison with conventional microdiscectomy.
METHODS
All of the comparative studies published in the PubMed, Cochrane Library, Medline, Web of Science, and EMBASE databases as of 1 May 2023 were included. All outcomes were analysed using Review Manager 5.4.
RESULTS
This meta-analysis included four randomized controlled studies with a total of 523 patients. The results showed that using tubular microdiscectomy for lumbar disc herniation was more effective than conventional microdiscectomy in improving the Oswestry Disability Index (P < 0.05). However, there were no significant differences in operating time, intraoperative blood loss, hospital stay, Visual Analogue Scale, reoperation rate, postoperative recurrence rate, dural tear incidence, and complications rate (all P > 0.05) between the tubular microdiscectomy and conventional microdiscectomy groups.
CONCLUSIONS
Based on our meta-analysis, it was found that the tubular microdiscectomy group had better outcomes than the conventional microdiscectomy group in terms of Oswestry Disability Index. However, there were no significant differences between the two groups in terms of operating time, intraoperative blood loss, hospital stay, Visual Analogue Scale, reoperation rate, postoperative recurrence rate, dural tear incidence, and complications rate. Current research suggests that tubular microdiscectomy can achieve clinical results similar to those of conventional microdiscectomy. PROSPERO registration number is: CRD42023407995.
Topics: Humans; Intervertebral Disc Displacement; Blood Loss, Surgical; Lumbar Vertebrae; Microsurgery; Randomized Controlled Trials as Topic; Diskectomy; Treatment Outcome
PubMed: 37400862
DOI: 10.1186/s13018-023-03962-8 -
The Bone & Joint Journal Aug 2018The aim of this study was to determine how the short- and medium- to long-term outcome measures after total disc replacement (TDR) compare with those of anterior... (Meta-Analysis)
Meta-Analysis Review
Total disc replacement versus anterior cervical discectomy and fusion: a systematic review with meta-analysis of data from a total of 3160 patients across 14 randomized controlled trials with both short- and medium- to long-term outcomes.
AIMS
The aim of this study was to determine how the short- and medium- to long-term outcome measures after total disc replacement (TDR) compare with those of anterior cervical discectomy and fusion (ACDF), using a systematic review and meta-analysis.
PATIENTS AND METHODS
Databases including Medline, Embase, and Scopus were searched. Inclusion criteria involved prospective randomized control trials (RCTs) reporting the surgical treatment of patients with symptomatic degenerative cervical disc disease. Two independent investigators extracted the data. The strength of evidence was assessed using the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) criteria. The primary outcome measures were overall and neurological success, and these were included in the meta-analysis. Standardized patient-reported outcomes, including the incidence of further surgery and adjacent segment disease, were summarized and discussed.
RESULTS
A total of 22 papers published from 14 RCTs were included, representing 3160 patients with follow-up of up to ten years. Meta-analysis indicated that TDR is superior to ACDF at two years and between four and seven years. In the short-term, patients who underwent TDR had better patient-reported outcomes than those who underwent ACDF, but at two years this was typically not significant. Results between four and seven years showed significant differences in Neck Disability Index (NDI), 36-Item Short-Form Health Survey (SF-36) physical component scores, dysphagia, and satisfaction, all favouring TDR. Most trials found significantly less adjacent segment disease after TDR at both two years (short-term) and between four and seven years (medium- to long-term).
CONCLUSION
TDR is as effective as ACDF and superior for some outcomes. Disc replacement reduces the risk of adjacent segment disease. Continued uncertainty remains about degeneration of the prosthesis. Long-term surveillance of patients who undergo TDR may allow its routine use. Cite this article: Bone Joint J 2018;100-B:991-1001.
Topics: Cervical Vertebrae; Diskectomy; Humans; Intervertebral Disc Degeneration; Randomized Controlled Trials as Topic; Range of Motion, Articular; Spinal Fusion; Total Disc Replacement; Treatment Outcome
PubMed: 30062947
DOI: 10.1302/0301-620X.100B8.BJJ-2018-0120.R1 -
International Journal of Surgery... Jul 2016The purpose of the study is to perform a systematic review and meta-analysis to evaluate the clinical results of percutaneous endoscopic lumbar discectomy (PELD) and... (Comparative Study)
Comparative Study Meta-Analysis Review
PURPOSE
The purpose of the study is to perform a systematic review and meta-analysis to evaluate the clinical results of percutaneous endoscopic lumbar discectomy (PELD) and open lumbar microdiscectomy (OLM) for the treatment of lumbar disc herniation (LDH).
