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Clinical Spine Surgery Jul 2024A meta-analysis. (Meta-Analysis)
Meta-Analysis
STUDY DESIGN
A meta-analysis.
OBJECTIVE
This study aimed to analyze the incidence of spontaneous resorption of lumbar disk herniation (LDH) after conservative treatment.
SUMMARY OF BACKGROUND DATA
The resorption of intervertebral disks has been more frequently reported, but there is a lack of reference to the probability of resorption.
METHODS
We strictly refer to the standard established in the PRISMA (Preferred Reporting Items for a Systematic Review and Meta-analysis) statement, comprehensively searched electronic databases using the terms related to the spontaneous resorption of LDH. Two reviewers independently evaluated the potential studies, extracted, and analyzed the enrolled data.
RESULTS
Thirty-one studies with 2233 patients who received conservative treatment were included for this analysis. We found that the pooled overall incidence of disk resorption was 70.39%, 87.77% for disk sequestration, 66.91% for disk extrusion, 37.53% for disk protrusion, and 13.33% for disk bugle, respectively. The resorption incidence in of 25%≤ reduction of disk herniation (RDH) 50%, RDH≥50%, and RDH=100% were 40.19%, 43.62, and 36.89%. The resorption incidence was 66.98% in Japan, 61.66% in the United States, 83.52% in Korea, 60.68% in China, 78.30% in the UK, 56.70% in Italy, and 83.68% in Turkey, respectively. Subgroup analysis showed that there was no significant difference in resorption incidence among prospective, retrospective studies and randomized controlled trials ( P =0.77), and there was no significant difference in evaluation method among qualitative and quantitative studies ( P =0.05).
CONCLUSIONS
The existing evidence shows that the overall resorption incidence of LDH was 70.39%, the resorption incidence of ruptured LDH is higher than that of contained LDH. There are significant differences in the resorption incidence among countries. The resorption process mainly occurred within 6 months of conservative treatment.
Topics: Humans; Intervertebral Disc Displacement; Incidence; Lumbar Vertebrae
PubMed: 37559207
DOI: 10.1097/BSD.0000000000001490 -
Clinical Spine Surgery Dec 2023Systematic Review. (Meta-Analysis)
Meta-Analysis
STUDY DESIGNS
Systematic Review.
OBJECTIVE
To examine the impact of anesthesia type on patient-reported outcomes (PROs) and complications after percutaneous endoscopic lumbar discectomy (PELD).
SUMMARY OF BACKGROUND DATA
A significant advantage of PELD involves the option to use alternative sedation to general anesthesia (GA). Two options include local anesthesia (LA) and epidural anesthesia (EA). While EA is more involved, it may yield improved pain control and surgical results compared with LA. However, few studies have directly examined outcomes for PELD after LA versus EA, and it remains unknown which technique results in superior outcomes.
MATERIALS AND METHODS
A systematic review and meta-analysis of the PubMed, EMBASE, and SCOPUS databases examining PELD performed with LA or EA from inception to August 16, 2021 were conducted. All studies reported greater than 6 months of follow-up in addition to PRO data. PROs, including visual analog scale (VAS)-leg/back, and Oswestry Disability Index (ODI) scores were collected. Complications, recurrent disk herniation, durotomy, and reoperation rates, as well as surgical data, were recorded. All outcomes were compared between pooled studies examining LA or EA.
RESULTS
Fifty-six studies consisting of 4465 patients (366 EA, 4099 LA) were included. Overall complication rate, durotomy rate, length of stay, recurrent disk herniation, and reoperation rates were similar between groups. VAS back/leg and ODI scores were all significantly improved at the first and last follow-up appointments in the LA group. VAS leg and ODI scores were significantly improved at the first and last follow-up appointments in the EA group, but VAS back was not.
CONCLUSIONS
EA can be a safe and feasible alternative to LA, potentially minimizing patient discomfort during PELD. Conclusions are limited by a high level of study bias and heterogeneity. Further investigation is necessary to determine if PELD under EA may have greater short-term PRO benefits compared with LA.
