-
Global Spine Journal Oct 2018Systematic review. (Review)
Review
STUDY DESIGN
Systematic review.
OBJECTIVES
Diagnosis of pseudarthrosis after anterior cervical fusion is difficult, and often depends on the surgeon's subjective assessment because recommended radiographic criteria are lacking. This review evaluated the available evidence for confirming fusion after anterior cervical surgery.
METHODS
Articles describing assessment of anterior cervical fusion were retrieved from MEDLINE and SCOPUS. The assessment methods and fusion rates at 1 and 2 years were evaluated to identify reliable radiographical criteria.
RESULTS
Ten fusion criteria were described. The 4 most common were presence of bridging trabecular bone between the endplates, absence of a radiolucent gap between the graft and endplate, absence of or minimal motion between adjacent vertebral bodies on flexion-extension radiographs, and absence of or minimal motion between the spinous processes on flexion-extension radiographs. The mean fusion rates were 90.2% at 1 year and 94.7% at 2 years. The fusion rate at 2 years had significant independence ( = .048).
CONCLUSIONS
The most common fusion criteria, bridging trabecular bone between the endplates and absence of a radiolucent gap between the graft and endplate, are subjective. We recommend using <1 mm of motion between spinous processes on extension and flexion to confirm fusion.
PubMed: 30443486
DOI: 10.1177/2192568218755141 -
Neurospine Sep 2023Cervical myelopathy (CM) describes the compressive cervical spinal cord state, often accompanied by serious clinical condition, by herniated disc or hypertrophied spurs...
Clinical Effectiveness of Artificial Disc Replacement in Comparison With Anterior Cervical Discectomy and Fusion in the Patients With Cervical Myelopathy: Systematic Review and Meta-analysis.
OBJECTIVE
Cervical myelopathy (CM) describes the compressive cervical spinal cord state, often accompanied by serious clinical condition, by herniated disc or hypertrophied spurs or ligament. Anterior cervical discectomy and fusion (ACDF) has been frequently employed as conventional surgical solution for this CM despite its inherent biomechanical handicap. Alternatively, an artificial disc replacement (ADR) preserves cervical motion while still decompressing the spinal canal and neural foramen. This analysis elaborated to clarify the potential benefits of ADR application to CM over ACDF from the conglomerated results of the past references.
METHODS
A literature search was performed using MEDLINE, Embase, Cochrane review, and KMbase databases from the studies published until March 2023. Six studies (3 randomized controlled study [RCTs] and 3 non-RCTs) were included in a qualitative and quantitative synthesis. Data were extracted and analyzed using a random effects model to obtain effect size and its statistical significance. Quality assessment and evidence level were established in accordance with the GRADE (Grading of Recommendations Assessment, Development and Evaluation) methodology.
RESULTS
Among 6 studies, 2 studies showed that ADR group achieved significantly better clinical improvement than the ACDF group, while the rest 4 studies revealed no significant difference. A meta-analysis showed better clinical outcomes with or without statistical significance. The level of evidence was low because of inconsistency and imprecision.
CONCLUSION
ADR was superior or at least, not inferior to ACDF in terms of functional recovery. However, its application to the CM patients is merely empowered with weak strength due to low level of evidence.
PubMed: 37798997
DOI: 10.14245/ns.2346498.249 -
AJNR. American Journal of Neuroradiology May 2014Endovascular therapy has become an acceptable alternative to traditional clipping for the management of intracranial aneurysms. However, a limited number of studies have... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND AND PURPOSE
Endovascular therapy has become an acceptable alternative to traditional clipping for the management of intracranial aneurysms. However, a limited number of studies have examined outcomes and complications specific to embolization of anterior communicating artery aneurysms.
MATERIALS AND METHODS
A systematic review of the literature was conducted with the use of multiple data bases to identify reports on endovascular treatment of anterior communicating artery aneurysms between 1994 and 2012. Angiographic results, clinical outcomes, and complication rates were pooled across studies by using random-effects meta-analysis with subgroup analysis of outcomes by rupture status and time trend stratification.
