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Maddy KS, Tigre JY, Lu VM, Costello MC, Errante EL, Levi AD, Burks SS. Influence of instrumentation type on outcomes after surgical management of spondylodiscitis: a systematic review and meta-analysis. 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 2024; 33:3175-3190. [PMID: 38148366 DOI: 10.1007/s00586-023-08065-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/14/2023] [Revised: 11/22/2023] [Accepted: 11/23/2023] [Indexed: 12/28/2023]
Abstract
OBJECTIVE Spondylodiscitis refers to infection of the intervertebral disk and neighboring structures. Outcomes based on instrumentation type are not well reported in the literature, but are important in establishing guidelines for surgical management of spondylodiscitis. This study aims to clarify the effect of instrumentation material selection on clinical and radiographic outcomes in patients with spondylodiscitis. METHODS Studies that evaluated the use of polyetheretherketone (PEEK), titanium, allograft, and/or autologous bone grafts for spondylodiscitis were identified in the literature. Radiographic and clinical data were analyzed using a meta-analysis of proportions, with estimated risk and confidence intervals reported for our primary study outcomes. RESULTS Thirty-two retrospective studies totaling 1088 patients undergoing surgical management of spondylodiscitis with PEEK, TTN, allograft, and autologous bone graft instrumentation were included. There were no differences in fusion rates (p-interaction = 0.55) with rates of fusion of 93.4% with TTN, 98.6% with allograft, 84.2% with autologous bone graft, and 93.9% with PEEK. There were no differences in screw loosening (p-interaction = 0.52) with rates of 0.33% with TTN, 0% with allograft, 1.3% with autologous bone graft, and 8.2% with PEEK. There were no differences in reoperation (p-interaction = 0.59) with rates of 2.64% with TTN, 0% with allograft, 1.69% with autologous bone graft, and 3.3% with PEEK. CONCLUSIONS This meta-analysis demonstrates that the choice of instrumentation type in the surgical management of spondylodiscitis resulted in no significant differences in rate of radiographic fusion, screw loosening, or reoperation. Future comparative studies to optimize guidelines for the management of spondylodiscitis are needed.
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Affiliation(s)
- Krisna S Maddy
- Department of Neurological Surgery, University of Miami Miller School of Medicine, 1600 NW 10th Ave Miami, Miami, FL, 33136, USA.
| | - Joseph Yunga Tigre
- Department of Neurological Surgery, University of Miami Miller School of Medicine, 1600 NW 10th Ave Miami, Miami, FL, 33136, USA
| | - Victor M Lu
- Department of Neurological Surgery, University of Miami Miller School of Medicine, 1600 NW 10th Ave Miami, Miami, FL, 33136, USA
| | - Meredith C Costello
- Department of Neurological Surgery, University of Miami Miller School of Medicine, 1600 NW 10th Ave Miami, Miami, FL, 33136, USA
| | - Emily L Errante
- Department of Neurological Surgery, University of Miami Miller School of Medicine, 1600 NW 10th Ave Miami, Miami, FL, 33136, USA
| | - Allan D Levi
- Department of Neurological Surgery, University of Miami Miller School of Medicine, 1600 NW 10th Ave Miami, Miami, FL, 33136, USA
- The Miami Project to Cure Paralysis, University of Miami Miller School of Medicine, Miami, FL, USA
| | - S Shelby Burks
- Department of Neurological Surgery, University of Miami Miller School of Medicine, 1600 NW 10th Ave Miami, Miami, FL, 33136, USA
- The Miami Project to Cure Paralysis, University of Miami Miller School of Medicine, Miami, FL, USA
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Zhong W, Tang K, Quan Z. A novel nanohydroxyapatite/polyamide 66 strut for reducing subsidence after one-level anterior cervical corpectomy and fusion: a finite-element study. Eur J Med Res 2024; 29:375. [PMID: 39030641 PMCID: PMC11264631 DOI: 10.1186/s40001-024-01978-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Accepted: 07/14/2024] [Indexed: 07/21/2024] Open
Abstract
BACKGROUND The aim of this study is to introduce a novel nanohydroxyapatite/polyamide 66(n-HA/PA66)n strut to improve biomechanical performance and reduce subsidence. METHODS One validated intact and 2 ACCF-simulated C3-C7 cervical spine models were developed (old strut: Group A, new strut: Group B). In the ACCF models, C5 underwent corpectomy and was fixed by an anterior cervical plate. Screw angles were categorized as 1 (0 ) and 2 (45 ) and divided into 4 groups, A1, A2, B1 and B2, for each model. An axial force of 74 N and a moment couple of 1.0 Nm were imposed on the C3 vertebra. The range of motion (ROM) of each segment and the stress distribution on the screw-vertebra interface, strut, and strut-endplate interface were recorded and analysed. RESULTS There was no significant difference in ROM between Group A and Group B during bending, extension and rotation under 74 N axial pressure. The stress concentration on the strut body in Group A was higher than that in Group B. The peak stress values at the screw-vertebral interface in Groups A1 and A2 were higher than those in Groups B1 and B2, except for during extension and lateral bending. Under axial pressure, the peak stress values at the strut body-endplate interface during bending, extension and rotation were lower in the A1 and A2 groups than in the B1 and B2 groups. The Group B model showed much higher graft stress than the Group A model. CONCLUSIONS Based on finite-element analysis, compared with the old strut, the novel strut showed better biomechanical performance at the screw-vertebra interface.
