首页 > 最新文献

International Journal of Spine Surgery最新文献

英文 中文
Letter to the Editor: Rasch Analysis and High Value Spinal Endoscopy-Another Perspective. 致编辑的信:拉施分析与高价值脊柱内窥镜检查--另一种视角。
IF 1.7 Q2 SURGERY Pub Date : 2024-11-20 DOI: 10.14444/8682
Daniel K Resnick
{"title":"Letter to the Editor: Rasch Analysis and High Value Spinal Endoscopy-Another Perspective.","authors":"Daniel K Resnick","doi":"10.14444/8682","DOIUrl":"10.14444/8682","url":null,"abstract":"","PeriodicalId":38486,"journal":{"name":"International Journal of Spine Surgery","volume":" ","pages":"S87-S88"},"PeriodicalIF":1.7,"publicationDate":"2024-11-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142583909","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Letter to the Editor: Hierarchy of Evidence. 致编辑的信:证据等级。
IF 1.7 Q2 SURGERY Pub Date : 2024-11-20 DOI: 10.14444/8677
Mauricio G Pereira
{"title":"Letter to the Editor: Hierarchy of Evidence.","authors":"Mauricio G Pereira","doi":"10.14444/8677","DOIUrl":"10.14444/8677","url":null,"abstract":"","PeriodicalId":38486,"journal":{"name":"International Journal of Spine Surgery","volume":" ","pages":"S83-S84"},"PeriodicalIF":1.7,"publicationDate":"2024-11-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142576882","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Management of Spinal Langerhans Cell Histiocytosis in Children: A Systematic Review. 儿童脊髓朗格汉斯细胞组织细胞增生症的治疗:系统回顾
IF 1.7 Q2 SURGERY Pub Date : 2024-11-19 DOI: 10.14444/8662
Macherla Haribabu Subramaniam, Victor Moirangthem, Muralidharan Venkatesan

Background: Spinal Langerhans cell histiocytosis can manifest as solitary site unifocal form or as systemic form in children. The management options for solitary spinal site unifocal form are many. They include spontaneous resolution of the lesion and supervised treatment, steroid injection of the lesion, systemic chemotherapy, radiation therapy and surgery. Multiple options create a decision-making dilemma for the treating specialist. The authors sought to formulate a management algorithm of spinal Langerhans cell histiocytosis based on Garg's grading of radiographic vertebral body collapse.

Materials and methods: The Preferred Reporting Items for Systematic Reviews and Meta-Analyses-2020 guidelines were followed in conducting the review and studies were filtered from established medical databases. Articles published between 2003 and 2022 were included after applying strict inclusion and exclusion criteria. The first and second authors reviewed the abstracts of filtered studies before including them. The study was registered with Prospero. The bias assessment of included studies was assessed using the MINOR's criteria.

Results: Eight retrospective case series were analyzed. Within these studies, a total of 116 children (mean age 7.4 years) had undergone treatment. The mean follow-up period was 52.1 months. Among these patients, there were 37 tumors in the cervical spine, 40 in the thoracic spine, 25 in the lumbar spine, and a single tumor in the sacrum. Systemic chemotherapy has been found to reduce the risk of radiographic vertebral body collapse (p < 0.05). Surgery provides optimal outcomes in patients with Garg's grade IB , II spinal tumors and restores vertebral body height (p < 0.05). No case series were found pertaining to grade III. Reconstitution of vertebral body height, an important radiological parameter indicating the endpoint or healing of the lesion, was early achieved with surgery followed by systemic chemotherapy, bracing, and supervised management.

Conclusion: Observation can be preferred in Garg's grade IA. Grade IB and II tumors respond well to surgery. Treatment for grade III tumors needs to be tailored on an individual basis.

Grade of recommendation: C.

背景:脊柱朗格汉斯细胞组织细胞增生症在儿童中可表现为单发的单灶型或全身型。脊柱单发性组织细胞增生症的治疗方法很多。其中包括病灶自发消退和监督治疗、病灶注射类固醇、全身化疗、放疗和手术。多种选择给治疗专家带来了决策难题。作者试图根据Garg对放射学椎体塌陷的分级,制定脊柱朗格汉斯细胞组织细胞增生症的管理算法:在进行综述时遵循了《系统综述和元分析首选报告项目-2020》指南,并从已建立的医学数据库中筛选了相关研究。在采用严格的纳入和排除标准后,纳入了 2003 年至 2022 年间发表的文章。第一作者和第二作者对筛选出的研究摘要进行了审阅,然后再将其纳入研究。研究已在 Prospero 注册。纳入研究的偏倚评估采用 MINOR 标准:结果:分析了 8 项回顾性系列病例研究。在这些研究中,共有 116 名儿童(平均年龄为 7.4 岁)接受了治疗。平均随访时间为 52.1 个月。在这些患者中,有 37 例肿瘤位于颈椎,40 例位于胸椎,25 例位于腰椎,1 例位于骶骨。研究发现,全身化疗可降低放射性椎体塌陷的风险(P < 0.05)。手术治疗能为伽格 IB 和 II 级脊柱肿瘤患者带来最佳疗效,并能恢复椎体高度(P < 0.05)。没有发现与 III 级相关的病例系列。椎体高度的恢复是表明病变终点或愈合的一个重要放射学参数,通过手术、全身化疗、支具和监护管理可以尽早实现椎体高度的恢复:结论:Garg的IA级肿瘤可首选观察治疗。结论:Garg'sⅠA 级肿瘤可首选观察治疗,ⅠB 和Ⅱ级肿瘤对手术治疗反应良好。III级肿瘤的治疗需要因人而异:C.
{"title":"Management of Spinal Langerhans Cell Histiocytosis in Children: A Systematic Review.","authors":"Macherla Haribabu Subramaniam, Victor Moirangthem, Muralidharan Venkatesan","doi":"10.14444/8662","DOIUrl":"https://doi.org/10.14444/8662","url":null,"abstract":"<p><strong>Background: </strong>Spinal Langerhans cell histiocytosis can manifest as solitary site unifocal form or as systemic form in children. The management options for solitary spinal site unifocal form are many. They include spontaneous resolution of the lesion and supervised treatment, steroid injection of the lesion, systemic chemotherapy, radiation therapy and surgery. Multiple options create a decision-making dilemma for the treating specialist. The authors sought to formulate a management algorithm of spinal Langerhans cell histiocytosis based on Garg's grading of radiographic vertebral body collapse.</p><p><strong>Materials and methods: </strong>The Preferred Reporting Items for Systematic Reviews and Meta-Analyses-2020 guidelines were followed in conducting the review and studies were filtered from established medical databases. Articles published between 2003 and 2022 were included after applying strict inclusion and exclusion criteria. The first and second authors reviewed the abstracts of filtered studies before including them. The study was registered with Prospero. The bias assessment of included studies was assessed using the MINOR's criteria.</p><p><strong>Results: </strong>Eight retrospective case series were analyzed. Within these studies, a total of 116 children (mean age 7.4 years) had undergone treatment. The mean follow-up period was 52.1 months. Among these patients, there were 37 tumors in the cervical spine, 40 in the thoracic spine, 25 in the lumbar spine, and a single tumor in the sacrum. Systemic chemotherapy has been found to reduce the risk of radiographic vertebral body collapse (p < 0.05). Surgery provides optimal outcomes in patients with Garg's grade IB , II spinal tumors and restores vertebral body height (p < 0.05). No case series were found pertaining to grade III. Reconstitution of vertebral body height, an important radiological parameter indicating the endpoint or healing of the lesion, was early achieved with surgery followed by systemic chemotherapy, bracing, and supervised management.</p><p><strong>Conclusion: </strong>Observation can be preferred in Garg's grade IA. Grade IB and II tumors respond well to surgery. Treatment for grade III tumors needs to be tailored on an individual basis.</p><p><strong>Grade of recommendation: </strong>C.</p>","PeriodicalId":38486,"journal":{"name":"International Journal of Spine Surgery","volume":" ","pages":""},"PeriodicalIF":1.7,"publicationDate":"2024-11-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142677186","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Safety of Outpatient Anterior Lumbar Interbody Fusion Surgery: A Systematic Review With Meta-Analyses. 门诊前路腰椎椎间融合手术的安全性:系统性回顾与 Meta 分析。
IF 1.7 Q2 SURGERY Pub Date : 2024-11-19 DOI: 10.14444/8661
Luke J Weisbrod, Brandon L Staple, Danielle M Westmark, Andrew P Gard, Daniel L Surdell

