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Journal of Orthopaedic Case Reports Jun 2024Fixed Equinus deformity is characterized by limited dorsiflexion of ankle joint and restricted passive movement, along with medial and lateral tibiotalar instability,...
INTRODUCTION
Fixed Equinus deformity is characterized by limited dorsiflexion of ankle joint and restricted passive movement, along with medial and lateral tibiotalar instability, progressive hindfoot varus, and a supination deformity of the forefoot. Degree of equinus deformity is determined by the Tibio-Metatarsal (TM) angle, subtended between the longitudinal axes of Tibia and 1st Metatarsal, in lateral view of foot. Lambrinudi triple arthrodesis involves the surgical fusion of the talonavicular, talocalcaneal, and calcaneocuboid joints to correct fixed foot deformities, to relieve pain from joint, to provide stability to the imbalanced foot, and to create a plantigrade foot. We combined a Lambrinudi type arthrodesis with a transfer of the posterior tibial tendon (PTT) in adult patients to provide dynamic dorsiflexion and pronation.
CASE REPORT
The case was of 39-year-old male diagnosed as fixed cavoequinus deformity of right foot and ankle, who was operated with Lambrinudi triple arthrodesis with PTT transfer in January 2019 and followed up to 5 years. Outcome measurements included radiographic and clinical investigations, including the TM Angle, American Orthopaedic Foot and Ankle Society (AOFAS) Score and Ankle range of motion (ROM), which were assessed preoperatively, immediate postoperatively, at 3 months, 6 months, 1 year, and 5 years.The TM angles were 177, 133, 125, and 122, at pre-operative, immediate post-operative, 3 months, 5 years, respectively. Fusion was seen at 1-year follow-up. Improvement in AOFAS Score with values 38, 57, 73, and improvement in Ankle ROM with values 0 (fixed), 10, 15° at pre-operative, 3 months, and 5 years postoperative, respectively. Patient could use ordinary footwear afterward and had no significant subjective pain or pain which affected his daily activities, but patient had post-procedural right lower limb shortening of 1 cm..
CONCLUSION
This combined procedure demonstrated clinical correction of foot deformity and significant improvement in functional outcome in the form of AOFAS score and Ankle ROM. The ability of all patients to use normal shoes and significant reduction in pain scores represent ultimately, the improvement in quality of life. We have corrected muscle imbalance and provided dynamic force for dorsiflexion and pronation of foot in the form of tibialis posterior.
PubMed: 38910996
DOI: 10.13107/jocr.2024.v14.i06.4540 -
The Spine Journal : Official Journal of... Jul 2024
Topics: Humans; Spinal Fusion; Patient Reported Outcome Measures; Patient Satisfaction; Lumbar Vertebrae
PubMed: 38910016
DOI: 10.1016/j.spinee.2024.02.025 -
BMC Surgery Jun 2024posterior pedicle screw fixation is common method, one of the most severe complications is iatrogenic vascular damage, no report investigated association of different...
BACKGROUND
posterior pedicle screw fixation is common method, one of the most severe complications is iatrogenic vascular damage, no report investigated association of different introversion angles (INTAs) and length of pedicle screw. The aims were to investigate the optimal introversion angle and length of pedicle screw for improving the safety of the operation, and to analyze the differences of vascular damage types at L1-S1.
METHODS
Lumbar CT imaging data from110 patients were analyzed by DICOM software, and all parameters were measured by new Cartesian coordinate system, INTAs (L1-L5:5°,10°,15°,S1: 0°, 5°,10°,15°), D (the distance between the origin (O) with anterior vertebral cortex (AVC)), D (the distance between AVC and the prevertebral great vessels (PGVs)), D (the distance between the O and PGVs). At different INTAs, D were divided into four grades: Grade III: D ≤ 3 mm, Grade II: 3 mm < D ≤ 5 mm, Grade I: D > 5 mm, and N: the not touching PGVs.
RESULTS
The optimal INTA was 5° at L1-L3, the left was 5° and the right was 15° at L4, and screw length was less than 50 mm at L1-L4. At L5, the left optimal INTA was 5° and the right was 10°, and screw length was less than 45 mm. The optimal INTA was 15° at S1, and screw length was less than 50 mm. However, screw length was less than 40 mm when the INTA was 0° or 5° at S1.
