Nonsurgical Treatments Research Articles

Progress in MGJWS: A 74-Year Review of Marcus Gunn Jaw-Winking Syndrome.

We present an overview of the epidemiology and differential diagnosis of Marcus Gunn jaw-winking syndrome. We scrutinize various hypotheses regarding its etiology and pathogenesis, encompassing abnormal nerve connections, heredity factors, genetic variation, and the release hypothesis, as proposed in prior studies. Furthermore, we discuss the clinical manifestations of Marcus Gunn jaw-winking syndrome and highlight cases with exceptional clinical presentations or concurrent diseases. Moreover, we not only describe the existing surgical and nonsurgical treatments for Marcus Gunn jaw-winking syndrome but also delineate therapies for related conditions such as Meige syndrome, sequelae of facial paralysis, and other oculopalpebral and facial synkinesis. This comprehensive approach serves as a valuable reference for the holistic management of Marcus Gunn jaw-winking syndrome.

Effectiveness of Brandt-Daroff exercises in benign paroxysmal positional vertigo: a systematic review

IntroductionBenign Paroxysmal Positional Vertigo (BPPV) is defined as a disorder of the inner ear characterised by repeated episodes of positional vertigo. BPPV is one of the most prevalent vestibular disorders in the general population, accounting for one-third of all vestibular disorders. The prevalence of BPPV is higher in females than males and this prevalence increases with increasing age. The common non-surgical treatments of BPPV are repositioning manoeuvres and habituation exercises. This review aimed to explore the effectiveness of Brandt-Daroff exercises in patients with BPPV.MethodsTwo search engines, PubMed and Cochrane, were used. Articles focusing on Brandt-Daroff exercises as management of BPPV were included in this review. All articles were published in English and results up to February 2023 were included.ResultsEpley’s repositioning manoeuvre is a better treatment option for posterior canal BPPV. Epley’s manoeuvre is more effective if applied alone as compared to its application along with Brandt-Daroff exercises or with medication. Epley’s manoeuvre was more effective than any other repositioning manoeuvre, such as the Semontmanoeuvre. The application of Brandt-Daroff was ineffective when applied alone. However, it was effective when applied in combination with the Cawthorne-Cooksey exercises in reducing the symptoms of BPPV.ConclusionsBrandt-Daroff exercises have inconsistent results in the treatment of BPPV; hence, high-quality randomised controlled trials should be carried out to investigate their efficacy.

Clinical case report of non-surgical and surgical endodontic treatment (apicoectomy)

Endodontic treatment, both non-surgical and surgical, aims to eliminate the neurovascular bundle and the microbiota present within the root canal system and the extraradicular region. This study reports the clinical management of a 31-year-old female patient with odontalgia in tooth #46. Following clinical and radiographic evaluation, a periapical radiolucent lesion approximately 5 mm in diameter was identified. Initially, conventional endodontic treatment was performed using the Reciproc Blue mechanized system, followed by an apicoectomy due to persistent symptoms associated with a high bacterial load. The therapeutic approach was based on the review of 12 scientific articles to establish an accurate pulp and periapical diagnosis and to select appropriate techniques and materials. Treatment outcomes demonstrated adequate healing and periapical repair, with resolution of clinical symptoms and functional improvement of the treated tooth. It is concluded that the integration of non-surgical and surgical treatments is essential in cases of pulp necrosis and chronic periapical abscess with high bacterial load. This complementary approach optimizes therapeutic outcomes, preserves the tooth, and improves the patient’s quality of life

Efficacy of adjunctive systemic or local antibiotic therapy in peri-implantitis: a systematic review and meta-analysis of randomized controlled clinical trials.

