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Clinical Spine Surgery Nov 2023A meta-analysis of randomized controlled trials (RCTs). (Meta-Analysis)
Meta-Analysis
Mid-term and Long-term Outcomes After Total Cervical Disk Arthroplasty Compared With Anterior Cervical Discectomy and Fusion: A Systematic Review and Meta-analysis of Randomized Controlled Trials.
STUDY DESIGN
A meta-analysis of randomized controlled trials (RCTs).
OBJECTIVE
The aim of this study was to compare mid-term to long-term outcomes of cervical disk arthroplasty (CDA) with those of anterior cervical discectomy and fusion (ACDF) for the treatment of symptomatic cervical degenerative disk disease.
SUMMARY OF BACKGROUND DATA
After ACDF to treat symptomatic cervical degenerative disk disease, the loss of motion at the index level due to fusion may accelerate adjacent-level disk degeneration. CDA was developed to preserve motion and reduce the risk of adjacent segment degeneration. Early-term to mid-term clinical outcomes from RCTs suggest noninferiority of CDA compared with ACDF, but it remains unclear whether CDA yields better mid-term to long-term outcomes than ACDF.
MATERIALS AND METHODS
Two independent reviewers searched PubMed, Embase, and the Cochrane Library for RCTs with at least 60 months of follow-up. The risk ratio or standardized mean difference (and 95% CIs) were calculated for dichotomous or continuous variables, respectively.
RESULTS
Eighteen reports of 14 RCTs published in 2014-2023 were included. The pooled analysis demonstrated that the CDA group had a significantly greater improvement in neurological success and Neck Disability Index than the ACDF group. The ACDF group exhibited a significantly better improvement in the Short Form-36 Health Survey Physical Component Summary than the CDA group. Radiographic adjacent segment degeneration was significantly lower in the CDA group at 60- and 84-month follow-ups; at 120-month follow-up, there was no significant difference between the 2 groups. Although the overall rate of secondary surgical procedures was significantly lower in the CDA group, we did not observe any significant difference at 60-month follow-up between the CDA and ACDF group and appreciated statistically significant lower rates of radiographic adjacent segment degeneration, and symptomatic adjacent-level disease requiring surgery at 84-month and 108- to 120-month follow-up. The rate of adverse events and the neck and arm pain scores in the CDA group were not significantly different from those of the ACDF group.
CONCLUSIONS
In this meta-analysis of 14 RCTs with 5- to 10-year follow-up data, CDA resulted in significantly better neurological success and Neck Disability Index scores and lower rates of radiographic adjacent segment degeneration, secondary surgical procedures, and symptomatic adjacent-level disease requiring surgery than ACDF. ACDF resulted in improved Short Form-36 Health Survey Physical Component Summary scores. However, the CDA and ACDF groups did not exhibit significant differences in overall changes in neck and arm pain scores or rates of adverse events.
Topics: Humans; Spinal Fusion; Randomized Controlled Trials as Topic; Intervertebral Disc Degeneration; Diskectomy; Cervical Vertebrae; Pain; Arthroplasty; Treatment Outcome
PubMed: 37735768
DOI: 10.1097/BSD.0000000000001537 -
Clinical Spine Surgery Nov 2023Systemic review.
STUDY DESIGN
Systemic review.
OBJECTIVE
To understand the role of cervical disk arthroplasty in the treatment of cervical myelopathy.
SUMMARY OF BACKGROUND DATA
The surgical management of degenerative cervical myelopathy (DCM) most frequently involves decompression and fusion, but stiffness introduced by the fusion and adjacent segment degeneration remain problems that can result in significant morbidity. Cervical disk arthroplasty (CDA) is a newer procedure that has been demonstrated to be safe and effective for the management of cervical spine degenerative disk disease, but it has not been traditionally considered as a treatment option for DCM and the use for this indication has not been extensively studied.
