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Sensors (Basel, Switzerland) Apr 2022(1) Objective: to analyze current active noninvasive measurement systems of the thoracic range of movements of the spine. (2) Methods: A systematic review and... (Meta-Analysis)
Meta-Analysis Review
(1) Objective: to analyze current active noninvasive measurement systems of the thoracic range of movements of the spine. (2) Methods: A systematic review and meta-analysis were performed that included observational or clinical trial studies published in English or Spanish, whose subjects were healthy human males or females ≥18 years of age with reported measurements of thoracic range of motion measured with an active system in either flexion, extension, lateral bending, or axial rotation. All studies that passed the screening had a low risk of bias and good methodological results, according to the PEDro and MINORS scales. The mean values and 95% confidence interval of the reported measures were calculated for different types of device groups. To calculate the differences between the type of device measures, studies were pooled for different types of device groups using Review Manager software. (3) Results: 48 studies were included in the review; all had scores higher than 7.5 over 10 on the PEDro and MINORs methodological rating scales, collecting a total of 2365 healthy subjects, 1053 males and 1312 females; they were 39.24 ± 20.64 years old and had 24.44 ± 3.81 kg/m body mass indexes on average. We summarized and analyzed a total of 11,892 measurements: 1298 of flexoextension, 1394 of flexion, 1021 of extension, 491 of side-to-side lateral flexion, 637 of right lateral flexion, 607 of left lateral flexion, 2170 of side-to-side rotation, 2152 of right rotation and 2122 of left rotation. (4) Conclusions: All collected and analyzed measurements of physiological movements of the dorsal spine had very disparate results from each other, the cause of the reason for such analysis is that the measurement protocols of the different types of measurement tools used in these measurements are different and cause measurement biases. To solve this, it is proposed to establish a standardized measurement protocol for all tools.
Topics: Adolescent; Adult; Biomechanical Phenomena; Female; Humans; Male; Middle Aged; Movement; Range of Motion, Articular; Rotation; Spine; Young Adult
PubMed: 35459026
DOI: 10.3390/s22083042 -
European Journal of Trauma and... Oct 2022Traumatic cranio-cervical instability in childhood is rare and constitutes a challenge for the treating surgeon. The aim of therapy is to restore cervical stability... (Review)
Review
PURPOSE
Traumatic cranio-cervical instability in childhood is rare and constitutes a challenge for the treating surgeon. The aim of therapy is to restore cervical stability without limiting the range of motion. The goal of this systematic review was to find out whether, over the last 10 years, halo fixation (HF) could still be considered a successful treatment option without major risks or complications.
METHODS
We analyzed studies describing the use of HF in traumatic injuries of the cranio-cervical junction in children under the age of 17. Searches were performed in PubMed, MEDLINE and Embase databases for the years from 2010 to 2020. The general success rate, the success rate related to underlying pathologies, and complication rates were evaluated.
RESULTS
The main indications for HF range from pre-surgical correction to postoperative fusion support. C2 is the most frequently injured vertebra in children. The overall success rate of HF was very high. Evaluation according to the underlying pathology showed that, except for atlanto-occipital dislocation, HF generates high fusion rates among different patient cohorts, mainly in C2 vertebra injuries and atlantoaxial rotatory subluxation. Only minor complications were reported, such as pin infections.
CONCLUSION
The current data show that, when used according to the appropriate indication, HF is an effective conservative treatment option for cranio-cervical instability, associated with only minor complications.
Topics: Atlanto-Axial Joint; Cervical Vertebrae; Child; Humans; Joint Dislocations; Joint Instability; Spinal Fusion; Treatment Outcome
PubMed: 34881392
DOI: 10.1007/s00068-021-01849-z -
European Spine Journal : Official... Feb 2022Systematic Review and Meta-analysis. (Meta-Analysis)
Meta-Analysis Review
STUDY DESIGN
Systematic Review and Meta-analysis.
PURPOSE
Three-column injuries making the spine unstable require adequate fixation which can be achieved by anterior alone, posterior alone or combined anterior-posterior approach. There is no general consensus till date on a single best approach in sub-axial cervical spine trauma. This study comparing the three approaches is an attempt to establish a firmer guideline in this disputed topic.
