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Clinical Spine Surgery Nov 2016Systematic review and meta-analysis. (Meta-Analysis)
Meta-Analysis Review
STUDY DESIGN
Systematic review and meta-analysis.
OBJECTIVE
To assess the safety and efficacy of cervical disk arthroplasty (CDA) compared with anterior cervical decompression and fusion (ACDF) for the treatment of 2-level cervical spondylopathy.
SUMMARY OF BACKGROUND DATA
CDA has emerged as a potential alternative to ACDF in patients with cervical disk degeneration. But there are no published systematic reviews and meta-analyses comparing CDA with ACDF for the treatment of 2-level cervical spondylopathy.
METHODS
The Pubmed, Embase, Web of science, Scopus, and Cochrane library databases were searched comparing CDA to ACDF in patients with 2-level cervical spondylopathy. Outcome measures were neck disability index, visual analog scale (VAS) of arm and neck pain, range of movement (ROM) at C2-C7, functional segment unit ROM, ROM at the operated level, and incidence of radiologic changes at adjacent levels approximately 2 years after surgery, as well as operating time and incidence of surgery-related complications. Mean difference (MD), odds ratios (OR), and their corresponding 95% confidence intervals (95% CIs) were calculated.
RESULTS
Six studies involving 646 patients were included. There were no significant differences in neck disability index (MD, -1.53; 95% CI -3.80 to 0.73), VAS neck pain (MD, -0.19; 95% CI -0.71 to 0.33), and VAS arm pain (MD, -0.23; 95% CI -0.61 to 0.16) between 2-level CDA and 2-level ACDF cases. ROM at C2-C7 (MD, 15.82; 95% CI, 10.66-20.99), functional segment unit ROM (MD, 8.58; 95% CI, 7.93-9.23), and ROM at the operated level (MD, 9.54; 95% CI, 7.73-11.35) were greater, but the incidence of radiologic changes at adjacent levels (OR, 0.29; 95% CI, 0.13-0.67) were lower, in 2-level CDA cases. In 2-level CDA cases, the operating time was longer (MD, 57.41; 95% CI, 24.67-90.14), but surgery-related complications rates (OR, 0.47; 95% CI, 0.30-0.74) was lower.
CONCLUSIONS
CDA may be a safe and effective alternative to ACDF for the treatment of 2-level cervical degenerative disease.
LEVEL OF EVIDENCE
Level II.
Topics: Arthroplasty; Cervical Vertebrae; Decompression, Surgical; Humans; Spinal Fusion; Spondylosis
PubMed: 27295435
DOI: 10.1097/BSD.0000000000000395 -
Neurosurgical Review Apr 2022During lateral lumbar fusion, the trajectory of implant insertion approaches the great vessels anteriorly and the segmental arteries posteriorly, which carries the risk... (Review)
Review
Incidence of major and minor vascular injuries during lateral access lumbar interbody fusion procedures: a retrospective comparative study and systematic literature review.
During lateral lumbar fusion, the trajectory of implant insertion approaches the great vessels anteriorly and the segmental arteries posteriorly, which carries the risk of vascular complications. We aimed to analyze vascular injuries for potential differences between oblique lateral interbody fusion (OLIF) and lateral lumbar interbody fusion (LLIF) procedures at our institution. This was coupled with a systematic literature review of vascular complications associated with lateral lumbar fusions. A retrospective chart review was completed to identify consecutive patients who underwent lateral access fusions. The Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines were used for the systematic review with the search terms "vascular injury" and "lateral lumbar surgery." Of 260 procedures performed at our institution, 211 (81.2%) patients underwent an LLIF and 49 (18.8%) underwent an OLIF. There were no major vascular complications in either group in this comparative study, but there were four (1.5%) minor vascular injuries (2 LLIF, 0.95%; 2 OLIF, 4.1%). Patients who experienced vascular injury experienced a greater amount of blood loss than those who did not (227.5 ± 147.28 vs. 59.32 ± 68.30 ml) (p = 0.11). In our systematic review of 63 articles, major vascular injury occurred in 0-15.4% and minor vascular injury occurred in 0-6% of lateral lumbar fusions. The systematic review and comparative study demonstrate an increased rate of vascular injury in OLIF when compared to LLIF. However, vascular injuries in either procedure are rare, and this study aids previous literature to support the safety of both approaches.
