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PloS One 2019Many authors are interested in the effects that a specific exercise program could have on sagittal spinal curvatures. The purpose of this study was to determine the... (Meta-Analysis)
Meta-Analysis
Many authors are interested in the effects that a specific exercise program could have on sagittal spinal curvatures. The purpose of this study was to determine the effects of different exercise programs on thoracic kyphosis and lumbar lordotic angle. This meta-analysis adhered to the PRISMA guideline and it was registered at PROSPERO. Five electronic databases (Pub Med, Cochrane, WOS, PEDro and EBSCO) were searched up to 31 July 2018. Eligible studies were randomized controlled trials that applied an exercise intervention and measured a kyphosis and/or lordotic angle. Study quality was performance by PEDro score. Risk of bias was assessed using the SIGN 50 checklist for randomized controlled trials. External validity was assessed using the EVAT. Ten randomized controlled trials were included for systematic review and meta-analysis. Meta-analysis with a random effect model was performed to infer the pooled estimated standardized mean difference. All studies were RCTs and they involved a total of 284 cases and 255 controls. Seven studies measured kyphosis angle. A large significant effect of the exercise on kyphosis was identified (SMD = -1.400 (95% CI-2.150 a -0.660), p = 0.000). Four studies assessed lordotic angle and moderate but not significant improvement was shown (SMD = -0.530 (95% CI-1.760 a -0.700), p = 0.401). The results suggest that exercise programs may have a positive effect on thoracic kyphosis angle, but no clear effect on lordotic angle. This systematic review suggests that strengthening rather than stretching could be more relevant for kyphosis and both qualities are important for lordosis. It is necessary to conduct more randomized controlled trials to assess the effects of strengthening and/or stretching program on kyphosis and lordotic angle and to establish the type of the exercise that is better for maintaining the sagittal disposition within normal ranges.
Topics: Adolescent; Adult; Aged; Biomechanical Phenomena; Case-Control Studies; Exercise Therapy; Female; Humans; Kyphosis; Lordosis; Lumbar Vertebrae; Male; Middle Aged; Publication Bias; Thoracic Vertebrae; Young Adult
PubMed: 31034509
DOI: 10.1371/journal.pone.0216180 -
Journal of Clinical Anesthesia Jun 2022Erector spinae plane block (ESPB) has gained popularity for perioperative analgesia in various surgeries. However, its efficacy in lumbar surgery remains unclear. This... (Meta-Analysis)
Meta-Analysis Review
STUDY OBJECTIVE
Erector spinae plane block (ESPB) has gained popularity for perioperative analgesia in various surgeries. However, its efficacy in lumbar surgery remains unclear. This review aimed to determine whether ESPB could improve analgesic efficacy in lumbar spine surgery.
DESIGN
A meta-analysis of randomized controlled trials.
SETTING
Perioperative setting.
PATIENTS
Patients undergoing lumbar spine surgery under general anesthesia.
INTERVENTIONS
We searched the databases including PubMed, Cochrane Library, EMBASE, Web of Science etc. for published eligible controlled trials comparing ESPB with control (no block/sham block) in lumbar spine surgery.
MEASUREMENTS
The primary outcome was opioid consumption in the first 24 h after surgery.
MAIN RESULTS
Twelve studies comprising 665 participants were included. Compared to the control, ESPB reduced the opioid (morphine milligram equivalents) consumption significantly 24 h after surgery [mean difference (MD) = -14.55; 95% confidence interval (CI), -21.03 to -8.07; P < 0.0001] and lowered the pain scores at various time points (at rest or during movement) for 48 h after surgery. ESPB increased the patient satisfaction score (0-10) (MD = 2.38; 95% CI, 2.10 to 2.66; P < 0.0001), decreased the postoperative nausea and vomiting [risk ratio (RR) = 0.36; 95% CI, 0.20 to 0.67; P = 0.001], and minimized the length of hospital stay (MD = -1.24 days; 95% CI, -2.31 to -0.18; P = 0.02). Furthermore, subgroup analysis revealed additional reduction in opioid consumption by the block approach at the vertebral level of incision/operation than that at the fixed thoracic/lumbar level. However, considerable heterogeneity and low-grade quality of evidence were observed.
