Anterior Approach Surgery Research Articles

Impact of Age on the Occurrence of Vascular Complications in Patients Undergoing Anterior Lumbar Approach Surgery.

Retrospective cohort study. To investigate the impact of age on the incidence of vascular complications in patients undergoing anterior lumbar approach surgery. Anterior approach lumbar spinal surgery may facilitate the use of intervertebral devices with larger endplate coverage and increased lordosis. Despite the advantages of this approach, risks related to vascular injury in older patients have been described in the literature. In total, 751 consecutive patients with degenerative spinal pathology who underwent stand-alone anterior lumbar interbody fusion (ALIF), ALIF combined with posterior fusion and/or instrumentation (360), total disc replacement, or hybrid procedures (ALIF and total disc replacement) were included. Data collected included general patient descriptive data, surgery details, intraoperative vascular injury, and postoperative vascular complications (deep vein thrombosis and/or pulmonary embolism). Rates of vascular complications were compared across age groups. In addition, the mean age of patients was compared between those with versus without vascular complications. Overall mean age was 50.4 years (range: 20-83 yr). The mean estimated blood loss was 91.3mL (range: 10-2800mL). A total of 15 patients, 2.0%, had vascular complications. There were 10 cases (1.3%) of intraoperative injury to iliac arteries or iliolumbar veins (mean blood loss was 721mL, and all were repaired intraoperatively). Postoperatively, 6 patients (0.8%) developed deep vein thrombosis and/or pulmonary embolism (one patient had both). With respect to age, there were no significant differences in rates of intraoperative, postoperative, or combined vascular complication rates across the age group ( P > 0.38). In addition, there were no statistically significant differences in the mean ages of patients with versus those without vascular complications ( P > 0.17). Overall incidence of vascular complications was 2.0%. No relationship between vascular complications and age was demonstrated. These data suggest that increased age may not necessarily be an absolute contraindication for anterior lumbar approach surgery. Level III.

Innovations in the treatment of cervical spine myelopathy – a comprehensive review

Introduction and aim of the study Myelopathy of the cervical spine is a set of symptoms resulting from compression of the spinal cord. There are many causes that may lead to this disorder, including degenerative changes, ligament ossification and tumors. Middle-aged and older patients usually suffer from it, and its diagnosis is expected to increase as the population gets older. Due to non-specific and initially mild symptoms, cervical myelopathy is usually diagnosed in later stages, often when the patient's fitness and independence are significantly impaired. The aim of the study is to present the current state of knowledge about myelopathy of the cervical spine, methods of its effective diagnosis, and to present available therapeutic options, because early diagnosis and optimal treatment enable patients to maintain their ability to work and improve their overall quality of life. Materials and methods The literature included in the PubMed, BioMed Central and Polish Medical Platform databases is searched by means of the words such as cervical myelopathy, decompression, spinal cord, corpectomy, discectomy. Quoted sources in selected works were also used. Conclusion Surgical treatment is the most effective method to improve the clinical condition of people suffering from cervical myelopathy. Both anterior and posterior approach surgeries are characterized by similar effectiveness, and the choice of a specific method depends on the patient's general condition, the degree of cervical lordosis, and the number of affected spinal segments. Due to the correct diagnosis of the disease and applying treatment, it is possible to slow down the progression of the disease and improve the quality of life of patients.

Anterior approach in the surgical management of multiple lumbar fractures (clinical case)

Lumbar fractures are an urgent medical problem. They are often feature the compression of dural sac and roots followed by neurological deficit. This case study presents the anterior approach surgery as the method of choice for the management of multiple fractures with damage to the A and В columns ensuring optimal decompression of the spinal canal and deformity correction and avoiding multi-stage interventions.

Is the Use of Intraoperative Neuromonitoring Justified During Lumbar Anterior Approach Surgery?

