Traction For Low Backache With Or Without Sciatica: Is It Really Effective?

Cochrane Database Syst Rev. 2007 Apr 18;(2):CD003010. Update of: Cochrane Database Syst Rev. 2005;(4):CD003010.  TRACTION FOR LOW-BACK PAIN WITH OR WITHOUT SCIATICA. Clarke JA, van Tulder MW, Blomberg SE, de Vet HC, van der Heijden GJ, Bronfort G, Bouter LM.
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Surgery or physical activity in the management of sciatica: a systematic review and meta-analysis.Fernandez M, Ferreira ML,Refshauge KM, Hartvigsen J, Silva IR, Maher CG, Koes BW, Ferreira PH. Eur Spine J. 2016 Nov;25(11):3495-3512. Epub 2015 Jul 26.

PURPOSE: Previous reviews have compared surgical to non-surgical management of sciatica, but have overlooked the specific comparison between surgery and physical activity-based interventions.

METHODS: Systematic review using MEDLINE, CINAHL, Embase and PEDro databases was conducted. Randomised controlled trials comparing surgery to physical activity, where patients were experiencing the three most common causes of sciatica-disc herniation, spondylolisthesis and spinal stenosis. Two independent reviewers extracted pain and disability data (converted to a common 0-100 scale) and assessed methodological quality using the PEDro scale. The size of the effects was estimated for each outcome at three different time points, with a random effects model adopted and the GRADE approach used in summary conclusions.

RESULTS: Twelve trials were included. In the short term, surgery provided better outcomes than physical activity for disc herniation: disability [WMD -9.00 (95 % CI -13.73, -4.27)], leg pain [WMD -16.01 (95 % CI – 23.00, -9.02)] and back pain [WMD -12.44 (95 % CI -17.76, -7.09)]; for spondylolisthesis: disability [WMD -14.60 (95 % CI -17.12, -12.08)], leg pain [WMD -35.00 (95 % CI -39.66, -30.34)] and back pain [WMD -20.00 (95 % CI -24.66, -15.34)] and spinal stenosis: disability [WMD -11.39 (95 % CI -17.31, -5.46)], leg pain [WMD, -27.17 (95 % CI -35.87, -18.46)] and back pain [WMD -20.80 (95 % CI -25.15, -16.44)]. Long-term and greater than 2-year post-randomisation results favoured surgery for spondylolisthesis and stenosis, although the size of the effects reduced with time. For disc herniation, no significant effect was shown for leg and back pain comparing surgery to physical activity.

CONCLUSION: There are indications that surgery is superior to physical activity-based interventions in reducing pain and disability for disc herniation at short-term follow-up only; but high-quality evidence in this field is lacking (GRADE). For spondylolisthesis and spinal stenosis, surgery is superior to physical activity up to greater than 2 years follow-up. Results should guide clinicians and patients when facing the difficult decision of having surgery or engaging in active care interventions.

DOI: 10.1007/s00586-015-4148-y PMID: 26210309

Is Endoscopic Discectomy Superior To Conventional Open Discectomy? Unfortunately, meta-analysis of existing scientific evidence states that this “fashionable” approach is just an alternative to the conventional open discectomy!!!

Microendoscopic discectomy versus open discectomy for lumbar disc herniation: a meta-analysis. He J, Xiao S, Wu Z, Yuan Z. Eur Spine J. 2016 May; 25(5):1373-81. doi: 10.1007/s00586-016-4523-3. Epub 2016 Mar 21.

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When do you Need to Visit a Spine Surgeon?

A painful back is something that most individuals experience multiple times especially when they have been leading an active life. However, a niggling back pain or a twinge is not something that you are unduly worried about. You would just massage the affected area once or twice or apply a pain reliving ointment usually in such cases.

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Essential Items during Back Surgery Recovery

Opting for a spinal surgery and anticipating a healthy life minus the pain at the end of it is indeed something you look forward too. Yet just going to the best spine surgeon in India and having your back operated on does not make you eligible for full recovery automatically. There are several factors to consider once the surgery is over and done with. The top spine surgeons in Bangalore
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