-
Journal of Orthopaedic Surgery and... Nov 2022Anterior cervical diskectomy and fusion (ACDF) has been widely accepted as a gold standard for patients with cervical spondylotic myelopathy (CSM). However, there was... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Anterior cervical diskectomy and fusion (ACDF) has been widely accepted as a gold standard for patients with cervical spondylotic myelopathy (CSM). However, there was insufficient evidence to compare the changes in the cervical alignment with different fusion devices in a long follow-up period. This meta-analysis was performed to compare the radiologic outcomes and loss of correction (LOC) in cervical alignment of Zero-profile (ZP) device versus cage-plate (CP) construct for the treatment of CSM.
METHODS
Retrospective and prospective studies directly comparing the outcomes between the ZP device and CP construct in ACDF were included. Data extraction was conducted and study quality was assessed independently. A meta-analysis was carried out by using fixed effects and random effects models to calculate the odds ratio and mean difference in the ZP group and the CP group.
RESULTS
Fourteen trials with a total of 1067 participants were identified. ZP group had a lower rate of postoperative dysphagia at the 2- or 3-month and 6-month follow-up than CP group, and ZP group was associated with a decreased ASD rate at the last follow-up when compared with the CP group. The pooled data of radiologic outcomes revealed that there was no significant difference in postoperative and last follow-up IDH. However, postoperative and last follow-up cervical Cobb angle was significantly smaller in the ZP group when compared with the CP group. In subgroup analyses, when the length of the last follow-up was less than 3 years, there was no difference between two groups. However, as the last follow-up time increased, cervical Cobb angle was significantly lower in the ZP group when compared with the CP group.
CONCLUSION
Based on the results of our analysis, the application of ZP device in ACDF had a lower rate of postoperative dysphagia and ASD than CP construct. Both devices were safe in anterior cervical surgeries, and they had similar efficacy in correcting radiologic outcomes. However, as the last follow-up time increased, ZP group showed greater changes cervical alignment. In order to clarify the specific significance of LOC, additional large clinical studies with longer follow-up period are required.
Topics: Humans; Deglutition Disorders; Retrospective Studies; Prospective Studies; Spinal Fusion; Diskectomy; Spinal Cord Diseases
PubMed: 36434715
DOI: 10.1186/s13018-022-03400-1 -
Journal of Orthopaedic Surgery and... Nov 2022The clinical outcomes of single-level anterior cervical discectomy and fusion (ACDF) with the Zero-profile (Zero-p) were evaluated in comparison with the anterior... (Meta-Analysis)
Meta-Analysis
Zero-profile implant versus conventional cage-plate construct in anterior cervical discectomy and fusion for the treatment of single-level degenerative cervical spondylosis: a systematic review and meta-analysis.
BACKGROUND
The clinical outcomes of single-level anterior cervical discectomy and fusion (ACDF) with the Zero-profile (Zero-p) were evaluated in comparison with the anterior cervical cage-plate construct (CPC).
METHODS
We performed a systematic search covering PubMed, Embase, Cochrane Central Register of Controlled Trials, Web of Science, Medline, China National Knowledge Infrastructure (NCKI), Wan Fang Database, and Wei Pu Database. Articles focused on single-level ACDF or data of the single - level that can be extracted were included, and articles that did not directly compare Zero-p and CPC were excluded. Twenty-seven studies were included with a total of 1866 patients, 931 in the Zero-p group and 935 in the CPC group. All outcomes were analyzed using Review Manager 5.4.