MATERIALS AND METHODS
A systematic review was undertaken using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines using a search strategy to query all relevant articles on the use of cervical disk arthroplasty in the setting of cervical myelopathy over a 20-year period (2004-2023). This review examines the literature to assess our current understanding of the appropriateness, safety, and value of CDA in the treatment of DCM.
RESULTS
A total of 844 patients received CDA across the 14 studies that met inclusion criteria, with an average of 60.3±40.4 patients per study (range: 11-152 subjects). Featured studies included 5 (35.7%) prospective studies, of which 2 were randomized. All studies had primary outcome measures of disability and/or pain scores, with the Japanese Orthopedic Association myelopathy score and neck disability index as the most commonly assessed. Four (26.7%) studies compared arthroplasty with arthrodesis. Safety of CDA for DCM was found in all studies with improvement in clinical outcome measurements.
CONCLUSION
Cervical disk arthroplasty appears to be a safe and effective surgical option in the management of degenerative cervical myelopathy. Further study is needed to assess if arthroplasty provides clinical improvement in DCM of comparable magnitude and durability as traditional fusion strategies.
Topics: Humans; Arthroplasty; Cervical Vertebrae; Intervertebral Disc Degeneration; Prospective Studies; Spinal Cord Diseases; Treatment Outcome
PubMed: 37684716
DOI: 10.1097/BSD.0000000000001528 -
Journal of Orthopaedic Surgery and... Sep 2023The aim of this study was to comprehensively evaluate the short-term clinical efficacy and safety of unilateral biportal endoscopic transforaminal lumbar interbody... (Meta-Analysis)
Meta-Analysis
Short-term clinical efficacy and safety of unilateral biportal endoscopic transforaminal lumbar interbody fusion versus minimally invasive transforaminal lumbar interbody fusion in the treatment of lumbar degenerative diseases: a systematic review and meta-analysis.
BACKGROUND
The aim of this study was to comprehensively evaluate the short-term clinical efficacy and safety of unilateral biportal endoscopic transforaminal lumbar interbody fusion (UBE-TLIF) versus minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF) for the treatment of lumbar degenerative diseases by meta-analysis.
METHODS
A computer-based search of PubMed, Embase, Web of Science, Cochrane Database, China National Knowledge Infrastructure (CNKI), Wanfang Database, and Chinese Science and Technology Journal Database (VIP) was conducted from the inception of the each database to April 2023. The searched literature was then screened according to strict inclusion and exclusion criteria. The critical data were extracted and analyzed using Review Manager software5.4.1. Pooled effects were calculated on the basis of data attributes by mean difference (MD) or odds ratio (OR) with 95% confidence interval (CI). The Newcastle-Ottawa Scale was used to assess the quality of the studies.
RESULTS
A total of 13 studies and 949 patients met the inclusion criteria for this meta-analysis, 445 in the UBE-LIF group and 504 in the MIS-TLIF group. UBE-TLIF was superior to MIS-TLIF in terms of intraoperative blood flow, postoperative drainage flow, duration of hospital stay, VAS score for low back pain and ODI score, but the operative time was longer than MIS-TLIF group. There were no significant differences between the two groups in terms of total complication rate, modified Macnab grading criteria, fusion rate, VAS score of leg pain, lumbar lordosis, intervertebral disk height.
CONCLUSION
Both UBE-TLIF and MIS-TLIF are effective surgical modalities for the treatment of degenerative lumbar spine diseases. They have similar treatment outcomes, but UBE-TLIF has the advantages of less intraoperative blood loss, shorter postoperative hospital stay, and faster recovery.
TRIAL REGISTRATION
This study has been registered at INPLASY.COM (No. INPLASY202320087).
Topics: Animals; Humans; Endoscopy; Lumbar Vertebrae; Minimally Invasive Surgical Procedures; Spinal Fusion; Treatment Outcome
PubMed: 37667363
DOI: 10.1186/s13018-023-04138-0 -
Antimicrobial Resistance and Infection... Aug 2023Vancomycin-resistant Staphylococcus aureus, identified as a "high priority antibiotic-resistant pathogen" by the World Health Organization, poses a significant threat to... (Meta-Analysis)
Meta-Analysis Review
INTRODUCTION
Vancomycin-resistant Staphylococcus aureus, identified as a "high priority antibiotic-resistant pathogen" by the World Health Organization, poses a significant threat to human health. This systematic review and meta-analysis aimed to estimate the pooled prevalence of vancomycin-resistant Staphylococcus aureus in Ethiopia.
