Opportunistic CT screening of osteoporosis on thoracic and lumbar spine: a meta-analysis

A pre-procedural ultrasound of the lumbar spine is frequently used to facilitate neuraxial procedures. The aim of this review is to examine the evidence sustaining the utilization of pre-procedural neuraxial ultrasound compared to conventional methods. We perform a systematic review of randomized controlled trials with meta-analyses. We search the electronic databases Medline, Cochrane Central, Science Direct and Scopus up to 1 June 2019. We include trials comparing a pre-procedural lumbar spine ultrasound to a non-ultrasound-assisted method. The primary endpoints are technical failure rate, first-attempt success rate, number of needle redirections and procedure time. We retrieve 32 trials (3439 patients) comparing pre-procedural lumbar ultrasounds to palpations for neuraxial procedures in various clinical settings. Pre-procedural ultrasounds decrease the overall risk of technical failure (Risk Ratio (RR) 0.69 (99% CI, 0.43 to 1.10), p = 0.04) but not in obese and difficult spinal patients (RR 0.53, p = 0.06) and increase the first-attempt success rate (RR 1.5 (99% CI, 1.22 to 1.86), p < 0.0001, NNT = 5). In difficult spines and obese patients, the RR is 1.84 (99% CI, 1.44 to 2.3; p < 0.0001, NNT = 3). The number of needle redirections is lower with pre-procedural ultrasounds (SMD = −0.55 (99% CI, −0.81 to −0.29), p < 0.0001), as is the case in difficult spines and obese patients (SMD = −0.85 (99% CI, −1.08 to −0.61), p < 0.0001). No differences are observed in procedural times. Ιn conclusion, a pre-procedural ultrasound provides significant benefit in terms of technical failure, number of needle redirections and first attempt-success rate. Τhe effect of pre-procedural ultrasound scanning of the lumbar spine is more significant in a subgroup analysis of difficult spines and obese patients.

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The Influence of Stretching the Hip Flexor Muscles on Performance Parameters. A Systematic Review with Meta-Analysis

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph18041936 ◽

2021 ◽

Vol 18 (4) ◽

pp. 1936

Author(s):

Andreas Konrad ◽

Richard Močnik ◽

Sylvia Titze ◽

Masatoshi Nakamura ◽

Markus Tilp

Keyword(s):

Systematic Review ◽

Lumbar Spine ◽

Positive Impact ◽

Meta Analysis ◽

Force Production ◽

Performance Parameters ◽

Plantar Flexors ◽

Performance Change ◽

Flexor Muscles ◽

Hip Flexor

The hip flexor muscles are major contributors to lumbar spine stability. Tight hip flexors can lead to pain in the lumbar spine, and hence to an impairment in performance. Moreover, sedentary behavior is a common problem and a major contributor to restricted hip extension flexibility. Stretching can be a tool to reduce muscle tightness and to overcome the aforementioned problems. Therefore, the purpose of this systematic review with meta-analysis was to determine the effects of a single hip flexor stretching exercise on performance parameters. The online search was performed in the following three databases: PubMed, Scopus, and Web of Science. Eight studies were included in this review with a total of 165 subjects (male: 111; female 54). In contrast to other muscle groups (e.g., plantar flexors), where 120 s of stretching likely decreases force production, it seems that isolated hip flexor stretching of up to 120 s has no effect or even a positive impact on performance-related parameters. A comparison of the effects on performance between the three defined stretch durations (30–90 s; 120 s; 270–480 s) revealed a significantly different change in performance (p = 0.02) between the studies with the lowest hip flexor stretch duration (30–90 s; weighted mean performance change: −0.12%; CI (95%): −0.49 to 0.41) and the studies with the highest hip flexor stretch duration (270–480 s; performance change: −3.59%; CI (95%): −5.92 to −2.04). Meta-analysis revealed a significant (but trivial) impairment in the highest hip flexor stretch duration of 270–480 s (SMD effect size = −0.19; CI (95%) −0.379 to 0.000; Z = −1.959; p = 0.05; I2 = 0.62%), but not in the lowest stretch duration (30–90 s). This indicates a dose-response relationship in the hip flexor muscles. Although the evidence is based on a small number of studies, this information will be of great importance for both athletes and coaches.

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Outcomes and Complications Following Minimally Invasive Excision of Synovial Cysts of the Lumbar Spine: A Systematic Review and Meta-Analysis

Clinical Neurology and Neurosurgery ◽

10.1016/j.clineuro.2021.106667 ◽

2021 ◽

pp. 106667

Author(s):

Kanwaljeet Garg ◽

Manish K. Kasliwal

Keyword(s):

Systematic Review ◽

Lumbar Spine ◽

Minimally Invasive ◽

Meta Analysis ◽

Synovial Cysts

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Thoracic and lumbar spine pedicle morphology in Japanese patients

Surgical and Radiologic Anatomy ◽

10.1007/s00276-021-02707-8 ◽

2021 ◽

Author(s):

Kohei Morita ◽

Hiroki Ohashi ◽

Daichi Kawamura ◽

Satoshi Tani ◽

Kostadin Karagiozov ◽

...

Keyword(s):

Lumbar Spine ◽

Japanese Patients ◽

Thoracic And Lumbar Spine ◽

Pedicle Morphology

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Rating the incidence of iatrogenic vascular injuries in thoracic and lumbar spine surgery as regards the approach: A PRISMA-based literature review

European Spine Journal ◽

10.1007/s00586-021-06956-4 ◽

2021 ◽

Author(s):

Alice Giotta Lucifero ◽

Cristian Gragnaniello ◽

Matias Baldoncini ◽

Alvaro Campero ◽

Gabriele Savioli ◽

...

Keyword(s):

At Risk ◽

Lumbar Spine ◽

Spine Surgery ◽

Iliac Vein ◽

Lumbar Spine Surgery ◽

Common Iliac Vein ◽

Suture Repair ◽

Vascular Injuries ◽

Mesh Terms ◽

Thoracic And Lumbar Spine

Abstract Purpose To assess the rate, timing of diagnosis, and repairing strategies of vascular injuries in thoracic and lumbar spine surgery as their relationship to the approach. Methods PubMed, Medline, and Embase databases were utilized for a comprehensive literature search based on keywords and mesh terms to find articles reporting iatrogenic vascular injury during thoracic and lumbar spine surgery. English articles published in the last ten years were selected. The search was refined based on best match and relevance. Results Fifty-six articles were eligible, for a cumulative volume of 261 lesions. Vascular injuries occurred in 82% of instrumented procedures and in 59% during anterior approaches. The common iliac vein (CIV) was the most involved vessel, injured in 49% of anterior lumbar approaches. Common iliac artery, CIV, and aorta were affected in 40%, 28%, and 28% of posterior approaches, respectively. Segmental arteries were injured in 68% of lateral approaches. Direct vessel laceration occurred in 81% of cases and recognized intraoperatively in 39% of cases. Conclusions Incidence of iatrogenic vascular injuries during thoracic and lumbar spine surgery is low but associated with an overall mortality rate up to 65%, of which less than 1% for anterior approaches and more than 50% for posterior ones. Anterior approaches for instrumented procedures are at risk of direct avulsion of CIV. Posterior instrumented fusions are at risk for injuries of iliac vessels and aorta. Lateral routes are frequently associated with lesions of segmental vessels. Suture repair and endovascular techniques are useful in the management of these severe complications.

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