METHODS
Randomized controlled trials or non-randomized controlled trials published from the time when databases were built to March 2016 that compared the clinical effectiveness of PELD and OLM surgical approaches for the treatment of LDH were acquired by a comprehensive search in four electronic databases (PubMed, EMBASE, Web of Science and Cochrane library). A total of 7 studies (1389 patients) were included in this systematic review and meta-analysis. Pooled mean differences (MD) and odds ratios (OR) and with 95% CIs were calculated for the outcomes.
RESULT
The results showed that there were no statistically between the PELD group and OLM group in terms of preoperative VAS-BP score (WMD = 0.03; 95% CI: -0.99 to 1.05; P = 0.95), postoperative VAS-BP score (WMD = -0.56; 95% CI: -1.43 to 0.31; P = 0.21), postoperative ODI (WMD = -0.98; 95% CI: -4.96 to 3.00; P = 0.63), complication rate (OR = 1.79; 95% CI: 0.95 to 3.37; P = 0.07) or reoperation rate (OR = 1.44; 95% CI: 0.94 to 2.20; P = 0.09). PELD group was associated with shorter operation time (WMD = -12.83; 95% CI: -24.79 to -0.87; P = 0.04) and hospital stay (WMD = -5.49; 95% CI: -8.63 to -2.35; P = 0.0006).
CONCLUSION
The existing evidence indicate that no superiority exists between the two surgical approaches for the treatment of LDH in terms of functional outcome, complication rate and reoperation rate, in spite of that PELD surgical group can achieve shorter operation time and hospital stay than OLM surgical group.
Topics: Diskectomy; Diskectomy, Percutaneous; Endoscopy; Humans; Intervertebral Disc Displacement; Lumbar Vertebrae; Treatment Outcome
PubMed: 27260312
DOI: 10.1016/j.ijsu.2016.05.061 -
Journal of Orthopaedic Surgery and... Oct 2023Given the inconclusive literature on operative time, pain relief, functional outcomes, and complications, this meta-analysis aims to compare the efficacy of Unilateral... (Meta-Analysis)
Meta-Analysis
Comparative efficacy of unilateral biportal endoscopy and micro-endoscopic discectomy in the treatment of degenerative lumbar spinal stenosis: a systematic review and meta-analysis.
BACKGROUND
Given the inconclusive literature on operative time, pain relief, functional outcomes, and complications, this meta-analysis aims to compare the efficacy of Unilateral Biportal Endoscopy (UBE) and Micro-Endoscopic Discectomy (MED) in treating Degenerative Lumbar Spinal Stenosis (DLSS).
METHODS
A thorough literature search was conducted in accordance with the PRISMA guidelines and based on the PICO framework. The study interrogated four primary databases-PubMed, Embase, Web of Science, and the Cochrane Library-on August 16, 2023, without time restrictions. The search employed a strategic selection of keywords and was devoid of language barriers. Studies were included based on strict criteria, such as the diagnosis, surgical intervention types, and specific outcome measures. Quality assessment was performed using the Newcastle-Ottawa Scale, and statistical analysis was executed through Stata version 17.
RESULTS
The meta-analysis incorporated 9 articles out of an initial yield of 1,136 potential studies. Considerable heterogeneity was observed in surgical duration, but no statistically significant difference was identified (MD = - 2.11, P = 0.56). For VAS scores assessing lumbar and leg pain, UBE was statistically superior to MED (MD = - 0.18, P = 0.013; MD = - 0.15, P = 0.006, respectively). ODI scores demonstrated no significant difference between the two surgical methods (MD = - 0.57, P = 0.26). UBE had a lower incidence of complications compared to those receiving MED (OR = 0.54, P = 0.036).
CONCLUSIONS
UBE and MED exhibited comparable surgical durations and disability outcomes as measured by ODI. However, UBE demonstrated superior efficacy in alleviating lumbar and leg pain based on VAS scores. The findings present an intricate evaluation of the two surgical interventions for DLSS, lending valuable insights for clinical decision-making.