Background: Due to rapidly rising health care costs, leveraging outpatient surgery to reduce hospital inpatient burden is being explored. This study provides a systematic review of the literature on outpatient anterior lumbar interbody fusion (ALIF) with pooled analysis to determine its safety and feasibility.

Methods: Embase (Elsevier), MEDLINE (National Library of Medicine), CINAHL (EBSCO), and the Cochrane Library (Wiley) were searched on 8 April 2024 for articles mentioning the following search concepts: (1) ambulatory; (2) outpatient; and (3) ALIF surgery. Included studies had (1) patients undergoing outpatient ALIF; (2) an inpatient control group; (3) a sample size of ≥5 in each cohort; and (4) a population aged ≥18 years. Outcome data were extracted from studies meeting inclusion criteria, and Newcastle-Ottawa scores were assigned to included studies lacking a prospective, randomized design. Fixed and random effects models were used to establish ORs and mean difference with 95% CIs for each outcome.

Results: Pooled analysis included results from 4 studies. A total of 2070 patients underwent outpatient ALIF and 12,554 underwent inpatient ALIF. The results showed that compared with inpatient ALIF, outpatient ALIF resulted in a statistically significant decrease in postoperative adverse events (OR -0.89, 95% CI [-1.69, -0.09], I 2 = 54.88%, P = 0.03), comparable readmission rates (OR 0.02, 95% CI [-0.16, 0.20], I 2 = 0%, P = 0.816), and nearly statistically significant decrease in reoperation rates (OR -0.41, 95% CI [-0.83, -0.00], I 2 = 0%, P = 0.05).

Discussion: These meta-analyses suggest that outpatient ALIF is associated with a statistically significant decrease in postoperative adverse events without a significant difference in hospital readmission or reoperation rates. These results suggest that in carefully selected patients, outpatient ALIF is safe and feasible. This study is limited by pooled analysis of retrospective data.

Clinical relevance: This systematic review contributes to the assessment of the safety of outpatient ALIF spine surgery.

Level of evidence: 3:

背景:由于医疗费用的快速上涨,人们正在探索利用门诊手术来减轻住院患者的负担。本研究对有关门诊前路腰椎椎体间融合术(ALIF)的文献进行了系统回顾,并进行了汇总分析,以确定其安全性和可行性:于 2024 年 4 月 8 日检索了 Embase(Elsevier)、MEDLINE(美国国家医学图书馆)、CINAHL(EBSCO)和 Cochrane 图书馆(Wiley)中提及以下检索概念的文章:(1) 非卧床;(2) 门诊;(3) ALIF 手术。纳入的研究必须:(1) 接受门诊 ALIF 手术的患者;(2) 有住院对照组;(3) 每个队列的样本量≥5;(4) 年龄≥18 岁的人群。从符合纳入标准的研究中提取结果数据,并对缺乏前瞻性随机设计的纳入研究进行纽卡斯尔-渥太华评分。采用固定效应和随机效应模型确定每项结果的ORs和平均差,以及95% CIs:汇总分析包括 4 项研究的结果。结果显示,与住院患者相比,门诊患者的术后不良事件显著减少(OR -0.89,95% CI [-1.69,-0.09],I 2 = 54.88%,P = 0.03),再入院率相当(OR 0.02,95% CI [-0.16,0.20],I 2 = 0%,P = 0.816),再手术率几乎有统计学意义的显著下降(OR -0.41,95% CI [-0.83,-0.00],I 2 = 0%,P = 0.05):讨论:这些荟萃分析表明,门诊 ALIF 与术后不良事件的统计学意义上的显著减少有关,但在再入院率或再手术率方面没有显著差异。这些结果表明,对于经过严格筛选的患者,门诊 ALIF 是安全可行的。本研究受限于对回顾性数据的汇总分析:本系统综述有助于评估门诊ALIF脊柱手术的安全性:3:
{"title":"Safety of Outpatient Anterior Lumbar Interbody Fusion Surgery: A Systematic Review With Meta-Analyses.","authors":"Luke J Weisbrod, Brandon L Staple, Danielle M Westmark, Andrew P Gard, Daniel L Surdell","doi":"10.14444/8661","DOIUrl":"https://doi.org/10.14444/8661","url":null,"abstract":"<p><strong>Background: </strong>Due to rapidly rising health care costs, leveraging outpatient surgery to reduce hospital inpatient burden is being explored. This study provides a systematic review of the literature on outpatient anterior lumbar interbody fusion (ALIF) with pooled analysis to determine its safety and feasibility.</p><p><strong>Methods: </strong>Embase (Elsevier), MEDLINE (National Library of Medicine), CINAHL (EBSCO), and the Cochrane Library (Wiley) were searched on 8 April 2024 for articles mentioning the following search concepts: (1) ambulatory; (2) outpatient; and (3) ALIF surgery. Included studies had (1) patients undergoing outpatient ALIF; (2) an inpatient control group; (3) a sample size of ≥5 in each cohort; and (4) a population aged ≥18 years. Outcome data were extracted from studies meeting inclusion criteria, and Newcastle-Ottawa scores were assigned to included studies lacking a prospective, randomized design. Fixed and random effects models were used to establish ORs and mean difference with 95% CIs for each outcome.</p><p><strong>Results: </strong>Pooled analysis included results from 4 studies. A total of 2070 patients underwent outpatient ALIF and 12,554 underwent inpatient ALIF. The results showed that compared with inpatient ALIF, outpatient ALIF resulted in a statistically significant decrease in postoperative adverse events (OR -0.89, 95% CI [-1.69, -0.09], <i>I</i> <sup>2</sup> = 54.88%, <i>P</i> = 0.03), comparable readmission rates (OR 0.02, 95% CI [-0.16, 0.20], <i>I</i> <sup>2</sup> = 0%, <i>P</i> = 0.816), and nearly statistically significant decrease in reoperation rates (OR -0.41, 95% CI [-0.83, -0.00], <i>I</i> <sup>2</sup> = 0%, <i>P</i> = 0.05).</p><p><strong>Discussion: </strong>These meta-analyses suggest that outpatient ALIF is associated with a statistically significant decrease in postoperative adverse events without a significant difference in hospital readmission or reoperation rates. These results suggest that in carefully selected patients, outpatient ALIF is safe and feasible. This study is limited by pooled analysis of retrospective data.</p><p><strong>Clinical relevance: </strong>This systematic review contributes to the assessment of the safety of outpatient ALIF spine surgery.</p><p><strong>Level of evidence: 3: </strong></p>","PeriodicalId":38486,"journal":{"name":"International Journal of Spine Surgery","volume":" ","pages":""},"PeriodicalIF":1.7,"publicationDate":"2024-11-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142677187","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
When Would Minimally Invasive Spinal Surgery Not Be Preferable for Metastatic Spine Disease? 何时微创脊柱手术不适合转移性脊柱疾病?
IF 1.7 Q2 SURGERY Pub Date : 2024-11-15 DOI: 10.14444/8658
Si Jian Hui, Jiong Hao Tan, Sahil Athia, Priyambada Kumar, Renick Lee, Shahid Ali, Seok Woo Kim, Naresh Kumar

