Posterior Bone Graft Research Articles

Posterior Glenoid Bone Grafting in the Setting of Excessive Glenoid Retroversion Does Not Provide Adequate Stability in a Cadaveric Posterior Instability Model

Background: Excessive glenoid retroversion is a known risk factor for posterior shoulder instability and failure after soft tissue stabilization procedures. Whether excessive glenoid retroversion is a risk factor for failure after posterior glenoid bone grafting is unknown. Purpose: To evaluate the biomechanical effectiveness of posterior iliac crest bone grafting (ICBG) for posterior shoulder instability with increasing glenoid retroversion. Study Design: Controlled laboratory study. Methods: Six fresh-frozen cadaveric shoulders had a posterior glenoid osteotomy allowing the glenoid retroversion to be set at 0°, 10°, and 20°. At these 3 preset angles, 4 conditions were simulated consecutively on the same specimen: (1) intact glenohumeral joint, (2) posterior Bankart lesion, (3) 20% posterior glenoid bone defect, and (4) posterior ICBG. Stability was evaluated in the jerk position (60° of glenohumeral anteflexion, 60° of internal rotation) by measuring (A) posterior humeral head (HH) translation (in mm) and (B) peak translational force (in N) necessary for translation of the HH over 25% of glenoid width. Results: At 0° of retroversion, the ICBG restored posterior HH translation and peak translational force to values comparable with those of the intact condition (P = .649 and P = .979, respectively). At 10° of retroversion, the ICBG restored the peak translational force to a value comparable with that of the intact condition (22.3 vs 24.7 N, respectively; P = .418) but showed a significant difference in posterior HH translation in comparison to the intact condition (4.5 vs 2.0 mm, respectively; P = .026). There was a significant increase in posterior HH translation and significant decrease in peak translational force with the ICBG at 20° of glenoid retroversion compared with the intact condition (posterior HH translation: 7.9 vs 2.0 mm, respectively; P < .006; peak translational force: 15.3 vs 24.7 N, respectively; P = .014). Conclusion: In this cadaveric study, posterior ICBG was able to restore stability to a level comparable to that of the native condition at 0° and to some extent at 10° of retroversion. However, posterior ICBG was not able to provide adequate stability at 20° of glenoid retroversion. Clinical Relevance: Posterior glenoid bone grafting with ICBG should be used with caution when performed in isolation in the setting of posterior instability associated with glenoid bone loss and combined glenoid retroversion of >10°.

A Novel Technique for Repairing Alveolar Clefts: Computer-Assisted Design With Posterior of Mandible Block Bone Grafts

Objective: Iliac cancellous bone graft is the gold standard for the treatment of alveolar clefts. However, the resorption rate of iliac cancellous bone is generally high. In this study, the authors propose a new method for repairing alveolar clefts using block bone grafts in the posterior region of the mandibular molar and the anterior margin of the ascending branch. Methods: Ten patients with a diagnosis of unilateral or bilateral alveolar cleft were collected. Block bone grafting between the posterior mandibular molar region and the inner and outer oblique lines of the anterior margin of the ascending branch was used to treat the alveolar synostosis. Preoperative, 1-week postoperative, and 6-month postoperative multislice spiral computed tomography scans of the patients were collected and analyzed for preoperative design and postoperative graft bone morphology using computer-assisted software tools, which were also required to measure the changes in the bone tissue density in the posterior mandibular bone extraction area. Results: At 6 months postoperatively, the mean bone resorption rate of the posterior mandibular bone grafts for cleft alveolar processes was 33.96% ± 11.23%. Bone tissue density in the posterior mandibular bone grafting area recovered to near preoperative levels at 6 months postoperatively. Conclusion: The novel method of bone grafting for the cleft alveolar process used in this paper is really effective. Postoperative posterior mandibular bone extraction did not cause sequelae such as mandibular bone defects or poor morphology in the patients. Computer-assisted design and three-dimensional printing technology helped to improve intraoperative bone grafting accuracy and postoperative assessment.

