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British Journal of Neurosurgery Dec 2013Nerve and muscle biopsy are common procedures often performed by junior surgical trainees. This educational review article describes the operative details of performing... (Review)
Review
BACKGROUND
Nerve and muscle biopsy are common procedures often performed by junior surgical trainees. This educational review article describes the operative details of performing biopsies of muscle and nerve. Indications, pre-operative investigations and complication rates are described to aid in proper patient selection.
METHODS
A systematic literature review was performed to identify the indications, surgical techniques and results for nerve and muscle biopsy.
RESULTS
The most commonly described techniques involve vastus lateralis muscle, distal sural nerve, median sural nerve/gastrocnemius muscle, superficial peroneal nerve/peroneus brevis muscle and superficial radial nerve. Each technique has its own relative merits and intra-operative anatomical nuances. The yield from each of the techniques varies with the indications and patient selection. Complication rates are low but do vary between the techniques.
CONCLUSIONS
Judicious use of pre-operative investigations is required to select out patients whose nerve and muscle biopsy justifies the risk of complications. A thorough knowledge of relevant surgical anatomy and correct specimen handling is paramount to achieving optimal results while avoiding complications.
Topics: Biopsy; Clinical Competence; Humans; Internship and Residency; Muscle, Skeletal; Nervous System; Neuromuscular Diseases; Neurosurgery; Peroneal Nerve; Specimen Handling; Sural Nerve
PubMed: 23675830
DOI: 10.3109/02688697.2013.793288 -
European Journal of Endocrinology Oct 2012To evaluate the effects and safety of 300-600 mg α-lipoic acid (ALA) given i.v. for diabetic peripheral neuropathy (DPN). (Meta-Analysis)
Meta-Analysis Review
OBJECTIVE
To evaluate the effects and safety of 300-600 mg α-lipoic acid (ALA) given i.v. for diabetic peripheral neuropathy (DPN).
METHODS
We searched the databases of Medline, Embase, and Cochrane central register of Controlled Trials and Chinese biological medicine for clinical trials of ALA in the treatment of DPN. Data were extracted to examine methodological quality and describe characteristics of studies. The primary outcomes were efficacy, median motor nerve conduction velocity (MNCV), median sensory nerve conduction velocity (SNCV), peroneal MNCV, and peroneal SNCV. Secondary outcomes were adverse events.
RESULTS
Fifteen randomized controlled trials met the inclusion criteria. The treatment group involved the administration of ALA 300-600 mg i.v. per day. And the control group used the same interventions except for ALA. Compared with the control group, nerve conduction velocities increased significantly in the treatment group. The weighted mean differences in nerve conduction velocities were 4.63 (95% confidence interval 3.58-5.67) for median MNCV, 3.17 (1.75-4.59) for median SNCV, 4.25 (2.78-5.72) for peroneal MNCV, and 3.65 (1.50-5.80) for peroneal SNCV in favor of the treatment group. The odds ratio in terms of efficacy was 4.03 (2.73-5.94) for ALA. Furthermore, no serious adverse events were observed during the treatment period.
CONCLUSIONS
The results of this meta-analysis provide evidence that treatment with ALA (300-600 mg/day i.v. for 2-4 weeks) is safe and that the treatment can significantly improve both nerve conduction velocity and positive neuropathic symptoms. However, the evidence may not be strong because most of the studies included in this meta-analysis have poor methodological quality.
Topics: Adult; Aged; Antioxidants; Asian People; Diabetic Neuropathies; Humans; Middle Aged; Randomized Controlled Trials as Topic; Thioctic Acid; Treatment Outcome
PubMed: 22837391
DOI: 10.1530/EJE-12-0555 -
Hand (New York, N.Y.) May 2023The scratch-collapse test (SCT) is a provocative maneuver used to diagnose compressive neuropathies. Despite multiple studies supporting its use, the SCT remains a...
