RESUMO
Lumbar spinal stenosis refers to the narrowing of the spinal canal in the lumbar region. There is an increasing need to determine the treatment modality for lumbar spinal stenosis by comparing the outcomes of X-stop interspinous distractors and laminectomy. The objective of this study is to determine the effectiveness of the X-stop interspinous distractor compared to laminectomy. This systematic review fundamentally abides by the procedures delineated in the Cochrane methodology while the reporting is done according to the Preferred Reporting Items for Systematic Review and Meta-Analyses guidelines. Three databases searched generated a total of 943 studies, with PubMed being the source for the bulk of the articles. Six studies were selected for inclusion in this study. The effectiveness of the interspinous distractor devices and laminectomy can be determined through their impact on the quality of life, rates of complications, and the amount of money utilized. This meta-analysis fundamentally emphasizes that laminectomy is a more effective intervention for the treatment of lumbar spinal stenosis as it is more cost-effective and results in fewer complications in the long term.
RESUMO
Dysfunction of the cervical spine and its anatomical features, mostly innervated by the C1, C2, and C3 spinal nerves, can result in a secondary headache known as cervicogenic headache (CHA), mainly characterized by unilateral pain. The usefulness of pharmaceutical medications and physical therapy is currently the subject of scant literature. Interventional pain management techniques can be applied when conservative treatment is unsuccessful. This study looks at radiofrequency ablation (RFA) and epidural steroid injection (ESI) to identify their safety and efficacy in managing patients with cervicogenic headaches and neck pain. Three databases - PubMed, Cochrane CENTRAL Library, and Embase were searched, and 110 studies were identified. Nine screening processes were included for review and meta-analysis. Statistical evaluation was conducted through STATA version 17 (College Station, TX: StataCorp LLC) and effect measures were reported through random effects model risk ratios. The main subject of focus included three following outcomes: incidences of pain relief, degree and duration of pain, and incidences of adverse effects. The findings showed both interventions relieved pain by a factor of >50%, demonstrating a relative effects risk ratio of 1.45 (-0.50, 3.39) for RFA: pain relief, 84.76 (82.82, 86.69) RFA: adverse effects, and 19.46 (18.80, 20.11) ESI: pain relief at 95% confidence interval. The efficacy of RFA and ESI differ. Both interventions are effective in the reduction of cervicogenic headache pain intensity. However, their complication rates and pain duration are considerably different. With ESI, the headaches can still recur weekly, demanding the use of oral analgesics to deal with them. On the other hand, RFA has a low complication rate. Improving guidance from imaging technologies, RFA has the potential to be the most effective interventional treatment.