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Journal of Orthopaedic Surgery and... May 2023Autogenous granular bone graft (AG), autogenous massive bone graft (AM), and titanium mesh bone graft (TM) are the three commonly utilized bone implant methods for... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Autogenous granular bone graft (AG), autogenous massive bone graft (AM), and titanium mesh bone graft (TM) are the three commonly utilized bone implant methods for spinal tuberculosis. However, the gold standard is still controversial. Therefore, this study aimed to compare the clinical efficacy and surgical safety of three primary bone graft modalities.
METHODS
For systematic literature review, several databases, including PubMed, Embase, and Web of Science, were searched up to December 2022. Stata (version 14.0) was employed for data analysis.
RESULTS
Our network meta-analysis included 517 patients from 7 articles whose qualities are acceptable based on our quality assessment criteria. In direct comparison, AG was associated with a shorter operation time (MD = 73.51; CI 30.65-116.37) and a lesser blood loss (MD = 214.30; CI 7.17-421.44) than AM. TM had fewer loss of Cobb angle than AG (MD = 1.45; CI 0.13-2.76) and AM (MD = 1.21; CI 0.42-1.99). Compared with AG, TM (MD = 0.96; CI 0.06-1.87) was related to a shorter bone graft fusion time. In indirect comparison, for the clinical parameters, the rank of CRP (from best to worst) was as follows: TM (58%) > AM (27%) > AG (15%), the rank of ESR (from best to worst) was as follows: AG (61%) > AM (21%) > TM (18%), and the rank of VAS (from best to worst) was as follows: AG (65%) > TM (33%) > AM (2%). In the aspect of surgical data, what is noteworthy is that AG showed less blood loss [AG (93%) > TM (6%) > AM (1%)], operative time [AG (97%) > TM (3%) > AM (0)], and complications [AG (75%) > TM (21%) > AM (4%)] than AM and TM. As for imaging parameters, the rank of the loss of Cobb angle (from best to worst) was as follows: TM (99%) > AM (1%) > AG (0). Moreover, TM showed a shorter bone graft fusion time than AM and AG: TM (96%) > AM (3%) > AG (1%).
CONCLUSIONS
The results indicated that AG might be the optional treatment for spinal tuberculosis owing to the outcomes of surgical safety. Moreover, TM is another right choice which can significantly reduce the loss of Cobb angle and shorten bone graft fusion time with long-term follow-up.
Topics: Humans; Tuberculosis, Spinal; Network Meta-Analysis; Spinal Fusion; Lumbar Vertebrae; Thoracic Vertebrae; Treatment Outcome
PubMed: 37202780
DOI: 10.1186/s13018-023-03848-9 -
Journal of Orthopaedic Surgery and... May 2023Meta-analysis and systematic review. (Meta-Analysis)
Meta-Analysis
STUDY DESIGN
Meta-analysis and systematic review.
BACKGROUND
Robot-assisted pedicle screw placement technique offers greater accuracy than the traditional freehand screw placement technique. However, it is controversial whether there is a difference between the two procedures in terms of improved clinical outcomes.
MATERIALS AND METHODS
We systematically searched PubMed, EMBASE, Cochrane, and Web of Science to identify potentially eligible articles. Indispensable data such as the year of publication, study type, age, number of patients, sex distribution, and outcomes were extracted. The outcome indicators of interest included Oswestry disability index (ODI), visual analog scale (VAS) score, operative time, intraoperative blood loss, and post-operative length of stay. RevMan 5.4.1 was used for the meta-analysis.
RESULTS
A total of eight studies with 508 participants were included. Eight were related to ΔVAS, six were related to ΔODI, seven were related to operative time, five were related to intraoperative blood loss, and seven were related to the length of hospitalization. The results showed that, in terms of ΔVAS (95% CI, -1.20 to -0.36, P = 0.0003) and ΔODI (95% CI, -2.50 to -0.48, P = 0.004), robot-assisted pedicle screw placement technique scored higher than traditional freehand technique. Additionally, the intraoperative blood loss (95% CI, -140.34 to -10.94, P = 0.02) and the length of hospitalization (95% CI, -2.59 to -0.31, P = 0.01) for patients who underwent robotic-assisted pedicle screw placement were less than that of those who underwent the conventional freehand screw placement. No significant difference was found between robot-assisted techniques and conventional freehand techniques in pedicle screw placement in surgical time (95% CI, -2.24 to 26.32, P = 0.10).
