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Global Spine Journal Mar 2021Systematic review.
STUDY DESIGN
Systematic review.
OBJECTIVE
Anterior-alone surgery has gained wider reception for subaxial cervical spine facets dislocation. Questions remain on its efficacy and safety as a stand-alone entity within the contexts of concurrent facet fractures, unilateral versus bilateral dislocations, anterior open reduction, and old dislocation.
METHODS
A systematic review was performed with search strategy using translatable MESH terms across MEDLINE, EMBASE, VHL Regional Portal, and CENTRAL databases on patients with subaxial cervical dislocation intervened via anterior-alone approach. Two reviewers independently screened for eligible studies. PRISMA (Preferred Reporting Items for Systematic Review and Meta-Analysis) flow chart was adhered to. Nine retrospective studies were included. Narrative synthesis was performed to determine primary outcomes on spinal fusion and revisions and secondary outcomes on new occurrence or deterioration of neurology and infection rate.
RESULTS
Nonunion was not encountered across all contexts. A total of 0.86% of unilateral facet dislocation (1 out of 116) with inadequate reduction due to facet fragments between the facet joints removed its malpositioned plate following fusion. No new neurological deficit was observed. Cases that underwent anterior open reduction did not encounter failure that require subsequent posterior reduction surgery. One study (N = 52) on old dislocation incorporated partial corpectomy in their approach and limited anterior-alone approach to cases with persistent instability.
CONCLUSIONS
This systematic review supports the efficacy and success of anterior reduction, fusion, and instrumentation for cervical facet fracture dislocation. It is safe from a neurological standpoint. Revision rate due to concurrent facet fracture is low. Certain patients may require posteriorly based surgery or in specific cases combined anterior and posterior procedures.
PubMed: 32875872
DOI: 10.1177/2192568220907574 -
Injury Feb 2022Type-C pelvic fractures are a rare but potentially fatal injury that often leads to poor outcomes, despite surgical fixation. Many fixation methods are used but the... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Type-C pelvic fractures are a rare but potentially fatal injury that often leads to poor outcomes, despite surgical fixation. Many fixation methods are used but the optimal method remains contentious, with failure and complications common. This study compared outcomes for each fixation method.
METHODS
A systematic review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). A search of studies which reported on outcomes after surgically treated type-C pelvic fractures was undertaken. Data retrieved included fixation method, length of follow up, surgical revision, and complications rates (hardware breakage, post-operative outcomes, screw mal-positioning, screw loosening, loss of reduction and infection). Study quality was assessed using the Methodological Index for Non-Randomised Studies (MINORS). Pooled revision, outcome and complication rates were calculated using a quality-adjusted model in MetaXL 5.3.
RESULTS
Fifty-two studies met the inclusion criteria representing 1567 patients and 7 fixation methods. The meta-analyses demonstrated high rates of 'less-than-good' outcomes for most fixation methods, with a higher rate for bilateral injuries (overall 23%; unilateral 21% v bilateral 41%). The mean pooled rate for surgical revision rate was 4%, hardware breakage 3%, screw mal-positioning 2%, screw loosening 3%, loss of reduction 5% and infection 4%. Each fixation method had different performance profiles; however, anterior plating outperformed all other fixation methods for patient outcomes, with a 'less-than-good' rate of just 7% vs the pooled mean of 23% and demonstrated at or below pooled mean rates for all complications except revision which was 5%.
CONCLUSIONS
Post-operative outcomes for surgically treated type-C pelvic fractures revealed a 'less-than-good' pooled outcome rate of 23% and a revision rate of 4%. Anterior plates outperformed most other systems particularly for patient reported outcomes. Pooled revision, patient-reported outcome and complication rates for type-C pelvic fractures have not previously been reported and these data provide a benchmark for practice and future research.
Topics: Bone Screws; Fracture Fixation, Internal; Fractures, Bone; Humans; Pelvic Bones; Reoperation
PubMed: 34625237
DOI: 10.1016/j.injury.2021.09.004 -
Journal of Cardiovascular Development... Oct 2022The inadvertent lead malposition in the left heart (ILMLH) is an under-recognized event, which may complicate the implantation of cardiac electronic devices (CIEDs). (Review)
Review
BACKGROUND
The inadvertent lead malposition in the left heart (ILMLH) is an under-recognized event, which may complicate the implantation of cardiac electronic devices (CIEDs).
