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Colorectal Disease : the Official... Aug 2011Sacral nerve stimulation (SNS) reduces incontinence episodes and improves the quality of life of patients treated for faecal incontinence. However, the exact mechanism... (Review)
Review
AIM
Sacral nerve stimulation (SNS) reduces incontinence episodes and improves the quality of life of patients treated for faecal incontinence. However, the exact mechanism of action of this technique remains unclear. The present article reviews the pertinent neuroanatomy and neurophysiology related to SNS and provides explanations for potential mechanisms of action.
METHOD
A systematic review of the literature was performed for studies of the potential mechanisms of action of SNS, using MEDLINE, PubMed, Embase and the Cochrane Library. Articles dealing with the technique, adverse events and economic evaluations of SNS, as well as literature reviews, were excluded, except for reviews dealing with the mechanisms of action of SNS. The following inclusion criteria were used to select articles: (i) articles in English, (ii) randomized, double-blinded, sham-controlled studies, and (iii) cohort studies. Case-control studies or retrospective studies were cited only when randomized or cohort studies could not be found.
RESULTS
We propose three hypotheses to explain the mechanism of action of SNS: (i) a somato-visceral reflex, (ii) a modulation of the perception of afferent information, and (iii) an increase in external anal sphincter activity.
CONCLUSION
The mechanism of action of SNS in patients with faecal incontinence almost certainly depends on the modulation of spinal and/or supraspinal afferent inputs. Further research on humans and animals will be required to gain a better understanding of the mechanisms of action of SNS.
Topics: Anal Canal; Colon; Defecation; Electric Stimulation Therapy; Enteric Nervous System; Fecal Incontinence; Humans; Lumbosacral Plexus; Pelvic Floor
PubMed: 21689312
DOI: 10.1111/j.1463-1318.2011.02623.x -
European Spine Journal : Official... Mar 2024Lumbar spinal stenosis is one of the most common diseases affecting the elderly that is characterized by the narrowing of the spinal canal and peripheral neural pathways... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND CONTEXT
Lumbar spinal stenosis is one of the most common diseases affecting the elderly that is characterized by the narrowing of the spinal canal and peripheral neural pathways which may cause back pain and neurogenic intermittent claudication in affected patients. Recently, as an alternative treatment between conservative therapy and decompression surgery, interspinous process device (IPD) such as X-stop, Coflex, DIAM, Aperius, Wallis, etc., has gained enough popularity.
PURPOSE
The purpose of this study was to evaluate the efficacy and safety of IPD in the treatment of degenerative lumbar spinal stenosis compared with decompression surgery.
STUDY DESIGN
This study was a systematic review and meta-analysis of randomized controlled trials.
PATIENT SAMPLE
555 patients' samples were collected for this study.
OUTCOME MEASURES
The Visual Analogue Scale and the Oswestry Disability Index were analyzed, as well as the Zurich Claudication Questionnaire For efficacy evaluation. Complication and reoperation rate was utilized for the assessment of safety.
METHODS
A comprehensive literature search was performed through Pubmed, EMBASE, Web of Science, and Cochrane Library until October 2023. Among the studies meeting the eligible criteria, any study in which IPD was utilized in the treatment of degenerative lumbar spinal stenosis was included in the current review. For efficacy evaluation, the Visual Analogue Scale and the Oswestry Disability Index were analyzed, as well as the Zurich Claudication Questionnaire. Complication and reoperation rates were utilized for the assessment of safety.
RESULTS
Five randomized controlled trials with 555 patients were included. There were no significant differences in VAS leg pain (SMD - 0.08, 95% CI - 0.32 to 0.15) and back pain (SMD 0.09, 95%CI-0.27 to 0.45), ODI scores (MD 1.08, 95% CI - 11.23 to 13.39) and ZCQ physical function (MD-0.09, 95% CI-0.22 to 0.05) for IPD compared with decompression surgery. In terms of ZCQ symptom severity (MD - 0.22, 95% CI - 0.27 to - 016), decompression surgery showed superior to the IPD. As for complications (RR 1.08, 95% CI 0.36 to 3.27), the IPD had no advantages compared to decompression surgery, whereas inferior to it in reoperation rate (RR 2.58, 95% CI 1.67 to 3.96).
