Full-Endoscopic Procedures Versus Traditional
Discectomy Surgery for Discectomy: A
Systematic Review and Meta-analysis of
Current Global Clinical Trials

Background: Traditional discectomy surgery (TDS) provides good or excellent results in clinical surgical discectomy but may induce neural adhesion, spinal structural damage, instability, and other complications. The potential advantages of full-endoscopic (FE) procedures over standard TDS include less blood loss, less postoperative pain, shorter hospitalization, and an earlier return to work. However, more evidence is needed to support this new technology in clinical applications. Objective: The aim of this systematic review and meta-analysis was to compare the safety and efficacy of FE and TDS. Study Design: Comprehensive systematic review and meta-analysis of the literature. Methods: Electronic databases, including PubMed, EMBASE, SinoMed, and Cochrane Library, were searched to identify clinical therapeutic trials comparing FE to TDS for discectomy. Results: Six trials comprising 730 patients were included, and the overall quality of the literature was moderate, including 4 Grade I levels of evidence (4 randomized controlled trials, [RCTs]) and 2 Grade II levels (2 non-RCTs). The pooled data revealed no difference in reoperation rates between FE and TDS (P = 0.94), but the complication rate was significantly lower in the FE group (3.86%) than in the TDS group (11.4%). Perioperative parameters (operation time, blood loss, hospitalization time, and return to work days) were significantly lower in the FE group (P < 0.05 for all groups using either score). Postoperative pain and neurology score assessments were conducted at 4 different time points at 3 months, 6 months, 12 months, and 24 months. Significant differences were detected in the following: lumbar North American Spine Society (NASS) pain at 6 months (P = 0.008); cervical NASS neurology at 6 months (P = 0.03); visual analog scale (VAS) score in leg at 3 months (P < 0.001); VAS score in arm at 24 months (P = 0.002); VAS score in neck at 3 months, 6 months, and 12 months after therapy (P = 0.003, P = 0.004, P = 0.01); and VAS score in neck at 3 months and 6 months (P = 0.01, P = 0.004). Moreover, the pooled data revealed no statistically significant differences in improvements in the Oswestry disability index (ODI), instability (X-ray), and Hilibrand criteria (P > 0.05 for all groups). Limitations: Only 6 studies were included, 4 of which had the same authors. Between-study heterogeneity due to differences in socioeconomic factors, nutrition, and matching criteria is difficult to avoid. Conclusions: Based on this meta-analysis of 24 months of clinical results, we conclude that the FE procedure is as effective as TDS but has the additional benefits of lower complication rates and superior perioperative parameters. In addition, patients may experience less pain with FE techniques due to a smaller incision and less operative injury. However, large-volume, well-designed RCTs with extensive follow-up are needed to confirm and update the findings of this analysis. Key words: Full-endoscopic, minimally invasive, discectomy, meta-analysis

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The Role of Local Bupivacaine Irrigation in Postoperative Pain Control After Augmentation Mammoplasty: A Systematic Review and Meta-Analysis

Plastic Surgery ◽

10.1177/2292550317693816 ◽

2017 ◽

Vol 25 (1) ◽

pp. 32-39

Author(s):

Shan Shan Qiu ◽

Marta Roque ◽

Yi-Chieh Chen

Keyword(s):

Systematic Review ◽

Postoperative Pain ◽

Normal Saline ◽

Pain Control ◽

Meta Analysis ◽

A Priori ◽

Cochrane Collaboration ◽

Cochrane Library ◽

Augmentation Mammoplasty ◽

Mesh Terms

Background: The objective of this study is to analyze the efficacy of local bupivacaine irrigation after augmentation mammoplasty for the control of postoperative pain. Methods: A systematic review and meta-analysis was conducted including all randomized controlled trials (RCTs) that compared the irrigation of bupivacaine (±ketorolac) versus normal saline or no irrigation for pain control after breast augmentation. The primary outcome was postoperative pain measured by visual analog scale. The study protocol was established a priori according to the recommendations of the Cochrane Collaboration. A bibliographical search was conducted in September 2015 in the following Cochrane Library databases: CENTRAL, MEDLINE, EMBASE, and Scielo. The strategy used for the search was ((augmentation AND (“mammoplasty”[MeSH Terms] OR “mammoplasty”)) OR ((“breast”[MeSH Terms] OR “breast”) AND augmentation)) AND ((“pain, postoperative”[MeSH Terms])). Results: Four RCTs with a total of 264 participants were included. Two trials compared bupivacaine alone versus placebo (normal saline or no irrigation) and 3 trials compared bupivacaine plus ketorolac versus placebo. The combined irrigation of bupivacaine and ketorolac showed a clinically significant reduction of pain in the first postoperative hour and on postoperative day 5. The irrigation with bupivacaine compared with placebo significantly reduced pain assessed on postoperative day 4. Conclusion: The irrigation of bupivacaine with or without ketorolac was associated with a reduction of postoperative pain compared with control groups for the first 5 postoperative days. Due to the few number of trials included, these results should be correlated further clinically.

