Need For Revision Surgery Research Articles

In Situ Screw Fixation for Stable Slipped Capital Femoral Epiphysis Is Safely Treated in Both Inpatient and Outpatient Settings.

Patients diagnosed with slipped capital femoral epiphysis (SCFE) are admitted and treated with timely screw stabilization to prevent instability. This study compares the safety of SCFE stabilization in an inpatient versus outpatient setting, specifically evaluating the rates of revision procedures and complications between each setting. A retrospective review of all stable SCFEs treated at two, level 1, pediatric trauma centers with a minimum follow-up of 12 months was done. Comparisons were made between inpatient and outpatient groups. General demographics were collected along with slip severity as determined by Southwick angle. Outcomes reviewed included symptomatic femoroacetabular impingement and postoperative complications, including slip angle progression and revision screw fixation. Independent t-test was used to evaluate quantitative variables, chi-squared test for qualitative variables, and logistic regression for differences between severity groups. P values of <0.05 were considered notable. One hundred seventy-one SCFEs in 140 patients were reviewed. Overall, 108 were stabilized as an inpatient and 63 as an outpatient. No notable differences between either group were found when assessing for overall complications (P = 0.1705) and need for revision surgery (P = 0.1657). Frog-leg lateral hip angles progressed markedly over time for all patients (P = 0.0413) but not between patient groups (P = 0.0981). The odds of complication were 2 times higher (P = 0.023), and symptomatic femoroacetabular impingement were 2.1 times higher (P = 0.0027) for each increase in slip severity relative to the previous severity level. Interrater reliabilities for Southwick angles were good or excellent across all time measurements (intraclass correlation ≥0.8). Our data confirm that no difference exists between complication and revision rates with SCFE stabilization in an inpatient or outpatient setting. Although we did not perform a comprehensive safety analysis, outpatient SCFE stabilizations were associated with a low complication rate when performed in a high-volume center. More work is needed to establish proper outpatient SCFE treatment guidelines. Level III case-control series.

Medialization at the Site of Varus Derotational Osteotomy of the Proximal Femur May Reduce Instability Recurrence in Cerebral Palsy.

Osseous reconstructive surgery for hip displacement in children with cerebral palsy (CP) consists of proximal femoral reorientation by varus derotational osteotomy (VDRO) combined with pelvic osteotomy when indicated. The rate of recurrent hip instability after the index surgery can be as high as 77%. We evaluated the association between femoral diaphyseal medialization at the VDRO site and recurrent instability. We hypothesized that medialization may modify the hip joint reaction force (HJRF), reducing the femoral remodeling that leads to recurrent coxa valga and instability. A retrospective evaluation of the clinical and radiographic records of 140 patients (280 hips) with CP, Gross Motor Function Classification System (GMFCS) Level IV or V, who had been treated with bilateral VDRO as the index surgery for hip displacement between 1998 and 2012 (mean follow-up, 11.3 years) was conducted. Radiographic measurement of medialization was performed using the medialization index (MeI) preoperatively, at 6 weeks and 12 months postoperatively, and at skeletal maturity. Recurrent instability was defined as the need for revision surgery before skeletal maturity or a final migration percentage (MP) of >40%.The influence of the MeI was determined by Poisson regression with multiple variances. The inter- and intra-observer reliability of the MeI, measured by 4 different observers, was assessed using the Cohen d test. Groups with and without relapse were comparable preoperatively regarding femoral and acetabular parameters. The baseline MP was higher in the relapse group (p < 0.001). The MeI at 6 weeks postoperatively was significantly lower in the relapse group (p = 0.004, relative risk [RR] = 0.07, 95% confidence interval [CI] = 0.01 to 0.42) than in the no-relapse group in multivariable analysis. The MeI showed good inter- and intra-observer reliability, with a Cohen d of <0.5. Patients with greater medialization had lower rates of recurrent hip instability at long-term follow-up. The MeI proved to be reliable as a radiographic measurement, and medialization did not increase mechanical instability. Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.

Computer-Assisted Navigation in Shoulder Arthroplasty: A Narrative Review.