Topics: Humans; Spinal Stenosis; Endoscopy; Diskectomy; Outcome Assessment, Health Care; Pain; Lumbar Vertebrae; Treatment Outcome; Retrospective Studies
PubMed: 37907922
DOI: 10.1186/s13018-023-04322-2 -
International Journal of Environmental... Aug 2022Modic changes (MCs) are believed to be potential pain generators in the lumbar and cervical spine, but it is currently unclear if their presence affects postsurgical... (Meta-Analysis)
Meta-Analysis Review
Modic changes (MCs) are believed to be potential pain generators in the lumbar and cervical spine, but it is currently unclear if their presence affects postsurgical outcomes. We performed a systematic review in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. All studies evaluating cervical or lumbar spine postsurgical outcomes in patients with documented preoperative MCs were included. A total of 29 studies and 6013 patients with 2688 of those patients having preoperative MCs were included. Eight included studies evaluated cervical spine surgery, eleven evaluated lumbar discectomies, nine studied lumbar fusion surgery, and three assessed lumbar disc replacements. The presence of cervical MCs did not impact the clinical outcomes in the cervical spine procedures. Moreover, most studies found that MCs did not significantly impact the clinical outcomes following lumbar fusion, lumbar discectomy, or lumbar disc replacement. A meta-analysis of the relevant data found no significant association between MCs and VAS back pain or ODI following lumbar discectomy. Similarly, there was no association between MCs and JOA or neck pain following ACDF procedures. Patients with MC experienced statistically significant improvements following lumbar or cervical spine surgery. The postoperative improvements were similar to patients without MCs in the cervical and lumbar spine.
Topics: Cervical Vertebrae; Diskectomy; Humans; Lumbar Vertebrae; Lumbosacral Region; Neck Pain; Treatment Outcome
PubMed: 36011795
DOI: 10.3390/ijerph191610158 -
Medicine Jul 2016Prevalence estimates of adjacent segment degeneration (ASD) following cervical spine surgery varied greatly in current studies. We conducted a systematic review and... (Meta-Analysis)
Meta-Analysis Review
UNLABELLED
Prevalence estimates of adjacent segment degeneration (ASD) following cervical spine surgery varied greatly in current studies. We conducted a systematic review and meta-analysis to summarize the point prevalence of ASD after cervical spine surgery.
METHODS
Comprehensive electronic searches of PubMed, Embase, Web of Knowledge, and Cochrane Library databases were conducted to identify any study published from initial state to January 2016. Those reporting the prevalence of ASD after cervical surgery were included. A random-effects model was used to estimate the prevalence of radiographic ASD, symptomatic ASD, and reoperation ASD. Univariate meta-regression analyses were conducted to explore the potential associations between prevalence and length of follow-up. All analyses were performed using R version 3.2.3 (R Foundation for Statistical Computing).
RESULTS
A total of 83 studies were included in the meta-analysis. The prevalence of radiographic ASD, symptomatic ASD, and reoperation ASD after cervical surgery was 28.28% (95% confidence interval [CI], 20.96-36.96), 13.34% (95% CI, 11.06-16.00), and 5.78% (95% CI, 4.99-6.69), respectively, in a general analysis. It was found 2.79%, 1.43%, and 0.24% additions per year of follow-up in the incidence of radiographic ASD, symptomatic ASD, and reoperation ASD, respectively.
CONCLUSION
This meta-analysis provides some details about the prevalence of radiographic ASD, symptomatic ASD, and reoperation ASD after cervical spine surgery. However, the results of this meta-analysis should be interpreted with caution because of the heterogeneity among the studies.
Topics: Cervical Vertebrae; Diskectomy; Humans; Postoperative Complications; Prevalence; Spinal Diseases; Spinal Fusion
PubMed: 27399140
DOI: 10.1097/MD.0000000000004171 -
Clinical Orthopaedics and Related... Jun 2015Traditionally, lumbar discectomy involves removal of the free disc fragment followed by aggressive or conservative excision of the intervertebral disc. In selected... (Review)
Review
BACKGROUND
Traditionally, lumbar discectomy involves removal of the free disc fragment followed by aggressive or conservative excision of the intervertebral disc. In selected patients, however, it is possible to remove only the free fragment or sequester without clearing the intervertebral disc space. However, there is some controversy about whether that approach is sufficient to prevent recurrent symptoms and to provide adequate pain relief.
QUESTIONS/PURPOSES
This systematic review was designed to pose two questions: (1) Does performing a sequestrectomy only without conventional microdiscectomy lead to an increased reherniation rate; and (2) is there a difference in the patient-reported levels of radicular pain?
METHODS
Systematic MEDLINE and EMBASE searches were carried out to identify all articles published in peer-reviewed journals reporting the outcomes of interest for conventional microdiscectomy versus sequestrectomy for lumbar disc herniation from L2 to the sacrum (Level III evidence and above); hand-searching of bibliographies was also performed. A minimum of Level II evidence was required with a followup rate of greater than 75%. Followup in all studies was from 18 to 86 months. Seven studies met the inclusion criteria for this review. The studies were analyzed for operating time, hospital stay, pre- and postoperative visual analog scale, and reherniation rate.
