-
Annals of Palliative Medicine Aug 2022For some patients, local anesthesia (LA) in percutaneous transforaminal endoscopic discectomy (PTED), especially during canal shaping and discectomy, is insufficient for... (Meta-Analysis)
Meta-Analysis
BACKGROUND
For some patients, local anesthesia (LA) in percutaneous transforaminal endoscopic discectomy (PTED), especially during canal shaping and discectomy, is insufficient for analgesia. Epidural anesthesia (EA) is infrequently applied in PTED but reports satisfactory results. Previous studies present conflicting results in analgesia satisfactory and adverse events. Differences in surgery details and small sample size might explain conflicting results. Meta-analysis pools the results from individual studies to create a larger sample size and provides a more reliable conclusion. The aim of this study is to evaluate the efficacy and safety of EA in PTED.
METHODS
The search terms "percutaneous transforaminal endoscopic discectomy" and "anesthesia" are used to search Cochrane, Web of Science, PubMed, Embase, OVID, China National Knowledge Infrastructure (CNKI), VIP, and Wanfang from inception to 2021-08. Inclusion criteria is defined according to PICOS principals: P (patients): patients are diagnosed with lumbar disc herniation or spinal canal stenosis. I (intervention): patients undergo PTED under EA. C (comparisons): patients undergo PTED under LA. O (outcomes): primary outcomes: intraoperative visual analogue scale (VAS), anesthesia satisfactory, sufentanil usage. Secondary outcomes: adverse events, surgery exit, bleed volume, X-ray radiation. S (study design): randomized controlled trials (RCTs). The Cochrane RoB 2.0 is used to evaluate the quality of the included studies. Authors perform meta-analysis through Review Manager 5.4.
RESULTS
A total of 6 studies representing 529 patients are included: EA group includes 261 patients, and LA group includes 268 patients. All studies lack design of allocation concealment and blinding of participants and personnel. Only Luo reports blinding of outcome assessment in 2019. Meta analysis concludes that EA is superior in intraoperative analgesic [mean difference (MD) =-4.31; 95% confidence interval (CI): -4.52 to -4.09; P<0.00001], anesthesia satisfactory [odds ratio (OR) =10.06; 95% CI: 2.41 to 41.98; P=0.002], sufentanil usage (MD =-9.12; 95% CI: -10.34 to -7.90; P<0.00001), adverse events (OR =0.19; 95% CI: 0.07 to 0.52; P=0.001). There is no difference in bleed volume (MD =-2.61; 95% CI: -5.45 to 0.23; P=0.07), exit rate (OR =0.23; 95% CI: 0.04 to 1.35; P=0.10) and future effects (MD =-0.23; 95% CI: -0.50 to 0.03; P=0.08).
DISCUSSION
EA is an effective and safe anesthesia method for PTED and might achieve better clinical results than LA. More high-quality research is needed to provide high-quality evidence for efficacy and safety.
Topics: Anesthesia, Epidural; Anesthesia, Local; Diskectomy; Humans; Lumbar Vertebrae; Sufentanil; Treatment Outcome
PubMed: 35871273
DOI: 10.21037/apm-21-3413 -
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 -
World Neurosurgery Jun 2020The transcorporeal tunnel approach is a relatively new alternative of anterior cervical decompression and fusion for the treatment of cervical radiculopathy and... (Meta-Analysis)
Meta-Analysis
OBJECTIVE
The transcorporeal tunnel approach is a relatively new alternative of anterior cervical decompression and fusion for the treatment of cervical radiculopathy and myelopathy, with its main presumed advantage being the preservation of the intervertebral space. The aim of the present article is to present the outcomes of the systematic review and meta-analysis regarding the short-term outcomes of this surgical technique.
METHODS
A systematic review and a meta-analysis using the random-effects method of the available studies were performed to assess the safety and efficiency of the transcorporeal tunnel approach for cervical radiculopathy and myelopathy.
RESULTS
In total, 15 eligible studies were identified, with a cumulative number of 254 patients. Pooled data yielded a complication rate of 0.053 and a failure rate of the technique of 0.081; a patient-reported favorable outcome of 0.94 was documented. The available data did not allow for a definite conclusion on the effects of the technique on the intervertebral space height.
