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Picton B, Stone LE, Liang J, Solomon SS, Brown NJ, Luzzi S, Osorio JA, Pham MH. Patient-specific rods in adult spinal deformity: a systematic review. Spine Deform 2024; 12:577-585. [PMID: 38265734 PMCID: PMC11068670 DOI: 10.1007/s43390-023-00805-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2023] [Accepted: 12/09/2023] [Indexed: 01/25/2024]
Abstract
PURPOSE The purpose of this review was to evaluate the effectiveness of patient-specific rods for adult spinal deformity. METHODS A systematic review of the literature was performed through an electronic search of the PubMed, Scopus, and Web of Science databases. Human studies between 2012 and 2023 were included. Sample size, sagittal vertical axis (SVA), pelvic incidence-lumbar lordosis (PI-LL), pelvic tilt (PT), operation time, blood loss, follow-up duration, and complications were recorded for each study when available. RESULTS Seven studies with a total of 304 adult spinal deformity patients of various etiologies were included. All studies reported SVA, and PT; two studies did not report PI-LL. Four studies reported planned radiographic outcomes. Two found a significant association between preoperative plan and postoperative outcome in all three outcomes. One found a significant association for PI-LL alone. The fourth found no significant associations. SVA improved in six of seven studies, PI-LL improved in all five, and three of seven studies found improved postoperative PT. Significance of these results varied greatly by study. CONCLUSION Preliminary evidence suggests potential benefits of PSRs in achieving optimal spino-pelvic parameters in ASD surgery. Nevertheless, conclusions regarding the superiority of PSRs over traditional rods must be judiciously drawn, given the heterogeneity of patients and study methodologies, potential confounding variables, and the absence of robust randomized controlled trials. Future investigations should concentrate on enhancing preoperative planning, standardizing surgical methodologies, isolating specific patient subgroups, and head-to-head comparisons with traditional rods to fully elucidate the impact of PSRs in ASD surgery.
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Affiliation(s)
- Bryce Picton
- School of Medicine, University of California, Irvine, 101 The City Dr, Orange, CA, 92868, USA.
| | - Lauren E Stone
- Department of Neurological Surgery, University of California, San Diego, La Jolla, CA, USA
| | - Jason Liang
- School of Medicine, University of California, Irvine, 101 The City Dr, Orange, CA, 92868, USA
| | - Sean S Solomon
- School of Medicine, University of California, Irvine, 101 The City Dr, Orange, CA, 92868, USA
| | - Nolan J Brown
- School of Medicine, University of California, Irvine, 101 The City Dr, Orange, CA, 92868, USA
| | - Sophia Luzzi
- School of Medicine, University of California, Irvine, 101 The City Dr, Orange, CA, 92868, USA
| | - Joseph A Osorio
- Department of Neurological Surgery, University of California, San Diego, La Jolla, CA, USA
| | - Martin H Pham
- Department of Neurological Surgery, University of California, San Diego, La Jolla, CA, USA
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Chen YS, Lin YH, Wu YC, Shih CM, Chen KH, Lee CH, Lu WH, Pan CC. Radiographic and clinical outcomes of robot-assisted pedicle screw instrumentation for adolescent idiopathic scoliosis. Front Surg 2024; 11:1344802. [PMID: 38712338 PMCID: PMC11070498 DOI: 10.3389/fsurg.2024.1344802] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2023] [Accepted: 04/10/2024] [Indexed: 05/08/2024] Open
Abstract
Introduction Pedicle screw instrumentation (PSI) serves as the widely accepted surgical treatment for adolescent idiopathic scoliosis (AIS). The accuracy of screw positioning has remarkably improved with robotic assistance. Nonetheless, its impact on radiographic and clinical outcomes remains unexplored. This study aimed to investigate the radiographic and clinical outcomes of robot-assisted PSI vs. conventional freehand method in AIS patients. Methods Data of AIS patients who underwent PSI with all pedicle screws between April 2013 and March 2022 were included and retrospectively analyzed; those with hybrid implants were excluded. Recruited individuals were divided into the Robot-assisted or Freehand group according to the technique used. Radiographic parameters and clinical outcome measures were documented. Results In total, 50 patients (19, Freehand group; 31, Robot-assisted group) were eligible, with an average age and follow-up period of 17.6 years and 60.2 months, respectively, and female predominance (40/50, 80.0%). The correction rates of Cobb's angles for both groups were significant postoperatively. Compared to freehand, the robot-assisted technique achieved a significantly reduced breech rate and provided better trunk shift and radiographic shoulder height correction with preserved lumbar lordosis, resulting in significantly improved visual analog scale scores for back pain from the third postoperative month. Conclusion Overall, robot-assisted PSI provides satisfactory radiographic and clinical outcomes in AIS patients.
