Radiologic and Clinical Evaluation of Posterolateral Versus Transforaminal Interbody Fusion in Degenerative Lumbar Spondylolisthesis.

STUDY DESIGN: Retrospective cohort study. OBJECTIVE: The primary objective is to compare foraminal height (FH) and disk height (DH) differences in posterolateral (PLF) and transforaminal interbody fusions (TLIFs) and secondarily correlate these measurements with patient-reported outcomes. BACKGROUND: The impact FH has on patient outcomes in degenerative lumbar spinal fusion surgery is unknown. Postoperative FH change and how it relates to patient-reported outcomes in posteriorly based procedures has not been well evaluated. METHODS: A retrospective review of a subset of patients from a prospective cohort from the Canadian Spine Outcomes and Research Network was undertaken. Radiographic assessment preoperatively, at 3 months and 1 year, with standing lumbar spine radiographs were completed. FH and DH were recorded at each time interval, differences between groups were compared, and correlations with patient-reported outcomes were assessed. RESULTS: One hundred nine patients were included (23 PLF and 86 TLIF). At 3-month follow-up, the change in FH was greater in the TLIF group (mean difference =2.3; 95% CI: 0.8-3.5, P =0.002). The change in FH remained significantly different at 12 months (mean difference=1.6, 95% CI: 0.2, 3.0 mm, P =0.028). The change in DH was greater in the TLIF group, with a mean difference between groups of 4.1 mm (95% CI: 2.5, 5.7, P <0.001) and 3.6 mm (95% CI: 2.0, 5.3, P <0.001). A positive change in FH correlated with less back pain, less disability, and improved physical function in the TLIF group ( P <0.05). CONCLUSIONS: Patients treated with PLF lost FH over time. An increased difference in FH at 1 year was associated with improved function and less back pain in the TLIF group.

Preoperative Disc Angle is an Important Predictor of Segmental Lordosis After Degenerative Spondylolisthesis Fusion.

STUDY DESIGN: Retrospective Cohort Study. OBJECTIVES: To determine the effect of interbody cages inserted via posterior approach on segmental lordosis in the setting of preoperative lordotic vs kyphotic discs in patients with lumbar degenerative spondylolisthesis (LDS). METHODS: Retrospective analysis of prospectively collected data on assessment and management of LDS patients from 2 contributing centres. Patients were analyzed preoperatively and at 12-month follow-up with standing lumbar radiographs. Index level segmental lumbar lordosis (SLL), disc angle and global lumbar lordosis was measured. Patients were stratified into 4 groups based on index level disc angle and procedure: preoperative lordotic posterolateral fusion (group L-PLF); preoperative kyphotic PLF (group K-PLF); preoperative lordotic interbody fusion (IF) (group L-IF); preoperative kyphotic IF (group K-IF). RESULTS: A total of 100/111 (90%) patients completed follow-up with 40 in group L-IF and 48 in group K-IF. There were 18 patients in group L-PLF and 5 in group K-PLF. Among patients with preoperatively lordotic disc angles who had a worsening of SLL, group L-IF had worse SLL than group L-PLF patients, with differences persisting at one-year (mean difference 2.30, 95% CI, .3, 4.3, P = .029). Patients in group K-IF achieved improvement in SLL at one-year more frequently than group L-IF (67% vs 44%, P = .046), with similar mean improvement magnitude between groups L-IF and K-IF (-1.1, 95% CI, -3.7, 1.6, P = .415). CONCLUSION: Segmental lordosis worsening was greater with preoperative index lordotic disc angles when an interbody cage was used. Patients who have a kyphotic disc preoperatively gain more lordosis with interbody cage use.

Bone Grafts in Dental Implant Management: A Narrative Review.

Successful implant dentistry can be directly related to the quality and quantity of bone at the recipient site of the implant. Over the years, bone grafts have been used for the treatment of various osseous defects. Due to the widespread acceptance of dental implants, interest in bone reconstruction for the oral cavity has increased dramatically over the past decade. Many patients who request implant rehabilitation require ancillary procedures to increase the quantity and quality of the recipient's bone. The internal architecture of the bone is generally described in terms of quality of the bone, which in turn reflects the strength (degree of compactness) of the bone. This is considered a crucial factor about the available bone at the edentulous site while planing about the design of the planned implant, surgical approach, healing time, and the initial progressive bone loading during the prosthetic reconstruction. Atrophy of the alveolar processes is expressed as a reduction of height and width. Databases were electronically searched up to April 2019 to identify human bone graft studies to provide contemporary and comprehensive information about the various bone grafts used in dental implant management.

