Open Group Research Articles

Robotic salvage radical hysterectomy for locally recurrent cervical cancer: A comparison with open surgery in a single-surgeon series.

To compare the surgical and oncologic outcomes between patients with locally recurrent cervical cancer undergoing robotic-assisted salvage radical hysterectomy (RH) and those undergoing conventional open salvage RH, performed by a single surgeon. This retrospective comparative observational study utilized data obtained from consecutive patients with locally recurrent cervical cancer, developed after definitive radiotherapy. These patients either underwent robot-assisted RH (robotic group) or conventional open RH (open group). Clinicopathological characteristics, surgical outcomes, and oncological outcomes were compared between the two groups. The operative time was slightly longer in the robotic group; however, this difference was not statistically significant. Estimated blood loss was significantly lower in the robotic group (median; 0 mL [robotic group] vs. 700 mL [open group]: p < 0.01). The incidence of intraoperative and early and late complications did not statistically differ between the two groups. The mean follow-up was 29.0 and 17.1 months in the open and robotic groups, respectively. Disease recurrence rates were similar between the two groups (40% [robotic group] vs. 44.4% [open group]). Kaplan-Meier survival analysis for progression-free survival and overall survival did not show statistically significant differences between the two groups. Robot-assisted salvage RH in women with locally recurrent cervical cancer showed perioperative and oncological outcomes comparable to those of the open procedure. Although our results suggest that the robot-assisted approach is as good as or better than the open approach, further investigation is required to establish a more robust conclusion.

Quantitative analysis of iridocorneal angle and ciliary cleft structures in canine eyes using ultrasound biomicroscopy

IntroductionThis study aimed to examine the relationship between the relative opening of the ICA (RO-ICA) and the structure of the ciliary cleft (CC) using Ultrasound Biomicroscopy (UBM).Materials and methodsClinical data from 31 eyes of 17 dogs at the Veterinary Teaching Hospital of Chungbuk National University, Korea, were analyzed. RO-ICA was categorized as “Slightly Narrow”, “Narrow”, “Open”, and “Wide Open”, with eyes further grouped into “Narrow” (including Slightly Narrow and Narrow) and “Open” (including Open and Wide Open) for analysis. Statistical methods, including linear regression and average comparisons between groups, were employed to explore correlations between RO-ICA and parameters such as ICA, CC width (CCW), CC length (CCL), and CC area (CCA).ResultsThe distribution showed “Narrow” (3 eyes, 9.7%), “Slightly Narrow” (13 eyes, 41.9%), and “Open” (14 eyes, 45.2%) as the predominant categories. In the Open group, CCL and CCA were significantly larger compared to the Narrow group. A positive correlation was observed between RO-ICA and CCL, and CCA across all groups. Notably, in the Narrow group, RO-ICA demonstrated a particularly significant positive correlation with all assessed parameters, including ICA, CCW, CCL, and CCA. However, no significant correlation was observed between RO-ICA and the assessed parameters in the Open group. In conclusion, while a smaller RO-ICA generally correlates with a smaller CC, a larger RO-ICA does not guarantee a larger CC.ConclusionAdditional UBM examinations are recommended for comprehensive evaluations, particularly in cases where gonioscopy indicates an open iridocorneal angle.

Minimally invasive surgery versus open surgery in advanced stage endometrial cancer.

Staging surgery in early stage endometrial cancer has been shown to be feasible and safe with minimally invasive surgery (MIS) in many previous studies. However, there is limited literature on MIS's safety in advanced stages. This study aims to identify factors associated with survival in stage III endometrial cancer and investigate survival differences based on surgical approach. Patients with stage III endometrial cancer who underwent staging surgery from March 2002 to March 2023 were included in this study. Various clinicopathological features, disease-free survival (DFS), and overall survival (OS) were evaluated. Among the 79 patients included in this study, 20 patients underwent MIS (25.3%) and 59 patients underwent open surgery (74.7%). The open surgery group had a higher prevalence of aggressive histology, a higher median pretreatment CA-125 level, and a greater number of harvested lymph nodes compared to the MIS group. Five-year OS and DFS was higher in the open surgery group than in the MIS group (DFS: 67.9% vs. 59.9%, p = 0.046; OS: 74.3 vs. 50.6%, p = 0.008). In multivariate analysis, younger than 55 years old (OR, 2.778; 95% CI, 1.078-7.156; p = 0.034), and open surgery (OR, 3.671; 95% CI, 1.581-8.522; p = 0.002) was related to improved OS. Open staging surgery showed better survival outcomes when compared to MIS in stage III endometrial cancer patients in our study. For patients who are older than 55 years old and have aggressive histology in endometrial biopsy, considering open surgery may help improve their prognosis, even if preoperative MRI suggests early-stage endometrial cancer.