This systematic review and meta-analysis considered the results of randomized controlled clinical trials (RCTs) to evaluate the efficacy of systemic or local antibiotic therapy in peri-implantitis. Two independent authors screened publications from three electronic databases to include RCTs meeting all the inclusion and exclusion criteria. A meta-analysis was performed to evaluate the weighted mean differences in survival rate (SR) and changes in pocket probing depth (PPD), bone level (BL), and clinical attachment level (CAL). The study cohorts were defined as antibiotic and control groups with subgroups for analysis. Seven studies including 309 patients (390 implants) were considered. Within the limitations of this review, patients in the antibiotic groups exhibited significant improvements in PPD. Subgroup analysis indicated that the administration of systemic antibiotics or the use of antibiotics in non-surgical treatments did not result in a significant alteration in BL. It was established that the addition of antibiotics can ameliorate PPD and SR in the treatment of peri-implantitis, whether through surgical or non-surgical approaches, and also shows moderate performance regarding BL and CAL. Considering the lack of application of new technologies in the control group and the hardship of assessing the potential risks of antibiotics, careful clinical judgment is still necessary.

Current Trends in Deep Plane Neck Lifting: A Systematic Review.

The aging neck is a prevalent aesthetic concern, with over 160,000 neck procedures performed in 2020. It is characterized by increased soft tissue laxity and displacement of cervical structures. While nonsurgical interventions like cryoablation and laser resurfacing show promise, their variable responses highlight the necessity for surgical solutions. Traditional neck lifts address superficial structures but often neglect the subplatysmal plane. Recently, deep plane neck lifts have gained attention for addressing deeper anatomical structures. This paper systematically reviews the literature on subplatysmal modifications in cervicoplasty, aiming to clarify the risks and benefits of these evolving surgical techniques. On February 20, 2024, a systematic review adhering to Preferred Reporting Items for Systematic Review and Meta-Analyses 2020 guidelines was performed. MEDLINE, PubMed, Cochrane, and Scopus databases were searched for terms related to neck rejuvenation. Independent reviewers screened titles, abstracts, and full texts, including all relevant studies. Data extracted included patient numbers, procedures, outcomes, and complications. From an initial 771 articles, 57 studies encompassing 8648 patients met inclusion criteria. The most commonly altered anatomical structures during "deep plane" neck lift (DPNL) were the submandibular gland (69.9%), digastric muscles (58.6%), and subplatysmal fat (48.6%). Postoperative complications were reported in 59.6% of studies, with nerve palsy (0.2%-12%) and hematoma (0.2%-4%) being most common. Aesthetic outcomes were less frequently reported (56% of studies); patient satisfaction ranged from 81.6% to 98.6%, while objective measures were reported in only 12% of studies. Recent surveys indicate a growing concern over excess laxity under the chin, with patients increasingly seeking neck rejuvenation. Our review found that DPNL techniques vary widely, with the submandibular gland and digastric muscles being the most frequently altered structures. Despite a general lack of standardized outcome measures, patient satisfaction was high. However, DPNL showed a higher rate of postoperative nerve palsy compared to traditional neck lift. Overall, while DPNL demonstrates potential aesthetic benefits, the increased risk necessitates thorough patient counseling and further studies for standardization and comparison.

Unconventional Remedies for Squamous Cell Carcinoma: A Journey into Alternative Treatments.

Squamous cell carcinoma (SCC) is the second most common form of skin cancer and is typically found on sun-exposed skin. Risk factors include ultraviolet radiation exposure, older age, fairer complexion, smoking, and immunosuppression. SCC is a slow-growing tumor with the possibility of metastasis if not treated. The clinical presentation can range from a dry, scaly erythematous patch or plaque to a firm hyperkeratotic papule, plaque, or nodule, depending on the histological type via biopsy. The first-line therapies for SCC removal are standard excision and Mohs microscopic surgery; however, there are novel and alternative non-surgical options being considered for the treatment of SCC. This review summarizes the current guidelines for treating low-risk and high-risk SCC and discusses rare, experimental, and anecdotal non-surgical treatments for SCC in the literature.