RESULTS
Patients in both the microdiscectomy and sequestrectomy groups showed comparable improvement of visual analog scale (VAS) score for leg pain. VAS score improvement ranged from 5.6 to 6.5 points in the microdiscectomy groups and 5.5 to 6.6 in the sequestrectomy group. The reherniation rate in the microdiscectomy group ranged from 2.3% to 11.8% and in the sequestrectomy groups from 2% to 12.5%.
CONCLUSIONS
This review of the available literature suggests that, compared with conventional microdiscectomy, microsurgical lumbar sequestrectomy can achieve comparable reherniation rates and reduction in radicular pain when a small breach in the posterior fibrous ring is found intraoperatively.
Topics: Diskectomy; Humans; Intervertebral Disc; Intervertebral Disc Displacement; Low Back Pain; Lumbar Vertebrae; Microsurgery; Pain Measurement; Pain, Postoperative; Recurrence; Risk Factors; Treatment Outcome
PubMed: 25183219
DOI: 10.1007/s11999-014-3904-3 -
BMC Musculoskeletal Disorders Sep 2018Success rates for lumbar discectomy are estimated as 78-95% patients at 1-2 years post-surgery, supporting its effectiveness. However, ongoing pain and disability is an... (Review)
Review
BACKGROUND
Success rates for lumbar discectomy are estimated as 78-95% patients at 1-2 years post-surgery, supporting its effectiveness. However, ongoing pain and disability is an issue for some patients, and recurrence contributing to reoperation is reported. It is important to identify prognostic factors predicting outcome to inform decision-making for surgery and rehabilitation following surgery. The objective was to determine whether pre-operative physical factors are associated with post-operative outcomes in adult patients [≥16 years old] undergoing lumbar discectomy or microdiscectomy.
METHODS
A systematic review was conducted according to a registered protocol [PROSPERO CRD42015024168]. Key electronic databases were searched [PubMed, CINAHL, EMBASE, MEDLINE, PEDro and ZETOC] using pre-defined terms [e.g. radicular pain] to 31/3/2017; with additional searching of journals, reference lists and unpublished literature. Prospective cohort studies with ≥1-year follow-up, evaluating candidate physical prognostic factors [e.g. leg pain intensity and straight leg raise test], in adult patients undergoing lumbar discectomy/microdiscectomy were included. Two reviewers independently searched information sources, evaluated studies for inclusion, extracted data, and assessed risk of bias [QUIPS]. GRADE determined the overall quality of evidence.
RESULTS
1189 title and abstracts and 45 full texts were assessed, to include 6 studies; 1 low and 5 high risk of bias. Meta-analysis was not possible [risk of bias, clinical heterogeneity]. A narrative synthesis was performed. There is low level evidence that higher severity of pre-operative leg pain predicts better Core Outcome Measures Index at 12 months and better post-operative leg pain at 2 and 7 years. There is very low level evidence that a lower pre-operative EQ-5D predicts better EQ-5D at 2 years. Low level evidence supports duration of leg pain pre-operatively not being associated with outcome, and very low-quality evidence supports other factors [pre-operative ODI, duration back pain, severity back pain, ipsilateral SLR and forward bend] not being associated with outcome [range of outcome measures used].
CONCLUSION
An adequately powered low risk of bias prospective observational study is required to further investigate candidate physical prognostic factors owing to existing low/very-low level of evidence.
Topics: Adolescent; Adult; Aged; Aged, 80 and over; Disability Evaluation; Diskectomy; Female; Humans; Intervertebral Disc; Intervertebral Disc Degeneration; Lumbar Vertebrae; Male; Middle Aged; Pain Measurement; Pain, Postoperative; Recovery of Function; Risk Factors; Treatment Outcome; Young Adult
PubMed: 30205812
DOI: 10.1186/s12891-018-2240-2 -
Journal of Healthcare Engineering 2022Systematic analysis of the incidence of percutaneous spinal endoscopic technique and traditional open surgery for lumbar disc herniation. (Meta-Analysis)
Meta-Analysis
OBJECTIVE
Systematic analysis of the incidence of percutaneous spinal endoscopic technique and traditional open surgery for lumbar disc herniation.
