The spine journal : official journal of the North American Spine Society
-
Review Meta Analysis
Neurological examination of the peripheral nervous system to diagnose lumbar spinal disc herniation with suspected radiculopathy: a systematic review and meta-analysis.
Disc herniation is a common low back pain (LBP) disorder, and several clinical test procedures are routinely employed in its diagnosis. The neurological examination that assesses sensory neuron and motor responses has historically played a role in the differential diagnosis of disc herniation, particularly when radiculopathy is suspected; however, the diagnostic ability of this examination has not been explicitly investigated. ⋯ This systematic review and meta-analysis demonstrate that neurological testing procedures have limited overall diagnostic accuracy in detecting disc herniation with suspected radiculopathy. Pooled diagnostic accuracy values of the tests were poor, whereby all tests demonstrated low sensitivity, moderate specificity, and limited diagnostic accuracy independent of the disc herniation reference standard or the specific level of herniation. The lack of a standardized classification criterion for disc herniation, the variable psychometric properties of the testing procedures, and the complex pathoetiology of lumbar disc herniation with radiculopathy are suggested as possible reasons for these findings.
-
Although several publications in the last decade have proved equality in safety and efficacy of the total disc replacement (TDR) to the anterior fusion procedure in cervical spine, the claim that TDR may reduce the incidence of adjacent segment disease (ASD) has not been corroborated by clinical evidence. ⋯ The incidence of symptomatic ASD after cervical TDR is 3.1% annually regardless of the patient's age, sex, smoking habits, and design of the TDR device. The presence of osteopenia and lumbar degenerative disease significantly increase the risk of developing ASD after anterior cervical surgery.
-
Meta Analysis
Outcomes after spine surgery among racial/ethnic minorities: a meta-analysis of the literature.
Prior research has identified disparities in access to care, resource utilization, and outcomes in members of racial and ethnic minorities. However, the role that race/ethnicity may play in influencing outcomes after spine surgery has not been previously studied. ⋯ In light of the small number of studies able to be included in the meta-analysis, no firm conclusions can be drawn regarding the effect of race/ethnicity on outcome after spinal surgery. There is a pressing need for more robust research regarding spine surgical outcomes among different racial and ethnic minority groups.
-
Meta Analysis Comparative Study
Comparison of vertebroplasty and balloon kyphoplasty for treatment of vertebral compression fractures: a meta-analysis of the literature.
Previous investigators have reported on benefits and risks associated with vertebroplasty and kyphoplasty, but there are limited comparison data available. Additionally, much of the data is from retrospective studies and case series. ⋯ Both vertebroplasty and kyphoplasty provided significant improvement in VAS pain scores. Vertebroplasty had a significantly greater improvement in pain scores but also had statistically greater risk of cement leakage and new fracture.
-
Meta Analysis Comparative Study
The safety of instrumented outpatient anterior cervical discectomy and fusion.
Reported hospitalization times after an anterior cervical discectomy and fusion (ACDF) procedure range between 20 hours to 4 days. Reasons for this wide variation are manifold, but the safety of an instrumented ACDF in the setting of a hostile medical-legal climate is most likely the primary concern influencing such a discrepancy. ⋯ Performing ACDF with instrumentation on an outpatient basis is feasible, and it is not associated with higher overall or hardware-related complication rates as compared with complication rates reported in the literature, suggesting that this procedure is safe to perform on an outpatient basis.