CONCLUSIONS
ESPB provided effective postoperative analgesia resulting in better patient satisfaction and recovery with decreased postoperative nausea and vomiting in patients undergoing lumbar surgery compared to the control. However, the low-grade quality of evidence compromised the findings, therefore further high-quality of evidence is required. PROSPERO registration number: CRD42021233362.
Topics: Analgesics, Opioid; Humans; Nerve Block; Pain, Postoperative; Paraspinal Muscles; Postoperative Nausea and Vomiting
PubMed: 35030493
DOI: 10.1016/j.jclinane.2022.110647 -
Deutsches Arzteblatt International Oct 2021The prevalence of osteoporotic vertebral body fractures in Europe is 18-26%. Although most of these injuries can be treated conservatively, the underlying concepts have...
BACKGROUND
The prevalence of osteoporotic vertebral body fractures in Europe is 18-26%. Although most of these injuries can be treated conservatively, the underlying concepts have not been defined clearly or uniformly. In this article, we present the current state of the evidence on the diagnosis and conservative treatment of osteoporotic fractures of the thoracic and lumbar vertebrae.
METHODS
A systematic review of the literature up to May 2020 was carried out in the PubMed and Web of Science Core Collection databases. 549 articles were identified, of which 36 were suitable for inclusion in the review. Articles were sought in the areas of diagnosis, provision of physical aids, pharmacotherapy, physiotherapy, and treatments from the realm of alternative medicine.
RESULTS
The primary diagnostic technique was conventional x-ray in two planes (with the patient standing, if possible), which had 51.3% sensitivity and 75% specificity. If a fracture was suspected, magnetic resonance imaging (MRI) of the entire spine and regional computed tomography (CT) were carried out. The overall state of the evidence on treatment is poor; the best available evidence is for exercise therapy and physiotherapy, which are supported by three level I and four level II studies. Improvements were seen mainly in mobility and a reduced fear of falling. The use of an active orthosis can be useful as well. No evidence was found on the use of drugs or alternative medicine exclusively in the conservative treatment of osteoporotic vertebral body fractures.
CONCLUSION
It is reasonable to evaluate instability with imaging repeatedly, at regular intervals, over a period of six months. There is still a lack of reliable data on the optimal intensity and duration of physiotherapy, and on the use of orthoses.
Topics: Accidental Falls; Conservative Treatment; Fear; Humans; Lumbar Vertebrae; Osteoporotic Fractures; Spinal Fractures
PubMed: 34342263
DOI: 10.3238/arztebl.m2021.0295 -
Journal of Clinical Epidemiology Jan 2011Determining anatomic sites and circumstances under which a fracture may be a consequence of osteoporosis is a topic of ongoing debate and controversy that is important... (Review)
Review
BACKGROUND
Determining anatomic sites and circumstances under which a fracture may be a consequence of osteoporosis is a topic of ongoing debate and controversy that is important to both clinicians and researchers.
METHODS
We conducted a systematic literature review and generated an evidence report on fracture risk based on specific anatomic bone sites and fracture diagnosis codes. Using the Research and Development/University of California at Los Angeles appropriateness process, we convened a multidisciplinary panel of 11 experts who rated fractures according to their likelihood of being because of osteoporosis based on the evidence report. Fracture sites (as determined by International Classification of Diseases Clinical Modification codes) were stratified by four clinical risk factor categories based on age, sex, race/ethnicity (African American and Caucasian), and presence or absence of trauma.
RESULTS
Consistent with current clinical experience, the fractures rated most likely because of osteoporosis were the femoral neck, pathologic fractures of the vertebrae, and lumbar and thoracic vertebral fractures. The fractures rated least likely because of osteoporosis were open proximal humerus fractures, skull, and facial bones. The expert panel rated open fractures of the arm (except proximal humerus) and fractures of the tibia/fibula, patella, ribs, and sacrum as being highly likely because of osteoporosis in older Caucasian women but a lower likelihood in younger African American men.
CONCLUSION
Osteoporosis attribution scores for all fracture sites were determined by a multidisciplinary expert panel to provide an evidence-based continuum of the likelihood of a fracture being associated with osteoporosis.
