Bone graft in posterior spine fusion for adolescent idiopathic scoliosis: a meta-analysis.

BACKGROUNDS: The aim of this study was to systematically analyse and perform a meta-analysis on the current available literature comparing the fusion rates and complications associated with use of autograft, allograft and bone substitutes to supplement posterior spinal fusion for adolescent idiopathic scoliosis (AIS). METHODS: The electronic databases including Embase, PubMed, Medline, Cinahl and Cochrane Library were searched to identify relevant studies. A total of 12 studies with 2389 patients were included for meta-analysis. The primary outcome was fusion rate, while the secondary outcomes included blood loss, operation time, infection rates and post-operative pain. RESULTS: The current meta-analysis found no difference in fusion rates between groups with an overall fusion rate of 100% (95% confidence interval (CI) 0.99-1.00; P < 0.05). Total estimated blood loss was significantly higher in the iliac crest bone graft (ICBG) group compared with control group (1018 versus 861 mL; P < 0.01). In addition, the mean operative time was significantly higher in the ICBG group (259 versus 237 min; P < 0.001). The ICBG group also had increased post-operative pain issues compared with the control group (26 versus 9%; P < 0.001). There was no significant difference in terms of post-operative wound infection between groups with an overall infection rate of 1% (95% CI 0.0-0.02; P = 0.06). CONCLUSION: ICBG confers no advantage over the other graft options in achieving fusion in AIS surgery. Furthermore, crest harvesting was associated with significant increases in blood loss, operative time and post-operative pain issues. Therefore, allograft and bone substitutes are attractive alternatives to autogenous grafting during posterior fusion in AIS.

RSA in Spine: A Review.

STUDY DESIGN: Systematic review of literature. OBJECTIVES: This systematic review was conducted to investigate the accuracy of radiostereometric analysis (RSA), its assessment of spinal motion and disorders, and to investigate the limitations of this technique in spine assessment. METHODS: Systematic review in all current literature to invesigate the role of RSA in spine. RESULTS: The results of this review concluded that RSA is a very powerful tool to detect small changes between 2 rigid bodies such as a vertebral segment. The technique is described for animal and human studies for cervical and lumbar spine and can be used to analyze range of motion, inducible displacement, and fusion of segments. However, there are a few disadvantages with the technique; RSA percutaneous procedure needs to be performed to implant the markers (and cannot be used preoperatively), one needs a specific knowledge to handle data and interpret the results, and is relatively time consuming and expensive. CONCLUSIONS: RSA should be looked at as a very powerful research instrument and there are many questions suitable for RSA studies.

A Meta-Analysis of Cervical Laminoplasty Techniques: Are Mini-Plates Superior?

STUDY DESIGN: Meta-analysis and systematic review of literature. OBJECTIVE: In the late 1990s, spinal surgeons experimented by using maxillofacial fixation plates as an alternative to sutures, anchors, and local spinous process autografts to provide a more rigid and lasting fixation for laminoplasty. This eventually led to the advent of laminoplasty mini-plates, which are currently used. The objective is to compare laminoplasty techniques with plate and without plate with regard to functional outcome results. METHODS: Qualitative and quantitative analyses were performed to evaluate the currently available studies in an attempt to justify the use of a plate in laminoplasty. RESULTS: The principal finding of this study was that there was no statistically significant difference in clinical outcome between the 2 different techniques of laminoplasty. CONCLUSION: There is not enough evidence in the literature to support one technique over the other, and hence, there is no evidence to support change in practice (using or not using the plate in laminoplasty). A randomized controlled trial will give a better comparison between the 2 groups.

Modular neck total hip arthroplasty - a perfect storm.