RESULTS
The meta-analysis outcomes indicated that operative time (WMD = - 12.47, 95% CI (- 16.89, - 8.05), P < 0.00001), intraoperative blood loss (WMD = - 13.30, 95% CI (- 18.83, - 7.78), P < 0.00001), risk of adjacent segment degeneration (ASD) (OR 0.31, 95% CI (0.20, 0.48), P < 0.0001), risk of dysphagia of short-term (OR 0.40, 95% CI (0.30, 0.54), P < 0.0001), medium-term (OR 0.31, 95% CI (0.20, 0.49), P < 0.0001), and long-term (OR 0.29, 95% CI (0.17, 0.51), P < 0.0001) of Zero-p group were significantly lower. The JOA score of Zero-p group at the final follow-up was significantly higher (WMD = - 0.17, 95% CI (- 0.32, - 0.03), P = 0.02). There were no significant differences in length of stay (LOS), Neck Disability Index (NDI), Visual Analogue Score (VAS), fusion rate, segmental Cobb angle, cervical Cobb angle, prevertebral soft tissue thickness (PSTT), SF-36, subsidence, implant failure, and hoarseness between the two groups. This study was registered with PROSPERO, CRD42022347146.
CONCLUSION
Zero-p group reduced operative time, intraoperative blood loss, JOA score at follow-up and reduced the incidence of dysphagia and postoperative ASD, but the two devices had the same efficacy in restoring the cervical curvature, preventing the cage subsidence, and in postoperative VAS, NDI, LOS, PSTT, SF-36, fusion rate, implant failure, and hoarseness in single-level ACDF. The use of Zero-p in single-level ACDF was recommended.
Topics: Humans; Deglutition Disorders; Blood Loss, Surgical; Hoarseness; Cervical Vertebrae; Spinal Fusion; Diskectomy; Spondylosis
PubMed: 36434694
DOI: 10.1186/s13018-022-03387-9 -
Computational and Mathematical Methods... 2022In minimally invasive spinal surgery, the treatment of lumbar spinal stenosis with microendoscopic discectomy (MED) or unilateral biportal endoscopic discectomy (UBED)... (Meta-Analysis)
Meta-Analysis
OBJECTIVE
In minimally invasive spinal surgery, the treatment of lumbar spinal stenosis with microendoscopic discectomy (MED) or unilateral biportal endoscopic discectomy (UBED) shows effective results, but which is more effective is controversial. Our study aimed to evaluate the efficacy and safety of UBED versus MED in the treatment of lumbar spinal stenosis by a systematic review and meta-analysis, so as to provide reference for the promotion of UBED in clinical practice.
METHODS
The multiple databases like PubMed, EMBASE, Web of Science, Cochrane Library, Chinese National Knowledge Databases, Chinese BioMedical Database, and Wanfang Database were used to search for the relevant studies. Review Manager 5.4 was adopted to estimate the effects of the results among selected articles. Odds ratio (OR) and mean difference (MD) with 95% confidence intervals (CIs) were used to estimate the overall pooled effect. Subgroup analysis, forest plots, funnel plots and Egger's test for the articles included were also conducted.
RESULTS
Three randomized clinical trials and seven cohort studies were finally retrieved, these studies included 685 and 829 patients in the UBED and MED groups, respectively. There were no differences in terms of operation time (MD = -0.92, P =0.72), estimated blood loss (MD = -26.31, P =0.08), complications (MD =0.81, P =0.38) and Oswestry Disability Index (ODI) score (P >0.05 in four subgroup) between the two groups. The visual analog scale (VAS) score of back pain in the UBED group was better than MED group only at 6 months (MD = -0.23, P =0.006) after operation, the VAS score of leg pain in the UBED group was better than that of MED group at 3 mouths (MD = -0.22, P =0.002) and 6 months (MD = -0.24, P =0.006) after operation, the UBED group had a less postoperative length of stay than the MED group (MD = -1.85, P <0.001). The bias analysis showed that there was no potential publication bias in the included literature.
CONCLUSION
This study showed that compared with MED, UBED has the advantages of short hospital stay and good short-term curative effect, but there is no significant difference in long-term efficacy and safety, they can be replaced by each other in clinical application.
Topics: Diskectomy; Endoscopy; Humans; Intervertebral Disc Displacement; Lumbar Vertebrae; Spinal Stenosis
PubMed: 36188105
DOI: 10.1155/2022/7667463 -
Medicine Sep 2022The purpose of this study was to analyze unilateral biportal endoscopic discectomy (UBE) and percutaneous endoscopic lumbar discectomy (PELD) for the treatment of lumbar... (Meta-Analysis)
Meta-Analysis
Comparison of unilateral biportal endoscopic discectomy versus percutaneous endoscopic lumbar discectomy for the treatment of lumbar disc herniation: A systematic review and meta-analysis.
