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Spine Jan 2019A systematic review and meta-analysis. (Meta-Analysis)
Meta-Analysis
STUDY DESIGN
A systematic review and meta-analysis.
OBJECTIVE
The aim of this study was to determine the differences in the sagittal spinopelvic parameters between the nonscoliotic controls, preoperative, and different time points postoperative in Lenke 1 and 5 adolescent idiopathic scoliosis (AIS).
SUMMARY OF BACKGROUND DATA
The postoperative changes in the sagittal profile of Lenke 1 and 5 AIS at varying time points after posterior spinal fusion (PSF) has not been rigorously demonstrated; studies performed have had conflicting results.
METHODS
Sagittal spinal and pelvic parameters, T5-T12 thoracic kyphosis (TK), L1-S1 lumbar lordosis (LL), pelvic incidence (PI), sacral slope (SS), and sagittal vertical axis (SVA), for Lenke 1 and 5 preoperatively, at immediate, less than 2-year, and more than 2-year postoperatively, and for nonscoliotic adolescents were searched. Differences in the sagittal spinopelvic parameters between preoperative and the follow-ups and between the nonscoliotic and pre- and postoperative AIS subtypes were calculated through meta-analysis.
RESULTS
A total of 22 studies on Lenke1 (1229 patients), 13 studies on Lenke5 (437 patients), and 18 studies on controls (1636 patients) were reviewed. Among all the measured variables, only PI in Lenke1 was significantly different between the final follow-up and controls, P < 0.05. In Lenke 1, SVA was significantly more anterior at the immediate postoperative than preoperative, but continued moving posteriorly up to 2-year postoperative resulting in no significant difference in the SVA position between the final follow-up and preoperative, P > 0.05. In Lenke 5, SVA was significantly more posterior at the immediate postoperative and more anterior at the final follow-up than the preoperative measurements, p < 0.05.
CONCLUSIONS
Continuous changes in the sagittal spinal parameters should be expected after PSF. Normalization of the sagittal spinal parameters appears to be the rule after PSF, and watchful waiting appears to be appropriate in this population when viewing the lateral X-ray postoperatively.
LEVEL OF EVIDENCE
4.
Topics: Adolescent; Child; Female; Follow-Up Studies; Humans; Kyphosis; Lordosis; Male; Pelvic Bones; Postoperative Period; Retrospective Studies; Sacrum; Scoliosis; Spinal Fusion; Young Adult
PubMed: 29889799
DOI: 10.1097/BRS.0000000000002736 -
Journal of Wound, Ostomy, and...To explore the effect of silicone dressings on the prevention of pressure injuries in patients cared for in the acute care setting. Three main comparisons were explored:... (Meta-Analysis)
Meta-Analysis
PURPOSE
To explore the effect of silicone dressings on the prevention of pressure injuries in patients cared for in the acute care setting. Three main comparisons were explored: silicone dressing versus no dressing, all anatomical areas; silicone dressing versus no dressing on the sacrum; and silicone dressing versus no dressing on the heels.
METHODS
Using a systematic review methodology, published randomized controlled trials and cluster randomized controlled trials were included. The search was conducted from December 2020 to January 2021 using CINAHL, full text on EBSCOhost, MEDLINE on EBSCOhost, and Cochrane databases. The search returned 130 studies; 10 met inclusion criteria. Data were extracted using a predesigned extraction tool. The Cochrane Collaboration tool was used to assess the risk of bias and the certainty of the evidence was appraised using a software program specifically designed for this purpose.
RESULTS
Silicone dressings probably reduce the incidence of pressure injuries compared to no dressings (relative risk [RR]: 0.40, 95% confidence interval [CI]: 0.31-0.53; moderate certainty evidence). Furthermore, silicone dressings probably reduce the incidence of pressure injuries on the sacrum compared to no dressings (RR: 0.44, 95% CI: 0.31-0.62; moderate certainty evidence). Finally, silicone dressings probably reduce the incidence of pressure injuries on the heels compared to no dressings (RR: 0.44, 95% CI: 0.31-0.62; moderate certainty evidence).
CONCLUSION
There is moderate certainty evidence of the effect of silicone dressings as a component of a pressure injury prevention strategy. The main limiting factor in the study designs was a high risk of performance and detection bias. Although this is a challenge to achieve in trials such as these, consideration should be given to how the effect of this could be minimized. A further issue is the lack of head-to-head trials that limits clinicians' abilities to determine whether any of the products in this category are more effective than others.
