Survey of major complications after prone transpsoas surgery: an analysis of early adopters' practice.

INTRODUCTION: The prone transpsoas technique (PTP) is a modification of the traditional lateral lumbar interbody fusion approach, which was first published in the literature in 2020. The technique provides several advantages, such as lordosis correction and redistribution, single-position surgery framework, and ease of performing posterior techniques when needed. However, the prone position also leads to the movement of some retroperitoneal, vascular, and neurological structures, which could impact the complication profile. Therefore, this study aimed to investigate the occurrence of major complications in the practice of early adopters of the PTP approach. METHODS: A questionnaire containing 8 questions was sent to 50 participants and events involving early adopters of the prone transpsoas technique. Of the 50 surgeons, 32 completed the questionnaire, which totaled 1963 cases of PTP surgeries. RESULTS: Nine of the 32 surgeons experienced a major complication (28%), with persistent neurological deficit being the most frequent (7/9). Of the total number of cases, the occurrence of permanent neurological deficits was approximately 0,6%, and the rate of vascular and visceral injuries were both 0,05% (1/1963 for each case). CONCLUSION: Based on the analysis of the questionnaire responses, it can be concluded that PTP is a safe technique with a very low rate of serious complications. However, future studies with a more heterogeneous group of surgeons and a more rigorous linkage between answers and patient data are needed to support the findings of this study.

Lateral versus posterior approaches to treat degenerative lumbar pathologies-systematic review and meta-analysis of recent literature.

INTRODUCTION: The lateral lumbar interbody fusion arose as a revolutionary approach to treating several spinal pathologies because the techniques were able to promote indirect decompression and lordosis restoration through a minimally invasive approach allowing for reduced blood loss and early recovery for patients. However, it is still not clear how the technique compares to other established approaches for treating spinal degenerative diseases, such as TLIF, PLIF, and PLF. MATERIAL AND METHODS: This is a systematic review and meta-analysis of articles published in the last 10 years comparing lateral approaches to posterior techniques. The authors included articles that compared the LLIF technique to one or more posterior approaches, treating only degenerative pathologies, and containing at least one of the key outcomes of the study. Exclusion articles that were not original and the ones that the authors could not obtain the full text; also articles without the possibility to calculate the standard deviation or mean were excluded. For count variables, the odds ratio was used, and for continuous variables, the standard means difference (SMD) was used, and the choice between random or fixed-effects model was made depending on the presence or not of significant (p < 0.05) heterogeneity in the sample. RESULTS: Twenty-four articles were included in the quantitative review. As for the intra-/perioperative variables, the lateral approaches showed a significant reduction in blood loss (SMD-1.56, p < 0.001) and similar operative time (SMD = - 0.33, p = 0.24). Moreover, the use of the lateral approaches showed a tendency to lead to reduced hospitalization days (SMD = - 0.15, p = 0.09), with significantly reduced odds ratios of complications (0.53, p = 0.01). As for the clinical outcomes, both approaches showed similar improvement both at improvement as for the last follow-up value, either in ODI or in VAS-BP. Finally, when analyzing the changes in segmental lordosis and lumbar lordosis, the lateral technique promoted significantly higher correction in both outcomes (p < 0.05). CONCLUSION: Lateral approaches can promote significant radiological correction and similar clinical improvement while reducing surgical blood loss and postoperative complications.

Comparação epidemiológica entre as fraturas de fêmur proximal atendidas em um hospital secundário e um terciário / Epidemiological comparison between proximal femur fractures in a secondary and a tertiary hospital

Objetivo: comparar a ocorrência de fraturas de fêmur proximal atendidas em um hospital secundário e em um terciário. Método: a amostra deste estudo foi composta por todos os pacientes que apresentaram fratura de fêmur proximal atendidos em dois serviços hospitalares, no período de 2015 a 2017, sendo realizada a avaliação dos prontuários. Resultados: embora um maior número de cirurgias tenha sido realizado no hospital terciário, os pacientes atendidos no hospital secundário apresentaram maior número de complicações, provavelmente em decorrência de mais tempo de espera pelo procedimento, incluindo as cirurgias que precisaram ser remarcadas. É provável, também, que esse fato tenha implicado em maior tempo de internação e necessidade de encaminhamento para UTI no período pós-operatório imediato, fenômenos também observados no hospital secundário. Conclusão: estes resultados chamam atenção para a necessidade de reformulação dos protocolos de atendimento a pacientes com fratura proximal de fêmur, visando sanar os problemas aqui apresentados.

Aim: to compare the occurrence of femur fractures treated in a secondary and in a tertiary hospitals. Method: the sample of this study consisted of all patients who had fractures of the proximal femur treated at two hospital services, from 2015 to 2017, and the medical records were evaluated. Results: a greater number of surgeries has been performed at the tertiary hospital, although the secondary hospital patients had the highest number of complications, resulted probably by longer waiting times for the procedure, including surgeries that needed to be scheduled. It is also likely that this fact implied in a longer hospital stay and the need for referral to the Intensive Unit Care in the immediate postoperative period, also observed in secondary hospitals. Conclusion: these results call attention to the need to reformulate the protocols for the care of patients with proximal fracture of the femur, to solve the problems presented here.