BACKGROUND
The purpose of this study was to analyze unilateral biportal endoscopic discectomy (UBE) and percutaneous endoscopic lumbar discectomy (PELD) for the treatment of lumbar disc herniation.
METHODS
PubMed, EMBASE, Web of Science, Cochrane Database, CNKI, and Wanfang databases were searched online. All statistical analyses were performed using STATA 16.0.
RESULTS
The selection criteria were met by 6 studies with a total of 281 patients (142 cases in the UBE group and 139 cases in the PELD group) and good methodological quality. PELD has the potential to improve outcomes such as operation time and intraoperative hemorrhage (MD = 36.808, 95% CI (23.766, 49.850), P = .000; MD = 59.269, 95% CI (21.527, 97.010), P = .000) compared with UBE. No differences were found in the back pain VAS score at preoperative (MD = -0.024, 95% CI [-0.572, 0.092], P = .998), at 1 day after operation (MD = -0.300, 95% CI [-0.845, 0.246], P = .878), the VAS score of leg pain at preoperative (MD = -0.099, 95% CI [-0.417, 0.220], P = .762), at 1 day after operation (MD = 0.843, 95% CI [0.193, 1.492], P = .420), at 1 month after operation (MD = -0.027, 95% CI [-0.433, 0.380], P = .386), at 6 months after operation (MD = 0.122, 95% CI [-0.035, 0.278], P = .946), hospital stay (MD = 3.708, 95% CI [3.202, 4.214], P = .000) and other clinical effects between UBE and PELD group.
CONCLUSIONS
There are no significant differences in clinical efficacy between UBE and PELD, according to the research. However, PELD has the potential to improve outcomes such as operation time and intraoperative hemorrhage. As just a result, PELD is better suited in the treatment of lumbar disc herniation.
Topics: Diskectomy; Diskectomy, Percutaneous; Endoscopy; Hemorrhage; Humans; Intervertebral Disc Displacement; Lumbar Vertebrae; Retrospective Studies; Treatment Outcome
PubMed: 36181014
DOI: 10.1097/MD.0000000000030612 -
Computational Intelligence and... 2022Surgery can reduce and improve lumbar disc herniation, but some patients still have pain after surgery, and the relationship between lumbar disc height and pain after... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Surgery can reduce and improve lumbar disc herniation, but some patients still have pain after surgery, and the relationship between lumbar disc height and pain after surgery is still unclear.
OBJECTIVE
The main objective is to investigate the relationship between lumbar disc height and postoperative pain.
METHODS
We searched Pubmed, Web of Science, the Cochrane library, and Embase online for cohort studies or RCT studies on discectomy and assessed the quality of the included articles using the Newcastle-Ottawa Scale (NOS scale), with disc height (DH) and postoperative back pain as the main clinical outcome indicators, and the correlation coefficient between DH and back pain as the statistic to assess the pooled effect size.
RESULTS
10 kinds of literature were included in this study for quantitative analysis. A total of 589 patients participated in the study. The follow-up time was between 1 and 2.3 years. Meta-analysis showed that after surgery, the relief of back pain was statistically significant ( = -2.57, 95% CI (-3.10,-2.04), = -9.570, < 0.0001), the reduction of disc height was statistically significant ( = -0.82, 95% CI (-1.11, -0.52), = -5.477, < 0.0001), the combined value of correlation coefficient Fisher's value was 0.33, 95% CI (0.25,0.42), with statistical significance ( < 0.00001), suggesting that the degree of back pain after surgery showed a moderate positive correlation with disc height in the short term. . After discectomy, the degree of pain is relieved, the disc height is reduced, and low back pain in the short term and disc height showed a moderate positive correlation, but the long-term correlation remains to be studied in depth.