Background: Metastatic spine tumor surgery (MSTS) is an important treatment modality of metastatic spinal disease (MSD). Open spine surgery (OSS) was previously the gold standard of treatment till the early 2010s. However, advancements in MSTS in recent years have led to the advent of minimally invasive spinal surgery (MISS) techniques for the treatment of MSD. The clear benefits of MISS have resulted in a current paradigm shift toward today's gold standard of MISS and early adjuvant radiotherapy in treating MSD patients. Nonetheless, despite improvements in surgical techniques and the rise of literature supporting MISS for MSD, there are still certain situations whereby MISS is not desirable or even suitable. There has also yet to be any literature describing the considerations of not using MISS in MSD in today's clinical context.

Methods: A narrative review was conducted for this manuscript. All studies related to OSS and MISS in MSTS were included.

Results: A total of 54 studies were included in this review. These studies discussed various advantages of MISS for MSD in today's clinical context, including the patient profile, location of vertebrae involved with metastasis requiring treatment, tumor characteristics, as well as equipment availability.

Conclusion: This study establishes situations in which MISS can be less applicable despite the advantages it may confer over traditional OSS. MSTS should be individualized, depending on the experience of the surgeon. OSS is a time-tested approach that still holds weight in MSTS and should be readily utilized depending on the clinical situation.

Level of evidence: 4:

背景:转移性脊柱肿瘤手术(MSTS)是转移性脊柱疾病(MSD)的一种重要治疗方式。直到 2010 年代初,开放脊柱手术(OSS)一直是治疗的金标准。然而,近年来脊柱微创手术(MSTS)的进步导致了用于治疗 MSD 的微创脊柱手术(MISS)技术的出现。微创脊柱手术的明显优势导致了目前治疗 MSD 患者的范式向微创脊柱手术和早期辅助放疗这一黄金标准转变。然而,尽管手术技术有所改进,支持 MISS 治疗 MSD 的文献也在增加,但在某些情况下,MISS 仍然不可取,甚至不适合。在当今的临床背景下,也还没有任何文献描述在 MSD 中不使用 MISS 的考虑因素:本手稿进行了叙述性综述。方法: 为撰写本稿件,我们进行了叙述性综述,纳入了所有与开放源码软件和 MISS 在 MSTS 中的应用相关的研究:结果:本综述共纳入 54 项研究。这些研究讨论了 MISS 在当今临床环境下用于 MSD 的各种优势,包括患者情况、需要治疗的转移椎体位置、肿瘤特征以及设备可用性:本研究确定了在哪些情况下 MISS 的适用性较低,尽管它可能比传统的 OSS 更具优势。MSTS 应根据外科医生的经验进行个性化设计。OSS是一种久经考验的方法,在MSTS中仍具有重要意义,应根据临床情况随时使用:4:
{"title":"When Would Minimally Invasive Spinal Surgery Not Be Preferable for Metastatic Spine Disease?","authors":"Si Jian Hui, Jiong Hao Tan, Sahil Athia, Priyambada Kumar, Renick Lee, Shahid Ali, Seok Woo Kim, Naresh Kumar","doi":"10.14444/8658","DOIUrl":"https://doi.org/10.14444/8658","url":null,"abstract":"<p><strong>Background: </strong>Metastatic spine tumor surgery (MSTS) is an important treatment modality of metastatic spinal disease (MSD). Open spine surgery (OSS) was previously the gold standard of treatment till the early 2010s. However, advancements in MSTS in recent years have led to the advent of minimally invasive spinal surgery (MISS) techniques for the treatment of MSD. The clear benefits of MISS have resulted in a current paradigm shift toward today's gold standard of MISS and early adjuvant radiotherapy in treating MSD patients. Nonetheless, despite improvements in surgical techniques and the rise of literature supporting MISS for MSD, there are still certain situations whereby MISS is not desirable or even suitable. There has also yet to be any literature describing the considerations of not using MISS in MSD in today's clinical context.</p><p><strong>Methods: </strong>A narrative review was conducted for this manuscript. All studies related to OSS and MISS in MSTS were included.</p><p><strong>Results: </strong>A total of 54 studies were included in this review. These studies discussed various advantages of MISS for MSD in today's clinical context, including the patient profile, location of vertebrae involved with metastasis requiring treatment, tumor characteristics, as well as equipment availability.</p><p><strong>Conclusion: </strong>This study establishes situations in which MISS can be less applicable despite the advantages it may confer over traditional OSS. MSTS should be individualized, depending on the experience of the surgeon. OSS is a time-tested approach that still holds weight in MSTS and should be readily utilized depending on the clinical situation.</p><p><strong>Level of evidence: 4: </strong></p>","PeriodicalId":38486,"journal":{"name":"International Journal of Spine Surgery","volume":" ","pages":""},"PeriodicalIF":1.7,"publicationDate":"2024-11-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142640061","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Personalized Approaches to Spine Surgery. 脊柱手术的个性化方法。
IF 16.4 Q2 SURGERY Pub Date : 2024-11-15 DOI: 10.14444/8644
Arati Patel, Abraham Dada, Satvir Saggi, Hunter Yamada, Vardhaan S Ambati, Elianna Goldstein, Edward C Hsiao, Praveen V Mummaneni