CONCLUSIONS
At L5-S1, the risk of vascular injury is the highest. INTA and length of the pedicle screw in lumbar operation are closely related. 3 mm interval of screw length may be more preferable to reduce vascular damage.
Topics: Humans; Pedicle Screws; Female; Male; Middle Aged; Lumbar Vertebrae; Aged; Vascular System Injuries; Adult; Spinal Fusion; Tomography, X-Ray Computed; Sacrum; Retrospective Studies
PubMed: 38907190
DOI: 10.1186/s12893-024-02483-3 -
Scientific Reports Jun 2024Overestimated the cross-match of preoperative PRC preparation for elective primary lumbar spinal fusion needs revision for cost-effectiveness. We aimed to develop a...
Overestimated the cross-match of preoperative PRC preparation for elective primary lumbar spinal fusion needs revision for cost-effectiveness. We aimed to develop a novel preoperative predictive model for appropriate PRC preparation. This clinical prediction model in a retrospective cohort was studied between January 2015 and September 2022. Multivariate logistic regression models were used to assess predictive variables. The logistic coefficient of each predictor generated scores to establish a predictive model. The area under the receiver operating characteristic curve (AuROC) was used to evaluate the model. The predictive performance was validated using bootstrapping techniques and externally validated in 102 independent cases. Among 416 patients, 178 (43%) required transfusion. Four final predictors: preoperative hematocrit level, laminectomy level, transforaminal lumbar interbody fusion level, and sacral fusion. When categorized into two risk groups, the positive predictive values for the low-risk score (≤ 4) were 18.4 (95% Cl 13.9, 23.6) and 83.9 (95% CI 77.1, 89.3) for the high-risk score (> 4). AuROC was 0.90. Internal validation (bootstrap shrinkage = 0.993) and external validation (AuROC: 0.91). A new model demonstrated exemplary performance and discrimination in predicting the appropriate preparation for PRC. This study should be corroborated by rigorous external validation in other hospitals and by prospective assessments.
Topics: Humans; Spinal Fusion; Male; Female; Middle Aged; Lumbar Vertebrae; Retrospective Studies; Aged; Elective Surgical Procedures; Erythrocyte Transfusion; ROC Curve; Hematocrit
PubMed: 38906974
DOI: 10.1038/s41598-024-65174-2 -
Scientific Reports Jun 2024Despite a 15% misplacement rate of screws in idiopathic scoliosis surgery, little is known about the relationship between pedicles and nerve structures in the entire...
Despite a 15% misplacement rate of screws in idiopathic scoliosis surgery, little is known about the relationship between pedicles and nerve structures in the entire thoracic curve. This study aimed to explore the spinal cord's proximity to the pedicle wall at each thoracic vertebra in the entire thoracic curve, while considering different anatomical changes. Spinal cord to medial pedicle distances were measured on magnetic resonance imaging in 73 patients who underwent posterior spinal fusion with pedicle screw instrumentation. Associations with different variables were examined. A total of 51 patients (69.9%) showed a distance within 2 mm at the apex vertebra on the concave side, more than 50% had a distance within 2 mm in the next thoracic vertebra level above and below, and more than 25% two levels above and below. Weak correlations were found between proximity of the spinal cord at the apex vertebra and vertebra's level and Cobb angle on the concave side (r = - 0.310, P = 0.008, r = 0.380, P = 0.001, respectively). These results emphasize the importance of thorough assessment when placing thoracic pedicle screws in idiopathic scoliosis patients. Further research is warranted to develop surgical strategies aimed at preventing potentially neurological complications resulting from screw misplacement.
Topics: Humans; Scoliosis; Female; Thoracic Vertebrae; Male; Pedicle Screws; Adolescent; Spinal Cord; Spinal Fusion; Magnetic Resonance Imaging; Child; Young Adult; Adult; Retrospective Studies
PubMed: 38906927
DOI: 10.1038/s41598-024-64971-z -
Medicine Jun 2024The research focused on the postoperative effect of using interbody fusion cage in lumbar posterior lamina decompression and interbody fusion with pedicle screw by...
