Bone Fusion Research Articles

Blinatumomab therapy for B cell acute lymphoblastic leukemia accompanied by persistent or relapsed low-level MRD prior to hematopoietic stem cell transplantation in Chinese children: a case series

BackgroundBlinatumomab could be successfully used to reduce minimal residual disease (MRD) prior to hematopoietic stem cell transplantation (HSCT) in pediatric B cell precursor acute lymphoblastic leukemia (BCP-ALL), but sound evidence is lacking in China.Case presentationThis retrospective study assessed the application of blinatumomab in B-ALL accompanied by persistent or relapsed low-level MRD before HSCT from April 2019 to July 2021. Two cases (Cases 1 and 2) initially achieved remission with MRD < 0.01% upon conventional therapy but had MRD relapse with MRD ≥ 0.01% but < 1% during maintenance treatment. Case 3 had no response to routine treatment, with high MRD (9.88% and 1.23% at days 19 and 46, respectively). Nevertheless, all patients had undetectable MRD. Cases 2 and 3 had undetectable fusion gene following blinatumomab therapy. By bone marrow monitoring (bone marrow morphology, bone marrow MRD and fusion gene) post-HSCT, the patients were persistently negative until May 15, 2022. No patient had serious adverse events before or during blinatumomab treatment.ConclusionsBlinatumomab therapy showed a good performance for three pediatric cases with detectable but low MRD before HSCT in China. However, further prospective studies with large sample sizes are still needed for further clarification.

Multilevel anterior cervical fusion with standalone cage or cage-and-plate after cervical discectomy: Benefits and drawbacks

PurposeMultilevel anterior cervical discectomy and fusion (ACDF), especially two-level ACDF, has been usually performed in the cervical degenerative disease, and the incidence rate of complications is controversial. This study aimed to compare the outcomes of ACDF approach with cage alone and with plate fixation in multilevel discectomy. MethodsPatients who had undergone multilevel ACDF by the Smith-Robinson methods were included from 2018 to 2020. Data were collected using a questionnaire containing demographic characteristics, surgical complications, and outcome. All the patients were followed for 18 months post-surgery. Visual Analogue Scale (VAS), Neck Disability Index (NDI) and Nurick Grading scale were used to measure the pain degree, neck pain effect, and myelopathy grade, respectively. Bone fusion rate, subsidence and instrument failure were checked through radiography. Data were analyzed using SPSS, and the significant level was considered 0.05. Results24 patients were included. There was no significant difference between the mean blood losses in the two groups. The rate of subsidence was much higher in group B after 18 months (60% vs 14.3%). As to the VAS score, NDI, and Nurick scale, trend change overtime was significantly improved in each group, but there was no significant difference between the groups. There was no significant difference between the two groups regarding bony fusion rate. DiscussionACDF with plate leads to a more prolonged surgery with no significant benefits. Stand-alone cage approach could be suggested as the gold standard for anterior cervical discectomy.

Frontotemporal Craniotomy for Clipping of Unruptured Aneurysm Using a Diamond-Coated Thread Wire Saw and Reconstruction Using Calcium Phosphate Cement without Metal Fixation.

Metal fixation systems for cranial bone flaps cut by a drill are convenient devices for cranioplasty, but cause several complications. We use modified craniotomy using a fine diamond-coated threadwire saw (diamond T-saw) to reduce the bone defect, and osteoplasty calcium phosphate cement without metal fixation. We report our outcomes and tips of this method. A total of 78 consecutive patients underwent elective frontotemporal craniotomy for clipping of unruptured intracranial aneurysms between 2015 and 2019. The follow-up periods ranged from 13 to 66 months. The bone fixation state was evaluated by bone computed tomography (CT) and three-dimensional CT (3D-CT). The diamond T-saw could minimize the bone defect. Only one wound infection occurred within 1 week postoperatively, and no late infection. No pain, palpable/cosmetically noticeable displacement of the bone flap, fluid accumulations, or other complications were observed. The condition of bone fixation and the cosmetic efficacy were thoroughly satisfactory for all patients, and bone CT and 3D-CT demonstrated that good bone fusion. No complication typical of metal fixation occurred. Our method is technically easy and safety, and achieved good mid-term bone flap fixation in the mid-term course, so has potential for bone fixation without the use of metal plates.

