Effects on clinical outcomes of grafts and spacers used in transforaminal lumbar interbody fusion: a critical review.

Transforaminal lumbar interbody fusion (TLIF) is a relatively new and popular spinal fusion technique that has proven very useful since its introduction. To date, fusion rates for different combinations of modalities and materials have not been thoroughly compared and assessed. In this review of published reports, 29 papers met criteria for assessing fusion rates for three different interbody spacers and four different combinations of bone grafts and extenders. The spacers included Capstone, polyether ether ketones and Telamon cages, and the grafting materials reviewed were locally harvested bone, iliac crest bone with local, local bone plus recombinant human bone morphogenetic protein 2 and a mixture of local and allograft bone. Of these, it was found that only the Capstone cage and locally harvested bone achieved statistically significant higher fusion rates (96.46% ± 2.89% and 97.07% ± 1.94% respectively) than the other modalities and materials studied. Oswestry Disability Index scores and visual pain scales were also examined as indicators of overall improvement after using each spacer and graft; the Telamon cage and local bone mixed with rhBMP-2 stood out as conferring statistically significant greater improvements according to these two scales. Our findings are that Capstone and locally harvested bone alone are relatively superior in terms of fusion rates.

Bedside fasciotomy under local anesthesia for acute compartment syndrome: a feasible and reliable procedure in selected cases.

BACKGROUND: Fasciotomy for compartment syndrome is an emergent procedure that is usually done in the operating theater under general anesthesia. Delay in performing the procedure can lead to worse outcome. Various reasons can cause delay in performing the surgery. Bedside fasciotomy under local anesthesia can be done in these cases to avoid delay in compartment release. MATERIALS AND METHODS: This was a retrospective study of 34 cases of acute compartment syndrome for which fasciotomy was done at the bedside under local anesthesia. The minimum follow-up period was 6 months. RESULTS: All patients had immediate and marked improvement in pain. Thirty-three patients regained their normal muscle strength. Thirty-two patients regained normal range of motion of adjacent joints. One patient developed flexion contracture of the great toe. There was no deep infection, chronic osteomyelitis, or amputation. Superficial wound infection was noted in three patients; one patient had persistent foot drop. CONCLUSION: Bedside fasciotomy under local anesthesia is a feasible, safe, and effective choice for treating compartment syndrome in patients with delayed presentation or those with anticipated delay to undergo surgery in the operating theater under general or regional anesthesia. The results of this study are encouraging, as all wounds healed satisfactory and there were no cases of deep infections. The formal release of compartments in the operating room under general anesthesia continues to be the standard of care. This is the first description in the literature for bedside fasciotomy under local anesthesia with a relatively large number of patients.

Outcome of thoracolumbar burst fractures treated with indirect reduction and fixation without fusion.

Indirect reduction and fixation is not a new method in the treatment of thoracolumbar burst fractures but the indications and efficacy are controversial. The current study was designed to evaluate the efficacy of indirect reduction without fusion. Sixty-four patients with single-level thoracolumbar burst fractures were identified and treated by this method. The outcome was analyzed by the Frankel method, radiographic measurements, and at the latest follow-up the Denis Pain Scale and Oswestry disability index (ODI) were used to assess back pain and functional outcome. The average follow-up period was 40.1 months. The anterior vertebral height (AVH) was corrected from 55.2 to 97.2% post-operatively and decreased to 88.9% after hardware removal. The posterior vertebral height (PVH) increased from 88.9 to 99.1% post-operatively and decreased slightly after implant removal to 93.7%. The average pre-operative canal compromise was 41.4%, which decreased to 13.7% at last follow-up. Except for three paraplegic patients, neurological status significantly improved or stayed normal in the study's remaining 61 patients. Fifty-two of sixty-four patients had excellent or good function. At latest follow-up the average ODI score was 16.7 and the Denis pain score improved in all patients but one. Indirect reduction and fixation can not only restore vertebral column structure but also, more importantly, patients' functional outcome.

Sacroiliac joint fusion with fibular bone graft in patients with failed percutaneous iliosacral screw fixation.

BACKGROUND: Numerous studies have described screw fixation of sacroiliac (SI) joint, but there have been very few reports in the literature regarding long-term pain levels after SI joint fixation and their management. The objective of this study was to analyze the results of SI joint fusion with fibular bone graft in patients with persistent late pain after iliosacral screw fixation. METHODS: Eleven consecutive patients with persistent late pain following iliosacral screw fixation with failed conservative methods were managed with fibular bone grafting of the SI joint. The patients were followed up at 2, 6, 12, 24 weeks and every 3 months thereafter. They were clinically assessed for pain, infection, and ambulation. RESULTS: The average duration of follow-up was 18 months. There were neither intraoperative complications nor postoperative wound infection. Eight patients were pain free and returned to their work. The remaining three patients were having persistent-localized pain, but they were able to manage their daily activities. CONCLUSIONS: Fibular graft is feasible and apparently effective choice for SI joint fusion. This procedure avoids further metal work, which results in successful fusion and pain relief as well as stabilizing the SI joint.

Transplanted mesenchymal stem cells with pure fibrinous gelatin-transforming growth factor-beta1 decrease rabbit intervertebral disc degeneration.

BACKGROUND CONTEXT: Disc degeneration is a major reason for low back pain and can be caused by apoptosis. The prevention of apoptosis using mesenchymal stem cells (MSCs) may lead to new treatments for low back pain. Previous studies have reported that transplanted MSCs can proliferate and differentiate into cells expressing some of the major phenotypic qualities of nucleus pulposus cells. However, the effects of MSC transplantation on the disc height index (DHI) and apoptosis inhibition have not yet been thoroughly investigated. PURPOSE: The present study evaluates the effects of MSC transplantation on DHI and its potential to inhibit apoptosis. STUDY DESIGN/SETTING: Random, controlled, animal experiment study. METHODS: The annulus fibrosus of 54 white New Zealand rabbits was punctured with a 21-gauge needle, and the nucleus pulposus tissue from the intervertebral discs was aspirated. The degenerative disc model was produced in each rabbit, which were then randomly divided into three groups: degenerative model group; pure fibrinous gelatin-transforming growth factor-beta1 (PFG-TGF-beta1) transplanted group; and MSC-PFG-TGF-beta1 transplanted group. Computed radiography imaging, magnetic resonance imaging, and histological examinations were performed at Weeks 4, 8, and 12. RESULTS: The transplanted MSCs inhibited apoptosis and slowed the rate of decrease in DHI. Magnetic resonance imaging results showed that the MSC-PFG-TGF-beta1 group had less degeneration and a slower decrease in DHI compared with both the degenerative model and PFG-TGF-beta1 groups. An increased quantity of nucleus pulposus and type II collagen content and a decrease in the rate of cell apoptosis were noted in the MSC-PFG-TGF-beta1 group. CONCLUSIONS: Mesenchymal stem cells can slow the rate at which the DHI decreases. This effect may be because of the inhibition of apoptosis by MSCs.