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Spine Dec 2023Systematic review and meta-analysis. (Meta-Analysis)
Meta-Analysis
STUDY DESIGN
Systematic review and meta-analysis.
OBJECTIVE
Evaluate the role of systemic steroids in treating patients with sciatica due to lumbar disk herniation (LDH).
SUMMARY OF BACKGROUND DATA
The association between LDH and sciatica has been well described. The use of steroids seems logical in this context; however, their efficacy is not well described, and their use remains controversial.
METHODS
A comprehensive search on PubMed, EMBASE, and Scopus databases (up to February 15, 2022) was performed to identify randomized clinical trials that included patients with symptoms of sciatica due to LDH that were treated with systemic steroids. The risk of bias was judged using the Cochrane risk-of-Bias2 tool. Meta-analysis was conducted using a random-effects model to estimate the between-group effect size for pain and functional outcomes. The risk of developing adverse events (AE) was computed using relative risks. All pooled results are reported with their 95% confidence interval (CI) and certainty of evidence analyzed using the Grading of Recommendations Assessment, Development, and Evaluation framework.
RESULTS
Ten studies met inclusion criteria, comprising a total of 1017 participants: 540 in the treatment group and 477 in the control group. Steroid treatment was associated with a significant superior reduction of pain (SMD = -0.42, 95% CI -0.76 to -0.08, weak effect, very-low certainty) and reduction in disability (SMD = -0.30, 95% CI -0.51 to -0.10, weak effect, very-low certainty). Corticosteroid administration was associated with a significant increased risk of developing an AE (relative risks = 2.00, 95% CI 1.40 to 2.85, low certainty).
CONCLUSION
The use of systemic steroids in the treatment of sciatica due to LDH seems reasonable despite a 2-fold higher risk of developing mild AEs. However, the effect size is small for reducing pain in the short term and improving functional outcomes at long-term follow-up.
Topics: Humans; Sciatica; Intervertebral Disc Displacement; Steroids; Adrenal Cortex Hormones; Pain
PubMed: 37642478
DOI: 10.1097/BRS.0000000000004801 -
International Ophthalmology Nov 2021To evaluate the diagnostic value of laser speckle flowgraphy (LSFG) in glaucoma by investigating the mean blur rate (MBR) in the optic nerve head. (Meta-Analysis)
Meta-Analysis Review
PURPOSE
To evaluate the diagnostic value of laser speckle flowgraphy (LSFG) in glaucoma by investigating the mean blur rate (MBR) in the optic nerve head.
METHODS
Systematic literature search was performed in the CENTRAL, Web of Science, PubMed, and EMBASE databases to obtain relevant studies published until December 2020 without restrictions. The Newcastle-Ottawa Scale (NOS) was used for study quality assessment. The outcome measures included the MBRs of the entire (MA), vascular (MV), and tissue (MT) areas. Subgroup analyses were performed according to glaucoma type. All data were analyzed using RevMan and Comprehensive Meta-Analysis 3.3 software.
RESULTS
Fifteen studies, including 692 glaucomatous and 386 healthy eyes, were included. Of these, 11 studies reported the MA, MV, and MT, three studies only reported MT, and one study only reported MV. All were classified as case-control studies and had good NOS scores. The meta-analysis showed that the MA and MT were significantly reduced in glaucomatous eyes (mean difference [MD] - 5.59, 95% confidence interval [CI] - 6.19 to - 4.99, p = 0.1; MD - 2.2, 95% CI - 2.49 to - 1.91, p = 0.07, respectively) with moderate heterogeneity (p = 0.1, I = 38%; p = 0.07, I = 39%, respectively). There was also a significant difference in the MV between glaucomatous and healthy eyes (MD - 5.92, 95% CI - 7.77 to - 4.07) with significant heterogeneity (p = 0.0003, I = 69%). The subgroup analyses revealed significant differences in the MBR among different glaucoma types.
CONCLUSIONS
Glaucoma is closely related to ocular blood flow changes. This meta-analysis suggests that LSFG is a feasible diagnostic tool for glaucoma. However, further longitudinal prospective studies are needed.