Effect of intervertebral bone graft area on the effect of single-level posterior lumbar decompression and bone graft fusion

To study the effect of intervertebral grafting area on the effect of single segment lumbar posterior decompression and intervertebral bone grafting fusion. The clinical data of 52 patients who underwent single-segment lumbar posterior decompression pedicle internal fixation and bone grafting fusion from January 2020 to December 2022 were retrospective reviewed. The area of the intervertebral bone graft was measured one week postoperatively using Computed Tomography (CT), and based on the ratio of the bone graft area to the average area of the endplates, the patients were divided into three groups:17 cases in group A(the intervertebral bone graft area did not exceed the area of one pedicle) included 9 males and 8 females with an average age of (56.0±11.5) years old;15 cases in group B(the intervertebral bone graft area exceeded one pedicle but did not reach the opposite pedicle) included 10 males and 5 females with an average of (52.0±14.0) years old; 20 cases in group C (the intervertebral bone graft area exceeded the opposite pedicle) included 12 males and 8 females with an average of (49.5±12.8) years old. X-rays and CT scans were performed at 3, 6, 12 months, and the final follow-up postoperatively, the interbody fusion Brantigan scores, pain visual analogue scale (VAS), and Oswestry Disability Index (ODI) at each follow-up were recorded. The gender, age, and surgical segments showed no significant differences among three groups(P>0.05). There was also no significant difference in the preoperative VAS and ODI among three groups (P>0.05). All patients of three groups were followed up from 12 to 36 months. Compared with preoperative, VAS and ODI scores of three groups showed significant improvement at 1 week postoperatively and the final follow-up (P<0.05). Compared with preoperative measurements, the height of the intervertebral space was restored at 1 week postoperatively in three groups;at the final follow-up, the loss of height in the intervertebral space was less in groups B and C, and the height of the intervertebral space in group B and C was significantly higher than in group A(P<0.05). The modified Brantigan scores at 3 and 6 months postoperatively were significantly higher in group C than in groups A and B (P<0.05);at 12 months postoperatively, the scores in groups B and C were significantly higher than in group A(P<0.05);however, at the final follow-up, there was no significant difference in the modified Brantigan scores among three groups(P>0.05). The bone graft fusion rate in group C was significantly higher than in groups A and B at 3 months postoperatively(P<0.05);at 6 and 12 months postoperatively, the fusion rates in groups B and C were significantly higher than in group A(P<0.05);at the final follow-up, the fusion rate in group A was still lower than in groups B and C, but the difference among three groups was not significant(P>0.05). Single segment posterior lumbar decompression and interbody fusion surgery can significantly improve the clinical symptoms of patients with lumbar degenerative related diseases. However, as the proportion of bone grafting area increases, the early bone grafting fusion rate and fusion score of patients are significantly improved.

Clinical Implementation of Tissue-Sparing Posterior Cervical Fusion: Addressing Market Access Challenges.

Background: The traditional open midline posterior cervical spine fusion procedure has several shortcomings. It can cause soft tissue damage, muscle atrophy, compromise of the lateral masses and painful prominent posterior cervical instrumentation or spinous process if there is dehiscence of the fascia. Additionally, patients frequently experience the rapid development of adjacent segment disease, which can result in the reemergence of debilitating pain and functional impairment. Clinical relevance: Tissue-sparing posterior cervical fusion is an alternative method for treating patients with symptomatic cervical degenerative disc disease. However, widespread clinical adoption has been challenged by ambiguity, misunderstandings and misinterpretations regarding appropriate procedural reimbursement coding. Technological advancement: The tissue-sparing posterior cervical fusion procedure was approved by the US Food and Drug Administration (FDA) in 2018 (CORUS™ Spinal System and CAVUX® Facet Fixation System (CORUS/CAVUX); Providence™ Medical Technology). This technique addresses the concerns with traditional spine fusion methods by achieving the stability and outcomes of posterior cervical fusion without the morbidity associated with significant muscle stripping in the traditional approach. This technology uses specialized implants and instrumentation to perform all of the steps required to facilitate bone fusion and provide stability while minimizing tissue disruption. The technique involves extensive bone preparation for fusion and placement of specialized stabilization implants that span the facet joint, promoting natural bone growth and fusion while reducing the need for extensive exposure. This procedure provides an effective, less invasive solution for patients with cervical degenerative disc disease. Reimbursement and coding clarity: The article provides a comprehensive rationale for appropriate reimbursement coding for tissue-sparing posterior cervical fusion. This is a critical aspect for the adoption and accessibility of medical technologies. This information is crucial for practitioners and healthcare administrators, ensuring that innovative procedures are accurately coded and reimbursed. Procedural details and clinical evidence: By detailing the procedural steps, instruments used and the physiological basis for the procedure, this article serves as a valuable educational resource for spine surgeons and payers to appropriately code for this procedure. Conclusions: The description of work for CORUS/CAVUX is equivalent to the current surgical standard of lateral mass screw fixation with decortication and onlay posterior grafting to facilitate posterior fusion. Thus, it is recommended that CPT codes 22600/22840 be used, as they best reflect the surgical approach, instrumentation, decortication, posterior cervical fusion and bone grafting procedures.