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Affiliation(s)
- Weiyang Zhong
- Department of Orthopaedic Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China.
- Orthopaedic Laboratory of Chongqing Medical University, Chongqing, China.
| | - Ke Tang
- Department of Orthopaedic Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
- Orthopaedic Laboratory of Chongqing Medical University, Chongqing, China
| | - Zhengxue Quan
- Department of Orthopaedic Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
- Orthopaedic Laboratory of Chongqing Medical University, Chongqing, China
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Rodrigues AJ, Varshneya K, Stienen MN, Schonfeld E, Than KD, Veeravagu A. Clinical Outcomes and Cost Profiles for Cage and Allograft Anterior Cervical Discectomy and Fusion Procedures in the Adult Population: A Propensity Score-Matched Study. Asian Spine J 2023; 17:620-631. [PMID: 37226385 PMCID: PMC10460669 DOI: 10.31616/asj.2022.0261] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2022] [Revised: 09/04/2022] [Accepted: 09/13/2022] [Indexed: 05/27/2023] Open
Abstract
STUDY DESIGN Retrospective cohort study. PURPOSE To characterize the postoperative outcomes and economic costs of anterior cervical discectomy and fusion (ACDF) procedures using synthetic biomechanical intervertebral cage (BC) and structural allograft (SA) implants. OVERVIEW OF LITERATURE ACDF is a common spine procedure that typically uses an SA or BC for the cervical fusion. Previous studies that compared the outcomes between the two implants were limited by small sample sizes, short-term postoperative outcomes, and procedures with single-level fusion. METHODS Adult patients who underwent an ACDF procedure in 2007-2016 were included. Patient records were extracted from MarketScan, a national registry that captures person-specific clinical utilization, expenditures, and enrollments across millions of inpatient, outpatient, and prescription drug services. Propensity-score matching (PSM) was employed to match the patient cohorts across demographic characteristics, comorbidities, and treatments. RESULTS Of 110,911 patients, 65,151 (58.7%) received BC implants while 45,760 (41.3%) received SA implants. Patients who underwent BC surgeries had slightly higher reoperation rates within 1 year after the index ACDF procedure (3.3% vs. 3.0%, p=0.004), higher postoperative complication rates (4.9% vs. 4.6%, p=0.022), and higher 90-day readmission rates (4.9% vs. 4.4%, p =0.001). After PSM, the postoperative complication rates did not vary between the two cohorts (4.8% vs. 4.6%, p=0.369), although dysphagia (2.2% vs. 1.8%, p<0.001) and infection (0.3% vs. 0.2%, p=0.007) rates remained higher for the BC group. Other outcome differences, including readmission and reoperation, decreased. Physician's fees remained high for BC implantation procedures. CONCLUSIONS We found marginal differences in clinical outcomes between BC and SA ACDF interventions in the largest published database cohort of adult ACDF surgeries. After adjusting for group-level differences in comorbidity burden and demographic characteristics, BC and SA ACDF surgeries showed similar clinical outcomes. Physician's fees, however, were higher for BC implantation procedures.
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Affiliation(s)
- Adrian John Rodrigues
- Neurosurgery AI Lab & Department of Neurosurgery, Stanford University School of Medicine, Stanford, CA,
USA
| | - Kunal Varshneya
- Neurosurgery AI Lab & Department of Neurosurgery, Stanford University School of Medicine, Stanford, CA,
USA
| | - Martin Nikolaus Stienen
- Department of Neurosurgery & Spine Center of Eastern Switzerland, Kantonsspital St. Gallen & Medical School of St.Gallen, St. Gallen,
Switzerland
| | - Ethan Schonfeld
- Neurosurgery AI Lab & Department of Neurosurgery, Stanford University School of Medicine, Stanford, CA,
USA
| | - Khoi Duc Than
- Department of Neurosurgery, Duke University, Durham, NC,
USA
| | - Anand Veeravagu
- Neurosurgery AI Lab & Department of Neurosurgery, Stanford University School of Medicine, Stanford, CA,
USA
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Treffy RW, Laing B, Eraky AM, Shabani S. Cervical spine spondylodiscitis: Review of literature on current treatment strategies. Heliyon 2023; 9:e17875. [PMID: 37483708 PMCID: PMC10359881 DOI: 10.1016/j.heliyon.2023.e17875] [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: 01/16/2023] [Revised: 05/15/2023] [Accepted: 06/29/2023] [Indexed: 07/25/2023] Open
Abstract
Infections of the spine are an ever-increasing health concern requiring an often complex and prolonged treatment that can lead to significant morbidity. Of particular interest is the cervical spine where there is an increase rate of post-infectious deformity, secondary neurological deficits and substantially higher rates of associated morbidity and mortality than the thoracic or lumbar spine. In this review, we explore the diagnosis and treatment of spondylodiscitis with particular focus on the cervical spine.