CONCLUSIONS
This systematic review and meta-analysis indicated no superiority in the clinical outcome for IPD compared with decompression surgery. However, more clinical studies are warranted to determine the efficacy and safety of IPD.
Topics: Humans; Aged; Spinal Stenosis; Decompression, Surgical; Lumbar Vertebrae; Randomized Controlled Trials as Topic; Back Pain; Treatment Outcome
PubMed: 38342843
DOI: 10.1007/s00586-023-08119-z -
Neurosurgical Review Apr 2021Pneumorrhachis (PR) refers to free air in the spinal canal. We aim to describe a case report and conduct a systematic review focused on the clinical presentation,...
Pneumorrhachis (PR) refers to free air in the spinal canal. We aim to describe a case report and conduct a systematic review focused on the clinical presentation, diagnosis, and management of traumatic PR. We conducted a language-restricted PubMed, SciELO, Scopus, and Ovid database search for traumatic PR cases published till June 2019. Categorical variables were assessed by Fisher's exact test. In addition to our reported index case, there were 82 articles (96 individual cases) eligible for meta-analysis according to our inclusion/exclusion criteria. Eighty per cent of patients had blunt trauma, while 17% had penetrating injuries. Thirty-four per cent of cases were extradural PR, 21% intradural PR, and unreported PR type in 43%. Nine per cent of patients presented with symptoms directly attributed to PR: sensory radiculopathy (2%), motor radiculopathy (1%), and myelopathy (6%). CT had a 100% sensitivity for diagnosing PR, MRI 60%, and plain radiograph 48%. Concurrent injuries reported include pneumocephalus (42%), pneumothorax (36%), spine fracture (27%), skull fracture (27%), pneumomediastinum (24%), and cerebrospinal fluid leak (14%). PR was managed conservatively in every case, with spontaneous resolution in 96% on follow-up (median = 10 days). Prophylactic antibiotics for meningitis were given in 13% PR cases, but there was no association with the incidence of meningitis (overall incidence: 3%; prophylaxis group (0%) vs non-prophylaxis group (4%) (p = 1)). Occasionally, traumatic PR may present with radiculopathy or myelopathy. Traumatic PR is almost always associated with further air distributions and/or underlying injuries. There is insufficient evidence to support the use of prophylactic antibiotic in preventing meningitis in traumatic PR patients.
Topics: Aged; Humans; Male; Pneumocephalus; Pneumorrhachis; Radiography; Spinal Canal; Spinal Cord Injuries; Thoracic Vertebrae
PubMed: 32307638
DOI: 10.1007/s10143-020-01300-8 -
Global Spine Journal Mar 2024Systematic review and meta-analysis. (Review)
Review
STUDY DESIGN
Systematic review and meta-analysis.
OBJECTIVES
To assess the radiographic risk factors for adjacent segment disease (ASD) following anterior cervical discectomy and fusion (ACDF) for degenerative cervical spine pathologies.
METHODS
PubMed, Embase and the Cochrane Library databases were searched up to December 2023. The primary inclusion criteria were degenerative spinal conditions treated with ACDF, comparing radiological parameters in patients with and without postoperative ASD. The radiographic parameters included intervertebral disc height, cervical sagittal alignment, sagittal segmental alignment, range of motion, segmental height, T1 slope, sagittal vertical axis (SVA), thoracic inlet angle (TIA), and plate to disc distance (PPD). Risk of bias was assessed for all studies. The Cochrane Review Manager was utilized to perform the meta-analysis.