Topics: Humans; Incidence; Lumbar Vertebrae; Retrospective Studies; Spinal Fusion; Vascular System Injuries
PubMed: 34850322
DOI: 10.1007/s10143-021-01699-8 -
European Spine Journal : Official... Feb 2014At present, most spinal surgeons undertake pedicle screw implantation using either anatomical landmarks or C-arm fluoroscopy. Reported rates of screw malposition using... (Review)
Review
PURPOSE
At present, most spinal surgeons undertake pedicle screw implantation using either anatomical landmarks or C-arm fluoroscopy. Reported rates of screw malposition using these techniques vary considerably, though the evidence generally favors the use of image-guidance systems. A miniature spine-mounted robot has recently been developed to further improve the accuracy of pedicle screw placement. In this systematic review, we critically appraise the perceived benefits of robot-assisted pedicle screw placement compared to conventional fluoroscopy-guided technique.
METHODS
The Cochrane Central Register of Controlled Trials, PubMed, and EMBASE databases were searched between January 2006 and January 2013 to identify relevant publications that (1) featured placement of pedicle screws, (2) compared robot-assisted and fluoroscopy-guided surgery, (3) assessed outcome in terms of pedicle screw position, and (4) present sufficient data in each arm to enable meaningful comparison (>10 pedicle screws in each study group).
RESULTS
A total of 246 articles were retrieved, of which 5 articles met inclusion criteria, collectively reporting placement of 1,308 pedicle screws (729 robot-assisted, 579 fluoroscopy-guided). The findings of these studies are mixed, with limited higher level of evidence data favoring fluoroscopy-guided procedures, and remaining comparative studies supporting robot-assisted pedicle screw placement.
CONCLUSIONS
There is insufficient evidence to unequivocally recommend one surgical technique over the other. Given the high cost of robotic systems, and the high risk of spinal surgery, further high quality studies are required to address unresolved clinical equipoise in this field.
Topics: Fluoroscopy; Humans; Pedicle Screws; Robotic Surgical Procedures; Spinal Fusion
PubMed: 23801017
DOI: 10.1007/s00586-013-2879-1 -
Journal of Postgraduate Medicine 2019Multiple studies have compared primary arthrodesis versus open reduction with internal fixation (ORIF) for surgical treatment of fractures of the Lisfranc joint, but... (Meta-Analysis)
Meta-Analysis
OBJECTIVE
Multiple studies have compared primary arthrodesis versus open reduction with internal fixation (ORIF) for surgical treatment of fractures of the Lisfranc joint, but their results have been inconsistent. Therefore, the present systematic review and meta-analysis was performed to compare the clinical efficacy of arthrodesis versus ORIF for the treatment of Lisfranc injuries.
METHODS
Through searching the Embase, PubMed, PMC, CINAHL, PQDT, and Cochrane Library databases (from July 1998 to July 2018), we identified five case-controlled trials and two randomized controlled trials that compared the clinical efficacy of primary arthrodesis and ORIF for treating Lisfranc injuries. The extracted data were analyzed using Review manager 5.3 software.
RESULTS
Through comparisons of data for primary arthrodesis and ORIF groups, we found no significant differences in the anatomic reduction rate, revision surgery rate, and total rate of complications between the different treatment approaches. However, arthrodesis was associated with a significantly better American Orthopedic Foot and Ankle Society (AOFAS) score, return to duty rate, and visual analog scale score with a lower incidence of hardware removal compared with ORIF.
CONCLUSIONS
For the treatment for Lisfranc injuries, primary arthrodesis was superior to ORIF based on a higher AOFAS score, better return to duty rate, lower postoperative pain, and lower requirement for internal fixation removal. Further evidence from future randomized controlled trials with higher quality and larger sample sizes is needed to confirm these findings.
