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The article presents summaries of articles on neuroscience, published as of March 2018. Topics include impact of postoperative bracing on pain and quality of life after posterior spinal instrumented fusion (PSIF), implantation of an empty polyetheretherketone cage in anterior cervical discectomy and fusion, and comparison between tubular discectomy and conventional microdiscectomy for the treatment of lumbar disc herniation.

The article presents abstracts on medical topics including a comparison of transforaminal endoscopic discectomy and microdiscectomy, the effect of lordotic correction on C5 palsy after cervical laminectomy and fusion, and mechanical thrombectomy following intravenous alteplase after stroke.

BACKGROUND CONTEXT Unplanned hospital readmissions after surgery are increasingly scrutinized as markers of health care quality. Thus there is great incentive in understanding and reducing readmissions for both the surgeon and the hospital. PURPOSE In this study we analyze rates of readmission, and the timing and reasons for readmission after 1-2 level anterior cervical discectomy and fusion (ACDF). STUDY DESIGN/SETTING Retrospective cohort study. PATIENT SAMPLE Patients undergoing one or two-level ACDF for degenerative indications in the American College of Surgeons National Surgical Quality Improvement Program (NSQIP) from 2012 to 2016. OUTCOME MEASURES Complications and readmissions within 30 days, reasons for readmission, timing of readmission METHODS Demographics, comorbidities, and procedural characteristics were collected for all patients undergoing one or two-level ACDF identified by CPT coding in the NSQIP database. Patients undergoing surgery for oncologic, traumatic, infectious, or revision indications and patients undergoing combined anterior-posterior cervical fusion were excluded. The incidence of 30-day complications and readmissions was calculated, and the reasons for readmission as well as the timing of readmission was reviewed. Multivariate logistic regression analyses were performed to identify risk factors associated with complications or readmissions within 30 days of surgery. RESULTS A total of 18,833 patients who underwent ACDF were identified (15,464 single-level and 3,369 two-level). Mean age was 53.7 years (SD:11.6) and 50% of patients were male. The overall rate of any postoperative complication was 4.3% in two-level fusions and 3.5% in single-level fusion (p=.027). In total, 569 unplanned readmissions were identified (3.0%), of which 39.5% were related to the surgical site and 49.7% were unrelated to the surgical site (10.5% unknown cause of readmission). The most frequent reason for 30-day readmission was pneumonia (9.3%, mean time to readmission of 11.3 days) followed by dysphagia (7.4%, 6.3 days), acute postoperative pain (7.2%, 11.4 days) and edema, hematoma or seroma (7.0%, 7.4 days). The most influential independent risk factors for readmission identified via multivariate analysis American Society of Anesthesiology (ASA) score ≥3 (Odds Ratio [OR] 1.96, 95% Confidence Interval [CI] 1.6–2.4, p<.001), history of steroid use (OR: 1.76, CI 1.3–2.5, p<.001), and age of 70 or greater (versus younger than 50, OR: 1.66, CI 1.2–2.2, p<.001). The most influential risk factors for any complication included dependent functional status (OR: 3.0, CI 2.2–4.2, p<.001), age of 70 or greater (versus younger than 50, OR: 2.76, CI 2.1–3.6, p<.001). and ASA score ≥3 (OR: 1.8, CI 1.5–2.1, p<.001). CONCLUSIONS In this nationwide analysis of 18,833 ACDFs, 3.0% of patients were readmitted within 30 days, of which at least 49.7% were for reasons unrelated to the surgical site. Follow-up with primary care providers in the immediate postoperative period may improve quality in preventing unplanned readmissions in high-risk patients. FDA DEVICE/DRUG STATUS This abstract does not discuss or include any applicable devices or drugs. [ABSTRACT FROM AUTHOR]