RESULTS
Fourteen studies, consisting of 1552 treated anterior communicating artery aneurysms, were included in this meta-analysis. The rate of immediate and long-term complete and near-complete angiographic occlusion was 88% (95% CI = 81-93%) and 85% (95% CI = 78-90%), respectively. Intraprocedural rupture rate was 4% (95% CI = 3-6%). The re-bleeding rate was 2% (95% CI = 1-4%) and the retreatment rate was 7% (95% CI = 5-12%). Morbidity or mortality caused by perioperative stroke occurred at a 3% (95% CI = 2-6%) rate. Overall procedure-related morbidity and mortality were 6% (95% CI = 4-8%) and 3% (95% CI = 2-4%), respectively. Outcomes did not differ between ruptured and unruptured aneurysms, nor did outcomes change over time, though these latter subanalyses were relatively underpowered.
CONCLUSIONS
Endovascular therapy for anterior communicating artery aneurysms is associated with a high rate of complete angiographic occlusion. However, the procedure-related permanent morbidity and mortality are not negligible for aneurysms in this location.
Topics: Cerebral Hemorrhage; Embolization, Therapeutic; Endovascular Procedures; Female; Humans; Intracranial Aneurysm; Male; Postoperative Complications; Prevalence; Radiography; Risk Factors; Stents; Survival Rate; Treatment Outcome
PubMed: 24287090
DOI: 10.3174/ajnr.A3802 -
Sports Health 2020Anterior cruciate ligament (ACL) reconstruction (ACLR) is frequently performed in patients younger than 20 years whose goal is to return to sport (RTS). Varying reinjury...
CONTEXT
Anterior cruciate ligament (ACL) reconstruction (ACLR) is frequently performed in patients younger than 20 years whose goal is to return to sport (RTS). Varying reinjury rates have been reported, and the factors responsible are unclear. Studies differ with regard to age, graft type, surgical techniques, postoperative rehabilitation, RTS guidelines, and methods used to determine ACL failures.
OBJECTIVE
To determine RTS rates; the effect of participation in high-risk sports, sex, and graft type on ACL reinjury rates; and whether objective test criteria before RTS correlate with lower reinjury rates.
DATA SOURCES
A systematic review of the literature from inception to May 31, 2019, was conducted using the PubMed and Cochrane databases.
STUDY SELECTION
Studies on transphyseal ACLR in athletes <20 years old with a minimum mean follow-up of 2 years that reported reinjury rates, the number that RTS, and detailed the type of sport were included.
STUDY DESIGN
Systematic review.
LEVEL OF EVIDENCE
Level 4.
RESULTS
A total of 1239 patients in 8 studies were included; 87% returned to sport and 80% resumed high-risk activities. Of the patients, 18% reinjured the ACL graft and/or the contralateral ACL. Nine percent of patellar tendon autografts and 15% of hamstring autografts failed (odds ratio [OR], 0.52; = 0.002). Of reinjuries, 90% occurred during high-risk sports. Male patients had a significantly higher rate of ACL graft failure than female patients (OR, 1.64; = 0.01). There was no sex-based effect on contralateral ACL injuries. Only 1 study cited objective criteria for RTS.
CONCLUSION
A high percentage of athletes returned to sport, but 1 in 5 suffered reinjuries to either knee. Male patients were more likely to reinjure the ACL graft. Objective criteria for RTS were rarely mentioned or not detailed. The need for testing of knee stability, strength, neuromuscular control, agility, and psychological measures before RTS remains paramount in young athletes.
Topics: Adolescent; Anterior Cruciate Ligament Injuries; Anterior Cruciate Ligament Reconstruction; Autografts; Child; Exercise Test; Hamstring Tendons; Humans; Patellar Ligament; Recurrence; Return to Sport; Risk Factors; Sex Factors; Young Adult
PubMed: 32374646
DOI: 10.1177/1941738120912846 -
Medicine Dec 2022Contemporary techniques for repair of acute anterior cruciate ligament (ACL) rupture have been receiving renewed interest recently because of reports of good outcomes. (Meta-Analysis)
Meta-Analysis
BACKGROUND
Contemporary techniques for repair of acute anterior cruciate ligament (ACL) rupture have been receiving renewed interest recently because of reports of good outcomes.
METHODS
A literature search of PUBMED, MEDLINE, EMBASE, and the Cochrane Library was performed in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Only RCTs published in English and comparing clinical outcomes of ACL repair versus reconstruction were included. Outcomes were evaluated using the International Knee Documentation Committee subjective score, Lysholm score, Tegner activity scale, visual analog scale pain score, anterior laxity, Lachman test, hop tests, knee injury and osteoarthritis outcome score, extension deficit, revision rate, and re-rupture rate. Statistical analysis was performed with Review Manager 5.4 and Stata 14.0. Two-tailed P < .05 was considered statistically significant.
