Bone Fusion Research Articles

Transoral Atlantoaxial Reduction Plate (TARP) Technique for the Treatment of Irreducible Atlantoaxial Dislocation (IAAD) Caused by Old Odontoid Fracture.

Retrospective case series study. This study aimed to evaluate the clinical efficacy of TARP technique for treating IAAD caused by old odontoid fracture and assess the outcomes of patients who underwent TARP technique over 2years of follow-up. Between January 2005 and September 2017, 56 patients with IAAD caused by old odontoid fractures were treated with TARP technique. Patients' clinical, radiological, and surgical data were retrospectively analyzed. Radiological parameters included the atlantodental interval (ADI) and the space available for the spinal cord (SAC) were measured. Occipitocervical pain levels and neurologic status were evaluated with Visual Analog Scale (VAS) and Japanese Orthopaedic Association (JOA) score respectively. Degree of cervical dysfunction was assessed by Neck Disability Index (NDI). Fusion status was evaluated by images during the follow-ups. Surgeries for 56 cases were performed successfully with no injury to the spinal cord, nerve, or blood vessels. All patients achieved satisfactory reduction and fixation. Clinical symptomatic relief was obtained in all cases (100%). Patients were followed up for an average of 33.9 ± 9.6 months (ranged 24-60 months). Improvements in the postoperative ADI, SAC, VAS, JOA score and NDI were significant (P < .05). Besides, Bone fusion was observed in all patients. No hardware failure or re-dislocation occurred during the follow-up period. TARP technique is an effective procedure for the treatment of IAAD caused by old odontoid fracture, which can achieve complete release, satisfactory decompression, reduction and fixation, and reliable bone fusion through a single transoral approach.

Post-traumatic synostosis of the metatarsals – a case report

BackgroundSynostosis refers to the abnormal fusion of bones, which have varying aetiologies as well as sites which are commonly affected. Existing literature mostly describes the condition arising congenitally, and affecting the radio-ulnar joint.Case presentationA 57-year-old gentleman presented to our department with symptomatic malunion and synostosis of the fourth and fifth metatarsals, two years following non-operative treatment of a closed fifth metatarsal fracture. The patient subsequently underwent surgical excision of the synostosis, but had complications of recurrence at the two-year post-operative date. Repeat surgical excision was performed with eventual good functional outcome and no signs of recurrence.ConclusionOur paper aims to describe the first known case of post-traumatic synostosis affecting the metatarsals, as well as provide a review of the current literature.

Assessment of factors implicated in bone fusion after percutaneous endoscopic lumbar intervertebral fusion

Assessment of factors implicated in bone fusion after percutaneous endoscopic lumbar intervertebral fusion

Structural design and biomechanical analysis of a combined titanium and polyetheretherketone cage based on PE-PLIF fusion.

In lumbar spinal fusion, the titanium cage tends to cause stress shielding due to their high elastic modulus, which can lead to degenerative lesions in adjacent spinal segments. Furthermore, polyetheretherketone (PEEK) cages have certain material characteristics that do not promote bone ingrowth and fusion stability. In this study, a new cage was designed, and its biomechanical performance in percutaneous endoscopic posterior lumbar interbody fusion (PE-PLIF) was analyzed using the finite element (FE) method. A complete model of the L4-L5 lumbar spine was established, and static and harmonic vibration FE analysis models were developed based on it. The biomechanical properties of titanium, PEEK, and combined cage in PE-PLIF fusion were compared. The strain capacity of the combined fusion increased by 9.5% when compared to the titanium fusion. The surgical model under the combined fusion reduces the L5 endplate stress by 12% in the forward flexion condition and the fusion stress by 17% in the vibration condition compared to the model supported by the titanium fusion, and the differences in screw stress and mobility among the three models are not significant in multiple conditions. Consequently, the combined cage demonstrates a certain reduction in the stress-shielding effect when compared to the titanium cage; it has better fusion effect and provides theoretical support and guidance for the design of the clinical fusion cage.