Trends in Management of Malignant Bowel Obstructions: A Longitudinal Analysis of the National Inpatient Sample.

Malignant bowel obstructions (MBO) are complex, heterogeneous disease processes which can be managed with surgical or endoscopic interventions. Patients with MBO often have advanced metastatic disease and poor functional status, which makes it difficult for providers to determine the best treatment strategy. Patients with urgent or emergent admissions and a primary or secondary ICD-9/ICD-10 diagnosis of bowel obstruction with an additional diagnosis of disseminated cancer were identified from the National Inpatient Sample (2000-2017). Patients were stratified into operative and non-operative intervention groups. Multivariate regression determined factors associated with surgical treatment of MBO based on significant factors on univariate analysis. Trends in treatment over time were calculated using log-linear regression to determine the annual percent change (APC). Of 1118 patients, 18% underwent surgery and 7% underwent endoscopic intervention. From 2000 to 2017, a decreasing proportion of patients underwent surgery (APC -2.4, p = 0.023) with a commensurate increase in endoscopic interventions (APC 5.3, p = 0.042). There was also a decrease in the proportion of patients who died during hospitalization (APC -4.3, p = 0.029). Surgery was associated with longer mean lengths of stay (13 days vs. 7 days, p < 0.001) and higher rates of in-hospital mortality (13% vs. 6%, p = 0.001) compared to non-operative management. The proportion of patients receiving surgery for MBO is decreasing and that receiving endoscopic interventions is increasing. In-hospital mortality is also decreasing proportionately, suggesting an improvement in patient selection.

Percutaneous isometric reconstruction of medial collateral and posterior oblique ligaments offers similar outcomes to open techniques with reduced complication rates at a medium-term follow-up: A retrospective comparative study

BackgroundKnee Injuries involving the superficial medial collateral ligament (sMCL) and posterior oblique ligament (POL) can cause severe instability. The open surgical technique involves larger incisions. A percutaneous technique may offer similar outcomes with reduced morbidity and a shorter recovery time. The purpose of this study was to compare the clinical and functional outcomes of percutaneous and open reconstruction using isometric allografts. MethodsA retrospective comparative analysis was conducted on 21 patients between 2010 and 2021. Eleven patients underwent open surgery, while 10 underwent percutaneous surgery. The subjective IKDC, Lysholm, and Tegner scores, and valgus laxity were evaluated. Complications were also recorded. ResultsBoth the groups demonstrated significant improvements in functional scores and a reduction in valgus laxity postoperatively, with no significant differences. The mean improvements were 32.3 for the IKDC score and 37.9 for the Lysholm score. The average reduction in the Tegner score was 1.1 points. Postoperative radiographic measurements of medial joint opening were < 2 mm in all patients. The percutaneous group had fewer complications, with arthrofibrosis being significantly less frequent (0 vs. 4 in the open group). The mean follow-up was 3.5 years. ConclusionPercutaneous reconstruction of the medial side of the knee with an isometric technique is a safe and effective procedure that provides results similar to those of open reconstruction. The advantages of percutaneous reconstruction include smaller incisions, less pain and scarring, shorter recovery time, and lower risk of complications. Allografts are preferred over autografts to avoid donor site morbidity and weakening of the medial stabilizers.

Recurrent oropharyngeal cancer: Analysis of surgical treatment outcomes

BACKGROUND The main goal of our research is to introduce transoral robotic surgery and laser resection (TLR) as a considerable way of treating patients with recurrent oropharyngeal malignancies. AIM To develop a foundation of minimally invasive transoral surgical technique for patients with oropharyngeal recurrence. METHODS This study prospectively and retrospectively included patients with recurrent tumors from 2003 to 2018. Subjects were allocated into two groups: (1) Group I; underwent TLR; and (2) Group II (control); underwent open surgeries of varying volume. Evaluation was done with intraoperative blood loss, postoperative infection incidence, and quality of life using the scale for patients with head and neck tumors known as the Functional Assessment of Cancer Therapy-Head &amp; Neck Scale. RESULTS One-hundred and forty one patients were included (103 males and 38 females), in 82 cases (85.4%), a recurrent tumor developed earlier than a year after primary tumor therapy; forty-six were in group I and 69 in group II, age ranging from 18 years to 86 years (average: 57.6 years). The first group showed a statistically significant less amount of blood loss and a decreased incidence of infectious complications (P &lt; 0.05). Additionally, there was a significant difference in functional outcomes (quality of life scores) but no significant difference in survival curves. CONCLUSION In properly elected patients, TLR is not just reasonable but tends to be a favorable alternative for recurrent oropharyngeal cancers compared to the outcomes of the open surgery group.

