Comparison of combined anterior–posterior approach versus posterior-only approach in treating adolescent idiopathic scoliosis: a meta-analysis

Purpose

Choosing a surgical approach to treat adolescent idiopathic scoliosis (AIS) is still controversial. To compare the effectiveness and safety of combined anterior–posterior approach to posterior-only approach, we conducted a meta-analysis.

Methods

We searched electronic database for relevant studies that compared anterior–posterior approach with posterior approach in AIS. Then data extraction and quality assessment were conducted. We used RevMan 5.1 for data analysis. A random effects model was used for heterogeneous data, while a fixed effect model was used for homogeneous data.

Results

A total of ten non-randomized controlled studies involving 872 patients were included. There was no significant difference in Cobb angle (95 % CI ?0.33 to 4.91, P = 0.09) and percent-predicted FEV1 (95 % CI ?6.79 to 4.54, P = 0.70) between the two groups. In subgroup analysis, the kyphosis angle correction was significantly higher than posterior group in severe subgroup (95 % CI 0.72–6.50, P = 0.01), while no significant difference was found in no-restriction subgroup (95 % CI ?2.75 to 5.42, P = 0.52). Patients in posterior group obtained a better percent-predicted FVC than those in anterior–posterior group (95 % CI ?13.18 to ?4.74, P < 0.0001). Significant less complication rate (95 % CI 2.75–17.49, P < 0.0001), blood loss (95 % CI 363.28–658.91, P < 0.00001), operative time (95 % CI 2.65–3.45, P < 0.00001) and length of hospital stay (95 % CI 1.98–22.94, P = 0.02) were found in posterior group.

Conclusions

Posterior-only approach can achieve similar coronal plane correction and percent-predicted FEV1 compared to combined anterior–posterior approach. The posterior approach even does better in sagittal correction in severe AIS patients. Significantly less complication rate, blood loss, operative time, length of hospital stay and better percent-predicted FVC are also achieved by posterior-only approach. Posterior-only approach seems to be effective and safe in treating AIS for experienced surgeons.

     

“En bloc” resection of sacral chordomas by combined anterior and posterior surgical approach: a monocentric retrospective review about 29 cases

Purpose

“En bloc” resection of sacral chordomas (SC) with wide margins is statistically linked with a decrease of local recurrence (LR). Nevertheless, surgery potentially leads to complications and neurological deficits. The effectiveness of radiotherapy (RT) and chemotherapy (CT) remains controversial. The aim of the study was to evaluate the margins of tumor resection, the morbidity of “En bloc” resection of SC by combined anterior and posterior surgical approach and to look for predictive factors on survival and LR.

Methods

We performed sacrococcygectomy by surgical combined approach in 29 SC between 1985 and 2012. We analyzed overall survival and survival to LR with survival analysis using Kaplan–Meier method. Complications and morbidity were reported.

Results

The mean follow-up was of 77.9 months (0–241 months). We found 18 (62.1 %) postoperative infections and 7 (24.1 %) wound dehiscences. Eighteen patients had tumor wide margins (62.1 %), 6 marginal (20.7 %) and 4 intralesional (13.8 %). Seven patients had a LR (24.1 %). OS rate was 84.4 % at 5 and 10 years, survival rate with LR was 64 and 56 %, respectively, after 5 and 10 years. Quality of margins (p = 0.106), tumor volume (p = 0.103), postoperative RT (p = 0.245) and postoperative local infection (p = 0.754) did not have effect on LR.

Conclusion

“En bloc” resection by combined surgical approach seems to be a relevant alternative especially for SC invading the high sacrum above S3. Nevertheless, it yet remains the problem of postoperative infection. Systematic Adjuvant RT might allow better control on LR in association with surgery.     

Comparison of anterior decompression with fusion and posterior decompression with fusion for cervical spondylotic myelopathy—A systematic review and meta-analysis