MATERIAL AND METHODS
The protocol was registered with PROSPERO. PubMed, Embase and Google Scholar were searched for relevant literature. For each study, pre-defined data were extracted which included correction of kyphosis, loss of correction, hospital stay, operative time, blood loss during surgery as the outcome variables. Studies were also screened for the complications.
RESULTS
Eleven studies were evaluated for qualitative analysis and quantitative synthesis of the data in our review. The result demonstrated significant difference with most correction achieved in combined approach subgroup. Though no significant difference was found, the anterior group was having maximum loss of correction. Combined approach showed significantly more operative time and blood loss followed by posterior approach and then anterior approach alone. The improvement in VAS was significantly more in anterior subgroup when compared to combined approach.
CONCLUSION
Cervical alignment is best restored by combined approach compared to the other two. Anterior only approach showed more correction than posterior approach. However, there is no significant difference between all three approaches in loss of correction at long-term follow-up. Anterior only approach is superior to posterior and combined approach on basis of intraoperative and perioperative parameters.
LEVEL OF EVIDENCE I
Diagnostic: individual cross-sectional studies with the consistently applied reference standard and blinding.
Topics: Cervical Vertebrae; Cross-Sectional Studies; Humans; Kyphosis; Neck; Operative Time; Treatment Outcome
PubMed: 34859269
DOI: 10.1007/s00586-021-07068-9 -
Animals : An Open Access Journal From... Sep 2021Mobilization and manipulation techniques are often used in small animal and equine practice; however, questions remain concerning indications, dosing and efficacy. A... (Review)
Review
Mobilization and manipulation techniques are often used in small animal and equine practice; however, questions remain concerning indications, dosing and efficacy. A bibliographic search was performed to identify peer-reviewed publications from 1980 to 2020 that evaluated the clinical effects of musculoskeletal mobilization and manipulation techniques in dogs, cats and horses. The search strategy identified 883 papers for review. Inclusion and exclusion criteria were applied. The clinical indications, dosages, outcome parameters, and reported efficacy within each publication were recorded and categorized for comparison with scientific quality assessed according to a standardized grading system. Fourteen articles were included in this systematic review of which 13 were equine and one was a canine study. Seven of these were cohort studies and seven were randomized controlled clinical trials. The canine study involved carpal immobilization-remobilization and all equine studies focused on the effects of passive mobilization ( = 5) or manipulation ( = 8) of the axial skeleton. Study quality was low ( = 4), moderate ( = 7), and high ( = 3) and included a wide array of outcome parameters with varying levels of efficacy and duration of therapeutic effects, which prevented further meta-analysis. Therefore, it was difficult to draw firm conclusions despite all studies reporting positive effects. Optimal technique indications and dosages need to be determined to improve the standardization of these treatment options.
PubMed: 34679808
DOI: 10.3390/ani11102787 -
The American Journal of Sports Medicine Sep 2022Meniscus root tears (MRTs) are defined as radial tears within 1 cm of the meniscus root insertion or an avulsion of the meniscus root itself. They lead to altered joint...
BACKGROUND
Meniscus root tears (MRTs) are defined as radial tears within 1 cm of the meniscus root insertion or an avulsion of the meniscus root itself. They lead to altered joint loading because of the failure to convert axial (compressive) loads into hoop stresses. Untreated MRTs can result in altered joint biomechanics and accelerated articular cartilage degeneration and the development of osteoarthritis (OA), yet optimal management remains unclear.
PURPOSE
To review treatment outcomes after acute MRTs by surgical repair, debridement, meniscectomy, or nonoperative treatment.
DESIGN
Systematic review; Level of evidence, 4.
METHODS
A systematic review of the evidence from human clinical studies was conducted with electronic searches of the PUBMED, Medline, EMBASE, and the Cochrane Library databases. One reviewer extracted the data and 2 reviewers assessed the risk of bias and performed synthesis of the evidence.