Intraoperative neuromonitoring (IONM) became widely used in spine surgery to reduce the risk of iatrogenic nerve injury. However, the proliferation of IONM has fallen into question based on effectiveness and costs, with a lack of evidence supporting its benefit for specific spine surgery procedures. The purpose of this study was to evaluate the use of IONM and the rate of neurological injury associated with anterior lumbar spinal surgery. This was a retrospective study on a consecutive series of 359 patients undergoing lumbar anterior approach surgery for anterior lumbar interbody fusion (ALIF), total disc replacement (TDR), or hybrid (ALIF with TDR) for the treatment of symptomatic disc degeneration. Patients undergoing any posterior spine surgery were excluded. Operative notes were reviewed to identify any changes in IONM and the surgeon's response. Clinic notes were reviewed up to 3 months postoperatively for indications of iatrogenic nerve injury. There were 3 aberrant results with respect to IONM. Changes in IONM of a lower extremity occurred for 1 patient (0.3%). The surgeon evaluated the situation and there was no observable reason for the IONM change. Upon waking, the patient was found to have no neurological deficit. There were 2 cases of neurologic deficits in this population, which were classified as false-negatives of IONM (0.56%, 95% CI: 0.1% to 1.8%). In both cases, the patients were found to have a foot drop after the anterior approach surgery. In this study, there was 1 false-positive and 2 false-negative results of IONM. These data suggest that IONM is not beneficial in this population. However, many surgeons may feel obligated to use IONM for medicolegal reasons. There is a need for future studies to delineate cases in which IONM is beneficial and the type of monitoring to use, if any, for specific spine surgery types. This study questions the routine use of IONM in anterior lumbar approach surgery for the treatment of symptomatic disc degeneration. This has significant implications related to the cost of this practice.

A Clinical Study on Outcomes Following Anterior Approach Surgery for Cervical Spondylotic Myelopathy

A Clinical Study on Outcomes Following Anterior Approach Surgery for Cervical Spondylotic Myelopathy

A Retrospective Study of Degenerative Cervical Myelopathy and the Surgical Management Within Northern Ireland.

Degenerative cervical myelopathy (DCM) is a condition of growing concern due to its increasing incidence among the ageing population. It involves age-associated pathological changes of the cervical spine that can result in spinal cord compression. This can lead to deficits in motor and sensory function of the upper and lower limbs, issues with balance and dexterity, as well as bladder and bowel disturbance. Patients can be categorised as having mild, moderate, or severe degenerative cervical myelopathy depending on their modified Japanese Orthopaedic Association (mJOA) score. This condition is generally managed surgically; however, patients with mild degenerative cervical myelopathy may be offered or opt for non-surgical treatment initially. The main aim of this study is to evaluate the surgical management of patients with DCM and to ascertain the degree of mJOA improvement from pre-surgery and one-year post-surgery follow-up. The second aim of the study is to explore the demographics within Northern Ireland who are diagnosed with DCM and who undergo surgery. This information could allow for better planning of services in the future for this patient cohort. This is a retrospective review of the surgical management of degenerative cervical myelopathy within the Regional Spinal Orthopaedic Unit in Northern Ireland over three years with one-year follow-up. The data was retrospectively collected from the Fracture Outcome Research Database. A total of 102 patients (10:7, male:female) with DCM were retrospectively evaluated. Exclusion criteria included all patients diagnosed with spinal tumour, fracture, central cord syndrome, and dislocation. Two patients were removed due to incorrect coding of DCM diagnosis and were not included. Key variables assessed were gender, age, symptoms, type of surgery, complications, and MRC score and mJOA score pre-surgery, 48 hours, six months, and one year post surgery. The choice of surgery was guided by the maximal angle of compression, the number of vertebral levels involved, patient comorbidities, and anesthetic risk. The sample consisted of 60 men (58.82%) and 42 women (41.17%) with an average age of 57.17 ± 12.13 years ranging from 27 to 83 years old. Statistical analysis was conducted to explore the effect of time before and after surgery up to one year on the mJOA score. There was a significant difference in mJOA score pre-surgery and at six months and one year post surgery (R = 0.579053, p <0.001). Of the patients,61.8% with a length of stay greater than three days and 71.4% of patients with a length of stay greater than seven days had a posterior approach surgery. A multiple linear regression analysis revealed that the mJOA score pre-surgery and the presence of complications significantly predicted the length of stay post-surgery (β -1.044, p = .011 and β -5.791, p = .028). The first key finding of this study is that the mJOA score tends to improve after surgery for the majority of patients, particularly at six months, which is consistent with the literature. The second key finding is that anterior approach surgery is associated with a lower rate of complications and shorter post-surgery length of stay in hospital compared to posterior approach surgery. The third key finding is that the pre-surgery mJOA score and the presence of complications post surgery significantly predict the post-surgery length of stay.