Topics: Aged; Aged, 80 and over; Bone Density; Disease Susceptibility; Female; Fractures, Bone; Humans; Male; Osteoporosis; Practice Guidelines as Topic; Probability; Risk Factors; United States
PubMed: 21130353
DOI: 10.1016/j.jclinepi.2010.07.007 -
Journal of Cachexia, Sarcopenia and... Dec 2022Sarcopenia measured through body composition analysis is emerging as an important prognosticator among various malignancies, including oesophageal cancer. Skeletal... (Meta-Analysis)
Meta-Analysis Review
Sarcopenia measured through body composition analysis is emerging as an important prognosticator among various malignancies, including oesophageal cancer. Skeletal muscle index (SMI) as determined by the third lumbar vertebrae on cross-sectional CT images has been demonstrated as a predictor of overall survival in oesophageal cancer, using pre-defined cut off values for sarcopenia. However, this is largely within the setting of resectable disease. The primary objective of this systematic review and meta-analysis was to determine the effect of sarcopenia defined by SMI on overall-survival in patients with unresectable oesophageal cancer. On 30 January 2021, a systematic search of the literature was conducted to identify the role of SMI among patients with unresectable oesophageal cancer, with overall survival as the primary outcome. Databases included MEDLINE, EMBASE, Scopus, Web of Science, and Cochrane Library. Inclusion criteria included age >18, diagnosis of oesophageal cancer, and non-operative management. A meta-analysis was conducted using RevMan 5.4.1 using an inverse variance, random effects model. After the removal of duplicates, 2755 unique search results were obtained. Manual screening of titles and abstracts resulted in 287 full text articles that were reviewed. Of these, five studies met the inclusion criteria with data evaluating the effect of sarcopenia defined by SMI on overall survival. A total of 783 patients, the majority of which were male (n = 638, 81%), with a mean age of 68 ± 2.3 years were included. 641 (82%) patients were diagnosed with squamous cell carcinoma. Sarcopenia, as determined by SMI using pre-defined cut-off values, was reported in 517 patients (66%). Meta-analysis demonstrated decreased overall survival in the sarcopenia group compared with the non-sarcopenia group (HR = 1.51; 95% CI 1.21-1.89; P = 0.0003; I = 0%; Figure 1). No significant publication bias was noted on assessment of funnel plot and Egger's test (P = 0.295). Sarcopenia as defined by SMI is predictive of overall survival among patients with nonoperative oesophageal cancer. Further analysis on the effect of sarcopenia on treatment related adverse effects and complications, particularly related to chemotherapy, radiotherapy, and oesophageal stenting, is needed to identify the degree of prognostication offered by body composition analysis. Studies on the modifiability of sarcopenia will help determine the utility of nutritional interventions.
Topics: Humans; Male; Female; Aged; Prognosis; Sarcopenia; Esophageal Neoplasms; Muscle, Skeletal; Body Composition
PubMed: 36151845
DOI: 10.1002/jcsm.13082 -
Medicina (Kaunas, Lithuania) May 2022Osteoporotic hyperkyphosis is associated with adverse outcomes, such as fatigue, back pain, or reduced back extensor strength, with a negative impact on functionality... (Review)
Review
Osteoporotic hyperkyphosis is associated with adverse outcomes, such as fatigue, back pain, or reduced back extensor strength, with a negative impact on functionality and quality of life. The purpose of this review is to assess the effectiveness of spinal orthosis on these adverse effects. A systematic review following the PRISMA guidelines was performed. Inclusion criteria were (1) women with osteoporosis; (2) randomized controlled trials only; and (3) type of intervention: spinal bracing. Exclusion criteria were (1) article not written in English; (2) full-text not available; and (3) no kyphosis assessment. Quality-of-life variables such as back pain, functional variables such as back extensor strength, and osteoporotic-related variables such as lumbar spine bone mineral density were extracted and recorded before and after the intervention. The characteristics of the intervention programs were also extracted and recorded. The characteristics of studies, interventions, and participants are summarized in a table. Then, the revised Cochrane risk-of-bias tool for randomized trials (RoB 2) was used to assess the quality of the studies. Four randomized controlled trials with a low risk of bias were included ( = 326 women with osteoporosis, aged 51-93 years). Interventions consisting of wearing a dynamic hyperextension orthosis for at least two hours per day for six months improved functionality, mobility, back extensor strength, respiratory function, and reduced the thoracic kyphosis angle. Spinal orthosis, especially dynamic hyperextension braces, seems effective in improving the adverse outcomes of osteoporotic hyperkyphosis. It does not seem necessary to wear the orthosis during all daily activities.
