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Orthopaedic Surgery Nov 2016Controversy remains over whether anterior cervical discectomy and fusion (ACDF) or posterior cervical foraminotomy (PCF) is superior for the treatment of cervical... (Comparative Study)
Comparative Study Review
Controversy remains over whether anterior cervical discectomy and fusion (ACDF) or posterior cervical foraminotomy (PCF) is superior for the treatment of cervical radiculopathy. We therefore performed a systematic review including three prospective randomized controlled trails (RCT) and seven retrospective comparative studies (RCoS) by searching PubMed and EMBASE. These studies were assessed on risk of bias according to the Cochrane Handbook for Systematic Reviews of Interventions, and the quality of evidence and level of recommendation were evaluated according to the GRADE approach. Clinical outcomes, complications, reoperation rates, radiological parameters, and cost/cost-utility were evaluated. The mean complication rate was 7% in the ACDF group and 4% in the PCF group, and the mean reoperation rate was 4% in the ACDF group and 6% in the PCF group within 2 years of the initial surgery. There was a strong level of recommendation that no difference existed in clinical outcome, complication rate and reoperation rate between the ACDF and the PCF group. There was conflicting evidence that the ACDF group had better clinical outcomes than the PCF group (one study with weak level of recommendation). PCF could preserve the range of motion (ROM) of the operated segment but did not increase the ROM of the adjacent segment (weak level of recommendation). Meanwhile, the average cost or cost-utility of the PCF group was significantly lower than that of the ACDF group (weak level of recommendation). In conclusion, the PCF was just as safe and effective as the ACDF in the treatment of cervical radiculopathy. Meanwhile, PCF might have lower medical cost than ACDF and decrease the incidence of adjacent segment disease. Based on the available evidence, PCF appears to be another good surgical approach in the treatment of cervical radiculopathy.
Topics: Cervical Vertebrae; Diskectomy; Foraminotomy; Humans; Radiculopathy; Spinal Fusion; Treatment Outcome
PubMed: 28032703
DOI: 10.1111/os.12285 -
Yonsei Medical Journal Sep 2022With an increasing number of anterior cervical discectomy and fusion (ACDF) being conducted for degenerative cervical disc disease, there is a rising interest in the... (Meta-Analysis)
Meta-Analysis
PURPOSE
With an increasing number of anterior cervical discectomy and fusion (ACDF) being conducted for degenerative cervical disc disease, there is a rising interest in the related quality of management and healthcare costs. Unplanned readmission after ACDF affects both the quality of management and medical expenses. This meta-analysis was performed to evaluate the risk factors of unplanned readmission after ACDF to improve the quality of management and prevent increase in healthcare costs.
MATERIALS AND METHODS
We searched the databases of PubMed, EMBASE, Web of Science, and Cochrane Library to identify eligible studies using the searching terms, "readmission" and "ACDF." A total of 10 studies were included.
RESULTS
Among the demographic risk factors, older age [weighted mean difference (WMD), 3.93; 95% confidence interval (CI), 2.30-5.56; <0.001], male [odds ratio (OR), 1.23; 95% CI, 1.10-1.36; <0.001], and private insurance (OR, 0.34; 95% CI, 0.17-0.69; <0.001) were significantly associated with unplanned readmission. Among patient characteristics, hypertension (HTN) (OR, 2.14; 95% CI, 1.41-3.25; <0.001), diabetes mellitus (DM) (OR, 1.59; 95% CI, 1.20-2.11; =0.001), coronary artery disease (CAD) (OR, 2.87; 95% CI, 2.13-3.86; <0.001), American Society of Anesthesiologists (ASA) physical status grade >2 (OR, 2.13; 95% CI, 1.68-2.72; <0.001), and anxiety and depression (OR, 1.39; 95% CI, 1.29-1.51; <0.001) were significantly associated with unplanned readmission. Among the perioperative factors, pulmonary complications (OR, 22.52; 95% CI, 7.21-70.41; <0.001) was significantly associated with unplanned readmission.
CONCLUSION
Male, older age, HTN, DM, CAD, ASA grade >2, anxiety and depression, pulmonary complications were significantly associated with an increased occurrence of unplanned readmission after ACDF.