BACKGROUND
The scratch-collapse test (SCT) is a provocative maneuver used to diagnose compressive neuropathies. Despite multiple studies supporting its use, the SCT remains a controversial point in the literature in regard to its exact clinical application. We performed a systematic review and statistical analysis to provide statistical data on SCT outcomes and elucidate its role in diagnosing compressive conditions.
METHODS
We performed a systematic review of the literature according to Preferred Reporting for Systematic Reviews and Meta-Analyses guidelines. We extracted data of patients with outcomes on the SCT (yes/no) and on an accepted gold standard examination (electrodiagnostic studies). These data were analyzed using a statistical software program to generate the sensitivity and specificity values of the pooled data, as well as kappa agreement statistics.
RESULTS
For patients with carpal tunnel, cubital tunnel, peroneal, and pronator compressive neuropathies, the overall sensitivity of the SCT was 38%, and the specificity was 94%, with the kappa statistic approximately 0.4. Sensitivity and specificity values were higher for cubital tunnel syndrome and peroneal compression syndrome but lower for carpal tunnel syndrome. Pronator syndrome was also examined, but the data were inadequate for analysis.
CONCLUSIONS
The SCT is a useful adjunct in the armament of diagnostic tools for the hand surgeon. Given its low sensitivity and high specificity, SCT should be used as a confirmatory test, rather than as a diagnostic screening test. More analyses are needed to identify subtler applications.
PubMed: 37222286
DOI: 10.1177/15589447231174483 -
The Knee Aug 2022Proximal tibiofibular joint (PTFJ) ganglion cysts are rare; however, their optimal management remains unclear. This study aimed to systematically review the surgical... (Review)
Review
BACKGROUND
Proximal tibiofibular joint (PTFJ) ganglion cysts are rare; however, their optimal management remains unclear. This study aimed to systematically review the surgical treatment options with a focus on recurrence rates and complications.
METHODS
A systematic review of the literature was performed, searching three electronic databases, according to the PRISMA guidelines. The presentation, treatment, and outcomes of PTFJ ganglion cysts of minimum 1-year follow-up was collected. Study quality was assessed using the Modified Downs and Blacks checklist. Surgical interventions were considered ordinally from simple to more extensive as follows; cyst aspiration, cyst excision, cyst excision with an intervention to the PTFJ, either a hemi-resection or arthrodesis.
RESULTS
Twenty-two studies comprising 100 patients (101 knees) met inclusion criteria. Among all patients, pain was present in 59.7%, a lateral fullness in 71.6% and symptoms of the common peroneal nerve in 57.4%. The overall rate of recurrence after primary treatment was 28.9%. Recurrence rates for aspiration, cyst excision, PTFJ hemi-resection and PTFJ arthrodesis were 81.8%, 27.4%, 8.3% and 0%, respectively. Revision excision for recurrence failed in all cases. Outcomes beyond recurrence were poorly reported.
CONCLUSION
Addressing the PTFJ at the time of cyst excision reduces recurrence rates, however, the morbidity from PTFJ hemi-resection and arthrodesis are poorly reported. Whilst primary excision offers resolution in most cases (73%), revision cyst excision in isolation for the treatment of recurrent cysts is an inadequate treatment option. Cyst aspiration is ineffective. Data pertaining to patient reported outcomes for all treatment types are lacking.