Topics: Arthrodesis; Fracture Fixation, Internal; Fractures, Bone; Humans; Ligaments, Articular; Metatarsophalangeal Joint; Open Fracture Reduction; Recovery of Function; Treatment Outcome
PubMed: 31036779
DOI: 10.4103/jpgm.JPGM_414_18 -
Foot and Ankle Surgery : Official... Apr 2020Injuries to the Lisfranc complex, although relatively rare carry a high morbidity and are often associated with other injuries. Despite a number published studies to... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Injuries to the Lisfranc complex, although relatively rare carry a high morbidity and are often associated with other injuries. Despite a number published studies to determine the best operative management, there is an ongoing debate to whether open reduction and internal fixation (ORIF) or primary arthrodesis (PA) produces the best outcomes for patients. There have been further studies published in the last few years that have not been assessed as part of the wider literature and therefore we wished to perform an updated systematic review and meta-analysis with inclusion of outcomes not assessed in the previous studies.
METHODS
We performed a structured search for retrospective and prospective comparative papers and identified 8 relevant articles (2 RCT studies and 6 non-RCT studies) that compared the outcomes of ORIF versus PA; these studies included a total of 547 patients. Each of the studies was assessed for suitability and quality before inclusion. We performed a statistical analysis of the aggregated results as part of the review.
RESULTS
We found no statistically significant difference between the outcomes of ORIF versus PA in terms of return to work or activity (Odds Ratio 0.80 (CI 95%, 0.32-2.02, P=0.64)) and satisfaction rates (Odds Ratio 0.15 (CI 95%, 0.01-.00, P=0.25)). Patients undergoing ORIF have a higher risk of undergoing further surgery to remove the metalwork (Odds Ration 13.13 (CI 95%, 7.65-22.54, P<0.00001)) or to undergo secondary fusion, but, the overall complication rates appear to be equivalent in both groups (risk difference 0.03 (CI 95%, -0.15-0.21, P=0.76)).
CONCLUSIONS
Although there were no significant differences in the functional outcomes, the overall power of the studies is low. The rates of metalwork removal and secondary fusion were higher in the ORIF group and this risk should be presented to the patient when counselling them for any procedure. We noted that there is a high level of heterogeneity in the type of injuries and measured outcomes included in each study and, therefore, further trials are needed to determine the best treatment across the spectrum of Lisfranc complex injuries.
Topics: Arthrodesis; Fracture Fixation, Internal; Fractures, Bone; Humans; Metatarsal Bones; Open Fracture Reduction
PubMed: 31103276
DOI: 10.1016/j.fas.2019.04.003 -
World Neurosurgery Nov 2016Vitamin D deficiency is a relatively common occurrence in patients presenting for spinal surgery; however, whether this abnormality has any effect on spinal fusion... (Review)
Review
BACKGROUND
Vitamin D deficiency is a relatively common occurrence in patients presenting for spinal surgery; however, whether this abnormality has any effect on spinal fusion outcomes remains unclear. We performed a systematic review of the available literature relevant to the association between vitamin D deficiency and spinal fusion outcomes.
METHODS
We conducted a systematic and critical review of recent literature following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The following databases were searched: MEDLINE/PubMed, Google Scholar, Cochrane, Web of Science, and Scopus. Key search terms were "vitamin D," "spinal surgery outcomes," "spinal fusion," and "pseudarthrosis." Papers included in the review were original research articles in peer-reviewed journals. The articles were thoroughly examined and compared on the basis of study design, outcomes, and results.
RESULTS
A total of 5 studies were included in the qualitative analysis. In these studies, patients presenting with vitamin D deficiency achieved lower fusion rates and suffered higher rates of recurrent-persistent low back pain compared with patients with normal vitamin D levels. Studies examining the effect of postoperative vitamin D supplementation in deficient patients reported significant improvements in low back pain intensity, patient-reported outcomes scores, and fusion rates compared with baseline as well as with control groups.
CONCLUSIONS
The literature suggests that patients presenting for spinal fusion may benefit from correction of vitamin D deficiency to maximize the chance of a successful arthrodesis and to achieve optimal surgical outcomes. Future prospective studies are needed to determine whether routine preoperative treatment of this metabolic derangement is warranted.