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Transosseous versus transmuscular repair of the posterior soft tissue in primary hip arthroplasty: a meta-analysis

Journal of Orthopaedic Surgery and Research ◽

10.1186/s13018-020-02084-9 ◽

2020 ◽

Vol 15 (1) ◽

Author(s):

Changjiao Sun ◽

Xiaofei Zhang ◽

Qi Ma ◽

Ruiyong Du ◽

Xu Cai ◽

...

Keyword(s):

Soft Tissue ◽

Blood Loss ◽

Hip Arthroplasty ◽

Meta Analysis ◽

Dislocation Rate ◽

Harris Hip Score ◽

Cochrane Library ◽

Vas Score ◽

Transosseous Repair ◽

Posterior Soft Tissue

Abstract Background During the posterior approach, it has been shown that a significant reduction in dislocation rate can be achieved with the repair of the posterior soft tissue. However, no consensus exists about the best way to perform this repair. This review aimed to compare the transosseous with transmuscular repair of the posterior soft tissue in total hip arthroplasty (THA). Methods We conducted a meta-analysis to identify studies involving transosseous versus transmuscular repair of the posterior soft tissue in THA in electronic databases, including Web of Science, Embase, PubMed, Cochrane Controlled Trials Register, Cochrane Library, Highwire, CBM, CNKI, VIP, Wanfang database, up to July 2020. Finally, we identified 1417 patients (1481 hips) assessed in seven studies. Results Compared with transmuscular repair, transosseous repair resulted in less incidence of dislocation (P = 0.003), less blood loss during operation (P < 0.00001) and lower VAS score within 3 months (P = 0.02). There were no significant differences in terms of trochanteric fracture rate (P = 0.56), Harris hip score at 3 months (P = 0.35) and 6 months (P = 0.89), VAS score within 6 months (P = 0.53), and operation time (P = 0.70) between two groups. Conclusion The lower dislocation rate, less blood loss, and lower VAS scores after operation supported transosseous repair's superiority to transmuscular repair. Besides, no additional medical cost and operating time were associated with transosseous repair compared with transmuscular repair. Hence, we recommend that transosseous repair be chosen first by orthopedists when performing reconstruction of the posterior soft tissue in THA via a posterolateral approach. Given the relevant possible biases in our meta-analysis, we required more adequately powered and better-designed RCT studies with long-term follow-up to reach a firmer conclusion.

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Open versus arthroscopic ankle arthrodesis: A systemic review and meta-analysis

10.21203/rs.3.rs-17549/v1 ◽

2020 ◽

Author(s):

Tsz Ngai Mok ◽

Qiyu He ◽

SOUNDARYA PANNEERSELVAM ◽

Huajun Wang ◽

Huige Hou ◽

...

Keyword(s):