Structural bone grafting for glenoid bone loss in primary anatomic total shoulder arthroplasty: a case series and technique report

IntroductionPosterior glenoid bone loss in glenohumeral osteoarthritis poses significant challenges in shoulder arthroplasty. Anatomic total shoulder arthroplasty with a humeral head autograft to address the glenoid bone deficiency is an option for these difficult cases. Variable results with this procedure are reported in the literature. This article describes the surgical technique of posterior glenoid bone grafting in TSA using a glenoid implant with hybrid fixation, and a series of reported patient functional and radiographic outcomes. Materials and MethodsA retrospective chart review of cases from 2015 to 2020 by a single surgeon revealed 10 patients who underwent primary TSA with hybrid glenoid component and posterior glenoid bone grafting. Preoperative and postoperative radiographs were assessed for glenoid inclination, glenoid version, acromiohumeral distance, humeral stem status, and glenoid implant status. Functional outcomes were evaluated by range of motion, strength, and patient-reported clinical outcomes (pain and function on a visual analog scale, disabilities of the arm, shoulder, and hand score, single assessment numeric evaluation, American Shoulder and Elbow Surgeons score). Complications and reoperations were also evaluated. ResultsAverage follow-up was 31.4 months, active forward flexion and external rotation improved on average from 105o to 150o and 20o to 60o, respectively (P<0.001) and average abduction improved from 100o to 140o (P<0.002). At an average of 26.7 months, patients reported assessments (VAS pain and function, QuickDASH, SANE, ASES scores) reveal significant (P<0.05) improvement in pain and functional outcomes. Radiographically, at 23.0 ± 20.1 months, all patients demonstrated a well fixed humeral and glenoid component without evidence of lucent lines. The bone graft used in each patient was well unionized and no radiographic complications were reported. No patients underwent revision surgery, and there was one clinical complication reported, which consisted of a suspected rotator cuff injury at follow-up. ConclusionHybrid fixation with structural glenoid bone grafting in TSA resulted in excellent outcomes with no evidence of graft or component failure on follow-up radiographs and significantly reduced pain, improved functional scores, and improved active ROM.

One-stage posterior transpedicular debridement, hemi-interbody and unilateral-posterior bone grafting, and instrumentation for the treatment of thoracic spinal tuberculosis: a retrospective study.

To investigate the clinical efficacy and feasibility of the surgical treatment of thoracic spinal tuberculosis using one-stage posterior instrumentation, transpedicular debridement, and hemi-interbody and unilateral posterior bone grafting. Fifty-six patients with thoracic spinal tuberculosis who underwent surgery performed by a single surgeon between September 2009 and August 2020 were enrolled in this study. Based on data from the erythrocyte sedimentation rate (ESR), Visual Analog Scale (VAS), and Cobb angle before surgery, after surgery, and at the most recent follow-up, clinical effectiveness was assessed using statistical analysis. The variables investigated included operating time, blood loss, complications, neurological function, and hemi-interbody fusion. None of the patients experienced significant surgery-associated complications. At the last follow-up, 23 of the 25 patients (92%) with neurological impairment showed improvement. The thoracic kyphotic angle was significantly decreased from 24.1 ± 9.9° to 13.4 ± 8.6° after operation (P < 0.05), and the angle was 14.44 ± 8.8° at final follow-up (P < 0.05). The Visual Analog Scale significantly decreased from 6.7 ± 1.4 preoperatively to 2.3 ± 0.8 postoperatively (P < 0.05) and finally to 1.2 ± 0.7 at the last follow-up (P < 0.05). Bone fusion was confirmed in 56 patients at 3-6 months postoperatively. One-stage posterior transpedicular debridement, hemi-interbody and unilateral posterior bone grafting, and instrumentation are effective and feasible treatment methods for thoracic spinal tuberculosis.