METHODS
We investigated the clinical conditions associated with ILMLH and the treatment strategies in these patients. We made a systematic review of the literature and identified 132 studies which reported 157 patients with ILMLH.
RESULTS
The mean age of patients was 68 years, and 83 were women. ILMLH was diagnosed, on average, 365 days after CIEDs implantation. Coexisting conditions were patent foramen ovale in 29% of patients, arterial puncture in 24%, perforation of the interatrial septum in 20%, atrial septal defect in 16% and perforation of the interventricular septum in 4%. At the time of diagnosis of ILMLH, 46% of patients were asymptomatic, 31% had acute TIA or stroke and 15% had overt heart failure. Overall, 14% of patients were receiving anticoagulants at the time of diagnosis of ILMLH. After diagnosis of ILMLH, percutaneous or surgical lead extraction was carried out in 93 patients (59%), whereas 43 (27%) received anticoagulation. During a mean 9-month follow-up after diagnosis of ILMLH, four patients experienced TIA or stroke (three on oral anticoagulant therapy and one after percutaneous lead extraction).
CONCLUSION
ILMLH is a rare complication, which is usually diagnosed about one year after implantation of CIEDs. An early diagnosis of ILMLH is important. Lead extraction is a safe and effective alternative to anticoagulants.
PubMed: 36286313
DOI: 10.3390/jcdd9100362 -
Journal of Perinatology : Official... Oct 2021To determine the incidence of adverse events (AEs) associated with umbilical catheters in the neonatal population. (Meta-Analysis)
Meta-Analysis
OBJECTIVE
To determine the incidence of adverse events (AEs) associated with umbilical catheters in the neonatal population.
STUDY DESIGN
Systematic review and meta-analysis of observational studies and randomized controlled trials published between 2010 and 2020.
RESULTS
In total 14,226 umbilical venous catheters (UVCs) and 4228 umbilical arterial catheters (UACs) were included. Overall, 13.4% of UVCs were associated with an AE (95% CI: 10.1-17.0) or 2.4 per 1000 catheter days (95% CI: 1.8-3.0). UACs had an AE rate of 9% (95% CI: 5.9-12.8) or 0.87 per 1000 catheter days (95% CI: 0.4-1.3). UVC malposition was the most common (41.7% [95% CI: 27.6-56.5]). Local injury from UAC taping was the most common AE in one study.
CONCLUSIONS
Umbilical catheters have a high incidence of AEs. Research into accurate methods of tip verification, tip surveillance, and securement is required.
Topics: Catheterization, Peripheral; Catheters; Catheters, Indwelling; Humans; Infant, Newborn; Umbilical Veins; Umbilicus; Vascular Access Devices
PubMed: 34272469
DOI: 10.1038/s41372-021-01147-x -
Journal of Orthopaedic Surgery and... Jul 2020Systematic review and meta-analysis. (Meta-Analysis)
Meta-Analysis
STUDY DESIGN
Systematic review and meta-analysis.
AIM
The purpose of this study was to compare the safety and accuracy of the C2 pedicle versus C2 pars screws placement and free-hand technique versus navigation for upper cervical fusion patients.
METHODS
Databases searched included PubMed, Scopus, Web of Science, and Cochrane Library to identify all papers published up to April 2020 that have evaluated C2 pedicle/pars screws placement accuracy. Two authors individually screened the literature according to the inclusion and exclusion criteria. The accuracy rates associated with C2 pedicle/pars were extracted. The pooled accuracy rate estimated was performed by the CMA software. A funnel plot based on accuracy rate estimate was used to evaluate publication bias.
