Base de dados : MEDLINE
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  1 / 4003 MEDLINE  
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[PMID]:29390319
[Au] Autor:Wang Y; Yi XD; Li CD
[Ad] Endereço:Department of Orthopedics, Peking University First Hospital, Beijing, China.
[Ti] Título:The influence of artificial nucleus pulposus replacement on stress distribution in the cartilaginous endplate in a 3-dimensional finite element model of the lumbar intervertebral disc.
[So] Source:Medicine (Baltimore);96(50):e9149, 2017 Dec.
[Is] ISSN:1536-5964
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:OBJECTIVE: This study aimed to investigate the effects involved with the artificial nucleus pulposus (NP) replacement on stress distribution of the cartilaginous endplate (CEP) in a 3-dimensional lumbar intervertebral disc (IVD) model using a finite element (FE) analysis. METHODS: A healthy male volunteer was recruited for the purposes of the study and a spiral computed tomography scan was subsequently conducted to obtain the data information in relation to the L4/5 motion segment. An FE model of the L4/5 motion segment constructed, on the basis of which degenerative IVD, IVD with NP removal, and IVD with NP replacement were in turn built. The stress distribution of the CEP and bulging of IVD were estimated using various motion states, including axial loading, forward flexion, backward extension, left axial rotation, and right axial rotation. RESULTS: Under different motion states, the vertebral stress was higher in the degenerative IVD, the IVD with NP removal, and the IVD with NP replacement, in comparison to that of the normal IVD. Furthermore, a higher vertebral stress was detected in the degenerative IVD than the IVD with NP removal and the IVD with NP replacement. An even distribution of vertebral stress was observed in the IVD model with an artificial NP replacement, while the vertebral stress and bulging displacement were lower than after NP removal. Our findings provided confirmation that stress of the CEP was consistent with the vertebral stress. CONCLUSION: This study provided evidence suggesting that NP replacement, vertebral stress, and bulging displacement are lower than that of degenerative IVD and IVD with NP removal under different motion states.
[Mh] Termos MeSH primário: Degeneração do Disco Intervertebral/cirurgia
Núcleo Pulposo/cirurgia
[Mh] Termos MeSH secundário: Fenômenos Biomecânicos
Simulação por Computador
Discotomia
Análise de Elementos Finitos
Voluntários Saudáveis
Seres Humanos
Imagem por Ressonância Magnética
Masculino
Modelos Anatômicos
Estresse Mecânico
Tomografia Computadorizada Espiral
Adulto Jovem
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1802
[Cu] Atualização por classe:180301
[Lr] Data última revisão:
180301
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:180203
[St] Status:MEDLINE
[do] DOI:10.1097/MD.0000000000009149


  2 / 4003 MEDLINE  
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[PMID]:29384882
[Au] Autor:Li X; Chang H; Meng X
[Ad] Endereço:Department of Spine Surgery, The Third Hospital of Hebei Medical University.
[Ti] Título:Tubular microscopes discectomy versus conventional microdiscectomy for treating lumbar disk herniation: Systematic review and meta-analysis.
[So] Source:Medicine (Baltimore);97(5):e9807, 2018 Feb.
[Is] ISSN:1536-5964
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: The application of tubular microscopes discectomy (TMD) was supposed to have similar or better results than conventional microdiscectomy (CMD). However, this conclusion had not been verified by sufficient evidence. Therefore, the focus of this meta-analysis was to assess the efficiency, safety, and clinical outcome of these 2 surgical procedures for treating lumbar disk herniation (LDH). METHODS: PubMed, Embase, and Cochrane Collaboration Central databases were searched for studies which compared the results of TMD and CMD for the treatment of LDH up to July 2017. Data analysis was conducted using RevMan 5.3. A standardized electronic form of 17 predefined criteria from the Consort statement was used for the quality assessment. RESULTS: Eight randomized controlled trials (RCT) and 2 retrospective studies were included in this review, including 804 patients. The pooled analysis showed that there was no significant difference in operative time (P = .38), blood loss (P = .14), the length of hospital stay (P = .47), the rate of intraoperative complications (P = .79), postoperative complications (P = .16), dural tear (P = .87), the reoperation (P = .20), the short-term back visual analog scale (VAS) scores (P = .76), the long-term back VAS scores (P = .64), the short-term leg VAS scores (P = .09), the long-term leg VAS scores (P = .35), and the Oswestry disability index (ODI) scores (P = .41). CONCLUSION: The results of this meta-analysis demonstrate that TMD and CMD are both safe and effective surgical procedures which can be recommended for treating LDH. Additionally, the conclusion should be cautiously treated, because it was reached in the context of limited amount of studies and relatively small sample size. Therefore, future studies with good design and more large samples are required to validate this conclusion.