Shoulder arthroplasty, including total shoulder arthroplasty (TSA) and reverse shoulder arthroplasty (RSA), is a well-established procedure for treating degenerative, post-traumatic, and inflammatory conditions of the shoulder joint. The success of these surgeries depends largely on the precise placement of implants, which helps restore proper joint mechanics, reduce complications, and extend the lifespan of the prosthesis. However, achieving accurate implant positioning can be challenging, especially in cases involving severe bone loss, anatomical deformities, or prior surgeries. Poor alignment can lead to instability, implant loosening, and the need for revision surgery. Computer-assisted navigation has become an important tool in shoulder arthroplasty, providing real-time intraoperative guidance to improve surgical accuracy and consistency. By integrating preoperative 3D imaging with intraoperative tracking, navigation technology allows surgeons to optimize glenoid component placement, reducing the risk of malalignment and mechanical failure. Research suggests that navigation-assisted techniques improve precision, enhance functional outcomes, and may even reduce complication rates by optimizing fixation strategies, such as using fewer but longer screws in RSA. Despite its benefits, navigation in shoulder arthroplasty is not without challenges. It requires additional surgical time, increases costs, and demands a learning curve for surgeons. However, with advancements in artificial intelligence, augmented reality, and robotic-assisted surgery, navigation is expected to become even more effective and accessible. This review explores the current impact of navigation on clinical outcomes, its role in complex cases, and the future potential of this technology. While early results are promising, further long-term studies are needed to fully assess its value and establish best practices for its routine use in shoulder arthroplasty.

Research progress of suture augmentation in anterior cruciate ligament reconstruction

To summarize the research progress of suture augmentation (SA) in anterior cruciate ligament (ACL) reconstruction. A comprehensive review of recent literature about SA in ACL reconstruction at home and abroad was conducted. The efficacy of SA in ACL reconstruction was evaluated by examining the definition, biomechanics, and histological studies of SA, along with its clinical application status in ACL reconstruction. SA demonstrates significant advantages in enhancing the biomechanical stability of ACL grafts, reducing the risk of re-rupture, and accelerating postoperative recovery. Specifically, SA improves graft stiffness, ultimate failure strength, and cyclic stability, thereby diminishing the risk of early postoperative failure and joint instability. Histologically, it fosters remodeling and tendon-bone integration through early load-sharing mechanisms; however, stress shielding may interfere with natural remodeling processes, warranting further attention. Clinically, SA reduces graft failure rates and the need for revision surgeries, markedly improving knee joint stability and functional recovery in young patients. Nevertheless, its impact on graft maturation and potential complications remains controversial. Despite the many advantages of SA in ACL reconstruction, future endeavors should focus on optimizing tensioning techniques, developing bioactive materials, and conducting large-scale randomized controlled trials to further elucidate its clinical value and scope of applicability, providing a more reliable solution for ACL reconstruction.

Comparison of autograft and allograft outcomes in adolescent ACL reconstruction: a propensity score analysis

PurposeTo assess 3-year clinical and functional outcomes, complication rates and graft survival in adolescents with closed growth plates subjected to primary unilateral anterior cruciate ligament reconstruction (ACLR) with a hamstring autograft or an allograft. The failure rate reported in the literature reaches up to 20%.MethodsWe reviewed the records of 170 patients subjected to ACLR with a single-bundle autograft or an allograft from 2017 to 2020 with 3-year follow-up. Application of 1:2 Propensity Score Matching (PSM) considering age, sex, body mass index, injury to surgery interval, graft diameter and pre-injury Tegner Activity Scale (TAS) scores and Lysholm Knee Score (LKS) yielded 38 allografts and 62 autografts. We compared functional outcomes using the TAS, LKS and International Knee Documentation Committee (IKDC) at 18 and 36 months and the failure rates, defined as need for revision surgery, before and after PSM.ResultsMean age ranged from 15.8 (standard deviation [SD], 1.2) to 15.9 (SD, 0.9) years and the pre-injury TAS ranged from 7.3 (SD, 1.0) to 7.3 (SD, 1.2) in allograft and autograft patients, respectively. Analysis of the LKS, TAS and IKDC values demonstrated comparable levels both before and after PSM, except for the pre-matching IKDC score and the post-matching TAS score at 36 months, which were significantly higher in autograft than allograft patients (p = 0.024 and p = 0.039, respectively). As regards graft failure, before PSM significantly more allografts (12/54) than autografts (5/116) required revision surgery (p < 0.001). After matching, the difference (6/38 vs 3/62, p = 0.079) was no longer significant.ConclusionOur cohort of active adolescent who underwent primary unilateral ACLR had a higher absolute number of failures in the allograft group compared to the autograft group, emphasizing the need for careful clinical consideration. However, after applying PSM, this difference, while numerically still present, lost statistical significance. This finding may suggest that when an allograft is deemed the most appropriate choice based on patient characteristics, its use may not necessarily expose the patient to a definitively higher risk of failure.