BACKGROUND CONTEXT With the changing landscape of health care, outpatient spine surgery is more commonly performed to reduce cost and improve efficiency. Anterior cervical discectomy and fusion (ACDF) is one of the mo st common spine surgeries performed and demand is expected to increase with an aging population. PURPOSE The purpose of this study was to determine the nationwide trends and complication rates associated with outpatient ACDF as compared to inpatient ACDF. STUDY DESIGN/SETTING This study is a retrospective review utilizing the Humana subset of the PearlDiver insurance records database. PATIENT SAMPLE The patient sample consisted of patients undergoing single level ACDF (CPT-22551 AND ICD-9-816.2) as either outpatients or inpatients from 2011 to 2016. OUTCOME MEASURES Perioperative medical and surgical complications were identified by querying for relevant International Classification of Diseases and Current Procedural Terminology codes. METHODS The incidence of perioperative medical and surgical complications was determined after the database query was performed. Multivariate logistic regression adjusting for age, gender and Charlson Comorbidity Index was used to calculate odds ratios (OR) of complications among outpatients relative to inpatients undergoing ACDF. RESULTS Cohorts of 1,215 patients who underwent outpatient ACDF and 10,964 patients who underwent inpatient ACDF were identified. The median age was in the age 65-69 age group for both cohorts. The annual relative incidence of outpatient ACDF increased from 0.11 in 2011 to 0.22 in 2016 (R2=0.82, p=.04). Adjusting for age, gender and comorbidities, patients undergoing outpatient ACDF were more likely to undergo revision surgery for posterior fusion at both 6 months (OR 1.58, CI 1.27–1.96, p<.001) and one year postoperatively (OR 1.79, CI 1.51–2.13, p<.001). Outpatient ACDF patients were also more likely to undergo revision anterior fusion surgery with extension at one year postoperatively (OR 1.46, CI 1.26–1.70, p<.001). Rates of hardware removal, surgical wound exploration, dural tears, and neurological injury were statistically comparable. Among medical complications, postoperative acute renal failure was more frequently associated with outpatient ACDF than inpatient (OR 1.25, CI 1.06–1.49, p=.010), while the rates of major thromboembolic, respiratory, and cardiovascular events were statistically comparable. CONCLUSIONS Outpatient spine surgery is growing increasingly popular due to changes in health care delivery and greater attention to cost reduction and improved efficiency. Data collected from a national private insurance database demonstrates greater risk of perioperative surgical complications associated with outpatient ACDF, including revision anterior and posterior fusion, as well as higher risk for postoperative acute renal failure. Candidates for outpatient ACDF should be counseled and carefully selected to reduce these risks. FDA DEVICE/DRUG STATUS This abstract does not discuss or include any applicable devices or drugs. [ABSTRACT FROM AUTHOR]

Objectives: The purpose of this study is to report a case of iatrogenic pharyngoesophageal diverticulum post-anterior cervical discectomy and fusion (ACDF) surgery, its management and management of postoperative complications. We also did a thorough review of literature about iatrogenic pharyngoesophageal diverticulum which is a rarely encountered complication occurring after a commonly performed surgery; ACDF. Methods: Here we describe a case of iatrogenic pharyngoesophageal diverticulum post-ACDF surgery. In this paper we also make comparisons to the 23 cases reported in the literature in terms of: presentations, clinical findings, management courses, and complications. This study was approved by the Institution Review Board of Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia. (Ref. no.: IRB-2023-01-473). The reported subject provided written informed consent before initiation of this study. Results: Our case is a 45-year-old male with a history of ACDF surgery 8 years ago. He presented with dysphagia and regurgitations which started 1 year after ACDF. He was labeled as a case of Zenker's diverticulum and underwent multiple failed open and endoscopic surgeries prior to presenting to us. Upon presenting to our center, barium swallow showed the pharyngoesophageal diverticulum. Patient definitive diagnosis of iatrogenic rather than Zenker's diverticulum was established intraoperatively with esophagoscopy which revealed exposed hardware inside the diverticulum. He underwent open diverticulectomy and diverticulopexy. Postoperatively he developed pharyngocutanous fistula and right vocal fold palsy, both successfully managed conservatively. Conclusion: Iatrogenic Pharyngoesophageal diverticulum is a rare complication following ACDF, however prolonged dysphagia shall warrant further investigation by contrast studies. Open diverticulectomy with muscle reinforcement is a good management modality. Due to the complicated anatomy secondary to previous operations, we recommend conservative management for patients with postoperative pharyngocutaneous fistula. [ABSTRACT FROM AUTHOR]

They looked at records of over 19,000 patients initially, but reduced to just over 7000 patients due to lack of data on some 6000, and operation at more than two levels, or not in the lumbar spine in some 6000. In Group A were ten patients, who had the lumbar stenosis treated first, as it was much more symptomatic, and Group B had 36 patients whose cervical stenosis symptoms were regarded as more significant. In the latter group (cervical surgery first), only 11 went on to have lumbar surgery, 25 patients had complete resolution of their lumbar symptoms. The deterioration of cervical stenosis if lumbar surgery is done first may be due to positioning of the patient for lumbar surgery. [Extracted from the article]

