Comparison of Outcomes in Percutaneous Fixation of Traumatic Fractures between Ankylosing Spondylitis and Diffuse Idiopathic Skeletal Hyperostosis

STUDY DESIGN

Retrospective cohort study.

OBJECTIVES

This study aims to analyze outcomes and complications of patients with thoracic and lumbar fractures in the setting of ankylosing spinal disorders (ASD) treated with minimally invasive surgery (MIS).

METHODS

The operative logs from 2012 to 2019 from one academic, Level I trauma center were reviewed for cases of thoracic and lumbar spinal fractures in patients with ASD treated with a MIS approach. Variables were compared between patients with ankylosing spondylitis (AS), diffuse idiopathic skeletal hyperostosis (DISH), and advanced spondylosis.

RESULTS

A total of 48 patients with ASD and concomitant thoracic or lumbar spinal fracture managed with an MIS approach were identified. A total of 11 patients were identified with AS, 21 with DISH, and 16 with advanced spondylosis. A total of 27 (56.3%) patients experienced complications. Complications differed between groups; DISH patients experienced a greater number of post-operative complications compared to AS and advanced spondylosis patients (P = .009). There was no significant difference in length of surgery, estimated blood loss, length of stay, readmission, and reoperation rates between AS and DISH patients. There were 3 mortalities unrelated to the surgery.

CONCLUSION

Percutaneous stabilization of patients with ankylosing spinal disorder fractures remains a viable management method. Operative characteristics were similar between AS, DISH, and advanced spondylosis patients; however, DISH patients experienced a greater number of post-operative complications.

Virtual and Augmented Reality in Spine Surgery: An Era of Immersive Healthcare

In the dynamic realm of spinal surgery, the integration of virtual reality (VR) and augmented reality (AR) technologies is heralding a transformative era. These cutting-edge tools are not only reshaping the training landscape for surgical trainees, offering immersive and interactive experiences but are also enhancing the surgical precision of seasoned professionals in the operating room. While the potential of VR and AR is vast, their adoption is tempered by significant costs and challenges in seamless integration. As the spinal surgery community looks ahead, it becomes imperative to emphasize the validation, reliability, and thorough cost-benefit analysis of these technologies. This article delves into the current applications, benefits, challenges, and future trajectories of VR and AR in spinal surgery, underscoring their pivotal role in the evolution of immersive healthcare.

Accountable Operating Room Teams

With Medicare reimbursement diminishing and the aging population consuming more health care, hospitals continue to push for reforms to improve the efficiency of health care delivery, decrease consumption, and elevate the quality of care. Operating rooms command a large share of hospital resources but are also major revenue generators. Surgical care has evolved to become more efficient and accountable. Defining the characteristics of an accountable operating room team has been more elusive and inconsistent. This review defines the characteristics of accountable operating room teams and recommends measures by which to evaluate them. [Orthopedics. 2021;44(4):e463-e470.].

Biomechanical strength comparison of pedicle screw augmentation using poly-dicalcium phosphate dihydrate (P-DCPD) and polymethylmethacrylate (PMMA) cements

STUDY DESIGN

A basic science, hypothesis-driven experimental study of the biomechanics of two bone cements in their ability to augment pedicle screws in bone foam.

OBJECTIVE

The purpose of our study was to compare the pullout and torque resistance of conventional pedicle screws (CPS) augmented with either polymethylmethacrylate (PMMA) or poly-dicalcium phosphate dihydrate (P-DCPD) cement in polyurethane foam blocks mimicking osteoporotic bone. P-DCPD cement has attractive safety characteristics such as non-exothermic curing and drug-eluting capacity. PMMA cement lacks these safety features yet is the current standard in pedicle screw augmentation.

METHODS

Standardized low-density polyurethane open-cell foam blocks were instrumented with conventional pedicle screws and categorized into three groups of six each. Group 1 was the control group and no cement was used. Groups 2 and 3 were augmented with PMMA and P-DCPD, respectively. An Instron machine applied an axial load to failure at a rate of 2 mm/min for 3 min and a torsional load to failure at a rate of 1°/s. Failure was defined by an evident drop in the load after maximum value.

RESULTS

Maximal pullout load for PMMA and P-DCPD was significantly greater than control (p < 0.0001). Interestingly, there was no significant difference in the pullout load to failure for the PMMA and P-DCPD groups. Analysis showed significant difference in torsional resistance between PMMA and P-DCPD, with PMMA having greater resistance (p = 0.00436).

CONCLUSIONS

No difference was observed between PMMA and P-DCPD in pullout load to failure conducted in low-density open-cell, rigid foam blocks. Although a significant difference did exist in our torque analysis, the clinical significance of such a load on a native spine is questionable. Further investigation is warranted for this promising compound that seems to be comparable in pullout resistance to PMMA and offers attractive safety features.

