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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Randomized Controlled Trial
What is success of treatment? Expected outcome scores in cervical radiculopathy patients were much higher than the previously reported cut-off values for success.
Treatment success can be defined by asking a patient how they perceive their condition compared to prior to treatment, but it can also be defined by establishing success criteria in advance. We evaluated treatment outcome expectations in patients undergoing surgery or non-operative treatment for cervical radiculopathy. ⋯ The expected improvement after treatment of cervical radiculopathy was much higher than the previously reported cut-off values for success. Patients with cervical radiculopathy had higher expectations to surgical treatment.
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To determine whether the open or the minimally invasive transforaminal lumbar interbody fusion (O-TLIF, MI-TLIF) is the favored treatment, we provide first meta-analyses using prospective studies with at least two years follow-up only and present the clinical relevance of statistical results for the first time. ⋯ After at least two years, O-TLIF and MI-TLIF can be considered equally efficacious, which simplifies surgeons' decision between both treatments, however, with the safety outcome measure postoperative complications per case and the perioperative outcome measures EBL and LOS in favor of MI-TLIF. LEVEL OF EVIDENCE I: Well conducted meta-analyses, systematic reviews, or RCTs with a low risk of bias.
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Review Meta Analysis
Is the routine use of systemic antibiotics after spine surgery warranted? A systematic review and meta-analysis.
To determine whether the published literature supports the current practice of utilizing antibiotics postoperatively in spine surgery. ⋯ A meta-analysis and comprehensive review of the literature show that the routine use of postoperative antibiotics in spine surgery may not be effective in preventing surgical site infections.
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Pedicle screw loosening is a frequent complication in lumbar spine fixation, most commonly among patients with poor bone quality. Determining patients at high risk for insufficient implant stability would allow clinicians to adapt the treatment accordingly. The aim of this study was to develop a computational model for quantitative and reliable assessment of the risk of screw loosening. ⋯ The use of a biomechanics-based score for risk assessment of implant fixation failure might represent a paradigm shift in addressing screw loosening after spondylodesis surgery.
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Review Meta Analysis
Lumbar plexus safe working zones with lateral lumbar interbody fusion: a systematic review and meta-analysis.
Significant risk of injury to the lumbar plexus and its departing motor and sensory nerves exists with lateral lumbar interbody fusion (LLIF). Several cadaveric and imaging studies have investigated the lumbar plexus position with respect to the vertebral body anteroposterior plane. To date, no systematic review and meta-analysis of the lumbar plexus safe working zones for LLIF has been performed. ⋯ This is the first comprehensive systematic review and meta-analysis of the lumbar neural components and safe working zones for LLIF. Our analysis suggests that the lumbar plexus is significantly displaced ventrally with the supine compared to lateral decubitus position, and that MRI may overestimate ventral encroachment of lumbar plexus.