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Astur N, Martins DE, Kanas M, de Mendonça RGM, Creek AT, Lenza M, Wajchenberg M. Quality assessment of systematic reviews of surgical treatment of cervical spine degenerative diseases: an overview. EINSTEIN-SAO PAULO 2022; 20:eAO6567. [PMID: 35476082 PMCID: PMC9000984 DOI: 10.31744/einstein_journal/2022ao6567] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2021] [Accepted: 07/19/2021] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVE To gather all systematic reviews of surgical treatment of degenerative cervical diseases and assess their quality, conclusions and outcomes. METHODS A literature search for systematic reviews of surgical treatment of degenerative cervical diseases was conducted. Studies should have at least one surgical procedure as an intervention. Included studies were assessed for quality through Preferred Reporting Items for Systematic Review and Meta-analysis (PRISMA) and Assessment of Multiple Systematic Reviews (AMSTAR) questionnaires. Quality of studies was rated accordingly to their final score as very poor (<30%), poor (30%-50%), fair (50%-70%), good (70%-90%), and excellent (>90%). If an article reported a conclusion addressing its primary objective with supportive statistical evidence for it, they were deemed to have an evidence-based conclusion. RESULTS A total of 65 systematic reviews were included. According to AMSTAR and PRISMA, 1.5% to 6.2% of studies were rated as excellent, while good studies counted for 21.5% to 47.7%. According to AMSTAR, most studies were of fair quality (46.2%), and 6.2% of very poor quality. Mean PRISMA score was 70.2%, meaning studies of good quality. For both tools, performing a meta-analysis significantly increased studies scores and quality. Cervical spondylosis studies reached highest scores among diseases analyzed. Authors stated conclusions for interventions compared in 70.7% of studies, and only two of them were not supported by statistical evidence. CONCLUSION Systematic reviews of surgical treatment of cervical degenerative diseases present "fair" to "good" quality in their majority, and most of the reported conclusions are supported by statistical evidence. Including a meta-analysis significantly increases the quality of a systematic review.
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Affiliation(s)
- Nelson Astur
- Hospital Israelita Albert EinsteinSão PauloSPBrazilHospital Israelita Albert Einstein, São Paulo, SP, Brazil.
| | - Delio Eulalio Martins
- Hospital Israelita Albert EinsteinSão PauloSPBrazilHospital Israelita Albert Einstein, São Paulo, SP, Brazil.
| | - Michel Kanas
- Hospital Israelita Albert EinsteinSão PauloSPBrazilHospital Israelita Albert Einstein, São Paulo, SP, Brazil.
| | - Rodrigo Góes Medéa de Mendonça
- Irmandade da Santa Casa de Misericórdia de São PauloSão PauloSPBrazilIrmandade da Santa Casa de Misericórdia de São Paulo, São Paulo, SP, Brazil.
| | - Aaron T. Creek
- Norton Leatherman Spine CenterLouisvilleUnited StatesNorton Leatherman Spine Center, Louisville, United States.
| | - Mario Lenza
- Hospital Israelita Albert EinsteinSão PauloSPBrazilHospital Israelita Albert Einstein, São Paulo, SP, Brazil.
| | - Marcelo Wajchenberg
- Hospital Israelita Albert EinsteinSão PauloSPBrazilHospital Israelita Albert Einstein, São Paulo, SP, Brazil.
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The Use of a Novel Heads-Up Display (HUD) to View Intra-Operative X-Rays During a One-Level Cervical Arthroplasty. World Neurosurg 2020; 138:369-373. [DOI: 10.1016/j.wneu.2020.03.073] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2020] [Revised: 03/11/2020] [Accepted: 03/12/2020] [Indexed: 11/24/2022]
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Zhai S, Li A, Li X, Wu X. Total disc replacement compared with fusion for cervical degenerative disc disease: A systematic review of overlapping meta-analyses. Medicine (Baltimore) 2020; 99:e20143. [PMID: 32384498 PMCID: PMC7220152 DOI: 10.1097/md.0000000000020143] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
STUDY DESIGN The present study was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) statement. OBJECTIVE The present study aimed to conduct a systematic review of overlapping meta-analyses comparing ACDR with fusion for treating CDDD in order to assist decision makers in their selection among conflicting meta-analyses and to provide treatment recommendations based on the best available evidence. SUMMARY OF BACKGROUND DATA Although several meta-analyses have been performed to compare total disc replacement (TDR) and fusion for treating cervical degenerative disc disease (CDDD), their findings are inconsistent. METHODS Multiple databases were comprehensively searched for meta-analyses comparing TDR with fusion for treating CDDD. The meta-analyses that comprised only randomized controlled trials (RCTs) were included. Two authors independently assessed the meta-analysis study quality and extracted the data. The Jadad decision algorithm was used to ascertain which meta-analysis studies represented the best evidence. RESULTS A total of 14 meta-analysis studies were included. All these studies only included RCTs and were determined as Level-II evidence. CONCLUSIONS Cervical disc arthroplasty was superior compared to anterior discectomy and fusion for the treatment of symptomatic cervical disc disease.
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Kurian SJ, Wahood W, Alvi MA, Yolcu YU, Zreik J, Bydon M. Assessing the Effects of Publication Bias on Reported Outcomes of Cervical Disc Replacement and Anterior Cervical Discectomy and Fusion: A Meta-Epidemiologic Study. World Neurosurg 2020; 137:443-450.e13. [PMID: 31926357 DOI: 10.1016/j.wneu.2019.12.129] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2019] [Revised: 12/20/2019] [Accepted: 12/21/2019] [Indexed: 12/17/2022]
Abstract
BACKGROUND There have been several clinical trials as well as observational studies that have compared the outcomes of different cervical disc replacement (CDR) devices with anterior cervical disc replacement and fusion (ACDF). Although the results of these studies have provided sufficient evidence for the safety of CDR, there is still a lack of consensus in terms of longer-term outcomes, with studies providing equivocal results for the 2 procedures. In the current study, we used a novel methodology, a meta-epidemiologic study, to investigate the impact of study characteristics on the observed effects in the literature on CDR and ACDF. METHODS Data were abstracted from available meta-analyses regarding author, study author, year, intervention events, control events, and sample size, as well as year and geographic location of each study within the meta-analyses. We grouped the studies based on median year of publication as well as the region of the submitting author(s). Odds ratios, 95% confidence intervals (CIs), and standard errors of individual studies were calculated based on the number of events and sample size for each arm (ACDF or CDR). Further, results of outcomes from individual studies were pooled and a meta-analysis was conducted. Ratio of odds ratio (ROR) was used to assess the impact of each of these factors on estimates of the study for CDR versus ACDF. RESULTS A total of 13 meta-analyses were analyzed after exclusions. Using the results from 10 meta-analyses, we found that studies published before 2012 reported significantly lower odds of a reoperation after CDR (vs. ACDF), compared with studies published after 2012 (ROR, 0.51; 95% CI, 0.38-0.67; P < 0.001). We did not observe a significant impact of study year on difference in estimates between CDR and ACDF for adjacent segment disease (ROR, 0.99; 95% CI, 0.64-1.55; P = 0.465). The region of submitting author was also found to have no impact on results of published studies. CONCLUSIONS These results indicate that there may be a publication bias regarding the year of publication, with earlier studies reporting lower reoperation rates for CDR compared with ACDF.
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Affiliation(s)
- Shyam Joshua Kurian
- Mayo Clinic Alix School of Medicine, Rochester, Minnesota, Mayo Clinic, Rochester, Minnesota, USA
| | - Waseem Wahood
- Mayo Clinic Neuro-Informatics Laboratory, Mayo Clinic, Rochester, Minnesota, USA; Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Mohammed Ali Alvi
- Mayo Clinic Neuro-Informatics Laboratory, Mayo Clinic, Rochester, Minnesota, USA; Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Yagiz Ugur Yolcu
- Mayo Clinic Neuro-Informatics Laboratory, Mayo Clinic, Rochester, Minnesota, USA; Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Jad Zreik
- Mayo Clinic Neuro-Informatics Laboratory, Mayo Clinic, Rochester, Minnesota, USA; Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Mohamad Bydon
- Mayo Clinic Neuro-Informatics Laboratory, Mayo Clinic, Rochester, Minnesota, USA; Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota, USA.
