Relationship between lumbar lordosis, pelvic parameters, PI-LL mismatch and outcome after short fusion surgery for lumbar degenerative disease. Literature review, rational and presentation of public study protocol: RELApSE study (registry for evaluation of lumbar artrodesis sagittal alignEment).

Background: Vertebral arthrodesis for degenerative pathology of the lumbar spine still remains burdened by clinical problems with significant negative results. The introduction of the sagittal balance assessment with the evaluation of the meaning of pelvic parameters and spinopelvic (PI-LL) mismatch offered new evaluation criteria for this widespread pathology, but there is a lack of consistent evidence on long-term outcome. Methods: The authors performed an extensive systematic review of literature, with the aim to identify all potentially relevant studies about the role and usefulness of the restoration or the assessment of Sagittal balance in lumbar degenerative disease. They present the study protocol RELApSE (NCT05448092 ID) and discuss the rationale through a comprehensive literature review. Results: From the 237 papers on this topic, a total of 176 articles were selected in this review. The analysis of these literature data shows sparse and variable evidence. There are no observations or guidelines about the value of lordosis restoration or PI-LL mismatch. Most of the works in the literature are retrospective, monocentric, based on small populations, and often address the topic evaluation partially. Conclusions: The RELApSE study is based on the possibility of comparing a heterogeneous population by pathology and different surgical technical options on some homogeneous clinical and anatomic-radiological measures aiming to understanding the value that global lumbar and segmental lordosis, distribution of lordosis, pelvic tilt, and PI-LL mismatch may have on clinical outcome in lumbar degenerative pathology and on the occurrence of adjacent segment disease.

Functional and radiological outcome of anterior retroperitoneal versus posterior transforaminal interbody fusion in the management of single-level lumbar degenerative disease.

OBJECTIVE: In this study the authors compared the anterior lumbar interbody fusion (ALIF) and posterior transforaminal lumbar interbody fusion (TLIF) techniques in a homogeneous group of patients affected by single-level L5-S1 degenerative disc disease (DDD) and postdiscectomy syndrome (PDS). The purpose of the study was to analyze perioperative, functional, and radiological data between the two techniques. METHODS: A retrospective analysis of patient data was performed between 2015 and 2018. Patients were clustered into two homogeneous groups (group 1 = ALIF, group 2 = TLIF) according to surgical procedure. A statistical analysis of clinical perioperative and radiological findings was performed to compare the two groups. A senior musculoskeletal radiologist retrospectively revised all radiological images. RESULTS: Seventy-two patients were comparable in terms of demographic features and surgical diagnosis and included in the study, involving 32 (44.4%) male and 40 (55.6%) female patients with an average age of 47.7 years. The mean follow-up duration was 49.7 months. Thirty-six patients (50%) were clustered in group 1, including 31 (86%) with DDD and 5 (14%) with PDS. Thirty-six patients (50%) were clustered in group 2, including 28 (78%) with DDD and 8 (22%) with PDS. A significant reduction in surgical time (107.4 vs 181.1 minutes) and blood loss (188.9 vs 387.1 ml) in group 1 (p < 0.0001) was observed. No significant differences in complications and reoperation rates between the two groups (p = 0.561) was observed. A significant improvement in functional outcome was observed in both groups (p < 0.001), but no significant difference between the two groups was found at the last follow-up. In group 1, a faster median time of return to work (2.4 vs 3.2 months) was recorded. A significant improvement in L5-S1 postoperative lordosis restoration was registered in the ALIF group (9.0 vs 5.0, p = 0.023). CONCLUSIONS: According to these results, interbody fusion is effective in the surgical management of discogenic pain. Even if clinical benefits were achieved earlier in the ALIF group (better scores and faster return to work), both procedures improved functional outcomes at last follow-up. The ALIF group showed significant reduction of blood loss, shorter surgical time, and better segmental lordosis restoration when compared to the TLIF group. No significant differences in postoperative complications were observed between the groups. Based on these results, the ALIF technique enhances radiological outcome improvement in spinopelvic parameters when compared to TLIF in the management of adult patients with L5-S1 DDD.

Locking Dorsal Plate in Four-Bone Arthrodesis in SLAC and SNAC 3 Wrist.

Purpose The aim of this study was to evaluate the effectiveness and the safety of performing a four-bone arthrodesis (FBA) with dorsal locking plate in patients suffering from stage III scapholunate advanced collapse/scaphoid nonunion advance collapse (SLAC/SNAC) wrist. Methods We evaluated retrospectively 20 patients surgically treated by a FBA with the use of locking dorsal plate. All the patients were clinically evaluated at follow-up for grip strength, range of motion, and pain (visual analog scale), and with the Disability of the Arm, Shoulder and Hand score and the Mayo wrist score. Imaging evaluation was performed on standard X-rays. Results The mean follow-up was 6 years (range: 1-11 years). During follow-up, the patients showed good clinical outcomes in terms of pain relief and grip strength. Revision surgery was necessary only in one case because of screws loosening. In all cases, a solid bone fusion was achieved except in one patient, who presented a healing of lunocapitate joint. This condition did not affect the clinical outcomes. Conclusion FBA performed using a dorsal locking plate is a salvage procedure effective in treating stage III SLAC/SNAC wrist. In our study, this technique provided good clinical outcomes at mid-term follow-up with a very low complication rate. Level of Evidence Level IV, therapeutic case series.

Trapeziometacarpal osteoarthritis: pyrocarbon interposition implants.

PURPOSE: the aim of this study was to evaluate the effectiveness of interposition arthroplasty of the trapeziometacarpal (TMC) joint with pyrolitic carbon implants for the treatment of TMC osteoarthritis. METHODS: we evaluated two groups of patients surgically treated for TMC osteoarthritis: group 1 (34 patients - 36 TMC joints) treated with PyroDisk implantation and group 2 (25 patients - 25 TMC joints) treated with the Pyrocardan implant. All these patients were clinically evaluated at follow-up using the DASH score, Mayo Wrist score and VAS pain score. RESULTS: the mean follow-up was 42 months in group 1 and 12 months in group 2. Both groups showed good clinical outcomes in terms of pain relief, range of motion, and pinch and grasp strength. Revision surgery was needed in only one case in group 1 (2.8%) and in three cases (12%) in group 2. CONCLUSIONS: prosthetic replacement of the TMC joint was found to be a good solution for low-demand patients. However, the PyroDisk could be a good solution in selected patients (Eaton stage I-III, non-subluxated joint): it provides good pain relief, good range of motion, good pinch and grasp strength, and stable results at more than three-years of follow-up. LEVEL OF EVIDENCE: Level IV, therapeutic case series.