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Journal of Healthcare Engineering 2022Systematic analysis of the incidence of percutaneous spinal endoscopic technique and traditional open surgery for lumbar disc herniation. (Meta-Analysis)
Meta-Analysis
OBJECTIVE
Systematic analysis of the incidence of percutaneous spinal endoscopic technique and traditional open surgery for lumbar disc herniation.
METHODS
A randomized controlled trial (RCT) and cohort study on complications related to traditional open surgery was searched on the MEDLINE, Cochrane Library, PubMed, Web of Science, Chinese journal full-text database (CNKI), Wanfang, and Embase database. Language is not limited. The quality of each study was evaluated, various complications were compiled into electronic baseline tables, and the data from these studies were available. Meta-analysis and synthesis were performed with the RevMan 5.3 software to evaluate the statistical significance of both surgical techniques in terms of various complications.
RESULTS
12 studies were eventually included, and a total of 2,797 patients were included in the analysis. Meta-analysis results showed that there was no statistical difference in postoperative paresthesia between percutaneous spinal endoscopy and traditional open surgery (OR = 1.17, 95% CI (0.82, 1.66), = 0.38, = 0%, = 0.88), direct nerve root damage (OR = 0.79, 95% CI (0.58, 1.07), = 0.13, = 73%, = 1.52), and intraoperative hemorrhage and hematoma formation (OR = 1.00, 95% CI (0.67, 1.48), = 0.99, = 0%, = 0.02), but there was a statistical difference in disc recurrence (OR = 2.24, 95% CI (1.56, 3.21), < 0.0001, = 81%, = 4.39).
CONCLUSION
Compared with the traditional open surgical treatment of lumbar disc herniation, percutaneous spinal endoscopic technology has obvious advantages in reducing nerve root injury, dural injury, and surgical area wound complications, but it is limited to preventing the technical characteristics of the surgical site, which is worse than that of open surgery.
Topics: Diskectomy, Percutaneous; Endoscopy; Humans; Intervertebral Disc Displacement; Lumbar Vertebrae; Randomized Controlled Trials as Topic; Treatment Outcome
PubMed: 35340255
DOI: 10.1155/2022/6033989 -
Journal of Orthopaedic Surgery and... Jan 2022The clinical outcomes of using a zero-profile for anterior cervical decompression and fusion were evaluated by comparison with anterior cervical plates. (Meta-Analysis)
Meta-Analysis Review
Comparison of outcomes between Zero-p implant and anterior cervical plate interbody fusion systems for anterior cervical decompression and fusion: a systematic review and meta-analysis of randomized controlled trials.
PURPOSE
The clinical outcomes of using a zero-profile for anterior cervical decompression and fusion were evaluated by comparison with anterior cervical plates.
METHODS
All of the comparative studies published in the PubMed, Cochrane Library, Medline, Web of Science, EBSOChost, and EMBASE databases as of 1 October 2021 were included. All outcomes were analysed using Review Manager 5.4.
RESULTS
Seven randomized controlled studies were included with a total of 528 patients, and all studies were randomized controlled studies. The meta-analysis outcomes indicated that the use of zero-profile fixation for anterior cervical decompression and fusion was better than anterior cervical plate fixation regarding the incidence of postoperative dysphagia (P < 0.05), adjacent-level ossification (P < 0.05), and operational time (P < 0.05). However, there were no statistically significant differences in intraoperative blood loss, Visual Analogue Scale, Neck Disability Index, or Japanese Orthopaedic Association scale (all P > 0.05) between the zero-profile and anterior cervical plate groups.
CONCLUSIONS
The systematic review and meta-analysis indicated that zero-profile and anterior cervical plates could result in good postoperative outcomes in anterior cervical decompression and fusion. No significant differences were found in intraoperative blood loss, Visual Analogue Scale, Neck Disability Index, or Japanese Orthopaedic Association scale. However, the zero-profile is superior to the anterior cervical plate in the following measures: incidence of postoperative dysphagia, adjacent-level ossification, and operational time. PROSPERO registration CRD42021278214.
