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The effects of surgical treatments for individuals with 'slipped' lumbar discs

Prolapsed lumbar discs ('slipped disc', 'herniated disc') account for less than five percent of all low‐back problems, but are the most common cause of nerve root pain ('sciatica'). Ninety percent of acute attacks of sciatica settle with non‐surgical management. Surgical options are usually considered for more rapid relief in the minority of patients whose recovery is unacceptably slow.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2008

Fusion techniques for degenerative disc disease

Degenerative disc disease is part of the natural aging process of the human spine and can cause complications stemming from the nerve root or spinal cord. Degenerative disc disease of the spine can result in significant pain, instability, disturbances with the nerve roots or spinal cord, or a combination of symptoms. The cause of these symptoms comes from compression of the nerves.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2011

Meta analysis of cervical disc replacement versus anterior cervical discectomy and fusion for degenerative cervical syndrome

Bibliographic details: Tang W, Liu ZL, Shu Y.  Meta analysis of cervical disc replacement versus anterior cervical discectomy and fusion for degenerative cervical syndrome. Journal of Clinical Rehabilitative Tissue Engineering Research 2010; 14(4): 615-620 Available from: http://eng.med.wanfangdata.com.cn/PaperDetail.aspx?qkid=xdkf&qcode=xdkf201004003

Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet] - Centre for Reviews and Dissemination (UK).

Version: 2010

Microendoscopic discectomy versus microscopic discectomy for treatment of lumbar disc herniations: a systematic review of randomized controlled trials

Bibliographic details: Liu QG, Song ZB, Gao JW, Li XG, Wu YL.  Microendoscopic discectomy versus microscopic discectomy for treatment of lumbar disc herniations: a systematic review of randomized controlled trials. Chinese Journal of Contemporary Neurology and Neurosurgery 2012; 12(4): 399-406 Available from: http://www.cjcnn.org/index.php/cjcnn/article/view/546

Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet] - Centre for Reviews and Dissemination (UK).

Version: 2012

Physiotherapy rehabilitation post first lumbar discectomy: a systematic review and meta-analysis of randomized controlled trials

STUDY DESIGN: Systematic review and meta-analysis.

Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet] - Centre for Reviews and Dissemination (UK).

Version: 2011

Anterior cervical discectomy with arthroplasty versus arthrodesis for single-level cervical spondylosis: a systematic review and meta-analysis

OBJECTIVE: To estimate the effectiveness of anterior cervical discectomy with arthroplasty (ACDA) compared to anterior cervical discectomy with fusion (ACDF) for patient-important outcomes for single-level cervical spondylosis.

Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet] - Centre for Reviews and Dissemination (UK).

Version: 2012

Artificial cervical disc arthroplasty versus anterior cervical discectomy and fusion: a systematic review

Bibliographic details: Bakar D, Lubelski D, Abdullah KG, Mroz TE.  Artificial cervical disc arthroplasty versus anterior cervical discectomy and fusion: a systematic review. Current Orthopaedic Practice 2014; 25(1): 9-13 Available from: http://journals.lww.com/c-orthopaedicpractice/Abstract/2014/01000/Artificial_cervical_disc_arthroplasty_versus.4.aspx

Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet] - Centre for Reviews and Dissemination (UK).

Version: 2014

Application of titanium cages and poly(ether-ether-ketone) cages in anterior cervical discectomy and fusion surgery

Bibliographic details: Duan W, Kong R, Huang W, Zhou R.  Application of titanium cages and poly(ether-ether-ketone) cages in anterior cervical discectomy and fusion surgery. Chinese Journal of Tissue Engineering Research 2014; 18(4): 625-630 Available from: http://www.crter.org/CN/abstract/abstract6687.shtml

Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet] - Centre for Reviews and Dissemination (UK).

