Spine
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Review Meta Analysis
A critical review of reviews on the treatment of chronic low back pain.
Systematic literature review. ⋯ Although the overall quality of systematic reviews was satisfactory, the quality of the individual papers included in the reviews varied considerably. The reviews often provided contradictory evidence on the effectiveness of a wide range of commonly used conservative interventions for chronic nonspecific low back pain. These findings illustrate the pitfalls of systematic reviews where there are a number of low-quality trials and underscore the need for high-quality primary trials that will allow for more conclusive reviews.
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A systematic review of randomized controlled trials. ⋯ There appears to be little scientific evidence for the effectiveness on neck and shoulder pain of multidisciplinary biopsychosocial rehabilitation compared with other rehabilitation methods. There is an urgent need for high-quality trials in this field.
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A systematic review and meta-analysis of studies on the putative mechanisms of action of lumbar supports in lifting activities. ⋯ There is evidence that lumbar supports reduce trunk motion for flexion-extension and lateral bending. More research is needed on the separate outcome measures for trunk motion before definite conclusions can be drawn about the work conditions in which lumbar supports may be most effective. Studies of trunk motion at the workplace or during specified lifting tasks would be especially useful in this regard.
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Meta Analysis
Cauda equina syndrome secondary to lumbar disc herniation: a meta-analysis of surgical outcomes.
A meta-analysis of surgical outcomes of cauda equina syndrome secondary to lumbar disc herniation. ⋯ There was a significant advantage to treating patients within 48 hours versus more than 48 hours after the onset of cauda equina syndrome. A significant improvement in sensory and motor deficits as well as urinary and rectal function occurred in patients who underwent decompression within 48 hours versus after 48 hours.
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Meta Analysis
The Cochrane review of surgery for lumbar disc prolapse and degenerative lumbar spondylosis.
A Cochrane review of randomized controlled trials. ⋯ There is now strong evidence on the relative effectiveness of surgical discectomy versus chemonucleolysis versus placebo. There is considerable evidence on the clinical effectiveness of discectomy for carefully selected patients with sciatica caused by lumbar disc prolapse that fails to resolve with conservative management. There is no scientific evidence on the effectiveness of any form of surgical decompression or fusion for degenerative lumbar spondylosis compared with natural history, placebo, or conservative management. The Cochrane reviews will be updated continuously as other trials become available.