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Zhang J, Meng F, Ding Y, Li J, Han J, Zhang X, Dong W. Comprehensive Analysis of Hybrid Surgery and Anterior Cervical Discectomy and Fusion in Cervical Diseases: A Meta-Analysis. Medicine (Baltimore) 2020; 99:e19055. [PMID: 32000453 PMCID: PMC7004776 DOI: 10.1097/md.0000000000019055] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2020] [Accepted: 01/09/2020] [Indexed: 12/15/2022] Open
Abstract
To investigate the outcomes and reliability of hybrid surgery (HS) versus anterior cervical discectomy and fusion (ACDF) for the treatment of multilevel cervical spondylosis and disc diseases.Hybrid surgery, combining cervical disc arthroplasty (CDA) with fusion, is a novel treatment to multilevel cervical degenerated disc disease in recent years. However, the effect and reliability of HS are still unclear compared with ACDF.To investigate the studies of HS versus ACDF in patients with multilevel cervical disease, electronic databases (Medline, Embase, Pubmed, Cochrane library, and Cochrane Central Register of Controlled Trials) were searched. Studies were included when they compared HS with ACDF and reported at least one of the following outcomes: functionality, neck pain, arm pain, cervical range of motion (ROM), quality of life, and incidence of complications. No language restrictions were used. Two authors independently assessed the methodological quality of included studies and extracted the relevant data.Seven clinical controlled trials were included in this study. Two trials were prospective and the other 5 were retrospective. The results of the meta-analysis indicated that HS achieved better recovery of NDI score (P = 0.038) and similar recovery of VAS score (P = 0.058) compared with ACDF at 2 years follow-up. Moreover, the total cervical ROM (C2-C7) after HS was preserved significantly more than the cervical ROM after ACDF (P = 0.000) at 2 years follow-up. Notably, the compensatory increase of the ROM of superior and inferior adjacent segments was significant in ACDF groups at 2-year follow-up (P < 0.01), compared with HS.The results demonstrate that HS provides equivalent outcomes and functional recovery for cervical disc diseases, and significantly better preservation of cervical ROM compared with ACDF in 2-year follow-up. This suggests the HS is an effective alternative invention for the treatment of multilevel cervical spondylosis to preserve cervical ROM and reduce the risk of adjacent disc degeneration. Nonetheless, more well-designed studies with large groups of patients are required to provide further evidence for the benefit and reliability of HS for the treatment of cervical disk diseases.
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Choi H, Baisden JL, Yoganandan N. A Comparative in vivo Study of Semi-constrained and Unconstrained Cervical Artificial Disc Prostheses. Mil Med 2019; 184:637-643. [PMID: 30901460 DOI: 10.1093/milmed/usy395] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2018] [Revised: 02/11/2018] [Indexed: 12/30/2022] Open
Abstract
PURPOSE The objective of this study is to directly compare different types of cervical artificial disc implants using an in vivo model capable of simulating the axial load on a neck that is similar to the human neck. METHODS Cervical arthroplasty was performed at C3-4 in 14 healthy female adult Alpine goats. The goats were divided into three groups. Group A received Bryan (unconstrained one-piece design); Group B received ProDisc-C (semi-constrained two-piece design); and Group C received Mobi-C (unconstrained three-piece design) artificial discs. The goats were monitored in a veterinary unit for 6 months with radiography at regular intervals. RESULTS Each goat tolerated cervical arthroplasty well and had satisfactory placement of their implant per intra-operative radiography. Implants monitored in Group A demonstrated no migration. One out of five implants in Group B experienced anterior migration at 3 months. In Group C, anterior migration and disintegration occurred in all four implants, with migration occurring during the first postoperative week in three implants and after 5 weeks in the fourth. CONCLUSIONS Unconstrained multi-piece artificial cervical discs may be prone to anterior migration and extrusion out of the disc space. This outcome deserves attention in individuals with a hypermobile neck and/or an occupation involving the use of a head-supported mass, such as helmets.
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Affiliation(s)
- Hoon Choi
- Center for Neuro-Trauma Research, Department of Neurosurgery, Medical College of Wisconsin, 9200 W Wisconsin Ave, Milwaukee, WI
| | - Jamie L Baisden
- Center for Neuro-Trauma Research, Department of Neurosurgery, Medical College of Wisconsin, 9200 W Wisconsin Ave, Milwaukee, WI
| | - Narayan Yoganandan
- Center for Neuro-Trauma Research, Department of Neurosurgery, Medical College of Wisconsin, 9200 W Wisconsin Ave, Milwaukee, WI
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Latka D, Kozlowska K, Miekisiak G, Latka K, Chowaniec J, Olbrycht T, Latka M. Safety and efficacy of cervical disc arthroplasty in preventing the adjacent segment disease: a meta-analysis of mid- to long-term outcomes in prospective, randomized, controlled multicenter studies. Ther Clin Risk Manag 2019; 15:531-539. [PMID: 30992666 PMCID: PMC6445235 DOI: 10.2147/tcrm.s196349] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Objectives Cervical disc arthroplasty (CDA) has become an alternative treatment for cervical radiculopathy and myelopathy. This technique preserves appropriate motion at both the index and adjacent disc levels and consequently may prevent adjacent segment degeneration (ASD). The authors performed a meta-analysis to compare the safety and efficacy of CDA to those of the gold standard, anterior cervical discectomy and fusion (ACDF). Both surgical and clinical parameters were employed to verify the hypothesis that CDA can reduce the risk of ASD. Methods The meta-analysis comprised high-quality randomized controlled trials that compared CDA and ACDF treatments of cervical degenerative disc disease. Included papers reported data for at least one of the following outcomes: 1) surgical parameters, 2) questionnaire clinical indices (pre- and postoperative values), and 3) complication rates at 24 months; in addition, for ASD we analyzed 60 month or longer follow-ups. We used mean differences (MDs) or ORs to compare treatment effects between CDA and ACDF. Results Twenty studies with 3,656 patients (2,140 with CDA and 1,516 with ACDF) met the inclusion criteria. CDA surgery, with mean duration longer than that of ACDF, was associated with higher blood loss. Visual analog scale neck pain score was significantly smaller for CDA (mean difference =−2.30, 95% CI [−3.72; −0.87], P=0.002). The frequency of dysphagia/dysphonia (OR =0.69, 95% CI [0.49; 0.98], P=0.04) as well as the long-term ASD rate for CDA was significantly smaller (OR =0.33, 95% CI [0.21; 0.50], P<0.0001). Conclusion A significantly lower probability of ASD reoperations in the CDA cohort after a 60-month or longer follow-up was the most important finding of this study. Despite the moderate quality of this evidence, the pooled data corroborated for the very first time that CDA was efficacious in preventing ASD.
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Affiliation(s)
- Dariusz Latka
- Department of Anatomy, Institute of Medicine, University of Opole, Opole, Poland, .,Department of Neurosurgery, University Hospital in Opole, Opole, Poland,
| | - Klaudia Kozlowska
- Department of Bioengineering, Institute of Biomedical Engineering, Technical University of Wroclaw, Wroclaw, Poland
| | - Grzegorz Miekisiak
- Department of Anatomy, Institute of Medicine, University of Opole, Opole, Poland, .,Department of Neurosurgery, University Hospital in Opole, Opole, Poland,
| | - Kajetan Latka
- Department of Neurosurgery, University Hospital in Opole, Opole, Poland,
| | - Jacek Chowaniec
- Department of Neurosurgery, University Hospital in Opole, Opole, Poland,
| | - Tomasz Olbrycht
- Department of Neurosurgery, University Hospital in Opole, Opole, Poland,
| | - Miroslaw Latka
- Department of Bioengineering, Institute of Biomedical Engineering, Technical University of Wroclaw, Wroclaw, Poland
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Zhao CM, Chen Q, Zhang Y, Huang AB, Ding WY, Zhang W. Anterior cervical discectomy and fusion versus hybrid surgery in multilevel cervical spondylotic myelopathy: A meta-analysis. Medicine (Baltimore) 2018; 97:e11973. [PMID: 30142827 PMCID: PMC6113029 DOI: 10.1097/md.0000000000011973] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
OBJECTIVE A meta-analysis was performed to compare the radiographic and surgical outcomes between anterior cervical discectomy and fusion (ACDF) and hybrid surgery (HS, corpectomy combined with discectomy) in the treatment for multilevel cervical spondylotic myelopathy (mCSM). SUMMARY OF BACKGROUND DATA Both ACDF and HS are used to treat mCSM, however, which one is better treatment for mCSM remains considerable controversy. METHODS An extensive search of literature was searched in PubMed/Medline, Embase, the Cochrane library, CNKI, and WANFANG databases on ACDF versus HS treating mCSM from January 2011 to December 2017. The following variables were extracted: blood loss, operation time, fusion rate, Cobb angles of C2-C7, total complications, dysphagia, hoarseness, C5 palsy, infection, cerebral fluid leakage, epidural hematoma, and graft subsidence. Data analysis was conducted with RevMan 5.3 and STATA 12.0. RESULTS A total of 4 studies including 669 patients were included in our study. The pooled analysis showed that there were no significant difference in the operation time, fusion rate, Cobb angles of C2-C7, dysphagia, hoarseness, C5 palsy, infection, cerebral fluid leakage, epidural hematoma, and graft subsidence. However, there were significant difference between 2 groups in blood loss [P < .00001, SMD = -30.29 (-45.06, -15.52); heterogeneity: P = .38, I = 0%= and total complications [P = .04, OR = 0.66 95%CI (0.44, 0.98); heterogeneity: P = .37, I = 4%]. CONCLUSIONS Based on our meta-analysis, except for blood loss and total complications, both ACDF and hybrid surgery are effective options for the treatment of multilevel cervical spondylotic myelopathy.