CONCLUSIONS
Robot-assisted technique helps improve short-term clinical outcomes, reduce intraoperative blood loss and patient suffering, and shorten recovery time compared to the freehand technique.
Topics: Humans; Pedicle Screws; Blood Loss, Surgical; Robotics; Robotic Surgical Procedures; Spinal Fusion; Retrospective Studies; Lumbar Vertebrae
PubMed: 37189203
DOI: 10.1186/s13018-023-03774-w -
Journal of Orthopaedic Surgery and... May 2023Rigid fixation, represented by titanium rods, is a widely used fixation technique for lumbar fusion. However, this technique carries the risk of degeneration of adjacent... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Rigid fixation, represented by titanium rods, is a widely used fixation technique for lumbar fusion. However, this technique carries the risk of degeneration of adjacent segments. In recent years, the semi-rigid fixation technique represented by PEEK rods has gradually matured, and its effectiveness has been verified by numerous studies. The aim of this study was to systematically evaluate the effectiveness of these two fixation modalities in posterior lumbar fusion surgery.
METHODS
Studies meeting the inclusion criteria were searched in PubMed, Cochrane Library, ScienceDirect, Embase, CNKI, and Wanfang databases. After data extraction and quality assessment of included studies, meta-analysis was performed using STATA 15.1 software. The protocol for this systematic review was registered on INPLASY (2021110049) and is available in full on the inplasy.com ( https://inplasy.com/inplasy-2021-11-0049/ ).
RESULTS
Fifteen relevant studies were finally included, including eight prospective studies and seven retrospective studies. The results of meta-analysis showed that in ODI (P = 0.000), JOA score (P = 0.017), VAS score for lower limb pain (P = 0.027), fusion rate of bone graft at week 12 (P = 0.001), fusion rate of bone graft at last follow-up (P = 0.028), there was a statistical difference between the two groups. The PEEK rod group was superior to the titanium rod group in the above aspects. While in VAS score for LBP (P = 0.396), there was no statistical difference between the two groups.
CONCLUSION
Both PEEK rods and titanium rods are effective fixation materials in lumbar fusion surgery. PEEK rods may be superior to titanium rods in improving postoperative function and improving bone graft fusion rates. However, given the limitations of this study, whether these conclusions are applicable needs further research.
Topics: Titanium; Prospective Studies; Retrospective Studies; Spinal Fusion; Polyethylene Glycols; Ketones; Lumbar Vertebrae
PubMed: 37170362
DOI: 10.1186/s13018-023-03817-2 -
Neurosurgical Review Apr 2023This meta-analysis compared the efficacy of oblique lumbar interbody fusion (OLIF) and minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF) in the... (Meta-Analysis)
Meta-Analysis
Oblique lumbar interbody fusion versus minimally invasive transforaminal lumbar interbody fusion for the treatment of degenerative disease of the lumbar spine: a systematic review and meta-analysis.
