An updated meta-analysis of clinical outcomes comparing minimally invasive with open transforaminal lumbar interbody fusion in patients with degenerative lumbar diseases.

BACKGROUND & AIMS: Open-transforaminal lumbar interbody fusion (O-TLIF) is regarded as the standard (S) approach which is currently available for patients with degenerative lumbar diseases patients. In addition, minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF) has proposed and gradually obtained popularity compared with O-TLIF procedures due to its beneficial outcomes in minimized tissue injury and quicker recovery. Nonetheless, debates exist concerning the use of MI-TLIF with its conflicting outcomes of clinical effect and safety in several publications. The purpose of the current study is to conduct an updated meta-analysis to provide eligible and systematical assessment available for the evaluation of the efficacy and safety of MI-TLIF in comparison with O-TLIF. METHODS: Publications on the comparison of O-TLIF and MI-TLIF in treating degenerative lumbar diseases in last 5 years were collected. After rigorous reviewing on the eligibility of publications, the available data was further extracted from qualified trials. All trials were conducted with the analysis of the summary hazard ratios (HRs) of the interest endpoints, including intraoperative and postoperative outcomes. RESULTS: Admittedly, it is hard to run a clinical RCT to compare the prognosis of patients undergoing O-TLIF and MI-TLIF. A total of 10 trials including non-randomized trials in the current study were collected according to our inclusion criteria. The pooled results of surgery duration indicated that MI-TLIF was highly associated with shorter length of hospital stay, less blood loss, and less complications. However, there were no remarkable differences in the operate time, VAS-BP, VAS-LP, and ODI between the 2 study groups. CONCLUSION: The quantitative analysis and combined results of our study suggest that MI-TLIF may be a valid and alternative method with safe profile in comparison of O-TLIF, with reduced blood loss, decreased length of stay, and complication rates. While, no remarkable differences were found or observed in the operate time, VAS-BP, VAS-LP, and ODI. Considering the limited available data and sample size, more RCTs with high quality are demanded to confirm the role of MI-TLIF as a standard approach in treating degenerative lumbar diseases.

Late deep cervical infection after anterior cervical discectomy and fusion: a case report and literature review.

BACKGROUND: Anterior cervical discectomy and fusion (ACDF) is often performed for the treatment of degenerative cervical spine. While this procedure is highly successful, 0.1-1.6% of early and late postoperative infection have been reported although the rate of late infection is very low. CASE PRESENTATION: Here, we report a case of 59-year-old male patient who developed deep cervical abscess 30 days after anterior cervical discectomy and titanium cage bone graft fusion (autologous bone) at C3/4 and C4/5. The patient did not have esophageal perforation. The abscess was managed through radical neck dissection approach with repated washing and removal of the titanium implant. Staphylococcus aureus was positively cultured from the abscess drainage, for which appropriate antibiotics including cefoxitin, vancomycin, levofloxacin, and cefoperazone were administered postoperatively. In addition, an external Hallo frame was used to support unstable cervical spine. The patient's deep cervical infection was healed 3 months after debridement and antibiotic administration. His cervial spine was stablized 11 months after the surgery with support of external Hallo Frame. CONCLUSIONS: This case suggested that deep cervical infection should be considered if a patient had history of ACDF even in the absence of esophageal perforation.

Unilateral versus bilateral percutaneous vertebroplasty for osteoporotic vertebral compression fractures in elderly patients: A meta-analysis.