A study on the effect of platelet-rich plasma (PRP) to promote bone fusion in lateral interbody fusion of the lumbar spine using artificial bone

BackgroundLateral lumbar interbody fusion (LLIF) via a retroperitoneum approach has gained popularity due to minimal invasiveness, which avoids resection of the spinous process and laminae. However, as challenges in grafting autogenous bone persist, artificial bone has been tested in Japan to fill the spinal cage. Platelet-rich plasma (PRP) contains growth factors and anti-inflammatory cytokines to promote cellular proliferation and repair damaged tissues. While the effects of PRP on tendon and ligament repair are widely known, any effects on bone healing are scarcely reported. However, PRP-loaded artificial bone carries potential to improve intervertebral bone fusion.ObjectiveThis study assessed whether PRP enhances intervertebral bone fusion in LLIF surgery using β-tricalcium phosphate artificial bone.MethodsThe current study was a prospective, randomized, controlled trial. We evaluated 13 consecutive patients undergoing LLIF surgery in our hospital. Patients received artificial bone impregnated with PRP or without PRP within the same fusion cage. The primary outcome was the intervertebral bone fusion rate at 6 and 12 months postoperatively, evaluated using CT imaging. The intervertebral bone fusion rates with and without PRP loading and with and without contact part between the endplate and the artificial bone were compared. Secondary outcomes included clinical evaluations using visual analog scale scores for low back pain, buttock-leg pain, and leg numbness from the Japanese Orthopaedic Association Back Pain Evaluation Questionnaire (JOA-BPEQ) and the Oswestry Disability Index (ODI), plus adverse events information.ResultsOf the 13 patients (29 vertebral segments) included, bone fusion was observed in 43.4% of the PRP group and 26.1% of the non-PRP group at 6 months (p = 0.216). At 12 months, fusion rates were 60.9% with PRP and 34.8% without PRP (p = 0.074). The fusion rate was significantly higher in cases with good contact between the vertebral endplate and the artificial bone (p = 0.0004). Clinical scores improved postoperatively. Adverse events were in accordance with expectations from LLIF surgery and no PRP-specific events occurred.ConclusionPRP did not significantly improve intervertebral bone fusion rates in LLIF surgeries, particularly in cases with poor contact between the vertebral endplate and artificial bone. While PRP may have a limited role in enhancing bone fusion, maintaining good contact between the vertebral endplate and artificial bone is crucial for successful outcomes. Further research is needed to explore optimal uses of PRP in spinal fusion surgeries.

Analysis of Failed Posterior Fossa Decompression and an Effective Revision Surgery in Patients with Basilar Invagination and Atlantoaxial Dislocation.

The objective of this study was to analyze failed posterior fossa decompression (PFD) in patients with basilar invagination and atlantoaxial dislocation (BI-AAD). Revision surgery in these patients is challenging and has been rarely reported. In addition, the anatomical variations of the vertebral artery increase the risk of revision surgery. Here, we introduce the implementation of a new type of one-stage posterior revision surgery, whose difficulties and effects are summarized. A total of 21 patients with BI-AAD who underwent PFD were retrospectively analyzed in our center from November 2017 to April 2021. The revision surgery in all patients was performed through the posterior approach. The Japanese Orthopaedic Association (JOA) score and the Short Term 12 (SF-12) score were employed to evaluate the clinical symptoms and health status. The distance from the tip of the odontoid to Chamberlain's line (DCL), the atlantodental interval (ADI), the clivus-canal angle (CCA), the diameter of the subarachnoid space (DSS), and the craniovertebral junction triangular area (CTA) were assessed radiographically. The pre- and postoperative results were compared by paired t test. The data of 21 consecutive patients were reviewed, with an average follow-up period of 28 ± 14 months. Postoperative imaging showed effectively reduced compression of BI-AAD. No implant failure or neurovascular injury occurred. Eleven patients had vertebral artery abnormalities, but none had vertebral artery injury. All patients had evidence of bone fusion on the CT scan images within a 12-month follow-up period. The JOA and SF-12 scores were significantly improved 1 year postoperatively (p < 0.001). Posterior surgery using the technique of interarticular distraction, fusion with cage grafting, and fixation is a safe and effective revision surgery to treat patients with basilar invagination and atlantoaxial dislocation who failed PFD, which will result in good outcome.