Preoperative teriparatide intervention is cost-effective for osteoporotic patients undergoing lumbar fusion: a break-even cost analysis.

Preoperative teriparatide intervention is cost-effective for osteoporotic patients undergoing lumbar fusion: a break-even cost analysis.

Complications and Outcomes of Chemically Treated Allograft in Preadolescent and Adolescent Patients Undergoing Medial Patellofemoral Ligament Reconstruction.

Chemically treated allografts (CTAs) have been developed with the goal of providing a graft that is fully sterilized while maintaining the structural integrity and biochemical properties of the graft without irradiation. Few studies have analyzed the complications and postoperative outcomes of CTA in medial patellofemoral ligament (MPFL) reconstruction. The rate of complications and the outcomes of pediatric patients undergoing MPFL reconstruction would be similar between CTAs and low-dose irradiated allografts (IAs). Cohort study; Level of evidence, 3. The medical charts of a consecutive cohort of pediatric patients (aged 12-18 years) who underwent MPFL reconstruction at a single center from June 2011 to September 2022 with either 1- or 2-year follow-up were retrospectively reviewed. Patient characteristics, operative data, and postoperative data were collected in those without diagnosed collagen disorder or multiligament reconstruction. Without deliberate allocation, CTAs were overwhelmingly gracilis tendon allografts, whereas the majority of IAs were semitendinosus. Complications were recorded and included infection, redislocation, and reoperation. Patient-reported outcomes were collected including the Single Assessment Numeric Evaluation score, Kujala score, overall rating of treatment satisfaction, and pain score. A total of 235 (114 CTA, 121 IA) patients had 1-year follow-up with no significant differences in complication rate noted between the cohorts (CTA: 6/114 [5.3%]; IA: 5/121 [4.1%]; P = .786). Of the entire group, 122 (60 CTA, 62 IA) patients had 2-year follow-up, with no significant differences in patient-reported outcomes between the CTA and IA cohorts at mean follow-ups of 35.9 and 38.3 months, respectively (P = .271). At a minimum 2-year follow-up, failure rates (defined as redislocation) were 5% (3/60) for the CTA group and 17.7% (11/62) for the IA group (P = .059). Reoperation rates (defined as redislocation requiring repeat operative intervention) were 5% (3/60) and 9.7% (6/62) for the CTA and IA cohorts, respectively (P = .433). CTA and IA for reconstruction of the MPFL in the pediatric patient demonstrate similarly low rates of complication, patellar redislocation, and need for revision surgery. Moreover, the outcomes appear to indicate that utilization of gracilis tendon CTA carries the same risk as low-dose semitendinosus IAs when managing children with MPFL reconstruction.

Does Vertebral Cement Augmentation Reduce Postoperative Proximal Junction Complications in Spinal Deformity Corrective Surgery: A Systematic Review and Meta-analysis.