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Affiliation(s)
- Chun-Ming Zhao
- Department of Orthopaedic Surgery, The Affiliated Taizhou People's Hospital of Nantong University, Taizhou, Jiangsu
| | - Qian Chen
- Department of Orthopaedic Surgery, The Affiliated Taizhou People's Hospital of Nantong University, Taizhou, Jiangsu
- Department of Orthopaedic Surgery, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Yu Zhang
- Department of Orthopaedic Surgery, The Affiliated Taizhou People's Hospital of Nantong University, Taizhou, Jiangsu
| | - Ai-Bing Huang
- Department of Orthopaedic Surgery, The Affiliated Taizhou People's Hospital of Nantong University, Taizhou, Jiangsu
| | - Wen-Yuan Ding
- Department of Orthopaedic Surgery, The Affiliated Taizhou People's Hospital of Nantong University, Taizhou, Jiangsu
| | - Wei Zhang
- Department of Orthopaedic Surgery, The Affiliated Taizhou People's Hospital of Nantong University, Taizhou, Jiangsu
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Xu JC, Goel C, Shriver MF, Tanenbaum JE, Steinmetz MP, Benzel EC, Mroz TE. Adverse Events Following Cervical Disc Arthroplasty: A Systematic Review. Global Spine J 2018; 8:178-189. [PMID: 29662749 PMCID: PMC5898676 DOI: 10.1177/2192568217720681] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
STUDY DESIGN Systematic review. OBJECTIVES Cervical arthroplasty is an increasingly popular treatment of cervical radiculopathy and myelopathy. An understanding of the potential adverse events (AEs) is important to help both clinicians and patients. We sought to provide a comprehensive systematic review of the AEs reported in all randomized controlled trials (RCTs) of cervical disc arthroplasty in an attempt to characterize the quality of reporting. METHODS We conducted a systematic review of MEDLINE and Web of Science for RCTs of cervical disc arthroplasty reporting AEs. We reported the most frequently mentioned AEs, including dysphagia/dysphonia, vascular compromise, dural injury, and infections. We recorded the presence of industry funding and scored the quality of collection methods and reporting of AEs. RESULTS Of the 3734 identified articles, 29 articles met full inclusion criteria. The quality of AE reporting varied significantly between studies, and a combined meta-analysis was not feasible. The 29 articles covered separate 19 RCTs. Eight studies were US Food and Drug Administration (FDA) investigational device exemption (IDE) trials. Rates were recorded for the following AEs: dysphagia/dysphonia (range = 1.3% to 27.2%), vascular compromise (range = 1.1% to 2.4%), cervical wound infection (range = 1.2% to 22.5%), and cerebrospinal fluid leak (range = 0.8% to 7.1%). CONCLUSIONS There is a lack of consistency in reporting of AEs among RCTs of cervical arthroplasty. FDA IDE trials scored better in AE event reporting compared to other studies. Standardized definitions for AEs and standardized data collection methodology are needed to improve future studies.
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Affiliation(s)
- Jordan C. Xu
- Case Western Reserve University, Cleveland, OH, USA,Jordan C. Xu, Case Western Reserve University School of Medicine, 2109 Adelbert Rd, Cleveland, OH 44106, USA.
| | - Chandni Goel
- Northeast Ohio Medical University, Rootstown, OH, USA
| | | | - Joseph E. Tanenbaum
- Case Western Reserve University, Cleveland, OH, USA,Cleveland Clinic, Cleveland, OH, USA
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Symptomatic Adjacent Segment Disease After Anterior Cervical Discectomy for Single-level Degenerative Disk Disease. Clin Spine Surg 2018; 31:E50-E54. [PMID: 28604508 DOI: 10.1097/bsd.0000000000000551] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
STUDY DESIGN A prospective cohort of 142 patients underwent either anterior cervical discectomy alone, anterior cervical discectomy with fusion by cage stand-alone, or anterior cervical discectomy with arthroplasty. We then followed up on their condition for a mean of 9.1±1.9 years (5.6-12.2 y) later. OBJECTIVE We aimed to evaluate the annual rate of clinically symptomatic adjacent segment disease (ASD) and to analyze predictive factors. SUMMARY OF BACKGROUND DATA Until recent, ASD has been predominantly evaluated radiologically. It is not known whether all patients had complaints. A frequent cited annual rate of ASD is 2.9%, but a growing number of studies report a lower annual rate. Furthermore, maintaining motion to prevent ASD is one reason for implanting a cervical disk prosthesis. However, the results of studies contradict one another. METHODS Participants took part in a randomized controlled trial that ended prematurely because of the publication of evidence that did not justify continuation of the trial. The patients were randomly allocated to 3 groups, each of which received one of the abovementioned treatments. We defined symptomatic ASD as signs and symptoms caused by degeneration of an intervertebral disk adjacent to a level of previous anterior cervical disk surgery. At the last follow-up, we were able to ascertain whether clinically symptomatic ASD was present in any of the participants. RESULTS The overall annual rate of symptomatic ASD was 0.7%. We found no statistically significant correlations between any of the investigated factors and symptomatic ASD except for the surgical method used. Symptomatic ASD was seen less often in anterior cervical discectomy solely or anterior cervical discectomy with arthroplasty than in anterior cervical discectomy with fusion by plate fixation. CONCLUSIONS The annual rate of symptomatic ASD after an anterior cervical discectomy procedure was estimated to be 0.7%. This seems to be related to the procedure, although firm conclusions cannot be drawn. LEVEL OF EVIDENCE Level 2-prospective cohort.
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Bartels RHMA, Donk RD, Verhagen WIM, Hosman AJF, Verbeek ALM. Reporting the results of meta-analyses: a plea for incorporating clinical relevance referring to an example. Spine J 2017; 17:1625-1632. [PMID: 28576501 DOI: 10.1016/j.spinee.2017.05.019] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2016] [Revised: 02/24/2017] [Accepted: 05/16/2017] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT The results of meta-analyses are frequently reported, but understanding and interpreting them is difficult for both clinicians and patients. Statistical significances are presented without referring to values that imply clinical relevance. PURPOSE This study aimed to use the minimal clinically important difference (MCID) to rate the clinical relevance of a meta-analysis. STUDY DESIGN This study is a review of the literature. PATIENT SAMPLE This study is a review of meta-analyses relating to a specific topic, clinical results of cervical arthroplasty. OUTCOME MEASURE The outcome measure used in the study was the MCID. METHODS We performed an extensive literature search of a series of meta-analyses evaluating a similar subject as an example. We searched in Pubmed and Embase through August 9, 2016, and found articles concerning meta-analyses of the clinical outcome of cervical arthroplasty compared with that of anterior cervical discectomy with fusion in cases of cervical degenerative disease. We evaluated the analyses for statistical significance and their relation to MCID. MCID was defined based on results in similar patient groups and a similar disease entity reported in the literature. RESULTS We identified 21 meta-analyses, only one of which referred to MCID. However, the researchers used an inappropriate measurement scale and, therefore, an incorrect MCID. The majority of the conclusions were based on statistical results without mentioning clinical relevance. CONCLUSIONS The majority of the articles we reviewed drew conclusions based on statistical differences instead of clinical relevance. We recommend introducing the concept of MCID while reporting the results of a meta-analysis, as well as mentioning the explicit scale of the analyzed measurement.
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Affiliation(s)
- Ronald H M A Bartels
- Department of Neurosurgery, Radboud University Medical Center, Geert Groote Plein-zuid 10, 6525 GA Nijmegen, The Netherlands; Department of Neurosurgery, Canisius Wilhelmina Hospital, Weg door Jonkerbos 100, 6532 SZ Nijmegen, The Netherlands.
| | - Roland D Donk
- Department of Orthopedic Surgery, Via Sana Clinics, Hoogveldseweg 1, 5451 AA Mill, The Netherlands
| | - Wim I M Verhagen
- Department of Neurology, Canisius Wilhelmina Hospital, Weg door Jonkerbos 100, 6532 SZ Nijmegen, The Netherlands
| | - Allard J F Hosman
- Department of Orthopedic Surgery, Radboud University Medical Center, Geert Groote Plein-zuid 10, 6525 GA Nijmegen, The Netherlands
| | - André L M Verbeek
- Department for Health Evidence, Radboud University Medical Center, Geert Groote Plein-zuid 10, 6525 GA Nijmegen, The Netherlands
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Indirect meta-analysis comparing clinical outcomes of total cervical disc replacements with fusions for cervical degenerative disc disease. Sci Rep 2017; 7:1740. [PMID: 28496111 PMCID: PMC5431800 DOI: 10.1038/s41598-017-01865-3] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2016] [Accepted: 04/04/2017] [Indexed: 01/12/2023] Open
Abstract
Anterior cervical discectomy and fusion (ACDF) and total cervical disc replacement (TDR) are considered effective treatments for patients with cervical degenerative disc disease (CDDD). An indirect meta-analysis including 19 randomized controlled trials (5343 patients) was conducted to compare the clinical outcomes of ACDF with TDR. Primary outcomes including functional indicators (NDI [neck disability index] score, neurological success and patient satisfaction), secondary outcomes including surgical outcomes (operation time, blood loss and length of stay) and secondary surgical procedures (secondary surgery at an adjacent level, secondary surgery at the index level, secondary surgery at both levels, removal, reoperation, revision and supplemental fixation) were included in the study. TDR using the Bryan disc was associated with a greater improvement in NDI score than ACDF (MD = -5.574, 95% CrIs [credible intervals] -11.73--0.219). For neurological success, the Bryan (odds ratio [OR] = 0.559, 95% CrIs 0.323-0.955) and Prestige (OR = 0.474, 95% CrIs 0.319-0.700) discs were superior to ACDF. However, no differences in the patient satisfaction rate were shown between TDR and ACDF. For patients with CDDD, ACDF using allograft and a plate is most effective for determining the surgical parameters. Moreover, TDR using the ProDisc-C, Mobi-C, Prestige and Bryan discs are good choices for improving functional outcomes and reducing secondary surgeries.