RESULTS
Eleven studies of low to moderate methodological quality were identified. All treatment options improved functional scores after >12 months. Arthroscopic repair may be associated with better functional outcomes when compared with partial meniscectomy and nonoperative management at 12-month follow-up. Radiographic progression of OA occurred in all treatment groups; there was some evidence that this was delayed after repair when compared with other treatments. Baseline severity of meniscal extrusion, varus malalignment, and pretreatment degeneration were predictors of poor functional outcomes. Age was not found to be an independent predictor of functional outcome.
CONCLUSION
The current level 3 and 4 evidence suggests that arthroscopic repair may result in slower progression of radiological deterioration compared with meniscectomy and nonoperative management. The current literature does not support the exclusion of patients from MRT repair on the basis of age. Patients undergoing acute MRT treatments (repair, debridement, or nonoperative) can be expected to experience improvement in functional outcomes after >12 months. The strength of conclusions are limited because of the paucity of high-quality studies on this subject. Further studies, preferably randomized sham controlled trials with function-oriented rehabilitation programs, are needed to compare treatment strategies and stratification of care based on the risk of meniscal extrusion.
REGISTRATION
CRD42018085092 (PROSPERO).
Topics: Arthroscopy; Debridement; Humans; Meniscectomy; Menisci, Tibial; Meniscus; Osteoarthritis; Tibial Meniscus Injuries
PubMed: 34633226
DOI: 10.1177/03635465211031250 -
Neurosurgical Focus Oct 2021Ankylosing spondylitis (AS) is a chronic inflammatory disease affecting the sacroiliac joints and axial spine that is closely linked with human leukocyte antigen-B27....
OBJECTIVE
Ankylosing spondylitis (AS) is a chronic inflammatory disease affecting the sacroiliac joints and axial spine that is closely linked with human leukocyte antigen-B27. There appears to be an increased frequency of associated epidural hematomas in spine fractures in patients with AS. The objective was to review the incidence within the literature and a single-institution experience of the occurrence of epidural hematoma in the context of patients with AS requiring spine surgery.
METHODS
Deep 6 AI software was used to search the entire database of patients at a single level I trauma center (since the advent of the institution's modern electronic health record system) to look at all patients with AS who underwent spinal surgery and who had a diagnosis of epidural hematoma. Additionally, a systemic literature review was performed of all papers evaluating the incidence of epidural hematoma in patients with spine fractures.
RESULTS
A single-institution, retrospective review of records from 2009 to 2020 yielded a total of 164 patients with AS who underwent spine surgery. Of those patients, 17 (10.4%) had epidural hematomas on imaging, with the majority requiring surgical decompression. These spine fractures occurred close to the cervicothoracic or thoracolumbar junction. The patients ranged in age from 51 to 88 years, and there were 14 males and 3 females in the cohort. Eight patients were administered an antiplatelet and/or anticoagulant agent, and the rest were not. All patients required surgical stabilization, with 64.7% of patients also requiring decompressive laminectomies for evacuation of the hematoma and spinal cord decompression. Only 1 death was reported in the series. There was a tendency toward neurological improvement after surgical intervention.
CONCLUSIONS
AS has been a well-described pathologic process that leads to an increased risk of three-column injury in spine fracture, with an increased incidence of symptomatic epidural hematoma compared with patients without AS. Early recognition of this entity is important to ensure that appropriate surgical management includes addressing compression of the neural elements in addition to surgical stabilization.
Topics: Aged; Aged, 80 and over; Female; Hematoma, Epidural, Spinal; Humans; Male; Middle Aged; Retrospective Studies; Spinal Fractures; Spine; Spondylitis, Ankylosing
PubMed: 34598124
DOI: 10.3171/2021.7.FOCUS21334 -
Archives of Orthopaedic and Trauma... Nov 2022The influence of limb malrotation on long-leg radiographs (LLR) is frequently discussed in literature. This systematic review aimed to describe the influence of limb... (Review)
Review
INTRODUCTION
The influence of limb malrotation on long-leg radiographs (LLR) is frequently discussed in literature. This systematic review aimed to describe the influence of limb rotation on alignment measurements alone and in combination with knee flexion, and determine its clinical impact.