LEVEL OF EVIDENCE

Basic science, not applicable.

Overview and recent advances in the treatment of neuroblastoma

INTRODUCTION

Children with neuroblastoma have widely divergent outcomes, ranging from cure in >90% of patients with low risk disease to <50% for those with high risk disease. Recent research has shed light on the biology of neuroblastoma, allowing for more accurate risk stratification and treatment reduction in many cases, although newer treatment strategies for children with high-risk and relapsed neuroblastoma are needed to improve outcomes. Areas covered: Neuroblastoma epidemiology, diagnosis, risk stratification, and recent advances in treatment of both newly diagnosed and relapsed neuroblastoma. Expert commentary: The identification of newer tumor targets and of novel cell-mediated immunotherapy agents may lead to novel therapeutic approaches, and clinical trials for regimens designed to target individual genetic aberrations in tumors are underway. A combination of therapeutic modalities will likely be required to improve survival and cure rates for patients with high-risk neuroblastoma.

Toward absolute quantification of iron oxide nanoparticles as well as cell internalized fraction using multiparametric MRI

Iron oxide nanoparticles (IONPs) are widely used as MR contrast agents because of their strong magnetic properties and broad range of applications. The contrast induced by IONPs typically depends on concentration, water accessibility, particle size and heterogeneity of IONP distribution within the microenvironment. Although the latter could be a tool to assess local physiological effects at the molecular level, it renders IONP quantification from relaxation measurements challenging. This study aims to quantify IONP concentration using susceptibility measurements. In addition, further analysis of relaxation data is proposed to extract quantitative information about the IONP spatial distribution. Mesenchymal stem cells were labeled with IONPs and the IONP concentration measured by mass spectroscopy. MR relaxation parameters (T(1), T(2), T(2)*) as well as magnetic susceptibility of cylindrical samples containing serial dilutions of mixtures of free and cell-internalized IONPs were measured and correlated with IONP concentration. Unlike relaxation data, magnetic susceptibility was independent of whether IONPs were free or internalized, making it an excellent candidate for IONP quantification. Using IONP concentration derived from mass spectroscopy and measured relaxation times, free and internalized IONP fractions were accurately calculated. Magnetic susceptibility was shown to be a robust technique to measure IONP concentration in this preliminary study. Novel imaging-based susceptibility mapping techniques could prove to be valuable tools to quantify IONP concentration directly by MRI, for samples of arbitrary shape. Combined with relaxation time mapping techniques, especially T(2) and T(2)*, this could be an efficient way to measure both IONP concentration and the internalized IONP fraction in vivo using MRI, to gain insight into tissue function and molecular imaging paradigms.

What did we learn about interdisciplinary collaboration in institutions?

The Interdisciplinary Generalist Curriculum (IGC) Project significantly advanced collaboration in the development of medical school curricula. As primary care faculty began to work together they encountered and overcame many challenges inherent in this new process. Inclusion of other faculty and departments, as well as dedicated support from the deans' offices, became necessary to the success of the projects. The continuation of successful collaborative projects in the medical school environment requires a common commitment of faculty, students, department chairs, and the dean's office; protected time; and involvement of faculty from other disciplines. This article outlines initial models of collaboration implemented in the IGC Project, followed by a description of the expected and unexpected outcomes of these collaborative efforts, and a discussion of the emergence of new ways of collaborating, with recommendations for successful collaborative efforts.

The Interdisciplinary Generalist Curriculum Project at Joan C. Edwards School of Medicine at Marshall University

The Interdisciplinary Generalist Curriculum (IGC) Project was designed to enhance interest in and support of generalism during the first two years of medical education. The original goals at Joan C. Edwards School of Medicine at Marshall University included the design and implementation of a core curriculum, Introduction to Patient Care (IPC), and enhancement of teaching excellence through faculty development. The core curriculum facilitated integration with the basic sciences and early introduction of physical examination skills, which were further developed in longitudinal clinical experiences with mentors. Although it was not originally intended to include basic scientists in the preceptor groups, they became important additions and created additional opportunities for interdisciplinary teaching and reciprocal learning. The mentor program, another well-received and intended curriculum change, evolved from a structured experience to a more flexible component of the curriculum. The program met the requirements of the IGC Project but 53% of the originally intended mentor time was achievable, due to curriculum constraints. Faculty development, another success, was originally intended to target IPC faculty but ultimately became a university-wide effort. The changes implemented as a result of the IGC Project continue to flourish beyond the funding period and have become integral aspects of the curriculum and the medical school.