Journal of orthopaedic surgery and research
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Comparative Study Observational Study
Comparison of outcomes between conventional lumbar fenestration discectomy and minimally invasive lumbar discectomy: an observational study with a minimum 2-year follow-up.
Different surgical techniques for lumbar discectomy are in vogue. This study compares the outcomes of two techniques for lumbar discectomy, viz. micro lumbar discectomy (LD) and conventional fenestration discectomy. ⋯ The study shows that both MLD and fenestration give comparable results at short-term follow-up. There is statistically significant improvement in MLD with regard to improvement in JOA, VAS and RM scores at 2 years. However, the difference is not large and may not be clinically significant.
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Multicenter Study
Should the tip-apex distance (TAD) rule be modified for the proximal femoral nail antirotation (PFNA)? A retrospective study.
Unstable proximal femoral fractures are common and challenging for the orthopaedic surgeon. Often, these are treated with intramedullary nails. The most common mode of failure of any device to treat these fractures is cut-out. The Synthes proximal femoral nail antirotation (PFNA) is unique because it is the only proximal femoral intramedullary nail which employs a helical blade in lieu of a lag screw. The optimal tip-apex distance is 25 mm or less for a dynamic hip screw. The optimal blade tip placement is not known for the PFNA. ⋯ The PFNA is a suitable fixation device for the treatment of unstable proximal femoral fractures. There were still a relatively large number of cut-outs, and the tip-apex distance in the failures showed a bimodal distribution, not like previously demonstrated with dynamic hip screw. We propose that the helical blade behaves differently to a screw, and placement too close to the subchondral bone may lead to penetration through the head.
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Comparative Study
Comparison of one-level microendoscopy laminoforaminotomy and cervical arthroplasty in cervical spondylotic radiculopathy: a minimum 2-year follow-up study.
This study aims to compare the perioperative parameters and clinical results between microendoscopy laminoforaminotomy (MELF) and cervical arthroplasty (CA) in the treatment of one-level cervical spondylotic radiculopathy in a retrospective study. ⋯ As alternatives of anterior cervical decompression and fusion (ACDF), both CA and MELF can produce satisfactory clinical outcomes. MELF has the additional benefits of less blood loss, less surgical time, less X-ray time, and shorter hospital stay.
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Although percutaneous endoscopic lumbar discectomy (PELD) has shown favorable outcomes in the majority of lumbar discectomy cases, there were also some failures. The most common cause of failure is the incomplete removal of disc fragments. The skin entry point for the guide-needle trajectory and the optimal placement of the working sleeve are largely blind, which might lead to the inadequate removal of disc fragments. The objective of this study was to present our early experiences with image-guided PELD using a specially designed fluoroscope with magnetic resonance imaging-equipped operative suite (XMR) for the treatment of lumbar disc herniation. ⋯ This prospective analysis indicates that XMR-assisted PELD provides a precise skin entry point. It also confirms that decompression occurs intraoperatively, which negates the need for a separate surgery and thus increases the success rate of PELD, particularly in highly migrated or sequestrated discs. However, further extensive experience is required to confirm the advantages and feasibility of PELD in terms of cost effectiveness.
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Comparative Study
Recombinant human Bone Morphogenetic Protein-2 (rhBMP-2) in posterolateral lumbar spine fusion: complications in the elderly.
Retrospective cohort study of 1430 patients undergoing lumbar spinal fusion from 2002 - 2009. ⋯ Despite being older and having more comorbidities, elderly patients have similar complication and reoperation rates compared to younger healthier patients undergoing instrumented lumbar decompression fusions with rhBMP-2.