-
Clinical Rheumatology Aug 2021Radiographic axial spondyloarthritis (also known as ankylosing spondylitis [AS]) is a chronic immune-mediated arthritis characterized by inflammation of the axial...
Radiographic axial spondyloarthritis (also known as ankylosing spondylitis [AS]) is a chronic immune-mediated arthritis characterized by inflammation of the axial skeleton, peripheral joints, and entheses. It is estimated that 1 in every 200 people are affected by AS, making it an important healthcare and socioeconomic issue. In this review, we aim to explore the current understanding of AS risk factors and provide a comprehensive update. Multiple search strings were used to identify articles of interest published in PubMed between January 1, 2013, and February 1, 2021. On the basis of the literature review and analysis, we present up-to-date information on the risk factors of developing AS and our viewpoints on disease onset and progression. Multiple genetic and nongenetic risk factors have been suggested in the onset of AS. HLA-B27 is known to have a strong association with the disease, but other genes have been implicated in disease development. Aside from genetics, other factors are thought to be involved; up to 70% of patients with AS have subclinical intestinal inflammation, suggesting that the origin of the disease may be in the gut. The exact mechanism by which AS onset begins is most likely complex and multifactorial. Key Points • It remains unclear how interactions between genes, microbes, mechanical stress, gender, and other environmental and lifestyle factors predispose patients to the development of ankylosing spondylitis (AS). • The exact mechanisms of AS are complex and multifactorial which will require much future research • Recognizing the risk factors, as well as understanding gene-environment interactions, may offer valuable insights into the etiology of AS and have important implications for diagnosis and treatment strategies.
Topics: HLA-B27 Antigen; Humans; Inflammation; Risk Factors; Spondylarthritis; Spondylitis, Ankylosing
PubMed: 33754220
DOI: 10.1007/s10067-021-05679-7 -
The Spine Journal : Official Journal of... Oct 2019Posterior cervical fusion (PCF) with decompression is a treatment option for patients with conditions such as spondylosis, spinal stenosis, and degenerative disc... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND CONTEXT
Posterior cervical fusion (PCF) with decompression is a treatment option for patients with conditions such as spondylosis, spinal stenosis, and degenerative disc disorders that result in myelopathy or radiculopathy. The annual rate, number, and cost of PCF in the United States has increased. Far fewer studies have been published on PCF outcomes than on anterior cervical fusion (ACF) outcomes, most likely because far fewer PCFs than ACFs are performed.
PURPOSE
To evaluate the patient-reported and clinical outcomes of adult patients who underwent subaxial posterior cervical fusion with decompression.
STUDY DESIGN/SETTING
Systematic review and meta-analysis.
PATIENT SAMPLE
The total number of patients in the 31 articles reviewed and included in the meta-analysis was 1,238 (range 7-166).
OUTCOME MEASURES
Preoperative to postoperative change in patient-reported outcomes (visual analog scales for arm pain and neck pain, Neck Disability Index, Japanese Orthopaedic Association [JOA] score, modified JOA score, and Nurick pain scale) and rates of fusion, revision, and complications or adverse events.
METHODS
This study was performed according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines and a preapproved protocol. PubMed and Embase databases were searched for articles published from January 2001 through July 2018. Statistical analyses for patient-reported outcomes were performed on the outcomes' raw mean differences, calculated as postoperative value minus preoperative value from each study. Pooled rates of successful fusion, revision surgery, and complications or adverse events, and their 95% confidence intervals, were also calculated. Two subgroup analyses were performed: one for studies in which only myelopathy or radiculopathy (or both) were stated as surgical indications and the other for studies in which only myelopathy or ossification of the posterior longitudinal ligament (or both) were stated as surgical indications. This study was funded by Providence Medical Technology, Inc. ($32,000).
RESULTS
Thirty-three articles were included in the systematic review, and 31 articles were included in the meta-analysis. For all surgical indications and for the 2 subgroup analyses, every cumulative change in patient-reported outcome improved. Many of the reported changes in patient-reported outcome also exceeded the minimal clinically important differences. Pooled outcome rates with all surgical indications were 98.25% for successful fusion, 1.09% for revision, and 9.02% for complications or adverse events. Commonly reported complications or adverse events were axial pain, C5 palsy, transient neurological worsening, and wound infection.
