Introduction. Fusion represents an effective treatment option in patients affected by end-stage arthritis. To minimise the risk of non-union following fusion, biological preparations such as bone marrow aspirate concentrate (BMAC) are commonly used intra-operatively. Mechanotransduction represents an emerging field of research whereby physical stimuli can be used to modulate the behaviour and differentiation of cells. Blast waves (a subtype of shock waves) are one such physical stimulus. The aim of this study was to investigate whether the osteogenic potential of BMAC can be enhanced using a blast wave, and thus improve its efficacy in
Lumbar
Purpose. The behavioural change wheel methodology and social cognitive theory were combined to inform and develop a rehabilitation programme following lumbar
Adolescent idiopathic scoliosis (AIS) is a complex three-dimensional deformity of the spine characterized by a Cobb angle of at least 10 degrees. The goal of surgery is to not only prevent progression but restore sagittal and coronal balance, protecting cardiopulmonary function and improving cosmesis. We reviewed the impact of deformity correction surgery in terms of radiology and patient reported outcome(PROMs). The senior authors prospectively maintained database from 2003 –2022 was retrospectively analysed in terms of pre- and post-operative patient reported outcome measures (SRS 22) as well as radiological parameters. 44 patients with AIS were identified with pre and post op PROMS. The average age at surgery was 15yrs with 84% female. 38% had a Lenke 1 curve and 3 patients had Lenke 6 curves. 73% had posterior surgery. There was a total improvement in SRS 22 scores by 7.8%. Patients reported significant satisfaction with treatment 4.8/5 and improvement in self-image with a change of 0.4 (p<0.001). However, no difference in function, pain and mental health were recorded. Overall, proximal thoracic (PT) curves improved from 24 degrees to 11 degrees (p<0.001), Main thoracic (MT) curve 55 degrees to 19 degrees and Thoracolumbar/Lumbar curves (TL/L) 45 degreesto 11 degrees. Pre-operative flexibility and post-operative correction were 0.40 and 0.41 respectively for PT curve. MT was 0.32 and 0.67. That for TL/L was 0.57 and 0.71 respectively. Surgery yields significant main curve correction correlating with high patient reported satisfaction rate. Although total SRS 22 score yielded 7.8% improvement, sub-analysis of self-image showed the most significant improvement.
Hemorrhage and transfusion requirements in spine surgery are common. This is especially true for thoracic and lumbar
The escalating demand for medical resources to address spinal diseases as society ages is an issue that requires careful evaluation. However, few studies have examined trends in spinal surgery, especially unscheduled hospitalizations or surgeries performed after hours, through large databases. Our study aimed to determine national trends in the number of spine surgeries in Japan. We also aimed to identify trends in after-hours surgeries and unscheduled hospitalizations and their impact on complications and costs. We retrospectively investigated data extracted from the Diagnosis Procedure Combination database, a representative inpatient database in Japan. The data from April 2010 to March 2020 were used for this study. We included all patients who had undergone any combination of laminectomy, laminoplasty, discectomy, and/or spinal arthrodesis.Aims
Methods
The objective of this paper is to demonstrate the difference in post-operative complication rates between Computer-assisted surgery (CAS) and conventional techniques in spine surgery. Several studies have shown that the accuracy of pedicle screw placement significantly improves with use of CAS. Yet, few studies have compared the incidence of post-operative complications between CAS and conventional techniques. The American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) database was used to identify patients that underwent posterior lumbar fusion from 2011 to 2013. Multivariate analysis was conducted to demonstrate the difference in post-operative complication rates between CAS and conventional techniques in spine surgery. Out of 15,222 patients, 14,382 (95.1%) were operated with conventional techniques and 740 (4.90%) were operated with CAS. Multivariate analysis showed that patients in the CAS group had less odds to experience adverse events post-operatively (OR 0.57, P <0.001). This paper examined the complications in lumbar spinal surgery with or without the use of CAS. These results suggest that CAS may provide a safer technique for implant placement in lumbar