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Affiliation(s)
- Yuan-Shao Chen
- Department of Orthopedic Surgery, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Yu-Hsien Lin
- Department of Orthopedic Surgery, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Yun-Che Wu
- Department of Orthopedic Surgery, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Cheng-Min Shih
- Department of Orthopedic Surgery, Taichung Veterans General Hospital, Taichung, Taiwan
- College of Medicine, National Chung Hsing University, Taichung, Taiwan
- Department of Physical Therapy, Hung Kuang University, Taichung, Taiwan
| | - Kun-Huei Chen
- Department of Orthopedic Surgery, Taichung Veterans General Hospital, Taichung, Taiwan
- Office of Research and Development, National Chung Hsing University, Taichung, Taiwan
- Department of Computer Science and Information Engineering, Providence University, Taichung, Taiwan
| | - Cheng-Hung Lee
- Department of Orthopedic Surgery, Taichung Veterans General Hospital, Taichung, Taiwan
- College of Medicine, National Chung Hsing University, Taichung, Taiwan
- Department of Food Science and Technology, Hung Kuang University, Taichung, Taiwan
| | - Wen-Hsien Lu
- Department of Orthopedic Surgery, Feng Yuan Hospital, Ministry of Health and Welfare, Taichung, Taiwan
| | - Chien-Chou Pan
- Department of Orthopedic Surgery, Taichung Veterans General Hospital, Taichung, Taiwan
- Department of Rehabilitation Science, Jenteh Junior College of Medicine, Nursing and Management, Miaoli, Taiwan
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Gharpinde MR, Pundkar A, Shrivastava S, Patel H, Chandanwale R. A Comprehensive Review of Platelet-Rich Plasma and Its Emerging Role in Accelerating Bone Healing. Cureus 2024; 16:e54122. [PMID: 38487114 PMCID: PMC10939108 DOI: 10.7759/cureus.54122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2023] [Accepted: 02/12/2024] [Indexed: 03/17/2024] Open
Abstract
This comprehensive review delves into the emerging role of platelet-rich plasma (PRP) in accelerating bone healing. PRP, a blood-derived product rich in platelets and growth factors, has garnered attention for its regenerative potential. The review begins by defining PRP and providing a historical background, highlighting its significance in expediting bone healing. PRP's composition and preparation methods, including centrifugation techniques and commercial kits, are explored. Mechanistically, PRP operates by releasing growth factors, chemotaxis, and angiogenesis, elucidating its cellular effects. Applications in fracture healing and orthopaedic surgeries, such as joint arthroplasty and spinal fusion, are discussed, emphasising the promising outcomes in clinical trials. Safety considerations, patient selection criteria, and the need for PRP preparation and application standardisation are underscored. The review outlines ongoing research trends, potential technological advancements, and unexplored areas in paediatric applications and inflammatory bone disorders. The implications for clinical practice involve informed decision-making, optimised protocols, and interdisciplinary collaboration. In conclusion, the future of PRP in bone healing holds exciting prospects, with the potential for precision medicine, integration with emerging therapies, expanded applications, and enhanced technological innovations shaping its trajectory in orthopaedics and regenerative medicine.
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Affiliation(s)
- Milind R Gharpinde
- Orthopedics, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Aditya Pundkar
- Orthopedics, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Sandeep Shrivastava
- Orthopedics, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Hardik Patel
- Orthopedics, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Rohan Chandanwale
- Orthopedics, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
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Faulks CR, Biddau DT, Munday NR, McKenzie DP, Malham GM. Patient-specific spinal rods in adult spinal deformity surgery reduce proximal junctional failure: a review of patient outcomes and surgical technique in a prospective observational cohort. JOURNAL OF SPINE SURGERY (HONG KONG) 2023; 9:409-421. [PMID: 38196735 PMCID: PMC10772658 DOI: 10.21037/jss-23-85] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/22/2023] [Accepted: 09/22/2023] [Indexed: 01/11/2024]
Abstract