"Redo" 2D-3D Fusion Technique during Endovascular Redo Aortic Repair.

The present study aims to describe a new 2D-3D fusion registration method in the case of endovascular redo aortic repair and compare the accuracy of the registration using the previously implanted devices vs. bones as landmarks. This single-center study prospectively analyzed all the patients that underwent elective endovascular re-interventions using the Redo Fusion technique between January 2016 and December 2021 at the Vascular Surgery Unit of the Fondazione Policlinico Universitario A. Gemelli (FPUG)-IRCCS in Rome, Italy. The fusion overlay was performed twice, first using bone landmarks (bone fusion) and the second using radiopaque markers of a previous endovascular device (redo fusion). The pre-operative 3D model was fused with live fluoroscopy to create a roadmap. Longitudinal distances between the inferior margin of the target vessel in live fluoroscopy and the inferior margin of the target vessel in bone fusion and redo fusion were measured. This single-center study prospectively analyzed 20 patients. There were 15 men and five women, with a median age of 69.7 (IQR 42) years. The median distance between the inferior margin of the target vessel ostium in digital subtraction angiography and the inferior margin of the target vessel ostium in bone fusion and redo fusion was 5.35 mm and 1.35 mm, respectively (p ≤ 0.0001). The redo fusion technique is accurate and allows the optimization of X-ray working views, supporting the endovascular navigation and vessel catheterization in case of endovascular redo aortic repair.

The safe and effective use of supercritical CO2-processed bone allografts for cervical and lumbar interbody fusion: A retrospective study.

The clinical efficacy and safety of supercritical CO2-processed bone allografts prepared from living donors has yet to be confirmed in spinal surgery. Here we report our clinical and surgical experience of using supercritical CO2-processed bone allografts for lumbar and cervical fusion. Sixteen patients underwent one or two level anterior cervical discectomy and fusion and 37 patients underwent anterior retroperitoneal route lumbar fusion using bone allografts processed using supercritical CO2 extraction combined with chemical viral inactivation. Fusion success was assessed radiographically in the immediate postoperative period and at one month, six months, one year, and three years postoperatively. Function and pain were assessed using visual analog scales, Odom's criteria, the neck disability index (NDI), and the Oswestry disability index (ODI). At a mean of 43 and 47 months postoperatively, 95.3% and 90.5% of cervical and lumbar fusion patients had radiographic evidence of bone fusion, respectively. Over 80% of patients reported good to excellent outcomes according to Odom's criteria, the perception of pain significantly decreased, and the mean NDI and ODI scores significantly improved at the last follow-up compared with before the operations. There were no safety concerns. For the cervical group, the mean NDI score improved from 26.3 ± 6.01 preoperatively to 15.00 ± 8.03 and 17.60 ± 13.95 at immediate post-op (p = 0.02) and last follow-up visits (p = 0.037) respectively. For the lumbar cases, the mean ODI score improved from 28.31 ± 6.48 preoperatively to 14.68 ± 5.49 (p < 0.0001) and 12.54 ± 10.21 (p < 00001) at immediate post-op and last follow-up visits respectively. Within the limitations of this study, the use of supercritical CO2-processed bone allografts resulted in satisfactory clinical outcomes and fusion rates with acceptable safety for both cervical and lumbar surgeries.