Topics: Blood Flow Velocity; Glaucoma; Humans; Laser-Doppler Flowmetry; Lasers; Optic Disk; Regional Blood Flow
PubMed: 34327617
DOI: 10.1007/s10792-021-01954-3 -
International Ophthalmology Aug 2020Optic disc drusen (ODD) are acellular deposits in the prelaminar optic nerve head. The most accredited theory is that they are secondary to abnormalities in axonal... (Review)
Review
BACKGROUND
Optic disc drusen (ODD) are acellular deposits in the prelaminar optic nerve head. The most accredited theory is that they are secondary to abnormalities in axonal metabolism and degeneration, but the pathogenesis is not clear to date.
CLINICAL MANIFESTATION
Although ODD are often considered a benign condition, the great majority of patients with ODD show visual field defects and are at higher risk for developing anterior ischemic optic neuropathy. ODD are classified as superficial or buried, with the latter being often misdiagnosed as papilledema with optic nerve head swelling, leading to an unnecessary investigation for causes of increased intracranial pressure.
AIM
The recent technological improvements in OCT imaging which allowed an earlier and more certain diagnosis even of the smallest ODD, renovated the interest around this pathology. However, an updated systematic review is still missing. Therefore, the aim of this work is to provide a concise yet comprehensive overview of the current state of art, focusing on pathophysiology, clinical presentation, diagnostic methods, treatment modalities and potential future perspectives of this condition.
Topics: Humans; Optic Disk; Optic Disk Drusen; Optic Neuropathy, Ischemic; Papilledema; Visual Field Tests
PubMed: 32383130
DOI: 10.1007/s10792-020-01365-w -
Frontiers in Medicine 2022Parkinson's disease (PD) is a multifaceted neurodegenerative disease. The optic nerve, as a window into the central nervous system (CNS), is known to be an important...
BACKGROUND
Parkinson's disease (PD) is a multifaceted neurodegenerative disease. The optic nerve, as a window into the central nervous system (CNS), is known to be an important part of the CNS and can be detected non-invasively. With the widespread availability of optical coherence tomography (OCT) devices, an increasing number of studies have paid attention to the neuropathological disorders in the retina of PD patients in recent years. However, it is still controversial whether OCT can be used as a complementary tool for PD diagnosis.
METHODS
This review is registered with PROSPERO, number CRD42022301258. The Embase, PUBMED, and The Cochrane Library databases were independently retrieved by 2 investigators to identify relevant papers published from 1 January 2017 to 24 January 2022. These studies used OCT or OCTA to evaluate the difference in the retinal nerve fiber layer (RNFL) thickness, ganglion cell layer(GCL) thickness, macula thickness, Cup and disk area superficial retinal capillary plexus (SCP), and deep retinal capillary plexus(DCP). The standard mean difference (SMD) with the 95% confidence interval (CI) was pooled for continuous outcomes.
RESULTS
In total, 26 studies had been enrolled in this meta-analysis with a total number of 2,790 eyes, including 1,343 eyes from the PD group along with 1,447 eyes from the HC group. The results revealed that the RNFL thickness (SMD: -0.53; 95%CI, -0.71∼-0.35; < 0.00001), GCL thickness (SMD: -0.43; 95%CI, -0.66 to -0.19; = 0.0003), macula thickness (SMD: -0.22; 95%CI, -0.22 to -0.11; < 0.0001) were significantly thinner in patients with PD. The SCP (SMD: -0.61; 95%CI, -1.31to -0.10; = 0.02) was significantly lower in PD patients. The DCP (SMD: -0.48; 95%CI, -1.02 to -0.06; = 0.08) is lower in PD patients, but the difference was statistically insignificant.
CONCLUSION
Retinal nerve fiber layer thickness, GCL thickness, macular thickness, and SVD of PD patients are lower than those of healthy control. OCT and OCTA could detect morphological retinal changes in PD and might be objective and reproducible auxiliary tools to assist clinician diagnosis.
