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Synopsis: 112 patients with a single-level disc herniation were randomized to undergo either microendoscopic discectomy or open (fenestration/laminotomy) discectomy either posterior lumbar interbody fusion or posterolateral fusion, to compare the safety and efficacy of the treatment methods.Following radiographic and clinical evaluations over a 12 month period, the results indicated that radicular pain was reduced equally by the two methods, but that the length of hospital stay was shorter and blood loss was lower for the Microendoscopic Discectomy group. However, due to... Read More »
Author verified Level 2 RCT
11%
Synopsis: 351 patients with a meniscus tear and knee osteoarthritis (OA) were randomized to either undergo arthroscopic partial meniscectomy (APM) followed by a physical therapy program or physical therapy alone, in order to compare clinical and functional outcomes. Following treatment over a 12 month period, all patients improved similarly in WOMAC physical-function score, KOOS pain score, and SF-36 physical-activity score. Read More »
Author verified Level 2 RCT
11%
Synopsis: 78 patients with painful osteoporotic vertebral fractures were randomized to receive a vertebroplasty spinal procedure or placebo approach, with the purpose of comparing clinical outcomes between treatments up to two years.Results indicated no significant between group differences in overall pain (primary outcome) and all other secondary outcomes at the 12-and 24-month follow-up assessments.Risk of developing clinical vertebral fractures was similar between groups, although this study was not adequately powered for this outcome. Routine vertebroplasty is... Read More »
Author verified Level 2 RCT
11%
Synopsis: 137 randomized controlled trials, consisting of 33,243 patients, were included in this network meta-analysis.The aim of this study was to assess and compare the efficacy of current pharmacologic treatments for primary knee osteoarthritis.Treatments such as intra-articular corticosteroids, intra-articular hyaluronic acid, acetaminophen, naproxen, ibuprofen, diclofenac, and celecoxib and oral and intra-articular placebos were compared based on their effect on pain, function, and stiffness.Results indicated that all interventions were significantly more favourable than oral placebo for pain outcomes. In addition, with the exception of intra-articular corticosteroids, all interventions were significantly superior to oral placebo with regards to functional outcomes. Naproxen, ibuprofen, diclofenac,... Read More »
Author verified Level 1 Meta Analysis
11%
Synopsis: 50 patients with single-level cervical radiculopathy presenting with chronic neck pain and undergoing anterior cervical discectomy and fusion (ACDF) were randomized to receive either a standalone anchored polyetheretherketone (PEEK) cage (PREVAIL) or a PEEK cage with plating.The purpose of the study was to compare clinical and radiological outcomes between groups over 2 year follow-up.The results indicated that the stand-alone anchored PEEK device provided comparable clinical and radiograpahical outcomes to that of PEEK cage with anterior plating. Dysphasia rate was... Read More »
Level 2 RCT
11%
Synopsis: 58 patients with low back pain due to degenerative lumbar disease were randomized to intradiscal injection of 1-2mL of either platelet-rich plasma (PRP) or contrast agent (Omnipaque 180).The purpose of this study was to evaluate the efficacy of PRP for improvement of measures of pain and function relative to a nonactive injection.Follow-up was performed over 8 weeks post-injection. Results after 8... Read More »
Level 2 RCT
11%
Synopsis: 554 patients with a lumbar disc herniation, large annular defect, and scheduled for lumbar discectomy were randomized to the surgery with or without additional intervention using an annular closure device (Barricaid; Intrinsic Therapeutics).Patients were followed primary for the incidence of re-herniation and composite endpoints of success over the first 2 years after surgery.Results demonstrated a significantly lower rate of subsequent symptomatic lumbar disc re-herniation at the index level among the group treated with the annular closure device. In addition, the... Read More »
Level 2 RCT
11%
Synopsis: 77 patients with lumbar disc herniation between L3-5 and scheduled for discectomy were randomized to surgery with or without the addition of an interspinous spacer (Wallis dynamic stabilization system; Zimmer).Patients were assessed for clinical and radiographic outcome after 3 years.At 3 years, no significant differences between groups were noted in pain scores on a visual analog scale, the Japanese Orthopaedic Association score, or the Oswestry Disability Index (ODI).Disc height at 3 years was significantly greater in the interspinous spacer group, however. There was no... Read More »
Level 2 RCT
11%
Synopsis: Femoral neck fractures, a type of hip fracture, are a common and disabling injury, particularly given an ageing population in many countries.Throughout the past half-century, multiple different treatments have evolved for the treatment of these fractures, and these include sliding hip screws, cannulated screws, hemiarthroplasty (HA), and total hip arthroplasty (THA).Given that femoral neck fractures have the potential to compromise blood flow to the femoral head, arthroplasty options have gained prominence in recent years.However, it remains unclear which of the two options (THA or HA) is optimal in this population.Thus, in this definitive, landmark randomized controlled trial, which is by far the largest of its kind to date, the investigators randomized 1495 patients 50 years of age older with a displaced femoral neck fracture to undergo HA or THA.The trial was conducted across 80 centres in 10 different countries.Primary outcome was a secondary hip procedure within 24 months.Secondary endpoints included death, serious adverse events, hip-related complications, health-related quality of life, function, and overall health.There was no significant difference between the two groups in terms of revision rate, mortality, serious adverse events, revision procedures, EQ-5D, timed up and go test, or Short-Form 12 scores.There was a trend toward higher dislocation rates in THA, though this was not statistically significant.There was a significant difference in favour of THA on the WOMAC total and sub-scores, though this difference fell below the minimal clinically important threshold.Overall, in the absence of a convincing indication for THA, HA is a comparable treatment for femoral neck fracture which does not result in a significant difference in revision rate.There may be a slightly higher rate of serious adverse events with THA, and slightly better function with THA, though these differences may not reach clinical significance. Read More »
Level 1 RCT
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