[Mh] Termos MeSH primário: Discotomia
Deslocamento do Disco Intervertebral/cirurgia
Vértebras Lombares
Microcirurgia
[Mh] Termos MeSH secundário: Seres Humanos
[Pt] Tipo de publicação:JOURNAL ARTICLE; META-ANALYSIS; REVIEW
[Em] Mês de entrada:1802
[Cu] Atualização por classe:180221
[Lr] Data última revisão:
180221
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:180201
[St] Status:MEDLINE
[do] DOI:10.1097/MD.0000000000009807


  3 / 4003 MEDLINE  
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[PMID]:29381941
[Au] Autor:Wang F; Hou HT; Wang P; Zhang JT; Shen Y
[Ad] Endereço:Department of Spine Surgery, The Third Hospital of Hebei Medical University, The Key Laboratory of Orthopedic Biomechanics of Hebei Province.
[Ti] Título:Symptomatic adjacent segment disease after single-lever anterior cervical discectomy and fusion: Incidence and risk factors.
[So] Source:Medicine (Baltimore);96(47):e8663, 2017 Nov.
[Is] ISSN:1536-5964
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:The purpose of this study was to determine the incidence and risk factors of symptomatic adjacent segment disease (ASD) following single-lever anterior cervical discectomy and fusion (ACDF) for cervical degenerative diseases.From January 2000 to December 2010, a total of 582 patients with cervical radiculopathy and myelopathy who had undergone single-lever ACDF surgery in the authors' institution were reviewed retrospectively. Patients who had a revision surgery for symptomatic ASD were selected for this study. The authors analyzed the incidence for ASD after single-lever ACDF. And univariate analysis and logistic regression analysis were performed to identify the risk factors of ASD.Among the 582 patients, 36 patients received subsequent surgical management for ASD after initial single-lever ACDF for an overall prevalence of 6.2%. The average onset time of ASD was 8.5 (2-15) years. The univariate analysis showed that there were no significant differences in sex, duration of disease, BMI, DM, smoking, operative levels, and follow-up period (P > .05) between the 2 groups with and without ASD. There were statistically significant differences in age at the time of operation (χ = 4.361, P = .037), and developmental canal stenosis (χ = 4.181, P = .041) between patients with and without ASD. The variables of age at the time of operation and developmental canal stenosis were included in a logistic regression model. The logistic regression analysis revealed that age at the time of operation ≤50 years (P = .045, OR = 3.015, 95% CI = 1.024-8.882) and developmental canal stenosis (P = .042, OR = 2.797, 95% CI = 1.039-7.527) were the risk factors for ASD after single-lever ACDF.In the present study, the incidence of symptomatic ASD after single-lever ACDF was 6.2%. And the age at the time of operation ≤50 years and developmental canal stenosis were the risk factors for ASD. The patients ≤50 years old at the time of operation or with developmental canal stenosis are more likely to develop ASD after surgery, and the risk of reoperation will increase.
[Mh] Termos MeSH primário: Discotomia/efeitos adversos
Degeneração do Disco Intervertebral
Complicações Pós-Operatórias
Radiculopatia/cirurgia
Reoperação/estatística & dados numéricos
Doenças da Medula Espinal/cirurgia
Fusão Vertebral/efeitos adversos
Estenose Espinal
[Mh] Termos MeSH secundário: Fatores Etários
Vértebras Cervicais/diagnóstico por imagem
Vértebras Cervicais/patologia
Vértebras Cervicais/cirurgia
China/epidemiologia
Discotomia/métodos
Feminino
Seres Humanos
Incidência
Degeneração do Disco Intervertebral/diagnóstico
Degeneração do Disco Intervertebral/epidemiologia
Degeneração do Disco Intervertebral/etiologia
Degeneração do Disco Intervertebral/cirurgia
Masculino
Meia-Idade
Avaliação de Processos e Resultados (Cuidados de Saúde)
Complicações Pós-Operatórias/diagnóstico
Complicações Pós-Operatórias/epidemiologia
Complicações Pós-Operatórias/cirurgia
Estudos Retrospectivos
Fatores de Risco
Fusão Vertebral/métodos
Estenose Espinal/diagnóstico
Estenose Espinal/epidemiologia
Estenose Espinal/etiologia
Estenose Espinal/cirurgia
[Pt] Tipo de publicação:JOURNAL ARTICLE; OBSERVATIONAL STUDY
[Em] Mês de entrada:1802
[Cu] Atualização por classe:180208
[Lr] Data última revisão:
180208
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:180201
[St] Status:MEDLINE
[do] DOI:10.1097/MD.0000000000008663


  4 / 4003 MEDLINE  
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[PMID]:29382028
[Au] Autor:Wang BY; Wu TK; Liu H; Deng YX; Ding C
[Ad] Endereço:Department of Orthopaedic Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan, China.