RESULTS
From 1123 potentially relevant studies, 142 full-text publications were screened. We analyzed data from 79 studies involving 4431 patients with 6026 C2 pedicle or pars screw placement. We used the Newcastle-Ottawa Scale (NOS) to evaluate the quality of studies included in this review. Overall, funnel plot and Begg's test did not indicate obvious publication bias. The pooled analysis reveals that the accuracy rates were 93.8% for C2 pedicle screw free-hand, 93.7% for pars screw free-hand, 92.2% for navigated C2 pedicle screw, and 86.2% for navigated C2 pars screw (all, P value < 0.001). No statistically significant differences were observed between the accuracy of placement C2 pedicle versus C2 pars screws with the free-hand technique and the free-hand C2 pedicle group versus the navigated C2 pedicle group (all, P value > 0.05).
CONCLUSION
Overall, there was no difference in the safety and accuracy between the free-hand and navigated techniques. Further well-conducted studies with detailed stratification are needed to complement our findings.
Topics: Adolescent; Adult; Aged; Aged, 80 and over; Cervical Vertebrae; Child; Child, Preschool; Female; Humans; Male; Middle Aged; Pedicle Screws; Quality Assurance, Health Care; Safety; Spinal Fusion; Surgery, Computer-Assisted; Tomography, X-Ray Computed; Young Adult
PubMed: 32690035
DOI: 10.1186/s13018-020-01798-0 -
The Spine Journal : Official Journal of... Mar 2022Cervical total disc arthroplasty (TDA) is an alternative procedure to anterior cervical discectomy and fusion that facilitates neural decompression while both preserving... (Meta-Analysis)
Meta-Analysis
Failure in cervical total disc arthroplasty: single institution experience, systematic review of the literature, and proposal of the RUSH TDA failure classification system.
BACKGROUND CONTEXT
Cervical total disc arthroplasty (TDA) is an alternative procedure to anterior cervical discectomy and fusion that facilitates neural decompression while both preserving motion of the spinal unit and decreasing the risk for degenerative changes at adjacent segments. However, due to its more recent introduction in clinical practice and low complication rates, the modes by which TDA may fail remain to be described.
PURPOSE
This study sought to identify the modes and frequencies of cervical TDA failure in order to propose a novel classification system.
STUDY DESIGN
Retrospective cohort and systematic review.
PATIENT SAMPLE
Patients who underwent single or two-level TDA for cervical radiculopathy or myelopathy at a single institution and in the literature of medium and large prospective studies.
OUTCOME MEASURES
Cervical TDA failure, defined as subsequent surgical intervention at the index segment.
METHODS
This study retrospectively reviewed patients who underwent single or two-level TDA for cervical radiculopathy or myelopathy at a single institution to identify the potential implant failure modes. A systematic review and meta-analysis of prospective data in the literature was then performed to further supplement failure mode identification and to describe the rates at which the various failure types occurred. Statistical analysis included between-group comparisons of Non-Failed and Failed patients and frequencies of each failure type among Failed patients.
RESULTS
A retrospective review at our institution of 169 patients (201 levels) identified eight failures, for a failure rate of 4.7%. Additionally, seven patients were revised who had the primary surgery at an outside institution. The systematic review of 3976 patients (4525 levels) identified 165 (4.1%) additional failures. Using this data, six primary failure types were classified, with several subtypes. These include recurrent or persistent index-level stenosis (Type I); migration (Type II) presenting as gross extrusion (A) or endplate failure with subsidence/acute fracture (B); instability (Type III) due to mechanical loosening (A), septic loosening (B), or device fracture (C); device motion loss (Type IV) such as "locking" of the device in kyphosis; implantation error (Type V) due to malposition (A) or improper sizing (B); and wear (Type VI) either without osteolysis (A) or with wear-particle-induced osteolysis (B). Stenosis (Type I) was the most common mode of failure found both through retrospective review and in the literature.
CONCLUSIONS
Cervical TDA fails through six primary mechanisms. While rates of certain failures requiring subsequent surgical intervention are low, it is possible that these complications may become more prevalent upon further longitudinal observation. Thus, future application and validation of this classification system is warranted to evaluate how failure frequencies change over time and with larger patient samples.
