In this systematic review and meta-analysis, we aim to thoroughly describe and objectively compare the efficacy of anterior cervical plate (ACP) and stand-alone cage (SAC). Although recognized as an effective procedure for cervical degenerative disease (CDD), a debate between the methods of anterior cervical discectomy and fusion exists. ACP provides stability to the fusion construct; however, some complications have been reported, such as dysphagia, adjacent disc disease, and soft tissue injury. To overcome these complications, a SAC was later introduced. A systematic search was conducted on the basis of PRISMA (preferred reporting items for systematic reviews and meta-analyses) guidelines to identify relevant studies through PubMed, Google Scholar, and Cochrane database. A total of 14 studies (960 patients) were included in the meta-analysis. Twenty outcomes were clinically and radiologically compared between the two procedures. ACP and SAC were comparable in terms of dysphasia rate, loss of segmental angle, loss of disc height, the Odom criteria, Robinson's criteria, hospital stay, Japanese Orthopaedic Association score, Neck Disability Index, Visual Analog Scale, and fusion time. However, SAC was superior in terms of shorter operation time, less blood loss, lower dysphagia rate, and lower rate of adjacent level disease, whereas ACP was advantageous in terms of lower subsidence rate, better maintenance of the cervical global and segmental angles and disc height, and higher fusion rate. Both procedures can be used in patients with CDD, although it might be more beneficial to choose ACP in patients with multi-level pathologies, wherein better mechanical stability is provided. However, SAC may be more beneficial to use in patients with comorbidities, anemia, or swelling problems because it offers lower complication rates.
Background. The standard Ponseti method is a mainstay of treatment for children with congenital talipes equinovarus (CTEV); involving weekly manipulation and long-leg casting, this approach has proven to produce good long-term outcomes. However, it takes approximately 45 weeks to correct all deformity components, making compliance a challenge for patients with limited economic resources and difficulty reaching healthcare centres. Aim. This study aims to compare treatment outcomes between standard Ponseti and an accelerated protocol applying the same casts but changing them more frequently, every 2-5 days for the CTEV pathology. Methods. A systematic search was conducted based on PRISMA guidelines to identify relevant studies through PubMed, Google Scholar, and Cochrane Database. A total of seven studies (324 patients, 408 feet) were included in the meta-analysis. Five outcomes were compared between the two procedures: post-procedure Pirani score, relapse rate, tenotomy rate, number of casts, and total duration of treatment. Results. For total duration of treatment, the accelerated Ponseti method was superior to standard Ponseti (24.25 vs. 41.54 days, p 0.00001). On the other hand, it achieved comparable efficacy as measured by post-procedure Pirani score (1.01 vs. 0.87, p = 0.19). Furthermore, the two procedures were also comparable in terms of the total number of casts needed (4.94 vs. 5.05, p = 0.76), tenotomy rate (73.29% vs. 65.27%, p = 0.07) , and relapse rate (27.72% vs 25.23%, p = 0.56). Conclusion. Accelerated Ponseti offers similar efficacy and shorter duration of treatment compared to the standard Ponseti technique.
BACKGROUND: Although major reconstructive surgeries in the form of excision and reconstruction have been the mainstay treatment for Giant Cell Tumour (GCT) of the bone, its recurrence rate remains high and poses various morbidities such as implant failure or skin breakdown. Minimal invasive surgery (MIS) techniques, which has gained popularity mostly in other fields in orthopaedic surgery, are being introduced as an alternative to limit the surgical complications while achieving the best possible outcome. Until now, there has been no literature summarising the evidence of MIS outcome in treating GCT of the bone. AIM: The purpose of this systematic review was to investigate the efficacy of this relatively new treatment. METHODS: We comprehensively searched PubMed, EMBASE, and Cochrane Library to search for studies about MIS for GCT of the bone treatment up to March 1, 2019. The selection of appropriate studies was performed by two independent investigators based on PRISMA guideline. Given the limited number of studies, there was no restriction in terms of patient’s demographics, the specific minimally invasive surgical method, and publication status. RESULTS: We found 120 articles from the database. After evaluating full text, 5 articles (16 patients) were found to be eligible. The minimally invasive methods were curettage, cryosurgery, and argon beam coagulator. The visualisation methods include a computer-assisted navigation system, endoscope, otoscope, CT, and MRI. Location of tumours includes axial and long bones. The follow-up period ranges from 7 to 126 months. The functional and oncological outcome was found to be satisfying with no recurrence or complications. CONCLUSION: In conclusion, MIS is a familiar method in orthopaedic surgery with potential expansion in tumour field. The current evidence shows that this approach for GCT results in good functional outcome, with low risk of recurrence.
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