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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Review Meta Analysis
The association between pain scores and disc height change following discectomy surgery in lumbar disc herniation patients: a systematic review and meta-analysis.
To evaluate the impact of discectomy on disc height (DH) in lumbar disc herniation (LDH) patients following discectomy surgery and address the association of DH change with pain score change. ⋯ Discectomy surgery produces significant and quantifiable reductions in DH and DHI. Additionally, the reduction in DH is responsible for the decrease in back pain scores post discectomy, but further studies will improve understanding and aid preoperative counselling.
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To assess the rate, timing of diagnosis, and repairing strategies of vascular injuries in thoracic and lumbar spine surgery as their relationship to the approach. ⋯ Incidence of iatrogenic vascular injuries during thoracic and lumbar spine surgery is low but associated with an overall mortality rate up to 65%, of which less than 1% for anterior approaches and more than 50% for posterior ones. Anterior approaches for instrumented procedures are at risk of direct avulsion of CIV. Posterior instrumented fusions are at risk for injuries of iliac vessels and aorta. Lateral routes are frequently associated with lesions of segmental vessels. Suture repair and endovascular techniques are useful in the management of these severe complications.
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Review Meta Analysis
Epidural steroid compared to placebo injection in sciatica: a systematic review and meta-analysis.
The purpose of this systematic review and meta-analysis was to determine whether epidural steroid injections (ESI) are superior to epidural or non-epidural placebo injections in sciatica patients. ⋯ The literature indicates that ESI induces larger improvements in pain and disability on the short term compared to epidural placebo, though evidence is of low to moderate quality and MCID is not met. Strong conclusions for longer follow-up or for comparisons with non-epidural placebo cannot be drawn due to general low quality of evidence and limited number of studies. Epidural injections can be considered a safe therapy.
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Observational Study
Prediction of walking ability following posterior decompression for lumbar spinal stenosis.
Following surgery for lumbar spinal stenosis (LSS) up to 40% of people report persistent walking disability. This study aimed to identify pre-operative factors that are predictive of walking ability post-surgery for LSS. ⋯ Older age, obesity, greater pre-operative pain and disability and lower quality of life are associated with risk of poor walking ability post-operatively. Greater pre-operative walking and higher education are associated with reduced risk of poor walking ability post-operatively. Patients should be counselled on their risk of poor outcome and considered for rehabilitation so that walking and surgical outcomes may be optimised.
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This study aimed to quantify osteotomy protocol for severe spinal deformity correction based on pre-operative demographic, clinical and radiologic parameters. ⋯ This study showed that osteotomy plan of severe spinal deformity could be determined as follows: Firstly, Ponte/2 + PSO/3 and BDBO/4 + SVCR/5 + MVCR/6 groups can be divided by either T-DAR (cutoff = 28) or the Cobb angle of pre-operative maximum kyphosis (cutoff = 100). Secondly, Ponte/2 + PSO/3 group could be further dichotomized into Ponte/2 and PSO/3 by age (cutoff = 18). Finally, BDBO/4 + SVCR/5 + MVCR/6 group could be divided into BDBO/4 + SVCR/5 and MVCR/6 groups by S-DAR (cutoff = 20).