Retrospective analysis of robot-assisted laparoscopic transabdominal anterior approach for the treatment of lumbar paravertebral schwannoma.

The main objective of this study was to investigate the impact of robot-assisted laparoscopic resection on paravertebral tumours using the anterior peritoneal approach. A retrospective analysis to identify patients with paravertebral tumours. A total of 21 patients, who underwent robot-assisted laparoscopic transabdominal anterior approach surgery from March 2012 to August 2020. The median operation time was 66.2±14.5min, with a range of 0-100min. Intraoperative blood loss was minimal, with a median of 11.4±7.9mL and a range of 5-30mL. The median tumour length was 4.8±2.3cm, ranging from 2.1 to 11.3cm. Postoperative hospitalisation lasted for a median of 3.2±0.9days. During the 48-month follow-up period, no tumour recurrence or residual was observed in any patient. Robot-assisted laparoscopic resection of lumbar paravertebral schwannoma proved to be a safe and viable surgical approach. It offers a relatively new treatment option for paraspinal schwannoma.

TRAINING IN HIP AND KNEE ARTHROPLASTY: ARE THEY DOING ENOUGH?

Orthopaedic surgery is a practical surgical specialization field, the exit exam for registrars remains written and oral. Despite logbook evaluation and surgical work-based assessments, the question remains: can registrars perform elective surgery upon qualification? In South Africa, obstacles to elective surgical training include the trauma workload, financial constraints, fellowships and the Covid pandemic. In hip and knee arthroplasty, new approaches like the direct anterior approach (DAA) and robotic-assisted knee surgery also contributed to the dilution of cases available for registrar training. There are concerns that orthopaedic registrars do not perform enough cases to achieve surgical proficiency.Review of the last 4 years of registrar logbooks in hip and knee arthroplasty surgery performed in a single tertiary academic hospital in South Africa. We included all primary total hip replacements (THR), total knee replacements (TKR) and hemiarthroplasties (HA) done for neck of femur (NOF) fractures between 1 April 2019 and 30 March 2023. Differentiation between registrar assisting, registrar performing with consultant supervision and registrar performing independent surgery was done.990 hip arthroplasties (472 Primary THR, 216 NOF THR, 302 NOF HA) and 316 Primary TKR were performed during the study period. In primary elective THR the posterior approach was dominant and used in 76% of cases. In NOF THA the DAA was dominant used in 98% of cases. Primary TKR robotic-assisted technologies was used in 27% (n=94) cases. Registrars as the primary surgeon were the highest in NOF THA at 70% of cases and the lowest performing TKR at 25%. During 3-month rotations, an average registrar performed 12 (2 TKR and 10 THR) and assisted in 35 (10 TKR and 25 THR) cases.Despite the large number of arthroplasties operations being performed over the last 4-year period, the surgical cases done by registrars are below, the proposed minimal cases to provide surgical proficiency during their training period.