CONCLUSIONS
Although technically challenging, like all minimally invasive methods, the transcorporeal tunnel approach seems to be a safe and efficient option for the treatment of cervical radiculopathy and myelopathy, presenting comparable outcome profiles to alternative open or less invasive techniques.
Topics: Cervical Vertebrae; Decompression, Surgical; Diskectomy, Percutaneous; Humans; Intervertebral Disc Degeneration; Minimally Invasive Surgical Procedures; Radiculopathy; Spinal Cord Diseases; Spinal Fusion
PubMed: 32217171
DOI: 10.1016/j.wneu.2020.03.082 -
World Neurosurgery Feb 2022Interbody cages are currently being used to address diseases of the vertebra requiring surgical stabilization. Titanium cages were first introduced in 1988.... (Meta-Analysis)
Meta-Analysis
Comparison of Outcomes Between Cage Materials Used for Patients Undergoing Anterior Cervical Discectomy and Fusion with Standalone Cages: A Systematic Review and Meta-Analysis.
INTRODUCTION
Interbody cages are currently being used to address diseases of the vertebra requiring surgical stabilization. Titanium cages were first introduced in 1988. Polyetheretherketone (PEEK) cages are used frequently as one of the alternatives to titanium cages in current practice. This study aimed to compare available cage materials by reviewing the surgical and radiographic outcomes following anterior cervical discectomy and fusion.
METHODS
A comprehensive search of several electronic databases was conducted following the PRISMA (Preferred Reporting Items for Systematic reviews and Meta-Analyses) guidelines. Baseline characteristics, operative outcomes, arthrodesis rates, subsidence rates, and complications were collected from included studies. Collected outcomes were further stratified according to the procedure type, the number of levels operated, and graft used to compare cage materials.
RESULTS
Following the screening for inclusion criteria, a total of 37 studies with 2363 patients were included. The median age was 49.5 years and the median follow-up was 26 months. Overall, no significant differences were found between PEEK and titanium cages regarding fusion, neurologic deficit, subsidence rates, or "good and excellent" outcome according to Odom criteria. However, the standalone comparison between PEEK, titanium, and poly-methyl-methacrylate (PMMA) cages showed a significantly lower fusion rate for PMMA (PEEK: 94%, PMMA: 56%, titanium: 95%, P < 0.01).
CONCLUSIONS
In the present systematic review and meta-analysis, a comparison of the long-term patient-reported and the radiographic outcomes associated with the use of titanium and PEEK, intervertebral body cages showed similar findings. However, there were significantly lower fusion rates for PMMA cages when using a standalone cage without graft material.
Topics: Cervical Vertebrae; Diskectomy; Humans; Ketones; Middle Aged; Polyethylene Glycols; Polymethyl Methacrylate; Spinal Fusion; Titanium; Treatment Outcome
PubMed: 34838765
DOI: 10.1016/j.wneu.2021.10.084 -
Neurosurgical Review Feb 2022Dysphagia is a common complication following anterior cervical spine surgery (ACSS). Although several literatures have reported the potential benefit of local... (Review)
Review
Dysphagia is a common complication following anterior cervical spine surgery (ACSS). Although several literatures have reported the potential benefit of local corticosteroid application on dysphagia, its safety and efficacy are still unclear. A systematic review was performed aiming to evaluate the evidence of local corticosteroid application in prevention or treatment of postoperative dysphagia following ACSS. A systematic search was performed in September 2018 in PubMed and Embase database. The following information was extracted: study investigator, year of publication, number of patients, study design, inclusion/exclusion criteria, administration protocol of steroid, type of surgical procedure, number of levels performed, assessment methodology of dysphagia, radiologic assessment of prevertebral soft tissue swelling (PSTS), follow-up time points, outcome of dysphagia, and corticosteroid-related complications. Qualitative synthesis was performed. Finally, 5 studies met the inclusion/exclusion criteria. Four studies found that local corticosteroid application could decrease the incidence and magnitude of postoperative dysphagia while 1 study showed no effect on dysphagia significantly at 6 weeks and 3 months follow-up time. A total of 2325 patients received local corticosteroid intraoperatively; no early corticosteroid-related complication was reported. Totally, 4 adverse events occurred in long-term follow-up time, including 2 bone nonunion at 1.5 and 2.5 years postoperatively, 2 esophageal perforation at 2 months and 11 months of follow-up, respectively. Local corticosteroid application can reduce the incidence and severity of dysphagia following ACSS without increasing early corticosteroid-related complications. But further high-quality study is necessary to analyze potential delayed complications.