Topics: Blood Loss, Surgical; Bone Plates; Cervical Vertebrae; Decompression; Deglutition Disorders; Diskectomy; Humans; Randomized Controlled Trials as Topic; Spinal Fusion; Treatment Outcome
PubMed: 35078496
DOI: 10.1186/s13018-022-02940-w -
The Korean Journal of Pain Jan 2022Percutaneous transforaminal endoscopic discectomy (PTED) has been widely used in the treatment of lumbar degenerative diseases. Epidural injection of steroids can reduce...
BACKGROUND
Percutaneous transforaminal endoscopic discectomy (PTED) has been widely used in the treatment of lumbar degenerative diseases. Epidural injection of steroids can reduce the incidence and duration of postoperative pain in a short period of time. Although steroids are widely believed to reduce the effect of surgical trauma, the observation indicators are not uniform, especially the long-term effects, so the problem remains controversial. Therefore, the purpose of this paper was to evaluate the efficacy of epidural steroids following PTED.
METHODS
We searched PubMed, Embase, and the Cochrane Database from 1980 to June 2021 to identify randomized and non-randomized controlled trials comparing epidural steroids and saline alone following PTED. The primary outcomes included postoperative pain at least 6 months as assessed using a visual analogue scale (VAS) and the Oswestry Disability Index (ODI). The secondary outcomes included length of hospital stay and the time of return to work.
RESULTS
A total of 451 patients were included in three randomized and two nonrandomized controlled trials. The primary outcomes, including VAS and ODI scores, did not differ significantly between epidural steroids following PTED and saline alone. There were no significant intergroup differences in length of hospital stay. Epidural steroids were shown to be superior in terms of the time to return to work (P < 0.001).
CONCLUSIONS
Intraoperative epidural steroids did not provide significant benefits, leg pain control, improvement in ODI scores, and length of stay in the hospital, but it can enable the patient to return to work faster.
PubMed: 34966016
DOI: 10.3344/kjp.2022.35.1.97 -
The Korean Journal of Pain Oct 2021Although the erector spinae plane block has been used in various truncal surgical procedures, its clinical benefits in patients undergoing spinal surgery remain...
BACKGROUND
Although the erector spinae plane block has been used in various truncal surgical procedures, its clinical benefits in patients undergoing spinal surgery remain controversial. The aim of this meta-analysis was to evaluate the clinical benefits of erector spinae plane block in patients undergoing spinal surgery.
METHODS
We searched the Cochrane Library, PubMed, EMBASE, and China National Knowledge Infrastructure for randomized controlled trials comparing the erector spinae plane block with a nonblocked control for spinal surgery.
RESULTS
Twelve studies encompassing 696 subjects were included in our systematic review and meta-analysis. We found that the erector spinae plane block decreased postoperative pain scores and opioid consumption in the postoperative and intraoperative periods. Moreover, it prolonged the time to the first rescue analgesic, reduced the number of patients who required rescue analgesia, and lowered the incidence of postoperative nausea and vomiting. However, it did not exhibit efficacy in decreasing the incidence of urinary retention and itching or shortening the length of hospital stays, or the time to first ambulation.
CONCLUSIONS
Erector spinae plane block improves analgesic efficacy among patients undergoing spinal surgery compared with nonblocked controls; however, there is insufficient evidence regarding the benefits of erector spinae plane block for rapid recovery.
PubMed: 34593667
DOI: 10.3344/kjp.2021.34.4.487 -
Pain Physician Jul 2021New approaches and technologies can be beneficial for patients but also bring corresponding complications. Traditional pairwise meta-analyses cannot be used to... (Meta-Analysis)
Meta-Analysis
BACKGROUND
New approaches and technologies can be beneficial for patients but also bring corresponding complications. Traditional pairwise meta-analyses cannot be used to comprehensively rank all surgical approaches.
OBJECTIVES
The purpose of this systematic review and network meta-analysis (NMA) was to compare the outcomes of different surgical approaches for lumbar disc herniation (LDH).
STUDY DESIGN
NMA of randomized controlled trials (RCTs) for multiple treatment comparisons of LDH.
METHODS
The PubMed, Embase, MEDLINE, Ovid, and Cochrane Library databases were searched for RCTs comparing different surgical approaches for patients with LDH from inception to February 10, 2020. The Markov chain Monte Carlo methods were used to perform a hierarchical Bayesian NMA in WinBUGS version 1.4.3 using a random effects consistency model. The primary outcomes were disability and pain intensity. The secondary outcomes were complications and reoperation. The PROSPERO number was CRD42020179406.
