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Sports Health 2021The prevalence of symptomatic lumbar disc herniation (LDH) in athletes can be as high as 75%. For elite athletes diagnosed with LDH, return to play (RTP) is a major... (Meta-Analysis)
Meta-Analysis
CONTEXT
The prevalence of symptomatic lumbar disc herniation (LDH) in athletes can be as high as 75%. For elite athletes diagnosed with LDH, return to play (RTP) is a major concern, and thus comparing surgical with nonoperative care is essential to guide practitioners and athletes, not just in terms of recovery rates but also speed of recovery.
OBJECTIVE
The purpose of this systematic review is to provide an update on RTP outcomes for elite athletes after lumbar discectomy versus nonoperative treatment of LDHs.
DATA SOURCES
A search of the literature was conducted using 3 online databases (MEDLINE, EMBASE, and PubMed) to identify pertinent studies.
STUDY SELECTION
Yielded studies were screened according to the inclusion criteria.
STUDY DESIGN
Systematic review with meta-analysis.
LEVEL OF EVIDENCE
Level 4.
DATA EXTRACTION
Relevant data were extracted. A meta-analysis was performed comparing RTP rate for all comparative studies.
RESULTS
Twenty studies met the inclusion criteria and were included in this review. Overall, 663 out of 799 patients (83.0%) returned to play in the surgical group and 251 out of 308 patients (81.5%) returned to play in the nonoperative group. No statistically significant difference for RTP rate was found (odds ratio, 1.39; 95% CI, 0.58-3.34; = 0.46; 2, 71%). The mean time to RTP for patients undergoing lumbar discectomy was 5.19 months (range 1.00-8.70 months), and 4.11 months (range 3.60-5.70 months) for those treated conservatively.
CONCLUSION
There was no significant difference in RTP rate between athletes treated with operative or nonoperative management of LDHs, nor did operative management have a faster time to RTP. Athletes should consider the lack of difference in RTP rate in addition to the potential risks associated with spinal surgery when choosing a treatment option. Future randomized controlled trials are needed on this topic to allow for high-powered conclusions.
Topics: Conservative Treatment; Diskectomy; Humans; Intervertebral Disc Displacement; Lumbar Vertebrae; Return to Sport
PubMed: 33563131
DOI: 10.1177/1941738121991782 -
Medicine May 2020The present study was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) statement. (Meta-Analysis)
Meta-Analysis
STUDY DESIGN
The present study was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) statement.
OBJECTIVE
The present study aimed to conduct a systematic review of overlapping meta-analyses comparing ACDR with fusion for treating CDDD in order to assist decision makers in their selection among conflicting meta-analyses and to provide treatment recommendations based on the best available evidence.
SUMMARY OF BACKGROUND DATA
Although several meta-analyses have been performed to compare total disc replacement (TDR) and fusion for treating cervical degenerative disc disease (CDDD), their findings are inconsistent.
METHODS
Multiple databases were comprehensively searched for meta-analyses comparing TDR with fusion for treating CDDD. The meta-analyses that comprised only randomized controlled trials (RCTs) were included. Two authors independently assessed the meta-analysis study quality and extracted the data. The Jadad decision algorithm was used to ascertain which meta-analysis studies represented the best evidence.
RESULTS
A total of 14 meta-analysis studies were included. All these studies only included RCTs and were determined as Level-II evidence.
CONCLUSIONS
Cervical disc arthroplasty was superior compared to anterior discectomy and fusion for the treatment of symptomatic cervical disc disease.
Topics: Algorithms; Cervical Vertebrae; Diskectomy; Humans; Intervertebral Disc Degeneration; Meta-Analysis as Topic; Operative Time; Randomized Controlled Trials as Topic; Range of Motion, Articular; Reoperation; Spinal Fusion; Total Disc Replacement
PubMed: 32384498
DOI: 10.1097/MD.0000000000020143 -
Journal of Orthopaedic Surgery and... Jun 2020To compare the effectiveness and safety of anterior cervical discectomy and fusion (ACDF) with posterior cervical foraminotomy (PCF) for patients diagnosed with...
BACKGROUND
To compare the effectiveness and safety of anterior cervical discectomy and fusion (ACDF) with posterior cervical foraminotomy (PCF) for patients diagnosed with single-level unilateral cervical radiculopathy.
METHODS
Relevant studies comparing ACDF with PCF for cervical radiculopathy were searched in an electronic database. After data extraction and quality assessment of included studies, a meta-analysis was done by using the RevMan 5.3 software. The random effects model was used if there was heterogeneity between studies; otherwise, the fixed effects model was used.
RESULTS
A total of 3 randomized controlled trials (RCT) and 12 retrospective studies including 52705 patients were included in the meta-analysis. There were no significant differences in Neck Disability Index (NDI), Visual Analog Scale (VAS), and patients' satisfaction (P > 0.05) between treatment groups. The complication rate of the PCF group was equivalent compared with the ACDF group (P = 0.60), but the reoperation rate following PCF was on the higher side (P = 0.02). Data analysis also showed that the PCF group was associated with shorter operation time (P = 0.001) and shorter length of hospital stay (P = 0.002).
CONCLUSIONS
Among patients with single-level unilateral cervical radiculopathy, PCF has comparable effectiveness and complication rate compared with ACDF. It seems that PCF is a sufficient alternative procedure with shorter operation time, shorter length of hospital stay, and less total hospital cost for the treatment of cervical radiculopathy. However, the higher reoperation rate following PCF should be also taken into consideration.
Topics: Cervical Vertebrae; Diskectomy; Foraminotomy; Humans; Radiculopathy; Spinal Fusion
PubMed: 32487109
DOI: 10.1186/s13018-020-01723-5