Topics: Arthrodesis; Ganglion Cysts; Humans; Knee Joint; Neoplasm Recurrence, Local; Peroneal Nerve
PubMed: 35696835
DOI: 10.1016/j.knee.2022.05.009 -
International Journal of Molecular... Jan 2024Regenerative Peripheral Nerve Interfaces (RPNIs) encompass neurotized muscle grafts employed for the purpose of amplifying peripheral nerve electrical signaling. The aim... (Review)
Review
Regenerative Peripheral Nerve Interfaces (RPNIs) encompass neurotized muscle grafts employed for the purpose of amplifying peripheral nerve electrical signaling. The aim of this investigation was to undertake an analysis of the extant literature concerning animal models utilized in the context of RPNIs. A systematic review of the literature of RPNI techniques in animal models was performed in line with the PRISMA statement using the MEDLINE/PubMed and Embase databases from January 1970 to September 2023. Within the compilation of one hundred and four articles employing the RPNI technique, a subset of thirty-five were conducted using animal models across six distinct institutions. The majority (91%) of these studies were performed on murine models, while the remaining (9%) were conducted employing macaque models. The most frequently employed anatomical components in the construction of the RPNIs were the common peroneal nerve and the extensor digitorum longus (EDL) muscle. Through various histological techniques, robust neoangiogenesis and axonal regeneration were evidenced. Functionally, the RPNIs demonstrated the capability to discern, record, and amplify action potentials, a competence that exhibited commendable long-term stability. Different RPNI animal models have been replicated across different studies. Histological, neurophysiological, and functional analyses are summarized to be used in future studies.
Topics: Animals; Mice; Action Potentials; Databases, Factual; Macaca; Models, Animal; Neovascularization, Pathologic
PubMed: 38256216
DOI: 10.3390/ijms25021141 -
Archives of Orthopaedic and Trauma... Jun 2023Periacetabular osteotomy (PAO) is often performed in patients with hip dysplasia. The aim of this systematic review and meta-analysis was to evaluate the harms and... (Meta-Analysis)
Meta-Analysis Review
INTRODUCTION
Periacetabular osteotomy (PAO) is often performed in patients with hip dysplasia. The aim of this systematic review and meta-analysis was to evaluate the harms and benefits of PAO in patients with hip dysplasia in studies reporting both adverse events and patient-reported hip pain and function.
MATERIALS AND METHODS
A systematic search combing PAO and patient-reported outcomes was performed in the databases MEDLINE, CINAHL, EMBASE, Sports Discuss and PsychINFO. Studies including both harms and benefits defined as adverse events and patient-reported hip pain and function were included. Risk of bias was assessed using The Cochrane Risk of Bias In Non-Randomized Studies - of Interventions.
RESULTS
Twenty-nine cohort studies were included, of which six studies included a comparison group. The majority of studies had serious risk of bias and the certainty of evidence was very low. The proportion of adverse events was 4.3 (95% CI 3.7; 4.9) for major adverse events and 14.0 (95% CI 13.0; 15.1) for minor adverse events. Peroneal nerve dysfunction was the most frequent adverse event among the major adverse events, followed by acetabular necrosis and delayed union or non-union. All patient-reported hip pain and function scores improved and exceeded the minimal clinically important differences after PAO. After 5 years, scores were still higher than the preoperative scores.
CONCLUSION
PAO surgery has a 4% risk of major, and 14% risk of minor adverse events and a positive effect on patient-reported hip pain and function among patients with hip dysplasia.
Topics: Humans; Hip Dislocation; Treatment Outcome; Retrospective Studies; Hip Dislocation, Congenital; Acetabulum; Arthralgia; Osteotomy; Hip Joint
PubMed: 36175675
DOI: 10.1007/s00402-022-04627-7 -
Prosthetics and Orthotics International Aug 2023Foot-drop is one of the most diagnosed and physically limiting symptoms persons with multiple sclerosis (pwMS) experience. Clinicians prescribe ankle-foot orthosis (AFO)... (Meta-Analysis)
Meta-Analysis
Foot-drop is one of the most diagnosed and physically limiting symptoms persons with multiple sclerosis (pwMS) experience. Clinicians prescribe ankle-foot orthosis (AFO) and functional electrical stimulation (FES) devices to help alleviate the effects of foot drop, but it is unclear how their clinical and functional gait improvements compare given the user's level of disability, type of multiple sclerosis, walking environment, or desired physical activity. The research questions explored were what is the current state of AFO and FES research for pwMS? What are the prevailing research trends? What definitive clinical and functional device comparisons exist for pwMS? eight databases were systematically searched for relevant literature published between 2009 and 2021. The American Association of Orthotists and Prosthetists and Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines for systematic literature reviews were followed. A team of 3 researchers critically evaluated 17 articles that passed eligibility criteria. This review discusses the current state and trends of research, provides evidence statements on device effects, and recommends improvements for future studies. A meta-analysis would be informative, but study variability across the literature makes directly comparing AFO and FES device effects unreliable. This review contributes new and useful information to multiple sclerosis literature that can be used by both clinicians and researchers. Clinicians can use the provided insights to prescribe more effective, customized treatments, and other researchers can use them to evaluate and design future studies.