Effective use of actifuse shape in spinal fusion: A retrospective chart review

Introduction: This study aimed to assess the safety and clinical performance of Actifuse Shape for spine surgery. Method: A retrospective real-world data study was conducted in two research sites in the U.S. Patient medical records had to show evidence of implantation with Actifuse Shape in 1-2 levels or 2 or more levels cervical (C2 or lower), in either posterolateral thoraco-lumbar or lumbar spine fusion procedures, among other eligibility criteria. All fusion assessments were completed using the Glassman 5 grade fusion scale. Results: Fifty-five (55) medical records were included in the full analysis set, and of these, 42 were eligible, achieving 97.6% bone fusion with a 95% CI (87.4%, 99.9%). Fusion success rates (Grade 4 or 5): 6 mo 72.7% (n=8/11), 12 mo 97.6% (n=41/42) and 24 mo 100% (n=49/49). No device-related adverse events were reported for Actifuse Shape. A “worst-case” imputation post hoc analysis was performed to take into account five patients who did not show evidence of fusion at 6 mo and were lost to follow up and were assumed to continue showing no evidence of fusion throughout the remaining study period. Forty-one out of 47 (87.2%) patients (95% CI: 74.3, 95.2) achieved successful fusion at 12 mo (±60 days) and 49/55 (89.1%) patients (95% CI: 77.8, 95.9) achieved successful fusion at 24 mo (+60 days). Conclusions: Actifuse Shape is safe and is associated with high rate of bony fusion when implanted as the primary bone graft substitute in spinal fusion surgeries.

Ceratophryid frogs in the late Miocene of central Andes of Argentina: insights on the paleoenvironment of Palo Pintado Formation

ABSTRACT Ceratophryid frogs inhabit the lowlands of South America and exhibit greater diversity in the semiarid Gran Chaco. The presence of Ceratophryidae dates back to the late Miocene on the eastern slopes of the Andes in Argentina. Herein, we describe the remains of Ceratophrys from late Miocene of Palo Pintado Formation (Salta, Argentina). Fragmentary bones were recovered from the base of the unit in beds dated between 8 and 7.7 million years ago. The specimen IBIGEO-P141 exhibits the fusion of dentary and mentomeckelian bones forming a fang, a sharp-edged lower jaw, and sculptured bones as Ceratophryidae. The granular pattern of sculpturation, differences between pars facialis and pars dentalis of maxillary, and the shape of lower jaw, support its assignment to the genus Ceratophrys. Combined bioclimatic data and geographic distribution of living Ceratophrys indicate a strong influence of precipitation variables in the distribution of these frogs with adaptations to survive long dry periods. These facts suggest a seasonal rainfall with a well-defined dry season during the deposition of lower levels of Palo Pintado Formation. The palaeoclimatic conditions resemble those occurring in the actual semiarid Chaco, and reveal that the historical geographic distribution of Ceratophryidae was retracted eastward due to the Andean uplift.

Regional differences in reimbursement rates from Medicare, Medicaid, and FAIR Health across common procedures for neurological surgeons.

FAIR Health-a nonprofit, state-funded database-was created as an independent repository of healthcare claims paid data to address allegations of price fixing. Many insurers have forced physicians to negotiate payments based on Medicare rates, rather than utilizing FAIR Health. The authors' objective was to provide an overview of regional differences in reimbursement rates per several sample neurosurgical Current Procedural Terminology (CPT) codes and to compare Medicare, Medicaid, and usual, customary, and reasonable rates via FAIR Health rate estimates. The authors compared FAIR Health rates for three common neurosurgical CPT codes: 61510 (removal of bone from skull for removal of upper brain tumor), 22630 (fusion of lower spine bones with removal of disc, posterior approach, single interspace), and 62223 (creation of a brain fluid drainage shunt, ventriculoperitoneal, ventriculopleural, or other terminus), with Medicare and Medicaid reimbursement to evaluate differences in five different regions in the US. Medicare and Medicaid reimbursement rates were consistently and significantly lower than FAIR Health in-network rates across all three CPT codes evaluated (p < 0.001 for all). Significant regional differences exist per census data in median age, median income, employment rates, and degree of health coverage (p < 0.001, p = 0.002, p = 0.002, and p = 0.001, respectively). Reimbursement estimates were found to have regional variation: Medicare/Medicaid rates were significantly lower than FAIR Health in-network rates for all codes across regions with a region-based interaction for reimbursement for code 62223 (p = 0.020). Medicare and Medicaid rates did not significantly vary across regions. Inherent differences exist between cities and states, including median income, employment rates, and health coverage. Despite geographic cost practice indices for Medicare and state-specific production of Medicaid, Medicaid/Medicare reimbursement rates did not vary across regions but were consistently and significantly lower than FAIR Health estimates throughout the US. Locale-specific variation in FAIR Health may further indicate a better accounting of regional differences in cost of practice.