OBJECTIVE: To contrast the effects and complications in unilateral and bilateral percutaneous vertebroplasty (PVP) for osteoporotic vertebral compression fractures in elderly patients. METHODS: Multiple databases were adopted to search relevant studies, and the articles eventually satisfied the criteria were included. All the meta-analyses were conducted with the Review Manager 5.2. To estimate the quality of each article, risk of bias table was performed. RESULTS: Finally, 627 patients were enrolled in 9 studies and ultimately met the eligibility criteria. The unilateral and bilateral surgical samples were 314 and 313, respectively. The meta-analysis showed no significant difference in Visual Analog Scale/Score (VAS) (MD = -0.05, 95% confidence interval [CI] [-0.24, 0.13], P = .57), Oswestry Disability Index (ODI) score (MD = 0.03, 95% CI [-0.57, 0.62], P = .93) and cement leakage (OR = 1.00, 95% CI [0.67, 1.50], P = 1.00) between unilateral group and bilateral group. The surgery time of unilateral PVP is much less than that of bilateral PVP (MD = -8.42, 95% CI [-13.17, -3.66], P = .0005). Patients with bilateral PVP surgery have been injected more cement than patients with a unilateral surgery (MD = -2.56, 95% CI [-2.79, -2.33], P <.00001). CONCLUSION: This study demonstrated unipedicular approach is the preferred surgical technique for treatment of osteoporotic vertebral fracture (OVF) compared with bilateral PVP since unipedicular approach injects less cement and cost less surgery time.

Comparison of Posterolateral Fusion and Posterior Lumbar Interbody Fusion in the Treatment of Lumbar Spondylolithesis: A Meta-Analysis.

Aim: Both posterior lumbar interbody fusion (PLIF) and posterolateral fusion (PLF) are the frequently-used techniques to treat lumbar spondylolithesis. The aim of this meta-analysis is to compare the safety and effectiveness between these two methods. Materials and Methods: The multiple databases were used to search for the relevant studies, and full-text articles involved in the comparison between PLIF and PLF were reviewed. Review Manager 5.0 was adopted to estimate the effects of the results among selected articles. Forest plots, sensitivity analysis and bias analysis for the articles included were also conducted. Results: Finally, 11 relevant studies were eventually satisfied the included criteria. The meta-analysis suggested that there was no significant difference of the clinical outcome, fusion rate, complication rate and blood loss (RR = 1.07, 95%CI [0.97, 1.17], P = 0.16; RR = 0.84, 95%CI [0.49, 1.45], P = 0.54; RR = 1.07, 95%CI [0.95, 1.21], P = 0.25; SMD = 0.24, 95%CI [-0.50, 0.98], P = 0.52; respectively). No publication bias was observed in this study (P > 0.05). Conclusions: Both these two procedures provide excellent outcomes for patients with spondylolisthesis. There was no significant difference of clinical outcome, complication rate, fusion rate and blood loss between PLIF and PLF techniques.

Risk factors for surgical site infection following lumbar spinal surgery: a meta-analysis.

OBJECTIVE: To identify risk factors for surgical site infection (SSI) in patients who had undergone lumbar spinal surgery. METHODS: Studies published in PubMed, Web of Science, and Embase were systematically reviewed to determine risk factors for SSI following lumbar spinal surgery. Results are expressed as risk ratios (RRs) with 95% CIs and weighted mean difference (WMD) with 95% CI. A fixed-effect or random-effect model was used to pool the estimates according to heterogeneity among the studies included. RESULTS: Sixteen studies involving 13,393 patients were included in this meta-analysis. Pooled estimates suggested that diabetes (RR 2.19, 95% CI 1.43-3.36; P<0.001), obesity (RR 2.87, 95% CI 1.62-5.09; P<0.001), BMI (WMD 1.32 kg/m2, 95% CI 0.39-2.25; P=0.006), prolonged operating time (WMD 24.96 minutes, 95% CI 14.77-35.15; P<0.001), prolonged hospital stay (WMD 2.07 days, 95% CI 0.28-3.87; P=0.024), hypertension (RR 1.28, 95% CI 1.08-1.52; P=0.005), and previous surgery (RR 2.06, 95% CI 1.39-3.06; P<0.001) were independent risk factors for SSI in patients who had undergone lumbar spine surgery. Current smoking (RR 0.89, 95% CI 0.75-1.06; P=0.178), American Society of Anesthesiologists grade >2 (RR 2.63, 95% CI 0.84-8.27; P=0.098), increased age (WMD 1.43 years, 95% CI -1.15 to 4.02; P=0.278), COPD (RR 1.21, 95% CI 0.68-2.17; P=0.521), cardiovascular disease (RR 1.63, 95% CI 0.40-6.70; P=0.495), rheumatoid arthritis (RR 1.76, 95% CI 0.53-5.90; P=0.359), and osteoporosis (RR 1.91, 95% CI 0.79-4.63; P=0.152) were not risk factors for postoperative SSI. CONCLUSION: Our results identified several important factors that increased the risk of postoperative SSI. Knowing these risk factors, surgeons could adequately analyze and evaluate risk factors in patients and then develop prevention measurements to reduce the rate of SSI.