Topics: Humans; Diskectomy, Percutaneous; Intervertebral Disc Displacement; Anesthesia, Local; Lumbar Vertebrae; Endoscopy; Diskectomy; Retrospective Studies; Treatment Outcome
PubMed: 37348062
DOI: 10.1097/BSD.0000000000001476 -
Archives of Gerontology and Geriatrics Nov 2023The purpose of this study was to systematically assess existing studies to demonstrate the association between potentially inappropriate medication (PIM) and frailty. (Meta-Analysis)
Meta-Analysis Review
OBJECTIVES
The purpose of this study was to systematically assess existing studies to demonstrate the association between potentially inappropriate medication (PIM) and frailty.
DESIGN
Systematic review and meta-analysis.
METHODS
We searched major electronic databases (PubMed, Web of Science, the Cochrane Library, Embase, CINHAL, PsycInfo, China National Knowledge Infrastructure, China Biology Medicine disk, Weipu, and Wanfang) from their inception until February 25, 2023 (data updated on May 4, 2023), for observational studies investigating PIM and frailty. I was used to measure the heterogeneity between studies quantitatively. A random effect model calculated pooled effect size owing to high heterogeneity. Subgroup analysis was conducted to explore sources of heterogeneity. Additionally, the studies' quality was evaluated using the Newcastle Ottawa Scale (a modified Newcastle Ottawa Scale was used to evaluate cross-sectional studies).
RESULTS
Twenty-four studies were included for systematic review, 14 of which were included in the meta-analysis. After pooling the effect size, the odds ratio with PIM as the dependent variable was 1.12 (95%CI: 1.01-1.25), and that with frailty as the dependent variable was 1.75 (95%CI: 1.25-2.43), indicating a bidirectional association between PIM and frailty.
CONCLUSIONS
PIM and frailty interact with each other and have a bidirectional association, thus providing additional information for early clinical identification and prevention of frailty, and medication safety management.
Topics: Humans; Aged; Frailty; Potentially Inappropriate Medication List; Cross-Sectional Studies; China
PubMed: 37311369
DOI: 10.1016/j.archger.2023.105087 -
The Ultrasound Journal May 2023Elevated intracranial pressure (eICP) is a serious medical emergency that requires prompt identification and monitoring. The current gold standards of eICP detection... (Review)
Review
BACKGROUND
Elevated intracranial pressure (eICP) is a serious medical emergency that requires prompt identification and monitoring. The current gold standards of eICP detection require patient transportation, radiation, and can be invasive. Ocular ultrasound has emerged as a rapid, non-invasive, bedside tool to measure correlates of eICP. This systematic review seeks to explore the utility of ultrasound detected optic disc elevation (ODE) as an ultrasonographic finding of eICP and to study its sensitivity and specificity as a marker of eICP.
METHODS
This systematic review followed the preferred reporting items for systematic reviews and meta-analyses guidelines. We systematically searched PubMed, EMBASE, and Cochrane Central for English articles published before April 2023; yielding 1,919 total citations. After eliminating duplicates, and screening the records, we identified 29 articles that addressed ultrasonographically detected ODE.
RESULTS
The 29 articles included a total of 1249 adult and pediatric participants. In patients with papilledema, the mean ODE ranged between 0.6 mm and 1.2 mm. Proposed cutoff values for ODE ranged between 0.3 mm and 1 mm. The majority of studies reported a sensitivity between 70 and 90%, and specificity ranged from 69 to 100%, with a majority of studies reporting a specificity of 100%.
CONCLUSIONS
ODE and ultrasonographic characteristics of the optic disc may aid in differentiating papilledema from other conditions. Further research on ODE elevation and its correlation with other ultrasonographic signs is warranted as a means to increase the diagnostic accuracy of ultrasound in the setting of eICP.
PubMed: 37227512
DOI: 10.1186/s13089-023-00324-7 -
Journal of the American Academy of... May 2023Primary spinal infections (PSIs) are a group of infectious diseases characterized by inflammation of the end plate-disk unit or its surroundings. PSI is considered more...