Dental Robotics: A Disruptive Technology.

Robotics is a disruptive technology that will change diagnostics and treatment protocols in dental medicine. Robots can perform repeated workflows for an indefinite length of time while enhancing the overall quality and quantity of patient care. Early robots required a human operator, but robotic systems have advanced significantly over the past decade, and the latest medical robots can perform patient intervention or remote monitoring autonomously. However, little research data on the therapeutic reliability and precision of autonomous robots are available. The present paper reviews the promise and practice of robots in dentistry by evaluating published work on commercial robot systems in dental implantology, oral and maxillofacial surgery, prosthetic and restorative dentistry, endodontics, orthodontics, oral radiology as well as dental education. In conclusion, this review critically addresses the current limitations of dental robotics and anticipates the potential future impact on oral healthcare and the dental profession.

Factors influencing the choice of otolaryngology (ORL) head and neck surgery as a future specialty for Saudi medical students.

AIM: To find out the factors and causes that motivate medical students to choose ear, nose, and throat (ORL head and neck surgery) as a specialty in Saudi Arabian medical universities. MATERIALS AND METHODS: A cross-sectional study was conducted at Kingdom of Saudi Arabia by distributing a self-administered questionnaire to 1,516 medical students across all medical universities. Chi-squared test and logistic regression analyses were used to examine the association between the participants' choices and factors motivating their choice of specialty. RESULTS: ORL head and neck surgery was chosen as a future specialty by 27% of the participants. Of these, 52% chose lifestyle as the most influential factor determining their choice of specialty. Further analysis of participant preferences revealed that 87.6% listed flexibility within medicine as their main reason for choosing a specialty, followed by reasonable hours of practice in 86%, while 15.9% considered a strong mentor relationship to be important. Students from King Abdulaziz University more frequently chose ORL head and neck, along with those from the eastern kingdom compared with other areas. Student preference for ORL head and neck did not vary significantly with gender, age, or duration of clinical rounds. CONCLUSION: Approximately 27% of students chose ORL head and neck, with lifestyle being the most influential factor, followed by flexibility within medicine. Among students who chose ORL head and neck, the highest percentage was from King Abdulaziz University.

Utilization of cross-matched blood in elective thyroid and parathyroid surgeries: a single-center retrospective study.

BACKGROUND: Hospital blood banks face the common challenge of maintaining an adequate supply of blood products to serve all potential patients while minimizing the need to discard expired blood products. This study aimed to determine the risk of blood transfusion during elective thyroid and parathyroid surgery and potential factors related to blood loss and risk of transfusion in these cases. METHODS: The study included all thyroid and parathyroid surgeries performed at King Abdulaziz University Hospital between January 2015 and December 2017. After exclusion of patients with incomplete data, 179 patients with complete data who had undergone thyroid and parathyroid surgery were analyzed. RESULTS: Of the179 patients included in this study, 33 (18.4%) were male. Overall, patients had a mean age and body-mass index of 44.55±13.67 years and 27.66±5.38 kg/m2, respectively. The mean duration of surgery was 168.48±90.69 minutes. None of the patients had a history of previous radiotherapy, bleeding disorder, or blood transfusion. Benign goiter was the most common finding (n=78, 43.6%), followed by papillary carcinoma (n=49, 27.4%). During surgery, most patients (n=136, 76.0%) experienced minimal blood loss. None of the patients in our cohort (n= 179) required any blood transfusion or products. CONCLUSION: In this study, we aimed to audit the surgical blood-ordering and -transfusion practices associated with elective thyroid and parathyroid surgeries at our institution. These practices are intended to balance the availability of blood products with the avoidance of unnecessary wastage. In our study of patients who underwent elective thyroid and parathyroid surgeries, parathyroid surgeries, none required blood transfusion.