Efficacy and safety of laminoplasty combined with C3 laminectomy for patients with multilevel degenerative cervical myelopathy: a systematic review and meta-analysis.

Laminoplasty (LP) combined with C3 laminectomy (LN) can effectively achieve spinal cord decompression while maintaining the integrity of the posterior ligament-muscle complex, thereby minimizing cervical muscle damage. However, its necessity and safety remain controversial. This study aimed to compare the safety and efficacy of LP and LP combined with C3 LN in the treatment of patients with multilevel degenerative cervical spondylotic myelopathy (DCM). A systematic review and meta-analysis of the literature was performed. A search of PubMed, Web of Science, Embase, and the Cochrane Library databases was conducted from inception through December 2023 and updated in February 2024. Search terms included laminoplasty, laminectomy, C3 and degenerative cervical spondylosis. The literature search yielded 14 studies that met our inclusion criteria. Outcomes included radiographic results, neck pain, neurologic function, surgical parameters, and postoperative complications. We also assessed methodologic quality, publication bias, and quality of evidence. Fourteen studies were identified, including 590 patients who underwent LP combined with C3 LN (modified group, MG) compared to 669 patients who underwent LP (traditional group, TG). The results of the study indicated a statistically significant improvement in cervical range of motion (WMD = 3.62, 95% CI: 0.39 to 6.85) and cervical sagittal angle (WMD = 2.07, 95% CI: 0.40 to 3.74) in the MG compared to the TG at the last follow-up (very low-level evidence). The TG had a higher number of patients with complications, especially C2-3 bone fusion. There was no significant difference found in improvement of neck pain, JOA, NDI, cSVA, T1 slope at latest follow-up. LP combined with C3 LN is an effective and necessary surgical method for multilevel DCM patients to maintain cervical sagittal balance. However, due to the low quality of evidence in existing studies, more and higher quality research on the technology is needed in the future.

Comparison of two surgical approaches in treating children with thoracolumbar junction tuberculosis: a multicenter study

ObjectivesWe conducted a multicenter retrospective analysis to compare the clinical outcomes and complications associated with the posterior-anterior and posterior-only approaches in treating Thoracolumbar Junction (TLJ) Tuberculosis (TB) in children aged 3–10 years.MethodsHerein, 52 TLJ TB patients (age range = 3–10 years; mean age = 6.8 ± 2.2 years; females = 22; males = 30) treated with debridement, fusion, and instrumentation were recruited from two hospitals in China between May 2008 and February 2022, and their clinical data were reviewed retrospectively. Among them, 24 group A patients and 28 group B patients underwent the posterior-anterior and posterior-only approaches, respectively. The two groups were assessed for surgical time, blood loss, hospitalization duration, operative complications, inflammatory indicators, Visual Analog Scale (VAS) scores, Oswestry Disability Index (ODI) scores, kyphosis angles, and neurologic functions. Results or differences with P < 0.05 were considered statistically significant.ResultsThe average follow-up period was 37.5 ± 23.3 months. Compared to group A patients, group B patients exhibited significantly lower surgical time, blood loss amount, time it took to stand, and hospitalization duration, as well as fewer complications. Notably, the Erythrocyte Sedimentation Rate (ESR) and C-Reactive Protein (CRP) values of patients in both groups returned to normal one year post-surgery. Furthermore, compared to the preoperative values, patients’ VAS and ODI scores, as well as neurological functions and kyphosis angles, were significantly improved postoperatively and at the final follow-up, but with no statistically significant differences between the two groups. Moreover, there was no internal fixation failure or TB recurrence, and all patients exhibited solid bone fusion at the last follow-up.ConclusionFor pediatric TLJ TB involving no or at most two segments, both posterior-anterior and posterior-only approaches could effectively remove lesions and decompress the spinal cord, restore spinal stability, correct kyphosis, and prevent deformity deterioration. Nonetheless, the posterior-only approach can more effectively shorten the surgical time, reduce related trauma and complications, and promote rapid recovery, making it a safer and highly preferable minimally invasive approach.