Radiomics-based nomogram for predicting total knee replacement in knee osteoarthritis patients

BackgroundThe incidence of total knee replacement (TKR) surgeries has increased, partly attributed to healthcare policies that cause premature and potentially unwarranted interventions. This has raised concerns regarding a potential trend of excessive surgeries. PurposeThis study aimed to propose a predictive model based on digital radiography (DR) radiomics to objectively assess the need for TKR surgery in patients with knee osteoarthritis (KOA) and to improve risk stratification, thereby avoiding unnecessary surgeries. MethodsA retrospective study was conducted on 1,785 KOA patients from January 2017 to December 2022. Radiomics features were extracted from DR images to quantify lesion phenotypes, followed by a two-step feature selection to derive robust signatures. Multiple models were constructed using independent risk factors and radiomics features, and these models were validated using logistic regression. The performance of the models was evaluated via receiver operating characteristic (ROC) curves, area under the curve (AUC), calibration curves, and decision curve analysis. A multivariable Cox regression-derived nomogram was used to predict operation-free survival (OFS), and the patients were categorized into high- or low-risk groups based on risk stratification. Kaplan-Meier curves were used to compare OFS between the two groups. ResultsDuring a follow-up period of at least one year, 962 of 1785 (53.89 %) patients underwent TKR. Age, presence of radiographic KOA (RKOA), and Kellgren–Lawrence (KL) grading were identified as independent risk factors for OFS. The combined RKOA model (including age, presence of RKOA, and Radscore; AUC = 0.969) and combined KL model (including age, KL grading, and Radscore; AUC = 0.968) showed similar performance, with both significantly outperforming other models (p < 0.001). The 1-, 2-, and 3-year AUCs for the RKOA nomogram were 0.891, 0.916, and 0.920, respectively, whereas those for the KL nomogram were 0.890, 0.914, and 0.931. The thresholds of 68.92 (RKOA nomogram) and 64.41 (KL nomogram) were derived from the median nomogram scores and used to stratify patients into high- and low-risk groups. K–M curves demonstrated that the risk stratification system effectively distinguished between high- and low-risk groups, with the high-risk group being more likely to require TKR. ConclusionsTwo nomograms incorporating age, RKOA (or KL grading), and Radscore were developed to predict 3-years OFS for KOA patients and establish risk thresholds, potentially guiding personalized non-surgical treatments during the OFS period.

Quantifying menorrhagia and overview of nonsurgical management of heavy menstrual bleeding.

Heavy menstrual bleeding (HMB) is a common problem, presenting in 1 in 5 females. The quantification of menstrual blood loss and the subsequent treatment of HMB are both nuanced tasks that require the physician to consider the patient perspective. The individualization of care and transition to methods that fit each individual patient are critical to building a successful relationship with the patient to facilitate follow-up care and evaluation of response to treatment. In this review we outline various methods of quantification of menstrual blood loss, including considerations of accuracy and practicality. These methods, all of which have the potential for clinical benefit, vary from pictorial assessment charts to the gold standard alkaline hematin method to asking the patient about their average amount of blood loss and how it affects their quality of life. Next, we outline nonsurgical treatments for HMB, including hormonal and nonhormonal options, and consider the potential for success, as well as treatment considerations and contraindications. Overall, options for the evaluation and nonsurgical management of menstrual blood loss and HMB are presented along with quality-of-life considerations.

How do non-surgical treatments compare with surgery for people with carpal tunnel syndrome (CTS)?

How do non-surgical treatments compare with surgery for people with carpal tunnel syndrome (CTS)?

The Initial Exploration of Polidocanol Sclerotherapy for the Treatment of Axillary Osmidrosis: A Retrospective Study