Topics: Humans; Incidence; Pressure Ulcer; Patients; Spine; Bandages
PubMed: 36867034
DOI: 10.1097/WON.0000000000000953 -
Clinical Orthopaedics and Related... Jun 2015Traditionally, lumbar discectomy involves removal of the free disc fragment followed by aggressive or conservative excision of the intervertebral disc. In selected... (Review)
Review
BACKGROUND
Traditionally, lumbar discectomy involves removal of the free disc fragment followed by aggressive or conservative excision of the intervertebral disc. In selected patients, however, it is possible to remove only the free fragment or sequester without clearing the intervertebral disc space. However, there is some controversy about whether that approach is sufficient to prevent recurrent symptoms and to provide adequate pain relief.
QUESTIONS/PURPOSES
This systematic review was designed to pose two questions: (1) Does performing a sequestrectomy only without conventional microdiscectomy lead to an increased reherniation rate; and (2) is there a difference in the patient-reported levels of radicular pain?
METHODS
Systematic MEDLINE and EMBASE searches were carried out to identify all articles published in peer-reviewed journals reporting the outcomes of interest for conventional microdiscectomy versus sequestrectomy for lumbar disc herniation from L2 to the sacrum (Level III evidence and above); hand-searching of bibliographies was also performed. A minimum of Level II evidence was required with a followup rate of greater than 75%. Followup in all studies was from 18 to 86 months. Seven studies met the inclusion criteria for this review. The studies were analyzed for operating time, hospital stay, pre- and postoperative visual analog scale, and reherniation rate.
RESULTS
Patients in both the microdiscectomy and sequestrectomy groups showed comparable improvement of visual analog scale (VAS) score for leg pain. VAS score improvement ranged from 5.6 to 6.5 points in the microdiscectomy groups and 5.5 to 6.6 in the sequestrectomy group. The reherniation rate in the microdiscectomy group ranged from 2.3% to 11.8% and in the sequestrectomy groups from 2% to 12.5%.
CONCLUSIONS
This review of the available literature suggests that, compared with conventional microdiscectomy, microsurgical lumbar sequestrectomy can achieve comparable reherniation rates and reduction in radicular pain when a small breach in the posterior fibrous ring is found intraoperatively.
Topics: Diskectomy; Humans; Intervertebral Disc; Intervertebral Disc Displacement; Low Back Pain; Lumbar Vertebrae; Microsurgery; Pain Measurement; Pain, Postoperative; Recurrence; Risk Factors; Treatment Outcome
PubMed: 25183219
DOI: 10.1007/s11999-014-3904-3 -
Journal of Neurosurgery. Spine Mar 2024Tarlov perineurial spinal cysts (TCs) are an underrecognized cause of spinal neuropathic symptoms. TCs form within the sensory nerve root sleeves, where CSF extends...
Tarlov perineurial spinal cysts (TCs) are an underrecognized cause of spinal neuropathic symptoms. TCs form within the sensory nerve root sleeves, where CSF extends distally and can accumulate pathologically. Typically, they develop at the sacral dermatomes where the nerve roots are under the highest hydrostatic pressure and lack enclosing vertebral foramina. In total, 90% of patients are women, and genetic disorders that weaken connective tissues, e.g., Ehlers-Danlos syndrome, convey considerable risk. Most small TCs are asymptomatic and do not require treatment, but even incidental visualizations should be documented in case symptoms develop later. Symptomatic TCs most commonly cause sacropelvic dermatomal neuropathic pain, as well as bladder, bowel, and sexual dysfunction. Large cysts routinely cause muscle atrophy and weakness by compressing the ventral motor roots, and multiple cysts or multiroot compression by one large cyst can cause even greater cauda equina syndromes. Rarely, giant cysts erode the sacrum or extend as intrapelvic masses. Disabling TCs require consideration for surgical intervention. The authors' systematic review of treatment analyzed 31 case series of interventional percutaneous procedures and open surgical procedures. The surgical series were smaller and reported somewhat better outcomes with longer term follow-up but slightly higher risks. When data were lacking, authorial expertise and case reports informed details of the specific interventional and surgical techniques, as well as medical, physical, and psychological management. Cyst-wrapping surgery appeared to offer the best long-term outcomes by permanently reducing cyst size and reconstructing the nerve root sleeves. This curtails ongoing injury to the axons and neuronal death, and may also promote axonal regeneration to improve somatic and autonomic sacral nerve function.