Background. Among the surgical methods for lumbar disc herniation, open lumbar microdiscectomy is considered the gold standard. Recently, percutaneous endoscopic lumbar discectomy is also commonly performed for lumbar disc herniation for its various strong points. Objectives. The present study aims to examine whether percutaneous endoscopic lumbar discectomy and open lumbar microdiscectomy show better results as surgical treatments for lumbar disc herniation in the Korean population. Methods. In the present meta-analysis, papers on Korean patients who underwent open lumbar microdiscectomy and percutaneous endoscopic lumbar discectomy were searched, both of which are surgical methods to treat lumbar disc herniation. The papers from 1973, when percutaneous endoscopic lumbar discectomy was first introduced, to March 2018 were searched at the databases of MEDLINE, EMBASE, PubMed, and Cochrane Library. Results. Seven papers with 1254 patients were selected. A comparison study revealed that percutaneous endoscopic lumbar discectomy had significantly better results than open lumbar microdiscectomy in the visual analogue pain scale at the final follow-up (leg: mean difference [MD]=-0.35; 95% confidence interval [CI]=-0.61, -0.09; p=0.009; back: MD=-0.79; 95% confidence interval [CI]=-1.42, -0.17; p=0.01), Oswestry Disability Index (MD=-2.12; 95% CI=-4.25, 0.01; p=0.05), operation time (MD=-23.06; 95% CI=-32.42, -13.70; p<0.00001), and hospital stay (MD=-4.64; 95% CI=-6.37, -2.90; p<0.00001). There were no statistical differences in the MacNab classification (odds ratio [OR]=1.02; 95% CI=0.71, 1.49; p=0.90), complication rate (OR=0.72; 95% CI=0.20, 2.62; p=0.62), recurrence rate (OR=0.83; 95% CI=0.50, 1.38; p=0.47), and reoperation rate (OR=1.45; 95% CI=0.89, 2.35; p=0.13). Limitations. All 7 papers used for the meta-analysis were non-RCTs. Some differences (type of surgery (primary or revisional), treatment options before the operation, follow-up period, etc.) existed depending on the selected paper, and the sample size was small as well. Conclusion. While percutaneous endoscopic lumbar discectomy showed better results than open lumbar microdiscectomy in some items, open lumbar microdiscectomy still showed good clinical results, and it is therefore reckoned that a randomized controlled trial with a large sample size would be required in the future to compare these two surgical methods. [ABSTRACT FROM AUTHOR]

Background: In the Netherlands most patients are currently seen in an outpatient clinic after an anterior cervical discectomy, which is an effective neurosurgical procedure with relatively low rate of severe complications. In this back sight, the need for patients returning to the post-operative outpatient clinic could be questioned. The aim of the study is to evaluate whether a post-operative outpatient appointment after anterior cervical discectomy could be replaced by an alternative or be omitted without adversely impacting, or increasing, the value of healthcare and patient satisfaction for this procedure.Methods: A narrative review was performed to evaluate the quality of care and patient satisfaction for patients with and without a post-operative outpatient appointment after spinal surgery. A literature search of the previous ten years was performed in Pubmed, CENTRAL and EMBASE.Results: A total of 403 articles were identified. Four studies remained after title and abstract selection by 3 independent reviewers. No papers were selected for further analysis, due to the absence of interventional studies that compared the utility of a post-operative outpatient clinic appointment with an intervention after spinal surgery.Conclusions: Currently, there is a lack of evidence for the need of a post-operative follow-up after anterior cervical discectomy. Nor is there any literature in favor of omitting these appointments. No determinants which patients benefits from these outpatient appointments could be identified. Potential harmful and beneficial effects of omitting these post-operative follow-ups should be investigated to identify possible determinant for patients who might benefit from a post-operative appointment. [ABSTRACT FROM AUTHOR]

Lumbar disc herniation (LDH) is a relatively common pathology usually presenting with unilateral radiculopathy ipsilateral to the disc herniation. Some patients can present with contralateral radicular symptoms. The objective of this article is to review the current literature on lumbar disc herniations with contralateral radiculopathy regarding its pathophysiology and surgical strategies. A systematic review of the literature on LDH with contralateral radiculopathy was performed using MEDLINE (via PubMed) using MeSH terms. This review was done following recommendations of PRISMA statement and PICOT strategy of search. Initial electronic search identified 126 papers. Finally, 18 articles were reviewed. None of the included papers was described as comparative. Pathophysiological processes underlying contralateral pain may include prominent spondylotic changes and the accompanying stenosis; hypertrophic yellow ligament; dural attachments along the posterior longitudinal ligament; nerve root traction forces; and friction radiculitis, migrated epidural fat, nerve root anomaly, and venous congestion inside the vertebral canal. In our pooled analysis, 11 patients reported were treated by bilateral approach with 100% of clinical success and no complications. Eight patients were treated by unilateral approach ipsilateral to pain with 100% of clinical success and no complications. Forty-eight patients were treated by unilateral approach ipsilateral to herniation with 100% of clinical success and no complications. Pathophysiology underlying contralateral pain in LDH is probably multifactorial. There is not enough scientific evidence to define the best surgical approach for patients with LDH and contralateral pain. [ABSTRACT FROM AUTHOR]