Topics: Cervical Vertebrae; Diskectomy; Humans; Intervertebral Disc Degeneration; Prospective Studies; Retrospective Studies; Spinal Fusion; Total Disc Replacement; Treatment Failure
PubMed: 34419625
DOI: 10.1016/j.spinee.2021.08.006 -
Journal of Personalized Medicine Sep 2021There has been an exponential growth in the use of advanced technologies for three-dimensional (3D) virtual pre- and intra-operative planning of pelvic ring injury... (Review)
Review
There has been an exponential growth in the use of advanced technologies for three-dimensional (3D) virtual pre- and intra-operative planning of pelvic ring injury surgery but potential benefits remain unclear. The purpose of this study was to evaluate differences in intra- and post-operative results between 3D and conventional (2D) surgery. A systematic review was performed including published studies between 1 January 2010 and 22 May 2020 on all available 3D techniques in pelvic ring injury surgery. Studies were assessed for their methodological quality according to the Modified McMaster Critical Review form. Differences in operation time, blood loss, fluoroscopy time, screw malposition rate, fracture reduction and functional outcome between 3D-assisted and conventional (2D) pelvic injury treatment were evaluated and a best-evidence synthesis was performed. Eighteen studies fulfilled the inclusion criteria, evaluating a total of 988 patients. Overall quality was moderate. Regarding intra-operative results of 3D-assisted versus conventional surgery: The weighted mean operation time per screw was 43 min versus 52 min; for overall operation time 126 min versus 141 min; blood loss 275 ± 197 mL versus 549 ± 404 mL; fluoroscopy time 74 s versus 125 s and fluoroscopy frequency 29 ± 4 versus 63 ± 3. In terms of post-operative outcomes of 3D-assisted versus conventional surgery: weighted mean screw malposition rate was 8% versus 18%; quality of fracture reduction measured by the total excellent/good rate by Matta was 86% versus 82% and Majeed excellent/good rate 88% versus 83%. The 3D-assisted surgery technologies seem to have a positive effect on operation time, blood loss, fluoroscopy dose, time and frequency as well as accuracy of screw placement. No improvement in clinical outcome in terms of fracture reduction and functional outcome has been established so far. Due to a wide range of methodological quality and heterogeneity between the included studies, results should be interpreted with caution.
PubMed: 34575708
DOI: 10.3390/jpm11090930 -
Indian Journal of Anaesthesia Jun 2023Subclavian vein catheterisation (SVC) is more effective than internal jugular or femoral catheterisation and is linked to a lesser incidence of infection and patient...
Efficacy and safety of supraclavicular versus infraclavicular approach for subclavian vein catheterisation: An updated systematic review and meta-analysis of randomised controlled trials.
BACKGROUND AND AIMS
Subclavian vein catheterisation (SVC) is more effective than internal jugular or femoral catheterisation and is linked to a lesser incidence of infection and patient discomfort. Whether the supraclavicular (SC) or infraclavicular (IC) approach is more effective for SVC is unclear in the previous systematic review. This updated review is designed to search the efficacy and safety of both approaches adopting the Grading of Recommendations Assessment, Development and Evaluation approach.
METHODS
In May 2022, we explored the databases of Embase, MEDLINE, CENTRAL, ClinicalTrials.gov and WHO-ICTRP for randomised controlled trials to compare the two approaches.
RESULTS
Seventeen trials (2482 cases) were included. In the primary outcomes, the SC approach likely reduces the failure proportion (relative risk [RR], 0.63; 95% confidence interval [CI], 0.47-0.86; = 5%) and the incidence of malposition (RR, 0.23; 95% CI, 0.13-0.39; = 0%) with moderate evidence and may slightly reduce the incidence of arterial puncture and pneumothorax (RR, 0.59; 95% CI, 0.29-1.22; = 0%) with low evidence. In the secondary outcomes, the SC approach may decrease the access time and may increase the first-attempt success proportion.
CONCLUSION
The SC approach for SVC should be selected after considering the clinician's expertise.
PubMed: 37476443
DOI: 10.4103/ija.ija_837_22 -
Frontiers in Genetics 2022Singleton-Merten syndrome type 1 (SGMRT1) is a rare autosomal dominant disorder caused by variations with blood vessel calcifications, teeth anomalies, and bone...
