El papel de la publicación tradicional de pruebas clínicas en la era de las modernas plataformas mediáticas / Theroleoftraditionalpublishingofclinicalevidenceintheageofmodernsocialmediaplatforms

Las redes sociales han revolucionado el uso de Internet. Según el Informe Digital de Estadísticas Globales de abril de 2022, hay unos 4.650 millones de usuarios de redes sociales en todo el mundo. 1 Este número equivale al 58,7 % de la población mundial, muchos de los cuales utilizan las redes sociales como principal fuente de información. ), youtube (2,2 mil millones), WhatsApp (2 mil millones), Instagram (2 mil millones), TikTok (1 mil millones), Snapchat (538 millones ), Pinterest (444 millones), Reddit (430 millones), Linkedin (250 millones) y Twitter (217 millones). Los cirujanos que están subiendo de rango son usuarios ávidos de las plataformas modernas de redes sociales o, al menos, son conscientes de ellos.

Socialmediahaverevolutionizedtheuseoftheinternet.Accord-ingtotheDigital2022AprilGlobalStatshotReport,therearesome4.65billionsocialmediausersworldwide.1Thisnumberistheequivalentto58.7%oftheglobalpopulation,manyofwhomareusingsocialmediaasaprimarysourceofinformation.Accordingtotheactiveusernumbers,themostpopularsocialmediaplatformsin2022areFacebook(2.9billion),youtube(2.2billion),WhatsApp(2billion),Instagram(2billion),TikTok(1billion),Snapchat(538million),Pinterest(444million),Reddit(430million),Linkedin(250million),andTwitter(217million).1SocialmediaisnotjustaU.S.phenomenonwhere84%ofAmericanshaveatleastoneoftheabove-listedsocialmediaaccounts.Thereareover1billionsocialmediausersinChina,despite415millionofitscitizenshavingnointernetaccess.1Mostyoungergenerationsoforthopedicsur-geonscominguptheranksareeitheravidusersofmodernsocialmediaplatformsorareatleastawareofthem

Rompiendo el efecto ''techo de cristal'' en la generación de evidencia clínica de alto nivel en ortopedia y traumatología / Breaking the "glass ceiling" effect in the generation of high-level clinical evidence in orthopedics and traumatology

Introduction: In clinical studies involving common orthopedic problems and traumatic injuries, randomization methods are difficult to orchestrate. The lack of high-level clinical evidence based on prospective, randomized, double-blind studies is often cited as a major reason for rejecting proposed therapeutic advances in orthopedic surgery. Materials and methods: This opinion document summarizes the limitations of clinical trials in surgical subspecialties. A consensus is presented about how the practicing orthopedic surgeon can produce high-quality clinical evidence and thus make changes to their clinical practice protocols. Results: This literature review revealed that level of evidence classifications vary among surgical subspecialties. Research in orthopedics and traumatology is primarily directed toward diagnosis, preferred treatment, and economic decision analysis, while other prognostic classifications are preferred in other areas, such as plastic surgery. In orthopedics, double-blind controlled studies are rare and often impractical or even unethical. Crossover between randomized surgical trials of study groups is more common. Other difficulties in surgical trials range from: lack of organizational and financial support, institutional approval or ethics committee and registration requirements for clinical trials, and to insufficient time outside of an already busy clinical program to dedicate to this laborious task. uncompensated task. Conclusion: Orthopedic surgery is a subspecialty based on experience and skill. Many innovations begin with enterprising surgeons reporting opinion reports or retrospective cohort studies, many of which are biased. Prospective observational cohort studies with consistent results may offer higher grade clinical evidence than poorly executed randomized trials.

Clinical results of XMR-assisted percutaneous transforaminal endoscopic lumbar discectomy.