Purpose: The goal is to conduct a review of the current literature to determine and evaluate the current classification metrics available for quantifying post-operative dysphagia. Methods: We surveyed the literature for the subjective and objective measures used to classify dysphagia, and further described and analyzed them in the context of post-operative dysphagia (PD) after anterior cervical spine surgery, with a focus on anterior cervical discectomy and fusion (ACDF). We searched PubMed from the years 2005–2021 using the terms "anterior cervical discectomy and fusion" and "dysphagia or postoperative dysphagia." We included papers that were meta-analyses, systemic reviews, prospective, or retrospective studies. Our selection was further consolidated via abstract and title screening. Ultimately, nineteen articles were included and had full-text reviews. Results: EAT-10 tool was shown to be more valid and reliable than the commonly used Bazaz grading system. HSS-DDI was found to have a high diagnostic accuracy in stratifying mild, moderate, and severe PD. A shortened 16-item version of the original 44-item SWAL-QOL was found to be statistically and clinically significant. When compared to PROMs, objective tests more accurately diagnose PD. Conclusion: We found that the most valuable subjective tests were the EAT-10 and HSS-DI because they are quick, sensitive, and correlated strongly with the well-established measurements of PD. The MBS and FEES provided accurate measurements of the severity of PD, but they required more time and equipment than the surveys. In some patient populations, such as those with pre-surgical dysphagia, objective testing should always be done. [ABSTRACT FROM AUTHOR]

Study Design. Retrospective cohort. Objective. To compare rates of all-cause surgical and medical complications between zero-profile (ZP; stand-alone) implants versus any graft type with an anterior plate in patients undergoing 1-2 level anterior cervical discectomy and fusion (ACDF) for treatment of degenerative cervical myeloradiculopathy. Summary of Background Data. Degenerative cervical myeloradiculopathy is increasingly prevalent in older adults. ACDF is a common surgical procedure for decompression of neural structures and stabilization and has been shown to have excellent outcomes. Although ACDFs performed with graft and plate have been the gold standard, more recently, ZP implants were developed to decrease implant-related complications, such as severe postoperative dysphagia. However, there is a paucity of papers comparing the surgical and medical complications profile of ZP (stand-alone) implants to grafts with plating systems. Materials and Methods. Data were extracted from the Pearl- Diver Mariner Database using Current Procedural Terminology codes to classify patients into 1 level, 2 levels, and a total of 1-2 level ACDFs. Patients undergoing surgery for non-degenerative pathologies such as tumors, trauma, or infection were excluded. Results. 1:1 exact matching created 2 equal groups of 7284 patients who underwent 1-2 level ACDF with either grafting with a plate or ZP (stand-alone) implant. There were no statistically significant differences in all-cause surgical complications, pseudarthrosis rate, dysphagia, or need for revision surgery between both cohorts (risk ratio: 0.99, 95% CI: 0.80--1.21, P = 0.95). In addition, all-cause medical complications were similar between both cohorts (risk ratio: 1.07, 95% CI: 0.862--1.330, P = 0.573) or any specific surgical or medical complication included in this study. Conclusion. After 1:1 exact matching, the results of this study suggest that ZP (stand-alone) implants have similar outcomes compared with grafts with plating systems, with no observed differences in all-cause surgical or medical complications profile. [ABSTRACT FROM AUTHOR]

Objective: With the advancement of minimally invasive spine surgery, endoscopic discectomy (ED) has become a common technique for degenerative disease of the spine. The present study aimed to explore the knowledge structure, emerging trends, and future research hotspots in this field. Methods: All relevant publications on ED from 2002 to 2021 were extracted from the Web of Science databases. Key bibliometric indicators, including countries/regions, institutions, authors, journals, references, and keywords were calculated and evaluated using VOSviewer and CiteSpace software. Results: A total of 1,196 articles and reviews were included for analysis. The number of publications regarding ED increased yearly. From the quality and quantity viewpoint, China, South Korea, and the United States were the major contributors in this field. The most influential institution in the field of ED was Wooridul Spine Hospital. We identified 3,488 authors, among which Lee SH had the most significant number of papers, and Ruetten S was cocited most often. World Neurosurgery was the journal with the most papers, and Spine was the most commonly cocited journal. Keywords were stratified into 4 clusters by VOSviewer software: cluster 1 (clinical outcomes of ED in the treatment of lumbar disc herniation); cluster 2 (surgical technique of percutaneous endoscopic lumbar discectomy); cluster 3 (clinical outcomes of ED in the treatment of lumbar spinal stenosis); and cluster 4 (clinical outcomes of percutaneous endoscopic cervical discectomy). Several topics including lateral recess stenosis, spinal stenosis, and reoperation were considered as the next hotspot in ED research. Conclusion: ED research has gained considerable attention over the last 2 decades. Our bibliometric findings illuminate the publication trends and research hotspots of the ED field, which may provide useful references for scholars and decision-makers interested in this field. [ABSTRACT FROM AUTHOR]