BACKGROUND Axillary osmidrosis (AO) is a strong, unpleasant odor that originates from the apocrine axillary glands. Treatments of AO include surgical treatment and nonsurgical treatment. The surgical procedure yields effective results with a low recurrence rate but requires a longer recovery time and has more postoperative complications. Nonsurgical treatments are minimally invasive and safe, but short-term recurrence may occur in some cases. OBJECTIVE Polidocanol sclerotherapy was first described for management of AO. This retrospective study explored the clinical efficacy in relieving symptom of AO assessed by AO severity using the axillary osmidrosis grading system and safety of polidocanol sclerotherapy in treating AO. PATIENTS AND METHODS This retrospective study included 25 patients with AO single-site study, with 12 patients receiving polidocanol (1%) sclerotherapy (the polidocanol group) and 13 receiving botulinum toxin A (BTX-A) injection (the BTX-A group). The short-term efficacy (7 days after injection), the long-term efficacy (6 months after injection), the recurrence rate, and complications were compared between the 2 groups. A p-value of &lt;0.05 was considered statistically significant. RESULTS The short-term efficacies of polidocanol sclerotherapy and BTX-A injection were 100% and 69.2%, which was not clinically significant (p &gt; .05), whereas their long-term efficacies were 100% and 46.2%, respectively (p &lt; .05). The recurrence rates in the polidocanol and BTX-A groups were 25.0% and 84.6%, respectively (p &lt; .05). The complications did not differ significantly between the 2 groups (p &gt; .05). Although the short-term efficacy and complications were comparable between the 2 groups, the long-term efficacy of polidocanol sclerotherapy was superior to BTX-A injection. The polidocanol group has a lower recurrence rate than the BTX-A group. CONCLUSION Polidocanol sclerotherapy may provide an effective and safe treatment with longer efficacy compared to toxin, which is an effective and safe option for AO treatment.

Knee4Life: Empowering Knee Recovery After Total Knee Replacement Through Digital Health Protocol.

Pain and knee stiffness are common problems following total knee replacement surgery, with 10-20% of patients reporting dissatisfaction following their procedure. A remote assessment of knee stiffness could improve outcomes through continuous monitoring, facilitating timely intervention. Using machine learning algorithms, computer vision can extract joint angles from video footage, offering a method to monitor knee range of motion in patients' homes. This study outlines a protocol to provide proof of concept and validate a computer vision-based approach for measuring knee range of motion in individuals who have undergone total knee replacement. The study also explores the feasibility of integrating this technology into clinical practice, enhancing post-operative care. The study is divided into three components: carrying out focus groups, validating the computer vision-based software, and home testing. The focus groups will involve five people who underwent total knee replacement and ten healthcare professionals or carers who will discuss the deployment of the software in clinical settings. For the validation phase, 60 participants, including 30 patients who underwent total knee replacement surgery five to nine weeks prior and 30 healthy controls, will be recruited. The participants will perform five tasks, including the sit-to-stand test, where knee range of motion will be measured using computer vision-based markerless motion capture software, marker-based motion capture, and physiotherapy assessments. The accuracy and reliability of the software will be evaluated against these established methods. Participants will perform the sit-to-stand task at home. This will allow for a comparison between home-recorded and lab-based data. The findings from this study have the potential to significantly enhance the monitoring of knee stiffness following total knee replacement. By providing accurate, remote measurements and enabling the early detection of issues, this technology could facilitate timely referrals to non-surgical treatments, ultimately reducing the need for costly and invasive procedures to improve knee range of motion.

Nonfacial Skin Rejuvenation of the Neck, Chest, and Hands. Part Two: Using Laser Techniques.

Interest in aesthetic procedures that help maintain a youthful look is on the rise. While many nonsurgical techniques focus on facial rejuvenation, there is a need for a detailed review of treatments, specifically for nonfacial areas. This review explores various clinic-based methods for revitalizing the neck, chest, and hands, with a particular emphasis on different laser treatments. For this second part of the review, we conducted a comprehensive search on PubMed to evaluate the effectiveness of various laser treatments. The review covers treatment parameters such as wavelength, fluence, and pulse, along with outcomes, follow-up care, and potential side effects. A discussion on the role of sclerotherapy in treating these areas was also included. This article compiles recent findings on the safety and effectiveness of these treatments, showcasing progress in laser technologies and the growing trend of noninvasive body rejuvenation. It offers practical insights for both practitioners and patients looking for reliable options in nonsurgical body treatments.