Version: 2014

Slipped disk surgery

Under certain circumstances, surgery is an option for treating a slipped disk. This usually involves the removal of spinal disk tissue to relieve pressure on irritated nerves. Surgery can often provide long term relief from symptoms, but there are risks.Surgery is always performed if the slipped disk is an emergency, for example if prolapsed disk tissue is affecting nerves so severely that the bladder or bowel no longer function properly, or certain muscles have become very weak. But this only happens rarely.The far more common reason to have surgery is that it has not been possible to relieve severe and chronic pain enough by using other treatment options. The question of whether to go through with surgery is often difficult to answer, though. For surgery to be considered, imaging techniques and the symptoms must clearly show that a slipped disk is causing the pain. Before deciding to go ahead with the procedure, it is important to carefully weigh the pros and cons together with your doctor. Your individual circumstances will also be part of this discussion because they can influence the success of the treatment as well.

Informed Health Online [Internet] - Institute for Quality and Efficiency in Health Care (IQWiG).

Version: October 9, 2014

The efficacy of minimally invasive discectomy compared with open discectomy: a meta-analysis of prospective randomized controlled trials

The review concluded that minimally invasive discectomy and open discectomy produced substantial and equivalent improvements in leg pain in patients with lumbar radiculopathy. Incidental durotomies were more frequent with minimally invasive surgery; overall complications did not differ. The limited number, uncertain quality, and variation between trials, and limitations in the review processes mean that the conclusions may not be reliable.

Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet] - Centre for Reviews and Dissemination (UK).

Version: 2012

Anterior versus posterior surgery for multilevel cervical myelopathy, which one is better? A systematic review

The objective of the study is to perform a systematic review to compare the clinical outcomes and complications of anterior surgery with posterior surgery for multilevel cervical myelopathy (MCM). MEDLINE, EMBASE databases and other databases were searched for all the relevant original articles published from January 1991 to November 2009 comparing anterior with posterior surgery for MCM. Subgroup analysis was performed according to the follow-up years. The following end points were mainly evaluated: final follow-up JOA (Japanese Orthopaedic Association) scale, recovery rate and complication outcomes. Ten articles fulfilled all inclusion criteria. For multilevel CSM patients, the final follow-up JOA score for the anterior group was significantly higher than the posterior group (p < 0.05, WMD 0.83 [0.24, 1.43]) in the 'follow-up time ≤ 5 years' subgroup, but had no significant differences in the 'follow-up time > 5 years' subgroup (p > 0.05). The recovery rate for the anterior group was significantly higher than the posterior group (p < 0.05, WMD 10.08 [1.39, 18.78]) in the 'follow-up time ≤ 5 years' subgroup. No study reported the recovery rate for the follow-up time > 5 years. For multilevel OPLL patients, the final follow-up JOA score and recovery rate for the anterior group were both significantly higher than the posterior group in the 'follow-up time ≤ 5 years' subgroup (p < 0.05, WMD 2.50 [0.16, 4.85]; p < 0.05, WMD 29.48 [29.09, 29.87], respectively). One study [31] which mean follow-up time was 6 years was enrolled in the 'follow-up time > 5 years' subgroup. The results showed there was no significant difference in final follow-up JOA score and recovery rate between anterior and posterior group for patients with occupying ratio of OPLL <60% (p > 0.05), while in patients with occupying ratio ≥ 60%, the final follow-up JOA score and recovery rate of anterior surgery were both superior to that of posterior surgery (p < 0.05). For both multilevel CSM and OPLL patients, the complications for the anterior group were significantly more than the posterior group in the 'follow-up time ≤ 5 years' subgroup (p < 0.05, OR 7.33 [2.96, 18.20] for CSM patients; p < 0.05, OR 4.44 [1.80, 10.98] for OPLL patients), but were similar to the posterior group in the 'follow-up time >5 years' subgroup (p > 0.05). In conclusion, anterior surgery had better clinical outcomes and more complications at the early stage after operation for both multilevel CSM and OPLL patients. At the late stage, posterior surgery had similar clinical outcomes and complications to anterior surgery for CSM patients, and OPLL patients with occupying ratio of OPLL <60%. While for OPLL patients with occupying ratio ≥ 60%, anterior surgery had superior clinical outcome to posterior surgery.

Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet] - Centre for Reviews and Dissemination (UK).

Version: 2011

Perioperative epidural steroids for lumbar spine surgery in degenerative spinal disease: a review

OBJECT: This systematic review assesses the efficacy of epidural steroids on adults undergoing lumbar spine surgery for degenerative spinal disease.

Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet] - Centre for Reviews and Dissemination (UK).

