The use of intraoperative navigation and robotic surgery for minimally invasive lumbar fusion has been increasing over the past decade. The aim of this study is to evaluate postoperative clinical outcomes, intraoperative parameters, and accuracy of pedicle screw insertion guided by intraoperative navigation in patients undergoing lumbar interbody fusion for spondylolisthesis. Patients who underwent posterior lumbar fusion interbody using intraoperative 3D navigation since December 2021 were included. Visual Analogue Scale (VAS), Oswestry Disability Index (ODI), and Short Form Health Survey-36 (SF-36) were assessed preoperatively and postoperatively at 1, 3, and 6 months. Screw placement accuracy, measured by Gertzbein and Robbins classification, and facet joint infringement, measured by Yson classification, were assessed by intraoperative Cone Beam CT scans performed at the end of instrumentation. Finally, operation time, intraoperative blood loss, hospital stay, and screw insertion time were evaluated. This study involved 50 patients with a mean age of 63.7 years. VAS decreased from 65.8±23 to 20±22 (p<.01). ODI decreased from 35.4%±15 to 11.8%±14 (p<.01). An increase of SF-36 from 51.5±14 to 76±13 (p<.01) was demonstrated. The accuracy of “perfect” and “clinically acceptable” pedicle screw fixation was 89.5% and 98.4%, respectively. Regarding facet violation, 96.8% of the screws were at grade 0. Finally, the average screw insertion time was 4.3±2 min, hospital stay was 4.2±0.8 days, operation time was 205±53 min, and blood loss was 169±107 ml. Finally, a statistically significant correlation of operation time with hospital stay, blood loss and placement time per screw was found. We demonstrated excellent results for accuracy of pedicle screw fixation and violation of facet joints. VAS, ODI and SF-36 showed statistically significant improvements from the control at one month after surgery. Navigation with intraoperative 3D images represents an effective system to improve operative performance in the surgical treatment of spondylolisthesis

The current study aims to compare the clinico radiological outcomes between Non-Fusion Anterior Scoliosis (NFASC) Correction and Posterior Spinal Fusion (PSF) for Lenke 5 curves at 2 years follow up. Methods:38 consecutive Lenke 5 AIS patients treated by a single surgeon with NFASC (group A) or PSF (group B) were matched by age, Cobb's angle, and skeletal maturity. Intraoperative blood loss, operative time, LOS, coronal Cobbs, and SRS22 scores at 2 years were compared. Flexibility was assessed by modified Schober's test. Continuous variables were compared using student t-tests and categorical variables were compared using chi-square. The cohort included 19 patients each in group A and B . Group A had M:F distribution of 1:18 while group B had 2:17. The mean age in group A and group B were 14.8±2.9 and 15.3±3.1 years respectively. The mean follow-up of patients in groups A and B were 24.5±1.8 months and 27.4±2.1 months respectively. Mean pre-op thoracolumbar/lumbar (TL/L) cobbs for group A and group B were 55°±7° and 57.5°±8° respectively. At two years follow up, the cobbs for group A and B were 18.2°±3.6° and 17.6°±3.5° respectively (p=0.09). The average operating time for groups A and B were 169±14.2 mins and 219±20.5 mins respectively (p<0.05). The average blood loss of groups A and B were 105.3±15.4 and 325.3±120.4 respectively (p<0.05). The average number of instrumented vertebra between groups A and B were 6.2 and 8.5 respectively (p<0.05). The average LOS for NFASC and PSF was 3.3±0.9 days and 4.3±1.1 days respectively (p<0.05). No statistically significant difference in SRS 22 score was noted between the two groups. No complications were recorded. Our study shows no significant difference in PSF and NFASC in terms of Cobbs correction and SRS scores, but the NFASC group had significantly reduced blood loss, operative time, and fewer instrumented levels. NFASC is an effective alternative technique to fusion to correct and stabilize Lenke 5 AIS curves with preservation of spinal motion