Systematic Review ◽

Blood Loss ◽

Cohort Studies ◽

Open Surgery ◽

Meta Analysis ◽

Fusion Rate ◽

Ankle Arthritis ◽

Tourniquet Time ◽

Pooled Data ◽

Estimated Blood Loss

Abstract Background: Osteoarthritis (OA) is a growing health concern that affects approximately 27 million people in the USA and is associated with a $185 billion annual cost burden. Choosing between open surgery and arthroscopic arthrodesis for ankle arthritis is still controversial. This study compared arthroscopic arthrodesis and open surgery by performing a systematic review and meta-analysis. Methods: For the systematic review, a literature search was conducted in four English databases (PubMed, Embase, Medline and the Cochrane Library) from inception to February 2020. Two prospective cohort studies and 8 retrospective cohort studies, enrolling a total of 548 patients with ankle arthritis, were included. Result: For fusion rate, the pooled data showed a significantly higher rate of fusion during arthroscopic arthrodesis compared with open surgery (odds ratio 0.25, 95% CI 0.11 to 0.57, p = 0.0010). Regarding estimated blood loss, the pooled data showed significantly less blood loss during arthroscopic arthrodesis compared with open surgery (WMD 52.04, 95% CI 14.14 to 89.94, p = 0.007). For tourniquet time, the pooled data showed a shorter tourniquet time during arthroscopic arthrodesis compared with open surgery (WMD 22.68, 95% CI 1.92 to 43.43, p = 0.03). For length of hospital stay, the pooled data showed less hospitalisation time for patients undergoing arthroscopic arthrodesis compared with open surgery (WMD 1.62, 95% CI 0.97 to 2.26, p < 0.00001). The pooled data showed better recovery for the patients who underwent arthroscopic arthrodesis compared with open surgery at 1 year (WMD 14.73, 95% CI 6.66 to 22.80, p = 0.0003). Conclusion: In conclusion, arthroscopic arthrodesis was associated with a higher fusion rate, smaller estimated blood loss, shorter tourniquet time, shorter length of hospitalisation and better functional improvement at 1 year than open surgery.

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Open versus arthroscopic ankle arthrodesis: A systematic review and meta-analysis

10.21203/rs.3.rs-17549/v2 ◽

2020 ◽

Author(s):

Tsz Ngai Mok ◽

Qiyu He ◽

Soundarya Panneerselvam ◽

Huajun Wang ◽

Huige Hou ◽

...

Keyword(s):

Systematic Review ◽

Blood Loss ◽

Cohort Studies ◽

Open Surgery ◽

Meta Analysis ◽

Fusion Rate ◽

Ankle Arthritis ◽

Tourniquet Time ◽

Pooled Data ◽

Estimated Blood Loss

Abstract Background: Osteoarthritis (OA) is a growing health concern that affects approximately 27 million people in the USA and is associated with a $185 billion annual cost burden . Choosing between open surgery and arthroscopic arthrodesis for ankle arthritis is still controversial. This study compared arthroscopic arthrodesis and open surgery by performing a systematic review and meta-analysis. Methods: For the systematic review, a literature search was conducted in four English databases (PubMed, Embase, Medline and the Cochrane Library) from inception to February 2020. Two prospective cohort studies and 8 retrospective cohort studies, enrolling a total of 548 patients with ankle arthritis, were included. Result: For fusion rate, the pooled data showed a significantly higher rate of fusion during arthroscopic arthrodesis compared with open surgery (odds ratio 0.25, 95% CI 0.11 to 0.57, p = 0.0010). Regarding estimated blood loss, the pooled data showed significantly less blood loss during arthroscopic arthrodesis compared with open surgery (WMD 52.04, 95% CI 14.14 to 89.94, p = 0.007). For tourniquet time, the pooled data showed a shorter tourniquet time during arthroscopic arthrodesis compared with open surgery (WMD 22.68, 95% CI 1.92 to 43.43, p = 0.03). For length of hospital stay, the pooled data showed less hospitalisation time for patients undergoing arthroscopic arthrodesis compared with open surgery (WMD 1.62, 95% CI 0.97 to 2.26, p < 0.00001). The pooled data showed better recovery for the patients who underwent arthroscopic arthrodesis compared with open surgery at 1 year (WMD 14.73, 95% CI 6.66 to 22.80, p = 0.0003). Conclusion: In conclusion, arthroscopic arthrodesis was associated with a higher fusion rate, smaller estimated blood loss, shorter tourniquet time, shorter length of hospitalisation and better functional improvement at 1 year than open surgery.