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Wang T, Wang H, Liu S, An HD, Liu H, Ding WY. Anterior cervical discectomy and fusion versus anterior cervical corpectomy and fusion in multilevel cervical spondylotic myelopathy: A meta-analysis. Medicine (Baltimore) 2016; 95:e5437. [PMID: 27930523 PMCID: PMC5265995 DOI: 10.1097/md.0000000000005437] [Citation(s) in RCA: 43] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
BACKGROUND Both anterior cervical discectomy and fusion (ACDF) and anterior cervical corpectomy and fusion (ACCF) are used to treat multilevel cervical spondylotic myelopathy (mCSM); however, which one is better treatment for mCSM remains considerable controversy. A meta-analysis was performed to compare clinical outcomes, radiographic outcomes, and surgical outcomes between ACDF and ACCF in treatment for mCSM. METHODS An extensive search of literature was performed in Pubmed/MEDLINE, Embase, the Cochrane library, CNKI, and WANFANG databases on ACDF versus ACCF treatment for mCSM from January 2011 to August 2016. The following variables were extracted: length of hospital stay, blood loss, operation time, Japanese Orthopedic Association (JOA) scores, Neck Disability Index (NDI) score, fusion rate, Cobb angles of C2 to C7, dysphagia, hoarseness, C5 palsy, infection, cerebral fluid leakage, donor site pain, epidural hematoma, graft subsidence, graft dislodgment, pseudoarthrosis, and total complications. Data analysis was conducted with RevMan 5.3 and STATA 12.0. RESULTS A total of 8 studies containing 878 patients were included in our study. The results showed that ACDF is better than ACCF in the angle of C2 to C7 at the final follow-up (P < 0.00001, standardized mean difference = 4.76 [3.48, 6.03]; heterogeneity: P = 0.17, I = 43%), C5 plasy (P = 0.02, odds ratio [OR] 0.42, 95% confidence interval [CI] 0.21, 0.86; heterogeneity: P = 0.52, I = 0%), blood loss (P < 0.00001, standardized mean difference = -53.12, 95% CI -64.61, -41.64; heterogeneity: P = 0.29, I = 20%), fusion rate (P = 0.04, OR 2.54, 95% CI 1.05, 6.11; heterogeneity: P = 0.29, I = 20%), graft subsidence (P = 0.004, OR 0.11, 95% CI 0.02, 0.48; heterogeneity: P = 0.94, I = 0%), and total complications (P = 0.0009, OR 0.56, 95% CI 0.40, 0.79; heterogeneity: P = 0.29, I = 18%).However, there are no significant differences in length of hospital stay, operation time, JOA scores, NDI scores, preoperative angle of C2 to C7, dysphagia, hoarseness, infection, cerebral fluid leakage, donor site pain, epidural hematoma, graft dislodgment, and pseudoarthrosis (all P > 0.05). CONCLUSIONS Based on our meta-analysis, our results suggest that both ACDF and ACCF are good plans in clinical outcomes; however, ACDF is a better choice in radiographic outcomes and total complications for the treatment of multilevel CSM.
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Affiliation(s)
- Tao Wang
- Department of Spinal Surgery, The Third Hospital of Hebei Medical University
| | - Hui Wang
- Department of Spinal Surgery, The Third Hospital of Hebei Medical University
| | - Sen Liu
- Department of Spinal Surgery, The Third Hospital of Hebei Medical University
| | - Huang-Da An
- Department of Spinal Surgery, The Third Hospital of Hebei Medical University
| | - Huan Liu
- Department of Spinal Surgery, The Third Hospital of Hebei Medical University
| | - Wen-Yuan Ding
- Department of Spinal Surgery, The Third Hospital of Hebei Medical University
- Hebei Provincial Key Laboratory of Orthopedic Biomechanics, Shijiazhuang, China
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Cervical Disk Arthroplasty Versus Anterior Cervical Decompression and Fusion for the Treatment of 2-Level Cervical Spondylopathy: A Systematic Review and Meta-analysis. Clin Spine Surg 2016; 29:372-382. [PMID: 27295435 DOI: 10.1097/bsd.0000000000000395] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
STUDY DESIGN Systematic review and meta-analysis. OBJECTIVE To assess the safety and efficacy of cervical disk arthroplasty (CDA) compared with anterior cervical decompression and fusion (ACDF) for the treatment of 2-level cervical spondylopathy. SUMMARY OF BACKGROUND DATA CDA has emerged as a potential alternative to ACDF in patients with cervical disk degeneration. But there are no published systematic reviews and meta-analyses comparing CDA with ACDF for the treatment of 2-level cervical spondylopathy. METHODS The Pubmed, Embase, Web of science, Scopus, and Cochrane library databases were searched comparing CDA to ACDF in patients with 2-level cervical spondylopathy. Outcome measures were neck disability index, visual analog scale (VAS) of arm and neck pain, range of movement (ROM) at C2-C7, functional segment unit ROM, ROM at the operated level, and incidence of radiologic changes at adjacent levels approximately 2 years after surgery, as well as operating time and incidence of surgery-related complications. Mean difference (MD), odds ratios (OR), and their corresponding 95% confidence intervals (95% CIs) were calculated. RESULTS Six studies involving 646 patients were included. There were no significant differences in neck disability index (MD, -1.53; 95% CI -3.80 to 0.73), VAS neck pain (MD, -0.19; 95% CI -0.71 to 0.33), and VAS arm pain (MD, -0.23; 95% CI -0.61 to 0.16) between 2-level CDA and 2-level ACDF cases. ROM at C2-C7 (MD, 15.82; 95% CI, 10.66-20.99), functional segment unit ROM (MD, 8.58; 95% CI, 7.93-9.23), and ROM at the operated level (MD, 9.54; 95% CI, 7.73-11.35) were greater, but the incidence of radiologic changes at adjacent levels (OR, 0.29; 95% CI, 0.13-0.67) were lower, in 2-level CDA cases. In 2-level CDA cases, the operating time was longer (MD, 57.41; 95% CI, 24.67-90.14), but surgery-related complications rates (OR, 0.47; 95% CI, 0.30-0.74) was lower. CONCLUSIONS CDA may be a safe and effective alternative to ACDF for the treatment of 2-level cervical degenerative disease. LEVEL OF EVIDENCE Level II.
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Cervical disc arthroplasty for symptomatic cervical disc disease: Traditional and Bayesian meta-analysis with trial sequential analysis. Int J Surg 2016; 35:111-119. [PMID: 27693477 DOI: 10.1016/j.ijsu.2016.09.088] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2016] [Revised: 09/22/2016] [Accepted: 09/25/2016] [Indexed: 11/22/2022]
Abstract
OBJECTIVE Cervical disc arthroplasty (CDA) has been designed as a substitute for anterior cervical discectomy and fusion (ACDF) in the treatment of symptomatic cervical disc disease (CDD). Several researchers have compared CDA with ACDF for the treatment of symptomatic CDD; however, the findings of these studies are inconclusive. Using recently published evidence, this meta-analysis was conducted to further verify the benefits and harms of using CDA for treatment of symptomatic CDD. METHODS Relevant trials were identified by searching the PubMed, EMBASE, and Cochrane Library databases. Outcomes were reported as odds ratio or standardized mean difference. Both traditional frequentist and Bayesian approaches were used to synthesize evidence within random-effects models. Trial sequential analysis (TSA) was applied to test the robustness of our findings and obtain more conservative estimates. RESULTS Nineteen trials were included. The findings of this meta-analysis demonstrated better overall, neck disability index (NDI), and neurological success; lower NDI and neck and arm pain scores; higher 36-Item Short Form Health Survey (SF-36) Physical Component Summary (PCS) and Mental Component Summary (MCS) scores; more patient satisfaction; greater range of motion at the operative level; and fewer secondary surgical procedures (all P < 0.05) in the CDA group compared with the ACDF group. CDA was not significantly different from ACDF in the rate of adverse events (P > 0.05). TSA of overall success suggested that the cumulative z-curve crossed both the conventional boundary and the trial sequential monitoring boundary for benefit, indicating sufficient and conclusive evidence had been ascertained. CONCLUSIONS For treating symptomatic CDD, CDA was superior to ACDF in terms of overall, NDI, and neurological success; NDI and neck and arm pain scores; SF-36 PCS and MCS scores; patient satisfaction; ROM at the operative level; and secondary surgical procedures rate. Additionally, there was no significant difference between CDA and ACDF in the rate of adverse events. However, as the CDA procedure is a relatively newer operative technique, long-term results and evaluation are necessary before CDA is routinely used in clinical practice.