METHODS
A randomized controlled trial (RCT) and cohort study on complications related to traditional open surgery was searched on the MEDLINE, Cochrane Library, PubMed, Web of Science, Chinese journal full-text database (CNKI), Wanfang, and Embase database. Language is not limited. The quality of each study was evaluated, various complications were compiled into electronic baseline tables, and the data from these studies were available. Meta-analysis and synthesis were performed with the RevMan 5.3 software to evaluate the statistical significance of both surgical techniques in terms of various complications.
RESULTS
12 studies were eventually included, and a total of 2,797 patients were included in the analysis. Meta-analysis results showed that there was no statistical difference in postoperative paresthesia between percutaneous spinal endoscopy and traditional open surgery (OR = 1.17, 95% CI (0.82, 1.66), = 0.38, = 0%, = 0.88), direct nerve root damage (OR = 0.79, 95% CI (0.58, 1.07), = 0.13, = 73%, = 1.52), and intraoperative hemorrhage and hematoma formation (OR = 1.00, 95% CI (0.67, 1.48), = 0.99, = 0%, = 0.02), but there was a statistical difference in disc recurrence (OR = 2.24, 95% CI (1.56, 3.21), < 0.0001, = 81%, = 4.39).
CONCLUSION
Compared with the traditional open surgical treatment of lumbar disc herniation, percutaneous spinal endoscopic technology has obvious advantages in reducing nerve root injury, dural injury, and surgical area wound complications, but it is limited to preventing the technical characteristics of the surgical site, which is worse than that of open surgery.
Topics: Diskectomy, Percutaneous; Endoscopy; Humans; Intervertebral Disc Displacement; Lumbar Vertebrae; Randomized Controlled Trials as Topic; Treatment Outcome
PubMed: 35340255
DOI: 10.1155/2022/6033989 -
PloS One 2016This study aimed to investigate the mid- to long-term outcomes of cervical disc arthroplasty (CDA) versus anterior cervical discectomy and fusion (ACDF) for the... (Meta-Analysis)
Meta-Analysis Review
Mid- to Long-Term Outcomes of Cervical Disc Arthroplasty versus Anterior Cervical Discectomy and Fusion for Treatment of Symptomatic Cervical Disc Disease: A Systematic Review and Meta-Analysis of Eight Prospective Randomized Controlled Trials.
PURPOSE
This study aimed to investigate the mid- to long-term outcomes of cervical disc arthroplasty (CDA) versus anterior cervical discectomy and fusion (ACDF) for the treatment of 1-level or 2-level symptomatic cervical disc disease.
METHODS
Medline, Embase, and the Cochrane Central Register of Controlled Trials databases were searched to identify relevant randomized controlled trials that reported mid- to long-term outcomes (at least 48 months) of CDA versus ACDF. All data were analyzed by Review Manager 5.3 software. The relative risk (RR) and 95% confidence intervals (CIs) were calculated for dichotomous variables. The weighted mean difference (WMD) and 95%CIs were calculated for continuous variables. A random effect model was used for heterogeneous data; otherwise, a fixed effect model was used.
RESULTS
Eight prospective randomized controlled trials (RCTs) were retrieved in this meta-analysis, including 1317 and 1051 patients in CDA and ACDF groups, respectively. Patients after an ACDF had a significantly lower rate of follow-up than that after CDA. Pooled analysis showed patients in CDA group achieved significantly higher rates of overall success, Neck Disability Index (NDI) success, neurological success and significantly lower rates of implant/surgery-related serious adverse events and secondary procedure compared with that in ACDF group. The long-term functional outcomes (NDI, Visual Analog Scale (VAS) neck and arm pain scores, the Short Form 36 Health Survey physical component score (SF-36 PCS)), patient satisfaction and recommendation, and the incidence of superior adjacent segment degeneration also favored patients in CDA group with statistical difference. Regarding inferior adjacent segment degeneration, patients in CDA group had a lower rate without statistical significance.
CONCLUSIONS
This meta-analysis showed that cervical disc arthroplasty was superior over anterior discectomy and fusion for the treatment of symptomatic cervical disc disease in terms of overall success, NDI success, neurological success, implant/surgery-related serious adverse events, secondary procedure, functional outcomes, patient satisfaction and recommendation, and superior adjacent segment degeneration.
Topics: Arthroplasty; Cervical Vertebrae; Diskectomy; Humans; Intervertebral Disc Degeneration; Intervertebral Disc Displacement; Randomized Controlled Trials as Topic; Treatment Outcome
PubMed: 26872258
DOI: 10.1371/journal.pone.0149312