A Very Low-Calorie Ketogenic Diet Approach for Post-Bariatric Weight Regain: A Pilot Study

Weight regain (WR) after bariatric surgery, particularly sleeve gastrectomy, is a significant challenge, often driven by a combination of metabolic, behavioral, and lifestyle factors. Non-surgical interventions to manage WR are critical, given the increased risks and reduced efficacy of revisional surgeries. In this context, very low-calorie ketogenic diets (VLCKDs) have gained attention for their potential to promote weight loss and improve body composition in individuals struggling with WR. This study assessed the safety and efficacy of a VLCKD in 11 patients who experienced WR following sleeve gastrectomy. Over an 8-week period, patients demonstrated a significant average weight loss of 6.3% (p = 0.005), along with improvements in body composition, including reductions in body fat percentage (p = 0.003) and waist circumference (p = 0.003). Metabolic markers, such as insulin resistance (HOMA-IR), also improved significantly (p = 0.041). Although a decrease in the glomerular filtration rate was observed (p = 0.007), this finding is unlikely to be clinically relevant over the short term. Importantly, no major adverse events were reported, with only mild constipation observed. These results suggest that VLCKDs may be a promising non-surgical approach for managing WR post-bariatric surgery, though further studies are needed to assess long-term effects, especially on renal function.

Shaking Up Essential Tremor: Peripheral Devices and Mechanical Strategies to Reduce Tremor.

This review discusses non-pharmacological, non-surgical interventions for action tremor, including essential tremor (ET). We review transcutaneous peripheral nerve stimulation (PNS), a variety of orthotic/mechanical devices, cooling and vibration strategies, and adaptive utensils, most of which are currently available. The PNS section discusses open loop (CALA-Trio) and closed loop systems (Felix™, NeuroAI™ and Motimove® systems). Orthotic devices which physically dampen tremor include Tremulo™, GyroGlove™, WOTAS exoskeleton, Magnetorheological Fluid-Based Exoskeleton System, Steadi-One® and Steadi-Two®, and Readi-Steady®. Adaptive devices include weighted spoons, deep cavity spoons, counter-balance utensils, and electrical actuator devices. Despite availability, most of these devices have limited to no published clinical trial data.

Possible treatments for synchronous bilateral small renal masses

Currently, there is no established consensus on the best treatment approach for patients with bilateral synchronous renal masses (BSRM). The timing and method of managing these cases remain subjects of debate. This review aims to summarize the available literature and explore the ongoing controversies surrounding this topic. Three studies investigated non-surgical treatments within BSRM. Specifically, one study focused on active surveillance (AS) and showed no statistical differences in terms of progression and development of metastatic disease relative to their unilateral counterpart. Two studies investigated ablative techniques showing promising results. Eight papers have been published regarding robot assisted partial nephrectomy (RAPN) for BSRM. All these papers highlighted the safety, feasibility, and efficacy of bilateral RAPN for BSRM. Literature regarding treatments other than surgery such as AS and ablative therapies (ATs) for BSRM is scarce, but promising. Progression, rate of metastases and survival of BSRM are similar to unilateral disease, and AS is a safe option in these cases. Few studies focused on RAPN related outcomes for BSRMs, but all confirmed the safety, feasibility, and efficacy of this procedure. Finally, one step RAPN resulted as feasible as the two staged procedures, especially when selective clamping techniques can be chosen.

Nonsurgical Interventions for Gender-Affirming Facial Feminization: A Scoping Review.

Importance: Systematic review will improve understanding of nonsurgical facial feminization techniques, which are useful alternatives or adjuncts to surgical gender affirmation. Objective: To determine the effectiveness of nonsurgical facial feminization techniques in patients seeking gender-affirming feminization by reviewing the literature for patient-reported, subjective, and objective outcomes of feminization. Evidence Review: A comprehensive database search was conducted through July 28, 2022. A total of 264 titles and abstracts were screened by two independent reviewers in Covidence. Of all, 48 met the inclusion criteria for full-text review, and 20 articles were included in the final data extraction. Findings: The most described nonsurgical facial feminization techniques were neurotoxins, fillers, and hair removal. Techniques were derived from cisgender cosmetic procedures to achieve feminine qualities. The most common study type was expert opinion or literature reviews. There were only two studies that analyzed measurable nonsurgical facial feminization techniques. Conclusions and Relevance: There is a lack of high-quality prospective research and randomized, controlled trials specific to the transgender patient population that evaluate outcomes, patient satisfaction, or complications. Such studies are needed to inform evidence-based practices.