Topics: Adrenal Cortex Hormones; Cervical Vertebrae; Deglutition Disorders; Diskectomy; Humans; Postoperative Complications; Spinal Fusion
PubMed: 33982193
DOI: 10.1007/s10143-019-01207-z -
European Spine Journal : Official... Feb 2022The aim of this meta-analysis was to investigate the effects of retropharyngeal steroid use during operation on bony fusion and dysphagia rate after ACDF. (Meta-Analysis)
Meta-Analysis Review
PURPOSE
The aim of this meta-analysis was to investigate the effects of retropharyngeal steroid use during operation on bony fusion and dysphagia rate after ACDF.
METHODS
We searched the electronic literature database of PubMed, Embase and the Cochrane Library published from January 1990 to February 2020. The size of each group, mean age, proportion of female patients, dysphagia events and fusion rate at one-year follow-up were extracted. RevMan 5.3 was used for the meta-analysis.
RESULTS
A total of eight studies including six RCTs and two case-control studies met the inclusion criteria. This meta-analysis showed that retropharyngeal steroids could achieve significantly lower dysphagia rates (p < 0.001), higher fusion rates (p = 0.01), less moderate and severe events rates according to the Bazaz stratification (p < 0.001). However, there was no significant difference between two groups regarding operation time (p = 0.67), blood loss (p = 0.33), VAS scores at one day (p = 0.90) and VAS scores at two weeks (p = 0.80).
CONCLUSIONS
Retropharyngeal steroid use is an effective method in reducing dysphagia rate, severe dysphagia rate and increasing fusion rate during ACDF surgery, without increasing operating time, blood loss or VAS scores at one day and two weeks.
LEVEL OF EVIDENCE I
Diagnostic: individual cross-sectional studies with the consistently applied reference standard and blinding.
Topics: Cervical Vertebrae; Cross-Sectional Studies; Deglutition Disorders; Diskectomy; Female; Humans; Postoperative Complications; Spinal Fusion; Steroids; Treatment Outcome
PubMed: 34741220
DOI: 10.1007/s00586-021-06727-1 -
Clinical Spine Surgery Apr 2020This is a systematic review and meta-analysis study. (Meta-Analysis)
Meta-Analysis
STUDY DESIGN
This is a systematic review and meta-analysis study.
OBJECTIVE
The purpose of this systematic review and meta-analysis study is to evaluate the outcomes of a tantalum fusion device in anterior cervical discectomy and fusion (ACDF) for the treatment of cervical degeneration disease.
SUMMARY OF BACKGROUND DATA
A great interest has raised for porous tantalum in cervical fusion, but several studies reported the divergent clinical outcome and fusion rate. No systematic review and meta-analysis has been conducted up to present to evaluate the outcomes of the tantalum fusion device.
METHODS
We comprehensively searched multiple databases for studies that investigated the tantalum fusion device in ACDF. The retrieved results were last updated on February 15, 2018. Outcomes of interest comprised of operative parameters, fusion rate, the incidence of adverse events as well as patient-reported outcomes, including the Neck Disability Index (NDI) score, Visual Analog Scale (VAS) score, Short Form-36 Physical Component Scores and complications.
RESULTS
Ten studies included were included in this review and 6 randomized controlled trial studies included. All studies were pooled to evaluate the outcome of fusion rate, NDI, and VAS after tantalum fusion treatment. The results of the meta-analysis showed that implantation of the tantalum fusion device is associated with significantly shorter operative and fewer adverse events when compared with autologous iliac crest bone graft. However, no difference was found with regards to the fusion rate, NDI, VAS, and global assessment.