METHODS
This systematic review and meta-analysis was reported in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Studies that reported VRSA prevalence due to infection or carriage from human clinical specimens were extensively searched in bibliographic databases and grey literatures using entry terms and combination key words. Electronic databases like PubMed, Google Scholar, Wiley Online Library, African Journal Online, Scopus, Science Direct, Embase, and ResearchGate were used to find relevant articles. In addition, the Joanna Briggs Institute quality appraisal tool was used to assess the quality of the included studies. Stata version 14 software was used for statistical analysis. Forest plots using the random-effect model were used to compute the overall pooled prevalence of VRSA and for the subgroup analysis. Heterogeneity was assessed using Cochrane chi-square (I) statistics. After publication bias was assessed using a funnel plot and Egger's test, trim & fill analysis was carried out. Furthermore, sensitivity analysis was done to assess the impact of a single study on pooled effect size.
RESULTS
Of the 735 studies identified, 31 studies that fulfilled the eligibility criteria were included for meta-analysis consisted of 14,966 study participants and 2,348 S. aureus isolates. The overall pooled prevalence of VRSA was 14.52% (95% CI: 11.59, 17.44). Significantly high level of heterogeneity was observed among studies (I = 93.0%, p < 0.001). The region-based subgroup analysis depicted highest pooled prevalence of 47.74% (95% CI: 17.79, 77.69) in Sidama region, followed by 14.82% (95% CI: 8.68, 19.88) in Amhara region, while Oromia region had the least pooled prevalence 8.07% (95% CI: 4.09, 12.06). The subgroup analysis based on AST methods depicted a significant variation in pooled prevalence of VRSA (6.3% (95% CI: 3.14, 9.43) for MIC-based methods, and 18.4% (95% CI: 14.03, 22.79) for disk diffusion AST method) which clearly showed that disk diffusion AST method overestimates the pooled VRSA prevalence. The total number of S. aureus isolates was found to be the responsible variable for the existence of heterogeneity among studies (p = 0.033).
CONCLUSION
This study showed an alarmingly high pooled prevalence of VRSA necessitating routine screening, appropriate antibiotic usage, and robust infection prevention measures to manage MRSA infections and control the emergence of drug resistance. Furthermore, mainly attributable to the overestimation of VRSA burden while using disk diffusion method, there is an urgent need to improve the methods to determine vancomycin resistance in Ethiopia and incorporate MIC-based VRSA detection methods in routine clinical laboratory tests, and efforts should be directed at improving it nationally.
TRIAL REGISTRATION
PROSPERO registration identification number: CRD42023422043.
Topics: Humans; Vancomycin-Resistant Staphylococcus aureus; Ethiopia; Methicillin-Resistant Staphylococcus aureus; Staphylococcus aureus; Prevalence; Anti-Bacterial Agents
PubMed: 37649060
DOI: 10.1186/s13756-023-01291-3 -
Spine Dec 2023Systematic review and meta-analysis. (Meta-Analysis)
Meta-Analysis
STUDY DESIGN
Systematic review and meta-analysis.
OBJECTIVE
Evaluate the role of systemic steroids in treating patients with sciatica due to lumbar disk herniation (LDH).
SUMMARY OF BACKGROUND DATA
The association between LDH and sciatica has been well described. The use of steroids seems logical in this context; however, their efficacy is not well described, and their use remains controversial.