CONCLUSIONS
Posterior cervical fusion with decompression resulted in significant clinical improvement, as indicated by the changes in patient-reported outcomes. Additionally, high fusion rates and low rates of revision and of complications and adverse events were found.
Topics: Adult; Aged; Cervical Vertebrae; Decompression, Surgical; Female; Humans; Male; Middle Aged; Postoperative Complications; Reoperation; Spinal Cord Diseases; Spinal Fusion
PubMed: 31075361
DOI: 10.1016/j.spinee.2019.04.019 -
Journal of Indian Prosthodontic Society 2021This systematic review and meta-analysis evaluated the clinical survival of axial and tilted implants in atrophic edentulous maxilla after three years of immediate... (Meta-Analysis)
Meta-Analysis Review
AIM
This systematic review and meta-analysis evaluated the clinical survival of axial and tilted implants in atrophic edentulous maxilla after three years of immediate loading and also the corresponding marginal bone loss.
SETTING AND DESIGN
This systematic review was conducted in accordance with the Preferred Reporting Items for Systematic reviews and Meta-Analyses guidelines (PRISMA).
MATERIALS AND METHODS
The relevant studies were retrieved from MEDLINE(PubMed), the Cochrane Central Register of Controlled Trials (CENTRAL), Science Direct, Google Scholar databases. The search was limited to studies published in the English language with no date restrictions. A further hand search was conducted on individual journals and reference lists of studies. The risk of bias in included studies was assessed by using the Evidence Project risk of bias tool.
STATISTICAL ANALYSIS USED
Statistical meta-analysis was conducted using RevMan 5.4 software. The assessment for the level of evidence was done using GRADEpro software.
RESULTS
Eleven studies were finalised. All were included in the meta-analysis for implant survival, while only seven studies were included in the meta-analysis of marginal bone loss. After three years, the meta-analysis results for implant survival showed no statistical difference between axial and tilted implants, with the forest plot neither favouring axial nor tilted implants (RR = 1.00 (95% CI: 0.98-1.01); P-value = 0.59). After three years, the meta-analysis results for marginal bone showed no statistical difference between axial and tilted implants, with the forest plot neither favouring axial nor tilted implants (MD = -0.02; 95% CI; -0.09-0.06; P-value = 0.69).
CONCLUSION
In the immediately loaded rehabilitation of completely edentulous atrophic maxillae, tilting of implants did not induce any significant alteration in their survival and their corresponding marginal bone loss levels compared to conventionally placed axial implants even after three years of function.
Topics: Alveolar Bone Loss; Humans; Jaw, Edentulous; Maxilla; Mouth, Edentulous; Prostheses and Implants
PubMed: 34380808
DOI: 10.4103/jips.jips_79_21 -
Seminars in Arthritis and Rheumatism Dec 2020Axial spondyloarthropathy (axSpA) is an inflammatory arthritis which affects the sacroiliac joints and the spine. Many females affected are of childbearing age. Studies... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Axial spondyloarthropathy (axSpA) is an inflammatory arthritis which affects the sacroiliac joints and the spine. Many females affected are of childbearing age. Studies on effects of pregnancy on axSpA disease activity and medication use have been limited, with divergent conclusions.
OBJECTIVE
To review literature on axSpA in pregnancy to determine the effect of disease on pregnancy outcomes.
METHODS
A systematic review of case-control trials, observational studies, cross sectional studies and case series (n>5) on axSpA in pregnancy. EMBASE, Medline (OVID), CINAHL, Maternity and Infant Care (MIDIRS online), and Web of Science were searched for keywords. Two reviewers reviewed articles to determine suitability for inclusion. The Newcastle Ottawa Scale was used to assess risk of bias. Data extraction was performed using a standardized template to streamline data to allow comparison and meta-analysis.