Purpose: Perispinal core muscle strength has been theorized to be an important component in the pathogenesis of back pain. Recent research has demonstrated a strong association between preoperative perispinal musculature, adjusted for fatty infiltration and prospective outcomes and improvements in back pain in patients undergoing lumbar laminectomy without fusion. The purpose of this study is to determine if a similar relationship exists in patients undergoing elective posterior lumbar fusion and decompression (PLFD) surgery. Method: A retrospective observational study of prospectively collected outcomes data was conducted in which pre-operative function and patient variables of those undergoing PLFD were derived from a functional status questionnaire and medical records. ImageJ Digital Imaging Software was utilized to measure the total (CSA) and percentage of fatty infiltration of the psoas, multifidus, and erector spinae muscles in pre-operative L4 axial CT images. Pre-operative and post-operative lateral images were evaluated for degree of post-operative adjacent level degeneration. Follow-up consisted of a functional status questionnaire. Outcomes measured were improvements in back pain, leg pain, and Oswestry disability scores. Results: Twenty-three patients were analyzed with a mean follow-up of 2 years (range 1 – 5 years). Outcomes improved following surgery. There were strong to moderate correlations between percentage of fat in the pre-operative posterior spinal muscles and improvements in leg pain (r = 0.63, p = <
0.001) and improvements in back pain (r = 0.41, p = 0.05). There was a moderate trend towards greater adjacent level degeneration (r = 0.37, p = 0.1) in patients with higher percentage of fat in the pre-operative posterior spinal muscles. There was a strong relationship between greater adjacent level degeneration and pre-operative disability as measured by the Oswestry (r = 0.62, p = 0.03). Conclusion: The results demonstrate that a potential relationship exists between pre-operative fatty infiltration of posterior perispinal muscles and post-operative outcomes, and adjacent level degeneration following lumbar
Failed fusions are difficult to treat. This is an analysis of a subgroup of 19 patients who received lumbar disc prostheses in a segment adjacent to previous posterolateral instrumented fusions. Out of 142 patients who received 181 lumbar disc replacements of two different models, 19 patients (11 men and eight women) had previously undergone posterolateral fusions of one or two lumbar segments. Seven of these patients had junctional replacement using a Charité disc prosthesis and 12 using a Centurion disc prosthesis. The mean age was 46 years (33 to 63). All patients had a significant flat back deformity of their lumbar spine before the index operation. All presented with sacro-iliac joint pain and 17 had spinal stenosis symptoms. The mean postoperative hospital stay was 3.4 days (2 to 8). All patients returned to their previous occupations at a mean of 29 days (21 to 42). Follow up ranges from 6 to 32 months. At the latest follow-up, 10 patients were very satisfied and nine were satisfied. The Oswestry score in the last 12 (Centurion) patients decreased from 49 ± 12 preoperatively to 16 ±22 at the latest follow-up. There are no published data on this particular subgroup of patients. They are difficult to treat and would otherwise require combined front and back procedures with extension of the fusion in order to correct the sagittal imbalance. Disc replacement seems to be a good salvage procedure for junctional failure after previous fusions.
Increasing numbers of posterior lumbar fusions
are being performed. The purpose of this study was to identify trends
in demographics, mortality and major complications in patients undergoing
primary posterior lumbar fusion. We accessed data collected for
the Nationwide Inpatient Sample for each year between 1998 and 2008
and analysed trends in the number of lumbar fusions, mean patient
age, comorbidity burden, length of hospital stay, discharge status,
major peri-operative complications and mortality. An estimated 1 288 496
primary posterior lumbar fusion operations were performed between
1998 and 2008 in the United States. The total number of procedures,
mean patient age and comorbidity burden increased over time. Hospital
length of stay decreased, although the in-hospital mortality (adjusted
and unadjusted for changes in length of hospital stay) remained
stable. However, a significant increase was observed in peri-operative
septic, pulmonary and cardiac complications. Although in-hospital mortality
rates did not change over time in the setting of increases in mean
patient age and comorbidity burden, some major peri-operative complications
increased. These trends highlight the need for appropriate peri-operative services
to optimise outcomes in an increasingly morbid and older population
of patients undergoing lumbar fusion.
