Spine
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Meta Analysis Comparative Study
A meta-analysis of circumferential fusion versus instrumented posterolateral fusion in the lumbar spine.
A meta-analysis of circumferential fusion versus instrumented posterolateral fusion (PLF) in the lumbar spine. ⋯ Compared with instrumented PLF, circumferential fusion can increase the fusion rate and reduce the reoperation rate, but it can also increase the complication rate and the amount of blood loss. No significant difference was found in the global assessment of clinical outcome about the 2 fusion procedures.
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We conducted a methodologic study. ⋯ We conclude that the 11-item Internal Validity Checklist is associated with effect size in randomized trials of interventions for back pain, and that our data support the use of a sum score of the number of fulfilled items in this list.
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Meta Analysis
Percutaneous treatment of vertebral compression fractures: a meta-analysis of complications.
This study performs a meta-analysis to compare complication rates from vertebroplasty (VP) and kyphoplasty (KP). ⋯ VP and KP are 2 minimally invasive procedures that have been shown to be effective in the treatment of symptomatic vertebral compression fractures. Although the incidence of adverse events for both VP and KP are low, it appears that VP is associated with a statistically significant increased rate of procedure-related complications and cement extravasation (symptomatic and asymptomatic). Future prospective studies with large patient enrollment will be needed to further validate the finding of this meta-analysis.
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Review Meta Analysis
Spinal mechanical load as a risk factor for low back pain: a systematic review of prospective cohort studies.
Systematic review. ⋯ We found strong evidence that leisure time sport or exercises, sitting, and prolonged standing/walking are not associated with LBP. Evidence for associations in leisure time activities (e.g., do-it-yourself home repair, gardening), whole-body vibration, nursing tasks, heavy physical work, and working with ones trunk in a bent and/or twisted position and LBP was conflicting. We found no studies, thus no evidence, for an association between sleeping or sporting on a professional level and LBP.
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A comprehensive literature review. ⋯ The literature reveals a number of rare, potentially catastrophic neurologic sequelae including brain and spinal cord infarction. Most of these are thought to be due to intravascular uptake of particulate steroids. The true overall incidence remains obscure due to the lack of blinded controlled studies. Injectionists, referring physicians, and patients should be aware of the nature and potential consequences of these complications. Additionally, it is imperative for injectionists to standardize techniques to minimize complications, especially by using a test dose of local anesthetic before injection of preferably nonparticulate corticosteroid.