GOING LOW: LOW MODULUS GRAFT-FREE 3D-PRINTED TITANIUM INTERBODY CAGES SHOW COMPARABLE BONE FORMATION TO PEEK WITH GRAFT

Polyetheretherketone (PEEK) interbody fusion cages combined with autologous bone graft is the current clinical gold standard treatment for spinal fusion, however, bone graft harvest increases surgical time, risk of infection and chronic pain. We describe novel low-stiffness 3D Printed titanium interbody cages without autologous bone graft and assessed their biological performance in a pre-clinical in vivo interbody fusion model in comparison to the gold standard, PEEK with graft.Titanium interbody spacers were 3D Printed with a microporous (Ti1: &lt;1000μm) and macroporous (Ti2: &gt;1000μm) design. Both Ti1 and Ti2 had an identical elastic modulus (stiffness), and were similar to the elastic modulus of PEEK. Interbody fusion was performed on L2-L3 and L4-L5 vertebral levels in 24 skeletally mature sheep using Ti1 or Ti2 spacers, or a PEEK spacer filled with iliac crest autograft, and assessed at 8 and 16 weeks. We quantitatively assessed bone fusion, bone area, mineral apposition rate and bone formation rate. Functional spinal units were biomechanically tested to analyse range of motion, neutral zone, and stiffness. Results: Bone formation in macroporous Ti2 was significantly greater than microporous Ti1 treatments (p=.006). Fusion scores for Ti2 and PEEK demonstrated greater rates of bone formation from 8 to 16 weeks, with bridging rates of 100% for Ti2 at 16 weeks compared to just 88% for PEEK and 50% for Ti1. Biomechanical outcomes significantly improved at 16 versus 8 weeks, with no significant differences between Ti and PEEK with graft.This study demonstrated that macroporous 3D Printed Ti spacers are able to achieve fixation and arthrodesis with complete bone fusion by 16 weeks without the need for bone graft. These significant data indicate that low-modulus 3D Printed titanium interbody cages have similar performance to autograft-filled PEEK, and could be reliably used in spinal fusion avoiding the complications of bone graft harvesting.

BE A SOFTY: ENHANCED BONE FORMATION IN OPTIMIZED, LOW-STIFFNESS 3D-PRINTED TITANIUM IMPLANTS. AN IN VIVO TIBIAL OSTEOTOMY STUDY

Introduction: The mechanobiology and response of bone formation to strain under physiological loading is well established, however investigation into exceedingly soft scaffolds relative to cancellous bone is limited. In this study we designed and 3D printed mechanically-optimised low-stiffness implants, targeting specific strain ranges inducing bone formation and assessed their biological performance in a pre-clinical in vivo load-bearing tibial tuberosity advancement (TTA) model. The TTA model provides an attractive pre-clinical framework to investigate implant osseointegration within an uneven loading environment due to the dominating patellar tendon force.A knee finite element model from ovine CT data was developed to determine physiological target strains from simulated TTA surgery. We 3D printed low-stiffness Ti wedge osteotomy implants with homogeneous stiffness of 0.8 GPa (Ti1), 0.6 GPa (Ti2) and a locally-optimised design with a 0.3 GPa cortex and soft 0.1 GPa core (Ti3), for implantation in a 12-week ovine tibial advancement osteotomy (9mm). We quantitatively assessed bone fusion, bone area, mineral apposition rate and bone formation rate.Optimised Ti3 implants exhibited evenly high strains throughout, despite uneven wedge osteotomy loading. We demonstrated that higher strains above 3.75%, led to greater bone formation. Histomorphometry showed uniform bone ingrowthin optimised Ti3 compared to homogeneous designs (Ti1 and Ti2), and greater bone-implant contact. The greatest bone formation scores were seen in Ti3, followed by Ti2 and Ti1.Results from our study indicate lower stiffness and higher strain ranges than normally achieved in Ti scaffolds stimulate early bone formation. By accounting for loading environments through rational design, implants can be optimised to improve uniform osseointegration. Design and 3D printing of exceedingly soft titanium orthopaedic implants enhance strain induced bone formation and have significant importance in future implant design for knee, hip arthroplasty and treatment of large load-bearing bone defects.

A novel surgical management for pediatric patients with irreducible atlantoaxial dislocation: Transoral intraarticular cage distraction and fusion with C-JAWS staple fixation.

Currently, irreducible atlantoaxial dislocation (IAAD) can be treated by a single transoral approach in one stage to reduce surgical injuries to patients. However, the widely used fixation devices are not suitable for pediatric patients because of larger profile of devices. The purpose of this study is to report the preliminary clinical outcomes of a novel surgical technique by transoral intraarticular cage distraction and fusion with C-JAWS staple fixation for pediatric patients with IAAD. From June 2011 to June 2014, eight pediatric patients with IAAD were enrolled and treated by this technique in our department. Patients' clinical data were retrospectively analyzed, including neurological status, clinical symptoms, reduction, bone fusion, and complications. The surgeries were successfully performed in all patients without injuries to spinal cord, nerve and blood vessel. Clinical symptomatic relief was presented on all 8 patients (100%). Satisfactory reduction was indicated by significant decrease of atlanto-dental interval postoperatively (P < 0.05). The remarkable improvement of postoperative neurological function has been proved by significant increase of Japanese Orthopaedic Association score (P < 0.05). The average follow-up duration was 19.4 ± 5.8 months (range 12-30 months). Bone fusion was achieved in all 8 cases. No complications were documented after operation and during follow-up. Transoral intraarticular cage distraction and fusion with C-JAWS staple fixation is an effective treatment for pediatric patients with IAAD, which can achieve satisfactory reduction, fixation and bone fusion.