BackgroundThe optimal surgical procedure for the treatment of cervical spondylotic myelopathy (CSM) remains controversial. Recently, laminectomy/laminoplasty with instrumented fusion (LAMF) has been increasingly applied to treat CSM. However, few comprehensive studies have compared anterior decompression with fusion (ADF) and LAMF. Therefore, we conducted a meta-analysis to evaluate the evidence in the literature and to compare the surgical outcomes between the 2 procedures. Since the surgical outcomes and risks differ between patients with CSM and ossification of the posterior longitudinal ligament (OPLL) and between only posterior decompression and decompression with fusion treatments, we excluded patients with OPLL and patients with only posterior decompression in this review.MethodsAn extensive literature search was performed using PubMed, Embase, and the Cochrane Library to identify comparative studies of ADF and LAMF for the treatment of CSM. The language was restricted to English, and the publication period was from January 2001 to July 2019. We only included studies about CSM and excluded studies that involved patients with ossification of the posterior longitudinal ligament and with the treatment of posterior decompression without fusion. We extracted outcomes from the studies, such as preoperative and postoperative Japanese Orthopaedic Association (JOA) scores, neck disability index (NDI) scores, cervical alignment data, and surgical complications. Then, a meta-analysis was performed on these surgical outcomes.ResultsEleven studies were obtained, and the quality of the studies was acceptable. In the meta-analysis, the pre- and postoperative JOA scores were similar between the ADF and LAMF groups. The ADF group exhibited more favorable results than the LAMF group in terms of postoperative cervical alignment and the NDI. Overall complications were similar between the ADF and LAMF groups; however, C5 palsy was more frequently observed in the LAMF group than in the ADF group.ConclusionsWhile the ADF and LAMF groups demonstrated similar results in terms of neurological recovery, postoperative cervical lordosis and NDI scores were more favorable with ADF than with LAMF. The overall complication rate was similar between the ADF and LAMF groups. Surgeons should understand the merits and shortcomings of both procedures when deciding on a surgical procedure.     

The impact of computed tomography-assessed sarcopenia on outcomes for trauma patients – a systematic review and meta-analysis

IntroductionSarcopenia is the progressive loss of skeletal muscle mass, strength and general decline in function associated with age, and has previously been shown to be a predictor of poor outcomes following surgery. Computed tomography (CT)-assessed sarcopenia has been proposed to be an independent predictor of outcomes for trauma patients. This systematic review aims to determine the impact of CT-assessed sarcopenia on patient mortality following trauma.Materials and MethodsA systematic review and meta-analysis of the literature was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. EMBASE, MEDLINE and CENTRAL databases were searched from database inception to 26 November 2018. Bibliographies of included articles were hand searched for potential articles. All observational studies which included trauma patients who had skeletal muscle mass or density assessed by CT were included in the review. Two authors independently performed the search with decisions reached by consensus. Meta-analysis was performed using Review Manager v5.3 using a random effects model. The primary outcome was all cause mortality, as established a priori.ResultsFollowing an initial search of 1984 records, a total of 20 retrospective observational studies were included for qualitative analysis. Ten of these studies consisting of a pooled, partly-overlapping, 2867 patients were included in the meta-analysis. There was a wide variation in the reported prevalence of sarcopenia (25.0–71.1%). Sarcopenia patients were at a significantly increased risk of mortality during inpatient stay (RR 1.96 [95%CI 1.30–2.94], p = 0.001), at 30 days (RR 1.60 [95%CI 1.21–2.13], p = 0.001) and at 1-year (RR 3.11 [95%CI 1.94–4.96], p < 0.00001). There was no significant difference in total complications encountered, ICU duration or total inpatient stay.ConclusionSarcopenia identified by CT is associated with increased risk of inpatient, 30-day, and 1-year mortality in trauma patients.     

Avanafil for male erectile dysfunction： a systematic review and meta-analysis

Avanafil, a potent new selective phosphodiesterase type 5 （PDE5） inhibitor, has been developed for the treatment of erectile dysfunction （ED）. We carried out a systematic review and meta-analysis to assess the efficacy and safety of this drug for the treatment of ED. A literature review was performed to identify all published randomized, double-blind, placebo-controlled trials of avanafil for the treatment of ED. The search included the following databases： MEDLINE, EMBASE and the Cochrane Controlled Trials Register. The reference lists of the retrieved studies were also investigated. Four publications, involving a total of 1381 patients, were used in the analysis, including four randomized controlled trials （RCTs） that compared avanafU with a placebo. Among the co-primary efficacy end points indicating that avanafil 100 mg was more effective than a placebo were successful vaginal penetration （SEP2） （the odds ratio （OR） =5.06, 95% confidence interval （CI） =3.29-7.78, P〈 0.00001） and successful intercourse （SEP3） （OR = 3.99, 95% CI = 2.80-5.67, P 〈 0.00001）. Men randomized to receive avanafil were less likely than those receiving the placebo to drop out due to an adverse event （AE） （OR = 1.48, 95% CI = 0.54-4.08, P = 0.44）. Specific AEs with avanafil included headache and flushing, which were significantly less likely to occur with placebo. This meta-analysis indicates that avanafil 100 or 200 mg is an effective and well-tolerated treatment for ED. Compared with avanafil 100 mg, patients who take avanafil 200 mg are more likely to experience headaches.     

