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
Surgery or physical activity in the management of sciatica: a systematic review and meta-analysis.
Previous reviews have compared surgical to non-surgical management of sciatica, but have overlooked the specific comparison between surgery and physical activity-based interventions. ⋯ There are indications that surgery is superior to physical activity-based interventions in reducing pain and disability for disc herniation at short-term follow-up only; but high-quality evidence in this field is lacking (GRADE). For spondylolisthesis and spinal stenosis, surgery is superior to physical activity up to greater than 2 years follow-up. Results should guide clinicians and patients when facing the difficult decision of having surgery or engaging in active care interventions. PROSPERO registration number : CRD42013005746.
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Review Meta Analysis
The location of Modic changes in the lumbar spine: a meta-analysis.
This meta-analysis was to study the location of Modic changes in the lumbar spine. ⋯ In this study, Modic Changes was more common in the lowest two levels, especially in L5/S1. Additionally, the sub-types (type I and type II) were also more likely to appear in L5/S1. It appeared that there existed a correlation between MC and biomechanics. And it seemed that local biomechanical stress might contributed to the distribution of MC and the conversion of type I to type II for the patients treated conservatively.
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To compare the short- and long-term clinical outcomes, operation times, restoration rate, dosage of polymethylmeth-acrylate (PMMA) injected, complications and X-rays exposure frequency between unilateral and bilateral kyphoplasty approaches for the treatment of OVCF. ⋯ A definitive verdict could not be reached regarding which approach is better for the treatment of OVCF. Although unilateral PKP was associated with shorter operative time, less X- ray exposure frequency and dosage of PMMA than bilateral PKP. There was no apparent difference in the short- and long-term clinical outcomes and complications between them. However, bilateral PKP approaches were higher than unilateral PKP in term of the restoration rate. But on account of lack of some high-quality evidence, we hold that amounts of high-quality randomized controlled trials should be required and more complications should be analysed to resolve which surgical approach is better for the treatment of OVCF in the future.
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To analyse the incidence and risk factors associated with proximal junctional kyphosis (PJK) following spinal fusion, we collect relative statistics from the articles on PJK and perform a meta-analysis. ⋯ The results of our meta-analysis suggest that age at surgery >55 years, fusion to S1, T5-T12 >40°, low BMD and SVA difference >5 cm are risk factors for PJK. However, gender, combined anterior-posterior surgery, use of pedicle screw at top of construct, hybrid instrumentation and thoracoplasty are not associated with PJK.
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To investigate the prevalence of axial symptoms (AS) in patients following posterior cervical decompression. ⋯ Posterior cervical surgery carries a high risk of postoperative AS. Postoperative AS may be reduced through preserving posterior muscles and structures, stabilizing cervical vertebrae, and reducing external cervical immobilization time.