Topics: Cervical Vertebrae; Diskectomy; Humans; Male; Patient Readmission; Postoperative Complications; Risk Factors; Spinal Fusion
PubMed: 36031784
DOI: 10.3349/ymj.2022.63.9.842 -
The Cochrane Database of Systematic... Sep 2014Microdiscectomy or open discectomy (MD/OD) are the standard procedures for symptomatic lumbar disc herniation and they involve removal of the portion of the... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Microdiscectomy or open discectomy (MD/OD) are the standard procedures for symptomatic lumbar disc herniation and they involve removal of the portion of the intervertebral disc compressing the nerve root or spinal cord (or both) with or without the aid of a headlight loupe or microscope magnification. Potential advantages of newer minimally invasive discectomy (MID) procedures over standard MD/OD include less blood loss, less postoperative pain, shorter hospitalisation and earlier return to work.
OBJECTIVES
To compare the benefits and harms of MID versus MD/OD for management of lumbar intervertebral discopathy.
SEARCH METHODS
We searched the Cochrane Central Register of Controlled Trials (CENTRAL) (November 2013), MEDLINE (1946 to November 2013) and EMBASE (1974 to November 2013) and applied no language restrictions. We also contacted experts in the field for additional studies and reviewed reference lists of relevant studies.
SELECTION CRITERIA
We selected randomised controlled trials (RCTs) and quasi-randomised controlled trials (QRCTs) that compared MD/OD with a MID (percutaneous endoscopic interlaminar or transforaminal lumbar discectomy, transmuscular tubular microdiscectomy and automated percutaneous lumbar discectomy) for treatment of adults with lumbar radiculopathy secondary to discopathy. We evaluated the following primary outcomes: pain related to sciatica or low back pain (LBP) as measured by a visual analogue scale, sciatic specific outcomes such as neurological deficit of lower extremity or bowel/urinary incontinence and functional outcomes (including daily activity or return to work). We also evaluated the following secondary outcomes: complications of surgery, duration of hospital stay, postoperative opioid use, quality of life and overall participant satisfaction. Two authors checked data abstractions and articles for inclusion. We resolved discrepancies by consensus.
DATA COLLECTION AND ANALYSIS
We used standard methodological procedures expected by The Cochrane Collaboration. We used pre-developed forms to extract data and two authors independently assessed risk of bias. For statistical analysis, we used risk ratio (RR) for dichotomous outcomes and mean difference (MD) for continuous outcomes with 95% confidence intervals (CI) for each outcome.
MAIN RESULTS
We identified 11 studies (1172 participants). We assessed seven out of 11 studies as having high overall risk of bias. There was low-quality evidence that MID was associated with worse leg pain than MD/OD at follow-up ranging from six months to two years (e.g. at one year: MD 0.13, 95% CI 0.09 to 0.16), but differences were small (less than 0.5 points on a 0 to 10 scale) and did not meet standard thresholds for clinically meaningful differences. There was low-quality evidence that MID was associated with worse LBP than MD/OD at six-month follow-up (MD 0.35, 95% CI 0.19 to 0.51) and at two years (MD 0.54, 95% CI 0.29 to 0.79). There was no significant difference at one year (0 to 10 scale: MD 0.19, 95% CI -0.22 to 0.59). Statistical heterogeneity was small to high (I(2) statistic = 35% at six months, 90% at one year and 65% at two years). There were no clear differences between MID techniques and MD/OD on other primary outcomes related to functional disability (Oswestry Disability Index greater than six months postoperatively) and persistence of motor and sensory neurological deficits, though evidence on neurological deficits was limited by the small numbers of participants in the trials with neurological deficits at baseline. There was just one study for each of the sciatica-specific outcomes including the Sciatica Bothersomeness Index and the Sciatica Frequency Index, which did not need further analysis. For secondary outcomes, MID was associated with lower risk of surgical site and other infections, but higher risk of re-hospitalisation due to recurrent disc herniation. In addition, MID was associated with slightly lower quality of life (less than 5 points on a 100-point scale) on some measures of quality of life, such as some physical subclasses of the 36-item Short Form. Some trials found MID to be associated with shorter duration of hospitalisation than MD/OD, but results were inconsistent.
AUTHORS' CONCLUSIONS
MID may be inferior in terms of relief of leg pain, LBP and re-hospitalisation; however, differences in pain relief appeared to be small and may not be clinically important. Potential advantages of MID are lower risk of surgical site and other infections. MID may be associated with shorter hospital stay but the evidence was inconsistent. Given these potential advantages, more research is needed to define appropriate indications for MID as an alternative to standard MD/OD.