Xanthogranulomatous Cholecystitis: A Retrospective Review of Clinical Diagnosis and Treatment from a Single Center.

The objective of this study was to evaluate and compare the histopathological, clinical, and treatment characteristics of xanthogranulomatous cholecystitis (XGC) in patients undergoing cholecystectomy at a single center. Aim: We aim to enhance the understanding of its presentation and improve its differential diagnosis from other gallbladder pathologies. Methods: We retrospectively reviewed 6783 cholecystectomy cases performed between January 2015 and January 2023 at the General Surgery Clinic of Haydarpaşa Numune Training and Research Hospital, and a diagnosis of xanthogranulomatous cholecystitis was histopathologically established in 131 patients. In this retrospective study, we examined the clinicopathological characteristics, preoperative imaging methods and findings, histopathological images, surgical procedure methods, and postoperative complications of 131 patients. Results: The study included 131 patients, with ages ranging from 18 to 88 years, of which 74 (56.5%) were female and 57 (43.5%) were male. Ultrasound imaging was performed on 128 patients. Ultrasound imaging revealed wall thickening in 72.7% of cases, hypoechoic nodules in 13.3%, biliary tract pathologies in 10.9%, and adenomyomatosis in 3.1%. A total of 59 cases had MRI. On MRI, wall thickening was observed in 50.8% of cases, biliary tract pathologies in 33.9%, adenomyomatosis in 10.2%, hypoechoic nodules in 3.4%, and hypoechoic nodules + wall thickening (HN + WT) in 1.7%. Histopathological diagnosis was diffuse in 79.4% of cases and focal in 20.6%. In addition to cholecystectomy, non-surgical interventions were not required in 77.1% of the cases, while 11.5% underwent ERCP, 9.2% underwent percutaneous procedures, 1.5% underwent both ERCP and percutaneous procedures, and 0.8% underwent other non-surgical interventions. Of the surgeries, 93.1% were elective and 6.9% were emergency. Postoperative complications were not observed in 84% of the patients; 5.3% experienced surgical complications, 5.3% had surgical site infection, and 5.3% had other complications (pneumonia and urinary infection). The length of hospital stay ranged from 0 to 26 days, with a mean of 5.27 ± 4.59 days and a median of 4 days. Conclusions: Xanthogranulomatous cholecystitis is a rare disease of the gallbladder with no characteristic radiological or clinical findings and can often be confused with gallbladder cancer. Further studies involving larger populations are needed to improve the preoperative diagnosis.

Evaluation of Treatment Strategies for Patients with Stage IIIA Non-Small Cell Lung Cancer in the Immunotherapy Era