Clinical effect of posterior-only approach debridement, intervertebral fusion, and internal fixation for upper thoracic tuberculosis.

This study aimed to evaluate the effectiveness and feasibility of the posterior-only approach for debridement, interbody fusion, and internal fixation in treating upper thoracic tuberculosis. This study retrospectively analysed the clinical and radiographic data of 8 patients diagnosed with upper thoracic tuberculosis. All patients underwent posterior approach debridement, interbody fusion, and internal fixation. We conducted pre- and postoperative assessments of the visual analog scale (VAS), Oswestry disability index (ODI) scores, erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), ASIA score, and kyphotic Cobb angle. Back pain and lower limb weakness were the most common presenting symptoms. The mean duration of surgery, amount of blood loss, and volume of postoperative drainage were 262.5 ± 43.3 min, 625.0 ± 333.8 mL, and 285.0 ± 118.1 mL, respectively. Patients were followed up for 36 to 48 months. Three months after surgery, there was a significant improvement in VAS and ODI scores, which further improved until the final follow-up. A statistically significant difference was observed between the preoperative and postoperative periods (P < .05). At the final follow-up, lower extremity function had fully returned to normal in all 5 paralyzed patients. The ESR and CRP returned to normal, 18.1 ± 7.3 mm/h and 9.95 ± 5.41 mg/L, respectively, within 3 months postoperatively. There were statistical differences between the preoperative and postoperative periods (P < .05). The average kyphotic correction rate was (71.5 ± 7.3)%, and the average loss of correction angle was (3.5 ± 1.4)°. Intervertebral bone fusion was achieved by all patients within 15 months (mean 8.3 ± 3.2 months) postoperatively. The posterior-only approach seems an effective, safe, and reliable treatment method for upper thoracic tuberculosis, with favourable clinical and radiological outcomes. Level IV, Therapeutic study.

3D-ink-extruded titanium scaffolds with porous struts and bioactive supramolecular polymers for orthopedic implants

Porous titanium addresses the longstanding orthopedic challenges of aseptic loosening and stress shielding. This work expands on the evolution of porous Ti with the manufacturing of hierarchically porous, low stiffness, ductile Ti scaffolds via direct-ink write (DIW) extrusion and sintering of inks containing Ti and NaCl particles. Scaffold macrochannels were filled with a subtherapeutic dose of recombinant bone morphogenetic protein-2 (rhBMP-2) alone or co-delivered within a bioactive supramolecular polymer slurry (SPS) composed of peptide amphiphile nanofibrils and collagen, creating four treatment conditions (Ti struts: microporous vs. fully dense; BMP-2 alone or with SPS). The BMP-2-loaded scaffolds were implanted bilaterally across the L4 and L5 transverse processes in a rat posterolateral lumbar fusion model. In-vivo bone growth in these scaffolds is evaluated with synchrotron X-ray computed microtomography (µCT) to study the effects of strut microporosity and added biological signaling agents on the bone formation response. Optical and scanning electron microscopy confirms the ∼100 µm space-holder micropore size, high-curvature morphology, and pore fenestrations within the struts. Uniaxial compression testing shows that the microporous strut scaffolds have low stiffness and high ductility. A significant promotion in bone formation was observed for groups utilizing the SPS, while no significant differences were found for the scaffolds with the incorporation of micropores. Statement of significanceBy 2050, the anticipated number of people aged 60 years and older worldwide is anticipated to double to 2.1 billion. This rapid increase in the geriatric population will require a corresponding increase in orthopedic surgeries and more effective materials for longer indwelling times. Titanium alloys have been the gold standard of bone fusion and fixation, but their use has longstanding limitations in bone-implant stiffness mismatch and insufficient osseointegration. We utilize 3D-printing of titanium with NaCl space holders for large- and small-scale porosity and incorporate bioactive supramolecular polymers into the scaffolds to increase bone growth. This work finds no significant change in bone ingrowth via space-holder-induced microporosity but significant increases in bone ingrowth via the bioactive supramolecular polymers in a rat posterolateral fusion model.