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Affiliation(s)
- Randall W. Treffy
- Department of Neurosurgery, Medical College of Wisconsin, 8701 Watertown Plank Rd, Milwaukee, WI 53226, USA
| | - Brandon Laing
- Department of Neurosurgery, Medical College of Wisconsin, 8701 Watertown Plank Rd, Milwaukee, WI 53226, USA
| | - Akram M. Eraky
- Department of Neurosurgery, Medical College of Wisconsin, 8701 Watertown Plank Rd, Milwaukee, WI 53226, USA
| | - Saman Shabani
- Department of Neurosurgery, Medical College of Wisconsin, 8701 Watertown Plank Rd, Milwaukee, WI 53226, USA
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Zheng HL, Li B, Song SK, Chen PB, Zheng XF, Jiang LS, Jiang SD. Safety and Efficacy of Polyetheretherketone (PEEK) Cages and Cadaveric Allografts in Transforaminal Lumbar Interbody Fusion (TLIF) for Treating Lumbar Pyogenic Spondylodiscitis. Mediators Inflamm 2023; 2023:5171620. [PMID: 37284349 PMCID: PMC10241573 DOI: 10.1155/2023/5171620] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2022] [Revised: 01/26/2023] [Accepted: 04/05/2023] [Indexed: 06/08/2023] Open
Abstract
Purpose There have been many studies in the operative management of pyogenic spondylodiscitis with foreign materials. However, it still remains an issue of debate on whether the allografts may be used in pyogenic spondylodiscitis. This study sought to evaluate the safety and effectiveness of PEEK cages and the cadaveric allograft in transforaminal lumbar interbody fusion (TLIF) for treating lumbar pyogenic spondylodiscitis. Methods From January 2012 to December 2019, 56 patients underwent surgery for lumbar pyogenic spondylodiscitis. The posterior debridement of all patients and their fusion with allografts, local bone grafts, and bone chip cages were performed before posterior pedicle screw fusion. An assessment of the residual pain, the grade of neurological injury, and the resolution of infection was conducted on 39 patients. The clinical outcome was evaluated using a visual analog scale (VAS) and the Oswestry Disability Index (ODI), and neurological outcomes were appraised based on Frankel grades. The radiological outcomes were evaluated via focal lordosis, lumbar lordosis, and the state of the fusion. Results Staphylococcus aureus and Staphylococcus epidermidis were the most common causative organisms. The mean preoperative focal lordosis was -1.2° (-11.4° to 5.7°), and the mean postoperative focal lordosis increased to 10.3° (4.3°-17.2°). At the final follow-up, there were five cases with subsidence of the cage, no case of recurrence, and no case with cage and screw loosening or migration. The mean preoperative VAS and ODI scores were 8.9 and 74.6%, respectively, and improvements in VAS and ODI were 6.6 ± 2.2 and 50.4 ± 21.3%, respectively. The Frankel grade D was found in 10 patients and grade C in 7. Following the final follow-up, only one patient improved from Frankel grade C to grade D while the others recovered completely. Conclusion The PEEK cage and cadaveric allograft combined with local bone grafts is a safe and effective choice for intervertebral fusion and restoring sagittal alignment without increased incidence of relapse for treating lumbar pyogenic spondylodiscitis.
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Affiliation(s)
- Huo-Liang Zheng
- Department of Clinic of Spine Center, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200092, China
| | - Bo Li
- Department of Clinic of Spine Center, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200092, China
| | - Shao-Kuan Song
- Department of Clinic of Spine Center, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200092, China
| | - Peng-Bo Chen
- Department of Clinic of Spine Center, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200092, China
| | - Xin-Feng Zheng
- Department of Clinic of Spine Center, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200092, China
| | - Lei-Sheng Jiang
- Department of Clinic of Spine Center, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200092, China
| | - Sheng-Dan Jiang
- Department of Clinic of Spine Center, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200092, China
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Kim WJ, Park C, Sarraf K. Management of vertebral osteomyelitis in adults. Br J Hosp Med (Lond) 2023; 84:1-5. [PMID: 36708343 DOI: 10.12968/hmed.2022.0362] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Vertebral osteomyelitis is a condition that predominantly affects older men with chronic comorbidities, such as diabetes, renal and hepatic failure, or immunosuppression. Symptoms develop insidiously and a high index of suspicion is required to diagnose the condition; this is achieved through serological testing and imaging. The mainstay of treatment is long-term antibiotic therapy, lasting a minimum of 6 weeks; however, surgical debridement with stabilisation is required when conservative treatment is proving ineffective and infection progresses. It is critically important that sufficient treatment is provided for those experiencing vertebral osteomyelitis, as not doing so could lead to severe neurological compromise and death.