RESULTS
Four RCTs (with a total of 293 patients) that met the eligibility criteria were included in this review. Over short-term follow-up, none of the studies found significant differences between the repair groups and reconstruction groups with respect to International Knee Documentation Committee, Lysholm, Tegner, visual analog scale, anterior laxity, Lachman test, re-rupture rate, extension deficit, and performance of 3 hop tests (P > .05). In both groups, the hop tests scores were >90%.
CONCLUSION
ACL repair and ACL reconstruction appear to provide comparable short-term outcomes. The low revision rate after primary repair is encouraging. For patients with ACL injury, current repair techniques such as dynamic intraligamentary stabilization and bridge-enhanced ACL repair may be an effective alternative to reconstruction.
Topics: Humans; Anterior Cruciate Ligament Injuries; Anterior Cruciate Ligament; Treatment Outcome; Knee Joint; Lysholm Knee Score; Rupture
PubMed: 36595828
DOI: 10.1097/MD.0000000000032411 -
Frontiers in Surgery 2022Compared with standard anterior cruciate ligament (ACL) reconstruction, it is controversial whether anterior cruciate ligament reconstruction (ACLR) with remnant... (Review)
Review
BACKGROUND
Compared with standard anterior cruciate ligament (ACL) reconstruction, it is controversial whether anterior cruciate ligament reconstruction (ACLR) with remnant preservation can lead to better clinical outcomes. We conducted a systematic study and meta-analysis to assess the differences in clinical efficacy between the two.
METHOD
We searched for clinical randomized controlled studies and cohort studies included in the Cochrane library, PubMed, and Embase from March 2012 to March 2022 in English. The included studies were ACLR with or without remant preservation, and the data were extracted and the quality of the included studies was assessed by two authors, respectively. Revman 5.4 was used for statistical analysis and conclusions were presented.
RESULT
Ten articles containing a total of 777 patients were finally included. There was no significant difference in postoperative Lachman test [OR = 1.66, 95%CI (0.79, 3.49), = 0.18 > 0.05], Tegner score [SMD = -0.13, 95%CI (-0.47, 0.22), = 0.46 > 0.05], synovial coverage rate by second-look arthroscopy [OR = 1.55, 95%CI (0.66, 3.65), = 0.32 > 0.05], the rate of cyclops lesion [OR = 3.92, 95%CI (0.53, 29.29), = 0.18 > 0.05], joint range of motion [SMD = 0.27, 95%CI (-0.13, 0.68), = 0.19 > 0.05] and re-injury rate [OR = 0.57, 95%CI (0.18, 1.74), = 0.32 > 0.05] between the two groups. There were statistically significant differences in postoperative Lysholm score [SMD = 0.98, 95% CI (0.32, 1.64), = 0.004 < 0.05], International Knee Documantation Committee grade (IKDC grade) [OR = 2.19, 95%CI (1.03, 4.65), = 0.04 < 0.05], Pivot shift test [OR = 1.71, 95%CI (1.06, 2.77), = 0.03 < 0.05], KT1000/2000 arthrometer side-to-side difference [SMD = -0.22, 95%CI (-0.42, -0.03), = 0.02 < 0.05], operation time [SMD = 11.69, 95%CI (8.85, 14.54), = 0.00001 < 0.05] and degree of tibial tunnel enlargement [SMD = -0.66, 95%CI (-1.08, -0.23), = 0.002 < 0.05].
CONCLUSION
This meta-analysis concluded that remnant preservation significantly had better results in terms of patient functional score (Lysholm, IKDC), knee stability (Pivot shift test, postoperative side-to-side anterior laxity) and tibial tunnel enlargement. In terms of complications (incidence of Cyclops lesions, range of motion, re-injury rate), no significant differences were seen between the two groups. Although many studies concluded that remnant preservation could bring better synovial coverage, this meta-analysis indicated that there is insufficient evidence to support it, possibly due to different remnant preservation procedures.The potential risks associated with longer operation times are also worth considering.