Topics: Back Pain; Diskectomy; Humans; Intervertebral Disc Displacement; Low Back Pain; Lumbar Vertebrae
PubMed: 36035825
DOI: 10.1155/2022/2580004 -
Yonsei Medical Journal Sep 2022With an increasing number of anterior cervical discectomy and fusion (ACDF) being conducted for degenerative cervical disc disease, there is a rising interest in the... (Meta-Analysis)
Meta-Analysis
PURPOSE
With an increasing number of anterior cervical discectomy and fusion (ACDF) being conducted for degenerative cervical disc disease, there is a rising interest in the related quality of management and healthcare costs. Unplanned readmission after ACDF affects both the quality of management and medical expenses. This meta-analysis was performed to evaluate the risk factors of unplanned readmission after ACDF to improve the quality of management and prevent increase in healthcare costs.
MATERIALS AND METHODS
We searched the databases of PubMed, EMBASE, Web of Science, and Cochrane Library to identify eligible studies using the searching terms, "readmission" and "ACDF." A total of 10 studies were included.
RESULTS
Among the demographic risk factors, older age [weighted mean difference (WMD), 3.93; 95% confidence interval (CI), 2.30-5.56; <0.001], male [odds ratio (OR), 1.23; 95% CI, 1.10-1.36; <0.001], and private insurance (OR, 0.34; 95% CI, 0.17-0.69; <0.001) were significantly associated with unplanned readmission. Among patient characteristics, hypertension (HTN) (OR, 2.14; 95% CI, 1.41-3.25; <0.001), diabetes mellitus (DM) (OR, 1.59; 95% CI, 1.20-2.11; =0.001), coronary artery disease (CAD) (OR, 2.87; 95% CI, 2.13-3.86; <0.001), American Society of Anesthesiologists (ASA) physical status grade >2 (OR, 2.13; 95% CI, 1.68-2.72; <0.001), and anxiety and depression (OR, 1.39; 95% CI, 1.29-1.51; <0.001) were significantly associated with unplanned readmission. Among the perioperative factors, pulmonary complications (OR, 22.52; 95% CI, 7.21-70.41; <0.001) was significantly associated with unplanned readmission.
CONCLUSION
Male, older age, HTN, DM, CAD, ASA grade >2, anxiety and depression, pulmonary complications were significantly associated with an increased occurrence of unplanned readmission after ACDF.
Topics: Cervical Vertebrae; Diskectomy; Humans; Male; Patient Readmission; Postoperative Complications; Risk Factors; Spinal Fusion
PubMed: 36031784
DOI: 10.3349/ymj.2022.63.9.842 -
International Journal of Environmental... Aug 2022Modic changes (MCs) are believed to be potential pain generators in the lumbar and cervical spine, but it is currently unclear if their presence affects postsurgical... (Meta-Analysis)
Meta-Analysis Review
Modic changes (MCs) are believed to be potential pain generators in the lumbar and cervical spine, but it is currently unclear if their presence affects postsurgical outcomes. We performed a systematic review in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. All studies evaluating cervical or lumbar spine postsurgical outcomes in patients with documented preoperative MCs were included. A total of 29 studies and 6013 patients with 2688 of those patients having preoperative MCs were included. Eight included studies evaluated cervical spine surgery, eleven evaluated lumbar discectomies, nine studied lumbar fusion surgery, and three assessed lumbar disc replacements. The presence of cervical MCs did not impact the clinical outcomes in the cervical spine procedures. Moreover, most studies found that MCs did not significantly impact the clinical outcomes following lumbar fusion, lumbar discectomy, or lumbar disc replacement. A meta-analysis of the relevant data found no significant association between MCs and VAS back pain or ODI following lumbar discectomy. Similarly, there was no association between MCs and JOA or neck pain following ACDF procedures. Patients with MC experienced statistically significant improvements following lumbar or cervical spine surgery. The postoperative improvements were similar to patients without MCs in the cervical and lumbar spine.