RESULTS
A total of 22 trials including 2529 patients and all 5 different approaches (open discectomy or microdiscectomy [OD/MD], microendoscopic discectomy [MED], percutaneous endoscopic discectomy [PED], percutaneous discectomy [PD], and tubular discectomy [TD]) were retrospectively retrieved. PED had the best efficacy in improving patients' dysfunction with no statistical significance (probability = 50%). PD was significantly worse than OD/MD, MED, and PED in relieving patients' pain (standardized mean differences: 0.87 [0.03, 1.76], 0.94 [0.06, 1.88], and 1.02 [0.13, 1.94], respectively). There was no statistically significant difference between any 2 surgical approaches in dural tear; intraoperative, postoperative, and overall complications; or reoperation rate. PED had the lowest dural tear rate and the lowest intraoperative and overall complication rates (probability = 51%, 67%, and 33%, respectively). TD had the lowest postoperative complication and reoperation rates (probability = 35% and 39%, respectively).
LIMITATIONS
The limitations of this NMA include the inconsistent follow-up times, the criteria for complications, and the reasons for reoperation.
CONCLUSIONS
Compared with other approaches used to treat LDH, PED had the best safety and efficacy in general, and TD had the lowest reoperation rate. Finally, we recommended PED for LDH.
Topics: Diskectomy, Percutaneous; Humans; Intervertebral Disc Degeneration; Intervertebral Disc Displacement; Lumbar Vertebrae; Network Meta-Analysis
PubMed: 34213864
DOI: No ID Found -
Sports Health 2021The prevalence of symptomatic lumbar disc herniation (LDH) in athletes can be as high as 75%. For elite athletes diagnosed with LDH, return to play (RTP) is a major... (Meta-Analysis)
Meta-Analysis
CONTEXT
The prevalence of symptomatic lumbar disc herniation (LDH) in athletes can be as high as 75%. For elite athletes diagnosed with LDH, return to play (RTP) is a major concern, and thus comparing surgical with nonoperative care is essential to guide practitioners and athletes, not just in terms of recovery rates but also speed of recovery.
OBJECTIVE
The purpose of this systematic review is to provide an update on RTP outcomes for elite athletes after lumbar discectomy versus nonoperative treatment of LDHs.
DATA SOURCES
A search of the literature was conducted using 3 online databases (MEDLINE, EMBASE, and PubMed) to identify pertinent studies.
STUDY SELECTION
Yielded studies were screened according to the inclusion criteria.
STUDY DESIGN
Systematic review with meta-analysis.
LEVEL OF EVIDENCE
Level 4.
DATA EXTRACTION
Relevant data were extracted. A meta-analysis was performed comparing RTP rate for all comparative studies.
RESULTS
Twenty studies met the inclusion criteria and were included in this review. Overall, 663 out of 799 patients (83.0%) returned to play in the surgical group and 251 out of 308 patients (81.5%) returned to play in the nonoperative group. No statistically significant difference for RTP rate was found (odds ratio, 1.39; 95% CI, 0.58-3.34; = 0.46; 2, 71%). The mean time to RTP for patients undergoing lumbar discectomy was 5.19 months (range 1.00-8.70 months), and 4.11 months (range 3.60-5.70 months) for those treated conservatively.
CONCLUSION
There was no significant difference in RTP rate between athletes treated with operative or nonoperative management of LDHs, nor did operative management have a faster time to RTP. Athletes should consider the lack of difference in RTP rate in addition to the potential risks associated with spinal surgery when choosing a treatment option. Future randomized controlled trials are needed on this topic to allow for high-powered conclusions.