This meta-analysis compared the efficacy of oblique lumbar interbody fusion (OLIF) and minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF) in the treatment of lumbar degenerative diseases. A computer search for the published literature on OLIF and MIS-TLIF for the treatment of lumbar degenerative diseases in the PubMed, Web of Science, Embase, CINAHL, MEDLINE, Cochrane Library, and other databases was performed, from which 522 related articles were retrieved and 13 were finally included. Two reviewers independently extracted data from the included studies and analyzed them using RevMan 5.4. The quality of the studies was assessed using the Cochrane systematic analysis and the Newcastle-Ottawa scale. Meta-analysis showed that the blood loss [95% confidence intervals (CI) (- 121.01, - 54.56), [Formula: see text]], hospital stay [95% CI (- 1.98, - 0.85), [Formula: see text]], postoperative fusion rate [95%CI (1.04, 3.60), [Formula: see text]], postoperative disc height [95% CI (0.50, 3.63), [Formula: see text]], and postoperative foraminal height [95% CI (0.96, 4.13), [Formula: see text]] were all better in the OLIF group; however, the complication rates were significantly lower in the MIS-TLIF group [95% CI (1.01, 2.06), [Formula: see text]]. However, there were no significant differences between the two in terms of surgery time, patient satisfaction, or postoperative functional scores. The OLIF group had the advantages of lower blood loss, a shorter hospital stay, a higher postoperative fusion rate, and better recovery of the disc and foraminal heights, whereas MIS-TLIF had a relatively lower complication rate.
Topics: Humans; Lumbar Vertebrae; Minimally Invasive Surgical Procedures; Spinal Fusion; Patient Satisfaction; Lumbosacral Region; Treatment Outcome; Retrospective Studies
PubMed: 37119422
DOI: 10.1007/s10143-023-02009-0 -
EFORT Open Reviews Apr 2023The biomechanical characteristics of different techniques to perform the modified Lapidus procedure are controversial, discussing the issue of stability, rigidity, and... (Review)
Review
PURPOSE
The biomechanical characteristics of different techniques to perform the modified Lapidus procedure are controversial, discussing the issue of stability, rigidity, and compression forces from a biomechanical point of view. The aim of this systematic review was to investigate the available options to identify whether there is a procedure providing superior biomechanical results.
METHODS
A comprehensive literature search was performed by screening PubMed, Embase, and Cochrane databases until September 2021. There was a wide heterogeneity of the available data in the different studies. Load to failure, stiffness, and compression forces were summarized and evaluated.
RESULTS
Seventeen biomechanical studies were retrieved - ten cadaveric and seven polyurethane foam (artificial bone) studies. Fixation methods ranged from the classic crossed screw approach (n = 5) to plates (dorsomedial and plantar) with or without compression screws (n = 11). Newer implants such as intramedullary stabilization screws (n = 1) and memory alloy staples (n = 2) were investigated.
CONCLUSION
The two crossed screws construct is still a biomechanical option; however, according to this systematic review, there is strong evidence that a plate-screw construct provides superior stability especially in combination with a compression screw. There is also evidence about plate position and low evidence about compression screw position. Plantar plates seem to be advantageous from a biomechanical point of view, whereas compression screws could be better when positioned outside the plate. Overall, this review suggests the biomechanical advantages of using a combination of locking plates with a compression screw.
PubMed: 37097047
DOI: 10.1530/EOR-22-0069 -
Archives of Orthopaedic and Trauma... Sep 2023This meta-analysis aimed to compare the differences in postoperative efficacy between oblique lumbar interbody fusion (OLIF) and transforaminal lumbar interbody fusion... (Meta-Analysis)
Meta-Analysis Review
Efficacy of oblique lumbar interbody fusion versus transforaminal lumbar interbody fusion in the treatment of lumbar degenerative diseases: a systematic review and meta-analysis.
INTRODUCTION
This meta-analysis aimed to compare the differences in postoperative efficacy between oblique lumbar interbody fusion (OLIF) and transforaminal lumbar interbody fusion (TLIF) in the treatment of lumbar degenerative diseases.
MATERIALS AND METHODS
Strictly based on the search strategy, we searched the published papers on OLIF and TLIF for the treatment of lumbar degenerative diseases in PubMed, Embase, CINAHL, and Cochrane Library. A total of 607 related papers were retrieved, and 15 articles were finally included. The quality of the papers was evaluated according to the Cochrane systematic review methodology, and the data were extracted and meta-analyzed using Review manager 5.4 software.