Retrospective Analysis of the Efficacy and Safety of Endoscopic Spinal Tuberculosis Focus Removal versus Posterior Pedicle Lesion Removal, Bone Grafting, and Internal Fixation Combined with Drug Chemotherapy for Thoracolumbar Tuberculosis.

This study aims to investigate the clinical efficacy of endoscopic spinal tuberculosis focus removal, posterior pedicle lesion removal, bone grafting, and internal fixation combined with drug chemotherapy in treating thoracolumbar tuberculosis. It also seeks to summarize strategies for preventing complications and provide a reference for clinical treatment. We retrospectively analyzed 105 patients with spinal tuberculosis treated in our hospital from January 2018 to December 2022. Patients were divided into two groups: Group A (n=38), who underwent endoscopic spinal tuberculosis focus removal, and Group B (n=67), who underwent posterior pedicle lesion removal, bone grafting, and internal fixation. All patients received preoperative quadruple anti-tuberculosis drug chemotherapy (Isoniazid, Rifampicin, Pyrazinamide, Ethambutol) for 2-4 weeks. We recorded and compared parameters such as operation time, intraoperative blood loss, postoperative drainage, recovery time, hospital stay, blood transfusion, and complications. We also compared pre- and postoperative lumbar VAS, ODI, erythrocyte sedimentation rate, C-reactive protein, Procalcitonin, D-Dimer, Neutrophil to Lymphocyte ratio, hemoglobin, total protein, and Cobb angle to evaluate kyphotic deformity and correction. Preoperative data including age, sex, body mass index, segment involvement, past medical history, smoking history, preoperative erythrocyte sedimentation rate, C-reactive protein, Procalcitonin, D-Dimer, Neutrophil to Lymphocyte ratio, hemoglobin, total protein, lumbar VAS score, lumbar ODI score, and spinal Cobb's angle showed no significant difference between the groups (P>0.05). Main postoperative indicators revealed that Group A had significantly lower lumbar VAS scores, higher hemoglobin and total protein levels, and a lower recurrence rate than Group B at the last follow-up (P<0.05). Secondary postoperative indicators showed that Group A required significantly less blood transfusion, had shorter operative time, less intraoperative blood loss, shorter postoperative hospitalization time, and lower Cobb Angle than Group B (P<0.05). Endoscopic spinal tuberculosis focus removal can achieve comparable safety to posterior pedicle lesion removal, bone grafting, and internal fixation, with shorter operation time, less intraoperative bleeding, lower postoperative recurrence rate, and less postoperative drainage. This method can effectively improve blood sedimentation, lumbar function, restore Cobb angle, and reduce pain, making it worthy of promotion and application.

Posterior fixation, anterior debridement and bone grafting in the treatment of thoracic and lumbar tuberculosis in children younger than 3years of age.

This study aimed to investigate the clinical outcomes of posterior fixation, combined with one- or two-stage anterior debridement and bone grafting in treating children younger than 3years of age with thoracic and lumbar tuberculosis. This was a retrospective study involving 16 young children with thoracic or lumbar tuberculosis. Surgical data were recorded. Frankel Grade was used to assess neurological function. The regional kyphosis angle was measured to evaluate the deformity correction. Erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) levels were detected to assess the activity of tuberculosis. Bony fusion and complications were also recorded. The mean operation time was 204.4 ± 41.8min. The mean estimated blood loss was 126.3 ± 94.4ml. Preoperative Frankel Grade results indicated five patients with Grade C, six with Grade D, and five with Grade E. At the final follow-up, all patients were in Grade E. Twelve patients were brought back to normal spinal alignment and the rest four patients remained kyphotic. There was an improvement of 29.3° ± 18.3° in regional kyphotic angle postoperatively. And the deformity correction was 27.4° ± 19.1° at the final follow-up. ESR and CRP decreased to a normal range at three months follow-up. Bony fusion was achieved in all patients. None of the cases developed fixation failure, pseudoarthrosis, or tuberculosis recurrence. Posterior fixation, combined with one- or two-stage anterior debridement and bone grafting, is a safe and effective surgical strategy for treating young children with thoracic and lumbar tuberculosis.

Retrospective Analysis of the Efficacy and Safety of Endoscopic Spinal Tuberculosis and Brucellosis Lesion Removal and Posterior Pedicle Lesion Removal, Bone Grafting, Internal Fixation and Surgery Combined with Medical Chemotherapy in the Treatment of Spinal Tuberculosis and Brucellosis.