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Abstract
Cervical myelopathy is the most common cause of acquired spinal cord compromise. The concept of degenerative cervical myelopathy (DCM), defined as symptomatic myelopathy associated with degenerative arthropathic changes in the spine axis, is being introduced. Given its progressive nature, treatment options have to be chosen in a timely manner. Surgical options include anterior discectomy and fusion (ACDF), anterior corpectomy and fusion (ACCF), arthroplasty (in highly select cases), posterior laminectomy with/without fusion, and laminoplasty. Indications for each should be carefully considered in individual patients. Riluzole, a sodium-glutamate antagonist, is a promising option to optimize neurologic outcomes post-surgery and is being examined in the CSM-Protect Randomized Controlled Trial. Preoperative risk assessment is mandatory for prognostication. Sagittal alignment is known to play an important role to optimize surgical outcome. Guidelines for optimal management of DCM are in process. In principle, all but the mildest cases of DCM should be offered surgery for optimal outcome.
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Affiliation(s)
- So Kato
- Krembil Neuroscience Centre, Toronto Western Hospital, University Health Network, Toronto, ON, Canada
| | - Michael Fehlings
- Krembil Neuroscience Centre, Toronto Western Hospital, University Health Network, Toronto, ON, Canada.
- Krembil Research Institute, Toronto Western Hospital, University Health Network, Toronto, ON, Canada.
- Division of Neurosurgery, Toronto Western Hospital, 399 Bathurst St. Suite 4WW-449, Toronto, ON, M5T2S8, Canada.
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Yang Y, Ma L, Liu H, Liu Y, Hong Y, Wang B, Ding C, Deng Y, Song Y, Liu L. Comparison of the incidence of patient-reported post-operative dysphagia between ACDF with a traditional anterior plate and artificial cervical disc replacement. Clin Neurol Neurosurg 2016; 148:72-8. [DOI: 10.1016/j.clineuro.2016.07.020] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2016] [Revised: 07/05/2016] [Accepted: 07/10/2016] [Indexed: 10/21/2022]
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Xie L, Liu M, Ding F, Li P, Ma D. Cervical disc arthroplasty (CDA) versus anterior cervical discectomy and fusion (ACDF) in symptomatic cervical degenerative disc diseases (CDDDs): an updated meta-analysis of prospective randomized controlled trials (RCTs). SPRINGERPLUS 2016; 5:1188. [PMID: 27516926 PMCID: PMC4963351 DOI: 10.1186/s40064-016-2851-8] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/17/2016] [Accepted: 07/15/2016] [Indexed: 01/10/2023]
Abstract
PURPOSE This meta-analysis of randomized controlled trials (RCTs) aims to evaluate the efficacy and safety in cervical disc arthroplasty (CDA) and anterior cervical discectomy and fusion (ACDF) for treating cervical degenerative disc diseases (CDDDs). METHODS The authors searched RCTs in the electronic databases (Cochrane Central Register of Controlled Trials, PubMed, EMBASE, Medline, Embase, Springer Link, Web of Knowledge, OVID and Google Scholar) from their establishment to march 2016 without language restrictions. We also manually searched the reference lists of articles and reviews for possible relevant studies. Researches on CDA versus ACDF in CDDDs were selected in this meta-analysis. The quality of all studies was assessed and effective data was pooled for this meta-analysis. Outcome measurements were surgical parameters (operative time, blood loss, and length of hospital stay), clinical indexes [neck disability index (NDI), neurological success, range of motion (ROM), Visual Analogue Score (VAS)], complications [the number of adverse events, adjacent segment disease (ASD), and reoperation]. Subgroup analysis, sensitivity analysis, and publication bias assessment were also performed, respectively. The meta-analysis was performed with software revman 5.3. RESULTS 37 articles (20 RCTs) with a total 4004 patients (2212 in the CDA and 1792 in the ACDF) met inclusion criteria. Eight types of disc prostheses were used in the included studies. Patients were followed up for at least 2 years in all the studies. No statistically significant differences were found between CDA and ACDF for blood loss [SMD -0.02; 95 % CI (-0.20, 0.17)], length of hospital stay [MD -0.06; 95 % CI (-0.19, 0.06)]. Statistical differences were found between operative time [MD 14.22; 95 % CI (6.73, 21.71)], NDI [SMD -0.27; 95 % CI (-0.43, -0.10)], neurological success [RR 1.13; 95 % CI (1.08, 1.18)], ROM [MD 6.72; 95 % CI (5.72, 7.71)], VAS of neck [SMD -0.40; 95 % CI (-0.75, -0.04)], VAS of arm [SMD -0.55; 95 % CI (-1.04, -0.06)], the rate of adverse events [RR 0.72 95 % CI (0.53, 0.96)], the rate of ASD [RR 0.62; 95 % CI (0.43, 0.88)], and reoperation [RR 0.50; 95 % CI (0.39, 0.63)]. Subgroup analysis stratified by different types of disc prostheses was also performed. CONCLUSIONS CDA is associated with higher clinical indexes and fewer complications than ACDF, indicating that it is a safe and effective treatment for CDDDs. However, the operative time of CDA is longer than ACDF. Because of some limitations, these findings should be interpreted with caution. Additional studies are needed. Large, definitive RCTs are needed.
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Affiliation(s)
- Lin Xie
- Department of Orthopedic Surgery, Wuhan Orthopedic Hospital, Wuhan Puai Hospital, Huazhong University of Science and Technology, Hanzheng Street 473#, Wuhan, 430033 Hubei Province China
| | - Ming Liu
- Department of Orthopedic Surgery, Wuhan Orthopedic Hospital, Wuhan Puai Hospital, Huazhong University of Science and Technology, Hanzheng Street 473#, Wuhan, 430033 Hubei Province China
| | - Fan Ding
- Department of Orthopedic Surgery, Wuhan Orthopedic Hospital, Wuhan Puai Hospital, Huazhong University of Science and Technology, Hanzheng Street 473#, Wuhan, 430033 Hubei Province China
| | - Peng Li
- Department of Orthopedic Surgery, Wuhan Orthopedic Hospital, Wuhan Puai Hospital, Huazhong University of Science and Technology, Hanzheng Street 473#, Wuhan, 430033 Hubei Province China
| | - Dezhang Ma
- Department of Orthopedic Surgery, Wuhan Orthopedic Hospital, Wuhan Puai Hospital, Huazhong University of Science and Technology, Hanzheng Street 473#, Wuhan, 430033 Hubei Province China
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Zhang J, Meng F, Ding Y, Li J, Han J, Zhang X, Dong W. Hybrid Surgery Versus Anterior Cervical Discectomy and Fusion in Multilevel Cervical Disc Diseases: A Meta-Analysis. Medicine (Baltimore) 2016; 95:e3621. [PMID: 27227922 PMCID: PMC4902346 DOI: 10.1097/md.0000000000003621] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2016] [Revised: 04/04/2016] [Accepted: 04/06/2016] [Indexed: 12/05/2022] Open
Abstract
To investigate the outcomes and reliability of hybrid surgery (HS) versus anterior cervical discectomy and fusion (ACDF) for the treatment of multilevel cervical spondylosis and disc diseases.Hybrid surgery, combining cervical disc arthroplasty (CDA) with fusion, is a novel treatment to multilevel cervical degenerated disc disease in recent years. However, the effect and reliability of HS are still unclear compared with ACDF.To investigate the studies of HS versus ACDF in patients with multilevel cervical disease, electronic databases (Medline, Embase, Pubmed, Cochrane library, and Cochrane Central Register of Controlled Trials) were searched. Studies were included when they compared HS with ACDF and reported at least one of the following outcomes: functionality, neck pain, arm pain, cervical range of motion (ROM), quality of life, and incidence of complications. No language restrictions were used. Two authors independently assessed the methodological quality of included studies and extracted the relevant data.Seven clinical controlled trials were included in this study. Two trials were prospective and the other 5 were retrospective. The results of the meta-analysis indicated that HS achieved better recovery of NDI score (P = 0.038) and similar recovery of VAS score (P = 0.058) compared with ACDF at 2 years follow-up. Moreover, the total cervical ROM (C2-C7) after HS was preserved significantly more than the cervical ROM after ACDF (P = 0.000) at 2 years follow-up. Notably, the compensatory increase of the ROM of superior and inferior adjacent segments was significant in ACDF groups at 2-year follow-up (P < 0.01), compared with HS.The results demonstrate that HS provides equivalent outcomes and functional recovery for cervical disc diseases, and significantly better preservation of cervical ROM compared with ACDF in 2-year follow-up. This suggests the HS is an effective alternative invention for the treatment of multilevel cervical spondylosis to preserve cervical ROM and reduce the risk of adjacent disc degeneration. Nonetheless, more well-designed studies with large groups of patients are required to provide further evidence for the benefit and reliability of HS for the treatment of cervical disk diseases.