BACKGROUND
The research focused on the postoperative effect of using interbody fusion cage in lumbar posterior lamina decompression and interbody fusion with pedicle screw by comparing the postoperative effect of using 3D printing (Ti6Al4V) and PEEK material interbody fusion cage.
METHODS
Ninety-one patients with lumbar degenerative diseases from the Department of Spine Surgery of Tianjin Hospital were included in the study cohort. They were divided into 3D group (n = 39) and PEEK group (n = 52) according to the use of interbody fusion cage. The imaging data of the patients were collected and the postoperative data of the 2 groups were compared to evaluate patients' health status and the recovery of lumbar structure and function after operation.
RESULTS
Combined with the degree of fusion, the clinical effect of 3D printing titanium alloy interbody fusion cage was comprehensively judged. At the last follow-up, the JOA score, ODI index, VAS, prolo function score, and SF-36 scale of the 2 groups showed that the clinical symptoms were better than those before operation (P < .05). The height of intervertebral disc, the area of intervertebral foramen and the physiological curvature of lumbar vertebrae increased in varying degrees after operation (P < .05). At the last follow-up, the vertebral cage fusion rates were as high as 89.13% and 90.91% in the 3D and PEEK groups, with collapse rates of 6.5% and 4.5%, respectively. There were 10 cases of cage displacement in 3D group and 7 cases of cage displacement in PEEK group. There was no significant difference between the 2 groups (P > .05).
CONCLUSIONS
In conclusion, 3D printed (Ti6Al4V) interbody fusion cage can obtain good clinical effect in the surgical treatment of lumbar degenerative diseases. Posterior lumbar lamina decompression, bilateral pedicle screw fixation combined with 3D printed cage interbody fusion is excellent in rebuilding the stability of lumbar vertebrae. 3D printed interbody fusion cage can be an ideal substitute material for intervertebral bone grafting. The stable fusion time of interbody fusion cage after lumbar fusion is mostly from 3 months to half a year after operation.
Topics: Humans; Spinal Fusion; Printing, Three-Dimensional; Titanium; Male; Lumbar Vertebrae; Female; Middle Aged; Alloys; Retrospective Studies; Pedicle Screws; Benzophenones; Polymers; Aged; Polyethylene Glycols; Ketones; Treatment Outcome; Decompression, Surgical; Adult; Intervertebral Disc Degeneration
PubMed: 38905365
DOI: 10.1097/MD.0000000000038431 -
Journal of Orthopaedic Surgery and... Jun 2024A systematic review and meta-analysis. (Meta-Analysis)
Meta-Analysis Comparative Study
Accuracy and postoperative assessment of robot-assisted placement of pedicle screws during scoliosis surgery compared with conventional freehand technique: a systematic review and meta-analysis.
STUDY DESIGN
A systematic review and meta-analysis.
BACKGROUND
The complexity of human anatomical structures and the variability of vertebral body structures in patients with scoliosis pose challenges in pedicle screw placement during spinal deformity correction surgery. Through technological advancements, robots have been introduced in spinal surgery to assist with pedicle screw placement.
METHODS
A systematic search was conducted using PubMed, Cochrane, Embase, and CNKI databases and comparative studies assessing the accuracy and postoperative efficacy of pedicle screw placement using robotic assistance or freehand techniques in patients with scoliosis were included. The analysis evaluated the accuracy of screw placement, operative duration, intraoperative blood loss, length of postoperative hospital stay, and complications.
RESULTS
Seven studies comprising 584 patients were included in the meta-analysis, with 282 patients (48.3%) in the robot-assisted group and 320 (51.7%) in the freehand group. Robot-assisted placement showed significantly better clinically acceptable screw placement results compared with freehand placement (odds ratio [OR]: 2.61, 95% confidence interval [CI]: 1.75-3.91, P < 0.0001). However, there were no statistically significant differences in achieving "perfect" screw placement between the two groups (OR: 1.52, 95% CI: 0.95-2.46, P = 0.08). The robot-assisted group had longer operation durations (mean deviation [MD]: 43.64, 95% CI: 22.25-64.74, P < 0.0001) but shorter postoperative hospital stays (MD: - 1.12, 95% CI: - 2.15 to - 0.08, P = 0.03) than the freehand group. There were no significant differences in overall complication rates or intraoperative blood loss between the two groups. There was no significant difference in Cobb Angle between the two groups before and after operation.