RESULTS
Search strategy returned 884 records, 130 full text articles were assessed for eligibility. Eighteen studies with a total of 3,166 axSpA participants were eligible for inclusion. There was an increased prevalence of pre-eclampsia (OR 1.3, 95% CI 0.92-1.82) and IUGR (OR 1.17, 95% CI 0.26-5.17) and a statistically significant increase in cesarean sections (OR 1.85, 95% CI 1.46-2.30) in axSpA females, with an especially high prevalence of elective cesarean sections (OR 2.26, 95% CI 1.74, 2.93). There was a trend towards increased prevalence of fetal complications in axSpA pregnancies (LBW OR 1.47, 95% CI 0.98-2.21; SGA OR1.66, 95% CI 0.93-2.95; congenital abnormalities OR 1.34, 95% CI0.63-1.24; NICU admissions OR 1.55, 95% CI 0.96-2.51) which did not reach significance.
CONCLUSION
AxSpA females have an increased prevalence of cesarean sections compared to the general population. There is a trend towards increased prevalence of pre-eclampsia, IUGR and certain fetal complications. Ongoing development of national registries could help to better understand axSpA in pregnancy.
Topics: Cross-Sectional Studies; Female; Humans; Pregnancy; Pregnancy Outcome; Sacroiliac Joint; Spondylarthritis; Spondylarthropathies
PubMed: 33065422
DOI: 10.1016/j.semarthrit.2020.08.011 -
Clinical Rheumatology Sep 2023C-reactive protein (CRP) and magnetic resonance imaging (MRI) are widely used to monitor inflammation in patients with axial spondyloarthritis (axSpA), but the... (Meta-Analysis)
Meta-Analysis
BACKGROUND
C-reactive protein (CRP) and magnetic resonance imaging (MRI) are widely used to monitor inflammation in patients with axial spondyloarthritis (axSpA), but the relationship between CRP and MRI-detected inflammation is incompletely understood. The present study was undertaken to assess correlations between CRP and MRI-detected inflammation in axSpA.
MATERIALS AND METHODS
A systematic literature search was performed (Medline, Embase, and Cochrane Library) to identify relevant studies concerning CRP and MRI-detected inflammation in axSpA patients. The MRI-detected inflammation was evaluated by MRI-based disease activity score (DAS). The correlation between CRP and MRI-based DAS was integrated by random-effect models.
RESULTS
Eighteen studies reported a total of 1392 axSpA patients which were included in this meta-analysis. CRP was significantly associated with spinal MR DAS (r=0.226, 95%CI [0.149, 0.291], p<0.001, I=23%). We also found a moderate correlation between CRP change and spinal MR DAS change (r[ASspiMRI-a]=0.354, 95%CI [0.282, 0.422], p<0.001, I=48%; r[SPARCC]=0.544, 95%CI [0.345, 0.701], p<0.001, I=19%). CRP at baseline was negatively associated with improvement in spinal MR DAS (r= - 0.327, 95%CI [-0.397, -0.264], p<0.001, I=0%). However, no significant association was found between CRP and sacroiliac joint (SIJ) MR DAS.
CONCLUSIONS
In axSpA patients, CRP is associated with MRI-detected inflammation in the spine but not in SIJ. We speculate that CRP could be a reasonable index to reflect spinal inflammation. Therefore, we suggest it is not essential to repeat spinal MRI in a short term, while SIJ MRI may be necessary to provide additional information on inflammation. Key Points • CRP is associated with MRI-detected inflammation in the spine but not in sacroiliac joints. • CRP at baseline was negatively associated with improvement in spinal MR DAS. • It was not essential to repeat spinal MRI frequently, while SIJ MRI may be necessary to provide additional information on inflammation.