A subgroup of nine patients, five women and four men, who received lumbar disc prostheses in a segment adjacent to previous posterolateral instrumented fusions (one or two levels) is reviewed. Two patients underwent double-level disc replacement. The mean age was 46.1 years (33 to 62). All patients had marked flattening of the lumbar spine before the operation. One patient developed subsidence within two weeks of the procedure but went on to a satisfactory result. One patient with a double-level disc replacement needed another operation because of a missed far out lateral disc. On day five after the procedure, the top-level disc was removed, the level properly decompressed and the disc reinserted, with good results. The mean postoperative hospital stay was 3.9 days (3 to 8). Within a mean time of 32 days (21 to 42), all patients returned to their previous occupations. Follow-up ranged from 3 to 19 months. At the latest follow-up, four of the patients were satisfied and five were very satisfied. Disc replacement seems an ideal salvage procedure for junctional failure after previous fusions. The short-term clinical results are good.
Aims. To determine the value of scoliosis surgery, it is necessary to evaluate outcomes in domains that matter to patients. Since randomized trials on adolescent idiopathic scoliosis (AIS) are scarce, prospective cohort studies with comparable outcome measures are important. To enhance comparison, a core set of patient-related outcome measures is available. The aim of this study was to evaluate the outcomes of AIS
The June 2023 Spine Roundup. 360. looks at: Characteristics and comparative study of thoracolumbar spine injury and dislocation fracture due to tertiary trauma; Sublingual sufentanil for postoperative pain management after lumbar spinal fusion surgery; Minimally invasive bipolar technique for adult neuromuscular scoliosis; Predictive factors for degenerative lumbar spinal stenosis; Lumbosacral transitional vertebrae and lumbar
The February 2023 Spine Roundup. 360. looks at: S2AI screws: At what cost?; Just how good is spinal deformity surgery?; Is 80 years of age too late in the day for spine surgery?; Factors affecting the accuracy of pedicle screw placement in robot-assisted surgery; Factors causing delay in discharge in patients eligible for ambulatory lumbar
Aims. Historically, patients undergoing surgery for adolescent idiopathic scoliosis (AIS) have been nursed postoperatively in a critical care (CC) setting because of the challenges posed by prone positioning, extensive exposures, prolonged operating times, significant blood loss, major intraoperative fluid shifts, cardiopulmonary complications, and difficulty in postoperative pain management. The primary aim of this paper was to determine whether a scoring system, which uses Cobb angle, forced vital capacity (FVC), forced expiratory volume in one second (FEV1), and number of levels to be fused, is a valid method of predicting the need for postoperative critical care in AIS patients who are to undergo scoliosis correction with posterior spinal fusion (PSF). Methods. We retrospectively reviewed all AIS patients who had undergone PSF between January 2018 and January 2020 in a specialist tertiary spinal referral centre. All patients were assessed preoperatively in an anaesthetic clinic. Postoperative care was defined as ward-based (WB) or critical care (CC), based on the preoperative FEV1, FVC, major curve Cobb angle, and the planned number of instrumented levels. Results. Overall, 105 patients were enrolled. Their mean age was 15.5 years (11 to 25) with a mean weight of 55 kg (35 to 103). The mean Cobb angle was 68° (38° to 122°). Of these, 38 patients were preoperatively scored to receive postoperative CC. However, only 19% of the cohort (20/105) actually needed CC-level support. Based on these figures, and an average paediatric intensive care unit stay of one day before stepdown to ward-based care, the potential cost-saving on the first postoperative night for this cohort was over £20,000. There was no statistically significant difference between the Total Pathway Score (TPS), the numerical representation of the four factors being assessed, and the actual level of care received (p = 0.052) or the American Society of Anesthesiologists grade (p = 0.187). Binary logistic regression analysis of the TPS variables showed that the preoperative Cobb angle was the only variable which significantly predicted the need for critical care. Conclusion. Most patients undergoing posterior
Aims. The aim of this study was to investigate the impact of maturity status at the time of surgery on final spinal height in patients with an adolescent idiopathic scoliosis (AIS) using the spine-pelvic index (SPI). The SPI is a self-control ratio that is independent of age and maturity status. Patients and Methods. The study recruited 152 female patients with a Lenke 1 AIS. The additional inclusion criteria were a thoracic Cobb angle between 45° and 70°, Risser 0 to 1 or 3 to 4 at the time of surgery, and follow-up until 18 years of age or Risser stage 5. The patients were stratified into four groups: Risser 0 to 1 and selective