To evaluate the clinical effectiveness of endoscopic removal of spinal infections and posterior pedicle surgery, including bone grafting, fixation, and chemotherapy, and to outline preventive strategies for complications, offering guidance for clinical practice. 128 spinal infectious disease patients (2018-2022) were categorized into Group A (endoscopic removal, n=44) and Group B (posterior pedicle removal+bone grafting+fixation, n=84). Pre-surgery, all received quadruple antibiotic therapy. Metrics tracked: operation time, blood loss, drainage, recovery, stay, transfusion, complications, and pre/post-surgery VAS, ODI, ESR, CRP, PCT, D-dimer, NLR, Hb, albumin. (1) Preoperative data: There were no statistically significant differences in age, gender, body mass index, involved segments, past medical history (cardiovascular and cerebrovascular diseases, respiratory diseases, endocrine system diseases, metabolic diseases and tuberculosis), smoking history, preoperative erythrocyte sedimentation rate, C-reactive protein, procalcitonin, D-dimer, lymphocyte and neutrophil-lymphocyte ratio, hemoglobin, total protein, waist VAS score and waist ODI score (P>0.05). (2) The main postoperative indexes were significantly lower than those of group B at the last follow-up at 3 months and the last follow-up in group A, and the difference was significant (P<0.05), the hemoglobin and total protein in group A were significantly higher than those in group B at the last postoperative follow-up (P<0.05), and the recurrence rate in group B was significantly higher than that in group A, and the difference was significant (P=0.048). (3) Postoperative secondary indicators: the amount of blood transfusion in group A was significantly lower than that in group B, and the difference between the two groups was statistically significant (P<0.05), while the operation time, intraoperative blood loss and postoperative hospital stay in group A were significantly smaller than those in group B, and the difference between the two groups was statistically significant (P<0.05). Endoscopic lesion removal for spinal infections achieves similar safety to posterior pedicle surgery, with shorter operation time, less blood loss, lower recurrence, and reduced drainage. It enhances ESR, spine function, and pain relief, meriting promotion.

Posterior Column Reconstruction of the Lumbar Spine Using En Bloc Resected Vertebral Arch in Spinal Tumor and Deformity Surgeries.

In high-grade spinal osteotomy involving large anterior column resection, restoration of the structural integrity of the posterior column at the osteotomy site can reduce postoperative instrumentation failure (IF). This study aimed to describe our technique of posterior strut bone grafting using an en bloc resected vertebral arch, which is useful for posterior column reconstruction after high-grade osteotomies during surgeries for spinal tumor and deformity in the lower lumbar spine. Using a posterior approach, en bloc resection of the targeted vertebral arch was performed in accordance with the surgical technique for total en bloc spondylectomy (TES). The posterior elements in the upper and lower adjacent vertebrae were separated by a significant space after vertebral body resection followed by cage insertion in TES or anterior column osteotomy followed by correction in deformity surgery. To create a new posterior column, the en bloc resected vertebral arch was placed at 90° rotation to bridge the upper and lower vertebral arches. Using this technique, an abundant amount of bone chips made from the resected vertebral elements were placed over the en bloc resected posterior arch as an additional bone graft. The technique was used in three patients who underwent TES for spinal tumors and in one patient who underwent grade 4 osteotomy for adult spinal deformity in the lower lumbar spine. One year after surgery, computed tomography showed that the structural integrity of bony fusion was successfully achieved between the en bloc resected arch and the posterior elements of the adjacent vertebrae in all patients and showed no postoperative IFs. This bone graft technique created new continuity of the posterior column after high-grade osteotomies in the lower lumbar spine. Bone fusion was achieved in the posterior elements to prevent IF after surgery.

Efficacy of posterior fixation and bone graft fusion for treatment of lumbar brucellosis spondylitis.