Impact of preoperative intervention for smoking cessation on postoperative length of stay and cost for spine surgery patients: Propensity score matching analysis

BackgroundPreoperative intervention for smoking cessation reduces the prevalence of postoperative complications in spine surgery. To date, however, the impact of these interventions on the length of stay (LOS) and cost for patients is unclear. Patients/methodsThis retrospective cohort study analyzed data from 317 patients who were current smokers and underwent spine surgery between January 2014 and December 2019 at a single facility in Tokyo, Japan. Most patients (262) received preoperative intervention for smoking cessation within 60 days before spine surgery; the remaining 55 patients did not receive the intervention. The postoperative LOS was compared using propensity score matching. Patients were matched for age, gender, body mass index, surgical plan (cervical surgery, anterior approach surgery, minimally invasive surgery), preoperative comorbidities (diabetes mellitus, hypertension, ischemic cardiac disease, chronic lung disease), and recent history of steroid therapy, which yielded 48 pairs of patients. ResultsThe length of postoperative hospital stay was significantly shorter in the intervention group (−10.60 days, [95% CI, −15.79 to −5.42]). The cost for service was significantly lower in the intervention group (coefficient, Japanese yen [JPY] −1,515,529; [95% CI, −2,130,631 to −900,426]; 110 JPY equivalent to 1 United States dollar). ConclusionsPreoperative interventions for smoking cessation may decrease postoperative hospital stay and hospitalization costs.

Correlation Analysis of Surgical Efficacy and Risk Factors of Cervical Spondylotic Myelopathy with High Signal Intensity on MRI-T2WI.

The purpose of this study was to investigate the surgical efficacy and risk factors of cervical spondylotic myelopathy (CSM) patients with increased signal intensity (ISI) on T2-weighted magnetic resonance imaging (MRI-T2WI). We compared the surgical outcomes of CSM patients with and without ISI. In addition, we compared the efficacy of anterior and posterior cervical decompression in CSM patients with ISI. We also analyzed the risk factors of MRI-T2WI ISI in CSM patients. The incidence of ISI among 153 CSM patients was 71.89 %. The JOA score and JOA remission rate were better in the ISI-free than in the ISI group. The postoperative JOA score and JOA remission rate were better in the posterior than the anterior approach surgery group. The disease duration and vertebral canal volume were found to be risk factors for ISI in CSM patients. Among patients with CSM, the prognosis is worse for those with ISI than those without ISI. Posterior cervical decompression surgery produces a better curative effect than anterior cervical decompression surgery in CSM patients with ISI. CSM patients with longer disease duration and small vertebral canal volume should undergo surgical treatment as early as possible.

Cervical Radiculopathy: Focus on Factors for Better Surgical Outcomes and Operative Techniques.

For patients with cervical radiculopathy, most studies have recommended conservative treatment as the first-line treatment; however, when conventional treatment fails, surgery is considered. A better understanding of the prognosis of cervical radiculopathy is essential to provide accurate information to the patients. If the patients complain of persistent and recurrent arm pain/numbness not respond to conservative treatment, or exhibit neurologic deficits, surgery is performed using anterior or posterior approaches. Anterior cervical discectomy and fusion (ACDF) has historically been widely used and has proven to be safe and effective. To improve surgical outcomes of ACDF surgery, many studies have been conducted on types of spacers, size/height/position of cages, anterior plating, patients' factors, surgical techniques, and so forth. Cervical disc replacement (CDR) is designed to reduce the incidence of adjacent segment disease during long-term follow-up by maintaining cervical spine motion postoperatively. Many studies on excellent indications for the CDR, proper type/size/shape/height of the implants, and surgical techniques were performed. Posterior cervical foraminotomy is a safe and effective surgical option to avoid complications associated with anterior approach and fusion surgery. Most recent literature demonstrated that all three surgical techniques for patients with cervical radiculopathy have clear advantages and disadvantages and reveal satisfactory surgical outcomes under a proper selection of patients and application of appropriate surgical methods. For this, it is important to fully understand the factors for better surgical outcomes and to adequately practice the operative techniques for patients with cervical radiculopathy.