PURPOSE: This study was aimed to highlight neck notching as a potential cause of failure in modular neck total hip arthroplasty. It aimed to identify both the combination of modular components that place patients at greatest risk of failure and the potential mechanism for failure. METHODS: This study involved a retrospective review of 301 total hip arthroplasties (THA) using Kinectiv modular neck Technology (Zimmer, Warsaw, Indiana). The primary outcome was the presence of neck notching requiring revision. Patient records, operative notes and postoperative radiographs were reviewed. A statistical analysis was performed. RESULTS: A total of 301 THA were performed on 290 patients. There were 7 failures (2.3%). All 7 failures involved a modular combination of an anteverted neck, extended offset and length code -8 (failure rate of 36.8%, p<0.001). CONCLUSIONS: We identified femoral neck notching as a potential cause of failure in modular neck THA. The combination of an anteverted neck, extended offset and length code -8 was associated with a high rate of neck notching using the Kinectiv modular neck Technology (Zimmer, Warsaw, Indiana). Based on our experience with this prosthesis we advise caution when using this particular combination of implants.

Surgical management of Mason type III radial head fractures.

The evidence for optimal management of Mason type III fracture of radial head is unclear hence a systematic review of the published literature was performed in April 2012. This review includes 5 prospective studies (including 2 randomized trials), 4 retrospective studies and 9 case series. No study can be interpreted as level 1 evidence. Level 2 and 3 evidence provides some insight into the success of each modality through subjective and objective measurements of function and complication rates. Radial head replacement, open reduction internal fixation (ORIF) and radial head resection all provide satisfactory outcomes for patients in most cases. One treatment modality cannot be recommended over any other due to the small number of clinical trials and cases included in each study. Further randomized control trials are needed to evaluate the full benefits and shortcomings of each of the different surgical treatment modalities.

A comparison of radiostereometric analysis and computed tomography for the assessment of lumbar spinal fusion in a sheep model.

Study Design Prospective animal study. Objective The aim of this animal study is to evaluate the accuracy of radiostereometric analysis (RSA) compared with computed tomographic (CT) scan in the assessment of spinal fusion after anterior lumbar interbody fusion (ALIF) using histology as a gold standard. Methods Three non-adjacent ALIFs (L1-L2, L3-L4, and L5-L6) were performed in nine sheep. The sheep were divided into three groups of three sheep. All the animals were humanely killed immediately after having the last scheduled RSA. The lumbar spine was removed and in vitro fine cut CT and histopathology were performed. Results Using histological assessment as the gold standard for assessing fusion, RSA demonstrated better results (100% sensitivity and 66.7% specificity; positive predictive value [PPV] = 27.3%, negative predictive value [NPV] =100.0%) compared with CT (66.7% sensitivity and 60.0% specificity [PPV = 16.7%, NPV = 93.8%]). Conclusions RSA demonstrated higher sensitivity and specificity when compared with CT. Furthermore, RSA has the advantage of much lower radiation exposure compared with fine cut CT. Further studies are required to see if RSA remains superior to CT scan for the assessment spinal fusion in the clinical setting. [Table: see text].

Validity of the DEXA diagnosis of involutional osteoporosis in patients with femoral neck fractures.

BACKGROUND: There exists no study comparing dual energy X-ray absorptimetry (DEXA) with histomorphometry to evaluate its accuracy and validity as an assessment tool. A prospective study was done comparing the measurements of osteoporosis in patients with femoral neck fractures using the histological method of diagnosis and in the same patients with DEXA postoperatively. PATIENTS AND METHODS: The histological method depends on histomorphometric analysis of bone biopsies taken from the neck of femur during surgical treatment of the fracture. We depend on three indices in histomorphometric analysis: these are osteoid seam width, osteoblast surface, and osteoid surface. The radiological method depends on the measurement of the bone mineral density using DEXA for fractured patients with the scan performed onto the contralateral nonfractured hips and lumbar spines. RESULTS: We found positive histological histomorphometric parameters of osteoporosis in 68% of patients with the femoral neck fracture, and there is a moderate correlation between histological histomorphometric analysis and DEXA in the diagnosis of osteoporosis in these patients. In our study, DEXA can detect up to 88.2% of possible cases of osteoporosis (sensitivity 88.2%), but the specificity of this diagnostic tool is 62.5% at a t-score of