Is anterior decompression and fusion superior to laminoplasty for cervical myelopathy due to ossification of posterior longitudinal ligament? A systematic review and meta-analysis

Context: Considerable controversy exists over surgical procedures for ossification of the posterior longitudinal ligament (OPLL).Objective: The purpose of the meta-analysis was to compare the clinical outcome of anterior decompression and fusion (ADF) with laminoplasty (LAMP) in treatment of cervical myelopathy due to OPLL.Methods: PubMed, EMBASE and the Cochrane Register of Controlled Trials database were searched to identify potential clinical studies compared ADF with LAMP for cervical myelopathy owing to OPLL. We also manually searched the reference lists of articles and reviews for possible relevant studies. Thirteen studies with 1120 patients were included in our analysis. Subgroup analyses were performed by the canal occupying ratio of OPLL.Results: Overall, the mean preoperative Japanese Orthopaedic Association (JOA) score was similar between two groups. Compared with LAMP group, ADF group was higher at the mean postoperative JOA scores and mean recovery rate, reoperation rate, and longer at mean operation time. There was not significantly different in mean blood loss and complication rate between two groups. In subgroup analysis, ADF had a higher mean postoperative JOA score and recovery rate than LAMP in cases of OPLL with occupying ratios ≥ 50%, while those difference were not found in cases of OPLL with occupying ratios < 50%.Conclusion: ADF achieves better neurological improvement compared with LAMP in treatment of cervical myelopathy due to OPLL, especially in cases of OPLL with occupying ratios ≥ 50%. Complication rate is similar between two groups, but ADF can increase the risk of reoperation     

Reducing the risk of infection for transrectal prostate biopsy with povidone–iodine: a systematic review and meta-analysis

Purpose

To evaluate the efficacy of povidone–iodine (PI) in reducing the risk of infectious complications following transrectal prostate biopsy (TRPB).

Methods

Eligible randomized controlled trials (RCTs) were identified from electronic databases (Cochrane CENTRAL, MEDLINE, and EMBASE). The database search, quality assessment, and data extraction were performed independently by two reviewers. The main outcome for the efficacy of PI was the incidence of infectious complications after TRPB.

Results

Seven trials, including 2,049 patients, met the inclusion criteria. Data from the seven included RCTs favored the use of PI before TRPB to prevent infectious complications. PI for “PI versus blank control” significantly reduced fever, bacteriuria, and bacteremia compared with that for control [relative risk (RR) 0.31; 95 % confidence interval (CI) 0.21–0.45, P < 0.00001]. With PI versus antibiotics (ATB), patients treated with ATB alone had a significantly greater risk of bacteremia (RR 0.38; 95 % CI 0.16–0.90, P = 0.03). In “PI plus ATB versus ATB” trials, the risk of fever (RR 0.11; 95 % CI 0.02–0.85, P = 0.03) and bacteremia (RR 0.25; 95 % CI 0.08–0.75, P = 0.01) was diminished in the “PI plus ATB” group.

Conclusions

Rectal disinfection with PI provides a safe and effective method to reduce the risk of infectious complications following TRPB, regardless of mono-prophylaxis and combined prophylaxis with PI and ATB. Large, multicenter, and prospective RCTs of good quality trials are needed to confirm the efficacy of PI.     

Comparing the efficacy of chlorhexidine and povidone–iodine in preventing surgical site infections: A systematic review and meta-analysis

Surgical site infections (SSIs) post-surgery impact patient health and raise healthcare costs. This meta-analysis examines the efficacy of antiseptics, chlorhexidine and povidone–iodine, in reducing SSIs, including various types, to settle ongoing debates on their comparative effectiveness. A systematic literature search conforming to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines was executed on four established databases without temporal restrictions. Only randomized controlled trials (RCTs) including patients aged 18 years or older undergoing clean or potentially contaminated surgeries were included. Two independent evaluators carried out study selection, data extraction and quality assessment, adhering to Cochrane Collaboration's risk of bias tool. Statistical analyses were performed using chi-square tests and the I² index to evaluate heterogeneity, and meta-analyses were conducted employing either fixed-effects or random-effects models as warranted by the heterogeneity assessments. A total of 16 RCTs were included after rigorous selection from an initial pool of 1742 articles. The studies demonstrated low levels of heterogeneity, supporting the use of a fixed-effects model. Chlorhexidine exhibited statistically lower rates of overall SSIs (RR 0.75; 95% CI 0.64–0.88; p < 0.001), superficial SSIs (RR 0.62; 95% CI 0.47–0.82; p < 0.001) and deep SSIs compared to povidone–iodine. The study furnishes compelling evidence in favour of chlorhexidine as a more efficacious antiseptic agent over povidone–iodine in minimizing the risk of various types of SSIs.     