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502 Pain Prevention with Intraoperative Music: A Review and Meta-Analysis of The Impact of Intraoperative Music on The Post-Operative Pain of Abdominal Surgery Patients

British Journal of Surgery ◽

10.1093/bjs/znab134.292 ◽

2021 ◽

Vol 108 (Supplement_2) ◽

Author(s):

V Dale

Keyword(s):

Systematic Review ◽

Postoperative Pain ◽

Abdominal Surgery ◽

Meta Analysis ◽

Postoperative Pain Management ◽

Cochrane Library ◽

Music Intervention ◽

Standard Mean Difference ◽

Post Operative Pain ◽

The Impact

Abstract Introduction Postoperative pain is a significant problem that can lead to a range of complications including inadequate healing. Music has been shown to reduce postoperative pain across a range of surgical disciplines. This poster is novel as intra-operative awareness is an area of some debate and there has not previously been a systematic review of the impact of intraoperative music on the post-operative pain of abdominal surgery patients. Method A systematic review of Cochrane Library, PubMed, and Scopus identified randomised controlled trials comparing an intraoperative music intervention with standard care with postoperative pain as a measured outcome. To assess the quality of the studies and determine inclusion in meta-analysis the author collaborated with Robot Reviewer software based on the Cochrane bias methodology. Meta-analysis used standard mean difference and a random-effects model. Results The review found the majority of studies looking at intraoperative interventions determined that there was no significant impact on postoperative pain. However meta-analysis of the 250 subjects included determined that there is a significant reduction in pain (p = 0.02). The studies included also looked at opiod use, however this was not reported. Conclusions Whilst the meta-analysis is promising, findings support further investigation into intraoperative music as a low-cost addition to postoperative pain management.

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Meta-Analysis of 3D Printing Applications in Traumatic Fractures

Frontiers in Surgery ◽

10.3389/fsurg.2021.696391 ◽

2021 ◽

Vol 8 ◽

Author(s):

Sha Yang ◽

Huapeng Lin ◽

Cong Luo

Keyword(s):

3D Printing ◽

Blood Loss ◽

Meta Analysis ◽

Cochrane Library ◽

Complication Rates ◽

Intraoperative Blood Loss ◽

Fracture Union ◽

Conventional Surgery ◽

Traumatic Fracture ◽

Operation Duration

Background: Traumatic fracture is a common orthopaedic disease, and application of 3D printing technology in fracture treatment, which entails utilisation of pre-operative printed anatomic fracture model, is increasingly gaining popularity. However, effectiveness of 3D printing-assisted surgery lacks evidence-based findings to support its application.Materials and Methods: Embase, PubMed and Cochrane Library databases were systematically searched until October, 2020 to identify relevant studies. All randomised controlled trials (RCTs) comparing efficacy of 3D printing-assisted surgery vs. conventional surgery for traumatic fractures were reviewed. RevMan V.5.3 software was used to conduct meta-analysis.Results: A total of 12 RCTs involving 641 patients were included. Pooled findings showed that 3D printing-assisted surgery had shorter operation duration [standardised mean difference (SMD) = −1.52, 95% confidence interval (CI) – 1.70 ~ −1.34, P < 0.00001], less intraoperative blood loss (SMD = 1.34, 95% CI 1.74 ~ 0.94, P < 0.00001), fewer intraoperative fluoroscopies (SMD = 1.25, 95% CI 1.64 ~ 0.87, P < 0.00001), shorter fracture union time (SMD = −0.15, 95% CI −0.25 ~ −0.05, P = 0.003), and higher rate of excellent outcomes (OR = 2.40, 95% CI 1.07 ~ 5.37, P = 0.03) compared with conventional surgery. No significant differences in complication rates were observed between the two types of surgery (OR = 0.69, 95% CI 0.69 ~ 1.42, P = 0.32).Conclusions: Indicators including operation duration, intraoperative blood loss, number of intraoperative fluoroscopies, fracture union time, and rates of excellent outcomes showed that 3D printing-assisted surgery is a superior alternative in treatment of traumatic fractures compared with conventional surgery. Moreover, the current study did not report significant differences in incidence of complications between the two approaches.Systematic Review Registration: CRD42021239507.