RESULTS
Through comparison, it was found that in the treatment of lumbar degenerative diseases, the OLIF group had certain advantages over the TLIF group in terms of intraoperative blood loss, hospital stay, visual analog scale (VAS) for leg pain (VAS-LP), Oswestry disability index (ODI), disc height (DH), foraminal height (FH), fused segmental lordosis (FSL), and cage height, and the differences were statistically significant. The results were similar in terms of surgery time, complications, fusion rate, VAS for back pain (VAS-BP) and various sagittal imaging indicators, and there was no significant difference.
CONCLUSIONS
OLIF and TLIF can relieve low back pain symptoms in the treatment of lumbar degenerative diseases, but OLIF has certain advantages in terms of ODI and VAS-LP. In addition, OLIF has the advantages of minor intraoperative trauma and quick postoperative recovery.
Topics: Humans; Treatment Outcome; Retrospective Studies; Lumbar Vertebrae; Spinal Fusion; Lumbosacral Region; Minimally Invasive Surgical Procedures
PubMed: 37079105
DOI: 10.1007/s00402-023-04880-4 -
Medicine Apr 2023Interbody fusion combined with posterior screw fixation is a traditional method used for treating lumbar degenerative disease (LDD). But in recent years, there have been...
BACKGROUND
Interbody fusion combined with posterior screw fixation is a traditional method used for treating lumbar degenerative disease (LDD). But in recent years, there have been more and more reports about its complications. Dynamic Stabilization Systems (DSS) are another method for the treatment of LDD, but the clinical results are still inconclusive. The objective of this study is to review, analyze, and discuss the probability of disc rehydration by DSS designed for LDD by systematically reviewing previous relevant studies.
METHODS
The Pubmed, Web of Science, and Embase databases were searched using keywords for articles published before June 2022. The following keywords were used: rehydration, rehydrated, lumbar, spine, disc, spinal, degenerative disc disease, degenerative spine disease, vertebrae, vertebral column, thoracolumbar, and lumbosacral. The included studies were printed in English. Two independent investigators compiled all data. For the quality assessment, the Newcastle-Ottawa Scale was used to evaluate case-control studies, while the Joanna Briggs Institute critical appraisal checklist was used to evaluate the case series studies.
RESULTS
This systematic review included 7 studies comprised of 5 case series and 2 case-control studies. Seven articles involving 199 cases were enrolled for the data extraction. Of the 199 cases, 55 cases observed rehydration, as evaluated by Pfrimann grading on magnetic resonance imaging. The rehydration rate was 27.6% (55/199). DSS can provide positive clinical outcomes. Both visual analog scale and Oswestry Dysfunctional Index scores were significantly improved at the final follow-up.
CONCLUSION
DSS may promote disc rehydration and delay the development of LDD to some extent. Mechanical stretch may play an important role in the progress of intervertebral disc rehydration. It provides important evidence for the clinical application of DSS.
Topics: Humans; Intervertebral Disc Degeneration; Spinal Fusion; Treatment Outcome; Lumbar Vertebrae; Fluid Therapy; Retrospective Studies
PubMed: 37058035
DOI: 10.1097/MD.0000000000033163 -
Health Technology Assessment... Mar 2023We aimed to compare the clinical effectiveness, cost-effectiveness and complication rates of total ankle replacement with those of arthrodesis (i.e. ankle fusion) in the...
BACKGROUND
We aimed to compare the clinical effectiveness, cost-effectiveness and complication rates of total ankle replacement with those of arthrodesis (i.e. ankle fusion) in the treatment of end-stage ankle osteoarthritis.
METHODS
This was a pragmatic, multicentre, parallel-group, non-blinded randomised controlled trial. Patients with end-stage ankle osteoarthritis who were aged 50-85 years and were suitable for both procedures were recruited from 17 UK hospitals and randomised using minimisation. The primary outcome was the change in the Manchester-Oxford Foot Questionnaire walking/standing domain scores between the preoperative baseline and 52 weeks post surgery.