[Ti] Título:Intraoperative conversion of artificial cervical disc replacement to anterior cervical discectomy and fusion for iatrogenic fracture: A rare case report.
[So] Source:Medicine (Baltimore);96(47):e8917, 2017 Nov.
[Is] ISSN:1536-5964
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:RATIONALE: Artificial cervical disc replacement (ACDR) has been reported to be an effective and safe surgical treatment for cervical spondylosis. However, iatrogenic fracture during ACDR surgery has rarely been reported. Considering its infrequency, we report a rare clinical case, with the aim of sharing our experience and exploring when to convert ACDR to fusion intraoperatively. PATIENTS CONCERNS: A 47-year-old woman felt neck pain with weakness and numbness in both upper limbs for 5 months. DIAGNOSES: The patient had received discectomy and fusion procedure on C3/4 and C5/6 to relieve her radicular pain nearly 4 years prior. Neurologic examination revealed a diminished sensation at the C6-C8 skin areas and level Grade-4 power in the left wrist extensor and grip muscle strength. Magnetic resonance imaging (MRI) showed disc herniation compressing the spinal cord at C6/7. Computed tomography (CT) scans showed intervertebral fusion in both the C3/4 and C5/6 segments. INTERVENTIONS: Surgery was performed to remove the plate and replace C6/7 with an artificial disc, but a transverse cleavage endplate cortical fracture was detected after cutting the blades. Thus, we terminated artificial cervical disc replacement intraoperatively and changed to discectomy and fusion in C6/7. OUTCOMES: The patient's symptoms were remarkably relieved. Postoperative CT scans showed a transverse cleavage fracture in the backside of the C6 caudal endplate. Good fusion was achieved after 6 months. LESSONS: Iatrogenic fracture during ACDR is rare but does occur in clinic practice. Complete examination and an alternative approach determined before surgery are important for operative safety. Anterior cervical discectomy and fusion (ACDF) is recommended as a feasible remedial surgical strategy if ACDR fails intraoperatively.
[Mh] Termos MeSH primário: Vértebras Cervicais/cirurgia
Discotomia/métodos
Fraturas da Coluna Vertebral/cirurgia
Fusão Vertebral/métodos
Substituição Total de Disco/efeitos adversos
[Mh] Termos MeSH secundário: Vértebras Cervicais/lesões
Feminino
Seres Humanos
Doença Iatrogênica
Período Intraoperatório
Meia-Idade
Reoperação/métodos
Fraturas da Coluna Vertebral/etiologia
Espondilose/cirurgia
[Pt] Tipo de publicação:CASE REPORTS; JOURNAL ARTICLE
[Em] Mês de entrada:1802
[Cu] Atualização por classe:180207
[Lr] Data última revisão:
180207
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:180201
[St] Status:MEDLINE
[do] DOI:10.1097/MD.0000000000008917


  5 / 4003 MEDLINE  
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[PMID]:29369203
[Au] Autor:Xu B; Xu H; Ma X; Liu Y; Yang Q; Jiang H; Li N; Ji N
[Ti] Título:Bilateral decompression and intervertebral fusion via unilateral fenestration for complex lumbar spinal stenosis with a mobile microendoscopic technique.
[So] Source:Medicine (Baltimore);97(4):e9715, 2018 Jan.