METHODS
A comprehensive search on PubMed, EMBASE, and Scopus databases (up to February 15, 2022) was performed to identify randomized clinical trials that included patients with symptoms of sciatica due to LDH that were treated with systemic steroids. The risk of bias was judged using the Cochrane risk-of-Bias2 tool. Meta-analysis was conducted using a random-effects model to estimate the between-group effect size for pain and functional outcomes. The risk of developing adverse events (AE) was computed using relative risks. All pooled results are reported with their 95% confidence interval (CI) and certainty of evidence analyzed using the Grading of Recommendations Assessment, Development, and Evaluation framework.
RESULTS
Ten studies met inclusion criteria, comprising a total of 1017 participants: 540 in the treatment group and 477 in the control group. Steroid treatment was associated with a significant superior reduction of pain (SMD = -0.42, 95% CI -0.76 to -0.08, weak effect, very-low certainty) and reduction in disability (SMD = -0.30, 95% CI -0.51 to -0.10, weak effect, very-low certainty). Corticosteroid administration was associated with a significant increased risk of developing an AE (relative risks = 2.00, 95% CI 1.40 to 2.85, low certainty).
CONCLUSION
The use of systemic steroids in the treatment of sciatica due to LDH seems reasonable despite a 2-fold higher risk of developing mild AEs. However, the effect size is small for reducing pain in the short term and improving functional outcomes at long-term follow-up.
Topics: Humans; Sciatica; Intervertebral Disc Displacement; Steroids; Adrenal Cortex Hormones; Pain
PubMed: 37642478
DOI: 10.1097/BRS.0000000000004801 -
Neurosurgery Jan 2024Cervical/lumbar total disk replacements (TDRs) are often performed for degenerative conditions but rarely in athletes. Therefore, we sought to conduct a systematic...
BACKGROUND AND OBJECTIVES
Cervical/lumbar total disk replacements (TDRs) are often performed for degenerative conditions but rarely in athletes. Therefore, we sought to conduct a systematic review of athletes undergoing TDRs of both the scientific literature and lay press, with an emphasis on contact sport athletes.
METHODS
In accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines, PubMed/Embase/Cochrane/Scopus/Web of Science databases were queried for all primary literature reporting TDRs in athletes, including both cervical/lumbar disk replacements (CDRs/LDRs). Sports were dichotomized into contact vs limited/noncontact. Because of the public nature of injuries in elite athletes, the lay press was also queried.
RESULTS
A total of 488 scientific studies were screened, of which 10 met inclusion criteria. Cervical: seven studies reported CDRs in 53 athletes, of which 7 were professional, 22 semiprofessional, and 24 recreational. Of the seven professional athletes, there was one contact sport athlete (kickboxer). All 7/7 professional and 21/22 semiprofessional athletes successfully returned-to-play at 8-52 weeks without complication. Lumbar: Three studies discussed LDRs in 51 athletes, of which 17 were professional, 6 semiprofessional, and 28 recreational. Of the 17 professional athletes, eight played contact sports (2 boxing, 2 alpine skiing, 2 soccer, judo, rugby). All 17 professional and 6 semiprofessional athletes successfully returned to play at 9-21 weeks. Lay Press: five professional contact sport athletes underwent CDRs, and all returned to play: 3 hockey, 1 mixed-martial arts, and 1 Australian-rules football.
CONCLUSION
The scientific literature and lay press revealed 14 professional contact sport athletes who underwent TDR-6 CDRs and 8 LDRs-all with successful return to play. From the little data that exist, it seems that TDR may be safe in elite athletes; however, the small number of patients highlights the major paucity of data on the safety of TDR in elite contact sport athletes.