PubMed: 36117844
DOI: 10.3389/fsurg.2022.952930 -
Spine Surgery and Related Research 2022A thoracolumbar burst fracture (BF) is a severe type of compression fracture, which is the most common type of traumatic spine fractures. Generally, surgery is the... (Review)
Review
BACKGROUND
A thoracolumbar burst fracture (BF) is a severe type of compression fracture, which is the most common type of traumatic spine fractures. Generally, surgery is the preferred treatment, but whether the optimal approach is either an anterior or a posterior approach remains unclear. This study aims to determine whether either method provides an advantage.
METHODS
Following PRISMA guidelines, a systematic review was conducted, identifying studies comparing anterior versus posterior surgical approaches in patients with thoracolumbar BFs. Data were analyzed using Review Manager 5.3. Seven studies were included.
RESULTS
An operative time of 87.97 min (53.91, 122.03; p<0.0001) and blood loss of 497.04 mL (281.8, 712.28; p<0.0001) were lower in the posterior approach. Length of hospital stay, complications, reintervention rate, neurological outcomes, postoperative kyphotic angle, and costs were similar between both groups.
CONCLUSIONS
Surgical intervention is usually selected to rehabilitate patients with BFs. The data obtained from this study suggest that a posterior approach represents a viable alternative to an anterior approach, with various advantages such as a shorter operative time and decreased bleeding.
PubMed: 35478987
DOI: 10.22603/ssrr.2021-0122 -
European Spine Journal : Official... Feb 2014Surgical strategy for multilevel cervical myelopathy resulting from cervical spondylotic myelopathy (CSM) or ossification of posterior longitudinal ligament (OPLL) still... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Surgical strategy for multilevel cervical myelopathy resulting from cervical spondylotic myelopathy (CSM) or ossification of posterior longitudinal ligament (OPLL) still remains controversial. There are still questions about the relative benefit and safety of direct decompression by anterior corpectomy (CORP) versus indirect decompression by posterior laminoplasty (LAMP).
OBJECTIVE
To perform a systematic review and meta-analysis evaluating the results of anterior CORP compared with posterior LAMP for patients with multilevel cervical myelopathy.
METHODS
Systematic review and meta-analysis of cohort studies comparing anterior CORP with posterior LAMP for the treatment of multilevel cervical myelopathy due to CSM or OPLL from 1990 to December 2012. An extensive search of literature was performed in Pubmed, Embase, and the Cochrane library. The quality of the studies was assessed according to GRADE. The following outcome measures were extracted: pre- and postoperative Japanese orthopedic association (JOA) score, neurological recovery rate (RR), surgical complications, reoperation rate, operation time and blood loss. Two reviewers independently assessed each study for quality and extracted data. Subgroup analysis was conducted according to the mean number of surgical segments.
RESULTS
A total of 12 studies were included in this review, all of which were prospective or retrospective cohort studies with relatively low quality. The results indicated that the mean JOA score system for cervical myelopathy and the neurological RR in the CORP group were superior to those in the LAMP group when the mean surgical segments were <3, but were similar between the two groups in the case of the mean surgical segments equal to 3 or more. There was no statistical difference in the surgical complication rate between the two groups when the mean surgical segments <3, but were significantly higher incidences of surgical complications and complication-related reoperation in the CORP group compared with the LAMP group in the case of the mean surgical segments equal to 3 or more. Besides, the operation time in the CORP group was longer than that in the LAMP group, and the average blood loss was significantly more in the CORP group compared with the LAMP group.
CONCLUSION
Based on the results above, anterior CORP and fusion is recommended for the treatment of multilevel cervical myelopathy when the involved surgical segments were <3. Given the higher rates of surgical complications and complication-related reoperation and the higher surgical trauma associated with multilevel CORP, however, it is suggested that posterior LAMP may be the preferred method of treatment for multilevel cervical myelopathy when the involved surgical segments were equal to 3 or more. In addition, taking the limitations of this study into consideration, it was still not appropriate to draw a strong conclusion claiming superiority for CORP or LAMP. A well-designed, prospective, randomized controlled trial is necessary to provide objective data on the clinical results of both procedures.