[Is] ISSN:1536-5964
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:For complex lumbar spinal stenosis, using of endoscopy technique may provide clear vision with less invasive dissection of paravertebral muscle. The objective of this study was to evaluate the feasibility and clinical efficacy of bilateral decompression and intervertebral fusion via unilateral fenestration for complex lumbar spinal stenosis using mobile microendoscopic discectomy (MMED) technique.A total of 61 patients with complex lumbar spinal stenosis (lumbar canal stenosis combined with degenerative spondylolisthesis, instability, and scoliosis) were treated with this procedure. Patients with isolated lumbar spinal stenosis or spondylolisthesis greater than grade II were excluded. The index levels included L4/5 in 52 patients, L5/S1 in 6 patients, L3-L5 in 2 patients and L4-S1 in 1 patient. The preoperative Oswestry Disability Index (ODI) score was 42.6 ±â€Š10.2, lumbar visual analog scale (VAS) score was 6.1 ±â€Š4.2, and leg VAS score was 7.1 ±â€Š5.1. During the operation, ipsilateral enlarged fenestration was made using the MMED technique. The disc and cartilage endplate were thoroughly removed, and the contralateral ligamentum flavum and the inner layer of lamina were undercut to release the contralateral nerve root. The intervertebral space was released and prepared, followed by bone grafting and cage insertion. Percutaneous pedicle system was used for reduction and fixation. The operative time and blood loss were recorded, and patients were followed-up for at least 3 years (36-48 months, average 41 months) to evaluate the clinical efficacy.The procedure was successful in all patients, with no nerve injury or conversion to open operation. The mean operative time was 120 minutes (range, 100-180 minutes), with a mean blood loss of 100 mL (range, 50-200 mL). Postoperative x-ray and CT showed sufficient decompression and improvement of spinal alignment. At 3 years after surgery, the ODI scores, lumbar and leg VAS scores decreased from preoperative 42.6 ±â€Š10.2, 6.1 ±â€Š4.2, and 7.1 ±â€Š5.1 to 8.6 ±â€Š7.0, 1.8 ±â€Š1.3, and 0.9 ±â€Š0.6, respectively (P = .00 for each comparison). The clinical results were excellent in 36 cases, good in 23, and fair in 2, according to the MacNab scale.The procedure of bilateral decompression and intervertebral fusion via unilateral fenestration using the MMED technique can provide satisfactory clinical results for complex lumbar spinal stenosis.
[Mh] Termos MeSH primário: Descompressão Cirúrgica/métodos
Discotomia/métodos
Endoscopia/métodos
Fusão Vertebral/métodos
Estenose Espinal/cirurgia
[Mh] Termos MeSH secundário: Idoso
Estudos de Viabilidade
Feminino
Seres Humanos
Vértebras Lombares/cirurgia
Masculino
Meia-Idade
Estenose Espinal/patologia
Resultado do Tratamento
[Pt] Tipo de publicação:EVALUATION STUDIES; JOURNAL ARTICLE
[Em] Mês de entrada:1802
[Cu] Atualização por classe:180208
[Lr] Data última revisão:
180208
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:180126
[St] Status:MEDLINE
[do] DOI:10.1097/MD.0000000000009715


  6 / 4003 MEDLINE  
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[PMID]:28451842
[Au] Autor:de Rooij JD; Gadjradj PS; Soria van Hoeve JS; Harhangi BS
[Ad] Endereço:Department of Neurosurgery, Erasmus MC: University Medical Center Rotterdam, S-Gravendijkwal 230 HS-205, 3015 CE, Rotterdam, The Netherlands. j.derooij@erasmusmc.nl.
[Ti] Título:Anterior cervical discectomy without fusion for a symptomatic cervical disk herniation.
[So] Source:Acta Neurochir (Wien);159(7):1283-1287, 2017 Jul.
[Is] ISSN:0942-0940
[Cp] País de publicação:Austria
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: Cervical radiculopathy is characterized by dysfunction of the nerve root usually caused by a cervical disk herniation. The most important symptom is pain, radiating from the neck to the arm. When conservative treatment fails, surgical treatment is indicated to relieve symptoms. During the last decades, multiple fusion techniques have been developed, although without clinical evidence for added value of fusion over non-fusion. METHODS: The surgical procedure of anterior cervical discectomy without fusion is performed step by step, leading to removal of the entire intervertebral disk. CONCLUSION: Anterior cervical discectomy without fusion is a safe and effective treatment for cervical disk herniation.