Topics: Back Pain; Braces; Female; Humans; Kyphosis; Lumbar Vertebrae; Osteoporosis; Osteoporotic Fractures; Quality of Life; Spinal Fractures
PubMed: 35743956
DOI: 10.3390/medicina58060693 -
Archives of Orthopaedic and Trauma... Jul 2022The aim of this study was to give a systematic overview over the rate and location of concomitant injuries, the probability of suffering from neurological deficits, and... (Review)
Review
PURPOSE
The aim of this study was to give a systematic overview over the rate and location of concomitant injuries, the probability of suffering from neurological deficits, and to give evidence of the timing of surgery in severely injured patients with unstable thoracic vertebral body fractures.
METHODS
This review is based on articles retrieved by a systematic search in the PubMed and Web of Science database for publications up to November 2020 dealing with unstable fractures of the mid-thoracic spine.
RESULTS
Altogether, 1109 articles were retrieved from the literature search. A total of 1095 articles were excluded. Thus, 16 remaining original articles were included in this systematic review depicting the topics timing of surgery in polytraumatized patients, outcome neurologic deficits, and impact of concomitant injuries. The overall level of evidence of the vast majority of studies is low.
CONCLUSION
The evidence of the available literature is low. The cited studies reveal that thoracic spinal fractures are associated with a high number of neurological deficits and concomitant injuries, particularly of the thoracic cage and the lung. Thereby, diagnostic algorithm should include computer tomography of the whole thoracic cage if there is any clinical sign of concomitant injuries. Patients with incomplete neurologic deficits benefit from early surgery consisting of decompression and long-segmental stabilization.
Topics: Humans; Lumbar Vertebrae; Spinal Fractures; Thoracic Injuries; Thoracic Vertebrae; Vertebral Body
PubMed: 33649914
DOI: 10.1007/s00402-021-03830-2 -
BMJ Open Nov 2016The aim of this study was to compare outcomes when the upper and lower thoracic regions were used as the site of proximal instrumentation to treat adult spinal deformity. (Meta-Analysis)
Meta-Analysis Review
Long fusion correction of degenerative adult spinal deformity and the selection of the upper or lower thoracic region as the site of proximal instrumentation: a systematic review and meta-analysis.
OBJECTIVE
The aim of this study was to compare outcomes when the upper and lower thoracic regions were used as the site of proximal instrumentation to treat adult spinal deformity.
METHODS
MEDLINE, Embase and Cochrane library searches were performed to identify studies that compared outcome measures when the upper and lower thoracic vertebrae (UTV and LTV, respectively) were used as the site of proximal instrumentation. The weighted mean difference (WMD) was calculated for continuous outcomes, and the relative risk (RR) was calculated for dichotomous outcomes.
RESULTS
Seven articles (n=554 patients) met the final inclusion criteria, and we compared the outcome measures of a long fusion extending to the upper and lower thoracic regions. The pooled analysis revealed that extending fixation into the upper thoracic region decreased the risk of proximal junctional kyphosis (PJK) revision surgery (RR: 0.36, 95% CI 0.14 to 0.90, p<0.05). The operation time (WMD: 0.93, 95% CI 0.48 to 1.39, p<0.05) and estimated blood loss (WMD: 0.59, 95% CI 0.33 to 0.85, p<0.05) were significantly greater in the UTV group than in the LTV group. No significant differences were found in the Scoliosis Research Society pain, self-image, function, mental health, subtotal, satisfaction or total scores; the total number of complications or the total number of revision surgeries.
CONCLUSIONS
Long posterior fixation extending into the upper thoracic region reduces the incidence of revision surgery related to PJK; however, it increased the operative level resulting in a longer operative time and greater estimated blood loss. This initial analysis indicates that extending fixation to the upper thoracic region is appropriate for patients who are likely to develop PJK following initial scoliosis correction.