Graphene Oxide/Black Phosphorus Functionalized Collagen Scaffolds with Enhanced Near-Infrared Controlled In Situ Biomineralization for Promoting Infectious Bone Defect Repair through PI3K/Akt Pathway.

Infectious bone defects resulting from surgery, infection, or trauma are a prevalent clinical issue. Current treatments commonly used include systemic antibiotics and autografts or allografts. Nevertheless, therapies come with various disadvantages, including multidrug-resistant bacteria, complications arising from the donor site, and immune rejection, which makes artificial implants desirable. However, artificial implants can fail due to bacterial infections and inadequate bone fusion after implantation. Thus, the development of multifunctional bone substitutes that are biocompatible, antibacterial, osteoconductive, and osteoinductive would be of great clinical importance. This study designs and prepares 2D graphene oxide (GO) and black phosphorus (BP) reinforced porous collagen (Col) scaffolds as a viable strategy for treating infectious bone defects. The fabricated Col-GO@BP scaffold exhibited an efficient photothermal antibacterial effect under near-infrared (NIR) irradiation. A further benefit of the NIR-controlled degradation of BP was to promote biomineralization by phosphorus-driven and calcium-extracted phosphorus in situ. The abundant functional groups in GO could synergistically capture the ions and enhance the in situ biomineralization. The Col-GO@BP scaffold facilitated osteogenic differentiation of bone marrow-derived mesenchymal stem cells (BMSC) by leveraging its mild photothermal effect and biomineralization process, which upregulated heat shock proteins (HSPs) and activated PI3K/Akt pathways. Additionally, systematic in vivo experiments demonstrated that the Col-GO@BP scaffold obviously promotes infectious bone repair through admirable photothermal antibacterial performance and enhanced vascularization. As a result of this study, we provide new insights into the photothermal activity of GO@BP nanosheets, their degradation, and a new biological application for them.

Endochondral Ossification for Spinal Fusion: A Novel Perspective from Biological Mechanisms to Clinical Applications.

Degenerative scoliosis (DS), encompassing conditions like spondylolisthesis and spinal stenosis, is a common type of spinal deformity. Lumbar interbody fusion (LIF) stands as a conventional surgical intervention for this ailment, aiming at decompression, restoration of intervertebral height, and stabilization of motion segments. Despite its widespread use, the precise mechanism underlying spinal fusion remains elusive. In this review, our focus lies on endochondral ossification for spinal fusion, a process involving vertebral development and bone healing. Endochondral ossification is the key step for the successful vertebral fusion. Endochondral ossification can persist in hypoxic conditions and promote the parallel development of angiogenesis and osteogenesis, which corresponds to the fusion process of new bone formation in the hypoxic region between the vertebrae. The ideal material for interbody fusion cages should have the following characteristics: (1) Good biocompatibility; (2) Stable chemical properties; (3) Biomechanical properties similar to bone tissue; (4) Promotion of bone fusion; (5) Favorable for imaging observation; (6) Biodegradability. Utilizing cartilage-derived bone-like constructs holds promise in promoting bony fusion post-operation, thus warranting exploration in the context of spinal fusion procedures.