[Mh] Termos MeSH primário: Discotomia/métodos
Deslocamento do Disco Intervertebral/cirurgia
Complicações Pós-Operatórias/prevenção & controle
Radiculopatia/cirurgia
Fusão Vertebral/métodos
[Mh] Termos MeSH secundário: Vértebras Cervicais/cirurgia
Discotomia/efeitos adversos
Seres Humanos
Disco Intervertebral/cirurgia
Fusão Vertebral/efeitos adversos
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1802
[Cu] Atualização por classe:180205
[Lr] Data última revisão:
180205
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170429
[St] Status:MEDLINE
[do] DOI:10.1007/s00701-017-3189-x


  7 / 4003 MEDLINE  
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[PMID]:28455675
[Au] Autor:En'Wezoh DC; Leonard DA; Schoenfeld AJ; Harris MB; Zampini JM; Bono CM
[Ad] Endereço:Harvard Medical School, 25 Shattuck Street, Boston, MA, 02115, USA.
[Ti] Título:Relationship between size of disc and early postoperative outcomes after lumbar discectomy.
[So] Source:Arch Orthop Trauma Surg;137(6):805-811, 2017 Jun.
[Is] ISSN:1434-3916
[Cp] País de publicação:Germany
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: Previous studies suggest that patients with larger disc herniations (greater than 6 mm) will have better outcomes following discectomy. This has not been validated in a large series of patients. PURPOSE: We sought to empirically evaluate this relationship in a series of patients who had data collected prospectively as part of a randomized trial. METHODS: This retrospective review included 63 consecutive adult patients who underwent a single-level, primary lumbar discectomy. Outcomes were VAS for leg and back pain and the modified oswestry disability index (MODI). Statistical tests were used to compare patients using different cutoffs of preoperative disc diameters and disc volume removed. Regression analysis was performed to determine if there was a relationship between outcomes and the measured parameters. RESULTS: While patients who achieved substantial clinical benefit (SCB) for MODI had larger disc diameters, this relationship was not found for leg or back pain for any of the measured parameters. Using 5, 6, 7, or 8 mm as a cutoff for disc diameter demonstrated no differences. Regression analysis did not demonstrate a significant relationship between disc volume removed and final MODI scores. CONCLUSION: While patients with larger disc herniations on average might have a greater likelihood of superior clinical outcomes, the previously suggested "6 mm rule" was not supported.
[Mh] Termos MeSH primário: Discotomia/instrumentação
Deslocamento do Disco Intervertebral/cirurgia
Disco Intervertebral/diagnóstico por imagem
[Mh] Termos MeSH secundário: Adulto
Feminino
Seres Humanos
Deslocamento do Disco Intervertebral/diagnóstico
Imagem por Ressonância Magnética
Masculino
Tamanho do Órgão
Período Pós-Operatório
Estudos Prospectivos
Resultado do Tratamento
[Pt] Tipo de publicação:JOURNAL ARTICLE; MULTICENTER STUDY; RANDOMIZED CONTROLLED TRIAL
[Em] Mês de entrada:1801
[Cu] Atualização por classe:180126
[Lr] Data última revisão:
180126
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170430
[St] Status:MEDLINE
[do] DOI:10.1007/s00402-017-2699-6


  8 / 4003 MEDLINE  
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[PMID]:29305455
[Au] Autor:Peng B; Yang L; Yang C; Pang X; Chen X; Wu Y
[Ad] Endereço:General Hospital of Armed Police Force, 69 Yongding Road, Beijing 100039, China.
[Ti] Título:The effectiveness of anterior cervical decompression and fusion for the relief of dizziness in patients with cervical spondylosis: a multicentre prospective cohort study.
[So] Source:Bone Joint J;100-B(1):81-87, 2018 Jan.
[Is] ISSN:2049-4408
[Cp] País de publicação:England
[La] Idioma:eng
[Ab] Resumo:AIMS: Cervical spondylosis is often accompanied by dizziness. It has recently been shown that the ingrowth of Ruffini corpuscles into diseased cervical discs may be related to cervicogenic dizziness. In order to evaluate whether cervicogenic dizziness stems from the diseased cervical disc, we performed a prospective cohort study to assess the effectiveness of anterior cervical discectomy and fusion on the relief of dizziness. PATIENTS AND METHODS: Of 145 patients with cervical spondylosis and dizziness, 116 underwent anterior cervical decompression and fusion and 29 underwent conservative treatment. All were followed up for one year. The primary outcomes were measures of the intensity and frequency of dizziness. Secondary outcomes were changes in the modified Japanese Orthopaedic Association (mJOA) score and a visual analogue scale score for neck pain. RESULTS: There were significantly lower scores for the intensity and frequency of dizziness in the surgical group compared with the conservative group at different time points during the one-year follow-up period (p = 0.001). There was a significant improvement in mJOA scores in the surgical group. CONCLUSION: This study indicates that anterior cervical surgery can relieve dizziness in patients with cervical spondylosis and that dizziness is an accompanying manifestation of cervical spondylosis. Cite this article: 2018;100-B:81-7.