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Affiliation(s)
- Jianfeng Zhang
- From the Department of acupuncture and moxibustion, Linyi people hospital, Linyi City, Shandong Province (FM), department of spine surgery, Yantai mountain hospital, Yantai city, Shandong provinceGU (YD), Thyroid breast surgery, Zhongshan university first affiliated hospital, Guangdong province (JL), and Department of Bone Tumor, Yantishan Hospital, Yantai, Shandong Province, PR China (JH)
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Evaniew N, van der Watt L, Bhandari M, Ghert M, Aleem I, Drew B, Guyatt G. Strategies to improve the credibility of meta-analyses in spine surgery: a systematic survey. Spine J 2015; 15:2066-76. [PMID: 26002725 DOI: 10.1016/j.spinee.2015.05.018] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2014] [Revised: 03/09/2015] [Accepted: 05/13/2015] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT Meta-analyses are powerful tools that can synthesize existing research, inform clinical practice, and support evidence-based care. These studies have become increasingly popular in the spine surgery literature, but the rigor with which they are being conducted has not yet been evaluated. PURPOSE Our primary objectives were to evaluate the methodological quality (credibility) of spine surgery meta-analyses and to propose strategies to improve future research. Our secondary objectives were to evaluate completeness of reporting and identify factors associated with higher credibility and completeness of reporting. STUDY DESIGN This study is based on a systematic survey of meta-analyses. OUTCOME MEASURES We evaluated credibility according to the Users' Guide to the Medical Literature and completeness of reporting according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses checklist. METHODS We systematically searched MEDLINE, EMBASE, and The Cochrane Library, and two reviewers independently assessed eligibility, credibility, and completeness of reporting. We used multivariable linear regression to evaluate potential associations. Interrater agreement was quantified using kappa and intraclass correlation (ICC) coefficients. RESULTS We identified 132 eligible meta-analyses of spine surgery interventions. The mean credibility score was 3 of 7 (standard deviation [SD], 1.4; ICC, 0.86), with agreement for each item ranging from 0.54 (moderate) to 0.83 (almost perfect). Clinical questions were judged as sensible in 125 (95%), searches were exhaustive in 102 (77%), and risk of bias assessments were undertaken in 91 (69%). Seven (5%) meta-analyses addressed possible explanations for heterogeneity using a priori subgroup hypotheses and 24 (18%) presented results that were immediately clinically applicable. Investigators undertook duplicate assessments of eligibility, risk of bias, and data extraction in 46 (35%) and rated overall confidence in the evidence in 24 (18%). Later publication year, increasing Journal Impact Factor, increasing number of databases, inclusion of Randomized Controlled Trials, and inclusion of non-English studies were significantly associated with higher credibility scores (p<.05). The mean score for reporting was 18 of 27 (SD, 4.4; ICC, 0.94). CONCLUSIONS The credibility of many current spine surgery meta-analyses is limited. Researchers can improve future meta-analyses by performing exhaustive literature searches, addressing possible explanations of heterogeneity, presenting results in a clinically useful manner, reproducibly selecting and assessing primary studies, addressing confidence in the pooled effect estimates, and adhering to guidelines for complete reporting.
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Affiliation(s)
- Nathan Evaniew
- McMaster University, Department of Surgery, Division of Orthopaedics, 293 Wellington St. N, Hamilton ON, Canada, L8L 8E7.
| | - Leon van der Watt
- McMaster University, Department of Surgery, Division of Orthopaedics, 293 Wellington St. N, Hamilton ON, Canada, L8L 8E7
| | - Mohit Bhandari
- McMaster University, Department of Surgery, Division of Orthopaedics, 293 Wellington St. N, Hamilton ON, Canada, L8L 8E7
| | - Michelle Ghert
- McMaster University, Department of Surgery, Division of Orthopaedics, 293 Wellington St. N, Hamilton ON, Canada, L8L 8E7
| | - Ilyas Aleem
- McMaster University, Department of Surgery, Division of Orthopaedics, 293 Wellington St. N, Hamilton ON, Canada, L8L 8E7
| | - Brian Drew
- McMaster University, Department of Surgery, Division of Orthopaedics, 293 Wellington St. N, Hamilton ON, Canada, L8L 8E7
| | - Gordon Guyatt
- McMaster University, Department of Surgery, Division of Orthopaedics, 293 Wellington St. N, Hamilton ON, Canada, L8L 8E7
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Holsgrove TP, Nayak NR, Welch WC, Winkelstein BA. Advanced Multi-Axis Spine Testing: Clinical Relevance and Research Recommendations. Int J Spine Surg 2015; 9:34. [PMID: 26273552 DOI: 10.14444/2034] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Abstract
Back pain and spinal degeneration affect a large proportion of the general population. The economic burden of spinal degeneration is significant, and the treatment of spinal degeneration represents a large proportion of healthcare costs. However, spinal surgery does not always provide improved clinical outcomes compared to non-surgical alternatives, and modern interventions, such as total disc replacement, may not offer clinically relevant improvements over more established procedures. Although psychological and socioeconomic factors play an important role in the development and response to back pain, the variation in clinical success is also related to the complexity of the spine, and the multi-faceted manner by which spinal degeneration often occurs. The successful surgical treatment of degenerative spinal conditions requires collaboration between surgeons, engineers, and scientists in order to provide a multi-disciplinary approach to managing the complete condition. In this review, we provide relevant background from both the clinical and the basic research perspectives, which is synthesized into several examples and recommendations for consideration in increasing translational research between communities with the goal of providing improved knowledge and care. Current clinical imaging, and multi-axis testing machines, offer great promise for future research by combining invivo kinematics and loading with in-vitro testing in six degrees of freedom to offer more accurate predictions of the performance of new spinal instrumentation. Upon synthesis of the literature, it is recommended that in-vitro tests strive to recreate as many aspects of the in-vivo environment as possible, and that a physiological preload is a critical factor in assessing spinal biomechanics in the laboratory. A greater link between surgical procedures, and the outcomes in all three anatomical planes should be considered in both the in-vivo and in-vitro settings, to provide data relevant to quality of motion, and stability.
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Affiliation(s)
- Timothy P Holsgrove
- Department of Bioengineering, School of Engineering and Applied Science, University of Pennsylvania, Philadelphia, PA
| | - Nikhil R Nayak
- Department of Neurosurgery, University of Pennsylvania, Philadelphia, PA
| | - William C Welch
- Department of Neurosurgery, University of Pennsylvania, Philadelphia, PA
| | - Beth A Winkelstein
- Department of Bioengineering, School of Engineering and Applied Science, University of Pennsylvania, Philadelphia, PA
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Zang L, Fan N, Hai Y, Lu SB, Su QJ, Yang JC, Du P, Gao YJ. Using the modified Delphi method to establish a new Chinese clinical consensus of the treatments for cervical radiculopathy. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2015; 24:1116-26. [PMID: 25753006 DOI: 10.1007/s00586-015-3856-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/13/2015] [Accepted: 03/03/2015] [Indexed: 11/28/2022]
Abstract
PURPOSE Although cervical radiculopathy is very common, there is no standard treatment for this condition, with little high-level evidence available to guide the treatment choice. Thus, this study aimed to review the current data on the management of cervical radiculopathy; and, further, to establish a new Chinese clinical consensus of the treatments for cervical radiculopathy using the Delphi method. METHODS First, a systematic review of the previously established treatment guidelines and of articles related to cervical radiculopathy was conducted to establish a protocol for the clinical consensus of the treatment for cervical radiculopathy. Second, from February 2012 to June 2014, we performed a modified Delphi survey in which the current professional opinions from 30 experienced experts, representing almost all of the Chinese provinces, were gathered. Three rounds were performed, and consensus was defined as ≥70% agreement. RESULTS Consensus of the treatments for cervical radiculopathy was reached on seven aspects, including the proportion of patients requiring only non-surgical therapies; the effectiveness of neck immobilization, physiotherapy, pharmacologic treatment; surgical indications; contraindications; surgery. CONCLUSIONS The modified Delphi study conducted herein reached a consensus concerning several treatment issues for cervical radiculopathy. In the absence of high-level evidence, at present, these expert opinion findings will help guide health care providers to define the appropriate treatment in their regions. Items with no consensus provide excellent areas for future research.
