Evidence-based treatment of osteoporotic vertebral compression fracture

The prevalence and medical costs of osteoporotic vertebral compression fractures (OVCFs) are on the rise. However, a concrete evidence-based treatment guideline has not yet been established. Despite that numerous randomized controlled trials (RCTs) were performed, the study design and outcome measurement were heterogeneous, and the results were not unified. The purpose of this review is to compare the results of high level-evidence studies to provide a background for evidence-based OVCF treatment. Many reports showed that vertebroplasty has better clinical outcomes than non-surgical treatment for OVCF, but the results of three double-blinded RCTs with the highest level of evidence did not show a significant difference between vertebroplasty and sham procedure. Whether undergoing surgical or non-surgical treatment, OVCF patient management should be started by managing osteoporosis first. Meanwhile, in the results of RCTs related to the comparison of conservative treatment modalities, the benefit of braces and a specific analgesic prescription protocol was also unclear. The presented results of each clinical trial were generally inconsistent and may not be appropriate in all situations. Any decision by clinicians to apply this evidence must be made considering individual patients and available resources. At present, controversy remains about the best treatment modality for OVCF. Large, multicenter, placebo/sham-controlled trials are needed to address this gap and establish strong evidence-based guidelines.

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Surgical treatment is better than non-surgical treatment for primary patellar dislocation: a meta-analysis of randomized controlled trials

Archives of Orthopaedic and Trauma Surgery ◽

10.1007/s00402-019-03308-2 ◽

2019 ◽

Vol 140 (2) ◽

pp. 219-229 ◽

Cited By ~ 1

Author(s):

Zhengdao Fu ◽

Zhiqiang Zhu ◽

Haitao Chen ◽

Shiqin Zhang

Keyword(s):

Surgical Treatment ◽

Randomized Controlled Trials ◽

Patellar Dislocation ◽

Meta Analysis ◽

Controlled Trials ◽

Randomized Controlled ◽

Non Surgical Treatment ◽

Better Than

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Non-Surgical Treatment of Lateral Epicondylitis: A Aystematic Review of Randomized Controlled Trials

Hand ◽

10.1007/s11552-014-9642-x ◽

2014 ◽

Vol 9 (4) ◽

pp. 419-446 ◽

Cited By ~ 73

Author(s):

Susan E. G. Sims ◽

Katherine Miller ◽

John C. Elfar ◽

Warren C. Hammert

Keyword(s):

Surgical Treatment ◽

Randomized Controlled Trials ◽

Lateral Epicondylitis ◽

Controlled Trials ◽

Randomized Controlled ◽

Non Surgical Treatment

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Nonsurgical Management of Acute Uncomplicated Appendicitis in Children: the Analysis of Treatment Outcome in Relationship with Antimicrobial Regimens and Adverse Prognostic Factors

Acta Chirurgica Latviensis ◽

10.1515/chilat-2017-0003 ◽

2016 ◽

Vol 16 (2) ◽

pp. 12-16

Author(s):

Elina Silina ◽

Asnate Jurgele ◽

Arturs Viksne ◽

Zane Abola ◽

Arnis Engelis ◽

...

Keyword(s):