[Mh] Termos MeSH primário: Vértebras Cervicais/cirurgia
Descompressão Cirúrgica/métodos
Tontura/etiologia
Fusão Vertebral/métodos
Espondilose/complicações
Espondilose/cirurgia
[Mh] Termos MeSH secundário: Adulto
Idoso
Discotomia/métodos
Feminino
Seguimentos
Seres Humanos
Masculino
Meia-Idade
Cervicalgia/etiologia
Estudos Prospectivos
Índice de Gravidade de Doença
Resultado do Tratamento
[Pt] Tipo de publicação:EVALUATION STUDIES; JOURNAL ARTICLE; MULTICENTER STUDY
[Em] Mês de entrada:1801
[Cu] Atualização por classe:180116
[Lr] Data última revisão:
180116
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:180107
[St] Status:MEDLINE
[do] DOI:10.1302/0301-620X.100B1.BJJ-2017-0650.R2


  9 / 4003 MEDLINE  
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[PMID]:27771787
[Au] Autor:Ma Z; Ma X; Yang H; Guan X; Li X
[Ad] Endereço:Department of Orthopaedics, Shanxi Academy of Medical Sciences & Shanxi DaYi Hospital, No. 99 Long Cheng Street, Taiyuan, 030032, Shanxi Province, China.
[Ti] Título:Anterior cervical discectomy and fusion versus cervical arthroplasty for the management of cervical spondylosis: a meta-analysis.
[So] Source:Eur Spine J;26(4):998-1008, 2017 Apr.
[Is] ISSN:1432-0932
[Cp] País de publicação:Germany
[La] Idioma:eng
[Ab] Resumo:PURPOSE: The aim of this study was to compare the efficacy and safety of anterior cervical discectomy and fusion (ACDF) and cervical arthroplasty for patients with cervical spondylosis. METHODS: PubMed, Embase, and Cochrane Library were used to search for relevant articles published prior to April 2016 to identify studies comparing ACDF and cervical arthroplasty involving patients with cervical spondylosis. Relative risks (RR) and mean differences (MD) were used to measure the efficacy and safety of ACDF and cervical arthroplasty using the random effects model. RESULTS: The meta-analysis of 17 studies involved 3122 patients diagnosed with cervical spondylosis. Patients undergoing ACDF showed lower overall success rate (RR 0.84; 95 % CI 0.77-0.92; P < 0.001), higher VAS score (MD 0.36; 95 % CI 0.08-0.64; P = 0.011), and shorter mean surgical duration (MD -1.62; 95 % CI -2.80 to -0.44; P = 0.007) when compared with cervical arthroplasty. However, the association between ACDF therapy and the risk of mean blood loss (MD -0.16; 95 % CI -0.34 to 0.02; P = 0.082), mean hospitalization (MD 0.02; 95 % CI -0.31 to 0.36; P = 0.901), patient satisfaction (RR 0.96; 95 % CI 0.92-1.00; P = 0.066), neck disability index (MD 0.20; 95 % CI -0.05 to 0.44; P = 0.113), reoperation (RR 1.25; 95 % CI 0.64-2.41; P = 0.514), or complication (RR 1.17; 95 % CI 0.90-1.52; P = 0.242) was not statistically significant. CONCLUSIONS: Patients undergoing ACDF therapy tended to exhibit lower overall success rate, higher VAS score, and decreased mean surgical duration when compared with patients treated with cervical arthroplasty.
