Journal of orthopaedic science : official journal of the Japanese Orthopaedic Association
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Meta-analyses of randomized, controlled trials are considered the highest level-of-evidence, thus strongest source of information. However, questions concerning the validity of meta-analyses in orthopaedic surgery emerged recently. Among the most common sources for errors is publication bias. This describes the fact that studies with small or non-significant outcomes are less likely to be published, thus less likely to be identified and included in systematic reviews and meta-analyses. In this study we asked three questions: (1) Whether publication bias is assessed in orthopaedic meta-analyses, (2) What the actual prevalence of publication bias is, and (3) what effect publication bias has on the outcomes of orthopaedic meta-analyses. ⋯ We found a rather low prevalence of publication bias in orthopaedic meta-analyses, but recommend assessing for it and its effects, which might be substantial.
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Comparative Study
Does anterior lumbar interbody fusion promote adjacent degeneration in degenerative disc disease? A finite element study.
The increase in the number of anterior lumbar interbody fusions being performed carries with it the potential for the long-term complication of adjacent segmental degeneration. While its exact mechanism remains uncertain, adjacent segment degeneration has become much more widespread. Using a nonlinear, three-dimensional finite element model to analyze and compare the biomechanical influence of anterior lumbar interbody fusion and lumbar disc degeneration on the superior adjacent intervertebral disc, we attempt to determine if anterior lumbar interbody fusion aggravates adjacent segment degeneration. ⋯ Anterior lumbar interbody fusion has more adverse biomechanical influence than disc degeneration on the adjacent upper disc and may aggravate the adjacent upper segmental degeneration.
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The incidence of neurological deficits is reportedly low after sacrificing the affected nerve root during spinal schwannoma treatment. Although the incidence has been widely reported, the operative method for nerve root resection has been not clarified. To evaluate the safety of pure nerve root resection, we focused on solitary spinal schwannomas below the thoracolumbar level and investigated the effect of affected nerve resection. ⋯ On the basis of this study, we recommend pure single nerve resection for treatment of intradural spinal schwannomas before such tumors progress and involve other normal roots, because postoperative neurological deficits did not occur in our intradural schwannoma patients, irrespective of tumor size, when this procedure was used. However, dumbbell-shaped schwannoma patients should be carefully treated operatively, because high incidence of postoperative neurological deficits can be expected.