Anterior approach lumbar fusions cause a marked increase in thromboembolic events: Causal inferences from a propensity-matched analysis of 1147 patients

ObjectiveAnterior lumbar fusions are thought to be associated with elevated venous thromboembolic event (VTE) rates, but the magnitude of this increase in VTE is not well described. The objective of this study was to quantify any increase in VTE caused by anterior approach lumbar fusion. Methods1147 consecutive lumbar fusions performed at our institution over a six-year period were identified, and clinical and demographic data were collected. K-nearest neighbor propensity score matching and propensity score adjusted regression were performed. Patients undergoing anterior versus posterior approach lumbar fusions were matched according to age, body mass index, sex, VTE history, estimated blood loss, length of surgery, transfusion, selection for postoperative intensive care unit (ICU) admission, comorbid disease burden, and use of chemoprophylactic anticoagulation. ResultsAnterior approach surgery (OR=4.29, p < 0.001), a history of VTE (OR=8.67, p < 0.001), age (OR=1.53, p = 0.014), length of surgery (OR=1.16, p = 0.044), and selection for postoperative ICU admission (OR=4.60, p = 0.005) were independently associated with VTE on multivariable regression. 1058 anterior or posterior approach fusion patients were matched. After matching, overall bias was reduced by 71.0 %, no covariates remained significantly different between groups, and propensity scores were well balanced between populations (Rubin’s B≤0.25, 0.5 ≤Rubin’s R≤2.0). Significantly more patients in the anterior group underwent lower extremity duplex ultrasonography (LED) (36.9 % vs. 14.8 %, OR=3.36 [2.38, 4.76], p < 0.0001), and a statistically insignificantly higher proportion of LEDs were positive among patients in the anterior group (23.2 % vs. 13.2 %, OR=1.99 [0.92, 4.25], p = 0.108). After matching, the rate of VTE was 8.6 % for the anterior group and 1.3 % for the posterior group, with anterior approach surgery causing an increase in VTE by 7.2 % (95 % CI [2.28 %, 12.16 %], p = 0.004). ConclusionAmong patients undergoing lumbar fusions, anterior approach surgery causes an increase in VTE by 7.2%, which is a multifold increase in the proportion of patients with thromboembolic complications.

Surgical strategy for metastatic spinal tumor patients with surgically challenging situation.

The incidence of spinal metastasis is increasing as cancer patients live longer owing to the improvement of cancer treatments. However, traditional surgery (TS) which fixates at least 2 levels above and 2 levels below the affected vertebrae is sometimes difficult to perform as it is burdensome to the patients. In this article, we introduce our experience and strategy in treating spinal metastasis, focusing particularly on challenging cases.We retrospectively reviewed the data of 110 patients who underwent spinal surgery for metastatic spinal tumors from April 2018 to March 2020. Among them, 5 patients who received anterior approach surgery were excluded. The remaining 105 patients were enrolled. In addition to TS, we also performed cervical pedicle screw, cervicothoracic junction fixation, thoracolumbar short fixation, and decompression surgery, depending on the characteristics of the tumor. The overall survival was analyzed, and the local tumor control rate was evaluated using magnetic resonance imaging. Perioperative clinical characteristics including Spine Oncology Study Group Outcomes Questionnaire, visual analog scale, Eastern Cooperative Oncology Group performance score, and Karnofsky Performance Score were also investigated.The overall survival rate was 57.9% at 1 year, and the local tumor control rate was 81.1% after surgery. There was a statistically significant difference according to the type of the tumor in the survival analysis: the overall survival rates were 72.7% for favorable tumors and 48.6% for unfavorable tumors at 12 months after surgery (P = .04). Spine Oncology Study Group Outcomes Questionnaire, visual analog scale, Eastern Cooperative Oncology Group performance score, and Karnofsky Performance Score was improved after surgery. All surgical methods, including TS, cervical pedicle screw, cervicothoracic junction fixation, thoracolumbar short fixation, and decompression surgery, showed good clinical and radiological outcomes.Optimized surgical methods show similarly good clinical outcomes in managing spinal metastasis as TS.