PURPOSE
Primary spinal infections (PSIs) are a group of infectious diseases characterized by inflammation of the end plate-disk unit or its surroundings. PSI is considered more prevalent and aggressive among patients with chronic immunocompromised states. Association of PSIs, immunocompromising cancers, and hemoglobinopathies has not been systematically analyzed. We conducted a systematic review to study characteristics, clinical presentation, and mortality of patients with PSI in the setting of hematologic disease.
METHODS
A systematic literature search in PubMed, Web of Science, and Scopus was conducted in April 2022 in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. We included retrospective case series and individual case reports.
RESULTS
On careful review, 28 articles published between 1970 and 2022 were selected. These studies featured 29 patients who met inclusion criteria (mean age 29 years, age range 1.5 to 67 years; 63.3% male). Lumbar infection was the most common location (65.5%), with Salmonella (24.1%) as the main causative microorganism. Neurologic compromise was present in 41% of patients, and surgical intervention occurred in 48.3%. Average antibiotic duration was 13 weeks. The postoperative complication rate was 21.4%, with a mortality of 6.9%.
CONCLUSION
PSI in patients with hematologic disease, while having shorter periods to diagnosis, presents increased rates of neurologic deficit, surgical intervention, and complications.
Topics: Humans; Male; Infant; Child, Preschool; Child; Adolescent; Young Adult; Adult; Middle Aged; Aged; Female; Retrospective Studies; Aggression; Anti-Bacterial Agents; Bone Plates; Hemoglobinopathies
PubMed: 37159278
DOI: 10.5435/JAAOSGlobal-D-22-00178 -
Acta Ophthalmologica Feb 2024Optic disc drusen (ODD) are calcium-containing deposits in the optic nerve head, capable of causing visual field defects and sudden visual loss. The underlying... (Meta-Analysis)
Meta-Analysis Review
Optic disc drusen (ODD) are calcium-containing deposits in the optic nerve head, capable of causing visual field defects and sudden visual loss. The underlying pathophysiology remains inadequately understood and treatment options are missing. In this paper, we systematically reviewed prevalence studies of ODD in non-selected populations to provide an overview of its prevalence, conducted meta-analyses to determine modality-specific prevalence estimates and performed a forecasting study to estimate current and future global population number of individuals with ODD. We searched 11 literature databases on 25 October 2022 for prevalence studies of ODD in non-selected populations. Eight eligible studies provided data from a total of 27 463 individuals. Prevalence estimates were stratified according to diagnostic modalities: ophthalmoscopy 0.37% (95% CI: 0.10-0.95%), fundus photography 0.12% (95% CI: 0.03-0.24%), spectral domain optical coherence tomography with enhanced depth imaging 2.21% (95% CI: 1.25-3.42%) and histopathology 1.82% (95% CI: 1.32-2.38%). Using histopathology-based summary prevalence estimate, we forecast 145 million individuals with ODD currently, a number expected to increase further due to world population growth. These numbers underscore the importance of including ODD in health education and highlight the necessity of continuing research in ODD.
Topics: Humans; Optic Disk; Optic Disk Drusen; Prevalence; Tomography, Optical Coherence
PubMed: 37144704
DOI: 10.1111/aos.15690 -
The Clinical Journal of Pain Jul 2023Determine the relative effectiveness and safety profiles of percutaneous and minimally invasive interventions for chronic low back pain. (Meta-Analysis)
Meta-Analysis
OBJECTIVE
Determine the relative effectiveness and safety profiles of percutaneous and minimally invasive interventions for chronic low back pain.
METHODS
A systematic search was performed for randomized controlled trials published in the past 20 years reporting on radiofrequency ablation of the basivertebral, disk annulus and facet nerve structures, steroid injection of the disk, facet joint, and medial branch, biological therapies, and multifidus muscle stimulation. Outcomes evaluated included Visual Analog Scale (VAS) pain scores, Oswestry Disability Index (ODI) scores, quality of life (SF-36 and EQ-5D) scores, and serious adverse event (SAE) rates. Basivertebral nerve (BVN) ablation was chosen as the subject of comparison to all other therapies using a random-effects meta-analysis.