Topics: Humans; C-Reactive Protein; Spondylarthritis; Inflammation; Sacroiliac Joint; Magnetic Resonance Imaging; Axial Spondyloarthritis
PubMed: 37336841
DOI: 10.1007/s10067-023-06658-w -
Animals : An Open Access Journal From... Sep 2021Mobilization and manipulation techniques are often used in small animal and equine practice; however, questions remain concerning indications, dosing and efficacy. A... (Review)
Review
Mobilization and manipulation techniques are often used in small animal and equine practice; however, questions remain concerning indications, dosing and efficacy. A bibliographic search was performed to identify peer-reviewed publications from 1980 to 2020 that evaluated the clinical effects of musculoskeletal mobilization and manipulation techniques in dogs, cats and horses. The search strategy identified 883 papers for review. Inclusion and exclusion criteria were applied. The clinical indications, dosages, outcome parameters, and reported efficacy within each publication were recorded and categorized for comparison with scientific quality assessed according to a standardized grading system. Fourteen articles were included in this systematic review of which 13 were equine and one was a canine study. Seven of these were cohort studies and seven were randomized controlled clinical trials. The canine study involved carpal immobilization-remobilization and all equine studies focused on the effects of passive mobilization ( = 5) or manipulation ( = 8) of the axial skeleton. Study quality was low ( = 4), moderate ( = 7), and high ( = 3) and included a wide array of outcome parameters with varying levels of efficacy and duration of therapeutic effects, which prevented further meta-analysis. Therefore, it was difficult to draw firm conclusions despite all studies reporting positive effects. Optimal technique indications and dosages need to be determined to improve the standardization of these treatment options.
PubMed: 34679808
DOI: 10.3390/ani11102787 -
Clinical and Experimental Rheumatology 2021Ankylosing spondylitis (AS) is a chronic rheumatic disease which affects the axial skeleton and sacroiliac joints. By impacting spinal mobility and physical functions,... (Review)
Review
OBJECTIVES
Ankylosing spondylitis (AS) is a chronic rheumatic disease which affects the axial skeleton and sacroiliac joints. By impacting spinal mobility and physical functions, AS could also potentially impair gait. However, while published data are rather sparse, it appears that discrepancies exist regarding AS consequences on gait characteristics, tasks and analysis techniques used to assess gait ability of patients with AS. The review questions are twofold: (1) How is gait assessed in patients with AS? and (2) What are the consequences of AS on gait?
METHODS
Databases were systematically searched to identify studies satisfying the search criteria, using the synonyms of ankylosing spondylitis and gait. Two reviewers extracted from the articles study characteristics, methods and main results in relation to gait.
RESULTS
192 titles were extracted from databases and 21 studies were included in the review. 16 studies (76%) used clinical gait measurements and 5 (23%) used laboratory gait measurements. Only 7 involved a healthy control group. Studies used various protocols, instructions and parameters when assessing gait. Gait of patients with AS was associated with decreased stride length, pelvic movements and lower limbs angles in the sagittal plane, and increased hip abduction and external rotation compared to healthy controls.
CONCLUSIONS
Only few studies have assessed gait characteristics in patients with AS and published data evidence that kinematic parameters of gait is altered, but no consensus exists regarding gait analysis methods for patients with AS. Guidelines are provided to improve the design and methodology for future studies on gait and AS.
Topics: Biomechanical Phenomena; Gait; Humans; Sacroiliac Joint; Spine; Spondylitis, Ankylosing
PubMed: 33025884
DOI: 10.55563/clinexprheumatol/le3bmj -
Neurosurgical Review Dec 2021Despite being a common procedure, cranioplasty (CP) is associated with a variety of serious, at times lethal, complications. This study explored the relationship between... (Meta-Analysis)
Meta-Analysis Review
Despite being a common procedure, cranioplasty (CP) is associated with a variety of serious, at times lethal, complications. This study explored the relationship between the initial injury leading to decompressive craniectomy (DC) and the rates and types of complications after subsequent CP. It specifically compared between traumatic brain injury (TBI) patients and patients undergoing CP after DC for other indications.A comprehensive search of PubMed, Scopus, and the Cochrane Library databases using PRISMA guidelines was performed to include case-control studies, cohorts, and clinical trials reporting complication data for CP after DC. Information about the patients' characteristics and the rates of overall and specific complications in TBI and non-TBI patients was extracted, summarized, and analyzed.A total of 59 studies, including the authors' institutional experience, encompassing 9264 patients (4671 TBI vs. 4593 non-TBI) met the inclusion criteria; this total also included 149 cases from our institutional series. The results of the analysis of the published series are shown both with and without our series 23 studies reported overall complications, 40 reported infections, 10 reported new-onset seizures, 13 reported bone flap resorption (BFR), 5 reported post-CP hydrocephalus, 10 reported intracranial hemorrhage (ICH), and 8 reported extra-axial fluid collections (EFC). TBI was associated with increased odds of BFR (odds ratio [OR] 1.76, p < 0.01) and infection (OR 1.38, p = 0.02). No difference was detected in the odds of overall complications, seizures, hydrocephalus, ICH, or EFC.Awareness of increased risks of BFR and infection after CP in TBI patients promotes the implementation of new strategies to prevent these complications especially in this category of patients.