Effectiveness and postoperative rehabilitation of one-stage combined anterior-posterior surgery for severe thoracolumbar fractures with spinal cord injury

BACKGROUNDThoracolumbar fractures are generally combined with spinal cord injury to varying degrees, which may cause deterioration of the patients' condition and increase the difficulty of clinical treatment. At present, anterior or combined anterior-posterior surgery is preferred for severe thoracolumbar fractures.AIMTo investigate the effectiveness and postoperative rehabilitation of one-stage combined anterior-posterior surgery for severe thoracolumbar fractures with spinal cord injury.METHODSOne-hundred-and-twenty patients who received surgery for severe thoracolumbar fractures with spinal cord injury at our hospital from February 2018 to February 2020 were randomly enrolled. They were randomly divided into group 1 (one-stage combined anterior-posterior surgery, n = 60) and group 2 (one-stage anterior-approach surgery, n = 60). Treatment efficacy was compared between the two groups.RESULTSBlood loss was greater and the operation time was longer in group 1 than in group 2, and the differences were statistically significant (P < 0.05). Incision length, intraoperative X-rays, and length of hospital stay were not significantly different between the two groups (P > 0.05). Preoperative function of the affected vertebrae was not significantly different between the two groups (P > 0.05). In each group, the patients showed significant improvement after surgery. The anterior vertebral height ratio and the posterior vertebral height ratio in group 1 after surgery were significantly higher than those in group 2. The Cobb angle after surgery was significantly lower in group 1 than in group 2 (P < 0.05). The canal-occupying ratio of the affected vertebrae was not significantly different between the two groups (P > 0.05). Before surgery, there was no significant difference in the quality of life scores between the two groups (P > 0.05). The above indicators were significantly improved after surgery compared with before surgery in each group. In addition, these indicators were markedly better in group 1 than in group 2 after surgery (P < 0.05 for each).CONCLUSIONOne-stage combined anterior-posterior surgery effectively improves the function of the affected vertebrae and the life quality of patients with severe thoracolumbar fractures and spinal cord injury. This surgical approach is worthy of popularization in clinical use.

Vertebral body reconstruction by titanium mesh or PEEK after anterior cervical vertebroplasty, applications and difficulties

Cervical vertebroplasty is a successful operation for decompression of the spinal cord and optimum restoration of cervical lordosis in individuals with severe canal stenosis. In this research, we demonstrate our method of reconstruction and replacement to the cervical vertebral body disorders with an expandable titanium cage or polyetheretherketone (PEEK). Neurologic status, morbidity, and mortality were evaluated before and after the surgery. We conducted a single-center, prospective study for all patients with cervical vertebral body lesions, who underwent single-stage vertebrectomy with an expandable titanium cage or PEEK, plate and screws reconstruction of the vertebral body. The study period between January 2014 and June 2020 in Al- Azhar university hospitals. The study included 25 patients who underwent single-stage, anterior-approach surgery. We used an expandable titanium mesh cage in five of them, and the other 20 were reconstructed using PEEK, plate, and screws. All patients had neurological symptoms before surgery, including brachialgia, motor deficit, or sphincter problems. The mean follow-up was 45.7 months (1-65 months). Neurological improvement was recorded in 20 patients at the last follow-up time, and five patients were not improved.

Comparison of anterior or posterior approach in surgical treatment of thoracic and lumbar tuberculosis: a retrospective case–control study