Comparison between microendoscopic laminectomy and open posterior decompression surgery for two-level lumbar spinal stenosis: a multicenter retrospective cohort study

BackgroundExcellent surgical outcomes of microendoscopic laminectomy (MEL) have been reported for patients with lumbar spinal canal stenosis (LSCS). However, few reports have directly compared MEL with open laminectomy for multi-level LSCS. This study conducted a comparative analysis of patient-reported outcomes (PROs) and perioperative complications in patients undergoing two-level posterior decompression for LSCS by MEL versus open laminectomy.MethodsThis multicenter retrospective cohort study involved prospectively registered patients who underwent two-level posterior lumbar decompression surgery for LSCS at one of eight high-volume spine centers between April 2017 and February 2020. Chart sheets were used to prospectively evaluate demographic data, including diagnosis, operative procedure, operation time, estimated blood loss, and perioperative complications. The PROs evaluated were the numerical rating scale (NRS) score for lower back pain and leg pain, 12-item Short Form Health Survey (SF-12) score, EuroQol 5-Dimension (EQ-5D) score, Oswestry Disability Index (ODI) score, and patient satisfaction with the treatment.ResultsOf the 882 patients enrolled, 410 underwent MEL (MEL group) and 472 underwent open decompression (open group). A total of 667 (75.6%) patients completed the 1-year follow-up. Intraoperative blood loss was significantly lower in the MEL group than in the open group. The complication rate was comparable (12.4% in MEL group, 12.5% in open group). Although the revision rate did not differ significantly, the incidence of surgical site infection (SSI) was markedly lower in the MEL group (0.0% in MEL group, 1.3% in open group). Propensity score matching was employed to compare 333 patients who underwent MEL with 333 patients who underwent open laminectomy. Intraoperative blood loss was significantly lower in the matched MEL group than in the matched open group. The incidence of SSI was markedly lower in the matched MEL group (0.0% in matched MEL group, 1.2% in matched open group). No significant differences in the preoperative and postoperative values of the PROs or patient satisfaction were observed between the two groups.ConclusionsMEL required an equivalent operating time and resulted in less intraoperative blood loss compared with laminectomy in two-level procedures. The incidence of SSI was significantly lower in the MEL group.

Effects of closed- versus open-system intensive care units on mortality rates in patients with cancer requiring emergent surgical intervention for acute abdominal complications: a single-center retrospective study in Korea.

In this study, we aimed to compare the in-hospital mortality of patients with cancer who experienced acute abdominal complications that required emergent surgery in open (treatment decisions made by the primary attending physician of the patient's admission department) versus closed (treatment decisions made by intensive care unit [ICU] intensivists) ICUs. This retrospective, single-center study enrolled patients with cancer admitted to the ICU before or after emergency surgery between November 2020 and September 2023. Univariate and logistic regression analyses were conducted to explore the associations between patient characteristics in the open and closed ICUs and in-hospital mortality. Among the 100 patients (open ICU, 49; closed ICU, 51), 23 died during hospitalization. The closed ICU group had higher Acute Physiology and Chronic Health Evaluation (APACHE) II scores, vasopressor use, mechanical ventilation, and preoperative lactate levels and a shorter duration from diagnosis to ICU admission, surgery, and antibiotic administration than the open ICU group. Univariate analysis linked in-hospital mortality and APACHE II score, postoperative lactate levels, continuous renal replacement therapy (CRRT), and mechanical ventilation. Multivariate analysis revealed that in-hospital mortality rate increased with CRRT use and was lower in the closed ICU. Compared to an open ICU, a closed ICU was an independent factor in reducing in-hospital mortality through prompt and appropriate treatment.