SYSTEMATIC REVIEW REGISTRATION
[https://www.crd.york.ac.uk/prospero/], identifier [CRD42022301258].
PubMed: 36186761
DOI: 10.3389/fmed.2022.957700 -
Clinical Spine Surgery Jul 2023Systematic Review.
STUDY DESIGN
Systematic Review.
OBJECTIVES
To synthesize previous studies evaluating racial disparities in spine surgery.
METHODS
We queried PubMed, Embase, Cochrane Library, and Web of Science for literature on racial disparities in spine surgery. Our review was constructed in accordance with Preferred Reporting Items and Meta-analyses guidelines and protocol. The main outcome measures were the occurrence of racial disparities in postoperative outcomes, mortality, surgical management, readmissions, and length of stay.
RESULTS
A total of 1753 publications were assessed. Twenty-two articles met inclusion criteria. Seventeen studies compared Whites (Ws) and African Americans (AAs) groups; 14 studies reported adverse outcomes for AAs. When compared with Ws, AA patients had higher odds of postoperative complications including mortality, cerebrospinal fluid leak, nervous system complications, bleeding, infection, in-hospital complications, adverse discharge disposition, and delay in diagnosis. Further, AAs were found to have increased odds of readmission and longer length of stay. Finally, AAs were found to have higher odds of nonoperative treatment for spinal cord injury, were more likely to undergo posterior approach in the treatment of cervical spondylotic myelopathy, and were less likely to receive cervical disk arthroplasty compared with Ws for similar indications.
CONCLUSIONS
This systematic review of spine literature found that when compared with W patients, AA patients had worse health outcomes. Further investigation of root causes of these racial disparities in spine surgery is warranted.
Topics: Humans; Racial Groups; Cervical Vertebrae; Spinal Cord Diseases; Postoperative Complications; Retrospective Studies; White
PubMed: 35994052
DOI: 10.1097/BSD.0000000000001383 -
Computer Methods and Programs in... Jun 2022The optic nerve head (ONH) represents the intraocular section of the optic nerve, which is prone to damage by intraocular pressure (IOP). The advent of optical... (Review)
Review
The optic nerve head (ONH) represents the intraocular section of the optic nerve, which is prone to damage by intraocular pressure (IOP). The advent of optical coherence tomography (OCT) has enabled the evaluation of novel ONH parameters, namely the depth and curvature of the lamina cribrosa (LC). Together with the Bruch's membrane minimum-rim-width (BMO-MRW), these seem to be promising ONH parameters for diagnosis and monitoring of retinal diseases such as glaucoma. Nonetheless, these OCT derived biomarkers are mostly extracted through manual segmentation, which is time-consuming and prone to bias, thus limiting their usability in clinical practice. The automatic segmentation of ONH in OCT scans could further improve the current clinical management of glaucoma and other diseases. This review summarizes the current state-of-the-art in automatic segmentation of the ONH in OCT. PubMed and Scopus were used to perform a systematic review. Additional works from other databases (IEEE, Google Scholar and ARVO IOVS) were also included, resulting in a total of 29 reviewed studies. For each algorithm, the methods, the size and type of dataset used for validation, and the respective results were carefully analysed. The results show a lack of consensus regarding the definition of segmented regions, extracted parameters and validation approaches, highlighting the importance and need of standardized methodologies for ONH segmentation. Only with a concrete set of guidelines, these automatic segmentation algorithms will build trust in data-driven segmentation models and be able to enter clinical practice.
Topics: Bruch Membrane; Glaucoma; Humans; Intraocular Pressure; Optic Disk; Tomography, Optical Coherence
PubMed: 35429812
DOI: 10.1016/j.cmpb.2022.106801 -
Oral Surgery, Oral Medicine, Oral... Sep 2022This systematic review aimed to summarize the morphologic changes in the temporomandibular joint (TMJ) in patients who underwent orthodontic treatment and were assessed... (Review)
Review
OBJECTIVE
This systematic review aimed to summarize the morphologic changes in the temporomandibular joint (TMJ) in patients who underwent orthodontic treatment and were assessed by 3-dimensional (3D) imaging techniques (e.g., magnetic resonance imaging, cone beam computed tomography, and multidetector computed tomography).