To assess the effectiveness of vertebral cement augmentation (VCA) at upper instrumented vertebra (UIV) and UIV+1 in preventing proximal junction complications in correction surgery for adult spinal deformity patients. A literature search was conducted on Web of Science, PubMed, and Cochrane Library databases for comparative studies published before December 30th, 2024. Two reviewers independently screened eligible articles based on the inclusion and exclusion criteria, assessed study quality with Newcastle-Ottawa scale, and extracted data like study characteristics, surgical details, primary and secondary outcomes. Data analysis was performed using Review Manager 5.4 and Stata software. Of all 513 papers screened, a meta-analysis was conducted on 7 articles, which included 333 cases in the VCA group and 827 cases in the control group. Patients in the VCA group had significantly older age and lower T score than patients in the control group. Although there was no statistically significant difference in the incidence of proximal junctional failure between the 2 groups, the results of the meta-analysis showed that the incidence of proximal junctional failure and the need for revision surgery were reduced by 36% and 71%, respectively, in the VCA group. One study reported 2 clinically silent pulmonary cement embolism and 1 patient requiring surgical decompression for cement leak into the spinal canal. This meta-analysis supported the use of VCA in corrective surgery for spinal deformities patients, especially in patients with advanced age and osteoporosis.

Surgical outcomes and prognostic analysis of congenital cervicothoracic scoliosis with Klippel-Feil syndrome

Objective: To investigate the surgical outcomes of congenital cervicothoracic scoliosis (CTS) patients with Klippel-Feil syndrome (KFS) and prognostic characteristics across different subtypes. Methods: A retrospective case series study is conducted. Clinical and radiographic data of 41 CTS patients with KFS who underwent hemivertebra resection with instrumentation at Nanjing Drum Tower Hospital from March 2012 to September 2022, with a minimum follow-up of two years, were analyzed. The cohort included 16 males and 25 females, aged (8.6±3.7) years (range: 3 to 15 years). Preoperative, immediate postoperative, and final follow-up cervicothoracic deformity parameters were compared. Patients were classified into three subtypes based on preoperative coronal alignment: Type A (shoulder-neck type, 16 cases), Type B (trunk-tilt type, 16 cases), and Type C (thoracic compensatory curve type, 9 cases). The severity of KFS and the incidence of distal curve progression among subtypes were analyzed. Repeated measurement data were compared by repeated measurement ANOVA, pairwise comparison within groups was performed by Bonferroni method, and categorical variables were compared by Chi-square test or Fisher exact probability method. Results: All patients underwent successful surgery. Twenty-one patients (53.7%) had cervical fusion of ≥3 segments, and 63.1%(82/130) of fused cervical segments were located proximally to the instrumentation. Postoperative cervicothoracic Cobb angle, head tilt, head shift, neck tilt, and clavicle angle significantly improved (all P<0.05). The proportion of patients with cervical fusion of≥3 segments was higher in Types B and C (17/25) than that in Type A (5/16) (χ²=5.299, P=0.021). Four Type B (4/16) and 5 Type C (5/9) patients underwent long-segment fixation, with stable coronal alignment postoperatively. The remaining patients received short-segment fixation. In the short-segment group, the incidence of distal curve progression was significantly higher in Types B and C (8/16) than that in Type A (1/16) (P=0.015). Ultimately, 3 Type B patients underwent revision surgery, and 1 Type C patient met the criteria for revision (distal compensatory thoracic or lumbar curve>40°). Conclusions: Patients with KFS are predisposed to develop significant coronal malalignment involving trunk tilt (Type B) or thoracic compensatory curve (Type C) before surgery. Following hemivertebra resection with short-segment fixation, such patients have a high risk of distal curve progression and potential need for revision surgery.

Longer operative times but equally safe - a propensity score-matched analysis for laparoscopic procedures in women with early-stage (r-ASRM I-II) endometriosis performed by gynecology residents compared to attending surgeons