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Affiliation(s)
- Lei Zang
- Department of Orthopedics, Beijing Chaoyang Hospital, Capital Medical University, GongTiNanLu 8#, Chaoyang district, 100020, Beijing, China
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Cervical disc arthroplasty versus anterior cervical discectomy and fusion for treatment of symptomatic cervical disc disease: a meta-analysis of randomized controlled trials. Arch Orthop Trauma Surg 2015; 135:19-28. [PMID: 25475930 DOI: 10.1007/s00402-014-2122-5] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2014] [Indexed: 10/24/2022]
Abstract
OBJECTIVE The purpose of this study is to compare the effectiveness and safety of cervical disc arthroplasty with anterior cervical discectomy and fusion for treatment of symptomatic cervical disc disease. Anterior cervical discectomy and fusion (ACDF) is the conventional surgical treatment for symptomatic cervical disc disease. Recently, cervical disc arthroplasty (CDA) has been developed to address some of the shortcomings associated with ACDF by preserving function of the motion segment. Controversy still surrounds regarding whether CDA is better. METHODS We systematically searched six electronic databases (Medline, Embase, Clinical, Ovid, BIOSIS and Cochrane registry of controlled clinical trials) to identify randomized controlled trials (RCTs) published up to April 2014 in which CDA was compared with ACDF for the treatment of symptomatic cervical disc disease. Effective data were extracted after the assessment of methodological quality of the trials. Then, we performed the meta-analysis. RESULTS Eighteen relevant RCTs with a total of 4061 patients were included. The results of the meta-analysis indicated that CDA was superior to ACDF regarding better neurological success (P < 0.00001), greater motion preservation at the operated level (P < 0.00001), fewer secondary surgical procedures (P < 0.00001), and fewer rates of adverse events (P < 0.00001) but inferior to ACDF regarding operative times (P < 0.00001). No significant difference was identified between the two groups regarding blood loss (P = 0.87), lengths of hospital stay (P = 0.76), neck pain scores (P = 0.11) and arm pain scores (P = 0.78) reported on a visual analog scale. CONCLUSION The meta-analysis revealed that CDA demonstrated superiorities in better neurological success, greater motion preservation at the operated level, lower rate of adverse events and fewer secondary surgical procedures compared with ACDF. However, the benefits of blood loss, lengths of hospital stay, neck and arm pain functional recovery are still unable to be proved.
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Alvin MD, Mroz TE. The Mobi-C cervical disc for one-level and two-level cervical disc replacement: a review of the literature. MEDICAL DEVICES-EVIDENCE AND RESEARCH 2014; 7:397-403. [PMID: 25473319 PMCID: PMC4251744 DOI: 10.2147/mder.s54497] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Cervical disc arthroplasty (CDA) is a novel motion-preserving procedure that is an alternative to fusion. The Mobi-C disc prosthesis, one of many Food and Drug Administration (FDA)-approved devices for CDA, is the only FDA-approved prosthesis for two-level CDA. Hence, it may allow for improved outcomes compared with multilevel fusion procedures. PURPOSE To critically assess the available literature on CDA with the Mobi-C prosthesis, with a focus on two-level CDA. METHODS All clinical articles involving the Mobi-C disc prosthesis for CDA through September 1, 2014 were identified on Medline. Any paper that presented Mobi-C CDA clinical results was included. Study design, sample size, length of follow-up, use of statistical analysis, quality of life outcome scores, conflict of interest, and complications were recorded. RESULTS Fifteen studies were included that investigated Mobi-C CDA, only one of which was a level Ib randomized control trial. All studies included showed non-inferiority of one-level Mobi-C CDA to one-level anterior cervical discectomy and fusion (ACDF). Only one study analyzed outcomes of one-level versus two-level Mobi-C CDA, and only one study analyzed two-level Mobi-C CDA versus two-level ACDF. In comparison with other cervical disc prostheses, the Mobi-C prosthesis is associated with higher rates of heterotopic ossification (HO). Studies with conflicts of interest reported lower rates of HO. Adjacent segment degeneration or disease, along with other complications, were not assessed in most studies. CONCLUSION One-level Mobi-C CDA is non-inferior, but not superior, to one-level ACDF for patients with cervical degenerative disc disease. The Mobi-C CDA procedure is associated with high rates of HO. Two-level Mobi-C CDA may be superior to two-level ACDF. However, insufficient evidence exists, thereby mandating a need for unbiased, well-designed prospective studies with well-defined outcomes in the future.
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Affiliation(s)
- Matthew D Alvin
- Cleveland Clinic Center for Spine Health, Cleveland Clinic, Cleveland, OH, USA ; Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | - Thomas E Mroz
- Cleveland Clinic Center for Spine Health, Cleveland Clinic, Cleveland, OH, USA ; Cleveland Clinic Lerner College of Medicine, Cleveland, OH, USA ; Department of Neurological Surgery, Cleveland Clinic, Cleveland, OH, USA
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Alvin MD, Abbott EE, Lubelski D, Kuhns B, Nowacki AS, Steinmetz MP, Benzel EC, Mroz TE. Cervical arthroplasty: a critical review of the literature. Spine J 2014; 14:2231-45. [PMID: 24704679 DOI: 10.1016/j.spinee.2014.03.047] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2013] [Revised: 02/10/2014] [Accepted: 03/26/2014] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT Cervical disc arthroplasty (CDA) is a motion-preserving procedure that is an alternative to fusion. Proponents of arthroplasty assert that it will maintain cervical motion and prevent or reduce adjacent segment degeneration. Accordingly, CDA, compared with fusion, would have the potential to improve clinical outcomes. Published studies have varying conclusions on whether CDA reduces complications and/or improves outcomes. As many of these previous studies have been funded by CDA manufacturers, we wanted to ascertain whether there was a greater likelihood for these studies to report positive results. PURPOSE To critically assess the available literature on cervical arthroplasty with a focus on the time of publication and conflict of interest (COI). STUDY DESIGN/SETTING Review of the literature. METHODS All clinical articles about CDA published in English through August 1, 2013 were identified on Medline. Any article that presented CDA clinical results was included. Study design, sample size, type of disc, length of follow-up, use of statistical analysis, quality-of-life (QOL) outcome scores, COI, and complications were recorded. A meta-analysis was conducted stratifying studies by COI and publication date to identify differences in complication rates reported. RESULTS Seventy-four studies were included that investigated 8 types of disc prosthesis and 22 met the criteria for a randomized controlled trial (RCT). All Level Ib RCTs reported superior quality-of-life outcomes for CDA versus anterior cervical discectomy and fusion (ACDF) at 24 months. Fifty of the 74 articles (68%) had a disclosure section, including all Level Ib RCTs, which had significant COIs related to the respective studies. Those studies without a COI reported mean weighted average adjacent segment disease rates of 6.3% with CDA and 6.2% with ACDF. In contrast, the reverse was reported by studies with a COI, for which the averages were 2.5% with CDA and 6.3% with ACDF. Those studies with a COI (n=31) had an overall weighted average heterotopic ossification rate of 22%, whereas those studies with no COI (n=43) had a rate of 46%. CONCLUSIONS Associated COIs did not influence QOL outcomes. Conflicts of interest were more likely to be present in studies published after 2008, and those with a COI reported greater adjacent segment disease rates for ACDF than CDA. In addition, heterotopic ossification rates were much lower in studies with COI versus those without COI. Thus, COIs did not affect QOL outcomes but were associated with lower complication rates.
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Affiliation(s)
- Matthew D Alvin
- Neurological Institute, Center for Spine Health, Department of Orthopaedic and Neurological Surgery, Cleveland Clinic, 9500 Euclid Ave., S-80, Cleveland, OH 44195, USA; Case Western Reserve University School of Medicine, 10900 Euclid Ave, Cleveland, OH 44106, USA
| | - E Emily Abbott
- Neurological Institute, Center for Spine Health, Department of Orthopaedic and Neurological Surgery, Cleveland Clinic, 9500 Euclid Ave., S-80, Cleveland, OH 44195, USA; Department of Neurological Surgery, Cleveland Clinic, 9500 Euclid Ave., S-80, Cleveland, OH 44195, USA
| | - Daniel Lubelski
- Neurological Institute, Center for Spine Health, Department of Orthopaedic and Neurological Surgery, Cleveland Clinic, 9500 Euclid Ave., S-80, Cleveland, OH 44195, USA; Cleveland Clinic Lerner College of Medicine, 9500 Euclid Ave., S-80, Cleveland, OH 44195, USA
| | - Benjamin Kuhns
- Neurological Institute, Center for Spine Health, Department of Orthopaedic and Neurological Surgery, Cleveland Clinic, 9500 Euclid Ave., S-80, Cleveland, OH 44195, USA; Case Western Reserve University School of Medicine, 10900 Euclid Ave, Cleveland, OH 44106, USA
| | - Amy S Nowacki
- Cleveland Clinic Lerner College of Medicine, 9500 Euclid Ave., S-80, Cleveland, OH 44195, USA; Department of Quantitative Health Sciences, Cleveland Clinic, 9500 Euclid Ave., S-80, Cleveland, OH 44195, USA
| | - Michael P Steinmetz
- Neurological Institute, Center for Spine Health, Department of Orthopaedic and Neurological Surgery, Cleveland Clinic, 9500 Euclid Ave., S-80, Cleveland, OH 44195, USA; Department of Neurosciences, MetroHealth Medical Center, 2500 Metrohealth Dr., Cleveland, OH 44109, USA
| | - Edward C Benzel
- Neurological Institute, Center for Spine Health, Department of Orthopaedic and Neurological Surgery, Cleveland Clinic, 9500 Euclid Ave., S-80, Cleveland, OH 44195, USA; Department of Neurological Surgery, Cleveland Clinic, 9500 Euclid Ave., S-80, Cleveland, OH 44195, USA; Cleveland Clinic Lerner College of Medicine, 9500 Euclid Ave., S-80, Cleveland, OH 44195, USA
| | - Thomas E Mroz
- Neurological Institute, Center for Spine Health, Department of Orthopaedic and Neurological Surgery, Cleveland Clinic, 9500 Euclid Ave., S-80, Cleveland, OH 44195, USA; Department of Neurological Surgery, Cleveland Clinic, 9500 Euclid Ave., S-80, Cleveland, OH 44195, USA; Cleveland Clinic Lerner College of Medicine, 9500 Euclid Ave., S-80, Cleveland, OH 44195, USA.