MATERIALS AND METHODS
A literature search was conducted in June 2021 using the databases MEDLINE, Cochrane, Web of Science (Clarivate Analytics), and Embase. The search term ((radiograph OR X-ray) AND (position OR rotation) AND limb alignment) was used. Database query, record screening, and study inclusion and exclusion were performed by two reviewers independently. Experimental studies (using either specimens or synthetic bones) or clinical studies (prospective or retrospective using radiographs of patients) analyzing the influence of limb rotation on anatomic and mechanical limb alignment measurements were included. Characteristics and results of the included studies were summarized, simplified, and grouped for comparison to answer the research question. Studies were compared descriptively, and no meta-analysis was performed.
RESULTS
A total of 22 studies were included showing large heterogeneity, comprising studies with cadavers, patients, and synthetic bones. Most studies (7 out of 8) reported that external rotation (ER) causes less apparent valgus and leads to more varus and internal rotation (IR) causes more valgus and leads to less varus. However, there is no consensus on the extent of rotation influencing alignment measures. Studies reported about an average change of > 2° (n = 4) and < 2° (n = 4) hip-knee-ankle angle (HKA) between 15°IR and 15°ER. There is a consensus that the impact of rotation on mechanical alignment is higher if additional sagittal knee angulation, such as knee flexion, is present. All five studies analyzing the influence of rotation combined with knee flexion (5°-15°) showed an HKA change of > 2° between 15°IR and 15°ER.
CONCLUSION
Malrotation is frequently present on LLR, possibly influencing the measured alignment especially in knees with extension deficit. Surgeons must consider this when measuring and treating deformities (high tibial osteotomy or total knee arthroplasties), and analyzing surgical outcomes. Especially in patients with osteoarthritis with knee extension deficits or postoperative swelling, the effect of malrotation is significantly greater.
Topics: Arthroplasty, Replacement, Knee; Humans; Knee Joint; Lower Extremity; Osteoarthritis, Knee; Prospective Studies; Retrospective Studies; Tibia
PubMed: 34596760
DOI: 10.1007/s00402-021-04163-w -
Current Rheumatology Reviews 2022Axial spondyloarthritis (axSpA) is a chronic inflammatory disease predominantly affecting the axial skeleton. axSpA includes radiographic (i.e., ankylosing spondylitis...
Axial spondyloarthritis (axSpA) is a chronic inflammatory disease predominantly affecting the axial skeleton. axSpA includes radiographic (i.e., ankylosing spondylitis (AS)) and non-radiographic forms (nr-axSpA). Although recent studies have reported that patients with AS have impaired gait, axSpA's consequences on gait remain unknown. The present review's objectives were to identify: 1) how gait is assessed in patients with axSpA, and 2) what the gait characteristics are of patients with axSpA. This systematic review's protocol was registered in the Prospero database (CRD42020128509). Three databases were systematically searched using keywords related to axSpA and gait. Two independent reviewers selected the articles and extracted the data. The search revealed two hundred titles and abstracts, and two articles were finally included in this review, comprising a total of 132 patients with axSpA. One of the included studies used the 6 m maximum gait velocity test (axSpA: 2.2 ± 0.5 m/s), and the other used the six-minute walk test (axSpA: 414 ± 106 m). Neither study involved a control group to compare gait. Only two published studies assessed the gait performance of patients with axSpA using clinical tests. Furthermore, neither of them compared gait performance to healthy controls or differentiated gait between the AS and nr-axSpA forms of axSPA. The present literature review highlights the need for future research to learn more about how gait is impaired in different types of patients with axSpA.
Topics: Axial Spondyloarthritis; Gait; Humans; Spondylarthritis; Spondylitis, Ankylosing
PubMed: 34548003
DOI: 10.2174/1573397117666210921114949 -
Journal of Orthopaedic Surgery and... Sep 2021To compare the clinical outcomes of C laminectomy and C laminoplasty at the C segment during French-door laminoplasty. (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
To compare the clinical outcomes of C laminectomy and C laminoplasty at the C segment during French-door laminoplasty.