Background Spinal rods used for adult spinal deformity (ASD) correction are usually manufactured straight and bent manually during surgery. Pre-bent patient-specific spinal rods (PSSR) developed with software provide the surgeon with an intraoperative deformity correction consistent with the surgical plan. Our aim was to report clinical and radiological outcomes using PSSR. We investigated rates of junctional complications both proximally [kyphosis (PJK) and failure (PJF)] and distally [failure (DJF)]. Methods Prospective case series of 20 consecutive patients who underwent ≥4 level ASD surgery with PSSR at a single institution between January 2019 and December 2022. Preoperative, 6-week, 6-month, 12-month, 24-month, and final follow-ups assessed patient satisfaction (Ottawa decision regret questionnaire) and patient reported outcome measures (PROMs) [visual analogue scale (VAS; Back/Leg), Oswestry disability index (ODI), and 12-Item Short Form Survey (SF-12)]. Sagittal spinopelvic parameters [sagittal vertical axis (SVA), pelvic tilt (PT), and pelvic incidence and lumbar lordosis mismatch (PI-LL)] measured by serial EOS scans were performed preoperatively then compared to planned correction and postoperative measures. Interoperative cages (narrow/wide) were placed for interbody support. PJK risk score assessed likelihood of developing kyphosis. Serial computed tomography (CT) imaging assessed complication (fusion/subsidence). Results The mean age of the patients (75% female) was 71.9±6.9 years, and the mean follow-up was 25.2±8.6 [7-40] months. Preoperative mean PROMs showed statistically significant overall improvement (P<0.001) postoperatively to final follow-up. Four patients without wide footprint cages at L4/5 or L5/S1, suffered DJF and reported regret undergoing surgery. Statistically significant difference (P<0.001) between preoperative and surgical plan in SVA and PI-LL but not in PT (P=0.058). No statistically significant difference in surgical plan versus the postoperative SVA, PI-LL, and PT (due to difficulty achieving the surgical plan, and also to maintaining the correction). One patient suffered PJF. There was a mean proximal kyphotic angle (PKA) of 17.8±13.0 degrees and PJK risk score of 3.7±1.0 with 40% who experienced PJK. No rod breakages were observed. Conclusions In this series, PSSR improved PROMs and treated ASD. Sagittal parameters planned preoperatively correlated with postoperative correction. PJF was reduced, compared to the literature (35%), but PJK was observed over time. DJF occurred and was related to the absence of interbody cages at the lumbosacral junction and decisional regret.
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Affiliation(s)
- Charlie R. Faulks
- Neuroscience Institute, Epworth HealthCare, Melbourne, VIC, Australia
| | - Dean T. Biddau
- Neuroscience Institute, Epworth HealthCare, Melbourne, VIC, Australia
| | - Nigel R. Munday
- Neuroscience Institute, Epworth HealthCare, Melbourne, VIC, Australia
| | - Dean P. McKenzie
- Research Development & Governance, Epworth HealthCare, Melbourne, VIC, Australia
- Swinburne University of Technology, Melbourne, VIC, Australia
| | - Gregory M. Malham
- Neuroscience Institute, Epworth HealthCare, Melbourne, VIC, Australia
- Swinburne University of Technology, Melbourne, VIC, Australia
- Department of Surgery, University of Melbourne, Melbourne, VIC, Australia
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Joiner EF, Mummaneni PV, Shaffrey CI, Chan AK. Posterior-based Osteotomies for Deformity Correction. Neurosurg Clin N Am 2023; 34:555-566. [PMID: 37718102 DOI: 10.1016/j.nec.2023.06.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/19/2023]
Abstract
Posterior-based osteotomies are crucial to the restoration of lordosis in adult spinal deformity. Posterior-column osteotomies are suited for patients with an unfused anterior column and non-focal sagittal deformity requiring modest correction in lordosis. When performed on multiple levels, posterior-column osteotomy may provide significant harmonious correction in patients who require more extensive correction. Pedicle subtraction osteotomy and vertebral column resection are appropriate for patients with a fused anterior column and more severe deformity, particularly focal and/or multiplanar deformity. The power of pedicle subtraction osteotomy and vertebral column resection to provide greater correction and to address multiplanar deformity comes at the cost of higher complication rates than posterior-column osteotomy.
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Affiliation(s)
- Evan F Joiner
- Department of Neurological Surgery, Columbia University-NewYork Presbyterian Hospital, 710 West 168th Street, 4th Floor, New York, NY 10032, USA. https://twitter.com/efjoiner
| | - Praveen V Mummaneni
- Department of Neurological Surgery, University of California San Francisco, 505 Parnassus Avenue M779, San Francisco, CA 94143, USA
| | - Christopher I Shaffrey
- Department of Neurosurgery, Duke University, 40 Duke Medicine Circle Clinic 1B/1C, Durham, NC 27710, USA; Department of Orthopaedic Surgery, Duke University, 40 Duke Medicine Circle Clinic 1B/1C, Durham, NC 27710, USA
| | - Andrew K Chan
- Department of Neurological Surgery, Columbia University Vagelos College of Physicians and Surgeons, NewYork-Presbyterian Och Spine Hospital, 5141 Broadway, 3FW, New York, NY, USA.