CONCLUSIONS
Through this systemic review and meta-analysis, no significant difference was found with regards to fusion rate, postoperative NDI, and VAS between tantalum fusion and iliac crest bone graft in ACDF. More longer-term and randomized studies with large samples are warranted to validate any association found in this study.
LEVEL OF EVIDENCE
Level II.
Topics: Cervical Vertebrae; Diskectomy; Humans; Intervertebral Disc Degeneration; Spinal Fusion; Tantalum; Treatment Outcome
PubMed: 31634174
DOI: 10.1097/BSD.0000000000000875 -
Clinical Spine Surgery Jun 2020This study was a meta-analysis of published randomized controlled trials (RCTs). (Meta-Analysis)
Meta-Analysis
Mid-Term to Long-Term Outcomes After Total Cervical Disk Arthroplasty Compared With Anterior Diskectomy and Fusion: A Systematic Review and Meta-analysis of Randomized Controlled Trials.
STUDY DESIGN
This study was a meta-analysis of published randomized controlled trials (RCTs).
OBJECTIVE
We investigated the mid-term to long-term outcomes of cervical disk arthroplasty (CDA) versus anterior cervical diskectomy and fusion (ACDF) for the surgical treatment of symptomatic cervical disk degenerative disease.
SUMMARY OF BACKGROUND DATA
ACDF has been widely performed for the surgical treatment of symptomatic cervical disk degenerative disease. However, the loss of motion at the operated level has been hypothesized to accelerate adjacent-level disk degeneration. CDA was designed to preserve motion segments and decrease the risk/rate of adjacent segment degeneration. However, it is still uncertain whether mid-term to long-term outcomes after CDA is more effective and safer than those observed after ACDF.
METHODS
Two independent reviewers conducted a search of PubMed, Embase, and the Cochrane Library databases for RCTs with a minimum of 48 months of follow-up. For dichotomous variables, the risk ratio and 95% confidence intervals were calculated. For continuous variables, the standardized mean difference and 95% confidence intervals were calculated.
RESULTS
Eleven RCTs, finally, were included. The rate of neurological success in the CDA group was not significantly different from that in the ACDF group. The pooled results show that patients who underwent CDA had a significantly greater improvement in Neck Disability Index (NDI) and Short Form 36 Health Survey physical component (SF-36 HSPC) than did those who underwent ACDF. No significant difference was found when comparing the neck and arm pain scores between the CDA and ACDF groups. The overall rate of secondary surgical procedures was significantly lower in patients who underwent CDA than in those who underwent ACDF. We observed similar overall rates of adverse events and adjacent segment degeneration when comparing the CDA group with the ACDF group.
CONCLUSIONS
This meta-analysis provides evidence suggesting that CDA was superior to ACDF in terms of NDI score, SF-36 HSPC score, and low rate of secondary surgical procedures. Furthermore, no significant differences existed between the CDA group and the ACDF group in the neck pain visual analog scale score, arm pain visual analog scale score, the rate of neurological success, adjacent segment degeneration, and adverse events.
LEVEL OF EVIDENCE
Level 1.
Topics: Arthroplasty; Cervical Vertebrae; Diskectomy; Humans; Intervertebral Disc Degeneration; Intervertebral Disc Displacement; Randomized Controlled Trials as Topic; Range of Motion, Articular; Reproducibility of Results; Spinal Fusion; Total Disc Replacement; Treatment Outcome
PubMed: 32271175
DOI: 10.1097/BSD.0000000000000929 -
British Journal of Neurosurgery Feb 2024Controversy remains with the use of post-operative subfascial drains for anterior cervical discectomy and fusion, with limited guidelines and a paucity of conclusive... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Controversy remains with the use of post-operative subfascial drains for anterior cervical discectomy and fusion, with limited guidelines and a paucity of conclusive evidence. Thus, the aim of this meta-analysis was to analyse and collate an evidence summary to determine the efficacy of such drains.