BACKGROUND: Although percutaneous endoscopic lumbar discectomy (PELD) has shown favorable outcomes in the majority of lumbar discectomy cases, there were also some failures. The most common cause of failure is the incomplete removal of disc fragments. The skin entry point for the guide-needle trajectory and the optimal placement of the working sleeve are largely blind, which might lead to the inadequate removal of disc fragments. The objective of this study was to present our early experiences with image-guided PELD using a specially designed fluoroscope with magnetic resonance imaging-equipped operative suite (XMR) for the treatment of lumbar disc herniation. METHODS: This prospective study included 89 patients who had undergone PELD via the transforaminal approach using an XMR protocol. Pre- and postoperative examinations (at 12 weeks) included a detailed clinical history, visual analogue scale (VAS), Oswestry disability index (ODI), and radiological workups. The results were categorized as excellent, good, fair, and poor according to MacNab's criteria. At the final follow-up, the minimum follow-up time for the subjects was 2 years. The need for revision surgeries and postoperative complications were noted on follow-up. RESULTS: Postoperative mean ODI decreased from 67.4% to 5.61%. Mean VAS score for back and leg pain improved significantly from 4 to 2.3 and from 7.99 to 1.04, respectively. Four (4.49%) patients underwent a second-stage PELD after intraoperative XMR had shown remnant fragments after the first stage. As per MacNab's criteria, 76 patients (85.4%) showed excellent, 8 (8.89%) good, 3 (3.37%) fair, and 2 (2.25) poor results. Four (4.49%) patients had remnant disc fragments on XMR, which were removed during the same procedure. All of these patients had either highly migrated or sequestrated disc fragments preoperatively. Four (4.49%) other patients needed a second, open surgery due to symptomatic postoperative hematoma (n = 2) and recurrent disc herniation (n = 2). CONCLUSIONS: This prospective analysis indicates that XMR-assisted PELD provides a precise skin entry point. It also confirms that decompression occurs intraoperatively, which negates the need for a separate surgery and thus increases the success rate of PELD, particularly in highly migrated or sequestrated discs. However, further extensive experience is required to confirm the advantages and feasibility of PELD in terms of cost effectiveness.

Modified transcorporeal anterior cervical microforaminotomy assisted by O-arm-based navigation: a technical case report.

This study was done to present our surgical experience of modified transcorporeal anterior cervical microforaminotomy (MTACM) assisted by the O-arm-based navigation system for the treatment of cervical disc herniation. We present eight patients with foraminal disc herniations at the C5-C6, C6-C7, and C7-T1 levels. All patients had unilateral radicular arm pain and motor weakness. The inclusion criteria for the patients were the presence of single-level unilateral foraminal cervical disc herniation manifesting persistent radiculopathy despite conservative treatment. Hard disc herniation, down-migrated disc herniation, concomitant moderate to severe bony spur and foraminal stenosis were excluded. We performed MTACM to expose the foraminal area of the cervical disc and removed the herniated disc fragments successfully using O-arm-based navigation. Postoperatively, the patients' symptoms improved and there was no instability during the follow-up period. MTACM assisted by O-arm-based navigation is an effective, safe, and precise minimally invasive procedure that tends to preserve non-degenerated structures as much as possible while providing a complete removal of ruptured disc fragments in the cervical spine.

Risk of developing seizure after percutaneous endoscopic lumbar discectomy.