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Costăchescu B, Niculescu AG, Grumezescu AM, Teleanu DM. Screw Osteointegration-Increasing Biomechanical Resistance to Pull-Out Effect. MATERIALS (BASEL, SWITZERLAND) 2023; 16:5582. [PMID: 37629873 PMCID: PMC10456840 DOI: 10.3390/ma16165582] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/23/2023] [Revised: 08/03/2023] [Accepted: 08/09/2023] [Indexed: 08/27/2023]
Abstract
Spinal disorders cover a broad spectrum of pathologies and are among the most prevalent medical conditions. The management of these health issues was noted to be increasingly based on surgical interventions. Spinal fixation devices are often employed to improve surgery outcomes, increasing spinal stability, restoring structural integrity, and ensuring functionality. However, most of the currently used fixation tools are fabricated from materials with very different mechanical properties to native bone that are prone to pull-out effects or fail over time, requiring revision procedures. Solutions to these problems presently exploited in practice include the optimal selection of screw shape and size, modification of insertion trajectory, and utilization of bone cement to reinforce fixation constructs. Nevertheless, none of these methods are without risks and limitations. An alternative option to increasing biomechanical resistance to the pull-out effect is to tackle bone regenerative capacity and focus on screw osteointegration properties. Osteointegration was reportedly enhanced through various optimization strategies, including use of novel materials, surface modification techniques (e.g., application of coatings and topological optimization), and utilization of composites that allow synergistic effects between constituents. In this context, this paper takes a comprehensive path, starting with a brief presentation of spinal fixation devices, moving further to observations on how the pull-out strength can be enhanced with existing methods, and further focusing on techniques for implant osteointegration improvement.
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Affiliation(s)
- Bogdan Costăchescu
- “Gr. T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania;
- “Prof. Dr. N. Oblu” Emergency Clinical Hospital, 700309 Iasi, Romania
| | - Adelina-Gabriela Niculescu
- Research Institute of the University of Bucharest—ICUB, University of Bucharest, 050657 Bucharest, Romania;
- Department of Science and Engineering of Oxide Materials and Nanomaterials, Politehnica University of Bucharest, 011061 Bucharest, Romania
| | - Alexandru Mihai Grumezescu
- Research Institute of the University of Bucharest—ICUB, University of Bucharest, 050657 Bucharest, Romania;
- Department of Science and Engineering of Oxide Materials and Nanomaterials, Politehnica University of Bucharest, 011061 Bucharest, Romania
- Academy of Romanian Scientists, Ilfov No. 3, 050044 Bucharest, Romania
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Proximal junctional failure after surgical instrumentation in adult spinal deformity: biomechanical assessment of proximal instrumentation stiffness. Spine Deform 2023; 11:59-69. [PMID: 36083461 DOI: 10.1007/s43390-022-00574-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Accepted: 08/13/2022] [Indexed: 10/14/2022]
Abstract
STUDY DESIGN Assessment of different proximal instrumentation stiffness features to minimize the mechanical proximal junctional failure-related risks through computer-based biomechanical models. OBJECTIVE To biomechanically assess variations of proximal instrumentation and loads acting on the spine and construct to minimize proximal junctional failure (PJF) risks. The use of less-stiff fixation such as hooks or tensioned bands, compared to pedicle screws, at the proximal instrumentation level are considered to allow for a gradual transition in stiffness with the adjacent levels, but the impact of such flexible fixation on the loads balance and complications such as PJF remain uncertain. METHODS Six patients with adult spine deformity who underwent posterior spinal instrumentation were used to numerically model and simulate the surgical steps, erected posture, and flexion functional loading in patient-specific multibody analyses. Three types of upper-level fixation (pedicle screws (PS), supralaminar hooks (SH), and sublaminar bands (SB) with tensions of 50, 250, and 350 N) and rod stiffness (CoCr/6 mm, CoCr/5.5 mm, Ti/5.5 mm) were simulated. The loads acting on the spine and implants of the 90 simulated configurations were analyzed using Kruskal-Wallis statistical tests. RESULTS Simulated high-tensioned bands decreased the sagittal moment at the adjacent level proximal to the instrumentation (1.3 Nm at 250 N; 2.5 Nm at 350 N) compared to screws alone (PS) (15.6 Nm). At one level above, the high-tensioned SB increased the sagittal moment (17.7 Nm-SB vs. 15.5 Nm-PS) and bending moment on the rods (5.4 Nm and 5.7 Nm vs. 0.6 Nm) (p < 0.05). SB with 50 N tension yielded smaller changes in load transition compared to higher tension, with moments of 8.1 Nm and 16.8 Nm one and two levels above the instrumentation. The sagittal moment at the upper implant-vertebra connection decreased with the rod stiffness (1.0 Nm for CoCr/6 mm vs. 0.7 Nm for Ti/5.5 mm; p < 0.05). CONCLUSION Simulated sublaminar bands with lower tension produced smaller changes in the load transition across proximal junctional levels. Decreasing the rod stiffness further modified these changes, with a decrease in loads associated with bone failure, however, lower stiffness did increase the rod breakage risk. LEVEL OF EVIDENCE N/A.
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