Topics: Humans; Return to Sport; Australia; Athletes; Soccer
PubMed: 37607091
DOI: 10.1227/neu.0000000000002637 -
Journal de Mycologie Medicale Nov 2023The therapeutic management of invasive aspergillosis should be guided by antifungal susceptibility testing (AFST). The disk diffusion (DD) method due to its simplicity... (Review)
Review
The therapeutic management of invasive aspergillosis should be guided by antifungal susceptibility testing (AFST). The disk diffusion (DD) method due to its simplicity and low cost could be an appropriate alternative to the reference methods (CLSI, EUCAST) which are not suitable for AFST in routine clinical microbiology laboratories, particularly in resource-constrained settings. This review summarizes the available data on the performance of the DD method in determining triazole susceptibility profile of Aspergillus species. The published articles on the performance of DD method for determining triazole susceptibility of Aspergillus spp. were systematically searched on major medical databases and Google Scholar. We identified 2725 articles of which 13 met the inclusion criteria. The overall average agreement value obtained between DD and CLSI broth microdilution (CLSI-BMD) methods for the itraconazole 10 µg disk (70.75%) was low especially when the medium used was not Mueller-Hinton (MH) agar. In contrast average agreement for the voriconazole 1 µg disk and the posaconazole 5 µg disk were > 94% regardless of media used. The correlation coefficient values between the DD and CLSI-BMD methods on MH agar were acceptable (≥ 0.71) for the itraconazole 10 µg disk and posaconazole 5 µg disk and good (≥ 0.80) for the voriconazole 1 and 10 µg disk. The reproducibility of the DD method regardless to the medium used was ≥ 82%. This systematic review shows that the disk diffusion method could be a real alternative for triazole antifungals susceptibility testing of Aspergillus spp.
Topics: Voriconazole; Itraconazole; Agar; Reproducibility of Results; Microbial Sensitivity Tests; Antifungal Agents; Triazoles; Aspergillus
PubMed: 37603962
DOI: 10.1016/j.mycmed.2023.101413 -
Neuro-Chirurgie Sep 2023Back pain is a very widespread disease pattern and is one of the most frequent causes for consultation of a physician in general. In most cases, discogenic changes are... (Review)
Review
OBJECTIVE
Back pain is a very widespread disease pattern and is one of the most frequent causes for consultation of a physician in general. In most cases, discogenic changes are the pathomorphological correlate of back pain. Numerous risk factors have been identified for these degenerative changes, but the influence and significance of the risk factors remain unclear, which was the aim of this systematic review.
METHODS
A systematic literature search of the commonly used Pubmed database was performed using specific MESH terms. Further selection of the included studies was performed according to the PRISMA scheme, taking into account scientific merit as well as the relation to the research question.
RESULTS
A total of 111 studies out of 1035 found were finally included in the literature search. 134 risk factors for disc degeneration and disc herniation were identified. These were divided into (1) patient-specific risk factors (n░=░34), (2) radiological risk factors (n░=░31), (3) lifestyle risk factors (n░=░6), (4) workplace-related risk factors (n░=░12), (5) genetic risk factors (n░=░50), and (6) other risk factors (n░=░1). Non-adjustable risk factors were age >50 years (OR 1.7/year), female gender (OR 1.41), family disposition (OR 4.0), comorbidities like atherosclerosis (OR 2.24), arthritic changes in other joints (OR 3.1) and history of injuries of the back (OR 3.1). Adjustable factors were elevated BMI (OR 2.77), comorbidities like hypertension (OR 1.25), dyslipidemia (OR 1.26) and diabetes mellitus (OR 6.8), as well as lifestyle habits like smoking (OR 3.8).
DISCUSSION
In summary, intervertebral disc degenerations and herniations represent multifactorial events whose risk factors can be partly influenced and partly not influenced. This systematic review highlights the current state of knowledge as a basis for creating patient-specific algorithms to calculate risk for the development or progression of degenerative disc changes and disc herniations.
Topics: Humans; Female; Middle Aged; Intervertebral Disc Degeneration; Low Back Pain; Intervertebral Disc Displacement; Risk Factors; Life Style; Lumbar Vertebrae
PubMed: 37586480
DOI: 10.1016/j.neuchi.2023.101482 -
Ophthalmic Research 2023Although internal limiting membrane (ILM) peeling facilitates macular hole (MH) closure and reduces late hole reopening, it brings some detrimental consequences to the... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Although internal limiting membrane (ILM) peeling facilitates macular hole (MH) closure and reduces late hole reopening, it brings some detrimental consequences to the retinal microstructure and functional outcomes. So far, previous studies have not reached a consensus on the optimal ILM peeling size.
