Percutaneous versus open pedicle screw instrumentation in treatment of thoracic and lumbar spine fractures: A systematic review and meta-analysis.

BACKGROUND: To assess the safety and efficacy of percutaneous short-segment pedicle instrumentation compared with conventionally open short-segment pedicle instrumentation and provide recommendations for using these procedures to treat thoracolumbar fractures. METHODS: The Medline database, Cochrane database of Systematic Reviews, Cochrane Clinical Trial Register, and Embase were searched for articles published. The randomized controlled trials (RCTs) and non-RCTs that compared percutaneous short-segment pedicle instrumentation to open short-segment pedicle instrumentation and provided data on safety and clinical effects were included. Demographic characteristics, clinical outcomes, radiological outcomes, and adverse events were manually extracted from all of the selected studies. Methodological quality of included studies using Methodological Index for Non-Randomized Studies scale and Cochrane collaboration's tool for assessing the risk of bias by 2 reviewers independently. RESULTS: Nine studies encompassing 433 patients met the inclusion criteria. Subgroup meta-analyses were performed according to the study design. The pooled results showed there were significant differences between the 2 techniques in short- and long-term visual analog scale, intraoperative blood loss, operative time, postoperative draining loss, hospital stay, and incision size, although there were no significant differences in postoperative radiological outcomes, Oswestry Disability Index, hospitalization cost, intraoperative fluoroscopy time, and adverse events. CONCLUSION: Percutaneous short-segment pedicle instrumentation in cases with achieve satisfactory results, could replace in many cases extensive open surgery and not increased related complications. However, further high-quality RCTs are needed to assess the long-term outcome of patients between 2 techniques.

[Combined application of neural stem cell and self-assembly isoleucine-lysine-valine-alanine-valine nanofiber gel transplantation in the promotion of function recovery of spinal cord injury in rats].

OBJECTIVE: To observe the effects of neural stem cells (NSC) plus self-assembly isoleucine-lysine-valine-alanine-valine (IKVAV) nanofiber gel transplantation on the promotion of function recovery of spinal cord injury (SCI) in rats. METHODS: A total of 230 SD rats were randomized into gel, NSC, NSC plus self-assembly IKVAV nanofiber gel transplantation, normal saline and sham-operation groups. Function repair was evaluated by bundle branch block (BBB) score, immunofluorescence and Western blot respectively at Day 1, 3, 5, 7, 14, 28, 56 and 92 post-operation. RESULTS: There were statistically significant differences among bundle branch block (BBB) scores of different treatment groups (P < 0.01). Moreover, statistical significance existed between each treatment group and combined transplantation group (P = 0.000). The expression of glial fibrillary acidic protein in combined transplantation group (rats with spinal injury) was lower than that in other treatment groups (except for sham operation) and the expression of NF-200 in this group was higher than that in other treatment groups (except for sham operation). Significant differences existed in the expressions of brain-derived neurotrophic factor and nerve growth factor between combined transplantation and other treatment groups (P < 0.01). CONCLUSION: Transplantation with IKVAV nanofiber gel, NSC and NSC plus self-assembly IKVAV nanofiber gel may promote the repair of SCI in rats. But the method of NSC plus self-assembly IKVAV nanofiber gel is more effective.