Topics: Humans; Axons; Spinal Nerve Roots; Spine; Tarlov Cysts
PubMed: 38100766
DOI: 10.3171/2023.9.SPINE23559 -
Spine Jul 2013Systematic review. (Review)
Review
STUDY DESIGN
Systematic review.
OBJECTIVE
To identify and describe reconstruction methods for the treatment of transverse sacral fracture (TSF) and to evaluate outcomes based on treatment interventions.
SUMMARY OF BACKGROUND DATA
A variety of surgical interventions for stabilization of TSFs exist, yet the optimal management remains unclear. Although there are many individual case reports and series describing techniques to stabilize TSF, prior reviews fail to provide a comprehensive summary of current and past surgical techniques and their individual outcomes.
METHODS
Our systematic review searched the PubMed database using keywords identifying sacral fractures with a transverse component, requiring internal fixation for stabilization as well as a review of bibliographies and archives from meeting proceedings.
RESULTS
Our search located 417 publications for abstract review, of which 27 (109 patients) with TSF were included. Average follow-up was 22 months (range, 0-82 mo). Thirty-eight patients (34%) underwent spinopelvic fixation (SPF), 53 (49%) underwent posterior pelvic ring fixation (PPRF), and 18 (17%) underwent both. PPRF included iliosacral screws (37 patients), transiliac screws (11 patients), transiliac screws with plating (3 patients), posterior plating (1 patient), and transiliac bar (1 patient). Additional injuries causing lumbosacral instability were seen in 8 patients (42%) who underwent SPF, 2 patients (18%) treated with PPRF, and 5 patients (45%) who were treated with both SPF and PPRF. Of those who presented with a neurological deficit, 5 patients (45%) with SPF, 9 (39%) with PPRF, and 3 (30%) with SPF and PPRF experienced full neurological recovery. Five patients (45%) with SPF, 7 (30%) with PPRF, and 5 (50%) with both regained partial neurological function. One patient (9%) with SPF, 7 (30%) with PPRF, and 2 (20%) with both experienced no neurological recovery.
CONCLUSION
PPRF seems to be effective for stabilization of TSF. However, in the setting of further injuries causing additional lumbosacral instability, SPF should be used to ensure effective stabilization.
Topics: Bone Plates; Bone Screws; Fracture Fixation; Humans; Orthopedic Fixation Devices; Sacrum; Spinal Fractures; Spinal Injuries; Treatment Outcome
PubMed: 23632332
DOI: 10.1097/BRS.0b013e318297960a -
International Journal of Nursing Studies Dec 2019Pressure injury can cause significant patient physical pain, impact quality of life for individuals and their families, and increase hospital length of stay and... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Pressure injury can cause significant patient physical pain, impact quality of life for individuals and their families, and increase hospital length of stay and healthcare costs. Within the hospital setting, it is considered to be largely preventable and regarded as an adverse event. In this context, prophylactic use of a protective sacral dressing to prevent pressure injury has been investigated by various researchers.
OBJECTIVES
Analyse the effectiveness of prophylactic sacral protective dressings to prevent pressure injury.
DESIGN
Systematic review and meta-analysis of randomised controlled trials.
DATA SOURCES
Electronic database searches were undertaken in 2018 and 2019. Initial searches identified 557 articles. Following duplicate removal and screening, 49 full text articles were reviewed. Most were excluded, leaving six studies that met the criteria for full review.
REVIEW METHODS
Two authors assessed study bias and extracted data, with a third reviewer as arbitrator. A random effects meta-analysis was conducted using sample sizes based on intention-to-treat analysis. Sub-group meta-analyses were conducted of three studies in the intensive care setting and four studies that used the same dressing.
RESULTS
Overall, the six randomised controlled trials were judged to be of moderate quality. Due to visibility of the intervention, blinding was rare. Five studies were described as intention-to-treat; however two of these presented per-protocol analyses. All studies compared the intervention plus standard care to standard care. Five studies demonstrated statistically significant reduced pressure injury incidence in the intervention group. All studies were included in the meta-analysis (total n = 1872) and demonstrated homogeneity (I = 10%). Meta-analysis revealed an overall effect in favour of the intervention [risk ratio (RR) = 0.30, 95% CI 0.17-0.51] with a 95% prediction interval of 0.11-0.80. Sub-group analyses of intensive care studies and those using the same dressing demonstrated positive effects (RR = 0.17, 95% CI 0.06-0.49, I = 0%, and RR = 0.32, 95% CI 0.13-0.764, I = 31%; respectively).