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Zhao H, Cheng L, Hou Y, Liu Y, Liu B, Mundra JJ, Nie L. Multi-level cervical disc arthroplasty (CDA) versus single-level CDA for the treatment of cervical disc diseases: a meta-analysis. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2014; 24:101-12. [PMID: 24961223 DOI: 10.1007/s00586-014-3429-1] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/20/2013] [Revised: 06/16/2014] [Accepted: 06/16/2014] [Indexed: 12/12/2022]
Abstract
PURPOSE Cervical disc arthroplasty (CDA) was developed to treat cervical degenerated disc diseases with the advantages of preserving the kinematics of the functional spinal unit. However, the safety and reliability of multi-level CDA are still controverted when comparing to the single-level CDA. It has shown unclear benefits in terms of clinical results, functional recovery, heterotopic ossification, and the need for secondary surgical procedures. The purpose of this study is to estimate the effectiveness of multi-level cervical arthroplasty over single-level CDA for the treatment of cervical spondylosis and disc diseases. METHODS To compare the studies of multi-level CDA versus single-level CDA in patients with cervical spondylosis that reported at least one of the following outcomes: functionality, neck pain, arm pain, quality of life, reoperation and incidence of heterotopic ossification, electronic databases (Medline, Embase, Pubmed, Cochrane library, and Cochrane Central Register of Controlled Trials) were searched. No language restrictions were used. Two authors independently assessed the methodological quality of included studies and extracted the relevant data. RESULTS Out of Eight cohorts that were included in the study, four were prospective cohorts and the other four were retrospective. The results of the meta-analysis indicated that there was no significant difference in neck disability index scores, neck visual analog scale (VAS), arm VAS, morbidity of reoperation, heterotopic ossification, and parameters of living quality when comparing multi-level CDA with single-level CDA at 1 and 2 years follow-up postoperatively (p > 0.05). CONCLUSIONS The meta-analysis revealed that the outcomes and functional recovery of patients performed with multi-level CDA are equivalent to those with single-level CDA, which suggests the multi-level CDA is as effective and safe as single-level invention for the treatment of cervical spondylosis. Nonetheless, more well-designed studies with large groups of patients are needed to provide further evidence for the benefit and reliability of multi-level CDA in the treatment of cervical disc diseases.
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Affiliation(s)
- Hua Zhao
- Department of Spine Surgery, Qilu Hospital of Shandong University, Jinan, 250012, China
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Ray WZ, Ganju A, Harrop JS, Hoh DJ. Developing an anterior cervical diskectomy and fusion simulator for neurosurgical resident training. Neurosurgery 2014; 73 Suppl 1:100-6. [PMID: 24051871 DOI: 10.1227/neu.0000000000000088] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Surgical simulators are useful in many surgical disciplines to augment residency training. Duty hour restrictions and increasing emphasis on patient safety and attending oversight have changed neurosurgical education from the traditional apprenticeship model. The Congress of Neurological Surgeons Simulation Committee has been developing neurosurgical simulators for the purpose of enhancing resident education and assessing proficiency. OBJECTIVE To review the initial experience with an anterior cervical diskectomy and fusion (ACDF) simulator. METHODS The first ACDF training module was implemented at the 2012 Congress of Neurological Surgeons Annual Meeting. The 90-minute curriculum included a written pretest, didactics, a practical pretest on the simulator, hands-on training, a written posttest, a practical posttest, and postcourse feedback. Didactic material covered clinical indications for ACDF, comparison with other cervical procedures, surgical anatomy and approach, principles of arthrodesis and spinal fixation, and complication management. Written pretests and posttests were administered to assess baseline knowledge and evidence of improvement after the module. Qualitative evaluation of individual performance on the practical (simulator) portion was included. RESULTS Three neurosurgery residents, 2 senior medical students, and 1 attending neurosurgeon participated in the course. The pretest scores were an average 9.2 (range, 6-13). Posttest scores improved to 11.0 (range, 9-13; P = .03). CONCLUSION Initial experience with the ACDF simulator suggests that it may represent a meaningful training module for residents. Simulation will be an important training modality for residents to practice surgical technique and for teachers to assess competency. Further development of an ACDF simulator and didactic curriculum will require additional verification of simulator validity and reliability.
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Affiliation(s)
- Wilson Z Ray
- *Department of Neurological Surgery, Washington University School of Medicine, St. Louis, Missouri; ‡Department of Neurological Surgery, Northwestern, Chicago, Illinois; §Department of Neurological Surgery, Thomas Jefferson University, Philadelphia, Pennsylvania; ¶Department of Neurological Surgery, University Florida, Gainesville
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Ray WZ, Ganju A, Harrop JS, Hoh DJ. Developing an Anterior Cervical Diskectomy and Fusion Simulator for Neurosurgical Resident Training. Neurosurgery 2013. [DOI: 10.1093/neurosurgery/73.suppl_1.s100] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
Abstract
BACKGROUND:
Surgical simulators are useful in many surgical disciplines to augment residency training. Duty hour restrictions and increasing emphasis on patient safety and attending oversight have changed neurosurgical education from the traditional apprenticeship model. The Congress of Neurological Surgeons Simulation Committee has been developing neurosurgical simulators for the purpose of enhancing resident education and assessing proficiency.
OBJECTIVE:
To review the initial experience with an anterior cervical diskectomy and fusion (ACDF) simulator.
METHODS:
The first ACDF training module was implemented at the 2012 Congress of Neurological Surgeons Annual Meeting. The 90-minute curriculum included a written pretest, didactics, a practical pretest on the simulator, hands-on training, a written posttest, a practical posttest, and postcourse feedback. Didactic material covered clinical indications for ACDF, comparison with other cervical procedures, surgical anatomy and approach, principles of arthrodesis and spinal fixation, and complication management. Written pretests and posttests were administered to assess baseline knowledge and evidence of improvement after the module. Qualitative evaluation of individual performance on the practical (simulator) portion was included.
RESULTS:
Three neurosurgery residents, 2 senior medical students, and 1 attending neurosurgeon participated in the course. The pretest scores were an average 9.2 (range, 6-13). Posttest scores improved to 11.0 (range, 9-13; P = .03).
CONCLUSION:
Initial experience with the ACDF simulator suggests that it may represent a meaningful training module for residents. Simulation will be an important training modality for residents to practice surgical technique and for teachers to assess competency. Further development of an ACDF simulator and didactic curriculum will require additional verification of simulator validity and reliability.
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Affiliation(s)
- Wilson Z. Ray
- Department of Neurological Surgery, Washington University School of Medicine, St. Louis, Missouri
| | - Aruna Ganju
- Department of Neurological Surgery, Northwestern, Chicago, Illinois
| | - James S. Harrop
- Department of Neurological Surgery, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Daniel J. Hoh
- Department of Neurological Surgery, University Florida, Gainesville
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Landi A. Elastic resistance of the spine: Why does motion preservation surgery almost fail? World J Clin Cases 2013; 1:134-139. [PMID: 24303484 PMCID: PMC3845953 DOI: 10.12998/wjcc.v1.i4.134] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2013] [Revised: 04/11/2013] [Accepted: 06/10/2013] [Indexed: 02/05/2023] Open
Abstract
Single metamere motility should not be interpreted merely as a movement on the 3 planes but also, and above all, as elastic resistance to dynamic stress on these 3 planes. In the light of this consideration, the aim of motion preservation is to neutralize excessive movements while preserving the physiological biomechanical properties of the metamere involved to interrupt the progression of degenerative processes and to prevent adjacent segment disease. Despite the fact that a myriad of devices have been developed with the purpose of achieving dynamic neutralization of the spine, there are now some doubts regarding the true efficacy of these devices.
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