Clinical and Biomechanical Study of Laminoplasty for Thoracic and Lumbar Intradural Tumors

(1) Background: Primary intraspinal tumors account for 2-15% of all central nervous system (CNS) tumors. Most intraspinal tumors are benign, and about 40% of them occur intradurally, for which early surgery is the preferred treatment. Laminectomy with pedicle screw fixation is the conventional surgical treatment. However, laminectomy with pedicle screw fixation is likely to reduce the spinal range of motion (ROM), with many other complications, although it can maintain the stability of the spine. The aim of this study is to determine whether laminoplasty as a new surgical approach for thoracic and lumbar intradural tumors is superior to laminectomy in preserving spinal ROM, maintaining spinal stability and reducing postoperative complications. (2) Methods: We retrospectively analyzed 50 patients who received intradural tumor resection, including 23 who received traditional laminectomy with pedicle screw fixation and 27 who received new laminoplasty. Spinal ROM was evaluated by lumbar flexion/extension radiograph and biomechanical evaluation. Spinal stability was evaluated by imaging observations of the spinal Cobb angle and laminar bone fusion. Postoperative complications were evaluated according to cerebrospinal fluid (CSF) leakage and the length of hospital stay. (3) Results: Compared with the laminectomy group, patients in the laminoplasty group exhibited a better spinal ROM (31.6 ± 12.0° vs. 21.7 ± 11.8°, p = 0.013), a smaller Cobb angle (9.6 ± 4.3 vs. 12.5 ± 5.3, p = 0.034), a lower incidence of CSF leakage (4/14.8% vs. 11/47.8%, p = 0.015), and a shorter length of hospital stay (13.1 ± 1.8 vs. 15.1 ± 2.3 days, p = 0.001). Most patients in the laminoplasty group had satisfactory bone fusion. The biomechanical experiment also demonstrated that spinal ROM in laminoplasty was larger than that in the laminectomy group. (4) Conclusions: Compared with the traditional surgery, the new laminoplasty surgery can better maintain the stability of the spine, preserve spinal ROM, and reduce postoperative complications. It is a surgical method that can be clinically popularized.

A difficult extubation!

A difficult extubation!&#x0D; An 8 y old male child suffered from Crouzon syndrome, in whom intubation was perceived to be difficult, but extubation expected to be much more difficult. Crouzon syndrome is a genetic disorder characterized by the premature fusion of skull bones (craniosynostosis). This early fusion prevents the skull from growing normally and affects the shape of the head and face.

Study on The Treatment of Osteonecrosis of The Femoral Head Based on The Classic Theory of “Blood Stasis Removal - Regeneration Bone - Fusion”

Objective Based on Traditional Chinese Medicine (TCM) classics, this paper, by searching the literature on the treatment of femoral head necrosis with TCM, aims to explain the essence of the theory of “blood stasis removal - regeneration bone - fusion”, analyze the development of modern Chinese medicine in the treatment of osteonecrosis of femoral head (ONFH), and provide new ideas for the treatment of ONFH with integrated traditional Chinese and western medicine. Methods CNKI, PubMed, Wanfang and VIP databases were searched by computer to collect literature research on the theory of “blood stasis removal - regeneration bone - fusion” and the treatment of ONFH with integrated TCM Western medicine. Based on content analysis and bibliometric analysis, the modern integrated traditional Chinese and western medicine literature database of treating ONFH with the theory of “removing blood stasis and generating bone” was established and analyzed. Results Based on the theory of “blood stasis removal - regeneration - bone fusion”, this paper found that the TCM treatment of ONFH has the clinical effect of promoting blood circulation and removing blood stasis. The essence of the modern medicine of the theory of “blood stasis removal - regeneration - bone fusion” is to eliminate the microcirculation disorders caused by microvascular regeneration and hypoperfusion, so as to promote bone regeneration, which coincides with the treatment of ONFH by western medicine. Conclusions The theory of “blood stasis removal - regeneration - bone fusion” in modern Chinese medicine has a certain scientific and valuable value, which is worth more scientific research in the future.