CONCLUSIONS
The meta-analysis provides moderate evidence of the effectiveness of a prophylactic sacral dressing to prevent pressure injury, with an overall relative risk indicating that the intervention decreases pressure injury risk by 70%. Sub-group analysis of intensive care studies demonstrated a large relative risk reduction of 83% suggesting the dressing may be more effective in this high-risk group. The lower relative risk reduction of 68% found in four studies using the same dressing, in which there was moderate heterogeneity, indicates that further research is needed to clarify dressing choice.
Topics: Bandages; Humans; Length of Stay; Pressure Ulcer; Quality of Life; Sacrum
PubMed: 31629209
DOI: 10.1016/j.ijnurstu.2019.103400 -
International Journal of Computer... Dec 2016To perform a systematic review and meta-analysis to investigate the different of accuracy between robot-assisted and conventional freehand pedicle screw placement. (Comparative Study)
Comparative Study Meta-Analysis
PURPOSE
To perform a systematic review and meta-analysis to investigate the different of accuracy between robot-assisted and conventional freehand pedicle screw placement.
METHODS
The electronic databases of PubMed, Ovid MEDLINE, EMBASE, and Web of Science were searched for the literatures published up to January, 2016. Statistical analysis was performed using the Review Manager 5.3. The dichotomous data for the pedicle violation rate were summarized using relative risk (RR) and 95 % confidence intervals (CIs). The level of significance was set at [Formula: see text].
RESULTS
A total of 257 patients and 1105 screws were included in the five studies for this meta-analysis. The results revealed that there was no difference in the accuracy between robot-assisted and conventional freehand pedicle screw placement at the 0 mm grading criteria (RR 1.08, 95 % CI 0.86, 1.35, [Formula: see text], [Formula: see text]) and at 2 mm grading criteria (RR 1.02, 95 % CI 0.68, 1.51, [Formula: see text], [Formula: see text]). Among percutaneous robot-assisted technique, open robot-assisted technique and conventional freehand technique, there was also no significant difference at 0mm grading criteria (RO(P) vs FH : RR 1.10, 95 % CI 0.87, 1.40, [Formula: see text], [Formula: see text]; RO(O) versus FH : RR 0.87, 95 % CI 0.55, 1.38, [Formula: see text], [Formula: see text]; RO(P) vs RO(O): RR 1.20, 95 % CI 0.65, 2.24, [Formula: see text]) and at 2 mm grading criteria(RO(P) vs FH : RR 1.07, 95 % CI 0.43, 2.67, [Formula: see text], [Formula: see text]; RO(O) vs FH : RR 0.71, 95 % CI 0.36, 1.39, [Formula: see text], [Formula: see text]; RO(P) vs RO(O) : RR 0.84, 95 % CI 0.36, 1.94, [Formula: see text]).
CONCLUSION
Further high-quality studies are required to unequivocally recommend one surgical technique over the other. With the more application of robot-assisted navigation system, accuracy and clinical benefit of the technique will be gradually improved.
Topics: Humans; Lumbar Vertebrae; Pedicle Screws; Randomized Controlled Trials as Topic; Robotics; Sacrum; Spinal Fusion; Surgery, Computer-Assisted; Thoracic Vertebrae
PubMed: 27334134
DOI: 10.1007/s11548-016-1448-6 -
European Journal of Orthopaedic Surgery... Oct 2023The objective of this review was to present a thorough overview of the complications associated with conventional percutaneous sacroiliac screw fixation to identify... (Meta-Analysis)
Meta-Analysis
OBJECTIVES
The objective of this review was to present a thorough overview of the complications associated with conventional percutaneous sacroiliac screw fixation to identify areas for improvement in surgical technique and patient selection.
METHODS
PubMed/Medline, Web of Science, Embase, Ovid, Cochrane library, and Google Scholar were systematically searched for original human studies reporting on complications of conventional percutaneous sacroiliac fixation in traumatic pelvic ring injuries from January 1, 2000, to April 30, 2022. The main meta-analysis was based on the random effect model to pool all complications reported in the included studies. The results were reported as weighted proportions with 95% confidence intervals. This review was conducted in line with PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines.