Topics: Adult; Aged; Artificial Limbs; Diskectomy; Female; Humans; Intervertebral Disc Displacement; Length of Stay; Low Back Pain; Lumbosacral Region; Male; Microsurgery; Middle Aged; Outcome Assessment, Health Care; Pain Measurement; Randomized Controlled Trials as Topic; Sciatica
PubMed: 25184502
DOI: 10.1002/14651858.CD010328.pub2 -
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 -
Medicine Dec 2017Total disc replacement (TDR) using Mobi-C cervical artificial disc might be promising to treat symptomatic degenerative disc disease. However, the results remained... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Total disc replacement (TDR) using Mobi-C cervical artificial disc might be promising to treat symptomatic degenerative disc disease. However, the results remained controversial. We conducted a systematic review and meta-analysis to compare the efficacy and safety of Mobi-C cervical artificial disc and anterior cervical discectomy and fusion (ACDF) in patients with symptomatic degenerative disc disease.
METHODS
PubMed, EMbase, Web of science, EBSCO, and Cochrane library databases were systematically searched. Randomized controlled trials (RCTs) assessing the effect of Mobi-C versus ACDF on the treatment of symptomatic degenerative disc disease were included. Two investigators independently searched articles, extracted data, and assessed the quality of included studies. The primary outcomes were neck disability index (NDI) score, patient satisfaction, and subsequent surgical intervention. Meta-analysis was performed using the random-effect model.
RESULTS
Four RCTs were included in the meta-analysis. Overall, compared with ACDF surgery for symptomatic degenerative disc disease, TDR using Mobi-C was associated with a significantly increased NDI score (Std. mean difference = 0.32; 95% CI = 0.10-0.53; P = .004), patient satisfaction (odds risk [OR] = 2.75; 95% confidence interval [CI] = 1.43-5.27; P = .002), and reduced subsequent surgical intervention (OR = 0.20; 95% CI = 0.11-0.37; P < .001). Mobi-C was found to produce comparable neurological deterioration (OR = 0.77; 95% CI = 0.35-1.72; P = .53), radiographic success (OR = 1.18; 95% CI = 0.39-3.59; P = .77), and overall success (OR = 2.13; 95% CI = 0.80-5.70; P = .13) compared with ACDF treatment.
CONCLUSION
Among the 4 included RCTs, 3 articles were studying patients with 1 surgical level, and 1 article reported 2 surgical levels. When compared with ACDF surgery in symptomatic degenerative disc disease, TDR using Mobi-C cervical artificial disc resulted in a significantly improved NDI score, patient satisfaction, and reduced subsequent surgical intervention. There was no significant difference of neurological deterioration, radiographic success, and overall success between TDR using Mobi-C cervical artificial disc versus ACDF surgery. TDR using Mobi-C cervical artificial disc should be recommended for the treatment of symptomatic degenerative disc disease.
Topics: Adult; Artificial Organs; Cervical Vertebrae; Disability Evaluation; Diskectomy; Female; Follow-Up Studies; Humans; Intervertebral Disc Degeneration; Male; Middle Aged; Neck; Patient Satisfaction; Randomized Controlled Trials as Topic; Range of Motion, Articular; Spinal Fusion; Total Disc Replacement; Treatment Outcome
PubMed: 29245217
DOI: 10.1097/MD.0000000000008504 -
Clinical Orthopaedics and Related... Jun 2015The impact of the duration of preoperative symptoms on outcomes after lumbar discectomy has not been sufficiently answered in a single study but is a potentially... (Review)
Review
BACKGROUND
The impact of the duration of preoperative symptoms on outcomes after lumbar discectomy has not been sufficiently answered in a single study but is a potentially important clinical variable.
QUESTIONS/PURPOSES
A systematic review was performed to answer two questions: (1) Does symptomatic duration before surgery influence functional recovery after lumbar discectomy? (2) What is the time point for intervention beyond which the extent of postoperative recovery might be compromised?
METHODS
The systematic review began with a query of PubMed using a structured algorithm comprised of medical subject heading terms. This was supplemented by a keyword search in PubMed along with queries of Embase, Scopus, and Web of Science and searches of reference lists as well as the tables of contents of relevant journals. Eligible studies were those that evaluated aspects of recovery after elective discectomy and stratified duration of symptoms before surgery. Included papers were abstracted by two authors and determinations regarding the period of symptom duration and its impact on outcome were recorded. Eleven studies met all inclusion criteria. No prospectively randomized trials addressed our study questions.
RESULTS
Nine of 11 studies, four of which were prospective, maintained that longer symptom duration adversely impacted postsurgical recovery. There were substantial differences among the critical periods of symptom duration reported by individual studies, which ranged from 2 to 12 months. A preponderance of studies (five of nine) reported that surgical interventions could be performed at periods of 6 months or greater without impacting recovery.
