European spine journal : official publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society
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Patient-reported outcome measures (PROMs) have become an important part of routine auditing of outcomes in spinal surgery in the UK. PROMs can be used to help assess the quality of care provided by surgical units by determining the comparative health status of patients, before and after surgery. This study was designed to review the PROMs used to assess outcomes in spinal surgery and to determine if they are fit for the purpose. ⋯ The consistent use of PROMs supports the comparison of outcomes from different studies, although there was minimal evidence regarding the specificity and sensitivity of these measures for use with lumbar spinal patients. Our review highlights the need to determine a consensus regarding the use and reporting of outcome measures within the lumbar spine literature.
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Randomized Controlled Trial Comparative Study
A randomised controlled trial of transforaminal endoscopic discectomy vs microdiscectomy.
Transforaminal endoscopic discectomy (TED) minimises paraspinal muscle damage. The aim of this trial was to compare clinical outcomes of TED to Microdiscectomy (Micro). ⋯ Functional improvements were maintained at 2 years in both groups with less ongoing sciatica after TED. A greater revision rate after TED was offset by a more rapid recovery.
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A radiographic study to analyze the working zone and relationship of the nerve root to their corresponding intervertebral disc for transforaminal percutaneous approaches. ⋯ At lower lumbar levels the exiting nerve root is at risks of injury. Hence, it is advised to enlarge the foramen for safe passage of endoscopic instruments and to minimize the possibility of nerve injury.
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Review Meta Analysis
Total disc replacement versus fusion for lumbar degenerative disc disease: a systematic review of overlapping meta-analyses.
Although many meta-analyses have been performed to compare total disc replacement (TDR) and fusion for treating lumbar degenerative disc disease (LDDD), their findings are inconsistent. This study aimed to conduct a systematic review of overlapping meta-analyses comparing TDR with fusion for treating LDDD, to assist decision makers in selection among conflicting meta-analyses, and to provide treatment recommendations based on the best available evidence. ⋯ There is discord in results from meta-analyses that assessed TDR and fusion for LDDD. According to this systematic review of overlapping meta-analyses comparing TDR and fusion for LDDD, the current best available evidence suggests that TDR may be an effective technique for the treatment of selected patients with LDDD, and is at least equal to lumbar fusion in the short term. However, considering that disadvantages may appear after years, spine surgeons should be cautions about performing TDR on a large scale.