Patient-centric decision-making has imbued all aspects of health care, including spine surgery. This review describes how spine surgeons can use evolving technologies and knowledge of disease and pain states to tailor their surgical approach to the individual patient. This includes preoperative screening for and optimization of low bone mineral density, intraoperative selection of implant material and customization of interbody cages and screws, and postoperative personalization of pain regimens and rehabilitation courses. By working in a multidisciplinary fashion, spine surgeons can avail themselves of these advances to provide individualized care.

以患者为中心的决策已渗透到医疗保健的方方面面,包括脊柱外科。这篇综述介绍了脊柱外科医生如何利用不断发展的技术以及对疾病和疼痛状态的了解,为患者量身定制手术方法。这包括术前筛查和优化低骨矿物质密度,术中选择植入材料和定制椎间笼和螺钉,以及术后个性化疼痛治疗和康复课程。通过多学科合作,脊柱外科医生可以利用这些先进技术提供个性化治疗。
{"title":"Personalized Approaches to Spine Surgery.","authors":"Arati Patel, Abraham Dada, Satvir Saggi, Hunter Yamada, Vardhaan S Ambati, Elianna Goldstein, Edward C Hsiao, Praveen V Mummaneni","doi":"10.14444/8644","DOIUrl":"10.14444/8644","url":null,"abstract":"<p><p>Patient-centric decision-making has imbued all aspects of health care, including spine surgery. This review describes how spine surgeons can use evolving technologies and knowledge of disease and pain states to tailor their surgical approach to the individual patient. This includes preoperative screening for and optimization of low bone mineral density, intraoperative selection of implant material and customization of interbody cages and screws, and postoperative personalization of pain regimens and rehabilitation courses. By working in a multidisciplinary fashion, spine surgeons can avail themselves of these advances to provide individualized care.</p>","PeriodicalId":38486,"journal":{"name":"International Journal of Spine Surgery","volume":" ","pages":""},"PeriodicalIF":16.4,"publicationDate":"2024-11-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142082093","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Clinical Outcomes Following Treatment of Cervical Spondylotic Radiculopathy With Cervical Posterior Decompression Using Unilateral Biportal Endoscopic Technique: A Single Center Retrospective Series of 20 Patients. 使用单侧双侧内窥镜技术进行颈椎后路减压术治疗颈椎根性病变的临床疗效:20例患者的单中心回顾性系列研究。
IF 1.7 Q2 SURGERY Pub Date : 2024-11-15 DOI: 10.14444/8690
Keyur K Akbari, Teo Hong Lee Terry, Umesh Kanade, John Choi

Background: Unilateral biportal endoscopy (UBE) is a minimally invasive approach to treat cervical spondylotic radiculopathy (CSR), which is a common condition caused secondary to disc herniation, disc degeneration, uncal osteophytes, and other conditions manifesting as neuropathic radicular pain. Anterior cervical discectomy and fusion (ACDF) is the gold standard surgical technique for treating CSR. However, it has several disadvantages, including loss of mobile segment, adjacent segment degeneration (ASD), implant- and approach-related complications, and high hospitalization costs.

Objective: The current study aimed to evaluate the safety and efficacy of UBE decompression for CSR.

Methods: After obtaining IRB approval, a single-center retrospective study was undertaken. Included patients underwent UBE decompression for CSR with a minimum of 6 months of follow-up. Patient demographics, perioperative data, and length of hospital stay were reviewed. Clinical outcomes were assessed using VAS scores for neck and arm pain, and NDI scores were measure preoperatively and at 1 and 6 months after UBE decompression. A repeated analysis of variance test was performed to measure the difference between VAS and NDI scores.

Results: Twenty patients (M: 15, F: 5) with a mean age of 56.7 ± 10.2 years were included. The mean follow-up period was 8.4 ± 1.8 months. The mean surgical time was 64.3±10.6 minutes. The average length of hospital stay was 1 day. At the final follow-up, the mean VAS for arm pain improved from 6.4 ± 0.7 to 0.6 ± 0.5 (92% improvement) and the mean VAS for neck pain improved from 3.3 ± 0.4 to 2.0 ± 0.2 (40% improvement). NDI score improved from 23.2 ± 1.95 to 5.7 ± 0.6 at the final follow-up (75% improvement). There were no complications.

Conclusion: UBE is a safe and effective surgical treatment option for patients with CSR with excellent clinical outcomes.

Clinical relevance: Clinical relevance of this case series study is to demonstrate the safety and efficacy of the novel unilateral biportal endoscopic decompression of cervical spondylotic radiculopathy and its short term clinical outcomes.