IntroductionSurgery for endometriosis is usually performed through minimally invasive surgery, either by experienced endometriosis surgeons or by supervised gynecology residents during their surgical training. This trial aimed to assess the influence of surgical experience on the efficiency and safety of minimally invasive surgery treatment for early-stage endometriosis.Material and MethodsPost- and introperative complications rates and length of stay of patients with stage I and II (revised American Society of Reproductive Medicine stage (rASRM)) endometriosis undergoing laparoscopic surgery at the University Hospital Mainz, Germany, between 2018 and 2022 were evaluated in a propensity score-matched analysis based on the experience of the primary surgeon (resident/fellow vs. attending). Linear and logistic regression models were used on the matched data set to calculate the treatment effect on the treated.Results580 patients were included in the final data set. Of those, 339 were operated on by 11 attending surgeons and 241 by 22 residents/fellows. The matched dataset showed a mean difference of 0.02 in propensity scores after full propensity score-matching. Compared to surgical procedures performed by experienced surgeons, prolonged operating times were found for surgeries performed by residents/fellows (5.27 min in the whole data set (SE 1.36), p < 0.001), and 9.54 min (SE 3.57, p = 0.007) when analyzing only rASRM stage II endometriosis. The need for revision surgery was reduced in the resident/fellow group, but did not reach statistical significance (0.56 (95%CI: 0.301-0.1.02), p = 0.06). No significant differences were found for intra- or postoperative complications and length of hospital stay.ConclusionsGynecology residents and fellows trained on the patient can safely perform surgery for early-stage endometriosis at the cost of increased operative times. Additional training options, such as surgical simulation training, should be explored to shorten learning curves, reduce the financial burden on hospitals due to prolonged operative times and counter the impending reduction in intraoperative training possibilities for residents.

Patient Factors Associated with Recurrent Herniation and Revision Surgery Following Lumbar Microdiscectomy

Lumbar microdiscectomy is a commonly conducted surgical procedure for treating symptomatic lumbar disc herniations. Recurrence of herniation is a common cause of poor outcomes and the need for revision surgery, which occurs in as many as 21% of patients following primary discectomy. Identifying factors that are associated with the recurrence of herniation may be valuable for risk stratification and patient counseling. This study aimed to explore the relationship between various patient demographic variables and comorbidities and rates of reoperation after primary lumbar microdiscectomy. The American College of Surgeons National Surgical Quality Improvement Program database was queried for patients who were undergoing single-level primary lumbar microdiscectomy between 2016 and 2022. Eligibility for inclusion was determined by age >18 years and current procedural terminology codes 63030 and 63042. Patients with preoperative sepsis or cancer were excluded. Patient demographics, including age, race, ethnicity, and body mass index (BMI), and various comorbidities were compared between cohorts. To determine factors independently associated with the need for revision microdiscectomy, multivariable Poisson regressions were utilized. In this study, a total of 65,121 primary discectomy patients were included, with a separate cohort of 6,971 patients undergoing revision discectomy. In comparison with primary patients, the revision cohort was older and had higher proportions of female and non-Hispanic White patients (all c0.001). The odds ratio for revision discectomy was greater in patients aged ≥65 years (1.577, 95% CI [1.480, 1.680]) than in those aged <45 years (p>0.001). The odds ratio for revision was lower in Black (0.821, 95% CI [0.738, 0.914]) and Hispanic patients (0.819, 95% CI [0.738, 0.909]) when compared with non-Hispanic White patients (p<0.001). Obese patients with BMI ≥35 (1.193, 95% CI [1.103, 1.290]) were at greater risk of revision than those with BMI <25 (p<0.001). Diabetes (1.326, 95% CI [1.242, 1.416], p<0.001), functional dependence (1.411, 95% CI [1.183, 1.683], p<0.001), chronic obstructive pulmonary disorder (1.315, 95% CI [1.137, 1.512], p<0.001), hypertension (1.398, 95% CI [1.330, 1.470], p<0.001), and smoking (1.082, 95% CI [1.018, 1.151], p=0.012) were associated with greater risk of revision. Poisson log-linear regression demonstrated sex (χ 2=19.9, p<0.001), race (χ 2=39.5, p<0.001), diabetes (χ 2=10.1, p=0.001), smoking (χ 2=18.5, p<0.001), hypertension (χ 2=16.4, p<0.001), age (χ 2=102.4, p<0.001), and BMI (χ 2=4.7, p=0.029) as significant predictors of revision, with steroid use (χ 2=3.5, p=0.061) and functional status (χ 2=3.7, p=0.055) approaching significance. Patient demographics, comorbidities, and rehabilitative status may be significantly associated with rates of reherniation and revision surgery following lumbar microdiscectomy. We found that the significant predictors of revision surgery are functional dependence, advanced age, male sex, White race, obesity, diabetes, smoking, and hypertension. Early identification and attendance to the modifiable risk factors will aid patient guidance and outcomes following primary lumbar microdiscectomy.