Topics: Conservative Treatment; Diskectomy; Humans; Intervertebral Disc Displacement; Lumbar Vertebrae; Return to Sport
PubMed: 33563131
DOI: 10.1177/1941738121991782 -
Orthopaedics & Traumatology, Surgery &... Nov 2021Intraoperative imaging in minimally invasive spinal surgeries is associated with significant radiation exposure to surgeons, which overtime can lead to serious health... (Review)
Review
BACKGROUND
Intraoperative imaging in minimally invasive spinal surgeries is associated with significant radiation exposure to surgeons, which overtime can lead to serious health hazards including malignancy. In this study, the authors conducted a systematic review to evaluate the efficacy of navigation assisted fluoroscopy methods on radiation exposure to the surgeon in minimally invasive spine surgeries, percutaneous endoscopic lumbar discectomy/percutaneous endoscopic transforaminal discectomy versus minimally invasive spine transforaminal lumbar interbody fusion (PELD/PETD versus MIS-TLIF).
METHODS
A systematic literature search was conducted using PUBMED/MEDLINE on 20th July, 2020. Inclusion criteria were applied according to study design, surgical technique, spinal region, and language. Data extracted included lumbar segment, average operation time (min), fluoroscopic time (s), and radiation dose (μSV), efficacy of modified navigation versus conventional techniques; on reducing operation, fluoroscopy times and effective radiation dose.
RESULTS
Fifteen studies (ten prospectives, and five retrospectives) were included for quantitative analysis. PELD recorded a shorter operation time (by 126.3min, p<0.001) and fluoroscopic time (by 22.9s, p=0.3) than MIS-TLIF. The highest radiation dose/case (μSV) for both techniques were recorded at the surgeon's: finger, chest, neck and eye. The effective dose for MIS-TLIF was 30μSV higher than PELD. Modified navigation techniques recorded a shorter operation time (by 15.9min, p=0.3); fluoroscopy time (by 289.8s, p=0.3); effective radiation dose (by 169.5μSV, p=0.3) than conventional fluoroscopy methods.
DISCUSSION
This systematic literature review showed that although navigation assisted fluoroscopy techniques are superior to conventional methods in minimising radiation exposure, lack of statistical significance warrants future randomised controlled trials, to solidify their efficacy in reducing radiation related hazards.
Topics: Diskectomy, Percutaneous; Humans; Intervertebral Disc Displacement; Lumbar Vertebrae; Minimally Invasive Surgical Procedures; Radiation Exposure; Spinal Fusion; Surgeons; Treatment Outcome
PubMed: 33333283
DOI: 10.1016/j.otsr.2020.102795 -
Spine Apr 2021Systematic review and meta-analysis. (Comparative Study)
Comparative Study Meta-Analysis
STUDY DESIGN
Systematic review and meta-analysis.
OBJECTIVE
To give a systematic overview of effectiveness of percutaneous transforaminal endoscopic discectomy (PTED) compared with open microdiscectomy (OM) in the treatment of lumbar disk herniation (LDH).
SUMMARY OF BACKGROUND DATA
The current standard procedure for the treatment of sciatica caused by LDH, is OM. PTED is an alternative surgical technique which is thought to be less invasive. It is unclear if PTED has comparable outcomes compared with OM.
METHODS
Multiple online databases were systematically searched up to April 2020 for randomized controlled trials and prospective studies comparing PTED with OM for LDH. Primary outcomes were leg pain and functional status. Pooled effect estimates were calculated for the primary outcomes only and presented as standard mean differences (SMD) with their 95% confidence intervals (CI) at short (1-day postoperative), intermediate (3-6 months), and long-term (12 months).
RESULTS
We identified 2276 citations, of which eventually 14 studies were included. There was substantial heterogeneity in effects on leg pain at short term. There is moderate quality evidence suggesting no difference in leg pain at intermediate (SMD 0.05, 95% CI -0.10-0.21) and long-term follow-up (SMD 0.11, 95% CI -0.30-0.53). Only one study measured functional status at short-term and reported no differences. There is moderate quality evidence suggesting no difference in functional status at intermediate (SMD -0.09, 95% CI -0.24-0.07) and long-term (SMD -0.11, 95% CI -0.45-0.24).
CONCLUSION
There is moderate quality evidence suggesting no difference in leg pain or functional status at intermediate and long-term follow-up between PTED and OM in the treatment of LDH. High quality, robust studies reporting on clinical outcomes and cost-effectiveness on the long term are lacking.Level of Evidence: 2.