RESULTS
From 7044 articles, 13 retrospective studies were included in the final analysis. Three studies had "not serious" bias and the other 10 studies had serious or very serious bias. The total number of patients in the included studies was 1799 patients. Five studies included single-level ACDF, 2 studies included multi-level ACDF, and 6 studies included single or multi-level ACDF. On meta-analysis, the significant risk factors associated with ASD development were reduced postoperative cervical lordosis (mean difference [MD] = 3.35°, = .002), reduced last-follow-up cervical lordosis (MD = -3.02°, = .0003), increased preoperative to postoperative cervical sagittal alignment change (MD = -3.68°, = .03), and the presence of developmental cervical canal stenosis (Odds ratio [OR] = 4.17, < .001).
CONCLUSIONS
Decreased postoperative cervical lordosis, greater change in cervical sagittal alignment and developmental cervical canal stenosis were associated with an increased risk of ASD following ACDF.
PubMed: 38469858
DOI: 10.1177/21925682241237500 -
Spine Surgery and Related Research Jan 2023Magnetic resonance imaging (MRI) is a potential tool for the objective assessment of spinal cord injury (SCI) because it correlates well with the spatial and temporal... (Review)
Review
BACKGROUND
Magnetic resonance imaging (MRI) is a potential tool for the objective assessment of spinal cord injury (SCI) because it correlates well with the spatial and temporal extension of spinal cord pathology. This study aimed to systematically identify currently available scoring system based on MRI parameters, including measurement of the spinal cord lesion length in sagittal view (intramedullary lesion length (IMLL)) and morphology of the lesion in axial view (Brain and Spinal Injury Center (BASIC) score).
METHODS
A systematic search was conducted using the PubMed/MEDLINE database for English-language studies with the keywords "cervical," "spinal cord injury," "scoring system," "scoring," "classification," and "magnetic resonance imaging" to systematically identify the scoring system based on MRI parameters. The main outcomes of interest are the scoring system's inter- and intraobserver reliabilities and its predictive accuracy of neurological outcome.
RESULTS
After assessing the full text and applying the inclusion and exclusion criteria, 13 articles were found to be eligible. The inter- and intraobserver reliabilities were rated as good until perfect for increased signal intensity (ISI), maximum canal compromise (MCC), maximum spinal cord compression (MSCC), BASIC score, cord-canal-area ratio, space available for the cord, and the compression ratio. The weighted mean difference of IML between the group with converted ASIA Impairment Scale (AIS) grade and the group without conversion is 31.79 ( =93%, =0.008). The percentage of agreement between the initial BASIC score of 4 with AIS grade of A at follow-up is 100%.
CONCLUSIONS
Certain MRI parameters, including IML and BASIC score, have good reliability and correlate well with neurological outcome, making them candidates for building simple and objective scoring system for cervical SCI. Level of Evidence: 2A.
PubMed: 36819628
DOI: 10.22603/ssrr.2021-0255 -
Pain Physician 2009Post lumbar surgery syndrome or failed back surgery syndrome with persistent pain continues to increase over the years. The speculated causes of post lumbar laminectomy... (Review)
Review
BACKGROUND
Post lumbar surgery syndrome or failed back surgery syndrome with persistent pain continues to increase over the years. The speculated causes of post lumbar laminectomy syndrome include acquired stenosis, epidural fibrosis, arachnoiditis, radiculopathy, and recurrent disc herniation. Epidural fibrosis may account for as much as 20% to 36% of all cases of failed back surgery syndrome. Percutaneous epidural adhesiolysis has been employed in interventional pain management in the treatment of chronic, refractory low back and lower extremity pain after back surgery.
STUDY DESIGN
A systematic review of randomized trials and observational studies.
OBJECTIVE
To evaluate the effectiveness of percutaneous adhesiolysis in managing chronic low back and lower extremity pain due to post lumbar surgery syndrome.
METHODS
A comprehensive literature search was conducted utilizing electronic databases, as well as systematic reviews and cross references from 1966 through December 2008. The quality of individual articles used in this analysis was assessed by modified Cochrane review criteria for randomized trials and the Agency for Healthcare Research and Quality (AHRQ) criteria for assessment of observational studies. Clinical relevance was evaluated using 5 questions according to the criteria recommended by the Cochrane Review Back Group. Analysis was conducted using 5 levels of evidence, ranging from Level I to III, with 3 subcategories in Level II.