Aim: The aim of this study was to determine the effect of pedometer‐supported walking and telemonitoring after lumbar disc hernia surgery on pain and disability levels and quality of life. Methods: This was a randomized controlled trial with two randomly selected groups conducted between March 2018 and January 2019. Sixty‐seven participants (33 in the intervention group and 34 in the control group) who had undergone lumbar microdiscectomy were allocated to receive and not to receive walking exercise. Pain and disability levels and quality of life of groups were tested with the McGill Pain Questionnaire, the Oswestry Disability Index and the 36‐Item Short Form Survey. Measurements were taken 3 weeks after surgery and following completion of the first, second and third months. Results: Compared with the control group, pain level at the first and second months and disability level at the second and third months in the intervention group were significantly lower (p < 0.05), and in the third month, subdimension scores of quality of life (the physical role difficulty, energy and vitality, mental health, social functionality and pain) were higher (p < 0.05). Conclusions: Walking after herniated disc surgery decreased pain and disability levels and increased the quality of life; nurses can encourage adherence to walking as an effective intervention. SUMMARY STATEMENT: What is already known about this topic? After lumbar disc hernia surgery, patients experience low to moderate levels of pain and disability.Pain and disability levels can be decreased with appropriate post‐operative care and rehabilitation.Walking is a cheap and safe type of physical activity that is effective both in increasing physical activity after surgery and in decreasing pain and disability. What this paper adds? Walking was effective for reducing post lumbar disc hernia surgery pain and disability levels, positively contributing to better quality of life for these patients.This study showed that post discharge monitoring by nurses was necessary and important. The implications of this paper: Nurses should inform patients to gradually increase physical activity during discharge training.Walking is a simple and cheap activity with low risk of injury, which could be recommended as a type of exercise after lumbar disc herniation surgery.Nurses can use pedometers and the telemonitoring methods to motivate patients to walk. [ABSTRACT FROM AUTHOR]

Background: The paraspinal, posterolateral, or Wiltse approach is an old technique that observes the principles of an MIS procedure. The aim of this study was to provide a step-by-step description from the literature of the Wiltse paraspinal approach and analyze its main advantages and limitations. Methods: Here, we provide a step-by-step description of the Wiltse approach. Utilizing PubMed and Lilacs and the Mesh terms "Wiltse approach," "paraspinal approach," "muscle sparing approach," and "lumbar spine," we identified 10 papers. We then put together, based on these publications, a step-by-step analysis of the preparation, patient positioning, skin incision, fascial opening, dissection, bone identification, retractors, deperiostization, decompression, discectomy, instrumentation, arthrodesis, and closure for the Wiltse technique. Results: Most papers underscored the minimally invasive aspects of the typical Wiltse approach. Advantages included minimal intraoperative bleeding, a shorter hospital length of stay, and a low infection rate. Conclusion: The classical approach described by Wiltse is essentially minimally invasive, sparing both the muscle planes and soft tissues, allowing for ample far lateral lumbar decompression, including discectomy and fusion, with a low complication rate. [ABSTRACT FROM AUTHOR]

Objective. The purpose of this study was to investigate the effect of lumbar disc herniation (LDH) disease degree on lumbar discectomy and to explore the relationship between the degree of intervertebral disc disease and postoperative pain score changes. Methods. We conducted a comprehensive search in China National Knowledge Infrastructure (CNKI), Wanfang Data, PubMed, MEDLINE, Embase, Cochrane database, and other databases, obtained all relevant studies as of April 2017, and then followed strict inclusion and exclusion criteria. Standard screening was performed on the retrieved literature. We extract and analyze key data using Review Manager 5.3 software. Pooled effects were calculated by mean difference or odds ratio and 95% confidence interval analysis, depending on data attributes. Results. Various databases were searched for the results of papers from lumbar discectomy since April 2017 to April 2022. Nine papers from 2502 patients were selected. The average overall follow-up was 52 weeks. There were statistically significant reductions in postoperative pain scores and degree of disc disease. There was a significant correlation between the reduction in pain score after discectomy and the degree of disc disease (r = 0.73 , 95 % CI = 0.01 -1.20, p = 0.005). Conclusions. Decreased disc disease grade is one of the reasons for the lower back pain score after discectomy. Furthermore, region-dependent economic factors must be considered before developing a treatment strategy. Larger, well-defined randomized controlled trials are needed to further confirm these results. [ABSTRACT FROM AUTHOR]