BackgroundOptimal treatment for patients with stage IIIA NSCLC is controversial. Growing evidence indicates surgery with adjuvant or neoadjuvant chemotherapy (SC) may be superior to non-surgical treatments. Direct comparisons have not been performed between SC and chemoradiation with immunotherapy (CRI) among patients diagnosed with stage IIIA NSCLC since consolidation immunotherapy was added to treatment guidelines. MethodsThis retrospective study compared surgical and systemic non-surgical treatments (except targeted therapy) among adults diagnosed with stage IIIA NSCLC 2017-2021. Data was from ConcertAI's curated EHR Patient360™ NSCLC real-world care product. Real-world progression-free survival (rwPFS) and overall survival (rwOS) were evaluated among patients treated with SC or CRI using Kaplan-Meier and Cox proportional hazard methods. Baseline differences were balanced using propensity score-derived inverse probability treatment weights (IPTW). ResultsAmong 1718 eligible, the two main comparator groups (SC and CRI) had 431 (25%) and 576 (34%) patients; 711 patients received chemoradiation or monotherapy. A wide range of treatment strategies was observed across included oncology clinics (e.g., 0–67% clinic patients received surgery). IPTW-adjusted analyses showed reduced hazards in the SC group vs. CRI for rwPFS (HR 0.78, 95% CI: 0.63–0.97) and rwOS (HR 0.63, 95% CI: 0.49–0.82). SC was similarly beneficial for patients across nodal status groups and appeared especially beneficial for patients with resectable squamous-cell tumors. ConclusionStage IIIA NSCLC treatment is highly variable. Real-world studies can provide valuable evidence to support surgery as a treatment option for stage IIIA patients, who currently may only be offered chemoradiation with or without immunotherapy.

Achilles Tendon Pain in Male Professional Football Players - A Prospective Five-Season Study of 88 Injuries from the UEFA Elite Club Injury Study.

The objective was to describe the location, examination procedures, diagnoses, and treatment for gradual-onset Achilles tendon pain in male professional football (soccer) players. Forty-seven teams were followed prospectively for at least one season from 2013/14 to 2017/18. Time-loss injuries were recorded by the teams' medical staffs. For all non-contact Achilles tendon injuries, a specific Achilles tendon form was sent to teams. There were 88 time-loss injuries recorded with gradual-onset Achilles tendon pain amongst 72 players; 22 (25%) of them were severe lasting more than four weeks including one career-ending injury. The specific form was returned for 78 injuries (89%) with 55 cases (71%) having midportion and 23 cases (29%) insertional pain. There were 51 cases (65%) being examined with ultrasound and 29 cases (37%) with magnetic resonance imaging, both modalities being used in 18 cases (23%). Tendinopathy was the most frequently reported main diagnosis both for midportion and insertional pain with 60 cases (77%), but multiple diagnoses were recorded in 21 cases (27%). Surgery was performed in six cases (8%), and the majority of players were exposed to several non-surgical treatments in various combinations, with eccentric training and cryotherapy being most frequent with 52 cases (72%) each. Tendinopathy was the most frequent diagnosis both for midportion and insertional pain. Imaging was carried out for most injuries. A majority of injuries were managed non-surgically, with eccentric training and cryotherapy being the most frequently applied treatments.

Non-surgical treatment for tandem spinal stenosis: a systematic review protocol

BackgroundTandem Spinal Stenosis (TSS) is a disease characterised by the narrowing of the spinal canal in two or more non-adjacent areas of the spine, often affecting both the cervical and lumbar vertebrae. Doctors and patients increasingly favour non-surgical treatments that have the function of relieving symptoms and improving outcomes. This systematic review aims to evaluate the effectiveness and safety of non-surgical therapies for TSS and comprehensively summarise existing evidence.Methods and analysisWe will conduct comprehensive searches, both manual and electronic, of literature published up to 30 September 2024; database searches will commence after the publication of this agreement, with an estimated commencement date of 1 December 2024, and the end date is 31 May 2025, without language restrictions. Key databases such as MEDLINE, PubMed, EMBASE, Web of Science, Cochrane Library, WHO International Clinical Trial Registration Platform, China National Knowledge Infrastructure, China Biomedical Literature Database, China Scientific Journal Database and Wan-Fang Database will be explored. In addition, we will include resources such as library journals and conference abstracts. Following the identification and screening of all randomised controlled trials focusing on non-surgical treatments for TSS, two investigators will perform a meta-analysis of the included studies. The findings will be summarised as the risk ratio for binary data and the standardised or weighted mean difference for continuous data.Ethics and disseminationEthical approval is not required, as the review does not involve individual patient data. The review’s findings will provide clinicians with evidence on using non-surgical treatments for TSS, disseminated through peer-reviewed publications or conferences.PROSPERO registration numberCRD42024496634.