Topics: Brain Injuries, Traumatic; Decompressive Craniectomy; Humans; Postoperative Complications; Retrospective Studies; Skull; Surgical Flaps
PubMed: 33686551
DOI: 10.1007/s10143-021-01511-7 -
The Cochrane Database of Systematic... Oct 2022Fractures of the distal femur (the far end of the thigh bone just above the knee) are a considerable cause of morbidity. Various different surgical and non-surgical... (Review)
Review
BACKGROUND
Fractures of the distal femur (the far end of the thigh bone just above the knee) are a considerable cause of morbidity. Various different surgical and non-surgical treatments have been used in the management of these injuries but the best treatment remains unknown.
OBJECTIVES
To evaluate the benefits and harms of interventions for treating fractures of the distal femur in adults.
SEARCH METHODS
We used standard, extensive Cochrane search methods. The latest search date was October 2021.
SELECTION CRITERIA
We included randomised and quasi-randomised controlled trials in adults comparing interventions for treating fractures of the distal femur. Interventions included surgical implants (retrograde intramedullary nail (RIMN), fixed-angle devices, non-locking plate fixation, locking plate, internal fixation, distal femoral replacement, mono-axial plates, poly-axial plates and condylar buttress plates) and non-surgical management.
DATA COLLECTION AND ANALYSIS
We used standard Cochrane methods. Our critical outcomes were validated patient-reported outcome measures (PROMs), direct adverse events, participant-reported quality of life (QoL) and pain scores. Our other important outcomes were adverse events indirectly related to intervention, symptomatic non-union, malunion and resource use. We used GRADE to assess certainty of evidence for each outcome.
MAIN RESULTS
We included 14 studies with 753 participants: 13 studies compared different surgical interventions, and one study compared surgical with non-surgical management. Here, we report the effects for RIMN compared with locking plates. Three studies (221 participants) reported this comparison; it included the largest study population and these are the two most commonly used devices in contemporary orthopaedic trauma practice. Studies used three different tools to assess PROMs. We found very-low certainty evidence for lower Disability Rating Index scores after RIMN at short-term follow-up favouring RIMN (mean difference (MD) -21.90, 95% confidence interval (CI) -38.16 to -5.64; 1 study, 12 participants) and low-certainty evidence of little or no difference at long-term follow-up (standardised mean difference (SMD) -0.22, 95% CI -0.50 to 0.06; 2 studies, 198 participants). Re-expressing the SMD of the long-term follow-up data to Knee Society Score (KSS) used by one study found no clinical benefit of RIMN, based on a minimal clinically important difference of 9 points (MD 2.47, 95% CI -6.18 to 0.74). The effect on QoL was very uncertain at four months (MD 0.01, 95% CI -0.42 to 0.44; 1 study, 14 participants) and one year (MD 0.10, 95% CI -0.01 to 0.21; 1 study, 156 participants); this evidence was very low certainty. For direct adverse events, studies reported reoperation, loss of fixation, superficial and deep infection, haematoma formation and implant loosening. Effects for all events were imprecise with the possibility of benefit or harm for both treatments. We considered reoperation the most clinically relevant. There was very low-certainty evidence of little or no difference in reoperation between the two implants (risk ratio (RR) 1.48, 95% CI 0.55 to 4.00; 1 study, 104 participants). No studies reported pain. For other important outcomes, we noted that people treated with RIMN may be more likely to have varus/valgus deformity (RR 2.18, 95% CI 1.09 to 4.37; 1 study, 33 participants; low-certainty evidence). However, we found no evidence of any important differences between treatments in terms of bony union, indirect adverse events, or resource use. Other comparisons of surgical interventions included in the review were: RIMN versus single fixed-angle device (3 studies, 175 participants); RIMN versus non-locking plate fixation (1 study, 18 participants); locking plate versus single fixed-angle device (2 studies, 130 participants); internal fixation versus distal femoral replacement (1 study, 23 participants); mono-axial plates versus poly-axial plates (2 studies, 67 participants); mono-axial plate versus condylar buttress plate (1 study, 78 participants). The certainty of the evidence for outcomes in these comparisons was low to very low, and most effect estimates were imprecise.