Topics: Cervical Vertebrae; Decompression, Surgical; Female; Humans; Laminoplasty; Male; Postoperative Complications; Spinal Cord Diseases; Spinal Fusion; Treatment Outcome
PubMed: 24097230
DOI: 10.1007/s00586-013-3043-7 -
Orthopaedic Journal of Sports Medicine Nov 2018Anterior shoulder instability is the most common sequela of shoulder dislocation and can result in repeated dislocations or subluxation of the glenohumeral joint.... (Review)
Review
BACKGROUND
Anterior shoulder instability is the most common sequela of shoulder dislocation and can result in repeated dislocations or subluxation of the glenohumeral joint. Anterior shoulder instability can be treated conservatively or surgically with several procedures.
PURPOSE
To date, arthroscopic Bankart is the most common surgical procedure for the treatment of anterior shoulder instability. No previous studies have compared all anterior shoulder surgical procedures. In this study, the authors performed a systematic review of journal articles describing all surgical procedures for anterior shoulder instability to determine the scientific evidence and level of recommendation.
STUDY DESIGN
Systematic review; Level of evidence, 4.
METHOD
A comprehensive literature search was conducted (July 19, 2016) with 4 reputed databases: PubMed, EMBASE, the Cochrane databases, and Web of Science. The articles found in the literature search were screened by 2 reviewers on the basis of their titles, abstracts, and full text. Data were extracted from relevant studies, and potentially relevant records were selected for full-text review. Included articles were classified according to their scientific quality (level of evidence, 1-5). The studies were then combined for each surgical procedure, and a grade of recommendation was assigned for each procedure: grade A, treatment recommendation based on level 1 evidence studies; B, based on level 2 or 3 evidence studies; C, based on level 4 or 5 evidence and could represent conflicting results; or I, insufficient evidence to recommend a treatment. As such, the grade of recommendation provides a summary score for the quality and quantity of available literature to support the surgical procedures reviewed here.
RESULTS
The systematic literature review generated 11,281 articles. After screening, 655 articles were included. Results revealed 31 surgical procedures for shoulder instability following dislocation: 10 surgical procedures were given an A or B recommendation; 11, a C recommendation; and 10, an I recommendation.
CONCLUSION
This review identified many surgical procedures to treat anterior shoulder instability. Ten of these surgical procedures had an abundant amount of published articles to describe their safety and efficacy. Arthroscopic Bankart and open Bankart were the most commonly reported procedures that cite satisfactory postoperative outcomes and limited complications. Publications on the other surgical procedures were less common. Surgeons should be careful when recommending surgery, and they should choose the appropriate surgical procedure based on evidence-based literature.
PubMed: 30480013
DOI: 10.1177/2325967118805983 -
European Journal of Trauma and... Jun 2021The aim of this systematic review was to compare knee pain and function after tibial nail insertion through an infrapatellar, semi-extended and suprapatellar technique.
PURPOSE
The aim of this systematic review was to compare knee pain and function after tibial nail insertion through an infrapatellar, semi-extended and suprapatellar technique.
METHODS
A search was carried out to identify articles with an exact description of the method used for insertion of the tibial nail and description of the outcome parameters (knee pain or function). Data on study design, population, rate and severity of anterior knee pain and function scores were extracted. Pooled rates and scores were calculated.
RESULTS
67 studies with 3,499 patients were included. The pooled rate of patients with anterior knee pain was 38% (95% CI 32-44) after nail insertion through an infrapatellar approach and 10% (95% CI 1-26) after insertion through a suprapatellar approach. Pooled analysis was not possible for the semi-extended technique. Knee pain scores as measured by visual analogue score (0-10) ranged from 0.2 (95% CI - 0.1-0.5) for general knee pain to 3.7 (95% CI 1.3-6.1) for pain during kneeling. Pooled estimates for the Lysholm score were 87 points (range 77-97) for the infrapatellar technique and 85 points (range 82-85) for the suprapatellar technique. Iowa Knee scores were 94 (range 86-96) and Anterior Knee Pain Scale scores were 76 (range 75-80) after infrapatellar nail insertion.
DISCUSSION
Depending on the technique used, the proportion of patients with knee pain after tibial nailing varied between 10 and 38%. The actual measured knee pain scores were, however, surprisingly low. Knee function was good for both the infra- and suprapatellar technique.
Topics: Bone Nails; Fracture Fixation, Intramedullary; Humans; Pain; Tibia; Tibial Fractures; Treatment Outcome
PubMed: 32772136
DOI: 10.1007/s00068-020-01458-2