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 fusion surgery were divided into two groups. In the TXA group (n=50), the wound surface was soaked with TXA (1 g in 100 mL saline solution) for 3 minutes after exposure, after decompression, and before wound closure, and in the control group (n=116) using only saline. Intraoperative blood loss, drain volume 48 hours after surgery, amount of blood transfusion, transfusion rate, the haemoglobin, haematocrit after the surgery, the difference between them before and after the surgery, incision infection and the incidence of deep vein thrombosis between the two groups. Results. EBL for the control group was 783.33±332.71 mL and for intervention group 410.57±189.72 mL (p<0.001). The operative time for control group was 3.24±0.38 hours and for intervention group 2.99±0.79 hours (p<0.695). Hemovac drainage on days1 and 2 for control group was 167.10±53.83mL and 99.33±37.5 mL, respectively, and for intervention group 107.03±44.37mL and 53.38±21.99mL, respectively (p<0.001). The length of stay was significantly shorter in the intervention group (4.8±1.1 days) compared to control group (7.0±2.3 days). There was bo different in incision side infection and DVT. Conclusions. Topical TXA is a viable, cost-effective method of decreasing perioperative blood loss in major spine surgery with fewer overall complications than other methods. Further studies are required to find the ideal dosage and timing

Introduction and Objective. Wide awake local anaesthetic no tourniquet (WALANT) is being used for a wide variety of hand and wrist surgery. It has recently been used in distal radius fracture fixation. The purpose of this systematic review and meta-analysis was to assess the effectiveness of the WALANT technique in open reduction internal fixation. Materials and Methods. Pubmed, Embase, and Scopus databases were searched on 02/03/21 with the following search terms: radius, WALANT, local anesthetic, wide awake surgery. The primary outcome measure was conversion to general anaesthetic and mean intra-operative visual analogue scale (VAS) pain scores. Secondary measures were operative times, mean intraoperative blood loss, post-operative functional and radiological outcomes. Results. 110 articles were identified; eight studies were deemed eligible with 212 in the WALANT group and 247 in the comparative groups of regional anaesthesia and general Anaesthesia (GA). Two patients in the WALANT group required conversion to general anaesthesia due to anxiety rather than pain. Intra-operative VAS pain scores in the WALANT and regional anaesthetic group were 1.75 and 2.86 respectively (p<0.001). There was no statistically significant difference in Q-DASH scores, range of motion or radiological outcomes. There was a slight increase in mean blood loss in the WALANT group compared with those given a GA or regional anaesthetic with tourniquet (22.5ml vs 12.15ml, p<0.001). Conclusions. The WALANT technique is a viable option for anaesthetic when performing distal radius fracture fixation. It is well tolerated, giving similar post-operative outcomes to other anaesthetic methods. It is a potentially useful technique in a centre with an underresourced anaesthetic department or for patients who may not tolerate regional and general anaesthetic methods. Adequate patient counselling prior to the procedure should be performed with appropriate patient selection

Introduction. This study aimed to compare MIPO and IMNr in the treatment of supracondylar femur fracture following TKA in respect of fracture healing, complications and functional results. Materials and Methods. A retrospective analysis was made of 32 supracondylar femur fractures classified according to the Rorabeck classification, comprising 20 cases treated with MIPO and 12 with IMNr. The two techniques were compared in respect of ROM, KSS, SF-12 scores, intraoperative blood loss, surgery time, and radiological examination findings. Results. No significant difference was determined between the two groups in respect of age, gender and fracture type, or in the median time to union (MIPO 4.3 months, IMNr 4.2 mths) (p >0.05). In the MIPO group, 2 patients had delayed union, so revision surgery was applied. The mean postoperative ROM was comparable between IMNr and MIPO (86.2 °vs 86 °, p > 0.05). The mean Knee Society Score (KSS) and SF-12 score did not differ between the IMN and MIPO groups. (p>0.05). Reduction quality in the sagittal plane was better in the MIPO group and no difference was determined in coronal alignment. Greater shortening of the lower extremity was seen in the IMNr group than in the MIPO group. (20.3 vs 9.3mm, p<0.05). Perioperative blood loss was greater (2 units vs.1.2 units) and mean operating time was longerin the MIPO group. (126.5 min vs 102.2 min, p<0.05). Conclusion. In patients with good bone stock, supracondylar femur fracture following TKA can be treated successfully with IMN or MIPO. IMN has the advantage of less blood loss and a shorter operating time. Reduction quality may be improved with the MIPO technique. Both surgery techniques can be successfully used by orthopaedic surgeons taking a case-by-case approach