Combined Charcot hindfoot and midfoot reconstruction using internal fixation method-surgical technique and single surgeon series.

Isolated midfoot and hindfoot Charcot reconstruction using internal fixation is increasingly a common procedure in multidisciplinary diabetic foot units, and the surgical techniques using internal fixation have well been described. However, about a third of Charcot deformities that require surgical limb salvage present with the involvement of midfoot and hindfoot. Surgical reconstruction of a combined hindfoot and midfoot deformity is an evolving technique and technically challenging. We present the surgical technique of deformity correction and stabilisation using internal fixation, developed by the senior author (VK), and present the outcomes. All patients that had undergone combined hindfoot and midfoot reconstruction to address a limb threatening deformity due to Charcot neuroarthropathy, performed by the senior author, with a minimum follow-up of 12 months, have been included in this study. The principles of surgical reconstruction included adequate pre-operative optimisation of the patient, sequential deformity correction and stabilisation of the hindfoot followed by midfoot using the principle of long-segment rigid internal fixation with optimal bone opposition. Standard post-operative regime, including offloading, has been used in all patients. A total of 34 patients (35 feet) had undergone combined midfoot and hindfoot Charcot reconstruction between January 2009 and December 2019. Active ulcers were noted in 13 feet at the time of the procedure. Eleven reconstructions were performed as two-stage procedures due to the presence of active infection. At a mean follow-up of 53 months, 11/13 ulcer healed, and 32 patients (33 feet) were full weightbearing in surgical shoes or a brace at the latest follow-up. Bone fusion was noted in 28 feet in the hindfoot region and 32 feet in the midfoot. Metal work failure was noted in 5 feet requiring removal in 3 feet. Revision procedures were required in 4 patients. Our newly described technique of combined hindfoot and midfoot Charcot has provided functional limb salvage in majority of presentations, with an acceptable level of complications, at a medium-term follow-up of 53 months.

Repair of a calcaneal fracture with a combination of internal and external fixation in a calf.

A 6-day-old male Japanese Black calf presented with a transverse fracture of the left calcaneus. In calcaneal fractures, traction of the gastrocnemius muscle causes substantial displacement of the proximal fracture fragment; therefore, external fixation alone is prone to failure of fusion or deformed fusion. Furthermore, internal fixation alone may result in refracture due to the high load on the implant. Therefore, internal and external fixation were used to treat the fracture. Bone fusion was observed on postoperative day 50; the wire was removed on postoperative day 90. Radiographic examination at 4 months postoperatively revealed that the bone had fused in normal alignment. Therefore, a good prognosis can be expected for calcaneal fractures treated with combined internal and external fixation.

Atresia or severe stenosis of the external auditory canals with normal auricles in children

In the article we present the experience of observing 27 children with bilateral stenosis or atresia of the external auditory canals with normal or slightly hypoplastic auricles. Three children had bilateral stenosis of the external auditory canals due to abnormal or premature fusion of the skull bones. The remaining 24 children had external auditory canals atresia in the bone part or throughout. 9 of them had a syndrome of deletion of the long arm of chromosome 18, 1 child had a mosaic form of Edwards syndrome. The average age at the time of diagnosis was 4 years 3 months. Atresia of external auditory canals in normal auricle is often caused by abnormalities of 18 pairs of chromosomes, and severe stenosis of external auditory canals can be observed in children with craniostenosis and other anomalies of the skull bones.

