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김다현 김영문 김인겸 이동렬 이준원 임창진 정상훈 책임교수 엄상화

7. 김다현 김영문 김인겸 이동렬 이준원 임창진 정상훈 책임교수 엄상화. Comparison between MD and MED in VAS, MacNab and complications: Meta-analysis. 80%. Life-time prevalence of back p ain. * Adam and Victor’s Principles of Neurology, McGrew-hill, 2009. Herniated intervertebral disc.

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김다현 김영문 김인겸 이동렬 이준원 임창진 정상훈 책임교수 엄상화

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  1. 7 김다현 김영문 김인겸 이동렬 이준원 임창진 정상훈 책임교수 엄상화

  2. Comparison between MD and MED in VAS, MacNab and complications: Meta-analysis

  3. 80% Life-time prevalence of back pain * Adam and Victor’s Principles of Neurology, McGrew-hill, 2009

  4. Herniated intervertebral disc Most common in lumbar lesion

  5. Lumbar Discectomy • No response to conservative Tx. for 6wks • Early, progressive neurologic symptom Microsugicaldiscectomy (MD) Microendoscopicdiscectomy (MED)

  6. MD vs MED MD MED New technique Less bleeding Fast tissue recovery Short hospital stay Less Postop. pain • Standard • Short op. time • Wide indication

  7. Meta-analysis

  8. Weakness Process Hypothesis Strategy Collection Coding Analysis Conclusion • Qualitative research • Uneven article quality • Publication bias

  9. Method

  10. Search strategy • JAMA & Archives • PubMed • MEDLINE • EMBASE • Ovid • English • January, 2000~ September, 2010

  11. Selection of keywords

  12. Selection criteria

  13. VAS Visual Analogue Scale

  14. MacNab Excellent Free of pain No restriction of mobility Able to return to normal work and activities Occasional nonradicular pain Relief of presenting symptoms Able to return to modified work Some improved functional capacity Still handicapped and/or unemployed Continued objective symptoms of root involvement Additional operative intervention needed at the index level Irrespective of repeat or length of postoperative follow-up Good Fair Poor

  15. Complications MD MED Dysesthesia Dural tear CSF leakage Infection Hematoma • Dysesthesia • Dural tear • Patients transient urinary retention • Infection • Hematoma

  16. Quality assessment • Type of studies • Prospective, clinical trial • Retrospective + cohort • Retrospective • Journal grade • JAMA, NEJM, Lancet • SCI • Domestic, etc • : 1 point • : 0.8 point • : 0.6 point • : 1 point • : 0.8 point • : 0.6 point

  17. Stastistics • Tools • Excel 2007, PASW Statistics 18, MedCalc • Continuous measure (Mean-difference) • VAS • Crosstab • MacNab • Complications

  18. 8 VAS 82 to 8 14 MacNab 10 Cx.

  19. Study characteristics

  20. Study characteristics

  21. Result

  22. VAS

  23. MacNab Chi-square p-value = 0.001 Chi-square for trend = 0.002

  24. Complications p-value = 0.962 OR(MED/MD) = 1.010 (95% CI 0.67 – 1.51)

  25. Summary

  26. VAS MacNab Cx. No difference No difference No difference

  27. Limitation

  28. Limited language • Changed diagnostic criteria • Uneven article quality • Limited patient indication

  29. Conclusion

  30. World 1st • No difference • Health economics • RCT

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