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
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Review Meta Analysis
A systematic review and meta-analysis on the management of accidental dural tears in spinal surgery: drowning in information but thirsty for a clear message.
To systematically review the published techniques for dural tear (DT) repair in spinal surgery to determine the repair method associated with the lowest failure rate. ⋯ Direct repair was associated with low proportion of failure. Howver, the approach to DT treatment was commonly determined on an ad hoc basis according to surgeons' preferences, and few followed defined management protocols. Future studies reporting DT treatment ought to categorise the treatment outcome according to the complexity of the DT and the specific treatment used, thus improving research quality in the field.
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Meta Analysis Comparative Study
A meta-analysis of the safety and effectiveness of titanium mesh versus bone graft alone for the treatment of thoracolumbar tuberculosis.
The aim of this study is to investigate, using a meta-analysis, differences in safety and effectiveness between a titanium mesh bone graft and bone graft alone for the treatment of thoracolumbar spinal tuberculosis. ⋯ Both titanium mesh and bone grafts alone are effective for the treatment of thoracolumbar spinal tuberculosis based on safety. However, the results of this study do not support the superiority of titanium mesh bone grafts reported in previous studies. Because of the high risk of bias of the conclusions of a meta-analysis of non-randomized studies and the small sample sizes for some of the most important outcomes, randomized controlled trials are expected to further examine the reliability of the present findings.
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Randomized Controlled Trial
Augmented reality and artificial intelligence-based navigation during percutaneous vertebroplasty: a pilot randomised clinical trial.
To assess technical feasibility, accuracy, safety and patient radiation exposure of a novel navigational tool integrating augmented reality (AR) and artificial intelligence (AI), during percutaneous vertebroplasty of patients with vertebral compression fractures (VCFs). ⋯ AR/AI-guided percutaneous vertebroplasty appears feasible, accurate and safe, and facilitates lower patient radiation exposure compared to standard fluoroscopic guidance. These slides can be retrieved under Electronic Supplementary Material.
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Sciatic symptoms due to lumbar disc herniation are likely to be caused not solely by mechanical compression of the nerve root, but also by pain-inducing elements from inflammatory processes. Key components in the inflammatory reaction are M1 and M2 macrophages, with the M1 type being associated with pro-inflammatory processes and M2 with anti-inflammatory-processes. ⋯ While M1-related pro-inflammatory cytokines worsen pain symptoms, M2-related anti-inflammatory cytokines alleviate pain symptoms. Nevertheless, the present evidence is limited, and further research on the underlying pathophysiological mechanism in sciatica is required. These slides can be retrieved under Electronic Supplementary Material.
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Review Observational Study
Drug sensitivity patterns in Xpert-positive spinal tuberculosis: an observational study of 252 patients.
To evaluate the sensitivity patterns of anti-tubercular drugs in Xpert MTB-positive spinal tuberculosis (TB) patients and to formulate the guidelines for early start of empiric anti-tubercular treatment (ATT) in MDR-TB spine based on resistance pattern in this large series. ⋯ The Xpert MTB/RIF assay is an efficient technique for the rapid diagnosis of spinal TB and suspected MDR-TB; however, it is recommended to do culture and DST in all patients with spinal TB to guide the selection of appropriate second-line drugs when required. In cases of non-availability of culture and DST, it is suggested to use data from large series such as this to plan the best empirical ATT regimen. These slides can be retrieved under Electronic Supplementary Material.