Topics: Cervical Vertebrae; Diskectomy; Humans; Lumbar Vertebrae; Lumbosacral Region; Neck Pain; Treatment Outcome
PubMed: 36011795
DOI: 10.3390/ijerph191610158 -
Annals of Palliative Medicine Aug 2022For some patients, local anesthesia (LA) in percutaneous transforaminal endoscopic discectomy (PTED), especially during canal shaping and discectomy, is insufficient for... (Meta-Analysis)
Meta-Analysis
BACKGROUND
For some patients, local anesthesia (LA) in percutaneous transforaminal endoscopic discectomy (PTED), especially during canal shaping and discectomy, is insufficient for analgesia. Epidural anesthesia (EA) is infrequently applied in PTED but reports satisfactory results. Previous studies present conflicting results in analgesia satisfactory and adverse events. Differences in surgery details and small sample size might explain conflicting results. Meta-analysis pools the results from individual studies to create a larger sample size and provides a more reliable conclusion. The aim of this study is to evaluate the efficacy and safety of EA in PTED.
METHODS
The search terms "percutaneous transforaminal endoscopic discectomy" and "anesthesia" are used to search Cochrane, Web of Science, PubMed, Embase, OVID, China National Knowledge Infrastructure (CNKI), VIP, and Wanfang from inception to 2021-08. Inclusion criteria is defined according to PICOS principals: P (patients): patients are diagnosed with lumbar disc herniation or spinal canal stenosis. I (intervention): patients undergo PTED under EA. C (comparisons): patients undergo PTED under LA. O (outcomes): primary outcomes: intraoperative visual analogue scale (VAS), anesthesia satisfactory, sufentanil usage. Secondary outcomes: adverse events, surgery exit, bleed volume, X-ray radiation. S (study design): randomized controlled trials (RCTs). The Cochrane RoB 2.0 is used to evaluate the quality of the included studies. Authors perform meta-analysis through Review Manager 5.4.
RESULTS
A total of 6 studies representing 529 patients are included: EA group includes 261 patients, and LA group includes 268 patients. All studies lack design of allocation concealment and blinding of participants and personnel. Only Luo reports blinding of outcome assessment in 2019. Meta analysis concludes that EA is superior in intraoperative analgesic [mean difference (MD) =-4.31; 95% confidence interval (CI): -4.52 to -4.09; P<0.00001], anesthesia satisfactory [odds ratio (OR) =10.06; 95% CI: 2.41 to 41.98; P=0.002], sufentanil usage (MD =-9.12; 95% CI: -10.34 to -7.90; P<0.00001), adverse events (OR =0.19; 95% CI: 0.07 to 0.52; P=0.001). There is no difference in bleed volume (MD =-2.61; 95% CI: -5.45 to 0.23; P=0.07), exit rate (OR =0.23; 95% CI: 0.04 to 1.35; P=0.10) and future effects (MD =-0.23; 95% CI: -0.50 to 0.03; P=0.08).
DISCUSSION
EA is an effective and safe anesthesia method for PTED and might achieve better clinical results than LA. More high-quality research is needed to provide high-quality evidence for efficacy and safety.
Topics: Anesthesia, Epidural; Anesthesia, Local; Diskectomy; Humans; Lumbar Vertebrae; Sufentanil; Treatment Outcome
PubMed: 35871273
DOI: 10.21037/apm-21-3413 -
Computational and Mathematical Methods... 2022The purpose of this study was to investigate the effect of lumbar disc herniation (LDH) disease degree on lumbar discectomy and to explore the relationship between the... (Meta-Analysis)
Meta-Analysis
Effects of Enhanced Recovery Rehabilitation Surgery Concepts on the Surgical Process, Postoperative Pain, Complications, and Prognosis of Discectomy in Patients with Lumbar Disc Herniation: A Systematic Review and Meta-Analysis.
OBJECTIVE
The purpose of this study was to investigate the effect of lumbar disc herniation (LDH) disease degree on lumbar discectomy and to explore the relationship between the degree of intervertebral disc disease and postoperative pain score changes.