Topics: Back Pain; Humans; Patient Reported Outcome Measures; Postoperative Complications; Pseudarthrosis; Spinal Diseases; Spinal Fusion; Treatment Outcome; Vitamin D Deficiency
PubMed: 27481599
DOI: 10.1016/j.wneu.2016.07.074 -
Foot & Ankle Specialist Apr 2022The superiority of primary arthrodesis (PA) versus open reduction and internal fixation (ORIF) in Lisfranc injuries has been debated. Meta-analyses comparing these...
INTRODUCTION
The superiority of primary arthrodesis (PA) versus open reduction and internal fixation (ORIF) in Lisfranc injuries has been debated. Meta-analyses comparing these surgical options have reached contradicting conclusions. The goal of this article is to determine why different conclusions were reached and provide clarity on the comparable outcomes of PA and ORIF in Lisfranc injuries.
METHODS
A systematic literature review was conducted by searching for "meta-analysis" AND "Lisfranc" with keywords such as "ORIF" OR "open reduction" OR "arthrodesis" OR "fusion." Five meta-analysis articles discussing PA and ORIF in Lisfranc injuries were identified. Study outcomes were extracted from each article, and contradicting conclusions were identified for analysis.
RESULTS
PA had lower rates of hardware removal. There was no difference between PA and ORIF when considering revision surgery, anatomic reduction, postoperative infection, total complications, and patient satisfaction. However, contradicting conclusions were reached for return to duty, the American Orthopaedic Foot and Ankle Society (AOFAS) score, and visual analogue scale (VAS) score. Conclusions. There was no difference in PA and ORIF for return to work and VAS score. Repeat meta-analysis with truly equivocal outcomes would be necessary to reach a valid conclusion for return to full activity and AOFAS midfoot scores.
LEVELS OF EVIDENCE
Level II: Therapeutic studies.
Topics: Arthrodesis; Fracture Fixation, Internal; Fractures, Bone; Humans; Meta-Analysis as Topic; Open Fracture Reduction; Retrospective Studies; Treatment Outcome
PubMed: 33183089
DOI: 10.1177/1938640020971417 -
Journal of Clinical Neuroscience :... Aug 2016Lumbar fusion surgical intervention is often followed by bilateral pedicle screw fixation. There has been increasing support for unilateral pedicle screw fixation in an... (Meta-Analysis)
Meta-Analysis Review
Lumbar fusion surgical intervention is often followed by bilateral pedicle screw fixation. There has been increasing support for unilateral pedicle screw fixation in an attempt to reduce complications and costs. The following study assesses the efficacy and complications of bilateral versus unilateral pedicle screw fixation in open and minimally invasive lumbar interbody fusion techniques. A systematic review with meta-analysis and trial sequential analysis was performed using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines and recommendations. In comparison with existing meta-analyses, trial sequential analysis was implemented to reduce the potential for type I error. Of the 1310 citations screened, four observational studies and 13 randomised controlled trials were used comprising 574 bilateral cases and 549 unilateral cases. Statistical analysis showed no difference in fusion rates, total complications, dural tear rates, Visual Analogue Scale (VAS) score for back pain, VAS for leg pain, Oswestry Disability Index scores, and length of stay between bilateral and unilateral instrumentation. Unilateral instrumentation was significantly shorter in duration (P<0.00001) and led to significantly lower blood volume loss (P=0.0002). These results were the same for both open and minimally invasive surgical approaches. Unilateral pedicle screw fixation appears to have similar post-operative outcomes as bilateral fixation and improved efficacy in regards to procedure duration and blood volume loss.