CONCLUSION
Robot-assisted pedicle screw placement offers higher accuracy and shorter hospital stay than freehand placement in scoliosis surgery; although the robotics approach is associated with longer operative durations, similar complication rates and intraoperative blood loss.
Topics: Scoliosis; Humans; Pedicle Screws; Robotic Surgical Procedures; Length of Stay; Postoperative Complications; Spinal Fusion; Blood Loss, Surgical; Operative Time; Treatment Outcome; Postoperative Period
PubMed: 38902785
DOI: 10.1186/s13018-024-04848-z -
Foot (Edinburgh, Scotland) Jun 2024Arthrodesis of the naviculocuneiform joint (NCJ) can be performed in isolation or in conjunction with arthrodesis of other joints, often in the presence of deformity. In...
BACKGROUND
Arthrodesis of the naviculocuneiform joint (NCJ) can be performed in isolation or in conjunction with arthrodesis of other joints, often in the presence of deformity. In the literature there is relative rarity of articles reporting on results and complications of NCJ arthrodesis.
PATIENTS AND METHODS
Thirty-six patients (36 feet) with symptomatic NCJ arthritis underwent arthrodesis. Mean age was 59.1 years (SD 13.1; range 26-78) and 24 were women. Adjuvant procedures were performed simultaneously in 29 patients, whilst 17 had planovalgus and 1 had cavovarus foot deformity.
RESULTS
Union of the NCJ arthrodesis was achieved in 35 out of 36 (97.2 %) patients, whilst one patient developed non-union. Mean time to union was 13.1 weeks (SD 3.8; range 8-24). Two patients (5.6 %) developed deep infection and 5 patients (13.9 %) required secondary surgical procedures. Twenty-three patients (63.9 %) rated the outcome as good or excellent, 11 (30.6 %) as fair and 2 (5.6 %) as poor.
CONCLUSIONS
NCJ arthrodesis was part of a more complex procedure in most of the patients. Whilst union was achieved in almost all patients and complication rate was acceptable, only 64 % rated their outcome as good or excellent.
LEVEL OF CLINICAL EVIDENCE
IV.
PubMed: 38901354
DOI: 10.1016/j.foot.2024.102115 -
Journal of Orthopaedic Surgery and... Jun 2024In recent years, the zero-profile implant (Zero-p) has emerged as a promising internal fixation technique. Although studies have indicated its potential superiority over... (Meta-Analysis)
Meta-Analysis Comparative Study
Comparative efficacy of zero-profile implant and conventional cage-plate implant in the treatment of single-level degenerative cervical spondylosis: a systematic review and meta-analysis.
BACKGROUND
In recent years, the zero-profile implant (Zero-p) has emerged as a promising internal fixation technique. Although studies have indicated its potential superiority over conventional cage-plate implant (Cage-plate) in the treatment of degenerative cervical spondylosis, there remains a lack of definitive comparative reports regarding its indications, safety, and efficacy.
METHODS
A computerized search was conducted on English and Chinese databases, including PubMed, Web of Science, Cochrane Library, EMBASE, CNKI, Wanfang and VIP. Additionally, a manual search was meticulously carried out on Chinese medical journals, spanning from the inception of the respective databases until August 2023. The meta-analysis utilized a case-control study approach and was executed through the utilization of RevMan 5.3 software. Stringent quality evaluation and data extraction procedures were implemented to guarantee the reliability and validity of the findings.
RESULTS
Nine high-quality studies with 808 patients were included. Meta-analysis showed that the operation time (MD = - 13.28; 95% CI (- 17.53, - 9.04), P < 0.00001), intraoperative blood loss (MD = - 6.61; 95% CI (- 10.47, - 2.75), P = 0.0008), incidence of postoperative dysphagia at various time points: within the first month after surgery (OR = 0.36; 95% CI (0.22, 0.58), P < 0.0001), 1-3 months after surgery (OR = 0.20; 95% CI (0.08, 0.49), P = 0.0004), the final follow-up (OR = 0.21; 95% CI (0.05, 0.83), P = 0.003) and the rate of postoperative adjacent disc degeneration (OR = 0.46; 95% CI (0.25, 0.84), P = 0.01) were significantly lower in the Zero-p group than in the Cage-plate group. Additionally, was also significantly lower in the Zero-p group. However, there were no significant differences in the JOA score, the final follow-up NDI score, surgical segmental fusion rate, postoperative height of adjacent vertebrae, or postoperative subsidence rate between the two groups.