Aims. There is evidence that prior lumbar fusion increases the risk of dislocation and revision after total hip arthroplasty (THA). The relationship between prior lumbar fusion and the effect of femoral head diameter on THA dislocation has not been investigated. We examined the relationship between prior lumbar fusion or discectomy and the risk of dislocation or revision after THA. We also examined the effect of femoral head component diameter on the risk of dislocation or revision. Methods. Data used in this study were compiled from several Finnish national health registers, including the Finnish Arthroplasty Register (FAR) which was the primary source for prosthesis-related data. Other registers used in this study included the Finnish Health Care Register (HILMO), the Social Insurance Institutions (SII) registers, and Statistics Finland. The study was conducted as a prospective retrospective cohort study. Cox proportional hazards regression and Kaplan-Meier survival analysis were used for analysis. Results. Prior lumbar
Background. It has become increasingly important to conduct studies assessing clinical outcomes, reoperation rates, and revision rates to better define the indications and efficacy of lumbar spinal procedures and its association with symptomatic adjacent segment degeneration (sASD). Adjacent segment degeneration (ASD) is defined as the radiographic change in the intervertebral discs adjacent to the surgically treated spinal level. SASD represents adjacent segment degeneration which causes pain or numbness due to post-operative spinal instability or nerve compression at the same level. The most common reason for early reoperation and late operation is sASD, therefore is in our best interest to understand the causes of ASD and make steps to limit the occurrence. Method. A comprehensive literature search was performed selecting Randomized controlled trials (RCTs) and retrospective or prospective studies published up to December 2023. Meta-analysis was performed on 38 studies that met the inclusion criteria and included data of clinical outcomes of patients who had degenerative disc disease, disc herniation, radiculopathy, and spondylolisthesis and underwent lumbar fusion or motion-preservation device surgery; and reported on the prevalence of ASD, sASD, reoperation rate, visual analogue score (VAS), and Oswestry disability index (ODI) improvement. Results. When compared to
Adolescent idiopathic scoliosis is a three-dimensional deformity of the spine, affecting 1–3% of the population. Most cases are treated conservatively. Curves exceeding 45° in the thoracic spine and 40° in the lumbar spine may require correction and
Intraoperative range of motion (ROM) radiographs are routinely taken during scaphoidectomy and four corner
Aims. We compared decompression alone to decompression with
Introduction. Osteochondral lesions (OCLs) of the talus are a challenging and increasingly recognized problem in chronic ankle pain. Many novel techniques exist to attempt to treat this challenging entity. Difficulties associated with treating OCLs include lesion location, size, chronicity, and problems associated with potential graft harvest sites. Matrix associated stem cell transplantation (MAST) is one such treatment described for larger lesions >15mm2 or failed alternative therapies. This cohort study describes a medium-term review of the outcomes of talar lesions treated with MAST. Methods. A review of all patients treated with MAST by a single surgeon was conducted. Preoperative radiographs, MRIs and FAOS outcome questionnaire scores were conducted. Intraoperative classification was undertaken to correlate with imaging. Postoperative outcomes included FAOS scores, return to sport, revision surgery/failure of treatment and progression to arthritis/
Background and Purpose. The UK's NIHR and Australia's NHMRC have funded two randomised controlled trials (RCTs) to determine if lumbar
Spine surgery is common and costly. Researchers and policy makers believe that utilization of spine surgery in the US is significantly higher than in other industrialized countries. Although within-country variation in spine surgery utilization is well studied, there has been little exploration of variation in spine surgery between countries. We used population level administrative data from Ontario (years 2011–2015) and New York (2011–2014) to identify all adults who underwent inpatient spinal decompression or
Aims. Rotator cuff (RC) tears are common musculoskeletal injuries which often require surgical intervention. Noninvasive pulsed electromagnetic field (PEMF) devices have been approved for treatment of long-bone fracture nonunions and as an adjunct to lumbar and cervical spine
Abstract. Objectives. to evaluate the efficacy and safety of topically applied tranexamic acid (TXA) in thoracolumbar spinal tuberculosis surgery, posterior approach. Methods. Thoracolumbar spine tuberculosis patients who requiring debridement, pedicle screw fixation and
Resident involvement in the operating room is a vital component of their medical education. Conflicting and limited research exists regarding the effects of surgical resident participation on spine surgery patient outcomes. Our objective was to determine the effect of resident involvement on surgery duration, length of hospital stay and 30-day post-operative complication rates. This study was a multicenter retrospective analysis of the prospectively collected American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) database. All anterior cervical or posterior lumbar