The purpose of this study is to verify whether early stage patients with single-segment lumbar Brucella spondylitis can still be cured through simple posterior fixation and bone grafting, even without debridement. A retrospective study was conducted on 63 patients diagnosed with single-segment lumbar brucellosis spondylitis, who underwent posterior-only debridement (or not), bone grafting, and instrumentation from June 2016 to June 2019. Group A comprised 34 patients who did not undergo debridement, while group B comprised 29 patients who underwent debridement. The clinical data and imaging results of the patients were compared between the 2 groups to evaluate the clinical effects of debridement or not. Both groups of patients completed at least 1 year of follow-up. The group A had significantly lower values for operation time, blood loss, and hospital stay compared to the group B (P < .05). There were no significant differences between the 2 groups in terms of erythrocyte sedimentation rate, C-reactive protein, visual analogue scores, improvement of Japanese Orthopaedic Association Evaluation of treatment score, and Cobb angle. The bone fusion rate was 92% (31 patients) in group A and 96% (28 patients) in group B, with no significant difference between the 2 groups (P > .05). In summary, these findings suggest that posterior fixation and bone graft fusion are effective treatments for single-segment lumbar brucellosis spondylitis in early stages even without debridement. Importantly, these procedures offer several benefits, such as minimal trauma, short operation times, rapid postoperative recovery, and favorable bone graft fusion outcomes.

Three-dimensional printed titanium mesh combined with iliac cancellous bone in the reconstruction of mandibular defects secondary to ameloblastoma resection

BackgroundThe reconstruction of large mandibular defects is a challenge, and free vascularized bone flaps are most commonly used. However, the precision and symmetry of this repair are deficient, and patients have a risk of vascular embolism, flap necrosis, and donor site complications. Therefore, to explore an ideal alternative in mandibular reconstruction with high surgical accuracy and low complications is indispensable.MethodsSeven patients with recurrent or large-scope ameloblastoma were enrolled in this study. All patients were provided with a fully digital treatment plan, including the design of osteotomy lines, surgical guides, and three-dimensional printed titanium mesh for implantation. With the assistance of surgical guide, ameloblastomas were resected, and custom 3D printed titanium mesh combined with posterior iliac bone harvest was used in mandibular reconstruction. A comparison was made between the discrepant surgical outcomes and the intended surgical plan, as well as the average three-dimensional deviation of the mandible before and after the surgery. At the same time, the resorption rate of the implanted bone was evaluated.ResultsAll patients completed the fully digital treatment process successfully without severe complications. Image fusion showed that the postoperative contour of the mandible was basically consistent with surgical planning, except for a slight increase in the inferior border of the affected side. The mean three-dimensional deviation of the mandible between the preoperative and postoperative periods was 0.78 ± 0.41 mm. The mean error between the intraoperative bone volume and the digital planning bone volume was 2.44%±2.10%. Furthermore, the bone resorption rates of the harvested graft 6 months later were 32.15%±6.95%.ConclusionsThe use of digital surgical planning and 3D-printed templates can assist surgeons in performing surgery precisely, and the 3D-printed titanium mesh implant can improve the patient’s facial symmetry. 3D printed titanium mesh combined with posterior iliac cancellous bone graft can be regarded as an ideal alternative in extensive mandibular reconstruction.

Enhancing surgical outcomes of posterior iliac bone harvesting through a pivotal modification

Traditionally, patients are positioned in the prone position to access the donor site during the posterior iliac bone graft harvesting procedure. However, this well-established method is associated with complications such as pressure injuries, displacement of the endotracheal tube and intravenous catheter, and blindness. Moreover, the process of turning patients 180° between the supine and prone positions is both laborious and time consuming. However, no updates have been made in the approaches published in the literature to counteract these problems. Therefore, to overcome these challenges and improve patient outcomes, we proposed a pivotal modification: change prone position to the lateral decubitus position. This approach allowed us to effectively avoid the aforementioned complications. In addition, this modification offered significant advantages, including ease of implementation and timesaving benefits. The article presented results of the modification and a comprehensive evaluation of clinical and anesthetic considerations comparing the two methods.

The best position of bone grafts in the medial open-wedge high tibial osteotomy: A finite element analysis