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Affiliation(s)
- Woo Jae Kim
- Department of Trauma and Orthopaedics, Russells Hall Hospital, Dudley Group NHS Foundation Trust, Dudley, UK
| | - Chang Park
- Department of Trauma and Orthopaedics, Northwest Thames Rotation, London, UK
| | - Khaled Sarraf
- Department of Trauma and Orthopaedics, Imperial College Healthcare NHS Trust, London, UK
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Sommer F, Kirnaz S, Goldberg J, McGrath L, Navarro-Ramirez R, Gadjradj P, Medary B, Härtl R. Treatment of Odontoid Fractures in Elderly Patients Using C1/C2 Instrumented Fusion Supplemented With Bilateral Atlantoaxial Joint Spacers: A Case Series. Int J Spine Surg 2022; 16:442-449. [PMID: 35772974 PMCID: PMC9650199 DOI: 10.14444/8250] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND Spinal fractures are among the most common traumatic injuries in elderly patients, with the odontoid process being frequently affected. As this patient group usually has high rates of comorbidity and chronic diseases, a nonoperative approach may offer a reasonable solution for a favorable fracture pattern. OBJECTIVE We modified the procedure by implanting a bilateral atlantoaxial joint spacer (model DTRAX) into the joint space and review our experience utilizing this technique for the treatment of patients with a fracture of the odontoid process. METHODS A retrospective evaluation was performed on patients treated surgically for unstable traumatic fractures of the odontoid process. The stabilization was performed using a dorsal rod and screw instrumentation of the lateral mass of the atlas and the pars interarticularis of the axis. The procedure was further modified by implanting a bilateral atlantoaxial joint spacer (DTRAX) into the joint space bilaterally after the removal of the articular cartilage. Patients older than 70 years with a traumatic fracture of the odontoid process were included. Pain was assessed pre- and postoperatively using the visual analog scale (VAS). To verify fusion during follow-up, either x-ray imaging of the cervical spine or magnetic resonance imaging or computed tomography were performed. RESULTS A total of 5 patients were included in our study. Four patients had an American Society of Anesthesiology score of 3 and 1 had a score of 4. The average duration of surgery was 187 ± 38.1 minutes. The average blood loss during the procedure was 340 ± 270 mL. The average radiological follow-up period was 21.2 ± 17.5 months. Preoperatively, the average VAS pain score was 2.3 ± 3.3. Postoperatively, the mean VAS decreased to 0.6 ± 0.9. The average follow-up period for pain was 27.2 ± 19 months. No patient showed neurological deficits before or after surgery. Follow-up demonstrated solid fusion in all cases. CONCLUSION The fusion of the atlantoaxial joint with bilateral atlantoaxial joint spacers represents a suitable and feasible option for achieving high fusion rates in elderly patients with odontoid fractures. CLINICAL RELEVANCE A significant percentage of patients who are treated non-operatively will experience nonunion, which may cause instability of the atlantoaxial joint. Posterior fixation with screws and rods is a treatment option, but it leaves the cartilaginous joint surface in place, which can be an impediment to the fusion process. In other cases, degenerative collapse of the C1/C2 joint can cause compression of the C2 nerve root. LEVEL OF EVIDENCE: 4
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Affiliation(s)
- Fabian Sommer
- Department of Neurological Surgery, New York-Presbyterian Hospital/Weill Cornell Medicine, New York, NY, USA
| | - Sertac Kirnaz
- Department of Neurological Surgery, New York-Presbyterian Hospital/Weill Cornell Medicine, New York, NY, USA
| | - Jacob Goldberg
- Department of Neurological Surgery, New York-Presbyterian Hospital/Weill Cornell Medicine, New York, NY, USA
| | - Lynn McGrath
- Department of Neurological Surgery, New York-Presbyterian Hospital/Weill Cornell Medicine, New York, NY, USA
| | - Rodrigo Navarro-Ramirez
- Department of Neurological Surgery, New York-Presbyterian Hospital/Weill Cornell Medicine, New York, NY, USA
| | - Pravesh Gadjradj
- Department of Neurological Surgery, New York-Presbyterian Hospital/Weill Cornell Medicine, New York, NY, USA
| | - Branden Medary
- Department of Neurological Surgery, New York-Presbyterian Hospital/Weill Cornell Medicine, New York, NY, USA
| | - Roger Härtl
- Department of Neurological Surgery, New York-Presbyterian Hospital/Weill Cornell Medicine, New York, NY, USA
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Sommer F, Kirnaz S, Goldberg JL, McGrath LB, Schmidt F, Gadjradj P, Medary B, Härtl R. Safety and Feasibility of DTRAX Cervical Cages in the Atlantoaxial Joint for C1/2 Stabilization. Oper Neurosurg (Hagerstown) 2022; 22:322-327. [PMID: 35315806 DOI: 10.1227/ons.0000000000000139] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2021] [Accepted: 11/27/2021] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Pathological changes in the atlantoaxial joint often lead to instability, pain, and neurological deterioration. One treatment option is the surgical stabilization of the atlantoaxial joint. In other areas of the spine, fusion rates have been improved by the introduction of an interbody cage. Our aim was to use cervical interbody spacers, originally designed to augment fusion across subaxial posterior cervical facets, to optimize the conditions for atlantoaxial fusion. OBJECTIVE To evaluate the safety and efficacy of implanting cervical cages in the atlantoaxial joint for C1/2 stabilization. METHODS Our retrospective study evaluated patients who had undergone C1/2 cervical fusions by the Harms/Goel technique. This technique was modified by implanting a titanium cervical interbody spacer into the joint space. Mean overall pain, as measured by a 0 to 10 visual analog scale (VAS) and neurological outcomes were measured preoperatively and postoperatively. In addition, radiological outcomes were collected using follow-up imaging. RESULTS Nine patients were included in this case series. The mean preoperative VAS for overall pain was 5.0 ± 4.0, which changed to a mean VAS of 2.0 ± 3.0 after an average follow-up period of 41.4 ± 20.4 (P = .043). All patients showed a bony fusion in our case series. None of the radiological imaging during follow-up showed screw loosening, hardware breakage, implant migration, or nonunion. CONCLUSION The implantation of cervical titanium cages into the atlantoaxial joint in combination with posterior fixation appears to be a safe and effective method for achieving C1/2 fusion.