Treatment Outcome ◽

Surgical Treatment ◽

Acute Appendicitis ◽

Clinical Signs ◽

Drug Combinations ◽

Antimicrobial Drug ◽

Nonsurgical Management ◽

Unsuccessful Treatment ◽

Significant Difference ◽

Non Surgical Treatment

SummaryIntroduction.For acute appendicitis - the most frequent condition to perform an urgent abdominal operation in pediatric surgery - surgical appendectomy still remains the gold standard regarding treatment, nevertheless nonsurgical management has become more and more recognized as a treatment method for uncomplicated acute appendicitis (UAA). However there are still many unanswered questions regarding possible factors that could predict the treatment outcome as well as appropriate antimicrobial drug regimens.Aim of the Study.The aim was to investigate if there is a possible association between factors such as C-reactive protein (CRP) level, presence of appendicolith, the diameter of the appendix and treatment outcome; as well as to identify most successfully used antimicrobial drug combinations.Material and methods.A retrospective analysis of hospital cases, admitted to a single reference center during the time period from 2013 to 2015. Patients with clinical signs of acute appendicitis, elevated inflammatory markers and radiological findings suggestive for acute appendicitis were included in the study. Nonsurgical treated patients were divided in two groups based on the treatment outcome - successful or unsuccessful. Analysis of the three factors (CRP level, presence of appendicolith and the diameter of the appendix) and most commonly used antimicrobial drug regimen association with treatment outcome was performed.Results.Overall 384 children medical records with acute appendicitis were registered and non-surgical treatment was initiated in 147/384 (38 %) cases. Successful treatment outcome of nonsurgical management was identified in 114/147 (78 %) cases. Analyzing prognostic adverse factors results presents no statistically significant difference in association with CRP level >25 mg/l (p=0,479), presence of appendicolith (p=0,183) and the diameter of appendix >1 cm (p=0,183) with successful or unsuccessful treatment outcome. The two most commonly used antimicrobial drug combinations were - Ampicillin/Metronidazole for 49 patients and Ampicillin/Gentamicin for 44 patients. No relevance with treatment outcome and used antimicrobial agents was detected (p=0,597).The overall recurrence rate after initial presentation is 15 % (17/114). In 3 cases (3 %) recurrent appendicitis developed one month after discharge and in 14 cases (12 %) up to one year after discharge.Conclusions.Prognostic adverse factors - CRP, presence of appendicolith and diameter of appendix - were not statistically reliable in association with initial non-surgical treatment outcome. The success rate of conservative treatment with narrow spectrum antibiotics was 78 %, which is just as high as in cases treated conservatively with broad-spectrum antibiotics from previous studies. Therefore the question of which factors and antimicrobial drug combinations influence the course of treatment still remains unanswered and further studies are required.

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The effectiveness and appropriateness of Interval Laparoscopic Appendectomy on adult appendiceal mass, a retrospective cohort

10.21203/rs.2.14168/v1 ◽

2019 ◽

Author(s):

Shiro Fujihata ◽

Hidehiko Kitagami ◽

Yosuke Kitayama ◽

Ayumi Suzuki ◽

Moritsugu Tanaka ◽

...

Keyword(s):

Surgical Treatment ◽

Laparoscopic Appendectomy ◽

Perioperative Complications ◽

Oral Intake ◽

Operation Time ◽

Appendiceal Mass ◽

Uncomplicated Appendicitis ◽

Objective Parameter ◽

Significant Difference ◽

Non Surgical Treatment

Abstract Background: Appendiceal mass sometimes requires extended resection and difficult to treat postoperative complications. Interval appendectomy has been performed mainly in the field of pediatric surgery to avoid them. Recently, there are a few reports on interval laparoscopic appendectomy (ILA). We examined not only the safety and effectiveness of ILA for adult appendiceal mass (AAM), but also the appropriateness of ILA for which cases should be treated non-surgically for ILA or converted to surgical treatment. Methods: Among 956 appendectomies performed between April 2012 and March 2018, there were 49 cases of AAM, of which 34 cases underwent ILA; ILA group. The safety and efficacy of ILA were examined by comparing with 477 cases of adult uncomplicated appendicitis underwent laparoscopic appendectomy (LA); LA group. The appropriateness of ILA was examined by comparing with the remaining 15 cases of AAM; non-ILA group. Results: The ILA group had a longer operation time than the LA group, but the postoperative hospital stay was shorter, and no significant difference were found in the bleeding volume, the days required for oral intake of solid food, and the perioperative complications. Examining the factors for failure of non-surgical treatment or relapse of inflammation during interval period, higher WBC day3 / day0 was found to be an independent risk factor. Conclusion: ILA against AAM was almost as safe and effective as LA for adult uncomplicated appendicitis. WBC day3 / day0 may be effective as an objective parameter for judging the termination of non-surgical treatment for ILA. This determination to convert ineffective non-surgical treatment to surgical treatment earlier may reduce the burden on the patient.

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