Topics: Humans; Foot Orthoses; Ankle; Multiple Sclerosis; Peroneal Neuropathies; Electric Stimulation Therapy; Peroneal Nerve; Gait; Electric Stimulation; Gait Disorders, Neurologic; Stroke
PubMed: 36701192
DOI: 10.1097/PXR.0000000000000190 -
PloS One 2015Infected nonunion of tibia and femur are common in clinical practice, however, the treatment of these diseases has still been a challenge for orthopaedic surgeons.... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Infected nonunion of tibia and femur are common in clinical practice, however, the treatment of these diseases has still been a challenge for orthopaedic surgeons. Ilizarov methods can eradicate infection, compensate bone defects and promote the bone union through progressive bone histogenesis. The objective of this systematic review was to review current available studies reporting on Ilizarov methods in the treatment of infected nonunion of tibia and femur, and to perform meta-analysis of bone and functional results and complications to evaluate the efficacy of Ilizarov methods.
METHODS
A comprehensive literature search was performed from the SCI, PubMed, Cochrane Library; and Embase between January 1995 and August 2015. Some major data were statistically analyzed using weighted means based on the sample size in each study by SPSS 13.0, including number of patients, mean age, mean previous surgical procedures, mean bone defects, mean length of follow-up, bone union, complications per patient, external fixation time, and external fixation index(EFI). Bone results (excellent, good, fair and poor rate), functional results (excellent, good, fair and poor rate) and complications were analyzed by Stata 9.0.
FINDINGS
A total of 590 patients from 24 studies were included in this systematic review. The average of bone union rate was 97.26% in all included studies. The poor rate in bone results and functional results was 8% (95%CI, 0.04-0.12; I2 = 44.1%, P = 0.065) and 10% (95%CI, 0.05-0.14; I2 = 34.7%, P = 0.121) in patients with infected nonunion of tibia and femur treated by Ilizarov methods. The rate of refracture, malunion, infectious recurrence, knee stiffness, amputation, limb edema and peroneal nerve palsy was respectively 4%, 7%, 5%, 12%, 4%, 13% and 13%.
CONCLUSIONS
Our systematic review showed that the patients with infected nonunion of tibia and femur treated by Ilizarov methods had a low rate of poor bone and functional results. Therefore, Ilizarov methods may be a good choice for the treatment of infected nonunion of tibia and femur.
Topics: Femoral Fractures; Femur; Humans; Ilizarov Technique; Surgical Wound Infection; Tibia; Tibial Fractures
PubMed: 26529606
DOI: 10.1371/journal.pone.0141973 -
Knee Surgery, Sports Traumatology,... Jun 2023The objective of this systematic literature review was to report the results and complications of recent remnant preservation techniques in posterior cruciate ligament... (Review)
Review
PURPOSE
The objective of this systematic literature review was to report the results and complications of recent remnant preservation techniques in posterior cruciate ligament (PCL) reconstruction.
METHODS
A systematic review was conducted based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Two independent reviewers searched the PubMed, Scopus, Embase, and Cochrane Library databases using the terms "posterior cruciate ligament" or "PCL" and "remnant preserving." The outcome measures extracted from the studies were the Lysholm score, the International Knee Documentation Committee's (IKDC) subjective and objective scores, Tegner scores, Orthopädische Arbeitsgruppe Knie (OAK) rate of return to sports, and rate of complications. Data were also extracted from studies that used stress radiographs to perform a quantitative assessment of the preoperative and postoperative anteroposterior stability.