METHODS
The Cochrane Library, PubMed, Embase, and Web of Science databases were searched from inception to November 10, 2020 for studies comparing the clinical outcomes of two types of French-door laminoplasty in the treatment of multilevel cervical spondylotic myelopathy (MCSM). Review Manager 5.3 was used to analyze the following outcomes: operative time, intraoperative blood loss, preoperative and postoperative Japanese Orthopaedic Association (JOA) scores, recovery rate, cervical curvature, cervical range of motion (ROM), incidence of axial symptoms (AS), and C bony fusion rate.
RESULTS
A total of eight studies involving 776 patients were included; there were 424 patients in the C laminectomy group and 352 patients in the C laminoplasty group. The results of the meta-analysis showed that the C laminectomy group was superior to the C laminoplasty group in terms of operative time (P < 0.00001), cervical ROM (P = 0.04), and incidence of AS (P < 0.0001). However, no statistically significant differences between the two groups were noted regarding intraoperative bleeding (P = 0.44), preoperative JOA score (P = 0.57), postoperative JOA score (P = 0.09), recovery rate (P = 0.25), cervical curvature (P = 0.22), and C bony fusion rate (P = 0.06).
CONCLUSION
This meta-analysis demonstrated that both C laminoplasty and C laminectomy could effectively improve neurological function in patients with MCSM in French-door laminoplasty. However, C laminectomy can reduce the operative time, preserve cervical ROM, and reduce the incidence of postoperative AS.
TRIAL REGISTRATION
PROSPERO registration number is CRD42021230798 . Date of registration: February 11, 2021.
Topics: Cervical Vertebrae; Humans; Laminectomy; Laminoplasty; Retrospective Studies; Spinal Cord Diseases; Treatment Outcome
PubMed: 34521434
DOI: 10.1186/s13018-021-02596-y -
World Neurosurgery Nov 2021This study aimed to evaluate the superiority of open-door versus French-door posterior cervical laminoplasty in the treatment of multisegmental cervical spondylotic... (Comparative Study)
Comparative Study Meta-Analysis
This study aimed to evaluate the superiority of open-door versus French-door posterior cervical laminoplasty in the treatment of multisegmental cervical spondylotic myelopathy by comparing the intraoperative parameters and clinical and radiologic outcomes of these 2 procedures. PubMed, Embase, Cochrane Library, Web of Science, China National Knowledge Infrastructure, the Wanfang database, the Weipu database, and China Biology Medicine disk were searched. Articles were retrieved from database establishment through May 22, 2020. Data analysis was carried out on the retrieved articles using RevMan 5.3 software. This meta-analysis included 14 studies involving 1010 patients, among which 6 were randomized controlled trials and 8 were retrospective analyses. Comparing the open-door and French-door groups, no statistically significant differences were found in operative time (weighted mean difference [WMD] = -4.47, 95% CI [-17.85, 8.92], P = 0.51), postoperative Japanese Orthopaedic Association score (WMD= -0.24, 95% CI [-0.87, 0.38], P = 0.45), recovery rate (WMD= -0.58, 95% CI [-3.61, 2.45], P = 0.71), postoperative cervical lordosis (WMD= -0.15, 95% CI [-1.93, 1.63], P = 0.87), cervical range of motion (WMD = -3.04, 95% CI [-8.68, 2.59], P = 0.29), sagittal diameter of the spinal canal (WMD = -0.24, 95% CI [-0.54, 0.07], P = 0.13), incidence of C5 palsy (OR = 1.78, 95% CI [0.64, 4.93], P = 0.27), or incidence of cerebrospinal fluid leakage (OR = 1.51, 95% CI [0.48, 4.71], P = 0.48). However, the French-door group was associated with less intraoperative bleeding (WMD = 54.96, 95% CI [21.37, 88.55], P = 0.001) and a lower incidence of axial symptoms (OR = 2.50, 95% CI [1.32, 4.72], P = 0.005). This analysis suggests that both methods can achieve good postoperative outcomes. However, less intraoperative bleeding and a lower incidence of postoperative axial symptoms were found in the French-door group. This requires further validation and investigation in larger sample-size and well-designed randomized controlled studies.
Topics: Cervical Vertebrae; Humans; Laminoplasty; Randomized Controlled Trials as Topic; Spinal Cord Diseases; Spondylosis
PubMed: 34425291
DOI: 10.1016/j.wneu.2021.08.032