Topics: Blood Loss, Surgical; Humans; Kyphosis; Operative Time; Postoperative Complications; Reoperation; Scoliosis; Spinal Fusion; Treatment Outcome
PubMed: 27852709
DOI: 10.1136/bmjopen-2016-012103 -
European Journal of Trauma and... Oct 2021The aim of this review is to systematically screen the literature for clinical and biomechanical studies dealing with posterior stabilization of acute traumatic... (Review)
Review
PURPOSE
The aim of this review is to systematically screen the literature for clinical and biomechanical studies dealing with posterior stabilization of acute traumatic mid-thoracic vertebral fractures in patients with normal bone quality.
METHODS
This review is based on articles retrieved by a systematic search in the PubMed and Web of Science database for publications up to December 2018 dealing with the posterior stabilization of fractures of the mid-thoracic spine.
RESULTS
Altogether, 1012 articles were retrieved from the literature search. A total of 960 articles were excluded. A total of 16 articles were dealing with the timing of surgery in polytraumatized patients, patients suffering of neurologic deficits after midthoracic fractures, and the impact of concomitant thoracic injuries and were excluded. Thus, 36 remaining original articles were included in this systematic review depicting the topics biomechanics, screw insertion, and outcome after posterior stabilization. The overall level of evidence of the vast majority of studies is low.
CONCLUSION
High quality studies are lacking. Long-segmental stabilization is indicated in unstable midthoracic fractures with concomitant sternal fractures. Generally, long-segmental constructs seem to be the safer treatment strategy considering the relative high penetration rate of pedicle screws in this region. Thereby, navigated insertion techniques and intraoperative 3D-imaging help to improve pedicle screw placement accuracy.
Topics: Biomechanical Phenomena; Humans; Lumbar Vertebrae; Pedicle Screws; Spinal Fractures; Spinal Fusion; Thoracic Injuries; Thoracic Vertebrae; Treatment Outcome; Vertebral Body
PubMed: 33263816
DOI: 10.1007/s00068-020-01560-5 -
Spine Jul 2018Systematic review and meta-analysis. (Meta-Analysis)
Meta-Analysis Review
STUDY DESIGN
Systematic review and meta-analysis.
OBJECTIVE
Examine the functional outcomes and complications following laminectomy for thoracic myelopathy due to ossification of the ligamentum flavum (OLF).
SUMMARY OF BACKGROUND DATA
OLF is a rare condition that can cause thoracic myelopathy. Laminectomy is a procedure that can be performed to decompress the spinal cord in patients with thoracic myelopathy due to OLF. Few studies have examined postoperative outcomes and complications following laminectomy for thoracic myelopathy secondary to OLF.
METHODS
A systematic review and meta-analysis was performed. Literature search yielded six studies that met our selection criteria. Study characteristics and baseline patient demographics were extracted from each study. Primary outcomes included pre- and postoperative Japanese Orthopedic Association (JOA) scores and perioperative complications including dural tears, cerebrospinal fluid (CSF) leaks, neurological deficits, surgical site infections, and other complications. We calculated pooled proportion estimates for JOA scores and complications using a random effects model.
RESULTS
A total of 137 patients were included. The pooled pre- and postoperative JOA scores were 5.08 (95% confidence interval [CI], 2.70-7.47; I = 98%) and 8.29 (95% CI, 7.73-8.85; I = 18%), respectively, with a mean improvement of +3.03 points (95% CI, 1.08-4.98; I = 88%). Pooled proportion estimates for dural tears, CSF leaks, infections, and early neurological deficits were 18.4% (95% CI, 12.6-26.1; I = 0%), 12.1% (95% CI, 6.6-21.2; I = 0%), 5.8% (95% CI, 2.1-15.4; I = 0%), and 5.7% (95% CI, 2.2-14.3; I = 0%), respectively.
CONCLUSION
Thoracic myelopathy secondary to OLF can be treated with laminectomy. However, despite some improvement in JOA score, functional status remains poor postoperatively. Perioperative complications are common, with dural tears and CSF leaks occurring most frequently. OLF is an uncommon condition and more research is needed to better understand how we can improve the outcomes of laminectomy alone for the treatment of thoracic myelopathy due to OLF.
LEVEL OF EVIDENCE
3.
Topics: Humans; Laminectomy; Ligamentum Flavum; Ossification, Heterotopic; Postoperative Complications; Spinal Cord Diseases; Thoracic Vertebrae; Treatment Outcome
PubMed: 29940604
DOI: 10.1097/BRS.0000000000002563