Off-label usage of RhBMP-2 in posterior cervical fusion is not associated with early increased complication rate and has similar clinical outcomes.

BACKGROUND CONTEXT: Arthrodesis is important for the success of posterior cervical fusion (PCF), however, there exists limited data regarding the safety and efficacy of bone morphogenic protein (BMP) in PCF. PURPOSE: The primary objective was to evaluate early postoperative complications associated with BMP in PCF and determine whether BMP leads to adverse early clinical outcomes. A secondary objective was to determine the optimal location for BMP sponge placement, within the facet joint (IF) or elsewhere, and the optimal dosage/level. DESIGN: Retrospective, consecutive case-control study. PATIENT SAMPLE: Seven hundred sixty-five patients who underwent PCF OUTCOME MEASURES: Patient-reported outcomes (PROs), complications, arthrodesis, optimum dose/level of BMP METHODS: Surgical data, including preoperative diagnosis, levels fused, type of bone graft, BMP dose (when used), and fusion technique were recorded. Complications were assessed by reviewing the medical record encompassing the first 6-weeks postoperative. These included medical, neurological, and wound-related complications and reoperation. Neurological complications were defined as any new weakness, radicular pain, or numbness. PROs were collected, including SF36, VAS, EQ-5D, and NDI scores. To determine the optimal dosage and location for BMP placement, a sub-analysis was performed. RESULTS: There were no significant differences between the BMP and no BMP group with regards to wound complications, neurological complications, or reoperation. There were no differences in PROs between BMP and no BMP. Placement of BMP for IF and at a dose of 0.87 mg/level minimized wound-related complications. The BMP group had a higher fusion rate compared to the no BMP group (96% vs. 91%, p=.02) when assessed 1 year post-operatively. CONCLUSION: BMP was not associated with a higher rate of early complications after PCF when the dose was minimized. Complications thought to be associated with BMP, such as compressive seroma, radiculitis, and wound-related complications were not seen at a higher rate. PROs at early follow-up were similar. Placement of BMP for IF and at lower doses than previously reported may minimize complications.

Twenty-year survival analysis in total knee arthroplasty by a single surgeon.

Between January 1988 and December 2006, a total of 3014 primary total knee arthroplasties (TKAs) in 2042 patients were performed, and survivorship analysis was performed. Survivorship analysis showed a 10-year survival of 93.8% and a 20-year survival of 70.9%. There was no significant difference in the survival rate according to sex and diagnosis (P = .142 and .443, respectively). The survival rate was higher in the patients older than 60 years (P < .001). The survival rate of Total Condylar IV (TC-IV) was higher than that of Ortholoc (Dow Corning Wright Medical, Arlington, Tenn) (P < .001). Total knee arthroplasty results in satisfactory long-term survival rates. However, the survival rate decreases over time. The risk of requiring revision TKA was related to age and type of implants. Careful consideration is necessary to decide the time for TKA and select type of implants.

Analysis of spinopelvic parameters in lumbar degenerative kyphosis: correlation with spinal stenosis and spondylolisthesis.

STUDY DESIGN: Retrospective study. OBJECTIVE: To define the relationship between pelvic parameters and lumbar spinal disorders including spinal stenosis, spondylolisthesis, and lumbar degenerative kyphosis (LDK). SUMMARY OF BACKGROUND DATA: Although numerous studies have investigated the relationship between various lumbar spinal disorders and spinal parameters previously, none has reported on the relationship with LDK. METHODS: The present study analyzed 211 patients (163 females and 48 males) with spinal stenosis (n = 57), degenerative spondylolisthesis (n = 78), spondylolytic spondylolisthesis (n = 34), and LDK (n = 42). Lateral standing radiograph of the whole spine was analyzed with a dedicated software allowing calculation of the following parameters: pelvic incidence (PI), sacral slope (SS), pelvic tilt (PT), lumbar lordosis (LL), thoracic kyphosis (TK), and sagittal vertical axis. RESULTS: Significant differences in the pelvic parameter were observed between the groups. The mean PI in males (49.6°) was less than that in females (57.3°) (P < 0.05). PI was found to be proportional to SS, PT, and LL (P < 0.001). PT was inversely proportional to TK and LL (P < 0.001). Analysis revealed the values of SS, LL, and TK to be significantly higher and those of PT and the PT/PI ratio to be significantly lower in LDK than in the other groups. Values of PI, SS, and LL, but not PT, were significantly higher in subjects of LDK with Takemitsu type 1 than in those with type 2. PI was shown to possess statistically significant correlation to SS, PT, LL, and PT/PI ratio but not to TK or sagittal vertical axis. CONCLUSION: PI has a direct influence on the variable lumbar curvature in LDK. PI and SS may be complementary factors in determining the subtype of LDK, as PT appears to be relatively constant between the different subtypes of LDK.

Stage 4 compressive-extension injury of the cervical spine: a theoretical stage?

STUDY DESIGN: Case reports of stage 4 compressive-extension injury (CES-4). OBJECTIVE: To present CES-4, which has been known as a theoretical stage. SUMMARY OF BACKGROUND DATA: Compressive-extension stage 3 and 4 lesion has been considered as theoretical stages between the mild and advanced lesions of the compressive-extension phylogeny. METHODS: Clinical and radiologic details are presented documenting the CES-4 injury. RESULTS: The authors have encountered 2 cases of CES-4 injury and in this study report the radiographic findings and describe the surgical treatment of the cases. CONCLUSION: CES-4 is not a theoretical stage.