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Affiliation(s)
- Fabian Sommer
- Department of Neurological Surgery, New York-Presbyterian Hospital/Weill Cornell Medicine, New York, New York, USA
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Wassif RK, Elkayal M, Shamma RN, Elkheshen SA. Recent advances in the local antibiotics delivery systems for management of osteomyelitis. Drug Deliv 2021; 28:2392-2414. [PMID: 34755579 PMCID: PMC8583938 DOI: 10.1080/10717544.2021.1998246] [Citation(s) in RCA: 33] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Chronic osteomyelitis is a challenging disease due to its serious rates of mortality and morbidity while the currently available treatment strategies are suboptimal. In contrast to the adopted systemic treatment approaches after surgical debridement in chronic osteomyelitis, local drug delivery systems are receiving great attention in the recent decades. Local drug delivery systems using special carriers have the pros of enhancing the feasibility of penetration of antimicrobial agents to bone tissues, providing sustained release and localized concentrations of the antimicrobial agents in the infected area while avoiding the systemic side effects and toxicity. Most important, the incorporation of osteoinductive and osteoconductive materials in these systems assists bones proliferation and differentiation, hence the generation of new bone materials is enhanced. Some of these systems can also provide mechanical support for the long bones during the healing process. Most important, if the local systems are designed to be injectable to the affected site and biodegradable, they will reduce the level of invasion required for implantation and can win the patients’ compliance and reduce the healing period. They will also allow multiple injections during the course of therapy to guard against the side effect of the long-term systemic therapy. The current review presents different available approaches for delivering antimicrobial agents for the treatment of osteomyelitis focusing on the recent advances in researches for local delivery of antibiotics.HIGHLIGHTS Chronic osteomyelitis is a challenging disease due to its serious mortality and morbidity rates and limited effective treatment options. Local drug delivery systems are receiving great attention in the recent decades. Osteoinductive and osteoconductive materials in the local systems assists bones proliferation and differentiation Local systems can be designed to provide mechanical support for the long bones during the healing process. Designing the local system to be injectable to the affected site and biodegradable will reduces the level of invasion and win the patients’ compliance.
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Affiliation(s)
- Reem Khaled Wassif
- Department of Pharmaceutics and Pharmaceutical Technology, Faculty of Pharmacy, Future University in Egypt, Cairo, Egypt
| | - Maha Elkayal
- Department of Pharmaceutics and Pharmaceutical Technology, Faculty of Pharmacy, Future University in Egypt, Cairo, Egypt
| | - Rehab Nabil Shamma
- Department of Pharmaceutics and Industrial Pharmacy, Faculty of Pharmacy, Cairo University, Cairo, Egypt
| | - Seham A Elkheshen
- Department of Pharmaceutics and Industrial Pharmacy, Faculty of Pharmacy, Cairo University, Cairo, Egypt
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Martínez-Gutiérrez O, Peña-Martínez V, Camacho-Ortiz A, Vilchez-Cavazos F, Simental-Mendía M, Tamez-Mata Y, Acosta-Olivo C. Spondylodiscitis treated with freeze-dried bone allograft alone or combined with autograft: A randomized and blinded trial. J Orthop Surg (Hong Kong) 2021; 29:23094990211019101. [PMID: 34041968 DOI: 10.1177/23094990211019101] [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] [Indexed: 11/17/2022] Open
Abstract
PURPOSE To compare the bone fusion of freeze-dried allograft alone versus freeze-dried allograft combined autograft in spinal instrumentation due to spondylodiscitis. METHODS A randomized prospective trial of patients with spondylodiscitis treated with surgical debridement and spinal fixation with freeze-dried bone allograft and autograft (Group 1) or freeze-dried bone allograft alone (Group 2) was performed. Patient follow-up was assessed with a CT-scan for bone fusion; consecutive serum inflammatory marker detection (C-reactive protein, [CRP], and erythrocyte sedimentation rate, [ESR]) and clinical assessment (pain, functional disability, and spinal cord injury recovery) were other outcome parameters. The primary outcome was the grade of bone allograft integration with the scale of Tan (which ranges from 1 to 4, with lower scores indicating a better fusion rate) at 1 year after surgery. RESULTS A total of 20 patients were evaluated, 13 (65%) men and 7 (35%) women with a mean age of 47.2 (±14.3) years. Homogeneous distribution of demographic data was observed. A similar satisfactory bone graft fusion grade was observed in both graft groups at 1 year after surgery (p = 1.0000). Serum inflammatory markers gradually decreased in both groups after surgical intervention (CRP, p < 0.001; ESR, p < 0.01). At one-year follow-up, gradual improvement of pain, functional disability, and neurological spinal injury recovery in both graft groups were achieved. CONCLUSION Freeze-dried allograft alone could be a therapeutic option for spinal fixation surgery due to spondylodiscitis since it achieves a satisfactory graft fusion rate and clinical improvement. LEVEL OF EVIDENCE Level 1. Treatment. REGISTER NCT03265561.