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The comparative accuracy and safety of fluoroscopic and navigation-based techniques in cervical pedicle screw fixation: systematic review and meta-analysis

Journal of Neurosurgery Spine ◽

10.3171/2020.11.spine201877 ◽

2021 ◽

pp. 1-8

Author(s):

Ahmad M. Tarawneh ◽

Shahnawaz Haleem ◽

Daniel D’Aquino ◽

Nasir Quraishi

Keyword(s):

Systematic Review ◽

Pedicle Screw ◽

Meta Analysis ◽

Pedicle Screw Fixation ◽

Cochrane Library ◽

Complication Rates ◽

Ct Guided ◽

Cervical Pedicle Screw ◽

Comparative Accuracy ◽

Cervical Pedicle

OBJECTIVE The goal of this study was to evaluate the comparative accuracy and safety of navigation-based approaches for cervical pedicle screw (CPS) placement over fluoroscopic techniques. METHODS A systematic search of the literature published between January 2006 and December 2019 relating to CPS instrumentation and the comparative accuracy and safety of fluoroscopic and intraoperative computer-based navigation techniques was conducted. Several databases, including the Cochrane Library, PubMed, and EMBASE, were systematically searched to identify potentially eligible studies. Data relating to CPS insertion accuracy and associated complications, in particular neurovascular complications, were extrapolated from the included studies and summarized for analysis. RESULTS A total of 17 studies were identified from the search methodology. Eleven studies evaluated CPS placement under traditional fluoroscopic guidance and 6 studies addressed outcomes following navigation-assisted placement (3D C-arm or CT-guided placement). Overall, a total of 4278 screws were placed in 1065 patients. Misplacement rates of CPS were significantly lower (p < 0.0001) in navigation-assisted techniques (12.51% [range 2.5%–20.5%]) compared to fluoroscopy-guided techniques (18.8% [range 0%–43.5%]). Fluoroscopy-guided CPS insertion was associated with a significantly higher incidence of postoperative complications relating to neurovascular injuries (p < 0.038), with a mean incidence of 1.9% compared with 0.3% in navigation-assisted techniques. CONCLUSIONS This systematic review supports a logical conclusion that navigation-based techniques confer a statistically significantly more accurate screw placement and resultant lower complication rates.

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Comparison between Arm Port and Chest Port for Optimal Vascular Access Port in Patients with Breast Cancer: A Systematic Review and Meta-Analysis

BioMed Research International ◽

10.1155/2020/9082924 ◽

2020 ◽

Vol 2020 ◽

pp. 1-8 ◽

Cited By ~ 1

Author(s):

Ye Liu ◽

Li-li Li ◽

Lei Xu ◽

Dong-dong Feng ◽

Yu Cao ◽

...

Keyword(s):

Breast Cancer ◽

Systematic Review ◽

Subgroup Analysis ◽

Comparative Studies ◽

Randomized Clinical Trials ◽

Meta Analysis ◽

Cochrane Library ◽

Complication Rates ◽

Access Port ◽

Chest Port

Objectives. This meta-analysis was conducted to compare the complication rates between arm and chest ports in patients with breast cancer. Design and Data Sources. PubMed, Embase, Cochrane library, Chinese National Knowledge Infrastructure (CNKI), and Wanfang database were used to perform a systematic review and meta-analysis of publications published from the inception of the database to 11, October 2019. Our search generated a total of 22 articles published from 2011 to 2019, including 6 comparative studies and 16 single-arm articles, involving 4131 cases and 5272 controls. Single-arm studies combined with comparative studies were also pooled and analyzed. Finally, subgroup analysis was performed to compare the rates of infection and thrombosis between these two ports. Eligibility Criteria. Included articles were research studies comparing complication rates of arm ports with chest ports in patients with breast cancer. Any review or meta-analysis article would be removed. Data Extraction and Synthesis. Demographic data and information for the following analysis were extracted. DerSimonian and Laird random effect meta-analysis was conducted to analyze comparative studies while Begg’s and Egger’s tests were used for assessment of publication bias. Meta-regression analysis was performed to explain the sources of heterogeneity. Results. There was no difference in the risk of overall complications between arm and chest ports for comparative studies (P=0.083). While results of pooled comparative and single-arm studies indicated that arm port would increase the overall complication risks with RR of 2.64, results of the subgroup analysis showed that there was no difference in the risk of catheter-related infection between these two ports. However, arm port might be associated with the higher thrombosis rates compared with chest port according to the results of the analysis for only comparative studies (RR = 2.23, P=0.041) as well as pooled comparative and single-arm studies (RR = 1.21, P=0.029). Conclusions. This study indicated that the arm port might increase the risk of overall complication risks as well as the risk of catheter-related thrombosis compared with the chest port. However, these reported findings still need to be verified by large randomized clinical trials.

