Short Segment versus Long Segment Pedicle Screws Fixation in Management of Thoracolumbar Burst Fractures: Meta-Analysis

Posterior pedicle screw fixation has become a popular method for treating thoracolumbar burst fractures. However, it remains unclear whether additional fixation of more segments could improve clinical and radiological outcomes. This meta-analysis was performed to evaluate the effectiveness of fixation levels with pedicle screw fixation for thoracolumbar burst fractures. MEDLINE, EMBASE, the Cochrane Central Register of Controlled Trials, Springer, and Google Scholar were searched for relevant randomized and quasirandomized controlled trials that compared the clinical and radiological efficacy of short versus long segment for thoracolumbar burst fractures managed by posterior pedicle screw fixation. Risk of bias in included studies was assessed using the Cochrane Risk of Bias tool. Based on predefined inclusion criteria, Nine eligible trials with a total of 365 patients were included in this meta-analysis. Results were expressed as risk difference for dichotomous outcomes and standard mean difference for continuous outcomes with 95% confidence interval. Baseline characteristics were similar between the short and long segment fixation groups. No significant difference was identified between the two groups regarding radiological outcome, functional outcome, neurologic improvement, and implant failure rate. The results of this meta-analysis suggested that extension of fixation was not necessary when thoracolumbar burst fracture was treated by posterior pedicle screw fixation. More randomized controlled trials with high quality are still needed in the future.

efficacy of ranibizumab in the treatment of macular edema secondary to central retinal vein occlusion [CRVO]

Purpose: To evaluate the effect of 3 consecutive intravitreal injections of ranibizumab [Lucentis] on visual acuity [VA] and central macular thickness [CMT] for central retinal vein occlusion [CRVO] induced macular edema. Study design: Our study was a prospective interventional case series

Patients and Methods: Twenty eyes of 19 consecutive patients diagnosed as CRVO-related macular edema [eight perfused, twelve ischemic CRVO] treated with 3 monthly intravitreal injections of ranibizumab at presentation as a monotherapy. Follow up visits were scheduled on the first, third and sixth months post-injections. Main outcome measures included mean changes in BCVA and CMI as measured by OCT

Results: The mean time from diagnosis until injection was 20 days. The mean BCVA of 0.03 +/- 0.03 [2/60] at baseline improved to a mean BCVA of 0.07 +/- 0.02 [5/60] six months after the last injection [final outcome], which was statistically significant [p<0.05] .Eleven eyes showed improved visual acuity [ 55%], 8 eyes [40%] had a stable visual acuity and 1 eye [5%] had worse visual acuity compared with baseline. A mean CMT of 679 um +/- 198 at baseline was improved to a mean CMT of 411 um +/- 158 six months after the last injection [final outcome], which was statistically significant [p<0.001]. The improvement in BCVA was superior in perfused CRVO compared to ischemic CRVO No ocular or systemic side-effects were noted

Conclusion: Intravitreal injection of ranibizurnab has shown promising results in VA improvement and decrease in CMT in patients with macular edema associated with CRVO especially the perfused form. However, long term results need to be further investigated