Singleton-Merten syndrome type 1 (SGMRT1) is a rare autosomal dominant disorder caused by variations with blood vessel calcifications, teeth anomalies, and bone defects. We aimed to summarize the oral findings in SGMRT1 through a systematic review of the literature and to describe the phenotype of a 10-year-old patient with SGMRT1 diagnosis. A total of 20 patients were described in the literature, in nine articles. Eight mutations were described in 11 families. Delayed eruption, short roots, and premature loss of permanent teeth were the most described features (100%). Impacted teeth (89%) and carious lesions (67%) were also described. Our patient, a 10-year-old male with Singleton-Merten syndrome, presented numerous carious lesions, severe teeth malposition, especially in the anterior arch, and an oral hygiene deficiency with a 100% plaque index. The panoramic X-ray did not show any dental agenesis but revealed very short roots and a decrease in the jaw alveolar bone height. The whole-genome sequencing analysis revealed a heterozygous variant in (NM_022168.4) c.2465G > A (p.Arg822Gln). Confused descriptions of oral features occurred in the literature between congenital findings and "acquired" pathology, especially carious lesions. The dental phenotype of these patients encompasses eruption anomalies (delayed eruption and impacted teeth) and lack of root edification, leading to premature loss of permanent teeth, and it may contribute to the diagnosis. An early diagnosis is essential to prevent teeth loss and to improve the quality of life of these patients. : [https://www.crd.york.ac.uk/prospero/], identifier [CRD42022300025].
PubMed: 35754802
DOI: 10.3389/fgene.2022.875490 -
JBJS Reviews Aug 2023Glenoid baseplate malpositioning during reverse total shoulder arthroplasty can contribute to perimeter impingement, dislocation, and loosening. Despite advances in... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Glenoid baseplate malpositioning during reverse total shoulder arthroplasty can contribute to perimeter impingement, dislocation, and loosening. Despite advances in preoperative planning, conventional instrumentation may lead to considerable inaccuracy in implant positioning unless patient-specific guides are used. Optical navigation has the potential to improve accuracy and precision when implanting a reverse shoulder arthroplasty baseplate. This systematic review aimed to analyze the most recent evidence on the accuracy and precision of glenoid baseplate positioning using intraoperative navigation and its potential impact on component selection and surgical time.
METHODS
We conducted a systematic review following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses criteria. The PubMed, Scopus, and EMBASE databases were queried in July 2022 to identify all studies that compared navigation vs. conventional instrumentation for reverse shoulder arthroplasty. Data of deviation from the planned baseplate version and inclination, the use of standard or augmented glenoid components, and surgical time were extracted. Quantitative analysis from the included publications was performed using the inverse-variance approach and Mantel-Haenszel method.
RESULTS
Of the 2,048 records identified in the initial query, only 10 articles met the inclusion and exclusion criteria, comprising 667 shoulders that underwent reverse total shoulder arthroplasty. The pooled mean difference (MD) of the deviation from the planned baseplate position for the clinical studies was -0.44 (95% confidence interval [CI], -3.26; p = 0.76; I2 = 36%) for version and -8.75 (95% CI, -16.83 to -0.68; p = 0.02; I2 = 83%) for inclination, both in favor of navigation. The odds ratio of selecting an augmented glenoid component after preoperative planning and navigation-assisted surgery was 8.09 (95% CI, 3.82-17.14; p < 0.00001; I2 = 60%). The average surgical time was 12 minutes longer in the navigation group (MD 12.46, 95% CI, 5.20-19.72; p = 0.0008; I2 = 71%).
CONCLUSIONS
Preoperative planning integrated with computer-assisted navigation surgery seems to increase the accuracy and precision of glenoid baseplate inclination compared with the preoperatively planned placement during reverse total shoulder arthroplasty. The surgical time and proportion of augmented glenoid components significantly increase when using navigation. However, the clinical impact of these findings on improving prosthesis longevity, complications, and patient functional outcomes is still unknown.
LEVEL OF EVIDENCE
Level III, systematic review and meta-analysis. See Instructions for Authors for a complete description of levels of evidence.
Topics: Humans; Arthroplasty, Replacement, Shoulder; Scapula; Arthroplasty; Prosthesis Implantation; Computers
PubMed: 37616447
DOI: 10.2106/JBJS.RVW.23.00038