European spine journal : official publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society
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Randomized Controlled Trial
Addition of TLIF does not improve outcome over standard posterior instrumented fusion. 5-10 years long-term Follow-up: results from a RCT.
The use of inter-body device in lumbar fusions has been difficult to validate, only few long-term RCT are available. ⋯ In a long-term perspective, patients with TLIF's did not experience better outcome scores.
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Review Meta Analysis
Total disc replacement versus fusion for lumbar degenerative disc disease: a systematic review of overlapping meta-analyses.
Although many meta-analyses have been performed to compare total disc replacement (TDR) and fusion for treating lumbar degenerative disc disease (LDDD), their findings are inconsistent. This study aimed to conduct a systematic review of overlapping meta-analyses comparing TDR with fusion for treating LDDD, to assist decision makers in selection among conflicting meta-analyses, and to provide treatment recommendations based on the best available evidence. ⋯ There is discord in results from meta-analyses that assessed TDR and fusion for LDDD. According to this systematic review of overlapping meta-analyses comparing TDR and fusion for LDDD, the current best available evidence suggests that TDR may be an effective technique for the treatment of selected patients with LDDD, and is at least equal to lumbar fusion in the short term. However, considering that disadvantages may appear after years, spine surgeons should be cautions about performing TDR on a large scale.
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Recombinant human bone morphogenetic protein-2 (rhBMP-2) generally provides high rates of clinical improvement and fusion. However, rhBMP-2 has been associated with adverse effects. Recently, a beta tricalcium phosphate (β-TCP) bone substitute has been developed. The aim of this study was to determine the fusion rates and clinical outcomes of patients treated with β-TCP compared to rhBMP-2. ⋯ Comparable clinical outcomes and complication rates suggest that β-TCP is a viable alternative to rhBMP-2. The difference in fusion rates for the standalone patients suggests that β-TCP may require supplemental posterior instrumentation to enhance fusion.
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This study explored the performance characteristics of a cuff-leak test (CLT) combined with interventional fiberoptic bronchoscopy (FBS) for evaluating whether early nasoendotracheal extubation was possible for patients who had received transoral atlantoaxial reduction plate (TARP) internal fixation surgery. ⋯ Early extubation through IA is safe and interventional FBS assists successful extubation for CLT-positive patients who underwent TARP surgery.
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Case Reports
Rehydration of a degenerated disc on MRI synchronized with transition of Modic changes following stand-alone XLIF.
Lumbar intervertebral disc degeneration (LDD) is known to be associated with low back pain (LBP) and leads to degenerative lumbar disease. LDD is considered to be irreversible, and no truly effective treatment that suppresses LDD or regenerates the degenerated disc has been established thus far. Here, we report the case of a 42-year-old woman with a 10-year history of persistent LBP. ⋯ In addition, rehydration of the degenerated disc behind the XLIF cage was evident (Pfirrmann classification changed from grade IV to grade II). To our knowledge, this is the first report of a change in LDD. Several factors are likely responsible for the regenerative response, including curettage of the hyaline cartilaginous endplates and auto-iliac cancellous bone grafting, which were considered to have affected nucleus pulposus cells in the residual disc.