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Affiliation(s)
- Oscar Martínez-Gutiérrez
- 27771Universidad Autónoma de Nuevo León, Facultad de Medicina, Hospital Universitario "Dr. José E. González", Monterrey, Nuevo León, Mexico
| | - Victor Peña-Martínez
- 27771Universidad Autónoma de Nuevo León, Facultad de Medicina, Hospital Universitario "Dr. José E. González", Monterrey, Nuevo León, Mexico
| | - Adrián Camacho-Ortiz
- 27771Universidad Autónoma de Nuevo León, Facultad de Medicina, Hospital Universitario "Dr. José E. González", Monterrey, Nuevo León, Mexico
| | - Felix Vilchez-Cavazos
- 27771Universidad Autónoma de Nuevo León, Facultad de Medicina, Hospital Universitario "Dr. José E. González", Monterrey, Nuevo León, Mexico
| | - Mario Simental-Mendía
- 27771Universidad Autónoma de Nuevo León, Facultad de Medicina, Hospital Universitario "Dr. José E. González", Monterrey, Nuevo León, Mexico
| | - Yadira Tamez-Mata
- 27771Universidad Autónoma de Nuevo León, Facultad de Medicina, Hospital Universitario "Dr. José E. González", Monterrey, Nuevo León, Mexico
| | - Carlos Acosta-Olivo
- 27771Universidad Autónoma de Nuevo León, Facultad de Medicina, Hospital Universitario "Dr. José E. González", Monterrey, Nuevo León, Mexico
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Abstract
In July of 2018, the Second International Consensus Meeting (ICM) on Musculoskeletal Infection convened in Philadelphia, PA was held to discuss issues regarding infection in orthopedic patients and to provide consensus recommendations on these issues to practicing orthopedic surgeons. During this meeting, attending delegates divided into subspecialty groups to discuss topics specifics to their respective fields, which included the spine. At the spine subspecialty group meeting, delegates discussed and voted upon the recommendations for 63 questions regarding the prevention, diagnosis, and treatment of infection in spinal surgery. Of the 63 questions, 9 focused on implants questions in spine surgery, for which this article provides the recommendations, voting results, and rationales.
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Minimally Invasive Lateral Retropleural Approach to the Thoracic Spine for Salvage of a Subsided Expandable Interbody Cage. World Neurosurg 2020; 135:58-62. [DOI: 10.1016/j.wneu.2019.12.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2019] [Revised: 11/30/2019] [Accepted: 12/02/2019] [Indexed: 11/22/2022]
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Boody BS, Tarazona DA, Vaccaro AR. Evaluation and Management of Pyogenic and Tubercular Spine Infections. Curr Rev Musculoskelet Med 2018; 11:643-652. [PMID: 30280287 PMCID: PMC6220010 DOI: 10.1007/s12178-018-9523-y] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
PURPOSE OF REVIEW To review the most current diagnostic tools and treatment options for pyogenic and tubercular spine infection. RECENT FINDINGS Recent studies have focused on risk factors for failed nonoperative management in order to improve patient selection. Also, spine instrumentation and different grafting options have been safely utilized in the setting of an active infection without increasing the incidence of reoccurrence. However, the optimal surgical technique has yet to be established and instead should be patient specific. Spine infections include a broad spectrum of disorders including discitis, vertebral osteomyelitis, and spinal epidural abscess. It is paramount to recognized spine infections early due to the potential catastrophic consequences of paralysis and sepsis. The management of spine infections continues to evolve as newer diagnostic tools and surgical techniques become available. Magnetic resonance imaging with contrast is the imaging study of choice and computed tomography-guided biopsies are crucial for guiding antibiotic selection. Antibiotics are the mainstay of treatment and surgery is indicated in patients with neurological deficits, sepsis, spinal instability, and those who have failed nonoperative treatment.