Level of evidence: 4:

背景:颈椎病是由椎间盘突出症、椎间盘退变、椎间盘骨质增生和其他表现为神经根性疼痛的疾病引起的一种常见病。前路颈椎椎间盘切除融合术(ACDF)是治疗 CSR 的金标准手术技术。然而,它也有一些缺点,包括活动节段缺失、邻近节段变性(ASD)、植入物和方法相关的并发症以及高昂的住院费用:本研究旨在评估 UBE 减压术治疗 CSR 的安全性和有效性:在获得 IRB 批准后,进行了一项单中心回顾性研究。纳入的患者接受了 UBE 减压术治疗 CSR,随访时间至少 6 个月。研究回顾了患者的人口统计学特征、围手术期数据和住院时间。临床疗效采用颈部和手臂疼痛的 VAS 评分进行评估,NDI 评分在术前、UBE 减压术后 1 个月和 6 个月进行测量。对 VAS 和 NDI 评分之间的差异进行了重复方差分析检验:共纳入 20 名患者(男:15,女:5),平均年龄为(56.7 ± 10.2)岁。平均随访时间为 8.4 ± 1.8 个月。平均手术时间为(64.3±10.6)分钟。平均住院时间为 1 天。在最后的随访中,手臂疼痛的 VAS 平均值从 6.4 ± 0.7 改善到 0.6 ± 0.5(改善 92%),颈部疼痛的 VAS 平均值从 3.3 ± 0.4 改善到 2.0 ± 0.2(改善 40%)。最后随访时,NDI评分从23.2 ± 1.95降至5.7 ± 0.6(改善了75%)。无并发症:结论:对于 CSR 患者来说,UBE 是一种安全有效的手术治疗方案,临床效果极佳:本病例系列研究的临床意义在于证明新型单侧双侧内窥镜颈椎病根治性减压术的安全性、有效性及其短期临床疗效:4:
{"title":"Clinical Outcomes Following Treatment of Cervical Spondylotic Radiculopathy With Cervical Posterior Decompression Using Unilateral Biportal Endoscopic Technique: A Single Center Retrospective Series of 20 Patients.","authors":"Keyur K Akbari, Teo Hong Lee Terry, Umesh Kanade, John Choi","doi":"10.14444/8690","DOIUrl":"https://doi.org/10.14444/8690","url":null,"abstract":"<p><strong>Background: </strong>Unilateral biportal endoscopy (UBE) is a minimally invasive approach to treat cervical spondylotic radiculopathy (CSR), which is a common condition caused secondary to disc herniation, disc degeneration, uncal osteophytes, and other conditions manifesting as neuropathic radicular pain. Anterior cervical discectomy and fusion (ACDF) is the gold standard surgical technique for treating CSR. However, it has several disadvantages, including loss of mobile segment, adjacent segment degeneration (ASD), implant- and approach-related complications, and high hospitalization costs.</p><p><strong>Objective: </strong>The current study aimed to evaluate the safety and efficacy of UBE decompression for CSR.</p><p><strong>Methods: </strong>After obtaining IRB approval, a single-center retrospective study was undertaken. Included patients underwent UBE decompression for CSR with a minimum of 6 months of follow-up. Patient demographics, perioperative data, and length of hospital stay were reviewed. Clinical outcomes were assessed using VAS scores for neck and arm pain, and NDI scores were measure preoperatively and at 1 and 6 months after UBE decompression. A repeated analysis of variance test was performed to measure the difference between VAS and NDI scores.</p><p><strong>Results: </strong>Twenty patients (M: 15, F: 5) with a mean age of 56.7 ± 10.2 years were included. The mean follow-up period was 8.4 ± 1.8 months. The mean surgical time was 64.3±10.6 minutes. The average length of hospital stay was 1 day. At the final follow-up, the mean VAS for arm pain improved from 6.4 ± 0.7 to 0.6 ± 0.5 (92% improvement) and the mean VAS for neck pain improved from 3.3 ± 0.4 to 2.0 ± 0.2 (40% improvement). NDI score improved from 23.2 ± 1.95 to 5.7 ± 0.6 at the final follow-up (75% improvement). There were no complications.</p><p><strong>Conclusion: </strong>UBE is a safe and effective surgical treatment option for patients with CSR with excellent clinical outcomes.</p><p><strong>Clinical relevance: </strong>Clinical relevance of this case series study is to demonstrate the safety and efficacy of the novel unilateral biportal endoscopic decompression of cervical spondylotic radiculopathy and its short term clinical outcomes.</p><p><strong>Level of evidence: 4: </strong></p>","PeriodicalId":38486,"journal":{"name":"International Journal of Spine Surgery","volume":" ","pages":""},"PeriodicalIF":1.7,"publicationDate":"2024-11-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142640018","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Meta-Analysis Investigating Optimal Timing of Chemoprophylaxis for Venous Thromboembolism in Operatively Managed Blunt Spinal Injuries. 研究钝性脊椎损伤手术治疗中静脉血栓栓塞最佳化学预防时机的 Meta 分析。
IF 1.7 Q2 SURGERY Pub Date : 2024-11-15 DOI: 10.14444/8656
Faisal A AlGhamdi, Mohammed O Alzayer, Mohammed M AlKabbani, Renad M AlJoaid, Nasser A AlJoaib, Kawther M Hadhiah, Nisreen H AlMaghraby

Background: Blunt spinal injuries (BSIs) are associated with substantial morbidity and mortality. Management typically involves stabilization of the spinal column and may include chemoprophylaxis for venous thromboembolism (VTE) prevention. The optimal timing of chemoprophylaxis initiation in operatively managed BSI patients remains debated.

Objective: Analyze available literature on optimal chemoprophylaxis timing for the prevention of VTE in patients postinjury undergoing operative repair.

Study design: Systematic review and meta-analysis.

Methods: A systematic review and meta-analysis were conducted following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. PubMed and MEDLINE were searched for studies assessing chemoprophylaxis timing in adult BSI patients. Inclusion criteria focused on operatively managed BSIs and anticoagulant usage assessment.

Results: Three studies involving 4345 patients were included. Early chemoprophylaxis initiation was associated with significantly lower deep vein thrombosis (DVT) and overall VTE incidence compared with late initiation. No significant differences were found in pulmonary embolism (PE) incidence or mortality.

Conclusion: Early anticoagulant administration after spinal fixation for BSI reduces DVT and overall VTE risk without impacting PE incidence or mortality. Further research is recommended to solidify these findings and address existing gaps in the literature.

Clinical relevance: Early chemoprophylaxis initiation in operatively managed BSI patients reduces DVT and overall VTE risk without affecting PE incidence or mortality LEVEL OF EVIDENCE: 2.