Impact of a Restrictive Formulary on glycemic control compared with an Open Formulary

AbstractIntroductionIn 2019, California Governor Gavin Newsom introduced executive order N‐01‐19, which transitioned California's Medicaid (Medi‐Cal) health plan pharmacy benefits from multiple managed care plans to a single‐payer system. This transition occurred on January 1, 2022, and Medi‐Cal stopped enforcing formulary restrictions for beneficiaries.ObjectivesThis study compared glycemic control of hemoglobin A1c in a pharmacist‐led diabetes clinic during an open versus restrictive formulary.MethodsThis is a retrospective cohort study of Medi‐Cal patients seen in a pharmacist‐led diabetes clinic at Kern Medical in Bakersfield, California between January 2021 and September 2022. All new patients with type 2 diabetes and an A1c greater than 6.9% seen at the clinic between January and September 2021 were classified as the Restrictive Formulary group and those seen between January and September 2022 were the Open Formulary group. The primary end point was mean change in A1c at first follow‐up. Secondary end points included attainment of an A1c &lt;7%, change in weight, blood pressure, cholesterol, and statin use, and change in estimated monthly drug expenditure for glucose‐lowering medications per patient. Safety end points included diabetes‐related visits to Kern Medical's emergency room and hospitalizations.ResultsWhile both the Restrictive and Open Formulary groups had significant reductions in mean A1c from a baseline of −0.74 ± 2.1 (p = 0.02) and − 2.7 ± 2.4 (p &lt; 0.001), respectively, the magnitude of A1c reduction was greater in the Open group (p &lt; 0.001). For secondary outcomes, the Open group saw a higher utilization of agents with known cardiovascular and renal benefits. The Open group had a modest weight reduction (−2.5 kg ± 4.4 kg, p = 0.027). There was no significant difference in the cost of diabetes therapy between the two groups (p = 0.12).ConclusionsAn open formulary resulted in better glycemic control without significantly increasing the average monthly cost of diabetes medications.

Radiographic and clinical evaluation of external pedicle screw fixation as a definitive solution for selective acetabular fractures: a retrospective analysis

BackgroundAcetabular fractures typically require open surgery to restore hip joint function. Openness may lead to serious tissue damage, increased bleeding, and the risk of nerve and vascular damage. Minimally invasive closed reduction or percutaneous fixation aims to minimize additional harm to patients and provide reliable fixation to promote fracture recovery and functional rehabilitation. This study aimed to assess the radiographic and clinical effectiveness of pedicle screw external fixation as a definitive treatment approach for selective acetabular fractures.MethodsThe present study enrolled 43 patients with acetabular fractures who were categorized into three groups based on their definitive treatment plans: pedicle screw external fixation group, traditional external fixation stent fixation group, and open reduction internal fixation group, comparing the operative duration and the time required for fracture healing. Fracture reduction was evaluated using the Tornetta and Matta grading system, and postoperative clinical outcomes were analyzed using the Majeed score. Analyze three surgical methods by comparing clinical indicators and prognostic references.ResultsAmong the 43 patients, there were 12 cases in the pedicle screw external fixation group, 14 cases in the traditional external fixation stent fixation group, and 17 cases in the open reduction internal fixation group. There were no significant differences in age, gender, injury mechanism, Injury Severity Score (ISS), or other demographic factors among the three groups. The reduction of fractures with internal fixation was significantly better than that with external fixation(p = 0.032). Operative duration and quality of reduction did not significantly differ between the pedicle screw external fixation group and the traditional external fixation stent fixation group. However, the pedicle screw external fixation group exhibited distinct advantages in postoperative quality of life (p = 0.041) and a lower incidence of loose fixing screws compared to the traditional external fixation stent fixation group.ConclusionCompared to traditional external fixation stent fixation, pedicle screw external fixation represents a superior definitive treatment option for acetabular fractures due to its stability and improved patient quality of life.

Acute intestinal obstruction caused by gastrointestinal foreign bodies in children: a comparison of laparoscopically assisted approach and open surgery