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Affiliation(s)
- Barrett S Boody
- The Rothman Institute, 925 Chestnut St, 5th Floor, Philadelphia, PA, 19107, USA.
| | - Daniel A Tarazona
- The Rothman Institute, 925 Chestnut St, 5th Floor, Philadelphia, PA, 19107, USA
| | - Alexander R Vaccaro
- The Rothman Institute, 925 Chestnut St, 5th Floor, Philadelphia, PA, 19107, USA
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Is it Safe to Use Synthetic Grafts in Pyogenic Vertebral Osteodiskitis When Surgical Debridement is Required? Clin Spine Surg 2018; 31:269-273. [PMID: 29595748 DOI: 10.1097/bsd.0000000000000638] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
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Wu W, Chen C, Ning J, Sun P, Zhang J, Wu C, Bi Z, Fan J, Lai X, Ouyang J. A Novel Anterior Transpedicular Screw Artificial Vertebral Body System for Lower Cervical Spine Fixation: A Finite Element Study. J Biomech Eng 2017; 139:2618332. [DOI: 10.1115/1.4036393] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2016] [Indexed: 11/08/2022]
Abstract
A finite element model was used to compare the biomechanical properties of a novel anterior transpedicular screw artificial vertebral body system (AVBS) with a conventional anterior screw plate system (ASPS) for fixation in the lower cervical spine. A model of the intact cervical spine (C3–C7) was established. AVBS or ASPS constructs were implanted between C4 and C6. The models were loaded in three-dimensional (3D) motion. The Von Mises stress distribution in the internal fixators was evaluated, as well as the range of motion (ROM) and facet joint force. The models were generated and analyzed by mimics, geomagic studio, and ansys software. The intact model of the lower cervical spine consisted of 286,382 elements. The model was validated against previously reported cadaveric experimental data. In the ASPS model, stress was concentrated at the connection between the screw and plate and the connection between the titanium mesh and adjacent vertebral body. In the AVBS model, stress was evenly distributed. Compared to the intact cervical spine model, the ROM of the whole specimen after fixation with both constructs is decreased by approximately 3 deg. ROM of adjacent segments is increased by approximately 5 deg. Facet joint force of the ASPS and AVBS models was higher than those of the intact cervical spine model, especially in extension and lateral bending. AVBS fixation represents a novel reconstruction approach for the lower cervical spine. AVBS provides better stability and lower risk for internal fixator failure compared with traditional ASPS fixation.
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Affiliation(s)
- Weidong Wu
- Department of Anatomy, Guangdong Provincial Medical Biomechanical Key Laboratory, Academy of Orthopedics of Guangdong Province, Southern Medical University, Guangzhou 510515, China
- Wuhan Concrete Technology Company Limited, Gaoxin Avenue 818, Wuhan 430200, Hubei, China e-mail:
| | - Chun Chen
- Department of Orthopedics, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou 325000, Zhejiang, China e-mail:
| | - Jinpei Ning
- Department of Orthopedics, Wuzhou Red Cross Hospital, Wuzhou 543002, Guangxi, China e-mail:
| | - Peidong Sun
- Department of Anatomy, Guangdong Provincial Medical Biomechanical Key Laboratory, Academy of Orthopedics of Guangdong Province, Southern Medical University, Guangzhou 510515, China e-mail:
| | - Jinyuan Zhang
- Department of Anatomy, Guangdong Provincial Medical Biomechanical Key Laboratory, Academy of Orthopedics of Guangdong Province, Southern Medical University, Guangzhou 510515, China e-mail:
| | - Changfu Wu
- Department of Orthopedic Surgery, The Affiliated Hospital of Putian University, Putian 351100, Fujian, China
- Department of Orthopedic Surgery, The Affiliated Putian Hospital of Southern Medical University, Putian 351100, Fujian, China e-mail:
| | - Zhenyu Bi
- Department of Anatomy, Guangdong Provincial Medical Biomechanical Key Laboratory, Academy of Orthopedics of Guangdong Province, Southern Medical University, Guangzhou 510515, China e-mail:
| | - Jihong Fan
- Department of Anatomy, Guangdong Provincial Medical Biomechanical Key Laboratory, Academy of Orthopedics of Guangdong Province, Southern Medical University, Guangzhou 510515, China e-mail:
| | - Xianliang Lai
- Department of Orthopedic Surgery, Wenzhou Hospitals of Traditional Chinese and Western Medicine, Wenzhou 325000, Zhejiang, China e-mail:
| | - Jun Ouyang
- Professor Department of Anatomy, Guangdong Provincial Medical Biomechanical Key Laboratory, Academy of Orthopedics of Guangdong Province, Southern Medical University, No. 1023 Shatai Road, Baiyun District, Guangzhou 510515, China e-mail:
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Mesh cage for treatment of hematogenous spondylitis and spondylodiskitis. How safe and successful is its use in acute and chronic complicated cases? A systematic review of literature over a decade. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY AND TRAUMATOLOGY 2016; 26:753-61. [PMID: 27324195 DOI: 10.1007/s00590-016-1803-x] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/07/2016] [Accepted: 05/27/2016] [Indexed: 12/17/2022]
Abstract