RESULTS
Twenty-seven studies were included. BVN ablation was found to provide statistically significant improvements in VAS and ODI scores for 6-, 12- and 24-month follow-up ( P ≤0.05). Biological therapy and multifidus muscle stimulation were the only 2 treatments with both VAS and ODI outcomes not significantly different from BVN ablation at 6-, 12-, and 24-month follow-up. All outcomes found to be statistically significant represented inferior results to those of BVN ablation. Insufficient data precluded meaningful comparisons of SF-36 and EQ-5D scores. The SAE rates for all therapies and all reported time points were not significantly different from BVN ablation except for biological therapy and multifidus muscle stimulation at the 6-month follow-up.
CONCLUSIONS
BVN ablation, biological therapy, and multifidus stimulation all provide significant, durable improvements in both pain and disability compared with other interventions, which provided only short-term pain relief. Studies on BVN ablation reported no SAEs, a significantly better result than for studies of biological therapy and multifidus stimulation.
Topics: Humans; Low Back Pain; Pain Management; Quality of Life; Treatment Outcome; Pain Measurement; Chronic Pain
PubMed: 37104694
DOI: 10.1097/AJP.0000000000001116 -
Spine Jul 2023Systematic review and meta-analysis. (Meta-Analysis)
Meta-Analysis
STUDY DESIGN
Systematic review and meta-analysis.
OBJECTIVE
This study aimed to assess the incidence of heterotopic ossification (HO) 10 years after cervical disk replacement (CDR).
SUMMARY OF BACKGROUND DATA
HO is a common complication after CDR and may limit the range of motion of the artificial disk. As HO usually progresses slowly, a long-term follow-up is required to better understand its incidence. In recent years, the increasing number of original articles reporting 10-year outcomes gives us the opportunity to better understand the long-term incidence of HO.
MATERIALS AND METHODS
We searched PubMed, Medline, Embase, and Cochrane Library databases to identify eligible studies. The incidence of HO was pooled, and subgroup analysis was performed. Meta-regression analyses were conducted to identify factors contributing to heterogeneity.
RESULTS
Eleven studies with at least 10 years of follow-up comprising 1140 patients who underwent CDR were included. The pooled incidence of overall HO was 70% (95% CI, 60%-81%) at 10 years postoperatively, 60% (95% CI, 44%-75%) at five or six years postoperatively, and 50% (95% CI, 27%-72%) at one or two years postoperatively. The pooled incidence of severe HO (grade 3 or 4) was 37% (95% CI, 29%-45%), and mild HO (grade 1 to 2) was 30% (95% CI, 17%-44%) at 10 years of follow-up. Pooled range of motion decreased from 8.59° before surgery to 7.40° 10 years after surgery. Subgroup analysis showed that HO incidence differed according to the prosthesis type. The earlier publication was associated with a higher pooled incidence of severe HO in the meta-regression analysis.
CONCLUSIONS
This is the first meta-analysis providing detailed information on the pooled 10-year incidence of HO after CDR. The incidence of HO seems to increase with the length of follow-up.
LEVEL OF EVIDENCE
3.
Topics: Humans; Cervical Vertebrae; Incidence; Neck; Ossification, Heterotopic; Range of Motion, Articular; Retrospective Studies; Total Disc Replacement; Treatment Outcome
PubMed: 37036304
DOI: 10.1097/BRS.0000000000004674 -
Photodiagnosis and Photodynamic Therapy Jun 2023Exfoliative material has been shown to accumulate in ocular and systemic tissues. We aimed to perform a systematic review and meta-analysis of the current literature... (Meta-Analysis)
Meta-Analysis Review
PURPOSE
Exfoliative material has been shown to accumulate in ocular and systemic tissues. We aimed to perform a systematic review and meta-analysis of the current literature evaluating optic nerve head vessel density (VD) using optical coherence tomography angiography (OCTA) in patients with XFS and XFG.