RESULTS
A total of 56 studies with 3644 screws (2871 procedures) met the inclusion criteria, with a mean age of 40.5 years. The most frequently reported complications were screw malposition with a weighted proportion of 6% (95% CI: 5-9%) and involved 189 out of 3644 screws, persistent pain following the procedure with a weighted proportion of 3% (95% CI: 2-4%) and affected 98 out of 2871 patients, and nerve injury, which had a weighted proportion of 2% (95% CI: 1-3%) and was observed in 41 out of 2871 procedures. The L5 and S1 nerve roots were more frequently affected. Revision surgery was required for 184 out of 2871 patients with a weighted proportion of 5% (95% CI: 3-7%). The primary reason for the revision was persistent pain after the initial procedure, which affected 74 out of 184 patients, with a weighted proportion of 2.0% (95% CI: 1.2-2.8%).
CONCLUSIONS
This study showed that screw malposition, the need for revision surgery, persistent pain, and nerve injuries were the most frequent complications following conventional percutaneous sacroiliac screw fixation. However, these results must be interpreted in context due to confounding factors, including the lack of high-quality studies and the absence of uniformity in defining some complications across studies.
Topics: Humans; Adult; Pelvic Bones; Fracture Fixation, Internal; Sacrum; Fractures, Bone; Bone Screws; Pain; Retrospective Studies
PubMed: 37031332
DOI: 10.1007/s00590-023-03543-9 -
European Cells & Materials Mar 2021For spinal load and muscle force estimation as well as for numerical model and experimental setup validation, data on human intradiscal pressure are essential.... (Meta-Analysis)
Meta-Analysis
For spinal load and muscle force estimation as well as for numerical model and experimental setup validation, data on human intradiscal pressure are essential. Therefore, the aim of the present meta-analysis was to summarise all in vitro measurements of human intradiscal pressure performed under defined boundary conditions, i.e. without external loading (intrinsic pressure), under axial loading (compression, traction, shear) and under single-planar bending loading (flexion, extension, lateral bending, axial rotation). Data were evaluated based on segmental level and normalised to force and moment. Regression analysis was performed to investigate coefficients of determination and statistical significance of relationships between intradiscal pressure and segmental level for the single loading conditions. 35 studies fulfilled the inclusion criteria, from which a total of 451 data points were collected for the meta-analysis. High coefficients of determination were found in axial compression (r2 = 0.875) and flexion (r2 = 0.781), while being low for intrinsic pressure (r2 = 0.266) and lateral bending (r2 = 0.385), all showing significant regression fitting (p < 0.01). Intradiscal pressure decreases from the upper cervical spine to the sacrum in all loading conditions, considering the same amount of loading for all segmental levels, while the intrinsic pressure exhibits a minimum of the regression curve in the mid-thoracic spine. Apart from its potential for numerical and experimental model validation, this dataset may help to understand the load distribution along the human spine.
Topics: Humans; Intervertebral Disc; Pressure; Rotation; Spine; Weight-Bearing
PubMed: 33745125
DOI: 10.22203/eCM.v041a25 -
Neuromodulation : Journal of the... Oct 2021In some patients treated for urinary or fecal incontinence with sacral neuromodulation (SNM) persistence of symptoms, a reduction in efficacy or adverse effects of... (Review)
Review
OBJECTIVES
In some patients treated for urinary or fecal incontinence with sacral neuromodulation (SNM) persistence of symptoms, a reduction in efficacy or adverse effects of stimulation can occur. In such situations, further programming of the SNM device can help resolve problems. Infrequently hardware failure is detected. This article aims to provide practical guidance to solve sub-optimal outcomes (troubleshooting) occurring in the course of SNM therapy.
MATERIALS AND METHODS
A systematic literature review was performed. Collective clinical experience from an expert multidisciplinary group was used to form opinion where evidence was lacking.
RESULTS
Circumstances in which reprogramming is required are described. Actions to undertake include changes of electrode configuration, stimulation amplitude, pulse frequency, and pulse width. Guidance in case of loss of efficacy and adverse effects of stimulation, developed by a group of European experts, is presented. In addition, various hardware failure scenarios and their management are described.
CONCLUSIONS
Reprogramming aims to further improve patient symptoms or ensure a comfortable delivery of the therapy. Initial changes of electrode configuration and adjustment of stimulation parameters can be performed at home to avoid unnecessary hospital visits. A logical and stepwise approach to reprogramming can improve the outcome of therapy and restore patient satisfaction.
Topics: Electric Stimulation Therapy; Fecal Incontinence; Humans; Lumbosacral Plexus; Patient Satisfaction; Sacrum; Treatment Outcome
PubMed: 34264542
DOI: 10.1111/ner.13494