METHODS
A systematic search of Medline (2002-2022.11), PubMed (2003-2022.11), Scopus (2002-2022.11), Cochrane Library (2015-2022.11) databases and reference lists of articles was conducted as per Cochrane systematic reviews standards. All relevant RCTs and NRCTs were included in this study. Data was extracted in a standardised form and analysed with RevMan version 5.4.1. Bias was assessed with RoB2 tool for RCTs and ROBINS-E tool for NRCTs.
RESULTS
Two RCTs (136 patients) and five NRCTs (7563 patients) were included. These had a moderate to high risk of bias, except for one very high-risk article. Meta-analysis results showed no significant differences for post-operative haematoma ( = 0.31), surgical site infection ( = 0.84), take back to theatre ( = 0.27), length of stay ( = 0.34), and estimated blood loss ( = 0.09). Dysphagia ( = 0.002) and median operative time ( = 0.02) were significantly increased in the drain cohort.
CONCLUSION
The low quality of available data in the included studies is insufficient to estimate the effect of post-operative drains for elective spondylotic ACDF. The findings suggest that if the decision to leave a drain in is left to the surgeon, then there is no difference in the rates of POH, SSI, LOS, or take back to the theatre. The significant association of dysphagia and increased operative time with drains, and the non-significant trend towards increased EBL with drains, must be considered in the context in which procedures may influence the decision to place drains. The results could not be stratified by various confounders that affect the decision-making process, including the number of levels operated. Due to the decreased quality and amount of evidence available, large-scale RCTs that adequately account for confounders should be performed.
Topics: Humans; Cervical Vertebrae; Deglutition Disorders; Diskectomy; Drainage; Spinal Fusion; Surgical Wound Infection
PubMed: 37698296
DOI: 10.1080/02688697.2023.2254833 -
Journal of Orthopaedic Surgery and... Jun 2023Currently, self-locking stand-alone cages (SSC) are commonly applied in anterior cervical discectomy and fusion (ACDF), as are cage-plate constructs (CPC). However, it... (Meta-Analysis)
Meta-Analysis
Self-locking stand-alone cage versus cage-plate fixation in monosegmental anterior cervical discectomy and fusion with a minimum 2-year follow-up: a systematic review and meta-analysis.
BACKGROUND
Currently, self-locking stand-alone cages (SSC) are commonly applied in anterior cervical discectomy and fusion (ACDF), as are cage-plate constructs (CPC). However, it remains controversial concerning the long-term effectiveness of both apparatuses. Our purpose is to compare long-term effectiveness of SSC with CPC in monosegmental ACDF.
METHODS
Four electronic databases were queried to identify studies comparing SSC versus CPC in monosegmental ACDF. The meta-analysis was carried out with the use of the Stata MP 17.0 software package.
RESULTS
Ten trials with 979 patients were included. Compared to CPC, SSC significantly reduced operative time, intraoperative blood loss, duration of hospitalisation, cervical Cobb angle at final follow-up, 1-month postoperative dysphagia rate, and incidence of adjacent segment degeneration (ASD) at final follow-up. No significant difference was found regarding 1-month postoperative cervical Cobb angle, JOA scores, NDI scores, fusion rate and cage subsidence rate at final follow-up.
CONCLUSION
Both devices achieved similar long-term effectiveness in monosegmental ACDF regarding JOA scores, NDI scores, fusion rate and cage subsidence rate. SSC had significant advantages over CPC in reducing surgical duration, intraoperative bleeding, duration of hospitalisation, as well as rates of dysphagia and ASD after surgery. Therefore, SSC is a better option than CPC in monosegmental ACDF. However, SSC is inferior to CPC in maintaining cervical curvature at long-term follow-up. Whether radiological changes affect clinical symptoms needs confirmation in trials with longer follow-up.
Topics: Humans; Treatment Outcome; Deglutition Disorders; Intervertebral Disc Degeneration; Spinal Fusion; Cervical Vertebrae; Retrospective Studies; Diskectomy
PubMed: 37269002
DOI: 10.1186/s13018-023-03885-4