CONCLUSION
In summary, when treating single-segment degenerative cervical spondylosis, both internal fixation techniques are reliable and effective. However, Zero-P implant offer several advantages over cage-plate implant, including shorter operation duration, less intraoperative blood loss, reduced postoperative dysphagia, and slower adjacent disc degeneration. Additionally, Zero-P implant has a broader application space, making them a preferred choice in certain cases.
Topics: Humans; Cervical Vertebrae; Spondylosis; Bone Plates; Treatment Outcome; Postoperative Complications; Operative Time; Spinal Fusion; Male; Blood Loss, Surgical; Female; Internal Fixators
PubMed: 38898517
DOI: 10.1186/s13018-024-04729-5 -
Journal of Orthopaedic Surgery and... Jun 2024The zero-profile implant system (Zero-P) and conventional plates have been widely used in anterior cervical discectomy and fusion (ACDF) to treat cervical spondylosis.... (Comparative Study)
Comparative Study
BACKGROUND
The zero-profile implant system (Zero-P) and conventional plates have been widely used in anterior cervical discectomy and fusion (ACDF) to treat cervical spondylosis. The purpose of this study was to compare the effects of the application of Zero-P and new conventional plates (ZEVO, Skyline) in ACDF on the sagittal imaging parameters of cervical spondylosis patients and to analyze their clinical efficacy.
METHODS
We conducted a retrospective study on 119 cervical spondylosis patients from January 2018 to December 2021, comparing outcomes between those receiving the Zero-P device (n = 63) and those receiving a novel conventional plate (n = 56, including 46 ZEVO and 10 Skyline plates) through ACDF. Cervical sagittal alignment was assessed pre- and postoperatively via lateral radiographs. The Japanese Orthopedic Association (JOA), Neck Disability Index (NDI), and visual analog scale (VAS) scores were recorded at baseline, after surgery, and at the 2-year follow-up to evaluate patient recovery and intervention success.
RESULTS
There were significant differences in the postoperative C0-C2 Cobb angle and postoperative sagittal segmental angle (SSA) between patients in the novel conventional plate group and those in the Zero-P group (P < 0.05). Postoperatively, there were significant changes in the C2‒C7 Cobb angle, C0‒C2 Cobb angle, SSA, and average surgical disc height (ASDH) compared to the preoperative values in both patient groups (P < 0.05). Dysphagia in the immediate postoperative period was lower in the Zero-P group than in the new conventional plate group (0% in the Zero-P group, 7.14% in the novel conventional plate group, P = 0.046), and the symptoms disappeared within 2 years in both groups. There was no statistically significant difference between the two groups in terms of complications of adjacent spondylolisthesis (ASD) at 2 years postoperatively (3.17% in the Zero-P group, 8.93% in the novel conventional plate group; P = 0.252). According to the subgroup analysis, there were significant differences in the postoperative C2‒C7 Cobb angle, C0‒C2 Cobb angle, T1 slope, and ASDH between the ZEVO group and the Skyline group (P < 0.05). Compared with the preoperative scores, the JOA, NDI, and VAS scores of all groups significantly improved at the 2-year follow-up (P < 0.01). According to the subgroup analysis, the immediate postoperative NDI and VAS scores of the ZEVO group were significantly better than those of the Skyline group (P < 0.05).
CONCLUSION
In ACDF, both novel conventional plates and Zero-P can improve sagittal parameters and related scale scores. Compared to the Zero-P plate, the novel conventional plate has a greater advantage in correcting the curvature of the surgical segment, but the Zero-P plate is less likely to produce postoperative dysphagia.
Topics: Humans; Female; Retrospective Studies; Male; Spinal Fusion; Middle Aged; Bone Plates; Diskectomy; Cervical Vertebrae; Treatment Outcome; Spondylosis; Aged; Adult; Postural Balance; Follow-Up Studies
PubMed: 38898467
DOI: 10.1186/s13018-024-04857-y