ObjectiveThis study aims to explore the appropriate surgical treatment method for acute intestinal obstruction caused by gastrointestinal foreign bodies in children through a comparison of clinical characteristics in patients treated via laparoscopically assisted approach and open surgery.MethodsThis study retrospectively analyzed 12 children with acute intestinal obstruction caused by gastrointestinal foreign bodies treated at Shanghai Children’s Hospital and Huzhou Maternity and Child Care Hospital from June 2019 to June 2024. Basic information, treatment methods, and prognoses of the patients were collected. General data, operation time, postoperative fasting time, postoperative hospital stay, and intraoperative and postoperative complications were compared between the two groups. Categorical data were compared using Fisher’s exact test. Normally distributed continuous data were expressed as mean ± standard deviation and analyzed using an independent samples t-test; non-normally distributed data were expressed as M (P25, P75) and analyzed using the non-parametric Mann-Whitney U test.ResultsSix cases underwent laparoscopic transumbilical extended incision, successfully extracting the intestines and removing the foreign bodies without converting to open surgery. Compared to Six cases undergoing traditional open surgery during the same period, the postoperative fasting time and postoperative hospital stay in the laparoscopic group were 4 (5 ± 3.65) days and 5.5 (5 ± 7.5) days, respectively, while in the traditional open surgery group, they were 5 (4.25 ± 6) days and 6 (5 ± 8.6) days, respectively; the differences were statistically significant (P < 0.05). The laparoscopic group had significantly shorter operation time and faster postoperative recovery. The acceptance of the laparoscopically assisted approach by the families was significantly higher than that of the open surgery treatment.ConclusionThe method of extracting obstructed intestines and removing foreign bodies via laparoscopic-assisted transumbilical extended incision has advantages over open surgery for treating acute intestinal obstruction caused by gastrointestinal foreign bodies, such as shortening hospital stay and operation time. However, for children with secondary gastrointestinal perforation caused by magnetic foreign bodies, open surgery, due to its broader exploration scope, is more advantageous for detecting occult perforations.

Film Editing as a Tool for Emotional Regulation

Researchers have been writing about film and psychology for over a century, mostly referring to the perceptual processes while watching films rather than exploring the psychological implications that come with the act of filmmaking, especially the editing process. Investigating editing as an instrument for emotional regulation can not only bring helpful insights for editing professionals but also contribute to its implementation as a medium and an adjunct in psychotherapy and pedagogical settings. This project's concept is built on scientific research in FVBT (film/video-based therapy), with J. Lauren Johnson and Joshua L. Cohen representing contemporary scholars that employ the art of filmmaking in psychotherapy as a means of healing trauma. This paper investigates the potential of editing as a medium for emotional regulation through a case study conducted with four female participants aged 18 to 35. Over the course of five workshops, each lasting three hours, participants engaged in a structured program designed to explore the therapeutic benefits of film editing. Through open questionnaires and discussion groups, the self-perception and emotional awareness of the participants has been tracked and analyzed. Reoccurring themes were grouped into categories such as the differences in the editing. Emotional shifts can be noted throughout the workshop. After every editing session, the participants stated decreased frustration, sadness, and anxiety. Anger and disgust remained low, while the values for self-acceptance, self-understanding and self-awareness continued to be high.

Experiences of Psychologists and Sport Therapists Conducting Open and Closed Therapy Groups

Few studies compare differences between open and closed therapy groups. Different characteristics of both formats, which have been theoretically and practically substantiated to date, are presumably responsible for different therapeutically relevant effects. The present analysis documents and analyzes therapists' experiences with both open and closed group formats and provides information relevant to the selection of group format. To this end, psychologists and sport therapists in a department for behavioral orthopedic rehabilitation were asked in open, guided interviews about their experiences during a changeover from closed to open groups. Their responses were analyzed using qualitative content analysis. Characteristics of open and closed groups identified in the literature were largely confirmed, but differences not yet identified in the literature were also discovered. These relate to everyday therapeutic practice and therapist motivation. Additionally, similarities and differences between sport and psychotherapy groups are highlighted. In sum, closed groups are characterized by high group cohesion and deeper relationships in the course of therapy. Closed group sessions can build on each other and are structured. Open groups have a consistent level of energy and stronger dynamics over time and offer a wide range of contact opportunities. Different patient roles in group therapy must be kept in mind in both formats. Both group forms have characteristics that can be used for different therapeutic goals and indications and are therefore justified in a therapeutic context. These empirical findings suggest that therapists can strategically choose a specific group form for the support of specific types of patients or for reaching specific therapy goals.

Unpredictable Aortic Behavior in Identifying Risk Factors for Reintervention: A Prospective Cohort Study.