One or Two Drains for the Treatment of Surgical Site Infections After Lumbar Spine Surgery.

BACKGROUND: Optimal drainage after débridement for treating postoperative surgical site infection (SSI) is controversial. We compared single-tube drainage with double-tube drainage. METHODS: We retrospectively analyzed 1125 patients with lumbar degenerative disease who underwent lumbar surgery. Postoperative SSI was diagnosed in 26 patients, and these patients were divided into 2 groups: single-tube drainage group (1 drain) and double-tube drainage group (2 drains). RESULTS: The 26 adult patients (17 women and 9 men) with postoperative SSI after lumbar surgery (26/1125 [2.3%]) were treated with débridement. There were no significant differences in patient age, sex, body mass index, mean number of pedicle screws, operative time, amount of bleeding, and drainage between the 2 groups. There were no significant differences between groups in administration of antibiotics (P > 0.05). Bacterial cultures were routinely performed in all 26 cases of SSI; 80.7% (21/26) of patients had a positive culture. Staphylococcus species, including predominantly S. aureus, methicillin-resistant S. aureus, and S. epidermidis, were the most common pathogens, followed by Escherichia coli, Acinetobacter, Klebsiella pneumoniae, and Enterococcus faecalis. There were no significant differences in drainage efficiency between the 1 drain and 2 drains groups (P > 0.05). CONCLUSIONS: There were no significant differences between the 1 drain and 2 drains groups in surgery-related and patient-related risk factors, pathogenic bacteria and antibiotic therapy, laboratory tests results, or drainage efficiency and time. However, patients in the 1 drain group exhibited better clinical outcome and shorter hospital stay.

Association of the insulin-like growth factor-1 single nucleotide polymorphisms rs35767, rs2288377, and rs5742612 with osteoporosis risk: A meta-analysis.

BACKGROUND: Insulin-like growth factor-1 (IGF-1) plays an important role in the regulation of bone formation and mineralization. We aimed to perform a meta-analysis to assess the association of three IGF-1 single nucleotide polymorphisms (SNPs) rs35767, rs2288377, and rs5742612 with osteoporosis risk. METHODS: A systematic search of PubMed, Web of Science, Embase, Medline, Scopus, CNKI, and Wanfang databases was conducted. Odds ratios (OR) and 95% confidence intervals (CI) were calculated using a fixed effects model. RESULTS: Four Chinese case-control studies with a total of 2807 participants were included in this meta-analysis. The results revealed an association between rs35767 and osteoporosis risk in all study subjects (women and men) in dominant (OR 1.32, 95% CI 1.13-1.53, P < .001), recessive (OR 1.73, 95% CI 1.35-2.21, P < .001), homozygote (OR 1.89, 95% CI 1.46-2.45, P < .001), and allelic (OR 1.31, 95% CI 1.18-1.47, P < .001) models. Subgroup analysis according to gender showed that rs35767 was associated with osteoporosis risk in women under dominant (OR 1.29, 95% CI 1.08-1.54, P = .005), recessive (OR 1.59, 95% CI 1.19-2.12, P = .002), homozygote (OR 1.73, 95% CI 1.28-2.34, P < .001), and allelic (OR 1.28, 95% CI 1.12-1.47, P < .001) models. Meta-analysis did not find associations of rs2288377 and rs5742612 with osteoporosis risk. There was no evidence of between-study heterogeneity and publication bias. CONCLUSION: Our results suggest that rs35767 is associated with osteoporosis risk in Chinese, whereas there is no association of rs2288377 and rs5742612 with osteoporosis risk.