Version: 2010

Effectiveness and safety of cervical total disc replacement for single symptomatic single-level cervical degenerative disc disease: a systematic review

Bibliographic details: Jiang H, Xiao Z, Zhan X, Li S, Lao S, Li S.  Effectiveness and safety of cervical total disc replacement for single symptomatic single-level cervical degenerative disc disease: a systematic review. Chinese Journal of Evidence-Based Medicine 2010; 10(8): 957-963

Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet] - Centre for Reviews and Dissemination (UK).

Version: 2010

The choice of the best surgery after single level anterior cervical spine discectomy: a systematic review

BACKGROUND: The anterior cervical discectomy (ACD) is often used to treat spinal cord and nerve root compressions and the frequent use of interbody fusion (ACDF) has popularized it as a common practice associated or not with cages or plates for maintaining the intervertebral disc height.

Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet] - Centre for Reviews and Dissemination (UK).

Version: 2012

Impact of subsidence on clinical outcomes and radiographic fusion rates in anterior cervical discectomy and fusion: a systematic review

STUDY DESIGN: Systematic review.

Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet] - Centre for Reviews and Dissemination (UK).

Version: 2014

Anterior cervical discectomy and fusion for the management of axial neck pain in the absence of radiculopathy or myelopathy

STUDY DESIGN:  Systematic reviewStudy rationale: Anterior cervical discectomy and fusion (ACDF) is a proven, effective treatment for relieving neck pain due to degenerative conditions of the cervical spine. Since most patients also present with radiculopathy or myelopathy, little is known as to the effectiveness of ACDF to relieve pain and improve function in patients without radicular or myelopathic symptoms.

Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet] - Centre for Reviews and Dissemination (UK).

Version: 2010

Total disc replacement for chronic low back pain: background and a systematic review of the literature

This review assessed total disc replacement as a treatment for chronic lower-back pain. There was insufficient evidence on safety and efficacy to assess the performance of total disc replacement adequately. The authors' conclusions reflect the paucity of evidence found by the review.

Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet] - Centre for Reviews and Dissemination (UK).

Version: 2003

No additional value of fusion techniques on anterior discectomy for neck pain: a systematic review

We aimed to assess the effects of additional fusion on surgical interventions to the cervical spine for patients with neck pain with or without radiculopathy or myelopathy by performing a systematic review. The search strategy outlined by the Cochrane Back Review Group (CBRG) was followed. The primary search was conducted in MEDLINE, EMBASE, CINAHL, CENTRAL and PEDro up to June 2011. Only randomised, controlled trials of adults with neck pain that evaluated at least one clinically relevant primary outcome measure (pain, functional status, recovery) were included. Two authors independently assessed the risk of bias by using the criteria recommended by the CBRG and extracted the data. Data were pooled using a random effects model. The quality of the evidence was rated using the GRADE method. In total, 10 randomised, controlled trials were identified comparing additional fusion upon anterior decompression techniques, including 2 studies with a low risk of bias. Results revealed no clinically relevant differences in recovery: the pooled risk difference in the short-term follow-up was -0.06 (95% confidence interval -0.22 to 0.10) and -0.07 (95% confidence interval -0.14 to 0.00) in the long-term follow-up. Pooled risk differences for pain and return to work all demonstrated no differences. There is no additional benefit of fusion techniques applied within an anterior discectomy procedure on pain, recovery and return to work.

Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet] - Centre for Reviews and Dissemination (UK).

Version: 2012

Mid- to long-term outcomes after cervical disc arthroplasty compared with anterior discectomy and fusion: a systematic review and meta-analysis of randomized controlled trials

PURPOSE: To evaluate the mid- to long-term clinical outcomes after cervical disc arthroplasty (CDA) as compared with anterior cervical discectomy and fusion (ACDF) for the treatment of symptomatic cervical disc disease.

Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet] - Centre for Reviews and Dissemination (UK).

Version: 2014

Efficacy of intraoperative epidural steroids in lumbar discectomy: a systematic review

BACKGROUND: This study is a descriptive review of the literature aimed at examining the efficacy of the use of intraoperative epidural steroids in lumbar disc surgery, a matter that remains controversial.

Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet] - Centre for Reviews and Dissemination (UK).

Version: 2014

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