Although advancements in the management of thoracic aortic disease have led to a reduction in acute mortality, individuals requiring postoperative reintervention experience substantially worse long-term clinical outcomes and increased mortality. We aimed to identify the risk factors for postoperative reintervention in this high-risk population. This prospective observational cohort study included patients who survived endovascular or open surgical treatment for thoracic aortic disease between January 2009 and June 2020. We excluded those with inflammatory or traumatic thoracic aortic diseases. The risk factors were identified using multivariate logistic regression and Cox proportional hazards regression models. The study included 95 genetically tested patients aged 54.13 ± 12.13 years, comprising 67 men (70.53%) and 28 women (29.47%). Primary open surgery was performed in 74.7% and endovascular repair in 25.3% of the patients. Of these, 35.8% required one or more reinterventions at the time of follow-up (3 ± 2.5 years, mean ± standard deviation). The reintervention rate was higher in the endovascular repair group than in the open repair group. Among the potential risk factors, only residual aortic dissection emerged as an independent predictor of reintervention (odds ratio: 3.29, 95% confidence interval: 1.25-8.64). Reintervention after primary thoracic aortic repair remains a significant clinical issue, even in high-volume tertiary centers. Close follow-up and personalized care at aortic centers are imperative. In our cohort of patients with thoracic aortic disease undergoing open or endovascular surgery, postoperative residual dissection was independently associated with the necessity of reintervention, emphasizing the importance of intensified clinical monitoring in these patients.

Governance in Samarinda city using TOGAF (The open group architecture framework): Literature review

The governance in Samarinda City has faced various challenges related to efficiency, transparency, and citizen engagement. To address these issues, this study proposes the application of The Open Group Architecture Framework (TOGAF) for enhancing administrative and operational processes. TOGAF provides a structured approach to enterprise architecture, ensuring alignment between IT and business objectives, which is crucial for public sector entities aiming to improve service delivery and operational efficiency. This literature review explores the existing governance practices in Samarinda City, identifies key areas for improvement, and demonstrates how TOGAF can be effectively implemented to address these challenges. By integrating TOGAF principles, the study aims to create a comprehensive framework that can streamline processes, enhance data management, and foster better communication between government departments and the public. The review highlights successful case studies of TOGAF implementation in similar contexts, offering valuable insights and practical recommendations for Samarinda City. Through this approach, the study seeks to contribute to the body of knowledge on public sector governance and provide a viable roadmap for the effective adoption of TOGAF in local government settings.

Effectiveness of robot-assisted minimally invasive and open freehand transforaminal lumbar interbody fusion in treatment of single-level degenerative lumbar spondylolisthesis and the influence on adjacent segment degeneration

To compare the effectiveness of robot-assisted minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF) and open freehand TLIF for the treatment of single-level degenerative lumbar spondylolisthesis (DSL) and analyse the influence on postoperative adjacent segmental degeneration (ASD). The clinical data of 116 patients with L 4、5 DLS who were admitted between November 2019 and October 2021 and met the selection criteria were retrospectively analyzed. According to the surgical methods, they were divided into the robotic group (45 cases, who underwent robot-assisted MIS-TLIF) and the open group (71 cases, who underwent open freehand TLIF). There was no significant difference in baseline data such as gender, age, body mass index, DLS Meyerding grading, and preoperative Pfirrmann grading, Weishaupt grading, L 3, 4 intervertebral disc height (DH), L 3, 4 intervertebral mobility, sagittal parameters [including pelvic incidence (PI), lumbar lordosis (LL), sacral slope (SS), pelvic tilt (PT)], and Cage height ( P>0.05). The grade of facet joint violation (FJV) by pedicle screws on the superior articular process was assessed postoperatively. Sagittal parameters, L 3, 4 DH, L 3, 4 DH loss, and L 3, 4 intervertebral mobility were measured preoperatively and at last follow-up in order to determine whether ASD occurred. Based on the occurrence of postoperative ASD, logistic regression analysis was used to identify the risk factors for ASD after TLIF. Patients in both groups were followed up 21-47 months, with a mean of 36.1 months; there was no significant difference in the follow-up time between the two groups ( P>0.05). The occurrence of postoperative FJV was significantly better in the robotic group than in the open group ( P<0.05). At last follow-up, the difference in the change values of sagittal parameters PI, PT, SS, and LL was not significant when comparing the two groups of patients ( P>0.05); the change values of L 3, 4 DH and L 3, 4 DH loss in the robotic group were smaller than those in the open group, and the change value of L 3, 4 intervertebral mobility was larger than that in the open group, and the differences were significant ( P<0.05). At last follow-up, ASD occurred in 8 patients (17.8%) in the robotic group and 35 patients (49.3%) in the open group, and the difference in ASD incidence between the two groups was significant ( P<0.05). logistic regression analysis showed that open surgery, preoperative Pfirrmann grading Ⅳ-Ⅴ, preoperative Weishaupt grading ≥2, and postoperative FJV grading ≥1 were risk factors for the development of ASD after TLIF ( P<0.05). Compared with traditional open surgery, orthopedic robot-assisted MIS-TLIF in the treatment of single-level DLS can more accurately insert pedicle screws, reduce the loss of DH and the occurrence of FJV, and effectively reduce the incidence of mid-postoperative ASD. Preoperative disc and synovial joint degeneration in adjacent segments, nonrobotic-assisted minimally invasive therapy, and FJV are risk factors for ASD after TLIF.