Objectives: To present a synopsis of evidence on the efficacy of rehabilitation after cervical disk surgery performed for neck pain and radiculopathy. Data sources: The databases of Medline, EMBASE, and Cochrane Central were searched for studies reporting effects of rehabilitation interventions in patients undergoing surgery due to cervical disk disease with pain and radicular syndrome, published before 31 August 2018. Review methods: Project was registered with PROSPERO database (number CRD42018085937). Randomized controlled trials that evaluated the efficacy of rehabilitation interventions versus other, sham, or no treatment were selected. The primary outcomes were disability and pain. Secondary outcomes were other measures assessing biological, psychological or social effect of rehabilitation. Two reviewers independently screened studies for eligibility, assessed risk of bias and extracted data. Evaluation of evidence was performed with the GRADE system. Results: Five papers were included in the review. The eligible studies were heterogeneous in intervention and outcome reporting. There are low- to very-low-quality evidence that some interventions (use of cervical collars after non-plated anterior cervical diskectomy an fusion, structured physiotherapy, and interactive patients' education) provide some benefit within functioning, pain, and selected psychological variables in patients undergoing cervical disk surgery. Controlled trials addressing comprehensive interdisciplinary rehabilitation, multidisciplinary pain management, occupational therapy, psychotherapy, social and vocational interventions were not identified. Conclusion: There is insufficient evidence with few trials of low quality to allow any conclusion to be drawn about the effectiveness, harms, and general ineffectiveness of rehabilitation for people who have had cervical disk surgery for pain or radiculopathy. [ABSTRACT FROM AUTHOR]

Background: Percutaneous transforaminal endoscopic discectomy (PTED) has been widely used in the treatment of lumbar degenerative diseases. Epidural injection of steroids can reduce the incidence and duration of postoperative pain in a short period of time. Although steroids are widely believed to reduce the effect of surgical trauma, the observation indicators are not uniform, especially the long-term effects, so the problem remains controversial. Therefore, the purpose of this paper was to evaluate the efficacy of epidural steroids following PTED. Methods: We searched PubMed, Embase, and the Cochrane Database from 1980 to June 2021 to identify randomized and non-randomized controlled trials comparing epidural steroids and saline alone following PTED. The primary outcomes included postoperative pain at least 6 months as assessed using a visual analogue scale (VAS) and the Oswestry Disability Index (ODI). The secondary outcomes included length of hospital stay and the time of return to work. Results: A total of 451 patients were included in three randomized and two nonrandomized controlled trials. The primary outcomes, including VAS and ODI scores, did not differ significantly between epidural steroids following PTED and saline alone. There were no significant intergroup differences in length of hospital stay. Epidural steroids were shown to be superior in terms of the time to return to work (P < 0.001). Conclusions: Intraoperative epidural steroids did not provide significant benefits, leg pain control, improvement in ODI scores, and length of stay in the hospital, but it can enable the patient to return to work faster. [ABSTRACT FROM AUTHOR]

Purpose: To present a systematic review on ICF used in the Nordic countries from 2001 to 2013, describing and quantifying the development in utilization of ICF, and describe the extent to which the different components of the ICF have been used.Method: A search was conducted in EMBASE, MEDLINE and PsycInfo. Papers from Nordic countries were included if ICF was mentioned in title or abstract. Papers were assigned to one of eight categories covering the wide rehabilitation area; furthermore, area of focus was assigned. Use of ICF components and intervention were coded in papers categorized as 'Clinical and/or rehabilitation contexts' or 'Non clinical contexts'.Results: 170 papers were included, of these 99 papers were from the categories 'Clinical and/or rehabilitation contexts' or 'Non clinical contexts'. 42% of the 170 included papers were published in the period 2011-2013.Conclusions: There was an increase in ICF-relevant papers from 2001 to 2013, especially in the categories 'clinical and/or rehabilitation contexts' and 'non clinical contexts'. The most represented focus areas were neurology, musculoskeletal and work-related areas. All five or at least four ICF components were mentioned in the results or discussions in most papers; activity was most frequently mentioned. [ABSTRACT FROM AUTHOR]

Aim: To describe the modifications we made to the Taylor retractor (TR) used in routine spinal surgery and present the results of cases that underwent surgery with the modified TR. Materials and Methods: We made two basic modifications to the TR used in standard spinal surgery practice: reducing the size of the instrument and reshaping the blade part. The study included the cases in which we performed unilateral lumbar microdiscectomy (LM) at one level with standard and modified TR between January 2016 and August 2020. The preoperative and postoperative thirdmonth low back pain and ODI scores were statistically analyzed. Results: The mean age of the 50 patients was 42 years, and the male/female ratio was 1.38. Except a skin infection in Group A, no other complication was seen. The mean follow-up period was 12 months. The length of incision was 28 mm in Group A and 17 mm in Group B. When the preoperative and postoperative third-month VAS and ODI scores were statistically analyzed in terms of low back pain, a significant difference was found (p<0.001). Conclusion: Microdiscectomy is a gold standard method in LDH surgery. TR is a practical and easily accessible surgical instrument in spinal surgery. Technological advances in optical systems have provided a significant reduction in normal tissue damage in LM. In addition, the modified TR we presented in this paper does not require a learning curve and can contribute to obtaining satisfactory results in terms of normal tissue damage and reducing postoperative low back pain complaints. [ABSTRACT FROM AUTHOR]