An effective strategy for treatment of severe kyphosis secondary to ankylosing spondylitis: one-level modified osteotomy combined with shoulders lifting correction method

BackgroundSevere kyphosis is a common condition in patients with advanced ankylosing spondylitis (AS). Although two-level osteotomy may serve as a potential alternative, it is often associated with increased blood loss and elevated surgical risks. To date, the optimal treatment for the challenging condition remains unclear. This study aims to introduce an effective strategy for the treatment of severe kyphosis secondary to AS, using one-level modified osteotomy combined with shoulders lifting correction method.MethodsSeventy AS kyphosis who were treated with the strategy from 2012 to 2022, were reviewed retrospectively. All patients were followed up for a minimum duration of 2 years. Spinal and pelvic parameters were measured, including pelvic tilt (PT), pelvic incidence (PI), sacral slope (SS), lumber lordosis (LL), PI and LL mismatch (PI-LL), thoracic kyphosis, global kyphosis (GK), T1 pelvic angle (TPA), sagittal vertical axis (SVA), osteotomized vertebral angle (OVA), and chin-brow vertical angle (CBVA). Parameters of local osteotomized complex were measured and calculated, including the height of osteotomized complex and the length of spinal cord shortening. Clinical outcome was evaluated using Scoliosis Research Society-22 and Oswestry Disability Index scores.ResultsSeventy patients with average age of 39.8 years were followed-up for 29.3 months. Average operation time was 373.5 min, and average blood loss was 751.0 ml. Postoperatively, sagittal balance was successfully restored. GK decreased from 90.6° to 35.6°, LL decreased from 8.0° to -35.1°, TPA decreased from 56.8° to 27.8°, and SVA decreased from 24.4 cm to 8.7 cm (P < 0.05). A harmonious and matched spinopelvic alignment was achieved. PT decreased from 37.2° to 26.3°, PI-LL decreased from 54.1° to 10.2°, and SS increased from 9.2° to 19.7°(P < 0.05). Horizontal vision was obtained with postoperative CBVA of 8.8°. Average OVA correction was up to 47.3°, and the spinal cord was shortened by 24.3 mm, with a shortening rate of 36.0%. All patients demonstrated a favorable clinical outcome. No permanent nerve damage, screw loosening, rod breakage and main vascular injury were observed. One case required revision surgery due to screw cap loosening and delayed union. Solid bone fusion was achieved in all other patients.ConclusionsOne-level modified osteotomy combined with shoulders lifting correction method is a safe and effective strategy for the treatment of severe AS kyphosis. This strategy offers a promising alternative for managing severe AS kyphosis, and may be particularly well-suited for individuals with concurrent osteoporosis.Level of evidenceLevel IV, therapeutic study.

Current trend of sexual maturity, teeth eruption, and bone fusion in the present female population, relative to documented age and development of prediction model for age of females.

Understanding sexual maturity and bone fusion is crucial in forensic investigations and legal contexts. This study investigates the contemporary trend of sexual maturity and bone fusion in females, comparing the observed age-related characteristics with documented ages. Such analyses contribute to the accuracy of age estimation methods used in medico-legal scenarios. A comprehensive study was conducted involving a diverse sample of females, and their sexual maturity and bone fusion were assessed relative to documented ages. The research utilized a cross-sectional design, collecting data through interviews, medical examinations, and radiographic imaging. Ethical approval was obtained, and participants provided informed consent. Variables included documented age, age of menarche, stages of sexual maturity, dentition, and bone fusion. Validation of model performance was conducted. Among 70 cases studied, the mean age of menarche was 10.48 years (range: 7-12 years). Maternal reports indicated menarche onset between 12-17 years. Tanner's Staging 5 for pubic hair and fully developed breasts occurred at 14 years. Permanent teeth increased with age, with 28 or more teeth present at age 14 or above. Fusion of the distal end of the Radius and Ulna with the parent bone was positive from 15 years onwards. The regression model predicted age accurately (97.99% fit). The results highlight the early onset of sexual maturation, consistent teeth eruption, and bone fusion patterns in females. The observed correlations offer valuable insights for medicolegal practitioners and forensic experts.