STUDY DESIGN
The authors searched PubMed, Web of Science, and Embase databases to identify original articles from 2014 to 2021 containing keywords for morphologic changes in the TMJ, orthodontic treatment, and three-dimensional imaging methods. Prospective and retrospective studies, including observational, cross-sectional, randomized, and nonrandomized clinical trials, cohort studies, and case-control studies, were reviewed. The review was conducted in accordance with PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. The risk of bias was assessed in studies selected for the full-text review.
RESULTS
The search strategy yielded 294 publications. After an initial screening and the application of exclusion criteria, 13 studies were selected for the final review.
CONCLUSION
Differences were found in condylar positioning, typically in an anterior position; condylar morphology, primarily with increased diameter or head height; and articular disk position within the anterior-posterior plane post-treatment. Changes in the glenoid fossa were not consistent between the studies. The overall risk of bias among studies was moderate. The influence of orthodontic treatment on morphologic changes in the TMJ remains unclear.
Topics: Cross-Sectional Studies; Humans; Mandibular Condyle; Prospective Studies; Retrospective Studies; Temporomandibular Joint
PubMed: 35871168
DOI: 10.1016/j.oooo.2022.05.003 -
Journal of Neurological Surgery. Part... Nov 2020Complications rates vary across spinal surgery procedures and are difficult to predict due to heterogeneity in patient characteristics, surgical methods, and hospital... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Complications rates vary across spinal surgery procedures and are difficult to predict due to heterogeneity in patient characteristics, surgical methods, and hospital volume. Incorporation of predictive models for complications may guide surgeon decision making and improve outcomes.
METHODS
We evaluate current independently validated predictive models for complications in spinal surgery with respect to study design and model generation, accuracy, reliability, and utility. We conducted our search using Preferred Reporting Items for Systematic Review and Meta-analysis guidelines and the Participants, Intervention, Comparison, Outcomes, Study Design model through the PubMed and Ovid Medline databases.
RESULTS
A total of 18 articles met inclusion criteria including 30 validated predictive models of complications after adult spinal surgery. National registry databases were used in 12 studies. Validation cohorts were used in seven studies for verification; three studies used other methods including random sample bootstrapping techniques or cross-validation. Reported area under the curve (AUC) values ranged from 0.37 to 1.0. Studies described treatment for deformity, degenerative conditions, inclusive spinal surgery (neoplasm, trauma, infection, deformity, degenerative), and miscellaneous (disk herniation, spinal epidural abscess). The most commonly cited risk factors for complications included in predictive models included age, body mass index, diabetes, sex, and smoking. Those models in the deformity subset that included radiographic and anatomical grading features reported higher AUC values than those that included patient demographics or medical comorbidities alone.
CONCLUSIONS
We identified a cohort of 30 validated predictive models of complications following spinal surgery for degenerative conditions, deformity, infection, and trauma. Accurate evidence-based predictive models may enhance shared decision making, improve rehabilitation, reduce adverse events, and inform best practices.
Topics: Humans; Models, Theoretical; Neurosurgical Procedures; Postoperative Complications; Predictive Value of Tests; Prognosis; Spine
PubMed: 32797468
DOI: 10.1055/s-0040-1709709 -
Journal of Neurology Nov 2021The peripapillar nerve fiber layer (pRNFL) thinning in different retinal quadrants or sectors remains controversy. We conducted a systematic review and meta-analysis on... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND AND PURPOSE
The peripapillar nerve fiber layer (pRNFL) thinning in different retinal quadrants or sectors remains controversy. We conducted a systematic review and meta-analysis on the pattern of pRNFL thinning in Parkinson's disease (PD) patients to provide a biomarker for PD differential diagnosis.
