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Medicine May 2020The present study was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) statement. (Meta-Analysis)
Meta-Analysis
STUDY DESIGN
The present study was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) statement.
OBJECTIVE
The present study aimed to conduct a systematic review of overlapping meta-analyses comparing ACDR with fusion for treating CDDD in order to assist decision makers in their selection among conflicting meta-analyses and to provide treatment recommendations based on the best available evidence.
SUMMARY OF BACKGROUND DATA
Although several meta-analyses have been performed to compare total disc replacement (TDR) and fusion for treating cervical degenerative disc disease (CDDD), their findings are inconsistent.
METHODS
Multiple databases were comprehensively searched for meta-analyses comparing TDR with fusion for treating CDDD. The meta-analyses that comprised only randomized controlled trials (RCTs) were included. Two authors independently assessed the meta-analysis study quality and extracted the data. The Jadad decision algorithm was used to ascertain which meta-analysis studies represented the best evidence.
RESULTS
A total of 14 meta-analysis studies were included. All these studies only included RCTs and were determined as Level-II evidence.
CONCLUSIONS
Cervical disc arthroplasty was superior compared to anterior discectomy and fusion for the treatment of symptomatic cervical disc disease.
Topics: Algorithms; Cervical Vertebrae; Diskectomy; Humans; Intervertebral Disc Degeneration; Meta-Analysis as Topic; Operative Time; Randomized Controlled Trials as Topic; Range of Motion, Articular; Reoperation; Spinal Fusion; Total Disc Replacement
PubMed: 32384498
DOI: 10.1097/MD.0000000000020143 -
Medicine Jan 2020To compare the effectiveness and safety of epidural anesthesia (EA) with those of local anesthesia (LA) for percutaneous transforaminal endoscopic discectomy (PTED) and... (Comparative Study)
Comparative Study Meta-Analysis
Comparison of effectiveness and safety between epidural anesthesia vs local anesthesia for percutaneous transforaminal endoscopic discectomy: A systematic review and meta-analysis.
OBJECTIVES
To compare the effectiveness and safety of epidural anesthesia (EA) with those of local anesthesia (LA) for percutaneous transforaminal endoscopic discectomy (PTED) and provide reference data for clinical decision-making.
METHODS
We searched PubMed, Embase, the Cochrane library, Web of Science, Medline, ScienceDirect, and the China National Knowledge Infrastructure from inception to June 2019 in order to identify randomized and nonrandomized controlled trials comparing EA and LA for PTED. Studies assessing at least 2 of the following indicators were eligible: surgical duration, X-ray exposure time, satisfaction rate, visual analog scale (VAS) scores for pain, Oswestry Disability Index (ODI), and complications. Two assessors evaluated the quality of the literature using the Cochrane Handbook or Newcastle-Ottawa Scale. Meta-analysis was conducted using Review Manager 5.3.3 software.
RESULTS
Four randomized controlled trials and 4 retrospective cohort studies involving a total of 1000 patients were included. The LA and EA groups included 473 and 527 patients, respectively. Meta-analysis revealed significant intergroup differences in the intraoperative (P < .00001) and postoperative (P < .00001) lumbar VAS scores, intraoperative (P < .00001) and postoperative (P = .001) leg VAS scores, and anesthesia satisfaction rate (P < .00001), with EA being superior to LA in all aspects. There were no significant intergroup differences in the surgical duration, X-ray exposure time, postoperative ODI, and complication rate.
CONCLUSION
EA is as safe as LA and produces better anesthetic effects than does LA in patients undergoing PTED. Therefore, it should be promoted as a reliable anesthetic technique for PTED.
Topics: Anesthesia, Epidural; Anesthesia, Local; Diskectomy, Percutaneous; Humans
PubMed: 31895822
DOI: 10.1097/MD.0000000000018629 -
Orthopaedic Surgery Feb 2020Whether cervical disc arthroplasty (CDA) is superior to anterior cervical discectomy and fusion (ACDF) remains controversial, especially in relation to long-term... (Comparative Study)
Comparative Study Meta-Analysis
OBJECTIVE
Whether cervical disc arthroplasty (CDA) is superior to anterior cervical discectomy and fusion (ACDF) remains controversial, especially in relation to long-term results. The present study aimed to evaluate the long-term safety and efficiency of CDA and ACDF for cervical disc disease.
METHODS
We performed this study according to the Cochrane methodology. An extensive search was undertaken in PubMed, Embase, and Cochrane databases up to 1 June 2019 using the following key words: "anterior cervical fusion," "arthroplasty," "replacement" and "artificial disc". RevMan 5.3 (Cochrane, London, UK) was used to analyze data. Safety and efficiency outcome measures included the success rate, functional outcome measures, adverse events (AE), adjacent segment degeneration (ASD), secondary surgery, and patients' satisfaction and recommendation rates. The OR and MD with 95% confidence interval (CI) were used to evaluate discontinuous and continuous variables, respectively. The statistically significant level was set at P < 0.05.
RESULTS
A total of 11 randomized controlled trials with 3505 patients (CDA/ACDF: 1913/1592) were included in this meta-analysis. Compared with ACDF, CDA achieved significantly higher overall success (2.10, 95% CI [1.70, 2.59]), neck disability index (NDI) success (1.73, 95% CI [1.37, 2.18]), neurological success (1.65, 95% CI [1.24, 2.20]), patients' satisfaction (2.14, 95% CI [1.50, 3.05]), and patients' recommendation rates (3.23, 95% CI [1.79, 5.80]). Functional outcome measures such as visual analog score neck pain (-5.50, 95% CI [-8.49, -2.52]) and arm pain (-3.78, 95% CI [-7.04, -0.53]), the Short Form-36 physical component score (SF-36 PCS) (1.93, 95% CI [0.53, 3.32]), and the Short Form-36 mental component score (SF-36 MCS) (2.62, 95% CI [0.95, 4.29]), revealed superiority in the CDA group. CDA also achieved a significantly lower rate of symptomatic ASD (0.46, 95% CI [0.34, 0.63]), total secondary surgery (0.50, 95% CI [0.29, 0.87]), secondary surgery at the index level (0.46, 95% CI [0.29, 0.74]), and secondary surgery at the adjacent level (0.37, 95% CI [0.28, 0.49]). However, no significant difference was found in radiological success (1.35, 95% CI [0.88, 2.08]), NDI score (-2.88, 95% CI [-5.93, 0.17]), total reported AE (1.14, 95% CI [0.92, 1.42]), serious AE (0.89, 95% CI [0.71, 1.11]), device/surgery-related AE (0.90, 95% CI [0.68, 1.18]), radiological superior ASD (0.63, 95% CI [0.28, 1.43]), inferior ASD (0.45, 95% CI [0.19, 1.11]), and work status (1.33, 95% CI [0.78, 2.25]). Furthermore, subgroup analysis showed different results between US and non-US groups.
CONCLUSION
Our study provided further evidence that compared to ACDF, CDA had a higher long-term clinical success rate and better functional outcome measurements, and resulted in less symptomatic ASD and fewer secondary surgeries. However, worldwide multicenter RCT with long-term follow up are still needed for further evaluation in the future.
Topics: Arthroplasty; Cervical Vertebrae; Disability Evaluation; Diskectomy; Humans; Intervertebral Disc Degeneration; Intervertebral Disc Displacement; Pain Measurement; Randomized Controlled Trials as Topic; Spinal Fusion; Total Disc Replacement
PubMed: 31863642
DOI: 10.1111/os.12585