Introduction and Objective. Posterior and transforaminal lumbar interbody fusion (PLIF, TLIF) represent the most popular techniques in performing an interbody fusion amongst spine surgeons. Pseudarthrosis, cage migration, subsidence or infection can occur, with subsequent failed surgery, persistent pain and patient’ bad quality of life. The goal of revision
Hip instability is one of the most common causes for total hip arthroplasty (THA) revision surgery. Studies have indicated that lumbar
People with severe, persistent low back pain (LBP) may be offered lumbar spine fusion surgery if they have had insufficient benefit from recommended non-surgical treatments. However, National Institute for Health and Care Excellence (NICE) 2016 guidelines recommended not offering spinal fusion surgery for adults with LBP, except as part of a randomized clinical trial. This survey aims to describe UK clinicians’ views about the suitability of patients for such a future trial, along with their views regarding equipoise for randomizing patients in a future clinical trial comparing lumbar spine fusion surgery to best conservative care (BCC; the FORENSIC-UK trial). An online cross-sectional survey was piloted by the multidisciplinary research team, then shared with clinical professional groups in the UK who are involved in the management of adults with severe, persistent LBP. The survey had seven sections that covered the demographic details of the clinician, five hypothetical case vignettes of patients with varying presentations, a series of questions regarding the preferred management, and whether or not each clinician would be willing to recruit the example patients into future clinical trials.Aims
Methods
Introduction. Thoracic wall surgery can cause severe pain and inhibition of coughing with effects. (1) Various local anaesthetic (LA) techniques have been tried successfully to mitigate the use of opioids alone. We believe this is the first time that a serratus plane block using an epidural catheter (SABER)has been studied in anterior spinal fusion (ASF) procedures. Our aim was to ascertain how it would affect ASF compared to gold standard posterior spinal fusion (PSF) surgery. Materials and Methods. We identified 43 patients from the years 2017 to 2019. 24 had ASF and 19 had PSF. Detailed data were collected on local anaesthetic infusion (LAI) SaBER, mean pain scores(MPS), morphine, chirocaine usage and hospital length of stay (HLOS). We divided the patients into 4 groups: Short PSF (SPSF), Long PSF (LPSF), Thoracic anterior fusion (TA) and Thoracolumbar anterior
Repeated lumbar spine surgery has been associated with inferior clinical outcomes. This study aimed to examine and quantify the impact of this association in a national clinical register cohort. This is a population-based study from the Norwegian Registry for Spine surgery (NORspine). We included 26,723 consecutive cases operated for lumbar spinal stenosis or lumbar disc herniation from January 2007 to December 2018. The primary outcome was the Oswestry Disability Index (ODI), presented as the proportions reaching a patient-acceptable symptom state (PASS; defined as an ODI raw score ≤ 22) and ODI raw and change scores at 12-month follow-up. Secondary outcomes were the Global Perceived Effect scale, the numerical rating scale for pain, the EuroQoL five-dimensions health questionnaire, occurrence of perioperative complications and wound infections, and working capability. Binary logistic regression analysis was conducted to examine how the number of previous operations influenced the odds of not reaching a PASS.Aims
Methods
Background. The rate of subsidence for lumbar
The April 2024 Spine Roundup360 looks at: Lengthening behaviour of magnetically controlled growing rods in early-onset scoliosis: a multicentre study; LDL, cholesterol, and statins usage cause pseudarthrosis following lumbar interbody fusion; Decision-making in the treatment of degenerative lumbar spondylolisthesis of L4/L5; Does the interfacing angle between pedicle screws and support rods affect clinical outcomes after posterior thoracolumbar fusion?; Returning to the grind: how workload influences recovery post-lumbar spine surgery; Securing the spine: a leap forward with s2 alar-iliac screws in adult spinal deformity surgery.
The October 2023 Spine Roundup360 looks at: Cutting through surgical smoke: the science of cleaner air in spinal operations; Unlocking success: key factors in thoracic spine decompression and fusion for ossification of the posterior longitudinal ligament; Deep learning algorithm for identifying cervical cord compression due to degenerative canal stenosis on radiography; Surgeon experience influences robotics learning curve for minimally invasive lumbar fusion; Decision-making algorithm for the surgical treatment of degenerative lumbar spondylolisthesis of L4/L5; Response to preoperative steroid injections predicts surgical outcomes in patients undergoing fusion for isthmic spondylolisthesis.