METHODS
We systematically searched PubMed and EMBASE to identify studies comparing pRNFL thickness in PD patients and health controls using spectral domain-optical coherence tomography from inception to April 25, 2020. Random effects mode was used to pool mean difference (μm) of the average thickness of pRNFL and the thickness of pRNFL in four quadrants (superior, inferior, nasal and temporal) and in the subdivisions of superior (superonasal and superotemporal sectors) and inferior quadrants (inferonasal and inferotemporal sectors) between PD patients and health controls.
RESULTS
We included 32 studies (33 sets of data) enrolling 2126 PD eyes and 2318 health control eyes. Between the eyes of PD patients and that of health controls, the pooled mean difference (μm) of average pRNFL was - 4.85 (95% CI [- 6.12, - 3.58]); the pooled mean difference (μm) of four quadrants were - 2.30 (95% CI [- 3.32, - 1.28], nasal), - 2.74 (95% CI [- 4.34, - 1.14], temporal), - 5.24 (95% CI [- 7.04, - 3.43], superior) and - 7.29 (95% CI [- 9.23, - 5.34], inferior); those of four sectors were - 5.16 (95% CI [- 7.70, - 2.62], superotemporal), - 3.55 (95% CI [- 5.87, - 1.23], superonasal), - 9.19 (95% [- 13.27, - 5.12], inferotemporal) and - 7.62 (95% CI [- 11.84, - 3.40], inferonasal).
CONCLUSION
In PD patients, pRNFL thinning followed a specific pattern with inferotemporal thinning most and nasal quadrant thinning least.
Topics: Humans; Nerve Fibers; Optic Disk; Parkinson Disease; Retinal Ganglion Cells; Tomography, Optical Coherence
PubMed: 32691237
DOI: 10.1007/s00415-020-10094-0 -
European Spine Journal : Official... Jun 2024This study aimed to compare unilateral biportal endoscopic discectomy (UBED) with microdiscectomy (MD) for treating lumbar disk herniation (LDH). (Meta-Analysis)
Meta-Analysis Comparative Study Review
PURPOSE
This study aimed to compare unilateral biportal endoscopic discectomy (UBED) with microdiscectomy (MD) for treating lumbar disk herniation (LDH).
METHODS
A comprehensive literature search was conducted in the Embase, PubMed, Cochrane Library, CNKI, and Web of Science databases from database inception to April 2023 to identify studies comparing UBED and MD for treating LDH. This study evaluated the visual analog scale (VAS) score, Oswestry disability index (ODI), Macnab scores, operation time, estimated blood loss, hospital stay, and complications, estimated blood loss, visual analog scale (VAS) score, Oswestry disability index (ODI), and Macnab scores at various pre- and post-surgery stages. The meta-analysis was performed using RevMan 5.4 software.
RESULTS
The meta-analysis included 9 distinct studies with a total of 1001 patients. The VAS scores for low back pain showed no significant differences between the groups at postoperative 1-3 months (P = 0.09) and final follow-up (P = 0.13); however, the UBED group had lower VAS scores at postoperative 1-3 days (P = 0.02). There were no significant differences in leg pain VAS scores at baseline (P = 0.05), postoperative 1-3 days (P = 0.24), postoperative 1-3 months (P = 0.78), or at the final follow-up (P = 0.43). ODI comparisons revealed no significant differences preoperatively (P = 0.83), at postoperative 1 week (P = 0.47), or postoperative 1-3 months (P = 0.13), and the UBED group demonstrated better ODI at the final follow-up (P = 0.03). The UBED group also exhibited a shorter mean operative time (P = 0.03), significantly shorter hospital stay (P < 0.00001), and less estimated blood loss (P = 0.0002). Complications and modified MacNab scores showed no significant differences between the groups (P = 0.56 and P = 0.05, respectively).
CONCLUSION
The evidence revealed no significant differences in efficacy between UBED and MD for LDH treatment. However, UBED may offer potential benefits such as shorter hospital stays, lower estimated blood loss, and comparable complication rates.
Topics: Humans; Intervertebral Disc Displacement; Lumbar Vertebrae; Diskectomy; Endoscopy; Treatment Outcome; Microsurgery
PubMed: 38388729
DOI: 10.1007/s00586-023-08116-2