A case of Crouzon syndrome with papilloedema and exotropia

Early fusion of skull bones is the root cause of craniosynostosis. Nonsyndromic craniosynostosis affect only one suture of the skull while syndromic craniosynostosis affects multiple sutures and are associated with craniofacial dysmorphisms also abnormalities of extremities and other bony anomalies. 90% of cases are attributed to fibroblast growth factor gene 2 on chromosome 10p 25-q26, is responsible for more than. Crouzon syndrome is an autosomal dominant cause that constitutes 4.5% of craniosynostosis patients incidence of which is 0.16/10,000 population worldwide, most commonly involving coronal and frontosphenoidal suture. There is increased antero-posterior diameter of skull, hypoplasia of maxilla, and shallow orbits. Other features being brachycephaly, mid-face hypoplasia, and wider skull base anteriorly causing hypertelorism. Compensatory growth of uninvolved structure causes frontal bossing. Hydrocephalus, parrot beak-nose, hypoplasia of the maxilla, and high-arched palate is also noted. Relative proptosis is seen in most of the cases due to orbital hypoplasia. Ocular findings include vision impairment, strabismus, glaucoma, nystagmus, occasionally, corneal size abnormalities, keratoconus, corectopia, or aniridia. This case report is unique as it describes a 12 year old female of crouzon syndrome which presented with papilloedema and divergent squint which is rearely associated with this syndrome.

Study of Elbow Joint for Estimation of Age in 11 to 18 Years in both Sexes of Andhra Pradesh

Background: Age determination of individual is important in number of opportunities like education, sports, andmedico-legal factors. Ossification centres of bones play vital role in age determination. It is accepted in court oflaw.Method: 45 Boys and 45 Girls (total 90) children aged between 11 to 18 years were studied radiologically andclassified their numbers as per age and sex, Appearance and fusion of bones of elbow joints.Results: Equal number of boys and girls were selected from 11 years to 18 years of age. Appearance of trochlea at11 years appeared only in girls. Fusion of trochlea was 14 to 15 years in boys, 12 to 14 years in girls. Appearance oflateral epicondyle was 11 to 12 year in boys and 11 year in girls. Fusion of lateral epicondyle was 13 to 16 years inboys and 13 to 14 years in Girls. Fusion of medial epicondyle 14 to 16 years in boys, 11 to 15 years in girls. Fusion ofhead of radius 11 to 16 years in boys and 11 to 13 in girls. Appearance of olecranon process- 11 to 13 years in boysand 11 years in girls. Fusionof olecranon process 17 to 18 years in boys and 15 to 16 years in girls.Conclusion: This pragmatic radiological study of elbow joint between 11 to 18 years has regional, environmental,anatomical, anthropological and medico-legal importance because morphometric values of mesodermal origin areuncertain.

Technical aspects of total spondylectomy of C2.

Tumorous involvement of the second cervical vertebra is an infrequent, but severe disease. Primary tumors and solitary metastases can be addressed by a radical procedure, a complete removal of the whole compartment. The second cervical vertebra has a highly complex anatomy, and its operation requires considerable surgical skills. The aim of this retrospective study is to present technical aspects of complete resection of C2 for tumor indications, clinical and radiological evaluation of our group of patients and comparison of results of recent reports on surgery in this region in the literature. Between 2006 and 2019 we performed 10 total resections of C2 for primary bone tumor or solitary metastasis at our department. Operation was indicated for chordoma in 4 cases and for other diagnoses (plasmacytoma, EWSA, metastases of papillary thyroid carcinoma, medullary thyroid carcinoma, lung carcinoma and sinonasal carcinoma) in one case each. The operative procedure was in all cases performed in two steps. It always started with the posterior approach. The anterior procedure was scheduled according to the patient's condition after an average interval of 16.9 days (range 7-21). A stable upper cervical spine was achieved in all patients. A solid bone fusion over the whole instrumentation was present in all living patients and they returned to their preoperative activity level. By the final follow-up 6 patients died: one patient died on the 5th postop day because of diffuse uncontrollable bleeding from surgical wound, three patients died of generalization of the underlying disease and two patients due to complications associated with local recurrence of the disease. In addition to regular follow-ups, the surviving patients (N.=4) were also examined upon completion of the study, i.e., on average 91 months (range 17-179 months) postoperatively. With exclusion of an early deceased patient, the average follow-up period of deceased patients was 34.6 months (range 9-55) (N.=5). The average follow-up of the whole group of patients was 59,7 months (N.=9). Total spondylectomy of C2 is an exceptional surgical procedure associated with risk of serious complications but offers chance for a complete recovery of the patient. Defining indications accurately, especially in solitary metastases, is very difficult even with current level of imaging and other testing. The quality of life of long-term surviving patients in our study was not significantly impacted.