CONCLUSIONS
Longer symptom duration had an adverse impact on results in most studies after lumbar discectomy. A possible point beyond which outcomes may be compromised is 6 months after symptom onset. Limitations in the literature surveyed, however, prevent firm conclusions.
Topics: Diskectomy; Humans; Intervertebral Disc; Intervertebral Disc Displacement; Lumbar Vertebrae; Recovery of Function; Risk Factors; Time Factors; Time-to-Treatment; Treatment Outcome
PubMed: 24526298
DOI: 10.1007/s11999-014-3505-1 -
Orthopaedic Surgery Feb 2020Whether cervical disc arthroplasty (CDA) is superior to anterior cervical discectomy and fusion (ACDF) remains controversial, especially in relation to long-term... (Comparative Study)
Comparative Study Meta-Analysis
OBJECTIVE
Whether cervical disc arthroplasty (CDA) is superior to anterior cervical discectomy and fusion (ACDF) remains controversial, especially in relation to long-term results. The present study aimed to evaluate the long-term safety and efficiency of CDA and ACDF for cervical disc disease.
METHODS
We performed this study according to the Cochrane methodology. An extensive search was undertaken in PubMed, Embase, and Cochrane databases up to 1 June 2019 using the following key words: "anterior cervical fusion," "arthroplasty," "replacement" and "artificial disc". RevMan 5.3 (Cochrane, London, UK) was used to analyze data. Safety and efficiency outcome measures included the success rate, functional outcome measures, adverse events (AE), adjacent segment degeneration (ASD), secondary surgery, and patients' satisfaction and recommendation rates. The OR and MD with 95% confidence interval (CI) were used to evaluate discontinuous and continuous variables, respectively. The statistically significant level was set at P < 0.05.
RESULTS
A total of 11 randomized controlled trials with 3505 patients (CDA/ACDF: 1913/1592) were included in this meta-analysis. Compared with ACDF, CDA achieved significantly higher overall success (2.10, 95% CI [1.70, 2.59]), neck disability index (NDI) success (1.73, 95% CI [1.37, 2.18]), neurological success (1.65, 95% CI [1.24, 2.20]), patients' satisfaction (2.14, 95% CI [1.50, 3.05]), and patients' recommendation rates (3.23, 95% CI [1.79, 5.80]). Functional outcome measures such as visual analog score neck pain (-5.50, 95% CI [-8.49, -2.52]) and arm pain (-3.78, 95% CI [-7.04, -0.53]), the Short Form-36 physical component score (SF-36 PCS) (1.93, 95% CI [0.53, 3.32]), and the Short Form-36 mental component score (SF-36 MCS) (2.62, 95% CI [0.95, 4.29]), revealed superiority in the CDA group. CDA also achieved a significantly lower rate of symptomatic ASD (0.46, 95% CI [0.34, 0.63]), total secondary surgery (0.50, 95% CI [0.29, 0.87]), secondary surgery at the index level (0.46, 95% CI [0.29, 0.74]), and secondary surgery at the adjacent level (0.37, 95% CI [0.28, 0.49]). However, no significant difference was found in radiological success (1.35, 95% CI [0.88, 2.08]), NDI score (-2.88, 95% CI [-5.93, 0.17]), total reported AE (1.14, 95% CI [0.92, 1.42]), serious AE (0.89, 95% CI [0.71, 1.11]), device/surgery-related AE (0.90, 95% CI [0.68, 1.18]), radiological superior ASD (0.63, 95% CI [0.28, 1.43]), inferior ASD (0.45, 95% CI [0.19, 1.11]), and work status (1.33, 95% CI [0.78, 2.25]). Furthermore, subgroup analysis showed different results between US and non-US groups.
CONCLUSION
Our study provided further evidence that compared to ACDF, CDA had a higher long-term clinical success rate and better functional outcome measurements, and resulted in less symptomatic ASD and fewer secondary surgeries. However, worldwide multicenter RCT with long-term follow up are still needed for further evaluation in the future.
Topics: Arthroplasty; Cervical Vertebrae; Disability Evaluation; Diskectomy; Humans; Intervertebral Disc Degeneration; Intervertebral Disc Displacement; Pain Measurement; Randomized Controlled Trials as Topic; Spinal Fusion; Total Disc Replacement
PubMed: 31863642
DOI: 10.1111/os.12585 -
Computational Intelligence and... 2022Surgery can reduce and improve lumbar disc herniation, but some patients still have pain after surgery, and the relationship between lumbar disc height and pain after... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Surgery can reduce and improve lumbar disc herniation, but some patients still have pain after surgery, and the relationship between lumbar disc height and pain after surgery is still unclear.