METHODS
We conducted a comprehensive search in China National Knowledge Infrastructure (CNKI), Wanfang Data, PubMed, MEDLINE, Embase, Cochrane database, and other databases, obtained all relevant studies as of April 2017, and then followed strict inclusion and exclusion criteria. Standard screening was performed on the retrieved literature. We extract and analyze key data using Review Manager 5.3 software. Pooled effects were calculated by mean difference or odds ratio and 95% confidence interval analysis, depending on data attributes.
RESULTS
Various databases were searched for the results of papers from lumbar discectomy since April 2017 to April 2022. Nine papers from 2502 patients were selected. The average overall follow-up was 52 weeks. There were statistically significant reductions in postoperative pain scores and degree of disc disease. There was a significant correlation between the reduction in pain score after discectomy and the degree of disc disease ( = 0.73, 95%CI = 0.01-1.20, = 0.005).
CONCLUSIONS
Decreased disc disease grade is one of the reasons for the lower back pain score after discectomy. Furthermore, region-dependent economic factors must be considered before developing a treatment strategy. Larger, well-defined randomized controlled trials are needed to further confirm these results.
Topics: Diskectomy; Humans; Intervertebral Disc Degeneration; Intervertebral Disc Displacement; Lumbar Vertebrae; Pain, Postoperative; Prognosis; Treatment Outcome
PubMed: 35774293
DOI: 10.1155/2022/9736470 -
Clinical Spine Surgery Mar 2023A systematic review and meta-analysis. (Meta-Analysis)
Meta-Analysis
Microscopic Anterior Cervical Discectomy and Fusion Versus Posterior Percutaneous Endoscopic Cervical Keyhole Foraminotomy for Single-level Unilateral Cervical Radiculopathy: A Systematic Review and Meta-analysis.
STUDY DESIGN
A systematic review and meta-analysis.
OBJECTIVE
The objective of this study was to compare the safety of microscopic anterior cervical discectomy and fusion (MI-ACDF) and posterior percutaneous endoscopic keyhole foraminotomy (PPEKF) in patients diagnosed with single-level unilateral cervical radiculopathy.
SUMMARY OF BACKGROUND DATA
After conservative treatment, the symptoms will be relieved in about 90% of cervical radiculopathy patients. For the other one tenth of patients, surgical treatment is needed. The overall complication rate of MI-ACDF and PPEKF ranges from 0% to 25%, and the reoperation rate ranges from 0% to 20%.
MATERIALS AND METHODS
Electronic retrieval of studies from PubMed, Embase, and Cochrane Library was performed to identify comparative or single-arm studies on MI-ACDF and PPEKF. A total of 24 studies were included in our meta-analysis by screening according to the inclusion and exclusion criteria. After data extraction and quality assessment of the included studies, a meta-analysis was performed by using the R software. The pooled incidences of efficient rate, total complication rate, and reoperation rate were calculated.
RESULTS
A total of 24 studies with 1345 patients (MI-ACDF: 644, PPEKF: 701) were identified. There was no significantly statistical difference in pooled patient effective rate (MI-ACDF: 94.3% vs. PPEKF: 93.3%, P =0.625), total complication rate (MI-ACDF: 7.1% vs. PPEKF: 4.7%, P =0.198), and reoperation rate (MI-ACDF: 1.8% vs. PPEKF: 1.1%, P =0.312). However, the common complications of the 2 procedures were different. The most common complications of MI-ACDF were dysphagia and vertebral body sinking, whereas the most common complication of PPEKF was nerve root palsy.
CONCLUSIONS
Both MI-ACDF and PPEKF can provide a relatively safe and reliable treatment for single-level unilateral cervical radiculopathy. The 2 techniques are not significantly different in terms of effective rate, total complication rate, and reoperation rate.
Topics: Humans; Foraminotomy; Radiculopathy; Cervical Vertebrae; Treatment Outcome; Diskectomy; Spinal Fusion
PubMed: 35344521
DOI: 10.1097/BSD.0000000000001327