Short- and Long-Term Risk of Meningitis Following Pediatric Endoscopic Transsphenoidal Surgery.

To determine both the short- and long-term risks of meningitis in children and adolescents undergoing transsphenoidal skull base surgery. Retrospective analysis of the Pediatric Health Information System (PHIS) database over a 10-year period. The PHIS database was reviewed to identify individuals ≤ 18 years of age who underwent endoscopic transsphenoidal surgery from 2012 to 2022. Data regarding patient demographics, length of stay, and need for revision surgery was recorded. To assess both the short- and long-term risk of postoperative meningitis, a PHIS query was performed for all readmissions of the initial cohort between 2012 and 2024. Any readmission related to meningitis was reviewed and analyzed. Subgroup analysis was performed based on patient age at initial surgery, gender, geographic region, insurance carrier, and need for revision surgery. Total of 476 patients (501 cases) with a mean age of 12.8 years (SD: 4.0 years) met inclusion criteria. Twenty-four patients (5.0%) developed meningitis, 13 (2.7%) during their initial hospitalization and 11 (2.3%) following discharge, the latter within a range of 0.4-38.9 months (mean 8.1 months). Length of stay was significantly higher in patients who developed meningitis. Younger age at the time of surgery was the only risk factor identified. The short-term risk of postoperative meningitis following pediatric transsphenoidal skull base surgery is similar to that of the adult population. The long-term risk is also low, with most cases occurring within 1 year of discharge. Patients < 12 years of age have the highest risk and warrant consideration of prophylactic antibiotics.

Do all symptomatic adjacent segment diseases (ASD) require surgery? a prognostic classification and predictors of surgical treatment of lumbar ASD.

Symptomatic Adjacent segment disease presents in myriad ways with varying clinic-radiological presentation but the optimal management and the factors that predict need for revision surgery are unclear. Consecutive patients (n = 132) who experienced significant back or leg pain after an asymptomatic period (minimum 1 year) following a lumbar fusion were evaluated with dynamic radiographs and MRI. ASD was classified anatomically as proximal (86.3%), distal (12.1%, or combined (1.5%) and, sub-classified pathologically into six sub-types: Type 1: Disc prolapse (17.4%), Type 2: Disc degeneration with intra-discal instability (15.1%), Type 3: Anterolisthesis and facet instability (6.8%), Type 4: Retrolisthesis (25%), Type 5: Stenosis (21.9%) and Type 6: Combined types (13.6%). The mean duration between the index surgery and ASD was 5.9 ± 4.1 years. Surgery was required in 40.9% (54/132). Six factors were highly predictive of surgical treatment for ASD, viz., Diabetes mellitus (OR-4.3, p = 0.007), ASD- disc prolapse (OR 6.3, p = 0.018), ASD intra-discal instability (OR-16.8206, p = 0.003), ASD - anterolisthesis (OR - 8.2998, p = 0.043), Facet angle > 75° (OR 37.6, p = 0.02) and radiculopathy (OR 48.0, p = 0.002). Retrolisthesis was the most benign type as 84.8% patients were managed conservatively (p = 0.016). Among proximal ASD, retrolisthesis was the most common subtype (28.9%) while disc prolapse was the most common subtype in distal ASD 37.5% (p = 0.032). The study classifies the versatile clinic-radiological presentation of ASD, and identifies factors that predicted the development of the different sub-types of ASD. Knowledge about the six clinic-radiological factors that predict the need for surgical treatment in ASD is beneficial.