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Ankle arthrodesis-Open versus arthroscopic in the Treatment of Ankle Arthritis: A meta-analysis

10.21203/rs.2.18589/v1 ◽

2019 ◽

Author(s):

Tsz Ngai Mok ◽

Qiyu He ◽

Soundarya Panneerselvam ◽

Huige Hou ◽

Huajun Wang ◽

...

Keyword(s):

Blood Loss ◽

Open Surgery ◽

Meta Analysis ◽

Fusion Rate ◽

Functional Improvement ◽

Cochrane Library ◽

Ankle Arthritis ◽

Tourniquet Time ◽

Pooled Data ◽

Estimated Blood Loss

Abstract Background: This study intends in evaluating the comparsion between arthroscopic arthrodesis and open surgery for patients with ankle arthritis by performing a meta-analysis. Methods: A literature search for this meta-analysis was conducted using four English databases (Pubmed, Embase, Medline and the Cochrane Library), up to August 2019. These included two prospective cohort study and 7 retrospective cohort studies, enrolling a total of 507 patients with ankle arthritis. Result: For fusion rate, the pooled data showed significantly higher rate of fusion during the arthroscopic arthrodesis compared with open surgery (odds ratio 0.25, 95% CI 0.11 to 0.57, p = 0.0010). Regarding to the estimated blood loss, the pooled data showed significantly smaller blood losses during arthroscopic arthrodesis as compared with open surgery (WMD 52.04, 95% CI 14.14 to 89.94, p = 0.007). For tourniquet time, the pooled data showed smaller tourniquet time during arthroscopic arthrodesis compared with open surgery (WMD 22.68, 95% CI 1.92 to 43.43, p = 0.03). In the length of stay in the hospital, the pooled data showed less time of hospitalization for patients undergoing arthroscopic arthrodesis compared with open surgery (WMD 1.62, 95% CI 0.97 to 2.26, p < 0.00001). The pooled data showed better recovery for the patients who experienced arthroscopic arthrodesis as compared with open surgery at 1 year (WMD 14.73, 95% CI 6.66 to 22.80, p = 0.0003). Conclusion: For patients with ankle arthritis, arthroscopic arthrodesis seems to be associated with a higher fusion rate, lesser amount of estimated blood loss, shorter tourniquet time, shorter length of hospitalization and better functional improvement at 1 year.

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Epidural steroid compared to placebo injection in sciatica: a systematic review and meta-analysis

European Spine Journal ◽

10.1007/s00586-021-06854-9 ◽

2021 ◽

Author(s):

E. J. A. Verheijen ◽

C. A. Bonke ◽

E. M. J. Amorij ◽

C. L. A. Vleggeert-Lankamp

Keyword(s):

Systematic Review ◽

Meta Analysis ◽

Treatment Success ◽

Leg Pain ◽

Cochrane Library ◽

Complication Rates ◽

Quality Of Evidence ◽

Epidural Steroid

Abstract Purpose The purpose of this systematic review and meta-analysis was to determine whether epidural steroid injections (ESI) are superior to epidural or non-epidural placebo injections in sciatica patients. Methods The PubMed, Embase, Cochrane Library, and Web of science databases were searched for trials comparing ESI to epidural or non-epidural placebo. Risk of bias was assessed using the Cochrane RoB 2 tool. The primary outcome measures were pooled using a random-effects model for 6-week, 3-month, and 6-month follow-up. Secondary outcomes were described qualitatively. Quality of evidence was graded using GRADE classification. Results Seventeen out of 732 articles were included. ESI was superior compared to epidural placebo at 6 weeks (− 8.6 [− 13.4; − 3.9]) and 3 months (− 5.2 [− 10.1; − 0.2]) for leg pain and at 6 weeks for functional status (− 4.1 [− 6.5; − 1.6]), though the minimally clinical important difference (MCID) was not met. There was no difference in ESI and placebo for back pain, except for non-epidural placebo at 3 months (6.9 [1.3; 12.5]). Proportions of treatment success were not different. ESI reduced analgesic intake in some studies and complication rates are low. Conclusion The literature indicates that ESI induces larger improvements in pain and disability on the short term compared to epidural placebo, though evidence is of low to moderate quality and MCID is not met. Strong conclusions for longer follow-up or for comparisons with non-epidural placebo cannot be drawn due to general low quality of evidence and limited number of studies. Epidural injections can be considered a safe therapy.

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