RESULTS
Between March 2015 and January 2019, 303 participants were randomised using a minimisation algorithm: 152 to total ankle replacement and 151 to ankle fusion. At 52 weeks, the mean (standard deviation) Manchester-Oxford Foot Questionnaire walking/standing domain score was 31.4 (30.4) in the total ankle replacement arm ( = 136) and 36.8 (30.6) in the ankle fusion arm ( = 140); the adjusted difference in the change was -5.6 (95% confidence interval -12.5 to 1.4; = 0.12) in the intention-to-treat analysis. By week 52, one patient in the total ankle replacement arm required revision. Rates of wound-healing issues (13.4% vs. 5.7%) and nerve injuries (4.2% vs. < 1%) were higher and the rate of thromboembolic events was lower (2.9% vs. 4.9%) in the total ankle replacement arm than in the ankle fusion arm. The bone non-union rate (based on plain radiographs) in the ankle fusion arm was 12.1%, but only 7.1% of patients had symptoms. A post hoc analysis of fixed-bearing total ankle replacement showed a statistically significant improvement over ankle fusion in Manchester-Oxford Foot Questionnaire walking/standing domain score (-11.1, 95% confidence interval -19.3 to -2.9; = 0.008). We estimate a 69% likelihood that total ankle replacement is cost-effective compared with ankle fusion at the National Institute for Health and Care Excellence's cost-effectiveness threshold of £20,000 per quality-adjusted life-year gained over the patient's lifetime.
LIMITATIONS
This initial report contains only 52-week data, which must therefore be interpreted with caution. In addition, the pragmatic nature of the study means that there was heterogeneity between surgical implants and techniques. The trial was run across 17 NHS centres to ensure that decision-making streams reflected the standard of care in the NHS as closely as possible.
CONCLUSIONS
Both total ankle replacement and ankle fusion improved patients' quality of life at 1 year, and both appear to be safe. When total ankle replacement was compared with ankle fusion overall, we were unable to show a statistically significant difference between the two arms in terms of our primary outcome measure. The total ankle replacement versus ankle arthrodesis (TARVA) trial is inconclusive in terms of superiority of total ankle replacement, as the 95% confidence interval for the adjusted treatment effect includes both a difference of zero and the minimal important difference of 12, but it can rule out the superiority of ankle fusion. A post hoc analysis comparing fixed-bearing total ankle replacement with ankle fusion showed a statistically significant improvement of total ankle replacement over ankle fusion in Manchester-Oxford Foot Questionnaire walking/standing domain score. Total ankle replacement appears to be cost-effective compared with ankle fusion at the National Institute for Health and Care Excellence's cost-effectiveness threshold of £20,000 per quality-adjusted life-year gained over a patient's lifetime based on long-term economic modelling.
FUTURE WORK
We recommend long-term follow-up of this important cohort, in particular radiological and clinical progress. We also recommend studies to explore the sensitivity of clinical scores to detect clinically important differences between arms when both have already achieved a significant improvement from baseline.
TRIAL REGISTRATION
This trial is registered as ISRCTN60672307 and ClinicalTrials.gov NCT02128555.
FUNDING
This project was funded by the National Institute for Health and Care Research (NIHR) Health Technology Assessment programme and will be published in full in ; Vol. 27, No. 5. See the NIHR Journals Library website for further project information.
Topics: Humans; Arthroplasty, Replacement, Ankle; Ankle; Quality of Life; Osteoarthritis; Cost-Benefit Analysis; Arthrodesis; Randomized Controlled Trials as Topic; Multicenter Studies as Topic
PubMed: 37022932
DOI: 10.3310/PTYJ1146 -
Foot & Ankle Orthopaedics Jan 2023There is currently a scarcity of information and consensus for transportal (arthroscopic or fluoroscopic) joint preparation during tibiotalocalcaneal (TTC) fusion, and...
BACKGROUND
There is currently a scarcity of information and consensus for transportal (arthroscopic or fluoroscopic) joint preparation during tibiotalocalcaneal (TTC) fusion, and therefore this review aims to summarize the available techniques and to evaluate the outcomes after this procedure.