Frozen Section Analysis in Submandibular Gland Tumors: Optimizing Intraoperative Decision-Making

Introduction: With around 25 different salivary gland tumor entities described by the World Health Organization, the correct preoperative identification of masses as benign or malignant remains a challenge. If preoperative needle biopsy is inconclusive, frozen section analysis is a possible alternative for accurate histological identification. The purpose of our study was to evaluate the diagnostic effectiveness of frozen section performed for primary submandibular gland masses. Methods: In addition to acquiring epidemiological data from patients who underwent submandibular gland excision over a 20-year period, we analyzed the diagnostic effectiveness of frozen section performed for submandibular gland masses. We also examined the impact of frozen section on overall survival. Furthermore, we investigated whether there was an impact on the surgical revision rate for malignant submandibular gland masses that required additional neck dissection within the submandibular triangle. Results: Frozen section was performed for 54 submandibular gland tumors, with a specificity of 100% and a sensitivity of 81.3%. Frozen section was conducted in 12 cases of primary salivary gland malignancies, of which 9 cases were identified correctly. In three cases, the frozen section results were inconclusive. We calculated a relative risk reduction of 27% for revision surgery by performing frozen section. There was no significant association between frozen section results and overall survival. Conclusions: Frozen section demonstrates a significant reduction in the need for revision surgery. With a specificity of 100%, frozen section is especially suited to identifying benign masses. It is a valid diagnostic tool when preoperative sampling is not possible or is inconclusive.

Development of a deep learning radiomics model combining lumbar CT, multi-sequence MRI, and clinical data to predict high-risk cage subsidence after lumbar fusion: a retrospective multicenter study

BackgroundTo develop and validate a model that integrates clinical data, deep learning radiomics, and radiomic features to predict high-risk patients for cage subsidence (CS) after lumbar fusion.MethodsThis study analyzed preoperative CT and MRI data from 305 patients undergoing lumbar fusion surgery from three centers. Using a deep learning model based on 3D vision transformations, the data were divided the dataset into training (n = 214), validation (n = 61), and test (n = 30) groups. Feature selection was performed using LASSO regression, followed by the development of a logistic regression model. The predictive ability of the model was assessed using various machine learning algorithms, and a combined clinical model was also established.ResultsUltimately, 11 traditional radiomic features, 5 deep learning radiomic features, and 1 clinical feature were selected. The combined model demonstrated strong predictive performance, with area under the curve (AUC) values of 0.941, 0.832, and 0.935 for the training, validation, and test groups, respectively. Notably, our model outperformed predictions made by two experienced surgeons.ConclusionsThis study developed a robust predictive model that integrates clinical features and imaging data to identify high-risk patients for CS following lumbar fusion. This model has the potential to improve clinical decision-making and reduce the need for revision surgeries, easing the burden on healthcare systems.

Comparison of outcomes for Draf IIB vs Draf III in endoscopic frontal sinus surgery: a comprehensive systematic review and meta-analysis.

Understanding the factors associated with increased rates of restenosis following Draf procedures is crucial for developing targeted strategies to mitigate complications such as mucocele formation, reduce the need for revision surgeries, and improve long-term patient outcomes. A systematic search was conducted using Embase, Medline, CINAHL, AMED, PubMed, and the Cochrane Database on January 17th, 2024. Research articles published in English language were included. Abstracts were independently screened by two reviewers, and data were extracted and assessed for quality in adherence to PRISMA guidelines. Meta- and sub-group analyses were conducted using the REML model and random-effects model to address high heterogeneity and I² values. A total of 96 studies met the inclusion criteria. For the Draf IIB subgroup (15 studies, 239 sinuses), the restenosis rate was 7%, compared to 20% in the Draf III subgroup (40 studies, 1,910 sinuses). Revision surgery rates were 5% for Draf IIB versus 12% for Draf III. Adjuvant interventions, such as steroid-impregnated stents, were associated with improved outcomes, showing an ostium patency OR of 2.20. Draf IIB had superior outcomes compared to Draf III with respect to restenosis and revision surgery. The use of steroid-impregnated stents appears effective in reducing restenosis rates.

No difference in 2-year outcomes of arthroscopic rotator cuff repair in patients with osteoporosis.

No difference in 2-year outcomes of arthroscopic rotator cuff repair in patients with osteoporosis.

Integrating a randomized controlled trial with a parallel observational cohort study in cervical spine surgery insights from the foraminotomy ACDF cost-effectiveness trial (FACET).

