Mechanical Vertebral Body Augmentation Versus Conventional Balloon Kyphoplasty for Osteoporotic Thoracolumbar Compression Fractures: A Systematic Review and Meta-Analysis of Outcomes.

STUDY DESIGN: Systematic review and meta-analysis. OBJECTIVE: Surgical management of osteoporotic vertebral compression fractures (OVCFs) has traditionally consisted of vertebroplasty or kyphoplasty procedures. Mechanical percutaneous vertebral body augmentation (MPVA) systems have recently been introduced as alternatives to traditional methods. However, the effectiveness of MPVA systems vs conventional augmentation techniques for OVCFs remains unclear. This serves as the premise for this study. METHODS: A systematic review and meta-analysis was conducted as per the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Studies of interest included randomized controlled trials (RCTs) which directly compared patient outcomes following kyphoplasty to patients treated with MPVA systems. Clinical and radiological findings were collated and compared for significance between cohorts. RESULTS: 6 RCTs were identified with 1024 patients total. The mean age of all patients was 73.5 years. 17% of the cohort were male, 83% were female. 515 patients underwent kyphoplasty and 509 underwent mechanical vertebral body augmentation using MPVA systems. MPVAs showed similar efficacy for restoration of vertebral body height (P = .18), total complications (P = .36), cement extravasation (P = .58) and device-related complications (P = .06). MPVAs also showed reduced rates of all new fractures (16.4% vs 22.2%; P = .17) and adjacent fractures (14.7% vs 18.9%; P = .23), with improved visual analogue scale (VAS) scores at 6-month (P = .13). CONCLUSION: The results of this meta-analysis highlight no significant improvement in clinical or radiological outcomes for MPVA systems when compared to balloon kyphoplasty for vertebral body augmentation. Further research is needed to establish a true benefit over traditional operative methods.

Risk factors associated with the reported scores on the symptoms severity and functional limitations scales of the Boston Carpal Tunnel Questionnaire: a cross-sectional study.

Carpal tunnel syndrome (CTS) is the most common entrapment neuropathy. It presents with numbness, paresthesias, and pain. Multiple risk factors are associated with CTS, such as pregnancy, oral contraceptive use, rheumatoid arthritis (RA), and diabetes mellitus (DM). The Boston Carpal Tunnel Questionnaire (BCTQ) is a self-administered questionnaire for assessing the severity of symptoms and functional status of those previously diagnosed with CTS. We aim to identify risk factors associated with higher scores of CTS symptoms severity and functional limitations scales on the BCTQ. Materials and methods: This cross-sectional study was conducted among 366 female participants. The data was mainly collected using the BCTQ. Demographics and risk factors of CTS were added to the study's complete questionnaire; risk factors included RA, DM, hypothyroidism, number of pregnancies, usage of oral contraceptive pills (OCPs), use of smartphones and keyboards. A P value of less than 0.05 was considered statistically significant. Results: Most participants were in their 30s (44%) and housewives. RA, DM, hypothyroidism, and pregnancy were associated with reporting symptoms and functional limitations on BCTQ. OCPs and smartphone use were associated with functional limitations only. Conclusion: Different risk factors are associated with reporting symptoms and functional limitations of CTS on the BCTQ. For example, RA, DM, hypothyroidism, pregnancy, OCPs, and smartphone use have all been found to statistically affect the outcome of the BCTQ in this study. Therefore, clinical confirmation of the CTS diagnosis is required in future studies to ensure that these symptoms and functional limitations are associated with the CTS pathology rather than other risk factors and pathologies for proper targeted treatment plans and outcomes.

Effective Management Options for Treatment of Microinstability of the Hip: a Scoping Review.

PURPOSE OF REVIEW: To review the recent literature identifying and summarizing the research involving management of microinstability of the hip and highlight new and evolving techniques in its treatment. RECENT FINDINGS: Recent updates in the understanding of capsular management hip arthroscopy will likely lead to less revision surgery and a decreased incidence of persistent post-operative pain. Repair of residual capsular defects has shown good outcomes with high patient satisfaction. Capsular plication remains the gold standard for hips with increased pain that show signs of capsular laxity/deficiency on exam or imaging. Capsular reconstruction has shown equivalent results to other revision hip arthroscopy procedures with low rates of complications. Ligamentum teres pathology, although rare, should be considered a source of pain, particularly in patients with laxity on exam. In cases where CAM over-resection has occurred, remplissage using allograft is an effective option for restoring the capsular suction seal and stability. Microinstability is increasingly being recognized as a source of post-operative hip pain. Patients with collagen disorders remain a challenging clinical entity with increased rates of complications and post-operative pain. CAM resection should be performed carefully and not disrupt the suction seal but be sufficient to not cause further impingement. Improved evidence including well-designed prospective studies with large sample sizes will determine the future management of this complex problem.

Risk factors for the development of degenerative changes among patients undergoing rotator cuff repair: A systematic review.

Background: Osteoarthritis (OA) of the glenohumeral joint results in significant pain and functional limitations. It is unclear which risk factors increase the risk of developing glenohumeral OA amongst Rotator Cuff Repair (RCR) patients. The purpose of this systematic review was to examine the risk factors which may contribute to the development of osteoarthritic changes post-operatively. Methods: MEDLINE, Embase, and PubMed databases were searched to identify studies reporting on demographics of patients who develop OA following RCR. Results: Seventeen articles were identified investigating a total of 1292 patients. The overall quality of evidence was low. Pooled assessment of OA incidence following RCR at minimum 5 years follow-up found 26% of patients developed OA. Patients requiring revision surgery following retears developed OA at a rate of 29%. Surgical technique and patient demographics may also contribute to degenerative changes. Discussion: This review found correlations between the aforementioned risk factors and glenohumeral joint degeneration at long-term follow-up after RCR. These findings suggest that future long-term studies should aim to identify prognostic factors that may place a patient at increased risk of developing OA. Such data can be used to counsel patients with respect to long-term outcomes following surgical intervention.