OUTCOME PARAMETERS
The primary outcome measure was pain relief (short-term relief of at least 6 months and long-term relief of more than 6 months). Secondary outcome measures were improvement in functional status, psychological status, return to work, and change in opioid intake.
RESULTS
Of the 13 studies considered for inclusion, 3 randomized trials and 4 observational studies met the inclusion criteria for methodologic quality assessment and evidence synthesis based on methodologic quality scores of 50 or more. Evidence of percutaneous adhesiolysis in the management of chronic low back pain in post-lumbar surgery syndrome is Level I to Level II-1, with evidence derived from 3 randomized trials.
LIMITATIONS
There is a paucity of efficacy and pragmatic trials. No trials have been published after 2006.
CONCLUSION
The indicated level of evidence for percutaneous adhesiolysis is Level I or II-1 based on the US Preventative Services Task Force (USPSTF) criteria.
Topics: Chronic Disease; Disability Evaluation; Epidural Space; Failed Back Surgery Syndrome; Humans; Low Back Pain; Lumbosacral Region; Postoperative Period; Tissue Adhesions; Treatment Outcome
PubMed: 19305485
DOI: No ID Found -
The Spine Journal : Official Journal of... Nov 2012Surgical treatment of intracanal (both intramedullary and extramedullary) spine lesions requires posterior decompressive techniques in nearly all instances.... (Review)
Review
BACKGROUND CONTEXT
Surgical treatment of intracanal (both intramedullary and extramedullary) spine lesions requires posterior decompressive techniques in nearly all instances. Postoperative spinal deformities, most notably sagittal and coronal decompensation, are of significant concern for both the patient and the spinal surgeon.
PURPOSE
To review and define principles and features of spinal deformities after posterior spinal decompression for intracanal spinal lesions, and to define patients who may benefit from the concomitant spinal fusion.
METHODS
A systematic review of MEDLINE was conducted, including articles published between 1980 and 2011. Articles related to spinal deformities after posterior decompression for the treatment of intracanal spine lesions were identified.
RESULTS
Ten articles met all inclusion and exclusion criteria. All were case series with limited evidence (Level IV). Many risk factors to deformity were implied but with limited evidence. Young age was the most commonly identified risk in these articles.
CONCLUSIONS
Spinal deformity after posterior decompression is a common complication, most notably in children and young adults, after the removal of intramedullary tumors. Many risk factors have been implied to increase the postoperative development of spinal deformity, including young age, laminectomy extension, preoperative deformity, and extensive facet resection, among others. However, there is a lack of high-quality evidence to propose an algorithm for treatment or preventive measures. New studies with larger series of patients and standardized clinical outcomes are necessary to establish optimal treatment protocols.
Topics: Adolescent; Adult; Age Factors; Child; Child, Preschool; Decompression, Surgical; Female; Humans; Infant; Laminectomy; Male; Middle Aged; Patient Selection; Postoperative Complications; Spinal Canal; Spinal Curvatures; Spinal Fusion; Spinal Neoplasms; Young Adult
PubMed: 23116818
DOI: 10.1016/j.spinee.2012.09.054 -
Paediatric Anaesthesia Aug 2014The anatomy of the sacral hiatus and caudal canal is prone to significant variation, yet studies assessing this in the pediatric population remain limited. Awareness of... (Review)
Review
The anatomy of the sacral hiatus and caudal canal is prone to significant variation, yet studies assessing this in the pediatric population remain limited. Awareness of the possible anatomical variations is critical to the safety and success of caudal epidural blocks, particularly when image guidance is not employed. This systematic review analyzes the available evidence on the clinical anatomy of the caudal canal in pediatric patients, emphasizing surface anatomy and internal anatomical variations. A literature search using three electronic databases and standard pediatric and anatomy reference texts was conducted yielding 24 primary and seven secondary English-language sources. Appreciating that our current landmark-guided approaches to the caudal canal are not well studied in the pediatric population is important for both clinicians and researchers.
