医学
物理疗法
康复
外科
脊柱融合术
腰椎
Oswestry残疾指数
前瞻性队列研究
优势比
可视模拟标度
置信区间
腰痛
随机对照试验
内科学
病理
替代医学
作者
Jacob J Jones,Samuel Oduwole,Richard Feinn,James J. Yue
出处
期刊:Clinical spine surgery
[Ovid Technologies (Wolters Kluwer)]
日期:2020-08-28
卷期号:34 (2): 56-62
被引量:3
标识
DOI:10.1097/bsd.0000000000001060
摘要
Lumbar fusion surgeries in degenerative spinal conditions can be invasive and may challenge the normal biomechanical spine and joint function. Frequently, patients require postoperative rehabilitation management. The purpose of this meta-analysis is to determine if there is an advantage to using a postoperative lumbar orthosis with regard to postoperative function and surgical healing.Articles in the English language were searched in electronic databases including PubMed and Clinicaltrials.gov from January 1, 2004 to January 1, 2019.Studies were included if they were described as being a prospective randomized trial, utilized a common pain score determinant, reported complications postoperatively, analyzed disability, and were published within a 15-year period. After review of 218 citations by 2 authors, 4 studies were identified as meeting the inclusion criteria.Pain scores (Visual Analogue Scale/Dallas Pain Questionnaire), disability (Oswestry Disability Index, Short Form-36, Roland-Morris Disability Questionnaire), postoperative complications and fusion rate outcomes were collected.Four prospective randomized controlled trials were identified and met the inclusion criteria. The outcome disability level showed a combined effect differed from 0 and favored the control [g=0.26, 95% confidence interval (CI): 0.04-0.49, P=0.029]. Visual Analogue Scale pain's combined effect did not differ from 0 and did not favor either the control or brace group (g=0.01, 95% CI: -0.25 to 0.27, P=0.93). The odds ratio (ORs) for complication rates did not differ from 1 (OR=0.88, 95% CI: 0.47-1.65, P=0.69). There was no significant difference in the ORs for fusion rate. Study heterogeneity was measured for all outcomes and there was no excessive variation.The present meta-analysis indicated no significant difference in pain scores, a decrease in disability level for control (no brace), no significant change in fusion rate, and no significant difference in the odds of complication for the brace group. These conclusions support the theory that there is no significant advantage of postoperative lumbar orthoses.
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