Many navigation (Image Guided Surgery or IGS) systems are keyed to safely and accurately placing implants into complex anatomy. In spine surgery such as disc arthroplasty and
The aims of this study were first, to determine if adding fusion to a decompression of the lumbar spine for spinal stenosis decreases the rate of radiological restenosis and/or proximal adjacent level stenosis two years after surgery, and second, to evaluate the change in vertebral slip two years after surgery with and without fusion. The Swedish Spinal Stenosis Study (SSSS) was conducted between 2006 and 2012 at five public and two private hospitals. Six centres participated in this two-year MRI follow-up. We randomized 222 patients with central lumbar spinal stenosis at one or two adjacent levels into two groups, decompression alone and decompression with fusion. The presence or absence of a preoperative spondylolisthesis was noted. A new stenosis on two-year MRI was used as the primary outcome, defined as a dural sac cross-sectional area ≤ 75 mm2 at the operated level (restenosis) and/or at the level above (proximal adjacent level stenosis).Aims
Methods
The February 2024 Spine Roundup. 360. looks at: Surgeon assessment of bone – any good?; Robotics reduces radiation exposure in some spinal
The December 2022 Children’s orthopaedics Roundup360 looks at: Immobilization of torus fractures of the wrist in children (FORCE): a randomized controlled equivalence trial in the UK; Minimally invasive method in treatment of idiopathic congenital vertical talus: recurrence is uncommon; “You’re O.K. Anaesthesia”: closed reduction of displaced paediatric forearm and wrist fractures in the office without anaesthesia; Trunk range of motion and patient outcomes after anterior vertebral body tethering versus posterior spinal fusion: comparison using computerized 3D motion capture technology; Selective dorsal rhizotomy for individuals with spastic cerebral palsy; Scheuermann’s kyphosis and posterior spinal fusion; All-pedicle-screw constructs in skeletally immature patients with severe idiopathic early-onset scoliosis; Proximal femoral screw hemiepiphysiodesis in children with cerebral palsy.
To determine whether side-bending films in scoliosis are assessed for adequacy in clinical practice; and to introduce a novel method for doing so. Six surgeons and eight radiographers were invited to participate in four online surveys. The generic survey comprised erect and left and right bending radiographs of eight individuals with scoliosis, with an average age of 14.6 years. Respondents were asked to indicate whether each bending film was optimal (adequate) or suboptimal. In the first survey, they were also asked if they currently assessed the adequacy of bending films. A similar second survey was sent out two weeks later, using the same eight cases but in a different order. In the third survey, a guide for assessing bending film adequacy was attached along with the radiographs to introduce the novel T1-45B method, in which the upper endplate of T1 must tilt ≥ 45° from baseline for the study to be considered optimal. A fourth and final survey was subsequently conducted for confirmation.Aims
Methods
Symptomatic spinal stenosis is a very common problem, and decompression surgery has been shown to be superior to nonoperative treatment in selected patient groups. However, performing an instrumented fusion in addition to decompression may avoid revision and improve outcomes. The aim of the SpInOuT feasibility study was to establish whether a definitive randomized controlled trial (RCT) that accounted for the spectrum of pathology contributing to spinal stenosis, including pelvic incidence-lumbar lordosis (PI-LL) mismatch and mobile spondylolisthesis, could be conducted. As part of the SpInOuT-F study, a pilot randomized trial was carried out across five NHS hospitals. Patients were randomized to either spinal decompression alone or spinal decompression plus instrumented fusion. Patient-reported outcome measures were collected at baseline and three months. The intended sample size was 60 patients.Aims
Methods
The April 2023 Foot & Ankle Roundup360 looks at: Outcomes following a two-stage revision total ankle arthroplasty for periprosthetic joint infection; Temporary bridge plate fixation and joint motion after an unstable Lisfranc injury; Outcomes of fusion in type II os naviculare; Total ankle arthroplasty versus arthrodesis for end-stage ankle osteoarthritis; Normal saline for plantar fasciitis: placebo or therapeutic?; Distraction arthroplasty for ankle osteoarthritis: does it work?; Let there be movement: ankle arthroplasty after previous fusion; Morbidity and mortality after diabetic Charcot foot arthropathy.