BackgroundWith the widespread use of the posterior surgery, more and more surgeons chose posterior surgery to treat thoracic and lumbar tuberculosis. But others still believed that the anterior surgery is more conducive to eradicating the lesions, and easier to place larger bone pieces for bone graft fusion. We compared the clinical and radiological outcomes of anterior and posterior surgical approaches and presented our views.MethodsThis study included 52 thoracic and lumbar tuberculosis patients at Sun Yat-sen Memorial Hospital from January 2010 to June 2018. All cases underwent radical debridement, nerve decompression, intervertebral bone graft fusion and internal fixation. Cases were divided into anterior group (24 cases) and posterior group (28 cases). Statistical analysis was used to compare the clinical effectiveness, radiological outcomes, complications and other related information.ResultsPatients in the anterior group and the posterior group were followed up for an average of 27.4 and 22.3 months, respectively. There were no statistically significant differences between groups in the preoperative, postoperative and last follow-up VAS score, ASIA grade and Cobb angle of local kyphosis. Moreover, there were no statistically significant differences in the improvement of neurological function, loss of kyphotic correction, total incidence of complications, operative time, intraoperative blood loss and hospital stay between the two groups (P > 0.05). But there was greater correction of kyphosis, earlier bone fusion, lower incidence of poor wound healing, less interference with the normal spine and less internal fixation consumables and medical cost in the anterior group (P < 0.05).ConclusionsBoth anterior and posterior approaches are feasible for thoracic and lumbar tuberculosis. While for thoracic and lumbar tuberculosis patients with a single lesion limited in the anterior and middle columns of the spine without severe kyphosis, the anterior approach surgery may have greater advantages in kyphosis correction, bone fusion, wound healing, protection of the normal spine, and medical consumables and cost.

Effets du sulfonate de sodium carbazochrome combiné à l’acide tranexamique sur l’hémostase et l’inflammation pendant la période périopératoire de l’arthroplastie totale de la hanche: un essai contrôlé randomisé

BackgroundThe hemostatic effect of tranexamic acid (TXA) combined with carbazochrome sodium sulfonate (CSS) in total hip arthroplasty (THA) has not been determined. Therefore we performed a randomized study aiming to evaluate the effects of CSS combined with TXA on perioperative blood loss and inflammatory response of THA. HypothesisCSS combined with TXA can effectively reduce perioperative blood loss and immune response compared to TXA. Material and methodsThis randomized placebo-controlled trial assigned 150 patients undergoing unilateral primary total hip arthroplasty who underwent direct anterior approach surgery to 3 groups: group A received TXA plus topical CSS; group B received TXA only; and group C received placebo. The main outcome was total blood loss. Secondary outcomes included reduction in hemoglobin concentration, coagulation parameters, inflammatory marker levels, perioperative visual analog scale (VAS) pain score, transfusion rates, postoperative hospital stay, and incidence of thromboembolic events. ResultsTotal blood loss in group A (668.84±230.95mL) was lower than in group B (940.96±359.22mL) and C (1166.52±342.85mL, p<0.05). We also found that compared with group B, postoperative hip pain, biomarker level of inflammation, visual analogue score (VAS) pain score in group A were significantly improved. The transfusion rate and unit of group A were significantly lower than group C (8 patients; 17.5 units), but there was no statistical difference between group A (no transfusion) and group B (2 patients; 4 units). No differences were observed in thromboembolic and other outcomes among the groups. DiscussionThe combined application of topic CSS and TXA is more effective than TXA alone following THA in regard of reducing total blood loss. In addition, CSS combined with TXA is better than TXA alone in terms of improving postoperative hip pain and reducing the level of inflammatory factors. Level of evidenceI; randomized controlled study.

Comparison of Effect of Navigation Versus No Navigation on Vertebral Body Screw Placement in Anterior Approach Surgery for Thoracolumbar Burst Fractures: A Randomized Controlled Trial

We evaluated the effects of using a navigation technique with anterior approach surgery for thoracolumbar burst fractures on vertebral body screw placement and discussed its effects on the long-term prognosis of patients. We performed a prospective study of patients who had undergone anterior approach thoracolumbar surgery from May 2018 to August 2019. The 40 patients were randomly divided into the navigation group (NG) and control group (CG). In the NG, vertebral body screw placement was performed with 2-dimensional navigation guidance. For the CG, no navigation guidance was used. The clinical and radiological evaluations of the 2 groups were compared preoperatively, immediately after surgery, and at the final follow-up. Paired t tests and the χ2 test were used to evaluate the clinical and radiological indicators. No differences were found in the hospital stay, operation time, autologous blood recovery, postoperative drainage volume, Cobb angle of the preoperative coronal plane and sagittal plane, postoperative sagittal plane, postoperative Cobb angle of the coronal and sagittal planes measured on radiographs and computed tomography scans between the 2 groups (P > 0.05). The correction of the kyphosis deformity of the fracture segment was better in both groups (P < 0.001). The intraoperative blood loss and Cobb angle of the postoperative coronal plane in the NG was less than that in the CG (P < 0.05). Also, the 4 vertebral body screws in the NG were more parallel to the endplate than were those in the CG. We found that the use of navigation can improve the accuracy of screw placement in anterior approach surgery for thoracolumbar burst fractures and improve patients' long-term prognosis.