"Only fixation" in cases with failed decompression for lumbar canal stenosis - Analysis of outcome in 14 cases.

The rationale of "only fixation" of affected spinal segments without any form of bone or soft-tissue decompression in cases with failed decompressive laminectomy for lumbar canal stenosis is discussed on the basis of an experience with 14 cases. During the period between 2010 and 2022, 14 patients who symptomatically worsened or did not improve following a long-segment "wide" decompressive laminectomy for multisegmental lumbar canal stenosis were identified. All patients were treated by segmental spinal stabilization aimed at arthrodesis by facetal distraction by Goel's facetal spacers (6 cases) or Camille's transarticular facetal fixation (8 cases). No bone, soft tissue, or disc resection was done for spinal or neural canal "decompression." Oswestry Disability Index and Visual Analog Scale were used to clinically assess the patients before and after the surgery and at follow-up. In addition, video recordings of patient's self-assessment of clinical outcome were used to monitor the outcome. During the average period of follow-up of 71 months (range 6 months to 16 years), all patients recovered in majority of their major symptoms, the recovery was observed in the immediate postoperative period. During the period of follow-up, none of the patients complained of recurrent symptoms or needed any additional surgery. There was firm stabilization and evidences of bone fusion of the treated spinal segments in all patients. There were no infections or implant failure. No patient worsened after treatment. Instability of the spinal segments is the primary issue in cases with lumbar canal stenosis and stabilization in the treatment.

Biodegradable scaffolds for bone defect treatment

Purpose Animals, especially dogs are nowadays treated like family members so that when their pet's health condition has deteriorated, they go with them to the veterinarian. Common reasons for emergency visits include injuries and a decrease in animal performance due to progressive disease. The dynamic development of veterinary medicine and manufacturing techniques allows implants to be made using additive techniques. As an innovative solution dedicated as a scaffold for bone tissue reconstruction are the implants proposed by Cabiomede made of PLA. These implants should have the right properties to ensure the right conditions for bone fusion. It is also important to determine the time of degradation, which is associated with a significant loss of mechanical properties. Methods Therefore, the study assessed the mechanical properties of polymer implants made by FDM printing technology. The static compression and three-point bending tests, material wettability, and macro and microscopic observations were carried out. The effect of steam sterilization on the change in the determined parameters was also determined. Results Hydrolytic degradation initiated by exposure to Ringer's solution resulted in a change in structure from amorphous to semicrystalline. This indicates a partial dissolution of the amorphous phase and thus an increase in the percentage of the crystalline phase which resulted in the brittleness of the material. Conclusions The compressive strength values of PLA implants are similar to those of cancellous bone.

TREATMENT OF COMBAT SURGICAL TRAUMA OF THE LIMBS IN THE CONDITIONS OF MODERN WAR

Among the total number of wounded who entered the Military Medical Clinical Center of the Western Region from February to September 2022, combat injury to the limbs was in 63.3%. Bullet wounds caused combat injury to the limbs in 10.4%, shrapnel and mine-explosive – in 68.1%, explosive injury – in 21.5%. At the second role of medical care, emergency surgical interventions were performed on the wounded, immobilization of bone fractures with an external fixation and anti-shock therapy. At the third and fourth roles – the treatment of the wounded consisted in the use of a multidisciplinary approach with the involvement of doctors of various specialties, first of all, general surgeons, traumatologists, vascular, plastic surgeons and anesthesiologists. The most frequent surgical intervention was repeatened and secondary debridment of gunshot wounds, which was required by 93% of the wounded. The main pathogens that vegetated in wounds were Acinetobacter baumannii, Pseudomonas aeruginosa, Enterobacter aerogenes, Proteus vulgaris, Enterococcus faecalis with high levels of microbial contamination – 104-108/g in tissues., Various types of plastics were used to close soft tissue defects, according to the rule of the reconstruction ladder. After healing a soft tissue wound to determine the timing of replacing the method of fixing fractures with internal osteosynthesis, were analyzed clinical and laboratory parameters and assessed the risks of complications. The main causes of amputations of the limbs were common defects in soft tissue and bones, which were not subject to reconstruction with no prognosis for bone fusion and progression of the infectious-necrotic process.