RESULTS
The systematic review included 13 studies. The patient cohort of consisted of 643 participants (544 [84.6%] men and 99 [15.4%] women) with a mean age of 32.9 ± 4.0 years. The mean postoperative follow-up was 34.5 ± 10.9 months (range: 24-96 months), while the mean time from injury to surgery was 14.4 ± 9.9 months (range: 0-240 months). All studies reported clinically significant improvement at final follow-up, as evident from the measured subjective and objective IKDC scores, Lysholm score, Tegner score, and OAK rate. Only three studies reported return to sports activity, with a mean percentage of 90.8% (99/109). All studies showed a significant improvement in posterior translation, from 11.5 ± 1.2 mm to 3.3 ± 1.1 mm, using radiography (side-to-side difference). This systematic review revealed 13 (2.0%) failures and 33 (5.1%) minor complications: 10 (1.6%) cases of stiffness, 21 (4.9%) screws removal, 1 (0.2%) injury of the peroneal nerve, and 1 (0.2%) fibular fracture.
CONCLUSIONS
With the currently available data, all studies included in the review on posterior cruciate ligament reconstruction with remnant preservation demonstrated satisfactory outcomes at mid-term follow-up (> 24 months), despite varying surgical techniques and graft types, and intervals from injury to surgery. For clinical relevance, standard PCL reconstruction is a highly effective operation in terms of improvement in functional status, knee stability, quality of life, and cost effectiveness. The remnant preservation technique requires more comprehensive diagnostic assessments of the PCL remnant patterns and more complicated surgical procedures. Given the absence so far of high quality studies with long-term follow-up, the remnant-preserving techniques should be recommended only by experienced knee arthroscopic surgeons.
LEVEL OF EVIDENCE
Level IV.
STUDY REGISTRATION
reviewregistry1376- www.researchregistry.com .
Topics: Male; Humans; Female; Adult; Posterior Cruciate Ligament Reconstruction; Quality of Life; Treatment Outcome; Knee Joint; Arthroscopy; Radiography; Anterior Cruciate Ligament Injuries
PubMed: 36208342
DOI: 10.1007/s00167-022-07192-z -
Journal of Neurophysiology Jan 2023Neurological manifestations associated with Coronavirus Disease-2019 (COVID-19) are commonly reported, but patients were not referred to perform the electrophysiological... (Review)
Review
Neurological manifestations associated with Coronavirus Disease-2019 (COVID-19) are commonly reported, but patients were not referred to perform the electrophysiological assessment. We aimed to review the existing literature on clinical studies on COVID-19 peripheral neuropathy to correlate patients' symptoms and characteristics with nerve conduction studies/electromyography (NCS/EMG) outcomes. This protocol is registered in the Open Science Framework (https://www.doi.org/10.17605/OSF.IO/ZF4PK). The systematic search included PubMed, ScienceDirect, and Google Scholar, for articles published from December 2019 to March 2022. A total of 727 articles were collected, and according to our inclusion and exclusion criteria, only 6 articles were included. Of 195 participants, only 175 underwent NCS/EMG assessment. Of these, 44 participants (25.1%) had abnormal EMG, 54 participants (30.8%) had abnormal motor NCS, and only 7 participants (4%) had abnormal sensory NCS. All cases presented with myopathy, while a limited number of cases presented with polyneuropathy. According to motor NCS and EMG, the most affected nerves were the tibial and peroneal in the lower extremities and the ulnar nerve in the upper extremities. Interestingly, the median nerve was reported to be associated with the severity and the rate of motor recovery of patients with COVID-19. COVID-19 generates a demyelinating motor neuropathy and myopathy. Clinicians are encouraged to refer patients with COVID-19 presenting with neurological symptoms to be assessed by electrophysiological methods to objectively determine the nature of their symptoms, follow their prognosis, and plan their rehabilitation.
Topics: Humans; Peripheral Nervous System Diseases; Neural Conduction; COVID-19; Polyneuropathies; Electromyography; Muscular Diseases
PubMed: 36475865
DOI: 10.1152/jn.00386.2022