Short-term and long-term results of odontoid screw fixation in patients with Type II and rostral Type III dens fractures

ObjectivesTo evaluate both the short-term and long-term outcomes of odontoid screw fixation (OSF), identifying potential risk factors for implant-related complications in patients with odontoid fractures. MethodsThis is a retrospective observational cohort study. Inclusion criteria were as follows: 1) Type II fractures and rostral Type III fractures, according to the Anderson and D’Alonzo classification; 2) patients older than 15 years. Exclusion criteria were: 1) other Type III injuries; 2) osteoporosis confirmed by densitometry or a CT bone density score below 100 Hounsfield units; 3) odontoid fractures related to tumors or aneurysmal bone cysts. ResultsIn total, 56 patients were considered for the analysis of short-term results, and 26 patients were evaluated for long-term outcomes. No significant differences were observed in the preoperative imaging data and intraoperative features of OSF between patients with Type II and rostral Type III fractures. The mean operative duration was 63.9 ± 20.9 min, and the mean intraoperative blood loss was 22.1 ± 22.9 ml.Screw cut-out was identified in four patients with rostral Type III fractures (p = 0.04). The rate of screw cut-out was found to correlate with the degree of dens fragment displacement. The bone fusion rate was 95.7%. CT scans identified stable pseudarthrosis in two cases. We observed C2–C3 ankylosis in all cases following partial disc resection. One third of patients with screws placed through the anterior lip of C2 showed no C2–C3 ankylosis. A strong trend towards lateral joint ankylosis formation in patients with a median lateral mass dislocation of 11.9 mm was observed. Most SF-36 scores either matched or exceeded the corresponding normal median values in the published reference database. ConclusionsOSF is a reliable treatment method of Type II and rostral Type III odontoid fractures with fragment displacement of 4 mm or less. The minimally invasive OSF through the anterior-inferior lip of C2, using monocortical screw placement and cannulated instruments, without rigid intraoperative head immobilization, is sufficient to achieve favorable clinical and fusion results. This technique reduces the risk of ankylosis in the C2–C3 segment. OSF restore the quality of life for patients with odontoid fractures to levels comparable to those of the general population norm.

Skeletal computed tomography findings of upper extremities in middle-aged persons with thalidomide embryopathy.

Individuals with thalidomide embryopathy are now approximately 60 years old. For years, they have been compensating for their hypoplastic limbs in various aspects of daily living, and they face secondary problems such as limb and back pain. Imaging analysis is beneficial for understanding the pathogenesis of these problems. However, previous studies on skeletal imaging were mainly radiographic studies conducted at young ages, and there are few studies on skeletal imaging after aging, with most of them being case reports. In this study, detailed analyses of the skeletons of the upper extremities were performed using three-dimensional computed tomography and multiplanar reconstruction images in five individuals with thalidomide embryopathy aged approximately 60 years. Each individual frequently complained of neck, shoulder, and/or back pain. Dislocation, subluxation, and osteoarthritis were observed in the shoulder joints in some individuals. Hypoplasia of the trochlea and/or capitulum of the humerus, coronoid fossa, olecranon, and coronoid processes was observed in the elbow joints. Fusion and hypoplasia of the carpal bones were frequently observed in wrist joints. Radiocarpal and ulnocarpal synostoses were also observed. The joint instability and osteoarthritis found in this study may have contribute to upper limb pain in individuals with thalidomide embryopathy.

Single-stage management of Charcot neuroarthropathy and osteomyelitis in diabetic patients

Objective: Describe our experience treating Charcot neuroarthropathy (CN) coexisting with concurrent bone infection in a single step, treated with external fixation, and report the mid-term radiographic and functional outcomes. Methods: Retrospective case series of patients diagnosed with CN and osteomyelitis treated with a single-step approach consisting of necrotic bone debridement and fusion extended over the affected joints using a circular external fixator with a minimum of 18 months of follow-up. Results: Six patients were evaluated, and three patients achieved excellent results and were able to walk outside their homes. One of them required a below-the-knee amputation due to persistent infection. Two patients had good results according to the Pinzur proposed evaluation scheme. All patients agreed that they would choose the reconstruction process for their deformity over an infrapatellar amputation. Conclusion: We believe the results from our case series apply to the previously published literature on this therapeutic modality. Level of evidence IV; Case series.