Topics: Cauda Equina; Child; Child, Preschool; Epidural Space; Humans; Infant; Infant, Newborn; Sacrococcygeal Region; Sacrum
PubMed: 24666890
DOI: 10.1111/pan.12392 -
Spine Mar 2006Systematic review. (Review)
Review
STUDY DESIGN
Systematic review.
OBJECTIVES
To review the various radiographic parameters currently used to assess traumatic thoracolumbar injuries, emphasizing the validity and technique behind each one, to formulate evidence-based guidelines for a standardized radiographic method of assessment of these fractures.
SUMMARY OF BACKGROUND DATA
The treatment of thoracolumbar fractures is guided by various radiographic measurement parameters. Unfortunately, for each group of parameters, there has usually been more than 1 proposed measurement technique, thus creating confusion when gathering data and reporting outcomes. Ultimately, this effect results in clinical decisions being based on nonstandardized, nonvalidated outcome measures.
METHODS
Computerized bibliographic databases were searched up to January 2004 using key words and Medical Subject Headings on thoracolumbar spine trauma, radiographic parameters, and methodologic terms. Using strict inclusion criteria, 2 independent reviewers conducted study selection, data abstraction, and methodologic quality assessment.
RESULTS
There were 18 original articles that ultimately constituted the basis for the review. Of radiographic measurement parameters, 3 major groups were identified, depicting the properties of the injured spinal column: sagittal alignment, vertebral body compression, and spinal canal dimensions, with 14 radiographic parameters reported to assess these properties.
CONCLUSIONS
Based on a systematic review of the literature and expert opinion from an experienced group of spine trauma surgeons, it is recommended that the following radiographic parameters should be used routinely to assess thoracolumbar fractures: the Cobb angle, to assess sagittal alignment; vertebral body translation percentage, to express traumatic anterolisthesis; anterior vertebral body compression percentage, to assess vertebral body compression, the sagittal-to-transverse canal diameter ratio, and canal total cross-sectional area (measured or calculated); and the percent canal occlusion, to assess canal dimensions.
Topics: Consensus; Expert Testimony; Humans; Lumbar Vertebrae; Patient Care Management; Practice Guidelines as Topic; Radiography; Spinal Fractures; Thoracic Vertebrae
PubMed: 16508540
DOI: 10.1097/01.brs.0000201261.94907.0d -
Pain Practice : the Official Journal of... Apr 2014Lumbosacral radicular pain is a pain in the distribution area of one of the nerves of the lumbosacral plexus, with or without sensory and/or motor impairment. A major... (Review)
Review
Lumbosacral radicular pain is a pain in the distribution area of one of the nerves of the lumbosacral plexus, with or without sensory and/or motor impairment. A major source of lumbosacral radicular pain is failed back surgery, which is defined as persistent or recurrent pain, mainly in the region of the lower back and legs even after technically, anatomically successful spine surgeries. If lumbosacral radicular neuropathic pain fails to respond to conservative or interventional treatments, epiduroscopy can be performed as part of a multidisciplinary approach. Epiduroscopy aids in identifying painful structures in the epidural space, establishing a diagnosis and administering therapy. The novelty consists in the use of an epiduroscope to deliver therapies such as adhesiolysis and targeted administration of epidural medications. Clinical trials report favorable treatment outcomes in 30% to 50% of patients. Complications are rare and related to the rate or volume of epidural fluid infusion or inadvertent dural puncture. In patients with lumbosacral radicular pain, especially after back surgery, epiduroscopy with adhesiolysis may be considered (evidence rating 2 B+).
Topics: Anesthesia, Epidural; Epidural Space; Evidence-Based Medicine; Fluoroscopy; Humans; Low Back Pain; Lumbosacral Region
PubMed: 23941663
DOI: 10.1111/papr.12104