Effectiveness of modified temporomandibular joint disc reduction and suture with tragus incision assisted by arthroscopy

To investigate the effectiveness of modified temporomandibular joint disc reduction and suture with tragus incision assisted by arthroscopy for temporomandibular joint anterior disc displacement (ADD). A clinical data of 30 patients (45 sides) with temporomandibular joint ADD, who met selective criteria and were admitted between September 2022 and February 2024, was retrospectively analyzed. Among them, 15 patients (23 sides) were treated with temporomandibular joint disc reduction and suture via small incision (open operation group), and 15 patients (22 sides) with modified temporomandibular joint disc reduction and suture with tragus incision assisted by arthroscopy (arthroscopy group). There was no significant difference in gender, age, disease duration, affected side, Wilkes-Bronstein stage, preoperative visual analogue scale (VAS) score, maximal interincisal opening (MIO), and temporomandibular joint dysfunction index (DI), craniomandibular index (CMI), palpation index (PI), and other baseline data between groups ( P>0.05). VAS score, MIO, and temporomandibular joint function indicators (PI, DI, CMI) of patients were recorded at 3 months after operation, and the difference (change value) of the above indicators between pre- and post-operation was calculated. At 1 week after operation, MRI was performed to evaluate the reduction of the articular disc compared to the preoperative image. The results were classified as excellent, good, and poor, with excellent and good being considered effective reduction. The condition of condyle process repair was observed by cone beam CT (CBCT) at 3 months after operation. All incisions healed by first intention in the two groups. All patients were followed up 3-18 months (mean, 8.2 months). Facial nerve injury occurred in 3 cases in the open operation group and 1 case in the arthroscopy group, all of which returned to normal after physiotherapy and drug treatment. At 3 months after operation, MIO and VAS scores of both groups significantly improved when compared with those before operation ( P<0.05), and temporomandibular joint function indicators (PI, DI, CMI) significantly decreased ( P<0.05). The change values of MIO and temporomandibular joint function indicators in arthroscopy group were significantly higher than those in open operation group ( P<0.05). There was no significant difference in the change value of VAS score between groups ( P>0.05). There was no recurrence during follow-up. Postoperative MRI review showed that the effective reduction rate of joint disc was 95.65% (22/23) in the open operation group and 95.45% (21/22) in the arthroscopy group, with no significant difference between groups ( P>0.05). Postoperative CBCT found that early and timely effective reduction of joint disc was conducive to condyle process repair and reconstruction. Modified temporomandibular joint disc reduction and suture with tragus incision assisted by arthroscopy has a clear effect in the treatment of ADD, with less trauma, fewer postoperative complications, and good early effectiveness.

Effectiveness of unilateral biportal endoscopy technique combined with percutaneous pedicle screw fixation in treatment of lumbar burst fractures