STUDY DESIGN: A retrospective analysis in patients who underwent percutaneous endoscopic lumbar discectomy (PELD) and developed seizures during the procedure; and to identify the risk of developing seizure during PELD by measuring cervical epidural pressure. OBJECTIVE: To evaluate clinical significance, characteristics, and risk factors for developing seizure and neck pain in patients undergoing PELD. SUMMARY AND BACKGROUND DATA: Increased epidural pressure during PELD has been reported earlier. Risk of developing intraoperative seizure has not been investigated till date. We experienced some unexpected complication such as, seizures during PELD, and, therefore, we correlated it with the prodromal symptom and the strategies to avoid such complications during PELD. METHODS: Four of the total 16,725 patients who underwent PELD between 2000 and 2008 developed intraoperative seizures. A review of their medical records and radiologic files were correlated with the complication. Factors evaluated were the type of seizures, prodromal symptoms, comorbidities and clinical outcome. To postulate a pathophysiologic cause of seizure, we designed a study to monitor the intraoperative cervical epidural pressure in 33 patients undergoing PELD. RESULTS: A striking feature of the 4 patients in this series was that they all complained of neck pain before the seizure event. There was no identifiable pattern of seizure observed. The duration of the procedure in these patients was longer than uninvolved cases. None of the patients developed any type of sequel subsequent to seizure. The outcome of surgery has been similar with the patients that did not have any type of complications after PELD. In the subsequent study of cervical epidural pressure, no patients developed seizure. However, there was occurrence of neck pain in the group with increased cervical epidural pressure. CONCLUSIONS: Although rare (0.02%), seizure can occur in patients undergoing PELD, occurrence of neck pain is correlated with increase in cervical epidural pressure, which should be considered as prodromal sign and alert the surgeon. Duration of procedure and speed of infusion are associated risk factor.

Discectomia endoscópica percutânea cervical: 16 anos de experiência e revisão da literatura / Discectomía endoscópica percutánea cervical: 16 años de experiência y revisión de la literatura / Percutaneous endoscopic cervical discectomy: 16 years of experience and literature review

The advancement of the percutaneous endoscopic lumbar discectomy (PECD) and its clinical success have led to similar minimally invasive approaches to the cervical spine. The goal of PECD is the decompression of the cervical nerve root through a direct endoscopic visualization, removing the herniated mass and shrinking the nucleous pulposus with the use of microforceps and holmium: yttrium-aluminum-garnet (Ho:YAG) laser. The senior author have performed PECD with cervical laser assisted endoscopy since 1993. The PECD is indicate to patients with constrained or unconstrained soft herniated cervical disc, positive provocative test, and no bony spur larger than 2 mm, regardless of the herniation size. The authors described the surgical technique of PECD and report their 16 years of experience in the endoscopic treatment of the herniated cervical disc.

O avanço da discectomia endoscópica percutânea lombar e seu sucesso clínico levaram a abordagens minimamente invasivas para a coluna cervical. O objetivo da discectomia endoscópica percutânea cervical é o de descomprimir a raiz do nervo cervical por meio de uma visualização endoscópica direta, eliminando o fragmento herniado e diminuindo o núcleo pulposo, com o uso de fórceps e micro Hólmio: ítrio-alumínio-granada (Ho:YAG) laser. A discectomia endoscópica percutânea cervical com laser tem sido utilizada desde 1993 e é indicada nos pacientes com hérnia de disco, contida ou não, teste provocativo positivo e ausência de osteófito maior que 2 mm, independentemente do tamanho da hérnia. Os autores descreveram a técnica cirúrgica de discectomia endoscópica percutânea cervical e relataram 16 anos de experiência no tratamento endoscópico do disco cervical herniado.

El avance en la discectomía endoscópica percutánea lumbar y su triunfo clínico llevaron a abordajes mínimamente invasivos en la columna cervical. El objetivo de la discectomía endoscópica percutánea cervical es descomprimir la raíz del nervio cervical, por una visualización endoscópica directa, eliminando el fragmento herniado y disminuyendo el núcleo pulposo, con el uso de fórceps y micro Holmio: itrio-aluminio-granada (Ho:YAG) laser. La discectomía endoscópica percutánea cervical con laser ha sido utilizada desde 1993. Esta es indicada en pacientes con hernia discal contenida o no, test provocativo positivo, ausencia de osteofitos mayores que 2 mm, independientemente del tamaño de la hernia. Los autores describen la técnica quirúrgica de discectomía endoscópica percutánea cervical y relatan 16 años de experiencia en el tratamiento endoscópico de disco cervical herniado.