Lumbar Spinal Fusion Using Lateral Oblique (Pre-psoas) Approach (Review).

Lumbar spinal fusion is one of the most common operations in spinal surgery. For its implementation, anterolateral (pre-psoas) approach (oblique lumbar interbody fusion, OLIF) is now increasingly used due to its high efficacy and safety. However, there is still little information on the clinical and radiological results of using this technique.The aim of the study was to analyze the safety and efficacy of OLIF in the treatment of lumbar spine disorders as presented in the literature.Materials and MethodsThe systematic electronic search was performed using the Ovid Medline, PubMed, and eLIBRARY.RU electronic databases. The following search key words were used: Oblique Lumbar Interbody Fusion, OLIF, Anterior to Psoas Lumbar Interbody Fusion, and ATP.ResultsFor the final analysis, 17 sources were selected; with a total of 2900 patients. Total complication rate was 13.9% (403 cases). The incidence of severe persistent complications was less than 1%. Based on the data obtained, we compared the clinical and radiological results of OLIF with other lumbar fusion methods.ConclusionOLIF is an effective, versatile, and minimally traumatic option for lumbar fusion with relatively few complications, which makes it superior to other retroperitoneal approaches. However, the OLIF technique is not completely free of complications associated with the ventral approach, and it cannot provide adequate decompression of the spinal canal in all cases. In addition, anterior approach surgery is still of limited use in cases of spinal deformities; adequate correction of deformity is achievable mainly in combination with posterior surgery.

Effects of carbazochrome sodium sulfonate combined with tranexamic acid on hemostasis and inflammation during perioperative period of total hip arthroplasty: A randomized controlled trial

BackgroundThe hemostatic effect of tranexamic acid (TXA) combined with carbazochrome sodium sulfonate (CSS) in total hip arthroplasty (THA) has not been determined. Therefore we performed a randomized study aiming to evaluate the effects of CSS combined with TXA on perioperative blood loss and inflammatory response of THA. HypothesisCSS combined with TXA can effectively reduce perioperative blood loss and immune response compared to TXA. Material and methodsThis randomized placebo-controlled trial assigned 150 patients undergoing unilateral primary total hip arthroplasty who underwent direct anterior approach surgery to 3 groups: group A received TXA plus topical CSS; group B received TXA only; and group C received placebo. The main outcome was total blood loss. Secondary outcomes included reduction in hemoglobin concentration, coagulation parameters, inflammatory marker levels, perioperative visual analog scale (VAS) pain score, transfusion rates, postoperative hospital stay, and incidence of thromboembolic events. ResultsTotal blood loss in group A (668.84±230.95ml) was lower than in group B (940.96±359.22ml) and C (1166.52±342.85ml, p<0.05). We also found that compared with group B, postoperative hip pain, biomarker level of inflammation, visual analogue score (VAS) pain score in group A were significantly improved. The transfusion rate and unit of group A were significantly lower than group C (8 patients; 17.5 units), but there was no statistical difference between group A (no transfusion) and group B (2 patients; 4 units). No differences were observed in thromboembolic and other outcomes among the groups. DiscussionThe combined application of topic CSS and TXA is more effective than TXA alone following THA in regard of reducing total blood loss. In addition, CSS combined with TXA is better than TXA alone in terms of improving postoperative hip pain and reducing the level of inflammatory factors. Level of evidenceI; randomized controlled study.