Junming Ma

Is Extracorporeal Shock Wave Therapy Clinical Efficacy for Relief of Chronic, Recalcitrant Plantar Fasciitis? A Systematic Review and Meta-Analysis of Randomized Placebo or Active-Treatment Controlled Trials

OBJECTIVE To assess the efficacy of extracorporeal shockwave therapy (ESWT) and provide clinicians with an evidence base for their clinical decision making. DATA SOURCES PubMed, MEDLINE, Embase, Cochrane Central Register of Controlled Trials, and Evidence-Based Medicine Reviews. STUDY SELECTION All randomized or quasi-randomized controlled trials of ESWT for chronic recalcitrant plantar fasciitis were searched. Searching identified 108 potentially relevant articles; of these, 7 studies with 550 participants met inclusion criteria. DATA EXTRACTION Number of patients, population, body mass index, duration of symptoms, adverse effects, blinding method, and details of shockwave therapy were extracted. DATA SYNTHESIS For intervention success rate, ESWT of low intensity was more effective than control treatment of low intensity. For pain relief, the pooled data showed a significant difference between the ESWT and control groups. For function, only low-intensity ESWT was significantly superior over the control treatment. CONCLUSIONS The efficacy of low-intensity ESWT is worthy of recognition. The short-term pain relief and functional outcomes of this treatment are satisfactory. However, owing to the lack of a long-term follow-up, its long-term efficacy remains unknown.

New and Accurate Predictive Model for the Efficacy of Extracorporeal Shock Wave Therapy in Managing Patients With Chronic Plantar Fasciitis

OBJECTIVE To identify factors for the outcome of a minimum clinically successful therapy and to establish a predictive model of extracorporeal shock wave therapy (ESWT) in managing patients with chronic plantar fasciitis. DESIGN Randomized, controlled, prospective study. SETTING Outpatient of local medical center settings. PARTICIPANTS Patients treated for symptomatic chronic plantar fasciitis between 2014 and 2016 (N=278). INTERVENTIONS ESWT was performed by the principal authors to treat chronic plantar fasciitis. ESWT was administered in 3 sessions, with an interval of 2 weeks (±4d). In the low-, moderate-, and high-intensity groups, 2400 impulses total of ESWT with an energy flux density of 0.2, 0.4, and 0.6mJ/mm2, respectively (a rate of 8 impulses per second), were applied. MAIN OUTCOME MEASURES The independent variables were patient age, sex, body mass index, affected side, duration of symptoms, Roles and Maudsley score, visual analog scale (VAS) score when taking first steps in the morning, edema, bone spurs, and intensity grade of ESWT. A minimal reduction of 50% in the VAS score was considered as minimum clinically successful therapy. The correlations between the achievement of minimum clinically successful therapy and independent variables were analyzed. The statistically significant factors identified were further analyzed by multivariate logistic regression, and the predictive model was established. RESULTS The success rate of ESWT was 66.9%. Univariate analysis found that VAS score when taking first steps in the morning, edema, and the presence of heel spur in radiograph significantly affected the outcome of the treatment. Logistic regression drew the equation: minimum clinically successful therapy=(1+e[.011+42.807×heel spur+.109×edema+5.395×VASscore])-1.The sensitivity of the predictive factors was 96.77%, 87.63%, and 86.02%, respectively. The specificity of the predictive factors was 45.65%, 42.39%, and 85.87%, respectively. The area under the curve of the predictive factors was .751, .650, and .859, respectively. The Youden index was .4243, .3003, and .7189, respectively. The Hosmer-Lemeshow test showed a good fitting of the predictive model, with an overall accuracy of 89.6%. CONCLUSIONS This study establishes a new and accurate predictive model for the efficacy of ESWT in managing patients with chronic plantar fasciitis. The use of these parameters, in the form of a predictive model for ESWT efficacy, has the potential to improve decision-making in the application of ESWT.

Clinical characteristics and surgical treatment of spinal paraganglioma: A case series of 18 patients

BACKGROUND AND OBJECTIVES Paraganglioma rarely develops in the spine. With few cases reported, little knowledge about this disease was known. The objective of this study is to illustrate the clinical features, imaging manifestations, pathological appearances and long-term outcomes of the consecutive surgeries by literature review. METHODS The clinical and follow-up data of 18 patients who were diagnosed of spinal paraganglioma and treated with surgeries in our hospitals from 2003 to 2014 were retrospectively analyzed. RESULT A total of fourteen patients radiographed of intra-spinal tumor underwent extra-capsular tumor resection. Of five patients with obvious vertebral bone damage, four cases underwent piecemeal resection, and the left one with sacral tumor underwent en bloc tumor excision. Spinal reconstruction was performed in all cases. Follow-up lasted for 16-96 months (44.1 months on average). There was no local recurrence or distant metastasis in cases without obvious bone invasion. Of those five cases with vertebral bone damage, one case suffered and survived from the repeat relapse of T1 vertebral body tumor. Local recurrence was not observed in one case with T10 vertebral tumor after tumor resection, but the tumor metastasized to T2 attachment during the follow-up and was finally eradicated by re-operation. No tumor recurrence was observed in the left three cases. CONCLUSION Paraganglioma, usually benign, rarely occurs. Surgical resection, especially complete surgical resection, is preferred to treat spinal paraganglioma. Chemotherapy, radiotherapy, use of octreotide and other somatostatin are selected as adjuvant therapies, but their effects remain unknown.

The new Zero-P implant can effectively reduce the risk of postoperative dysphagia and complications compared with the traditional anterior cage and plate: a systematic review and meta-analysis

BackgroundThe low-profile angle-stable spacer Zero-P is a new kind of cervical fusion system that is claimed to limit the potential drawbacks and complications. The purpose of this meta-analysis was to compare the clinical and radiological results of the new Zero-P implant with those of the traditional anterior cage and plate in the treatment of symptomatic cervical spondylosis, and provides clinicians with evidence on which to base their clinical decision making.MethodsThe following electronic databases were searched: PMedline, PubMed, EMBASE, the Cochrane Central Register of Controlled Trials, Evidence Based Medicine Reviews, VIP, and CNKI. Conference posters and abstracts were also electronically searched. The efficacy was evaluated in intraoperative time, intraoperative blood loss, fusion rate and dysphagia.ResultsFor intraoperative time and intraoperative blood loss, the meta-analysis revealed that the Zero-P surgical technique is not superior to the cage and plate technique . For fusion rate, the two techniques both had good bone fusion, however, this difference is not statistically significant. For decrease of JOA and dysphagia, the pooled data showed that the Zero-P surgical technique is superior to the cage and plate technique.ConclusionsZero-P interbody fusion can attain good clinical efficacy and a satisfactory fusion rate in the treatment of symptomatic cervical spondylosis. It also can effectively reduce the risk of postoperative dysphagia and its complications. However, owing to the lack of long-term follow-up, its long-term efficacy remains unknown.