[Mh] Termos MeSH primário: Artroplastia/métodos
Vértebras Cervicais/cirurgia
Discotomia/métodos
Fusão Vertebral/métodos
Espondilose/cirurgia
[Mh] Termos MeSH secundário: Feminino
Seres Humanos
Cervicalgia/etiologia
Satisfação do Paciente
Reoperação
Espondilose/complicações
Fatores de Tempo
Resultado do Tratamento
[Pt] Tipo de publicação:COMPARATIVE STUDY; JOURNAL ARTICLE; META-ANALYSIS; REVIEW
[Em] Mês de entrada:1801
[Cu] Atualização por classe:180112
[Lr] Data última revisão:
180112
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:161025
[St] Status:MEDLINE
[do] DOI:10.1007/s00586-016-4779-7


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[PMID]:29245217
[Au] Autor:Lu H; Peng L
[Ad] Endereço:aDepartment of Orthopaedics, Jiangjin Central Hospital of ChongqingbDepartment of Orthopaedics, The People's Hospital of Bishan District, Chongqing, P.R. China.
[Ti] Título:Efficacy and safety of Mobi-C cervical artificial disc versus anterior discectomy and fusion in patients with symptomatic degenerative disc disease: A meta-analysis.
[So] Source:Medicine (Baltimore);96(49):e8504, 2017 Dec.
[Is] ISSN:1536-5964
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: Total disc replacement (TDR) using Mobi-C cervical artificial disc might be promising to treat symptomatic degenerative disc disease. However, the results remained controversial. We conducted a systematic review and meta-analysis to compare the efficacy and safety of Mobi-C cervical artificial disc and anterior cervical discectomy and fusion (ACDF) in patients with symptomatic degenerative disc disease. METHODS: PubMed, EMbase, Web of science, EBSCO, and Cochrane library databases were systematically searched. Randomized controlled trials (RCTs) assessing the effect of Mobi-C versus ACDF on the treatment of symptomatic degenerative disc disease were included. Two investigators independently searched articles, extracted data, and assessed the quality of included studies. The primary outcomes were neck disability index (NDI) score, patient satisfaction, and subsequent surgical intervention. Meta-analysis was performed using the random-effect model. RESULTS: Four RCTs were included in the meta-analysis. Overall, compared with ACDF surgery for symptomatic degenerative disc disease, TDR using Mobi-C was associated with a significantly increased NDI score (Std. mean difference = 0.32; 95% CI = 0.10-0.53; P = .004), patient satisfaction (odds risk [OR] = 2.75; 95% confidence interval [CI] = 1.43-5.27; P = .002), and reduced subsequent surgical intervention (OR = 0.20; 95% CI = 0.11-0.37; P < .001). Mobi-C was found to produce comparable neurological deterioration (OR = 0.77; 95% CI = 0.35-1.72; P = .53), radiographic success (OR = 1.18; 95% CI = 0.39-3.59; P = .77), and overall success (OR = 2.13; 95% CI = 0.80-5.70; P = .13) compared with ACDF treatment. CONCLUSION: Among the 4 included RCTs, 3 articles were studying patients with 1 surgical level, and 1 article reported 2 surgical levels. When compared with ACDF surgery in symptomatic degenerative disc disease, TDR using Mobi-C cervical artificial disc resulted in a significantly improved NDI score, patient satisfaction, and reduced subsequent surgical intervention. There was no significant difference of neurological deterioration, radiographic success, and overall success between TDR using Mobi-C cervical artificial disc versus ACDF surgery. TDR using Mobi-C cervical artificial disc should be recommended for the treatment of symptomatic degenerative disc disease.
[Mh] Termos MeSH primário: Órgãos Artificiais
Discotomia/métodos
Degeneração do Disco Intervertebral/cirurgia
Fusão Vertebral/métodos
Substituição Total de Disco/métodos
[Mh] Termos MeSH secundário: Adulto
Vértebras Cervicais/fisiopatologia
Vértebras Cervicais/cirurgia
Avaliação da Deficiência
Feminino
Seguimentos
Seres Humanos
Degeneração do Disco Intervertebral/fisiopatologia
Masculino
Meia-Idade
Pescoço/fisiopatologia
Pescoço/cirurgia
Satisfação do Paciente
Ensaios Clínicos Controlados Aleatórios como Assunto
Amplitude de Movimento Articular
Resultado do Tratamento
[Pt] Tipo de publicação:JOURNAL ARTICLE; META-ANALYSIS; REVIEW
[Em] Mês de entrada:1712
[Cu] Atualização por classe:171222
[Lr] Data última revisão:
171222
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:171217
[St] Status:MEDLINE
[do] DOI:10.1097/MD.0000000000008504



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