RESUMO
STUDY DESIGN: Systematic review and meta-analysis. OBJECTIVE: Current surgical management of degenerative spondylolisthesis (DS) involves decompression of the spinal canal followed by fusion with or without interbody. The additional functional and operative benefits derived from interbody inclusion has yet to be thoroughly established with a number of recent studies producing conflicting results. Thus, we aim to compare the functional and operative outcomes after fusion against interbody fusion in the treatment of DS. METHODS: This systematic review of the literature comparing posterolateral fusion (PLF) and posterior lumbar interbody fusion (PLIF) outcomes in the treatment of DS was performed using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Electronic searches of 6 databases yielded 386 articles from database inception to July 2016, which were screening against established criteria for inclusion into this study. RESULTS: A total of 6 studies, satisfied criteria and reported outcomes for 721 patients. Fusion alone was performed in 458 (63.5%) patients and interbody fusion was performed in 263 (36.5%) patients. Functional outcomes Oswestry Disability Index (P = .29) and visual analog scale (P = .13) were not statistically different between the 2 approaches. Furthermore, there was no significant inferiority between fusion alone and with interbody in terms of the operative outcomes of blood loss (P = .38), reoperation rate (P = .66), hospital stay (P = .96), complication rate (P = .78), or fusion rate (P = .15). CONCLUSIONS: There was no statistically significant difference in functional and operative outcomes following fusion alone versus with interbody. Additional subgroup analysis of intrinsic DS features in future large, prospective, randomized controlled trials will improve the validity of these findings.
RESUMO
This paper provides an empirically informed perspective on the notion of responsibility using an ethical framework that has received little attention in the engineering-related literature to date: ethics of care. In this work, we ground conceptual explorations of engineering responsibility in empirical findings from engineering student's writing on the human health and environmental impacts of "backyard" electronic waste recycling/disposal. Our findings, from a purposefully diverse sample of engineering students in an introductory electrical engineering course, indicate that most of these engineers of tomorrow associated engineers with responsibility for the electronic waste (e-waste) problem in some way. However, a number of responses suggested attempts to deflect responsibility away from engineers towards, for example, the government or the companies for whom engineers work. Still other students associated both engineers and non-engineers with responsibility, demonstrating the distributed/collective nature of responsibility that will be required to achieve a solution to the global problem of excessive e-waste. Building upon one element of a framework for care ethics adopted from the wider literature, these empirical findings are used to facilitate a preliminary, conceptual exploration of care-ethical responsibility within the context of engineering and e-waste recycling/disposal. The objective of this exploration is to provide a first step toward understanding how care-ethical responsibility applies to engineering. We also hope to seed dialogue within the engineering community about its ethical responsibilities on the issue. We conclude the paper with a discussion of its implications for engineering education and engineering ethics that suggests changes for educational policy and the practice of engineering.