Topics: Cost-Benefit Analysis; Diskectomy, Percutaneous; Endoscopy; Humans; Intervertebral Disc Degeneration; Intervertebral Disc Displacement; Lumbar Vertebrae; Microsurgery; Pain Measurement; Prospective Studies; Randomized Controlled Trials as Topic; Treatment Outcome
PubMed: 33290374
DOI: 10.1097/BRS.0000000000003843 -
Medicine Jun 2020To systematically analyze the differences of complications between percutaneous transforaminal endoscopic discectomy (PTED) and percutaneous interlaminar endoscopic... (Meta-Analysis)
Meta-Analysis
BACKGROUND
To systematically analyze the differences of complications between percutaneous transforaminal endoscopic discectomy (PTED) and percutaneous interlaminar endoscopic discectomy (PIED) in the treatment of lumbar disc herniation.
METHODS
We performed a systematic search in MEDLINE, EMBASE, PubMed, Web of Science, Cochrane databases, Chinese Biomedical Literature Database, CNKI, and Wanfang Data for all relevant studies. All statistical analysis was performed using Review Manager Version 5.3.
RESULTS
A total of 15 articles with 1156 study subjects were included, with 550 patients in PTED group and 606 patients in PIED group. The results of the meta-analysis showed that postoperative dysesthesia (odds ratio [OR] = 0.61, 95% confidence interval [CI], 0.33-1.13), nerve root injury (OR = 1.22, 95% CI, 0.30-5.02), surgical site wound complications (OR = 1.26, 95% CI, 0.29-5.40), recurrence (OR = 1.09, 95% CI, 0.54-2.21), conversion to open surgery (OR = 1.26, 95% CI, 0.33-4.81), incomplete decompression (OR = 1.62, 95% CI, 0.43-6.09), and total complication (OR = 0.72, 95% CI, 0.49-1.06) showed no significant differences between the PTED group and the PIED group, while the PTED group had significantly better results in dural tear compared with the PIED group (OR = 0.31, 95% CI, 0.13-0.79).
CONCLUSIONS
Dural tear was significantly less occured in PTED compared with PIED. The postoperative dysesthesia, nerve root injury, surgical site wound complications, recurrence, conversion to open surgery, incomplete decompression, and total complication did not differ significantly between PTED and PIED in the treatment of lumbar disc herniation.
Topics: Diskectomy, Percutaneous; Endoscopy; Humans; Intervertebral Disc Displacement; Postoperative Complications
PubMed: 32569205
DOI: 10.1097/MD.0000000000020709 -
Journal of Orthopaedic Surgery and... Jun 2020To compare the effectiveness and safety of anterior cervical discectomy and fusion (ACDF) with posterior cervical foraminotomy (PCF) for patients diagnosed with...
BACKGROUND
To compare the effectiveness and safety of anterior cervical discectomy and fusion (ACDF) with posterior cervical foraminotomy (PCF) for patients diagnosed with single-level unilateral cervical radiculopathy.
METHODS
Relevant studies comparing ACDF with PCF for cervical radiculopathy were searched in an electronic database. After data extraction and quality assessment of included studies, a meta-analysis was done by using the RevMan 5.3 software. The random effects model was used if there was heterogeneity between studies; otherwise, the fixed effects model was used.
RESULTS
A total of 3 randomized controlled trials (RCT) and 12 retrospective studies including 52705 patients were included in the meta-analysis. There were no significant differences in Neck Disability Index (NDI), Visual Analog Scale (VAS), and patients' satisfaction (P > 0.05) between treatment groups. The complication rate of the PCF group was equivalent compared with the ACDF group (P = 0.60), but the reoperation rate following PCF was on the higher side (P = 0.02). Data analysis also showed that the PCF group was associated with shorter operation time (P = 0.001) and shorter length of hospital stay (P = 0.002).
CONCLUSIONS
Among patients with single-level unilateral cervical radiculopathy, PCF has comparable effectiveness and complication rate compared with ACDF. It seems that PCF is a sufficient alternative procedure with shorter operation time, shorter length of hospital stay, and less total hospital cost for the treatment of cervical radiculopathy. However, the higher reoperation rate following PCF should be also taken into consideration.
Topics: Cervical Vertebrae; Diskectomy; Foraminotomy; Humans; Radiculopathy; Spinal Fusion
PubMed: 32487109
DOI: 10.1186/s13018-020-01723-5