METHODS
A systematic electronic search of MEDLINE, EMBASE, and Web of Science was performed for all English-language studies published from their inception to April 4, 2022. All articles addressing arthroscopy in TTC nailing were eligible for inclusion. The PRISMA Checklist guided the reporting and data abstraction. Descriptive statistics are presented.
RESULT
A total of 5 studies with 65 patients were included for analysis. All studies used arthroscopic portals for tibiotalar and subtalar joint preparation (in 4 studies) prior to TTC nailing, with 4 studies using an arthroscope and 1 study using fluoroscopy. The overall major complication rate was 13.8%; however, there was only 1 instance of deep wound infection (1.5%) and 4 instances of surgical site infections (6.2%). Full fusion was achieved in 86% of patients with an average time to fusion of 12.9 weeks. The mean American Orthopaedic Foot & Ankle Society (AOFAS) ankle-hindfoot score preoperatively was 34.0 and postoperatively was 70.5.
CONCLUSION
Although limited by the number of studies, transportal joint preparation during TTC nail ankle fusion is associated with good rates of complications and successful fusion.
LEVEL OF EVIDENCE
Level III, systematic review of Level III-IV studies.
PubMed: 36891124
DOI: 10.1177/24730114231156422 -
Journal of Neurology, Neurosurgery, and... Aug 2023To determine the efficacy of adding instrumented spinal fusion to decompression to treat degenerative spondylolisthesis (DS). (Meta-Analysis)
Meta-Analysis
Decompression alone versus decompression with instrumented fusion in the treatment of lumbar degenerative spondylolisthesis: a systematic review and meta-analysis of randomised trials.
OBJECTIVE
To determine the efficacy of adding instrumented spinal fusion to decompression to treat degenerative spondylolisthesis (DS).
DESIGN
Systematic review with meta-analysis.
DATA SOURCES
MEDLINE, Embase, Emcare, Cochrane Library, CINAHL, Scopus, ProQuest Dissertations & Theses Global, ClinicalTrials.gov and WHO International Clinical Trials Registry Platform from inception to May 2022.
ELIGIBILITY CRITERIA FOR STUDY SELECTION
Randomised controlled trials (RCTs) comparing decompression with instrumented fusion to decompression alone in patients with DS. Two reviewers independently screened the studies, assessed the risk of bias and extracted data. We provide the Grading of Recommendations, Assessment, Development and Evaluation assessment of the certainty of evidence (COE).
RESULTS
We identified 4514 records and included four trials with 523 participants. At a 2-year follow-up, adding fusion to decompression likely results in trivial difference in the Oswestry Disability Index (range 0-100, with higher values indicating greater impairment) with mean difference (MD) 0.86 (95% CI -4.53 to 6.26; moderate COE). Similar results were observed for back and leg pain measured on a scale of 0 to 100, with higher values indicating more severe pain. There was a slightly increased improvement in back pain (2-year follow-up) in the group without fusion shown by MD -5·92 points (95% CI -11.00 to -0.84; moderate COE). There was a trivial difference in leg pain between the groups, slightly favouring the one without fusion, with MD -1.25 points (95% CI -6.71 to 4.21; moderate COE). Our findings at 2-year follow-up suggest that omitting fusion may increase the reoperation rate slightly (OR 1.23; 0.70 to 2.17; low COE).
CONCLUSIONS
Evidence suggests no benefits of adding instrumented fusion to decompression for treating DS. Isolated decompression seems sufficient for most patients. Further RCTs assessing spondylolisthesis stability are needed to determine which patients would benefit from fusion.
PROSPERO REGISTRATION NUMBER
CRD42022308267.
Topics: Humans; Decompression, Surgical; Spinal Stenosis; Spondylolisthesis; Lumbar Vertebrae; Spinal Fusion; Pain; Treatment Outcome; Randomized Controlled Trials as Topic
PubMed: 36849239
DOI: 10.1136/jnnp-2022-330158