Although it is one of the most common and studied intervertebral disc lesions, lumbar disc herniation raises some questions today about its etiology and generates discussions about early diagnosis, therapeutic attitudes, and the functional impact on quality of life. Clinical manifestations are inconsistent, unpredictable; their good tolerance is generally known, often the practitioner having the opportunity to highlight a net discartosis without the patient experiencing the slightest sensation. These diseases remain clinically latent in most cases, their being highlighted by an acute clinical onset of lumbar or lumboscalia. Correct and early diagnosis is the first condition for effective treatment. That is why it is necessary to evaluate each case using a hierarchy system to classify the severity of the lesions. Thus, the staging and classification system used becomes a real "thinking tool" that helps us find the way to the right treatment faster. In this paper we wanted to achieve a biological staging by electron microscopy study of intervertebral disc lesions obtained on intraoperative material taken. [ABSTRACT FROM AUTHOR]

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Iatrogenic vascular laceration is a rare but well-known complication of posterior lumbar disc surgery (PLUDS). We performed a review of the literature to evaluate the management of this life-threatening complication. A total of 54 papers containing 100 cases of vascular laceration following PLUDS between 1969 and 2018 were analyzed with our representative case with a left common iliac artery (CIA) laceration during a posterior approach for a far lateral L4–L5 disc herniation. There were 54 females and 35 males (12 cases with unreported gender) with ages ranging from 20 to 72 years. The most commonly involved spinal level was L4–L5 (n = 67). The duration from the causative surgery to the symptom of the vascular injury ranged from 0 to 50 h (mean, 7.3 h). Only 47.3% of patients underwent postoperative imaging and the most commonly injured vessel was the CIA (n = 49). Vascular repair, open surgery, and/or an endovascular procedure was performed in 95 patients. The most frequent complications were deep venous thrombosis in the leg and pulmonary emboli, where a complete recovery was seen in 75.3% of patients. The mortality rate was 18.8%. In hemodynamically unstable cases, an emergent exploratory laparotomy was life-saving even without vascular imaging, although angiography with/without endovascular intervention may be used in stable patients. [ABSTRACT FROM AUTHOR]

Objectives: Due to recent developments and the wide application of percutaneous transforaminal discectomy (PTED) in China, we herein compare its clinical effects with microendoscopic discectomy (MED) for the treatment of lumbar disc herniation in terms of recurrence and revision rates. Methods: Six databases, namely, PubMed, EMBASE, Cochrane Library, Ovid, China National Knowledge Infrastructure and Wanfang, were searched by computer. The literature was screened according to inclusion and exclusion criteria, and the quality of the included literature was evaluated. After extracting the data from the papers, Review Manager 5.2 software (Cochrane Collaboration, Oxford, UK) was applied to analyze these data. Finally, sensitivity and publication bias analyses of the results were conducted. Results: A total of 12 studies consisting of 2400 patients were included in this meta-analysis. A comparison of PTED with MED revealed higher postoperative recurrence and postoperative revision rates for PTED (odds ratio [OR] recurrence, 1.60; 95% confidence interval [CI], 1.01 to 2.53; p=0.05 and OR revision, 1.77; 95% CI, 1.18 to 2.64, p=0.006). Conclusion: PTED has a number of advantages because it is a minimally invasive surgery, but its recurrence and revision rates are higher than MED. Therefore, MED should not be completely replaced by PTED. [ABSTRACT FROM AUTHOR]

Purpose: Even though the anterior cervical discectomy and fusion (ACDF) is one of the most common spinal procedures, a consensus on the real need for prescribing a cervical collar (CC) after surgery is still missing. In fact, the role of external immobilization in decreasing non-fusion rate and implants displacement has not been clarified yet.Methods: This study was conducted according to the PRISMA statement. Six different online medical databases were screened. Papers reporting the neck disability index (NDI), cervical range of motion (RoM) and fusion rate after ACDF without plating, on single or multiple levels, for cervical spondylosis were considered for eligibility.Results: There were no significant differences in terms of NDI scores at 2 weeks (WMD = 4.502; 95% CI - 5.953, 14.957; p = 0.399; I2 = 65.14%; p = 0.090) and 1-year (WMD = 2.052; 95% CI - 1.386, 5.490 p = 0.242; I2 = 0%; p = 0.793), RoM reduction at 1-year (WMD = 1.597; 95% CI - 5.886, 9.079; p = 0.676; I2 = 0%; p = 0.326) or fusion rate (OR = 1.127; 95% CI 0.387, 3.282; p = 0.827; I2 = 2.166%; p = 0.360).Conclusions: The use of a CC after ACDF without plating on single or double levels for cervical spondylosis seems not supported by scientific evidence. These slides can be retrieved under Electronic Supplementary Material. [ABSTRACT FROM AUTHOR]