Background and objectiveThe application of wedge-shaped bone grafts can increase the biomechanical stability of knee during the medial open-wedge high tibial osteotomy (MOWHTO) by reducing the von Mises stress of the medial plate and lateral cortical hinge area. However, the optimal position of bone grafts it remains unclear, so we aimed to determine search for the optimal position of the bone grafts in MOWHTO by using finite element analysis. MethodsIn the finite element analysis, MOWHTO models were established with three different osteotomy distraction heights and assembled into four groups according to different conditions, including the no bone grafts (NBG) group, the anterior bone grafts (ABG) group, the middle bone grafts (MBG) group, and the posterior bone grafts (PBG) group. Based on previous studies, 600 N and 1800 N loads were applied to the knee joint to simulate the static forces during a double and single leg stance to measure the von Mises stress of the medial implant area and lateral hinge area, the maximum displacement of different models, the relative displacement of the osteotomy area and the stress distribution in the bone grafts. ResultsCompared to the NBG and ABG groups, the stress of the lateral cortical hinge area and the medial implate area was significantly lower in the PBG group. For example, under the 600N force load, when the height of the osteotomy area was 10 mm, 15 mm, and 20 mm, the maximum von Mises stress of the medial implate area and lateral cortical hinge area in the NBG group were 140, 141, 172, and 53, 57, 60 MPa, respectively. Compared with the NBG group, the maximum von Mises stress of the medial implate area and lateral cortical hinge area in the PBG group were reduced by 45%, 56%, 63% and 14%, 39%, 68% at distraction height of 10 mm, 15 mm, and 20 mm, respectively. The bone grafts in the posterior parts provide the best stability,with the stress of the middle and posterior bone grafts are mainly concentrated in the edge. ConclusionsThe posterior part of the osteotomy area is the best position for bone graft placement since it provides optimal stability and reduces von Mises stress in the medial plate and lateral cortex hinge area, with the stress of the posterior bone grafts mainly concentrated in the edge. These findings guide bone graft placement sites in clinical surgery and are a basis for future research on bone graft materials and structures in MOWHTO.

Arthroscopic Posterior Articular Coverage and Shift (PACS) Procedure for Treatment of Preosteoarthritic Constitutional Static Posterior Shoulder Instability (Type C1)

Background: Different joint-preserving techniques for treatment of preosteoarthritic, constitutional static (type C1) posterior shoulder instability (PSI) have been proposed, including posterior glenoid open wedge osteotomy and bone graft augmentation. However, the techniques are demanding, the reported complication and reoperation rates are high, and posterior decentering cannot reliably be reversed. Purpose: To assess the clinical and radiological longitudinal outcomes of patients with type C1 PSI after arthroscopic posterior articular coverage and shift (PACS) surgery. Study Design: Case series; Level of evidence, 4. Methods: We performed a retrospective analysis of a prospective database with longitudinal follow-up including 14 shoulders in 13 patients who underwent an arthroscopic PACS procedure for symptomatic preosteoarthritic constitutional static posterior instability (type C1) with previous failed nonoperative treatment. Patients were clinically evaluated before surgery and at 3, 6, 12, and 24 months postoperatively in terms of satisfaction and pain levels as well as standardized physical examination, Subjective Shoulder Value (SSV), Western Ontario Shoulder Instability Index (WOSI) score, Constant score, and Rowe score. Preoperative, postoperative, and follow-up magnetic resonance imaging scans were obtained in all patients. A paired 2-sample t test was used to compare changes in continuous variable parameters over time. Correlation analyses were performed using the Pearson correlation coefficient. Results: All outcome scores and the pain level improved significantly from preoperatively to postoperatively, and the improvement was sustained over the follow-up period of 2 years (pain level, 6.4 preoperatively vs 3.3 at 2 years, P < .001; SSV, 40 vs 70, P = .001; WOSI, 33 vs 56, P = .001; Constant, 70 vs 79, P = .049; Rowe, 52 vs 76, P < .001). The mean glenohumeral and scapulohumeral subluxation indices were significantly lower in the early postoperative period compared with preoperative measurements (glenohumeral, 52% ± 6% vs 58% ± 10%, P = .02; scapulohumeral, 70% ± 8%; vs 77% ± 9%, P = .002, respectively); however, they returned to baseline values at follow-up (57% ± 7% vs 58% ± 10%, P = .7; 75% ± 6% vs 77% ± 9%, P = .4, respectively). A high scapulohumeral subluxation index, excessive glenoid retroversion, and increased posterior positioning of the humeral head in relation to scapular blade axis and older age were correlated with worse clinical outcomes. Conclusion: Over the follow-up period of 2 years, the PACS procedure significantly improved outcome scores in patients who had preosteoarthritic constitutional static posterior shoulder instability, especially in younger patients with less severe glenoid retroversion and posterior decentering of the humeral head. However, similar to other techniques, the PACS procedure needs to be considered a symptomatic therapy that does not reverse the underlying cause or stop the progressive pathology.

