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ce 3.Study design Meta-analysis. Objective To evaluate the efficacy and safety of total disc replacement (TDR) and anterior cervical discectomy and fusion for treating cervical degenerative diseases. Summary of background data Anterior cervical discectomy and fusion (ACDF) has been the traditional gold standard surgery for cervical degenerative diseases. Methods Clinical databases including PubMed, MEDLINE, Cochrane and Clinical Trials.gov were searched. Review Manager 5.1 software and Stata 11.1 were used to analyze clinical data. Dichotomous pooled results were reported as relative risk (RR) and its 95% confidence interval (CI). Endpoints included clinical success rate, NDI success rate, neurological success rate, incidence of adverse event, reoperation rate and patient satisfaction. Results Eight clinical trials and fifteen papers with 1440 TDR patients and 1237 ACDF patients were included in this meta-analysis. The TDR group had a higher clinical success rate (RR, 1.26; 95% CI, 1.13-1.41; P less then 0.001; I = 79%), NDI success rate (RR, 1.16; 95% CI, 1.06-1.26; P = 0.001; I = 77%), neurological success rate (RR, 1.06; 95% CI, 1.03-1.10; P = 0.0004; I = 58%), and secondary surgery rate p (RR, 1.06; 95% CI, 1.03-1.09; P less then 0.001; I = 0%) but lower secondary surgery rate (RR, 0.44; 95% CI, 0.31-0.63; P less then 0.00001; I = 43%) compared with the ACDF group. There was no significant difference in the adverse event rate between the TDR group and Athe CDF group (RR, 0.44; 95% CI, 0.31-0.63; P less then 0.001; I = 43%). Conclusion From the meta-analysis, we conclude that the efficacy and safety of TDA are equivalent or superior to ACDF. TDR is associated with a higher overall success rate, NDI success rate, neurological success rate, reoperation rate and satisfaction rate compared with ACDF group. No differences exist in the risk of adverse event between the two groups. Level of evidence 3.Study design Retrospective analysis of inpatient and outpatient medical insurance claims data from a database containing over 100 million individuals. Objective To quantify the healthcare resource utilization (HCRU) of non-surgical treatments in the first 2 years after a chronic, refractory low back pain (CRLBP) diagnosis. Summary of background data Patients with persistent low back pain (LBP) despite conventional medical management and who are not candidates for spine surgery are considered to have chronic, refractory low back pain (CRLBP) and incur substantial healthcare costs over time. Few data exist on the HCRU of this specific population. Methods The IBM MarketScan Research databases from 2009 to 2016 were retrospectively analyzed to identify US adults with a diagnosis of non-specific LBP and without cancer, spine surgery, failed back surgery syndrome, or recent pregnancy. We required > 30 days of utilization of pain medications or non-pharmacologic therapies within both the 3-12- and 12-24-month period few patients. Level of evidence 3.Study design Retrospective database study. Objective To assess the intra- and post-operative complications of cervical laminoplasty and to evaluate the effect of intraoperative neuromonitoring use on postoperative limb paralysis incidence. Summary of background data Cervical laminoplasty is a known procedure for the management of cervical spondylotic myelopathy (CSM). Methods This was a retrospective study of 532 patients with CSM who underwent cervical laminoplasty between 2007 and the first quarter of 2016 using the Humana subset of the PearlDiver Database. The database was queried using the relevant International Classification of Diseases (ICD-9 and ICD-10) codes for CSM and Current Procedural Terminology (CPT) codes for cervical laminoplasty. The intra- and post-operative incidence of surgical and medical complications and reoperations was then determined and was compared to a propensity score-matched cohort of patients who had posterior laminectomy and fusion (490 patients in each group), using multivariate logistic regression analysis. Results Laminoplasty was associated with a lower incidence of dysphagia (OR = 0.37, 95% CI = 0.16 to 0.79; P = 0.014), 30-day readmission (OR = 0.51, 95% CI = 0.35 to 0.75; P less then 0.001), urinary tract infection (OR = 0.58, 95% CI = 0.37 to 0.93; P = 0.023), and incision and drainage, exploration or evacuation (OR = 0.28, 95% CI = 0.08 to 0.79; P = 0.026). The use of intraoperative neuromonitoring was associated with a non-significant lower incidence of limb paralysis within one and three months postoperatively (OR = 0.52 and 0.51, 95% CI = 0.23 to 1.19 and 0.23 to 1.11; P = 0.119 and 0.091, respectively). Conclusions Compared to posterior laminectomy and fusion, laminoplasty had lower rates of dysphagia, urinary tract infection and 30-day readmission. The use of intraoperative neuromonitoring was associated with a lower risk of postoperative limb paralysis, but it did not achieve statistical significance. Level of evidence 4.Study design Retrospective cohort study OBJECTIVE. The primary objective of our study was to evaluate the surgical outcomes and complications of minimally invasive surgery (MIS) versus open surgery in the management of intermediate to high grade spondylolisthesis, and secondarily to compare the outcomes following MIS in-situ fusion vs MIS reduction and open in-situ fusion vs open reduction subgroups. Summary of background data High-grade spondylolisthesis is a relatively rare spine pathology with unknown prevalence. TH-Z816 solubility dmso The optimal management and long-term prognosis of high-grade spondylolisthesis remain controversial. Methods A multicenter, retrospective cohort study of adult patients who were surgically treated for grade II or higher lumbar or lumbosacral spondylolisthesis from January 2008 until February 2019, was conducted. Results A total of 57 patients were included in this study. Forty cases were treated with open surgery and 17 with MIS. Specifically, 07 patients underwent MIS in-situ fusion, 11 patients ay be better addressed via traditional open surgery. Level of evidence 3.Study design A prospective follow-up study. Objective To investigate if early lumbar disc degeneration (DD) in young low back pain (LBP) patients predicts progression of degenerative changes, pain, or disability in a 30-year follow-up. Summary of background data MRI is an accurate method for studying degenerative changes in intervertebral discs. Decreased signal intensity (SI) can be used as indication of decreased water content. Long-term prognosis of early DD remains unclear. Methods In an earlier study, 75 conscripts aged 20 years with LBP, had their lumbar spine examined by MRI. At a follow-up of 30 years, the subjects were contacted; 35/69 filled a pain and disability questionnaire, and 26/35 were also re-examined clinically and by MRI. The images were evaluated for decreased SI and other degenerative changes. Association between decreased SI of a disc at baseline and the presence of more severe degenerative changes in the same disc space at follow-up was analyzed using Fisher's exact test. Association between decreased baseline SI and pain/disability scores from the questionnaire was analyzed with Kruskal-Wallis H test.