pain outcomes

Analysis of predictive factors for the efficacy of reinforced radiculoplasty in symptomatic sacral Tarlov cysts

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In a single-center retrospective cohort study (n=41) Jin Zhu et al. from the Beijing Jishuitan Hospital, published in Neurosurgical Review to assess clinical predictors of symptom improvement following reinforced radiculoplasty in patients with symptomatic sacral Tarlov cysts (TCs). Reinforced radiculoplasty significantly improves pain and numbness in sacral TC patients. Greater likelihood of pain-free status is associated with older age and lower preoperative VAS scores. No variables significantly predicted numbness relief 1).

Critical Review:

The study targets an underexplored treatment avenue—reinforced radiculoplasty—for symptomatic Tarlov cysts, an entity often managed conservatively due to unclear pathophysiology and outcome data. The authors utilize a small retrospective sample, limiting statistical power and generalizability. While binary logistic regression is appropriately applied, the absence of a control group and the reliance on telephone follow-ups raise concerns regarding recall bias and subjective assessment of outcomes. Furthermore, the study fails to delineate surgical technique variability or operator-dependence, critical factors in neurosurgical outcome studies. The lack of correlation with imaging changes and omission of bowel/bladder symptom stratification are notable limitations.

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Pain Relief, Disability, and Hospital Costs After Intradiscal Ozone Treatment or Microdiscectomy for Lumbar Disc Herniation: A 24-Month Real-World Prospective Study

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In a prospective real-world comparative study Sara Bisshopp et al. from Dr. Negrín University Hospital, Las Palmas published in the Journal of Clinical Medicine to compare clinical outcomes, hospital stay, and direct costs between initial intradiscal ozone treatment and standard microdiscectomy/discectomy in patients with lumbar disc herniation over a 24-month follow-up. Both groups experienced significant improvements in pain and disability scores. The ozone group had similar clinical outcomes to surgery but with significantly fewer surgical interventions (47% vs. 100%), shorter hospital stays, and reduced costs at 12 months 1).

Critical Appraisal

This study taps into a timely and pragmatic clinical question: Can minimally invasive ozone therapy reduce the surgical burden and costs while maintaining efficacy for lumbar disc herniation? While the 24-month prospective design and real-world context strengthen external validity, several methodological shortcomings temper enthusiasm.

First, the non-randomized design introduces considerable selection bias. The criteria for choosing ozone therapy vs. surgery, though labeled as “offered,” are not rigorously controlled. This self-selection can strongly influence outcomes. Second, sample size is modest (n=70), particularly when divided into two groups (32 ozone, 38 surgery), limiting statistical power.

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