Integrating a randomized controlled trial with a parallel observational cohort study in cervical spine surgery insights from the foraminotomy ACDF cost-effectiveness trial (FACET).

Demographic Differences in the Surgical Management of Tibial Shaft Fractures: A Retrospective Study.

Background Tibial shaft fractures (TSFs) are the most common long bone fractures in the United States and are associated with significant morbidity and the potential need for revision surgeries, with many patients requiring reoperation. This can have significant physical, mental, and financial impacts on patients. A major complication faced by patients with TSF is nonunion (TSFN). The mainstay of surgical management of TSF is Intramedullary Nail (IMN), with some patients also being treated with Open Reduction Internal Fixation (ORIF). With the demographic makeup of the United States undergoing rapid change, a better understanding of patient characteristics of patients with TSF is useful to optimize patient care. This study aims to enhance our comprehension of the frequency and demographic variables associated with tibia fracture surgery and subsequent nonunion. Methods A retrospective study was conducted in August 2023, utilizing the TriNetX "Global Collaborative Network" database to form patient study cohorts. Data extracted included patient age, sex, ethnicity, race, smoking status, surgical management, and nonunion. Data was also extracted on specific surgical management utilized, comprising either IMN or ORIF. Results A total of 6,389 cases of TSFs were analyzed, with 65% (4,153) of patients undergoing ORIF compared to IMN (35%, or 2,236). The overall incidence of patients with TSF ORIF and IMN was highest among males and White patients. The incidence of patients with TSF ORIF was highest in the age groups of 40-64 and 64-90 years, while TSF IMN was highest in the age groups of 18-39 and 40-64 years. The overall rate of tibia nonunion among patients with a TSF ORIF was 4.6%, vs. 2.6% in patients who underwent IMN. Conclusion TSFs treated with IMN were found to have lower rates of nonunion compared to ORIF. IMN of TSF was more common in younger patients, while ORIF was more common in the older age groups. ORIF and IMN had similar rates of male-to-female utilization, indicating that both genders are being treated similarly with regard to the operative method of choice. White patients and those who were not Hispanic or Latino had much higher rates of both IMN and ORIF compared to all other racial groups, despite the increased complexity of fracture/injury characteristics and higher complication rates in minority patients.

Integration of advanced imaging and surgical navigation in the treatment of unstable thoracolumbar spine fractures: a systematic review of functional, neurological and postoperative outcomes

Advanced imaging and surgical field have improved treatment and management of unstable thoracolumbar spine fractures significantly. Its emergence is boosting surgical accuracy, efficiency and its use has increased patient recovery rate. This systematic analysis is conducted to explore how these technologies affect functional, neurological and postoperative outcomes. Our aim is to evaluate and investigate previous evidences and various studies. This systematic analysis will be based entirely on retrospective analyses, randomized controlled trials, and other systematic reviews. While conducting methodology, we assessed several factors like pedicle screw placement accuracy, surgery time, radiation exposure and noted overall patient outcomes across different navigation systems like intraoperative CT navigation (iCT-Nav), 3D navigation, and augmented reality. The primary results of this systematic review revealed pedicle screw placement accuracy was high (up to 96.9% with iCT-Nav), with fewer revision surgeries needed. 3D navigation reduced fluoroscopy time significantly (p=0.0002) while still maintaining accuracy and evidence confirmed these techniques also helped lower blood loss (p&lt;0.05) and improved spinal alignment without adding significant time to the surgery. Evidence showed radiation exposure remained an issue with varying levels of dose-length product (DLP) but it was dependent on the complexity of the procedures. Conservative management failed in 9.2% of cases while long-segment stabilization helped prevent further vertebral fractures. After all these results, we came to a conclusion that advanced imaging and navigation technologies have revolutionized thoracolumbar fracture management because its use has improved accuracy and patient outcomes which is confirmed. These technologies are also seen to reduce the need for revision surgeries and made minimally invasive surgeries more effective and also helped stabilize the spine in the long term. The challenges linked to these procedures are radiation exposure, standardization and costs which need to be carefully handled and need attention. Future research should explore what the role of artificial intelligence is and how it can work to bring maximum outcomes while making these technologies more accessible is also critical.