To compare the effectiveness of unilateral biportal endoscopy (UBE) technique assisted spinal canal decompression combined with percutaneous pedicle screw internal fixation versus traditional open decompression and internal fixation for treatment of lumbar burst fractures. A retrospective study was conducted on the clinical data of 61 patients with single-segment lumbar burst fractures who met the selection criteria and were admitted between October 2022 and December 2023. Of them, 25 patients received UBE technique assisted decompression combined with percutaneous pedicle screw fixation (UBE group), while 36 patients were treated with traditional posterior unilateral hemilaminectomy decompression and internal fixation (open group). There was no significant difference in baseline data between the two groups ( P>0.05), including gender, age, body mass index, fracture segment, cause of injury, AO classification of lumbar fractures, and preoperative height ratio of the anterior margin of injured vertebra, segmental kyphosis angle, rate of spinal canal invasion, the classification of American Spinal Injury Association (ASIA) grading, visual analogue scale (VAS) score, and Oswestry disability index (ODI). The operation time, intraoperative blood loss, and postoperative complications were recorded and compared between the two groups. VAS score, ODI, and ASIA grading were used to evaluate the effectiveness before operation, at 1 week after operation, and at last follow-up. Lumbar anteroposterior and lateral X-ray films and CT were performed to measure the segmental kyphosis angle, height ratio of the anterior margin of injured vertebra, and the rate of spinal canal invasion. Surgery was successfully completed in both groups. No complication such as dural sac, nerve root, or vascular injury was found during operation, and all incisions healed by first intention. There was no significant difference in operation time between the two groups ( P>0.05), the UBE group revealed significant less intraoperative blood loss when compared with open group ( P<0.05). Patients in both groups were followed up 6-20 months, with an average of 13 months. There was no loosening, breakage, or failure of internal fixation in all patients. The ASIA grading, VAS score, ODI of the two groups significantly improved at 1 week after operation and further improved at last follow-up ( P<0.05). There was no significant difference in ASIA grading at 1 week after operation and last follow-up between the two groups ( P>0.05), but the VAS score and ODI in the UBE group were significantly superior to the open group ( P<0.05). At 1 week after operation, the height ratio of the anterior margin of injured vertebra, segmental kyphosis angle, rate of spinal canal invasion significantly improved when compared to preoperative ones ( P<0.05), the height ratio of the anterior margin of injured vertebra and segmental kyphosis angle significantly decreased at last follow-up when compared to the values at 1 week after operation ( P<0.05), but the rate of spinal canal invasion was further significantly improved, and there was no significant difference between the two groups at different time point postoperatively. UBE technique assisted spinal canal decompression combined with percutaneous pedicle screw fixation is a safe and effective treatment for lumbar burst fractures, which with little trauma and faster recovery when compared with traditional open decompression and internal fixation.

The neurologically intact patient with TLICS 4 or 5 burst fracture should be given a trial of nonoperative management.

Thoracolumbar burst fracture treatment in neurologically intact patients is controversial with many classification systems to help guide management. Thoracolumbar Injury Classification and Severity score (TLICS) provides a framework, but evidence is limited, and recommendations are primarily based on expert opinion. In this retrospective cohort study, data was reviewed for patients with thoracolumbar burst fractures at a Level-1 Trauma Center in New England from 2013 to 2018. Neurologically intact patients without subluxation/dislocation on supine computed tomography were included. Multimodal pain control and early mobilization were encouraged. Patients that failed to mobilize due to pain were treated with operative stabilization. Outcome measures include degree of kyphosis, visual analog scale pain scores, and neurological function. Thirty-one patients with thoracolumbar burst fractures with TLICS scores of 4 or 5 were identified, of which 21 were treated nonoperatively. Kyphosis at final follow-up was 26.4 degrees for the nonoperative cohort versus 13.5 degrees for the operative group (P < .001). Nonoperative patients tended towards shorter hospital lengths-of-stay (3.0 vs 7.1 days, P = .085) and lower final pain scores (2.0 vs 4.0, P = .147) compared to the operative group. Two patients (6%) developed radicular pain with mobilization, which resolved after surgical intervention. No patients experienced decline in neurologic function. A trial of mobilization for neurologically intact TLICS grade 4 and 5 thoracolumbar burst fractures is a safe and reasonable treatment option that resulted in successful nonoperative management of 21 out of 31 (68%) patients.

Experiences and outcomes of patients participating in a perioperative shared decision-making pathway.

The Complex Decision Pathway (CDP) is a novel perioperative shared decision-making pathway that was established in the Bay of Plenty, New Zealand in 2018. Unique features of the pathway include the use of a structured communication tool to facilitate a goals-of-care conversation in addition to medical assessment, and the use of a tikanga Māori framework for Māori patients. From May 2019 until May 2022, 81 patients attending the CDP clinic were recruited to a prospective study of their demographics, health status and experience at the time of presentation, along with outcomes and opinions over the subsequent 12 months. Participants were mostly elderly and frail with multiple comorbidities, and just over half of participants chose to undergo surgery. Participants who chose, or were recommended, not to undergo surgery were older, more comorbid and had worse outcomes over the subsequent 12 months. Qualitative data suggested an overall positive patient experience of the pathway, and an economic analysis demonstrated its cost-effectiveness. Overall, the data presented here suggested that the CDP assisted in risk-stratifying patients into operative and non-operative groups, provided a positive patient experience, and was a cost-effective intervention.