Deep brain stimulation for Parkinson’s disease–related postural abnormalities: a systematic review and meta-analysis

Neurosurgical Review - Deep brain stimulation (DBS) has become a well-established treatment modality for Parkinson’s disease (PD), especially regarding motor fluctuations, dyskinesias, and...     

Is laparoscopic approach for pancreatic insulinomas safe? Results of a systematic review and meta-analysis

Background

No consensus exists as to whether laparoscopic treatment for pancreatic insulinomas (PIs) is safe and feasible. The aim of this meta-analysis was to assess the feasibility, safety, and potential benefits of laparoscopic approach (LA) for PIs. The abovementioned approach is also compared with open surgery.

Methods

A systematic literature search (MEDLINE, EMBASE, Cochrane Library, Science Citation Index, and Ovid journals) was performed to identify relevant articles. Articles that compare the use of LA and open approach to treat PI published on or before April 30, 2013, were included in the meta-analysis. The evaluated end points were operative outcomes, postoperative recovery, and postoperative complications.

Results

Seven observational clinical studies that recruited a total of 452 patients were included. The rates of conversion from LA to open surgery ranged from 0%–41.3%. The meta-analysis revealed that LA for PIs is associated with reduced length of hospital stay (weighted mean difference, −5.64; 95% confidence interval [CI], −7.11 to −4.16; P < 0.00001). No significant difference was observed between LA and open surgery in terms of operation time (weighted mean difference, 2.57; 95% CI, −10.91 to 16.05; P = 0.71), postoperative mortality, overall morbidity (odds ratio [OR], 0.64; 95% CI, 0.35–1.17; P = 0.14], incidence of pancreatic fistula (OR, 0.86; 95% CI, 0.51–1.44; P = 0.56), and recurrence of hyperglycemia (OR, 1.81; 95% CI, 0.41–7.95; P = 0.43).

Conclusions

Laparoscopic treatment for PIs is a safe and feasible approach associated with reduction in length of hospital stay and comparable rates of postoperative complications in relation with open surgery.     

Single-stage posterior vertebral column resection and internal fixation for old fracture–dislocations of thoracolumbar spine: a case series and systematic review

Purpose

To evaluate the efficacy of single-stage posterior vertebral column resection for old thoracolumbar fracture–dislocations with spinal cord injury.

Methods

From January 2007 to June 2013, twelve male patients (average age, 32.6 years; range 19–57 years) with old fracture–dislocations of the thoracolumbar spine and spinal cord injury underwent single-stage posterior vertebral column resection and internal fixation. All patients were assessed for relief of the pain and restoration of neurologic function. Postoperative Cobb angle was measured and bone graft fusion was evaluated by X-ray. A systematic review of 25 studies evaluating surgical management of thoracolumbar fractures with spinal cord injuries was also performed.

Results

From our case series, six of the nine patients with Frankel grade A had significant improvement in urination and defecation after surgery. The three patients with Frankel grades B and C had progression of 1–2 grades after surgery. Bony fusion was achieved and local back pain was relieved in all patients after surgery. From our systematic review of 25 studies, the majority of patients had improved back pain, the postoperative kyphotic angle was significantly reduced compared with pre-operative kyphotic angle.

Conclusion

Single-stage posterior vertebral column resection and internal fixation for old thoracolumbar fracture–dislocations is an ideal treatment allowing for thorough decompression, relief of pain, correction of deformities, and restoration of spinal stability.

Level of evidence

IV.

     

Glidescope? video-laryngoscopy versus direct laryngoscopy for endotracheal intubation: a systematic review and meta-analysis

Introduction

The Glidescope^? video-laryngoscopy appears to provide better glottic visualization than direct laryngoscopy. However, it remains unclear if it translates into increased success with intubation.

Methods

We systematically searched electronic databases, conference abstracts, and article references. We included trials in humans comparing Glidescope^? video-laryngoscopy to direct laryngoscopy regarding the glottic view, successful first-attempt intubation, and time to intubation. We generated pooled risk ratios or weighted mean differences across studies. Meta-regression was used to explore heterogeneity based on operator expertise and intubation difficulty.