AUTHORS' CONCLUSIONS
This review highlights the major limitations of the available evidence concerning current treatment interventions for fractures of the distal femur. The currently available evidence is incomplete and insufficient to inform clinical practice. Priority should be given to randomised controlled trials comparing contemporary treatments for people with fractures of the distal femur. At a minimum, these should report validated patient-reported functional and quality-of-life outcomes at one and two years, with an agreed core outcome set. All trials should be reported in full using the CONSORT guidelines.
Topics: Adult; Femur; Fracture Fixation; Fractures, Bone; Humans; Pain; Quality of Life
PubMed: 36197809
DOI: 10.1002/14651858.CD010606.pub3 -
Archives of Orthopaedic and Trauma... Nov 2022The influence of limb malrotation on long-leg radiographs (LLR) is frequently discussed in literature. This systematic review aimed to describe the influence of limb... (Review)
Review
INTRODUCTION
The influence of limb malrotation on long-leg radiographs (LLR) is frequently discussed in literature. This systematic review aimed to describe the influence of limb rotation on alignment measurements alone and in combination with knee flexion, and determine its clinical impact.
MATERIALS AND METHODS
A literature search was conducted in June 2021 using the databases MEDLINE, Cochrane, Web of Science (Clarivate Analytics), and Embase. The search term ((radiograph OR X-ray) AND (position OR rotation) AND limb alignment) was used. Database query, record screening, and study inclusion and exclusion were performed by two reviewers independently. Experimental studies (using either specimens or synthetic bones) or clinical studies (prospective or retrospective using radiographs of patients) analyzing the influence of limb rotation on anatomic and mechanical limb alignment measurements were included. Characteristics and results of the included studies were summarized, simplified, and grouped for comparison to answer the research question. Studies were compared descriptively, and no meta-analysis was performed.
RESULTS
A total of 22 studies were included showing large heterogeneity, comprising studies with cadavers, patients, and synthetic bones. Most studies (7 out of 8) reported that external rotation (ER) causes less apparent valgus and leads to more varus and internal rotation (IR) causes more valgus and leads to less varus. However, there is no consensus on the extent of rotation influencing alignment measures. Studies reported about an average change of > 2° (n = 4) and < 2° (n = 4) hip-knee-ankle angle (HKA) between 15°IR and 15°ER. There is a consensus that the impact of rotation on mechanical alignment is higher if additional sagittal knee angulation, such as knee flexion, is present. All five studies analyzing the influence of rotation combined with knee flexion (5°-15°) showed an HKA change of > 2° between 15°IR and 15°ER.
CONCLUSION
Malrotation is frequently present on LLR, possibly influencing the measured alignment especially in knees with extension deficit. Surgeons must consider this when measuring and treating deformities (high tibial osteotomy or total knee arthroplasties), and analyzing surgical outcomes. Especially in patients with osteoarthritis with knee extension deficits or postoperative swelling, the effect of malrotation is significantly greater.
Topics: Arthroplasty, Replacement, Knee; Humans; Knee Joint; Lower Extremity; Osteoarthritis, Knee; Prospective Studies; Retrospective Studies; Tibia
PubMed: 34596760
DOI: 10.1007/s00402-021-04163-w