背景:钝性脊柱损伤(BSI)与严重的发病率和死亡率有关。处理方法通常包括稳定脊柱,并可能包括预防静脉血栓栓塞(VTE)的化学预防。对于手术治疗的 BSI 患者启动化学预防的最佳时机仍存在争议:目的:分析现有文献中关于接受手术修复的伤后患者预防 VTE 的最佳化学预防时机:研究设计:系统综述和荟萃分析:方法:根据《系统综述和荟萃分析首选报告项目》指南进行系统综述和荟萃分析。在 PubMed 和 MEDLINE 上检索了评估成人 BSI 患者化学预防时机的研究。纳入标准侧重于手术治疗的 BSI 和抗凝剂使用评估:结果:共纳入三项研究,涉及 4345 名患者。与晚期开始化学预防相比,早期开始化学预防可显著降低深静脉血栓(DVT)和整体 VTE 发生率。在肺栓塞(PE)发生率或死亡率方面没有发现明显差异:结论:脊柱固定术治疗 BSI 后尽早使用抗凝剂可降低深静脉血栓形成和整体 VTE 风险,但不会影响 PE 发病率或死亡率。建议开展进一步研究,以巩固这些发现并填补现有文献空白:临床相关性:对接受手术治疗的 BSI 患者及早采取化学预防措施可降低深静脉血栓和整体 VTE 风险,但不会影响 PE 的发生率或死亡率 证据级别:2。
{"title":"Meta-Analysis Investigating Optimal Timing of Chemoprophylaxis for Venous Thromboembolism in Operatively Managed Blunt Spinal Injuries.","authors":"Faisal A AlGhamdi, Mohammed O Alzayer, Mohammed M AlKabbani, Renad M AlJoaid, Nasser A AlJoaib, Kawther M Hadhiah, Nisreen H AlMaghraby","doi":"10.14444/8656","DOIUrl":"https://doi.org/10.14444/8656","url":null,"abstract":"<p><strong>Background: </strong>Blunt spinal injuries (BSIs) are associated with substantial morbidity and mortality. Management typically involves stabilization of the spinal column and may include chemoprophylaxis for venous thromboembolism (VTE) prevention. The optimal timing of chemoprophylaxis initiation in operatively managed BSI patients remains debated.</p><p><strong>Objective: </strong>Analyze available literature on optimal chemoprophylaxis timing for the prevention of VTE in patients postinjury undergoing operative repair.</p><p><strong>Study design: </strong>Systematic review and meta-analysis.</p><p><strong>Methods: </strong>A systematic review and meta-analysis were conducted following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. PubMed and MEDLINE were searched for studies assessing chemoprophylaxis timing in adult BSI patients. Inclusion criteria focused on operatively managed BSIs and anticoagulant usage assessment.</p><p><strong>Results: </strong>Three studies involving 4345 patients were included. Early chemoprophylaxis initiation was associated with significantly lower deep vein thrombosis (DVT) and overall VTE incidence compared with late initiation. No significant differences were found in pulmonary embolism (PE) incidence or mortality.</p><p><strong>Conclusion: </strong>Early anticoagulant administration after spinal fixation for BSI reduces DVT and overall VTE risk without impacting PE incidence or mortality. Further research is recommended to solidify these findings and address existing gaps in the literature.</p><p><strong>Clinical relevance: </strong>Early chemoprophylaxis initiation in operatively managed BSI patients reduces DVT and overall VTE risk without affecting PE incidence or mortality LEVEL OF EVIDENCE: 2.</p>","PeriodicalId":38486,"journal":{"name":"International Journal of Spine Surgery","volume":" ","pages":""},"PeriodicalIF":1.7,"publicationDate":"2024-11-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142640060","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Efficacy and Safety of Biportal Endoscopic Decompressive Laminectomy in Octogenarians With Severe Lumbar Spinal Stenosis. 双门内窥镜减压椎板切除术对八高龄重度腰椎管狭窄症患者的有效性和安全性
IF 1.7 Q2 SURGERY Pub Date : 2024-11-08 DOI: 10.14444/8649
Sang-Min Park, John I Shin, Jin-Ho Park, Jonghun Jung, Jiwon Park, Ho-Joong Kim, Jin S Yeom, Hyun-Jin Park

Background: Lumbar spinal stenosis (LSS) is prevalent among octogenarians, causing significant pain and disability. Surgical intervention is often required because of the ineffectiveness of conservative treatments. This study investigates the efficacy and safety of biportal endoscopic decompressive laminectomy (BED) in octogenarians with severe LSS, evaluating its potential as a minimally invasive surgical option.

Methods: This retrospective study included 107 patients aged 80 years or older who underwent BED for LSS between March 2017 and December 2022. Data were collected from electronic medical records, including demographic information, clinical outcomes, and surgical details. Patients with fractures, infectious spondylitis, herniated discs, and follow-up less than 12 months were excluded. Clinical outcomes were assessed using the visual analog scale, Oswestry Disability Index, European Quality of Life-5 Dimensions, and painDETECT at baseline and at 3, 6, and 12 months after surgery.

Results: The mean age of the 107 patients was 84.1 years, with 59% being women. Significant improvements were observed in visual analog scale scores for lower back and lower extremities pain, Oswestry Disability Index, European Quality of Life-5 Dimensions, and painDETECT scores, indicating reduced pain, decreased disability, and enhanced quality of life. There were no significant differences in outcomes between patients aged 80 to 84 and those 85 or older. Surgery-related outcomes such as operation time, blood loss, and complications were similar in both age groups.

Conclusions: BED is a safe and effective treatment for LSS in octogenarians, providing significant pain relief and functional improvement. This minimally invasive technique is also viable for patients older than 85 years, without increased risk of complications, supporting its broader indications in managing LSS in the elderly.

Clinical relevance: This study highlights the efficacy and safety of BED for LSS in octogenarians, demonstrating its potential to improve quality of life and function with low risks, making it a feasible option for elderly patients.

Level of evidence: 4:

背景:腰椎管狭窄症(LSS)在八旬老人中很普遍,会导致严重的疼痛和残疾。由于保守治疗效果不佳,通常需要手术干预。本研究探讨了双皮质内镜下椎板减压切除术(BED)对八旬重度椎管狭窄症患者的疗效和安全性,评估了其作为微创手术选择的潜力:这项回顾性研究纳入了2017年3月至2022年12月期间接受BED治疗LSS的107名80岁或80岁以上的患者。数据来自电子病历,包括人口统计学信息、临床结果和手术细节。排除了骨折、感染性脊柱炎、椎间盘突出以及随访不足12个月的患者。临床结果采用视觉模拟量表、Oswestry残疾指数、欧洲生活质量-5维度和疼痛DETECT进行评估,评估时间为基线和术后3、6、12个月:107 名患者的平均年龄为 84.1 岁,其中 59% 为女性。下背部和下肢疼痛的视觉模拟量表评分、Oswestry残疾指数、欧洲生活质量-5维度和painDETECT评分均有明显改善,表明疼痛减轻、残疾减少和生活质量提高。80 至 84 岁的患者与 85 岁或以上的患者在治疗效果上没有明显差异。两个年龄组的手术相关结果,如手术时间、失血量和并发症等都相似:BED是治疗八旬老人LSS的一种安全有效的方法,能明显缓解疼痛并改善功能。这种微创技术对 85 岁以上的患者也是可行的,不会增加并发症风险,支持其在治疗老年 LSS 方面更广泛的适应症:本研究强调了 BED 治疗八旬老人 LSS 的有效性和安全性,证明了其改善生活质量和功能的潜力,且风险较低,是老年患者的可行选择:4:
{"title":"Efficacy and Safety of Biportal Endoscopic Decompressive Laminectomy in Octogenarians With Severe Lumbar Spinal Stenosis.","authors":"Sang-Min Park, John I Shin, Jin-Ho Park, Jonghun Jung, Jiwon Park, Ho-Joong Kim, Jin S Yeom, Hyun-Jin Park","doi":"10.14444/8649","DOIUrl":"10.14444/8649","url":null,"abstract":"<p><strong>Background: </strong>Lumbar spinal stenosis (LSS) is prevalent among octogenarians, causing significant pain and disability. Surgical intervention is often required because of the ineffectiveness of conservative treatments. This study investigates the efficacy and safety of biportal endoscopic decompressive laminectomy (BED) in octogenarians with severe LSS, evaluating its potential as a minimally invasive surgical option.</p><p><strong>Methods: </strong>This retrospective study included 107 patients aged 80 years or older who underwent BED for LSS between March 2017 and December 2022. Data were collected from electronic medical records, including demographic information, clinical outcomes, and surgical details. Patients with fractures, infectious spondylitis, herniated discs, and follow-up less than 12 months were excluded. Clinical outcomes were assessed using the visual analog scale, Oswestry Disability Index, European Quality of Life-5 Dimensions, and painDETECT at baseline and at 3, 6, and 12 months after surgery.</p><p><strong>Results: </strong>The mean age of the 107 patients was 84.1 years, with 59% being women. Significant improvements were observed in visual analog scale scores for lower back and lower extremities pain, Oswestry Disability Index, European Quality of Life-5 Dimensions, and painDETECT scores, indicating reduced pain, decreased disability, and enhanced quality of life. There were no significant differences in outcomes between patients aged 80 to 84 and those 85 or older. Surgery-related outcomes such as operation time, blood loss, and complications were similar in both age groups.</p><p><strong>Conclusions: </strong>BED is a safe and effective treatment for LSS in octogenarians, providing significant pain relief and functional improvement. This minimally invasive technique is also viable for patients older than 85 years, without increased risk of complications, supporting its broader indications in managing LSS in the elderly.</p><p><strong>Clinical relevance: </strong>This study highlights the efficacy and safety of BED for LSS in octogenarians, demonstrating its potential to improve quality of life and function with low risks, making it a feasible option for elderly patients.</p><p><strong>Level of evidence: 4: </strong></p>","PeriodicalId":38486,"journal":{"name":"International Journal of Spine Surgery","volume":" ","pages":"482-489"},"PeriodicalIF":1.7,"publicationDate":"2024-11-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142355884","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Impact of Postoperative Bracing Following Spinal Fusion for Degenerative Lumbar Conditions: An Updated Meta-Analysis of Randomized Controlled Trials. 腰椎退行性病变脊柱融合术后支撑的影响:随机对照试验的最新元分析。
IF 1.7 Q2 SURGERY Pub Date : 2024-11-08 DOI: 10.14444/8598
An-Ping Feng, Shang-Feng Yu, Ming-Tao Zhu, Li-Ru He, Guang-Xun Lin

Background: There is a lack of consensus on the use of postoperative bracing for lumbar degenerative conditions. Spine surgeons typically determine whether to apply postoperative braces based primarily on clinical experience rather than robust, evidence-based medical data. Thus, the present study sought to assess the impact of postoperative bracing on clinical outcomes, complications, and fusion rates following lumbar fusion surgery in patients with degenerative spinal conditions.

Methods: Only randomized controlled studies published between January 1990 and 20 October 2023 were included in this meta-analysis. The primary outcome measures consisted of pre- and postoperative assessments of the Oswestry Disability Index (ODI) and visual analog scale (VAS) scores. Improvements in VAS and ODI scores were analyzed in the early postoperative period (1 month after operation) and at final follow-up, respectively. The analysis also encompassed fusion rates and complications.

Results: Five studies with 362 patients were included in the present meta-analysis. In the early postoperative period, the brace group showed a relatively better improvement in ODI scores compared with the no-brace group (19.47 vs 18.18), although this difference was not statistically significant (P = 0.34). Similarly, during the late postoperative period, the brace group demonstrated a slightly greater improvement in VAS scores in comparison to the no-brace group (4.05 vs 3.84), but this difference did not reach statistical significance (P = 0.30). The complication rate was relatively lower in the brace group compared with the no-brace group (14.9% vs 17.4%), although there was no statistical difference between the 2 groups (P = 0.83). Importantly, there were no substantial differences in fusion rates between patients with or without braces.

Conclusion: The present meta-analysis revealed that the implementation of a brace following lumbar fusion surgery did not yield substantial differences in terms of postoperative pain relief, functional recovery, complication rates, or fusion rates when compared with cases where no brace was employed.

Clinical relevance: This meta-analysis provides valuable insights into the clinical impact of postoperative bracing following lumbar fusion surgery for degenerative spinal conditions.

Level of evidence: 1:

背景:对于腰椎退行性病变术后支具的使用缺乏共识。脊柱外科医生通常主要根据临床经验而非可靠的循证医学数据来决定是否使用术后支撑。因此,本研究试图评估术后支撑对脊柱退行性病变患者腰椎融合术后的临床效果、并发症和融合率的影响:本荟萃分析仅纳入 1990 年 1 月至 2023 年 10 月 20 日期间发表的随机对照研究。主要结果指标包括术前和术后的 Oswestry 失能指数(ODI)和视觉模拟量表(VAS)评分。VAS和ODI评分的改善情况分别在术后早期(术后1个月)和最终随访时进行分析。分析还包括融合率和并发症:本荟萃分析共纳入了五项研究,362 名患者。在术后早期,背架组与无背架组相比,ODI评分的改善程度相对较好(19.47 vs 18.18),但差异无统计学意义(P = 0.34)。同样,在术后晚期,与无背架组相比,有背架组的 VAS 评分改善幅度略大(4.05 vs 3.84),但这一差异没有统计学意义(P = 0.30)。支架组的并发症发生率相对低于无支架组(14.9% vs 17.4%),但两组间无统计学差异(P = 0.83)。重要的是,带或不带牙套患者的融合率没有实质性差异:本荟萃分析显示,腰椎融合术后使用支具与不使用支具的病例相比,在术后疼痛缓解、功能恢复、并发症发生率或融合率方面没有实质性差异:这项荟萃分析就腰椎退行性病变融合手术后使用术后支具的临床影响提供了有价值的见解:1:
{"title":"Impact of Postoperative Bracing Following Spinal Fusion for Degenerative Lumbar Conditions: An Updated Meta-Analysis of Randomized Controlled Trials.","authors":"An-Ping Feng, Shang-Feng Yu, Ming-Tao Zhu, Li-Ru He, Guang-Xun Lin","doi":"10.14444/8598","DOIUrl":"10.14444/8598","url":null,"abstract":"<p><strong>Background: </strong>There is a lack of consensus on the use of postoperative bracing for lumbar degenerative conditions. Spine surgeons typically determine whether to apply postoperative braces based primarily on clinical experience rather than robust, evidence-based medical data. Thus, the present study sought to assess the impact of postoperative bracing on clinical outcomes, complications, and fusion rates following lumbar fusion surgery in patients with degenerative spinal conditions.</p><p><strong>Methods: </strong>Only randomized controlled studies published between January 1990 and 20 October 2023 were included in this meta-analysis. The primary outcome measures consisted of pre- and postoperative assessments of the Oswestry Disability Index (ODI) and visual analog scale (VAS) scores. Improvements in VAS and ODI scores were analyzed in the early postoperative period (1 month after operation) and at final follow-up, respectively. The analysis also encompassed fusion rates and complications.</p><p><strong>Results: </strong>Five studies with 362 patients were included in the present meta-analysis. In the early postoperative period, the brace group showed a relatively better improvement in ODI scores compared with the no-brace group (19.47 vs 18.18), although this difference was not statistically significant (<i>P</i> = 0.34). Similarly, during the late postoperative period, the brace group demonstrated a slightly greater improvement in VAS scores in comparison to the no-brace group (4.05 vs 3.84), but this difference did not reach statistical significance (<i>P</i> = 0.30). The complication rate was relatively lower in the brace group compared with the no-brace group (14.9% vs 17.4%), although there was no statistical difference between the 2 groups (<i>P</i> = 0.83). Importantly, there were no substantial differences in fusion rates between patients with or without braces.</p><p><strong>Conclusion: </strong>The present meta-analysis revealed that the implementation of a brace following lumbar fusion surgery did not yield substantial differences in terms of postoperative pain relief, functional recovery, complication rates, or fusion rates when compared with cases where no brace was employed.</p><p><strong>Clinical relevance: </strong>This meta-analysis provides valuable insights into the clinical impact of postoperative bracing following lumbar fusion surgery for degenerative spinal conditions.</p><p><strong>Level of evidence: 1: </strong></p>","PeriodicalId":38486,"journal":{"name":"International Journal of Spine Surgery","volume":" ","pages":"540-550"},"PeriodicalIF":1.7,"publicationDate":"2024-11-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140923537","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
期刊
International Journal of Spine Surgery
全部 Acc. Chem. Res. ACS Applied Bio Materials ACS Appl. Electron. Mater. ACS Appl. Energy Mater. ACS Appl. Mater. Interfaces ACS Appl. Nano Mater. ACS Appl. Polym. Mater. ACS BIOMATER-SCI ENG ACS Catal. ACS Cent. Sci. ACS Chem. Biol. ACS Chemical Health & Safety ACS Chem. Neurosci. ACS Comb. Sci. ACS Earth Space Chem. ACS Energy Lett. ACS Infect. Dis. ACS Macro Lett. ACS Mater. Lett. ACS Med. Chem. Lett. ACS Nano ACS Omega ACS Photonics ACS Sens. ACS Sustainable Chem. Eng. ACS Synth. Biol. Anal. Chem. BIOCHEMISTRY-US Bioconjugate Chem. BIOMACROMOLECULES Chem. Res. Toxicol. Chem. Rev. Chem. Mater. CRYST GROWTH DES ENERG FUEL Environ. Sci. Technol. Environ. Sci. Technol. Lett. Eur. J. Inorg. Chem. IND ENG CHEM RES Inorg. Chem. J. Agric. Food. Chem. J. Chem. Eng. Data J. Chem. Educ. J. Chem. Inf. Model. J. Chem. Theory Comput. J. Med. Chem. J. Nat. Prod. J PROTEOME RES J. Am. Chem. Soc. LANGMUIR MACROMOLECULES Mol. Pharmaceutics Nano Lett. Org. Lett. ORG PROCESS RES DEV ORGANOMETALLICS J. Org. Chem. J. Phys. Chem. J. Phys. Chem. A J. Phys. Chem. B J. Phys. Chem. C J. Phys. Chem. Lett. Analyst Anal. Methods Biomater. Sci. Catal. Sci. Technol. Chem. Commun. Chem. Soc. Rev. CHEM EDUC RES PRACT CRYSTENGCOMM Dalton Trans. Energy Environ. Sci. ENVIRON SCI-NANO ENVIRON SCI-PROC IMP ENVIRON SCI-WAT RES Faraday Discuss. Food Funct. Green Chem. Inorg. Chem. Front. Integr. Biol. J. Anal. At. Spectrom. J. Mater. Chem. A J. Mater. Chem. B J. Mater. Chem. C Lab Chip Mater. Chem. Front. Mater. Horiz. MEDCHEMCOMM Metallomics Mol. Biosyst. Mol. Syst. Des. Eng. Nanoscale Nanoscale Horiz. Nat. Prod. Rep. New J. Chem. Org. Biomol. Chem. Org. Chem. Front. PHOTOCH PHOTOBIO SCI PCCP Polym. Chem.
×
引用
GB/T 7714-2015
复制
MLA
复制
APA
复制
导出至
BibTeX EndNote RefMan NoteFirst NoteExpress
×
0
微信
客服QQ
Book学术公众号 扫码关注我们
反馈
×
意见反馈
请填写您的意见或建议
请填写您的手机或邮箱
×
提示
您的信息不完整,为了账户安全,请先补充。
现在去补充
×
提示
您因"违规操作"
具体请查看互助需知
我知道了
×
提示
现在去查看 取消
×
提示
确定
Book学术官方微信
Book学术文献互助
Book学术文献互助群
群 号:481959085
Book学术
文献互助 智能选刊 最新文献 互助须知 联系我们:info@booksci.cn
Book学术提供免费学术资源搜索服务,方便国内外学者检索中英文文献。致力于提供最便捷和优质的服务体验。
Copyright © 2023 Book学术 All rights reserved.
ghs 京公网安备 11010802042870号 京ICP备2023020795号-1