Topics: Female; Humans; Lumbar Vertebrae; Male; Middle Aged; Minimally Invasive Surgical Procedures; Pedicle Screws; Postoperative Period; Spinal Fusion; Treatment Outcome
PubMed: 27068653
DOI: 10.1016/j.jocn.2016.01.013 -
Journal of Clinical Neuroscience :... Oct 2014The need for posterolateral fusion (PLF) in addition to interbody fusion during minimally invasive (MIS) transforaminal lumbar interbody fusion (TLIF) has yet to be... (Meta-Analysis)
Meta-Analysis Review
The need for posterolateral fusion (PLF) in addition to interbody fusion during minimally invasive (MIS) transforaminal lumbar interbody fusion (TLIF) has yet to be established. Omitting a PLF significantly reduces overall surface area available for achieving a solid arthrodesis, however it decreases the soft tissue dissection and costs of additional bone graft. The authors sought to perform a meta-analysis to establish the fusion rate of MIS TLIF performed without attempting a PLF. We performed an extensive Medline and Ovid database search through December 2010 revealing 39 articles. Inclusion criteria necessitated that a one or two level TLIF procedure was performed through a paramedian MIS approach with bilateral posterior pedicle screw instrumentation and without posterolateral bone grafting. CT scan verified fusion rates were mandatory for inclusion. Seven studies (case series and case-controls) met inclusion criteria with a total of 408 patients who underwent MIS TLIF as described above. The mean age was 50.7 years and 56.6% of patients were female. A total of 78.9% of patients underwent single level TLIF. Average radiographic follow-up was 15.6 months. All patients had local autologous interbody bone grafting harvested from the pars interarticularis and facet joint of the approach side. Either polyetheretherketone (PEEK) or allograft interbody cages were used in all patients. Overall fusion rate, confirmed by bridging trabecular interbody bone on CT scan, was 94.7%. This meta-analysis suggests that MIS TLIF performed with interbody bone grafting alone has similar fusion rates to MIS or open TLIF performed with interbody supplemented with posterolateral bone grafting and fusion.
Topics: Humans; Lumbar Vertebrae; Minimally Invasive Surgical Procedures; Spinal Fusion
PubMed: 24913928
DOI: 10.1016/j.jocn.2014.02.021 -
The Journal of Foot and Ankle Surgery :... Mar 2019This study aims to compare outcomes of open reduction and internal fixation (ORIF) and primary arthrodesis in management of Lisfranc injuries. In accordance with... (Comparative Study)
Comparative Study Meta-Analysis
This study aims to compare outcomes of open reduction and internal fixation (ORIF) and primary arthrodesis in management of Lisfranc injuries. In accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement standards, a systematic review was carried out. MEDLINE, EMBASE, CINAHL, and the Cochrane Central Register of Controlled Trials were searched to identify both randomised controlled trials (RCTs) and nonrandomised studies comparing the outcomes of ORIF and primary arthrodesis for Lisfranc injuries. Random- and fixed-effect statistical models were applied to calculate the pooled outcome data. Two RCTs and 3 observational studies were identified, compiling a total of 187 subjects with acute Lisfranc injuries and a mean follow-up duration of 62.3 months. Our results demonstrate that ORIF is associated with a significantly higher need for revision surgery (odds ratio [OR] 6.37, 95% confidence interval [CI] 2.68 to 15.11, p < .0001) and a significantly higher rate of persistent pain (OR 6.29, 95% CI 1.07 to 36.89, p = .04) compared with primary arthrodesis. However, we found no significant difference between the groups in terms of visual analogue scale pain score, American Orthopaedic Foot & Ankle Society functional score, or rates of infection. Separate analysis of RCTs showed that ORIF was associated with a more frequent need for revision surgery (OR 17.56, 95% CI 5.47 to 56.38, p < .00001), higher visual analogue scale pain score (mean difference 2.90, 95% CI 2.84 to 2.96, p < .00001), and lower American Orthopaedic Foot & Ankle Society score (mean difference -29.80, 95% CI -39.82 to -19.78, p < .00001). The results of the current study suggest that primary arthrodesis may be associated with better pain and functional outcomes and lower need for revision surgery compared with ORIF. The available evidence is limited and is not adequately robust to make explicit conclusions. The current literature requires high-quality and adequately powered RCTs.
Topics: Arthrodesis; Female; Foot Injuries; Fracture Fixation, Internal; Fracture Healing; Humans; Injury Severity Score; Male; Metatarsal Bones; Open Fracture Reduction; Postoperative Complications; Prognosis; Randomized Controlled Trials as Topic; Reoperation; Risk Assessment; Tarsal Bones
PubMed: 30850102
DOI: 10.1053/j.jfas.2018.08.061