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 retropharyngeal steroid use during operation on the fusion rate and dysphagia after ACDF? A systematic review and meta-analysis.
The aim of this meta-analysis was to investigate the effects of retropharyngeal steroid use during operation on bony fusion and dysphagia rate after ACDF. ⋯ Diagnostic: individual cross-sectional studies with the consistently applied reference standard and blinding.
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Back pain is a major problem worldwide and is linked to intervertebral disc degeneration and Modic change. Several studies report growth of bacteria following extraction of degenerate discs at spine surgery. A pathophysiological role for infection in back pain has been proposed. ⋯ Evidence to date implicates C. acnes identified through culture, microscopy and sequencing, with some suggestion of diverse bacterial colonisation in the disc. This review found studies which used culture methods and conventional PCR for bacterial detection. Further agnostic investigation using newer methods should be undertaken.
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Randomized Controlled Trial
Local vancomycin therapy to reduce surgical site infection in adult spine surgery: a randomized prospective study.
This prospective randomized controlled trial hypothesizes that intra wound vancomycin reduces postoperative infection. ⋯ Intra-wound vancomycin has no effect on SSI; in addition, it can increase the rate of gram-negative infections.
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The effect of paraspinal muscles atrophy and fat infiltration (FI) on the complications of spinal surgery has not been established. ⋯ Strong evidence was found for an association between preoperative paraspinal muscle degeneration and multiple postoperative complications after lumbar surgery. However, the findings should be interpreted with caution due to the small quantity of the available literature and high heterogeneity among studies.
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Multiple surgical techniques are practiced to treat sciatica caused by lumbar disk herniation. It is unknown which factors surgeons find important when offering certain surgical techniques. The objective of this study is threefold: 1) determine the relative weight surgeons place on various characteristics of sciatica treatment, 2) determine the trade-offs surgeons make between these characteristics and 3) identify preference heterogeneity for sciatica treatment. ⋯ In the context of this discrete choice experiment, it is shown that neurosurgeons consider the risk of complications as most important when a surgical technique is offered to treat sciatica, while the risk of recurrent disk herniation and effectiveness are also important factors. Neurosurgeons were prepared to trade off substantial amounts of effectiveness to achieve lower complication rates.