Results

We included 17 trials with a total of 1,998 patients. The pooled relative risk (RR) of grade 1 laryngoscopy (vs????grade 2) for the Glidescope^? was 2.0 [95% confidence interval (CI) 1.5 to 2.5]. Significant heterogeneity was partially explained by intubation difficulty using meta-regression analysis (P?=?0.003). The pooled RR for nondifficult intubations of grade 1 laryngoscopy (vs????grade 2) was 1.5 (95% CI 1.2 to 1.9), and for difficult intubations it was 3.5 (95% CI 2.3 to 5.5). There was no difference between the Glidescope^? and the direct laryngoscope regarding successful first-attempt intubation or time to intubation, although there was significant heterogeneity in both of these outcomes. In the two studies examining nonexperts, successful first-attempt intubation (RR 1.8, 95% CI 1.4 to 2.4) and time to intubation (weighted mean difference ?43 sec, 95% CI ?72 to ?14 sec) were improved using the Glidescope^?. These benefits were not seen with experts.

Conclusion

Compared to direct laryngoscopy, Glidescope^? video-laryngoscopy is associated with improved glottic visualization, particularly in patients with potential or simulated difficult airways.     

Clinical outcomes in ‘diabese’ burn patients: A systematic review and meta-analysis

ObjectiveThe objective of this study was to update the current status of clinical outcomes in diabetic (type II) and obese (BMI: 30–39.9 kg/m²) burn patients.MethodsWe adhered to Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines. We searched MEDLINE (PubMed), Google Scholar, Scopus, and Embase for studies related to a number of comorbidities and burn outcomes. Search terms for each of these databases are listed in the Appendix. From this search, we screened 6923 articles. Through our selection criteria, 12 articles focusing on either diabetes or obesity were selected for systematic review and meta-analysis. Data was analyzed using the “meta” package in R software to produce pooled odds ratios from the random effect model.ResultsDiabetic patients had 2.38 times higher odds of mortality [OR: 2.38, 95% CI:1.66, 3.41], however no statistically significant difference was found in mortality in obese patients [OR: 2.49, 95% CI: 0.36, 17.19]. Obese patients had 2.18 times higher odds of inhalation injury [95%CI: 1.23, 3.88], whereas diabetic patients did not show a difference in odds of inhalation injury [OR:1.02, 95% CI: 0.57, 1.81]. Diabetic patients had higher odds of complications resulting from infection: 5.47 times higher odds of wound, skin, or soft tissue infections [95% CI:1.97, 15.18]; 2.28 times higher odds of UTI or CAUTI [95% CI:1.50, 3.46]; and 1.78 times higher odds of pneumonia or respiratory tract infections [95% CI:1.15, 2.77]. Obese patients also had similar complications related to infection: 2.15 times higher odds of wound infection [95% CI: 1.04, 4.42] and 1.96 times higher odds of pneumonia [95% CI: 1.08, 3.56]. Other notable complications in diabetic patients were higher odds of amputation [OR: 37, 95% CI: 1.76, 779.34], respiratory failure [OR: 4.39, 95% CI: 1.85, 10.42], heart failure [OR: 6.22, 95% CI: 1.93, 20.06], and renal failure [OR: 2.95, 95% CI: 1.1, 7.86].ConclusionsDiabetic patients have higher odds of mortality, whereas no statistically significant difference of mortality was found in obese patients. Obese patients had higher odds of inhalation injury, whereas odds of inhalation injury was unchanged in diabetic patients. Diabetic patients had higher odds of failure in multiple organs, whereas such failure in obese patients was not reported. Both diabetic and obese patients had multiple complications related to infection.     

Survivorship and clinical outcomes of ‘cup–cage’ reconstruction in revision of hip arthroplasty for chronic pelvic discontinuity: A systematic review

BackgroundThis study was conducted to assess the survivorship and clinical outcomes of cup-cage reconstruction technique in the revision of THA.MethodsPubMed, OVID, EMBASE, and Cochrane Central Register of Controlled Trials (CENTRAL) up to February 2020 were searched. Studies that reported the clinical and radiological follow-up were identified.ResultsA total of 151 hips (145 patients) in six studies were included. The all-cause revision-free survivorship of cup-cage implant at the end of follow-up was 90.1% (136/151), with a mean follow-up of 64.4 months(range 12–135). The overall complication rate was 23.8% (36 of 151 hips), of which component problem, dislocation, infection and sciatic nerve palsy/injury were relatively common. All included studies reported improved clinical outcomes at the end of follow-up.ConclusionResults suggested that revision of THA with a cup-cage has a favourable implant survivorship and clinical outcomes for the treatment of pelvic discontinuity, despite the high complications occurrence rates.