Background: Multilevel cervical degenerative disc disease (CDDD) can be treated surgically with anterior cervical discectomy and fusion (ACDF), cervical disc arthroplasty (CDA), or a hybrid surgery (HS) of the two in which both procedures are used at different vertebral levels. A systematic review and meta-analysis was performed to compare the clinical and radiographical outcomes of HS against ACDF or CDA alone. Methods: Three electronic databases were searched for articles published before December 2018. The literature was searched and assessed by independent reviewers according to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) statement. Results: Eight papers were identified as eligible with a total of 424 patients. Post-operative C2–C7 range of motion (ROM) was significantly greater after HS than ACDF (p = 0.004; mean difference (MD) 6.14°). The ROM of the superior adjacent segment was significantly lower after HS than ACDF (p < 0.0001; MD − 2.87°) as was the ROM of the inferior adjacent segment (p = 0.0005; MD − 3.11°). HS patients' return to work was shorter than those who underwent ACDF (p < 0.00001; MD − 32.01 days) and CDA (p < 0.00001; MD − 32.92 days). There were no statistically significant differences in functional outcomes following CDA compared with HS. There was no significant difference in operation time, intra-operative blood loss, or post-operative complications between any of the procedures. Conclusion: The number of included studies was small, the heterogeneity between them was substantial, and the quality of evidence was very low. Large randomised controlled trials are required to provide strong evidence that would enable recommendation of one intervention over another. [ABSTRACT FROM AUTHOR]

Background: The aim of the present paper was to systematically review the literature on percutaneous endoscopic laser discectomy (PELD) with respect to the safety and efficacy of the procedure. Where possible the procedure was compared with open discectomy. Methods: Studies on PELD were identified using MEDLINE (1984 to December 1999), EMBASE (1974 to December 1999) and Current Contents (1993 to Week 1, 2000). A number of search terms were used: PELD; PLDD (percutaneous laser disc decompression); and laser and (spine or lumbar) and (disc* or disk*). The Cochrane Library was searched from 1966 to issue 4, 1999, using the search terms ‘discectomy’ or ‘discotomy’. Live human studies of patients with lumbar disc prolapses for whom surgery was appropriate were included. Cadaver studies were also included. A surgeon and reviewer independently assessed the retrieved articles for their inclusion in the review. Results: Only 12 papers were identified that related to PELD. The level of evidence for safety and efficacy was low; there were no controlled, blinded or randomized studies. The highest level of evidence came from time series studies. No quantitative analysis could be undertaken for the present review. Conclusions: Given the extremely low level of evidence available for this procedure it was recommended that the procedure be regarded as experimental until results are available from a controlled clinical trial, ideally with random allocation to an intervention and control group. [ABSTRACT FROM AUTHOR]

Context: Approaches suggested for treatment of neglected dislocations in the subaxial cervical spine (SACS) include only anterior approach (a), only posterior approach (b), posterior-anterior approach, posterior-anterior-posterior approach, and anterior-posterior-anterior-posterior approach. No protocol is suggested in literature to guide surgeons treating neglected dislocations. Aim: To describe a protocol for the treatment of neglected dislocation in the SACS. Settings and Designs: Retrospective case series and review of literature. Materials and Methods: Six consecutive patients of neglected dislocation (presenting to us more than 3 weeks following trauma) of the SACS were operated as per the protocol suggested in this paper. A retrospective review of the occupational therapy reports, patient records, and radiographs was performed. Only cases with time lapse of more than 3 weeks between the time of injury and initial management have been included in the review. Results: Closed reduction (CR) was achieved in three patients following cervical traction and these were managed by anterior cervical discectomy and fusion (ACDF). Open reduction via posterior approach and soft tissue release was required to achieve reduction in two patients. Following reduction posterior instrumented fusion was done in them. One patient with preoperative neurological deficit needed a facetectomy to achieve reduction. Following short-segment fixation, ACDF was also performed in this patient. None of the patients deteriorated neurologically following surgery. Fusion was achieved in all patients. Conclusions: Preoperative and intraoperative traction have a role in the management of neglected dislocations in the cervical spine. If CR is achieved the patient may be managed by ACDF. If CR is not achieved, posterior soft tissue release may be done to achieve reduction and partial facetectomy must be reserved for cases in which reduction is not achieved after soft tissue release. A treatment protocol for management of neglected dislocation in the SACS has been suggested in this paper. [ABSTRACT FROM AUTHOR]