BACKGROUND Surgical treatment of hematogenous pyogenic spondylitis and spondylodiskitis includes anterior debridement, stabilization, and fusion. Titanium mesh cage (TMC) has been advocated to immediately correct deformity and eradicate infection with low recurrence rates. There are no comprehensive reviews on TMC. PURPOSE To evaluate recorded information regarding surgical outcome with the use of TMC for treating patients with pyogenic spinal infection. STUDY DESIGN Comprehensive review. METHODS The terms "titanium cage", "spine", "infection" were searched. A total of 486 peer-reviewed papers published from 2002 to 2012 were obtained from PubMed search. Fifteen Level IV articles with 363 patients were enrolled for consideration. Finally, 192 (53 %) patients who received TMC were eligible and included in this review. Age, comorbidities, indications for surgery, abscess formation, time lapsed between symptoms initiation and surgery, microbiology, radiological spine restoration, neurological outcome, and complications following surgery are evaluated. RESULTS The average age at the index surgery was 57 years, range 15-85 years. The reported time lapsed from symptoms presentation to diagnosis varied significantly from 1 week to 2 years. On admission, there reported paravertebral and/or epidural abscess in 48 % and neurological impairment in 51 % of the patients. One hundred and seventy-seven comorbidities were recorded in 192 patients. Bone biopsy and culture revealed gram (+) bacteria in 71 %, gram (-) in 24 %, and multiple bacteria in 1 %, while it was negative in 3.1 % of the patients. TMC was most commonly (49 %) implanted in the lumbar spine. The follow-up observation following surgery averaged 26 months, range 10-116 months. Most of the studies reported decrease in segmental kyphosis and neurological improvement in incomplete lesions postoperatively. TMC was primarily revised for early dislodgment or cage misplacement in 3.2 % of the patients. Infection recurrence was recorded in two patients (1.3 %), but revision surgery needed in one (0.65 %) patient. Mortality was reported in 5.8 % of the patients. CONCLUSIONS TMC offers an advantageous and safe technique for spinal debridement and fusion for hematogenous spinal infection. TMC safeguarded medium-term spinal stability with low infection recurrence rates, which were independent form causative pathogen, age, and comorbidities.
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Evaluation of the Efficacy of Titanium Mesh Cages with Posterior C1 Lateral Mass and C2 Pedicle Screw Fixation in Patients with Atlantoaxial Instability. World Neurosurg 2016; 90:103-108. [DOI: 10.1016/j.wneu.2016.02.087] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2015] [Revised: 02/18/2016] [Accepted: 02/19/2016] [Indexed: 11/21/2022]
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Pyogenic osteomyelitis of the spine. CURRENT ORTHOPAEDIC PRACTICE 2014. [DOI: 10.1097/bco.0000000000000070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Fengbin Y, Jinhao M, Xinyuan L, Xinwei W, Yu C, Deyu C. Evaluation of a new type of titanium mesh cage versus the traditional titanium mesh cage for single-level, anterior cervical corpectomy and fusion. 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 2013; 22:2891-6. [PMID: 24000074 DOI: 10.1007/s00586-013-2976-1] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/20/2013] [Revised: 06/14/2013] [Accepted: 08/19/2013] [Indexed: 11/29/2022]
Abstract
STUDY DESIGN A retrospective review of prospectively collected data in an academic institution. OBJECTIVE To evaluate the safety and efficacy of a new type of titanium mesh cage (TMC) in single-level, anterior cervical corpectomy and fusion (ACCF). METHODS Fifty-eight patients consecutive with cervical spondylotic myelopathy (CSM) from cervical degenerative spondylosis and isolated ossification of the posterior longitudinal ligament were treated with a single-level ACCF using either a new type of TMC (28 patients, group A) or the traditional TMC (30 patients, group B). We evaluated the patients for TMC subsidence, cervical lordosis (C2-C7 Cobb and Cobb of fused segments) and fusion status for a minimum of 30 months postoperatively based on spine radiographs. In addition, neurologic outcomes were evaluated using the Japanese Orthopedic Association (JOA) scores. Neck pain was evaluated using a 10-point visual analog scale (VAS). RESULTS The loss of height of the fused segments was less for group A than for group B (0.8 ± 0.3 vs. 2.8 ± 0.4 mm) (p < 0.01); also, there was a lower rate of severe subsidence (≥3 mm) in group A (4 %, 1/28) than in group B (17 %, 5/30) (p < 0.01). There were no differences in the C2-C7 Cobb and Cobb of fused segments between the groups preoperatively or at final follow-up (p > 0.05), but the Cobb of fused segments immediately postoperative were significantly less for group B than for group A (p < 0.01). All patients, however, had successful fusion (100 %, each). Both groups had marked improvement in the JOA score after operation (p < 0.01), with no significant differences in the JOA recovery ratio (p > 0.05). The postoperative VAS neck pain scores for group A were significantly less than that for group B (p < 0.05); severe subsidence was correlated with neck pain. CONCLUSIONS The new type of TMC provides comparable clinical results and fusion rates with the traditional TMC for patients undergoing single-level corpectomy. The new design TMC decreases postoperative subsidence (compared to the traditional TMC); the unique design of the new type of TMC matches the vertebral endplate morphology which appears to decrease the severity of subsidence-related neck pain in follow-up.
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Affiliation(s)
- Yu Fengbin
- Department of Orthopaedic Surgery, No. 98 Hospital of PLA, No. 9 Chezhan Road, 313000, Huzhou, China,
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