METHODS
Studies were retrieved from PubMed, Scopus, and Web of Science databases. Studies comparing patients with XFS and/or XFG patients to healthy controls, using the optic nerve head-centred 4.5 × 4.5 mm square OCTA scan protocol were included. Pooled results are presented as standardised mean differences with 95% confidence intervals (CI). Meta-regression analysis was performed between mean difference in circumpapillary VD between XFG and controls and mean pRNFL thickness in patients with XFG.
RESULTS
Fifteen studies with 1475 eyes were included in this review. Whole image VD and circumpapillary VD (cpVD) were significantly decreased in patients with XFS [-0.78(95% Cl: -1.08, -0.47); -0.55(95% Cl: -0.80, -0.30); respectively] and XFG [-1.85(95% CI: -2.33, -1.36); -1.84 (95% CI: -2.30, -1.39); respectively] compared to healthy controls. Furthermore, pRNFL thickness decreased in patients with XFS [-0.55(95% Cl: -0.72, -0.35)] and XFG [-1.78(95% Cl: -2.21, -1.36)] compared to healthy controls. Meta-regression showed that pRNFL thickness decreased with increasing mean cpVD difference in XFG patients compared to healthy controls.
CONCLUSIONS
OCTA provides non-invasive, objective and reproducible assessment of peripapillary VD and is important for the detection of vasculopathy in patients with XFS or XFG. This study provides strong evidence for decreased cpVD in the eyes of patients with XFS and XFG.
Topics: Humans; Exfoliation Syndrome; Optic Disk; Photochemotherapy; Photosensitizing Agents; Glaucoma; Tomography, Optical Coherence
PubMed: 36933675
DOI: 10.1016/j.pdpdt.2023.103514 -
The Nigerian Postgraduate Medical... 2023Carbapenem antibiotics are considered one of the most effective and the last-resort antibiotics for the treatment of infections caused by multidrug-resistant... (Review)
Review
Carbapenem antibiotics are considered one of the most effective and the last-resort antibiotics for the treatment of infections caused by multidrug-resistant Gram-negative bacteria. However, with the advent of carbapenem resistance, it becomes obvious that quality health-care delivery will be hampered if adequate measure is not put in place. This review assessed the prevalence of carbapenem-resistant Gram-negative bacteria (CR-GNB) and also provided an up-to-date position on carbapenem resistance (CR) in Nigeria. Three electronic databases (Google Scholar, PubMed and African Journal online) were searched for relevant literatures, and 38 articles published between January 2013 and June 2022 that met the criteria for inclusion were recruited into the study. The mean prevalence of CR in Nigeria stands at 21.3%, with the southern and northern regions documenting a mean prevalence of 22.0% and 20.9%, respectively. Most of the reviewed articles were from clinical settings (81.6%), with urine samples (38.7%) constituting the most prevalent clinical sample in which CR-GNB were detected. The preponderance of phenotypic methods (55.3%) over molecular method (44.7%), particularly the use of disk diffusion test breakpoint and Modified Hodge test was documented. The most prevalent carbapenem-resistant bacteria were Escherichia coli (50.0%) and Klebsiella pneumoniae (26.3%). The blaNDM and blaVIM were the major reported carbapenemase-encoded genes, particularly among E. coli, K. pneumoniae and Pseudomonas species. This systematic review revealed a mean prevalence of CR-GNB in Nigeria that required urgent attention. Furthermore, the detection of clinically and epidemiologically important carbapenemase coding genes is of public health importance.
Topics: Humans; Anti-Bacterial Agents; Bacterial Proteins; Carbapenems; Escherichia coli; Gram-Negative Bacteria; Klebsiella pneumoniae; Microbial Sensitivity Tests; Nigeria; Public Health; Drug Resistance, Bacterial
PubMed: 36814157
DOI: 10.4103/npmj.npmj_240_22