Unilateral Posterior Fixation, Bone Grafting and Fusion in Treatment of Lumber Spinal Degenerative Disc Disease

Unilateral Posterior Fixation, Bone Grafting and Fusion in Treatment of Lumber Spinal Degenerative Disc Disease

Orbital in juries in wartime: Historical study from Paul Tessier's work in Iran

Paul Tessier was a leading French oculoplastic surgeon who took part in several surgical missions in Iran to manage victims of the Iraq-Iran conflict in the late 1980's and early 1990's. We collected the records of 322 patients who underwent surgical procedures for the management of wartime injuries by Paul Tessier's team in Iran from 1990 to 1993. We also report one of the most representative cases of orbital reconstruction performed by Tessier. Mean age at the time of trauma was 20.65±7.04 years (range: 2--62). Craniofacial CT-scans were available for 54 patients. The bones of the upper third of the face and the orbital contents were affected in 124/322 patients (38.50%). Soft-tissue lesions of the upper third included 13 frontal lacerations (4.04%), 60 orbital injuries (18.63%) and 95 uni- or bilateral enucleations (29.50%). Thirty-nine uni- or bilateral lid injuries (12.11%) and 8 tear duct injuries (2.48%) were reported. A specific case of orbital reconstruction using antero-internal and posterior iliac bone grafts was reported as a representative example of Tessier's techniques. This study highlights the challenges of orbital reconstruction in wartime injuries and provides insights on the work of one of the most renowned surgeons in this field.

Quality of Life Assessment and Co-Morbidities of Maxillofacial Surgery Department Patients Undergoing Iliac Crest Harvesting Procedures

Autogenous bone grafts are the gold standard for bone harvesting, namely the iliac crest. A retrospective, cross-sectional study was conducted, to assess the quality-of-life changes and donor site morbidity of patients who underwent anterior or posterior iliac crest autogenous bone graft harvesting procedures at King Abdulaziz University Hospital, using a survey instrument to obtain responses via phone call from 31 interviewed patients, mainly males (51.6%), with mean age of 36.77(17.1). Results

Analysis of the clinical effect of posterior focus debridement and interbody bone grafting in the treatment of spinal tuberculosis.

Analysis of the clinical effect of posterior focus debridement and interbody bone grafting in the treatment of spinal tuberculosis.

Radiological follow-up of the degenerated facet joints after lateral lumbar interbody fusion with percutaneous pedicle screw fixation: Focus on spontaneous facet joint fusion

BackgroundLateral lumbar interbody fusion (LLIF) is widely used in degenerative lumbar spine surgery. Previous studies of radiographic investigations after LLIF have assessed the anterior interbody fusion rate, the changes in the segmental lumbar lordosis, efficacy of indirect neural decompression, and remodeling of the ligamentum flavum hypertrophy and spinal canal dimension, and so on. The purpose of this study was to evaluate the radiological changes in the degenerated facet joints following LLIF with bilateral percutaneous pedicle screw (PPS) fixation, focusing on spontaneous fusion. MethodsWe retrospectively analyzed 31 patients (79 surgical levels) who underwent two- or three-level LLIF with PPS fixation without direct posterior decompression and bone grafting. We assessed the fusion rate and characteristics of the facet joints’ fusion process on the preoperative, immediately postoperative, 12-month, and at least 2-year computed tomography (CT) images. On average, the last follow-up CT was performed after 30.2 months. Multivariate logistic regression analysis investigated factors related to spontaneous facet joint fusion postoperatively. ResultsThe fusion rates of the interbody and facet joints were 32.9% (26/79) and 19.0% (15/79) after 12-months and 79.7% (63/79) and 58.2% (46/79) at the final CT follow-up, respectively. Of the 46 cases with spontaneous facet fusion, three cases fused posteriorly only. Concomitant anterior interbody fusion was seen in 43/46 (93.5%) cases. Facet fusion started in a ring shape from the outermost joint edges, exposing subchondral bone without cartilage covering, and progressed to the central thicker cartilage regions. Multivariate analysis established that concomitant anterior interbody fusion (adjusted odds ratio [aOR]: 12.10, P = 0.0035) and preoperative facet joint osteoarthritis of Weishaupt Grade ≧ 1 (aOR: 4.770, P = 0.0068) were significant contributing factors to postoperative spontaneous facet fusion. ConclusionsOur study shows that spontaneous facet fusion frequently occurs after LLIF and may be an indicator of the inherent structural stability of the LLIF construct.