OBJECTIVE
The main objective is to investigate the relationship between lumbar disc height and postoperative pain.
METHODS
We searched Pubmed, Web of Science, the Cochrane library, and Embase online for cohort studies or RCT studies on discectomy and assessed the quality of the included articles using the Newcastle-Ottawa Scale (NOS scale), with disc height (DH) and postoperative back pain as the main clinical outcome indicators, and the correlation coefficient between DH and back pain as the statistic to assess the pooled effect size.
RESULTS
10 kinds of literature were included in this study for quantitative analysis. A total of 589 patients participated in the study. The follow-up time was between 1 and 2.3 years. Meta-analysis showed that after surgery, the relief of back pain was statistically significant ( = -2.57, 95% CI (-3.10,-2.04), = -9.570, < 0.0001), the reduction of disc height was statistically significant ( = -0.82, 95% CI (-1.11, -0.52), = -5.477, < 0.0001), the combined value of correlation coefficient Fisher's value was 0.33, 95% CI (0.25,0.42), with statistical significance ( < 0.00001), suggesting that the degree of back pain after surgery showed a moderate positive correlation with disc height in the short term. . After discectomy, the degree of pain is relieved, the disc height is reduced, and low back pain in the short term and disc height showed a moderate positive correlation, but the long-term correlation remains to be studied in depth.
Topics: Back Pain; Diskectomy; Humans; Intervertebral Disc Displacement; Low Back Pain; Lumbar Vertebrae
PubMed: 36035825
DOI: 10.1155/2022/2580004 -
The Korean Journal of Pain Oct 2021Although the erector spinae plane block has been used in various truncal surgical procedures, its clinical benefits in patients undergoing spinal surgery remain...
BACKGROUND
Although the erector spinae plane block has been used in various truncal surgical procedures, its clinical benefits in patients undergoing spinal surgery remain controversial. The aim of this meta-analysis was to evaluate the clinical benefits of erector spinae plane block in patients undergoing spinal surgery.
METHODS
We searched the Cochrane Library, PubMed, EMBASE, and China National Knowledge Infrastructure for randomized controlled trials comparing the erector spinae plane block with a nonblocked control for spinal surgery.
RESULTS
Twelve studies encompassing 696 subjects were included in our systematic review and meta-analysis. We found that the erector spinae plane block decreased postoperative pain scores and opioid consumption in the postoperative and intraoperative periods. Moreover, it prolonged the time to the first rescue analgesic, reduced the number of patients who required rescue analgesia, and lowered the incidence of postoperative nausea and vomiting. However, it did not exhibit efficacy in decreasing the incidence of urinary retention and itching or shortening the length of hospital stays, or the time to first ambulation.
CONCLUSIONS
Erector spinae plane block improves analgesic efficacy among patients undergoing spinal surgery compared with nonblocked controls; however, there is insufficient evidence regarding the benefits of erector spinae plane block for rapid recovery.
PubMed: 34593667
DOI: 10.3344/kjp.2021.34.4.487 -
Revista Da Associacao Medica Brasileira... Sep 2018Lumbar herniated disc are common manifestations of degenerative spine diseases, the main cause of radiated lower back pain. This guideline followed standard of a...
Lumbar herniated disc are common manifestations of degenerative spine diseases, the main cause of radiated lower back pain. This guideline followed standard of a systematic review with recovery of evidence based on the movement of evidence-based medicine. We used the structured method for formulating the question synthesized by the acronym p.I.C.O., In which the p corresponds to the lumbar herniated disc, i to the treatment intervention with percutaneous hydrodiscectomy, c comparing with other treatment modalities, o the outcome of clinical evolution and complications. From the structured question, we identify the descriptors which constituted the evidence search base in the medline-pubmed databases (636 papers) and therefore, after the eligibility criteria (inclusion and exclusion), eight papers were selected to answer to clinical question. The details of the methodology and the results of this guideline are exposed in annex i.
Topics: Diskectomy, Percutaneous; Evidence-Based Medicine; Humans; Intervertebral Disc Degeneration; Intervertebral Disc Displacement; Low Back Pain; Lumbar Vertebrae
PubMed: 30672996
DOI: 10.1590/1806-9282.64.09.778