Lumbar disc prolapse is a frequent indication for surgery. The few available long-term follow-up studies focus mainly on repeated surgery for recurrent disease. The aim of this study was to analyze all reasons for additional surgery for patients operated on for a primary lumbar disc prolapse. We retrieved data from the Swedish spine register about 3,291 patients who underwent primary surgery for a lumbar disc prolapse between January 2007 and December 2008. These patients were followed until December 2020 to record all additional lumbar spine operations and the reason for them.Aims
Methods
In the UK, the NHS generates an estimated 25 megatonnes of carbon dioxide equivalents (4% to 5% of the nation’s total carbon emissions) and produces over 500,000 tonnes of waste annually. There is limited evidence demonstrating the principles of sustainability and its benefits within orthopaedic surgery. The primary aim of this study was to analyze the environmental impact of orthopaedic surgery and the environmentally sustainable initiatives undertaken to address this. The secondary aim of this study was to describe the barriers to making sustainable changes within orthopaedic surgery. A literature search was performed according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines through EMBASE, Medline, and PubMed libraries using two domains of terms: “orthopaedic surgery” and “environmental sustainability”.Aims
Methods
Osteochondral lesions (OCLs) of the talus are a challenging and increasingly recognized problem in chronic ankle pain. Many novel techniques exist to attempt to treat this challenging entity. Difficulties associated with treating OCLs include lesion location, size, chronicity and problems associated with potential graft harvest sites. Matrix associated stem cell transplantation (MAST) is one such treatment described for larger lesions >15mm. 2. or failed alternative therapies. This cohort study describes a 5 year review of the outcomes of talar lesions treated with MAST. A review of all patients treated with MAST by a single surgeon was conducted. Pre-operative radiographs, MRIs and FAOS outcome questionnaire scores were conducted. Intraoperative classification was conducted to correlate with imaging. Post-operative outcomes included FAOS scores, return to sport, revision surgery/failure of treatment and progression to arthritis/
The aim of this study was to compare the clinical and radiological outcomes of patients with early-onset scoliosis (EOS), who had undergone spinal fusion after distraction-based spinal growth modulation using either traditional growing rods (TGRs) or magnetically controlled growing rods (MCGRs). We undertook a retrospective review of skeletally mature patients who had undergone fusion for an EOS, which had been previously treated using either TGRs or MCGRs. Measured outcomes included sequential coronal T1 to S1 height and major curve (Cobb) angle on plain radiographs and any complications requiring unplanned surgery before final fusion.Aims
Methods
Objectives. The aim of this systematic literature review was to assess the clinical level of evidence of commercially available demineralised bone matrix (DBM) products for their use in trauma and orthopaedic related surgery. Methods. A total of 17 DBM products were used as search terms in two available databases: Embase and PubMed according to the Preferred Reporting Items for Systematic Reviews and Meta Analyses statement. All articles that reported the clinical use of a DBM-product in trauma and orthopaedic related surgery were included. Results. The literature search resulted in 823 manuscripts of which 64 manuscripts met the final inclusion criteria. The included manuscripts consisted of four randomised controlled trials (level I), eight cohort studies (level III) and 49 case-series (level IV). No clinical studies were found for ten DBM products, and most DBM products were only used in combination with other grafting materials. DBM products were most extensively investigated in spinal surgery, showing limited level I evidence that supports the use Grafton DBM (Osteotech, Eatontown, New Jersey) as a bone graft extender in posterolateral lumbar
Cervical radiculopathy is a significant cause of pain and morbidity. For patients with severe and poorly controlled symptoms who may not be candidates for surgical management, treatment with transforaminal epidural steroid injections (CTFESI) has gained widespread acceptance. However, a paucity of high-quality evidence supporting their use balanced against perceived high risks of the procedure potentially undermines the confidence of clinicians who use the technique. We undertook a systematic review of the available literature regarding CTFESI to assess the clinical efficacy and complication rates of the procedure. OVID, MEDLINE, and Embase database searches were performed independently by two authors who subsequently completed title, abstract, and full-text screening for inclusion against set criteria. Clinical outcomes and complication data were extracted, and a narrative synthesis presented.Aims
Methods