Journal of clinical neuroscience : official journal of the Neurosurgical Society of Australasia
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Review Meta Analysis
Diagnostic accuracy of somatosensory evoked potential monitoring during scoliosis fusion.
The goal of this review was to ascertain the diagnostic accuracy of intraoperative somatosensory evoked potential (SSEP) changes to predict perioperative neurological outcome in patients undergoing spinal deformity surgery to correct adolescent idiopathic scoliosis (AIS). The authors searched PubMed/MEDLINE and World Science databases to retrieve reports and/or experiments from January 1950 through January 2014 for studies on SSEP use during AIS surgery. All motor and sensory deficits were noted in the neurological examination administered after the procedure which was used to determine the effectiveness of SSEP as an intraoperative monitoring technique. ⋯ The diagnostic odds ratio of a patient who had a new neurological deficit with SSEP changes was a diagnostic odds ratio of 340 (95% confidence interval 125-926). Overall, detection of SSEP changes had excellent discriminant ability with an area under the curve of 0.99. Our meta-analysis covering 4763 operations on idiopathic patients showed that it is a highly sensitive and specific test and that iatrogenic spinal cord injury resulting in new neurological deficits was 340 times more likely to have changes in SSEP compared to those without any new deficits.
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Review Meta Analysis Comparative Study
Endovascular therapy including thrombectomy for acute ischemic stroke: A systematic review and meta-analysis with trial sequential analysis.
One of the primary strategies for the management of acute ischemic stroke is intravenous (IV) thrombolysis with tissue plasminogen activator (t-PA). Over the past decade, endovascular therapies such as the use of stent retrievers to perform mechanical thrombectomy have been found to improve functional outcomes compared to t-PA alone. We aimed to reassess the functional outcomes and complications of IV thrombolysis with and without endovascular treatment for acute ischemic stroke using conventional meta-analysis and trial sequential analysis. ⋯ Trial sequential analysis demonstrated endovascular treatment increased the RR of a good functional outcome by at least 30% compared to IV thrombolysis alone. There was no significant difference in all-cause mortality for mechanical thrombectomy compared to IV thrombolysis alone or the incidence of SICH at 3month follow-up. Endovascular treatment is more likely to result in a better functional outcome for patients compared to IV thrombolysis alone for acute ischemic stroke.
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Review Meta Analysis
Anterior cervical discectomy with arthroplasty versus anterior cervical discectomy and fusion for cervical spondylosis.
This meta-analysis aims to estimate the benefits and drawbacks associated with anterior cervical discectomy with arthroplasty (ACDA) versus anterior cervical discectomy and fusion (ACDF) for cervical spondylosis. Of 3651 identified citations, 10 randomised controlled studies involving 2380 participants were included. Moderate quality evidence supports that patients in the ACDA group had: (1) a higher Neck Disability Index (NDI) success rate at 3 month (relative risk [RR]=0.85, 95% confidence interval [CI] 0.78 to 0.93, p=0.0002) and 2 year follow-up (RR=0.95, 95%CI 0.91 to 1.00, p=0.04); (2) greater neurological success at 2 year follow-up (RR=0.95, 95%CI 0.92 to 0.98); and (3) were more likely to be employed within 6 weeks after surgery (RR=0.80 95%CI 0.66 to 0.96). ⋯ Patients who undergo ACDA may also have a greater likelihood of being employed in the short-term. However, all of the evidence reviewed is of moderate or low quality and the clinical significance often marginal or unclear. Additional data are needed to compare the benefits and limitations of ACDA and ACDF.
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Meta Analysis
Dexmedetomidine as an anesthetic adjuvant for intracranial procedures: meta-analysis of randomized controlled trials.
This meta-analysis aimed to systematically collect the current evidence regarding the efficacy and safety of dexmedetomidine (DEX) as an anesthetic adjuvant for patients undergoing intracranial surgery. A systematic literature search of randomized controlled trials (RCT) was conducted to compare DEX with placebo or opioids in patients undergoing intracranial procedures. Hemodynamic data, opioid consumption, and recovery parameters were pooled. ⋯ Patients also had lower mean arterial pressure and heart rate when extubated (mean difference [MD]=-9.74 mm Hg, 95% CI -12.35 to -7.12, p<0.00001; and MD=-16.35 beats/minute, 95% CI -20.00 to -12.70, p<0.00001, respectively), a lower intraoperative additional fentanyl consumption (MD=-0.78 μg/kg, 95% CI -1.51 to -0.05, p=0.04), and lower postoperative antiemetic requests (RR=0.51, 95% CI 0.33-0.80, p=0.003). DEX may not increase extubation time, postoperative PaCO2, or the risk of perioperative bradycardia. Only a small number of RCT are available, but meta-analysis shows evidence that DEX as an anesthetic adjuvant during intracranial procedures leads to better perioperative hemodynamic control, less intraoperative opioid consumption, and fewer postoperative antiemetic requests.
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Review Meta Analysis
Systematic review and meta-analysis of minimally invasive transforaminal lumbar interbody fusion rates performed without posterolateral fusion.
The need for posterolateral fusion (PLF) in addition to interbody fusion during minimally invasive (MIS) transforaminal lumbar interbody fusion (TLIF) has yet to be established. Omitting a PLF significantly reduces overall surface area available for achieving a solid arthrodesis, however it decreases the soft tissue dissection and costs of additional bone graft. The authors sought to perform a meta-analysis to establish the fusion rate of MIS TLIF performed without attempting a PLF. ⋯ Either polyetheretherketone (PEEK) or allograft interbody cages were used in all patients. Overall fusion rate, confirmed by bridging trabecular interbody bone on CT scan, was 94.7%. This meta-analysis suggests that MIS TLIF performed with interbody bone grafting alone has similar fusion rates to MIS or open TLIF performed with interbody supplemented with posterolateral bone grafting and fusion.