OBJECTIVES
The objective of this study was to evaluate the outcomes of different ILM peeling sizes for idiopathic MHs.
METHODS
PubMed, Embase, Cochrane Library, Web of Science, CNKI, and WANFANG were searched until April 10, 2022. Studies in English or Chinese that compare the effects of two ILM peeling sizes (>2 disk diameters [DDs] vs. ≤2DD) for idiopathic MHs were included. The overall closure rate, postoperative best-corrected visual acuity (BCVA), type 1 closure, and adverse events were extracted. BCVA was converted to logarithm of the minimum angle of resolution (LogMAR).
RESULTS
Seven eligible studies (560 eyes) including 3 randomized clinical trials, 3 prospective trials, and one retrospective cohort were included. Pooled results showed a significantly better postoperative BCVA (mean difference = -0.16; 95% confidence interval [CI]: -0.27 to -0.04; LogMAR) and higher type 1 closure rate (risk ratio [RR] = 1.24; 95% CI: 1.08-1.43) in eyes with ILM peeling >2DD than those with peeling ≤2DD. No significant difference was found in overall closure rate and adverse events between the two groups. Subgroup analysis indicated that in MHs >400 μm, peeling >2DD helped obtain a better postoperative BCVA (mean difference = -0.17; 95% CI: -0.29 to -0.04; LogMAR) and higher frequency of type 1 closure (RR = 1.25; 95% CI: 1.03-1.51).
CONCLUSIONS
Peeling >2DD shares similar safety level with peeling ≤2DD and has a superiority of facilitating visual recovery. Larger ILM peeling may be more beneficial for large MHs.
Topics: Humans; Retinal Perforations; Retrospective Studies; Prospective Studies; Vitrectomy; Treatment Outcome; Visual Acuity; Basement Membrane; Epiretinal Membrane; Tomography, Optical Coherence
PubMed: 37586342
DOI: 10.1159/000531510 -
Neuroprotective Strategies for Nonarteritic Anterior Ischemic Optic Neuropathy: A Systematic Review.Korean Journal of Ophthalmology : KJO Aug 2023Nonarteritic anterior ischemic optic neuropathy (NAION) is the second most common form of optic neuropathy. Most patients show no improvement over time. Until now, there...
PURPOSE
Nonarteritic anterior ischemic optic neuropathy (NAION) is the second most common form of optic neuropathy. Most patients show no improvement over time. Until now, there is still no definitive therapy for NAION. The available literatures on the possible treatment of NAION are quite diverse and controversial. Neuroprotection strategies have been suggested as one of the potential treatments for NAION. This review aims to critically evaluate the literature on neuroprotective strategy for NAION.
METHODS
This report was written in accordance with PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analysis) guidelines. We performed a systematic literature search in Pubmed, Science Direct, Proquest, and Cochrane databases. Only neuroprotective agents that directly work in protecting neurons were included. The outcome of interest in this review is retinal ganglion cell density and apoptosis for animal studies and retinal nerve fiber layer thickness for human studies.
RESULTS
The systematic search identified 591 studies of which 24 met the eligibility criteria, including 21 animal studies and three human studies. Only a few of the studies evaluated the same treatments, showing how diverse neuroprotector treatments are currently being evaluated as NAION treatment. From 21 animal studies, 14 studies showed significantly higher retinal ganglion cell density (1.49- to 2.81-fold) with neuroprotective treatment compared to control group. Two of three human studies in this review had also found a beneficial effect of preserving retinal nerve fiber layer thickness in NAION patients.
CONCLUSIONS
This review suggests the potential of neuroprotection as a viable option in the quest for an effective treatment strategy for NAION. Further studies, particularly clinical studies, are necessary to establish its efficacy in NAION patients.
Topics: Animals; Humans; Optic Neuropathy, Ischemic; Optic Disk; Neuroprotection; Visual Acuity; Tomography, Optical Coherence
PubMed: 37563973
DOI: 10.3341/kjo.2022.0166