Comparison between unilateral and bilateral percutaneous kyphoplasty in the treatment of osteoporotic vertebral compression fracture: A meta‑analysis and systematic review

The present study collected retrospective research data and compared the safety and efficacy of unilateral and bilateral percutaneous puncture kyphoplasty for the treatment of vertebral fractures caused by osteoporosis, to guide the selection of clinical surgical methods. In the present meta-analysis, PubMed, Embase and the Cochrane Library were searched from the establishment of the databases to March 2023. Studies that reported differences in the efficacy and safety between the unilateral and bilateral approaches in the treatment of osteoporotic vertebral compression fractures were included in the analysis. Duplicate published studies, unpublished studies, studies with incomplete data, animal experiments, literature reviews and systematic studies were excluded from the analysis. All data were processed using STATA 15.1 statistical software. The pooled results demonstrated that there were no significant differences between the unilateral and bilateral approaches in the visual analog scores, Oswestry disability index, height restoration rate or incidence of cement leakage. However, the post-kyphotic angle of the unilateral approach was significantly lower than that of the bilateral approach (standardized mean difference, -0.41; 95% confidence interval, -0.68 to -0.14; P=0.003). Furthermore, the pooled results demonstrated that the unilateral approach required less operative time and a lower volume of injected cement, which is safer for elderly patients who are more likely to have underlying diseases.

Minimally invasive thymectomy for myasthenia gravis: a 7-year retrospective study

BACKGROUND

Thymectomy has been identified as an effective strategy for patients with myasthenia gravis (MG) and thymic masses. However, the best surgical approach remains a matter of debate. The aim of the present study was to compare the surgical and neurological outcomes of video-assisted thoracoscopic thymectomy with a modified subxiphoid and bilateral approach in patients with MG and thymic masses.

METHODS

From August 2013 to April 2018, 68 patients who were diagnosed with MG and thymic masses and underwent video-assisted thoracoscopic thymectomy with a modified subxiphoid (44 patients) or bilateral (24 patients) approach were included in this retrospective study. The surgical and neurological results were analyzed with propensity score matching.

RESULTS

After propensity score matching, the modified subxiphoid approach in video-assisted thoracoscopic thymectomy resulted in an obviously shorter operative time (P=0.00), drainage duration (P=0.00), less intraoperative blood loss (P=0.00), and shorter postoperative hospital stay (P=0.01). In terms of neurological outcomes, no significant difference was observed in the improvement in MG, with 2-year complete stable remission rates of 21.1% and 26.3% (P=0.68) and 2-year pharmacological remission rates of 31.6% and 26.3% (P=0.60) for the bilateral and subxiphoid approaches, respectively. Additionally, the approaches resulted in similar effects on the magnitudes of decrease in the prednisolone and pyridostigmine doses after 2 years, with average pyridostigmine dose reductions of 72.2% and 71.1% (P=0.78) and average prednisolone reductions of 76.8% and 71.7% (P=0.96) for the bilateral and subxiphoid approaches, respectively.

CONCLUSIONS

The modified subxiphoid approach was found to be superior to the bilateral approach in video-assisted thoracic surgery thymectomy in terms of the surgical outcomes and yielded similar neurological outcomes. Therefore, the modified subxiphoid approach is recommended as an alternative to the bilateral approach in the treatment of patients with MG and thymic masses.

Bilateral Approach for Thoracoscopic Esophagectomy in a Patient with Esophageal Cancer and Solitary Posterior Thoracic Para-aortic Lymph Node Metastasis

We report a successful dissection of metastatic posterior thoracic para-aortic lymph node (No. 112aoP) via bilateral thoracoscopic surgery. With the anesthetized patient (a 73-year-old Japanese woman) in the prone position, two working ports were inserted for the left-side approach, and artificial pneumothorax was created. Thoracoscopic examination revealed a swollen LN posterior to the descending aorta. Fat and metastatic LNs posterior to the aorta were dissected from the aortic arch level to the diaphragm while preserving intercostal arteries. For the right-side approach, two working ports were inserted and a routine thoracoscopic esophagec-tomy was performed. Gastric conduit reconstruction was achieved laparoscopically. Operation time for the left thoracic procedure: 54 min; estimated blood loss: almost none. No recurrence was detected 24 months post-operatively. There are several surgical options for approaching No. 112aoP, including transhiatal, left thora-cotomy, and thoracoscopy. Although a wide dissection of the posterior thoracic para-aortic area has not been reported, it may be feasible and safe if the artery of Adamkiewicz and intercostal arteries are preserved. A min-imally invasive bilateral thoracoscopic approach for a thoracoscopic esophagectomy is safe and useful for esophageal cancer patients with solitary No. 112aoP metastasis.

Feasibility of Single-Staged Bilateral Anterior Scoliosis Correction in Growing Patients

STUDY DESIGN

Retrospective analysis.

OBJECTIVES

The objective of this study was to analyze the feasibility of correcting double-curve scoliosis using dynamic scoliosis correction (DSC, also known as vertebral body tethering), which requires a bilateral anterior approach with deflation of both lungs. Typically, this approach falls under the exclusionary criteria for the eligibility for anterior scoliosis surgery. No data exists on the feasibility of single-staged bilateral DSC.

METHODS

A retrospective analysis was performed utilizing the data from 25 patients who underwent a bilateral anterior thoracic approach and instrumentation. Thirty-day postoperative complication rates were analyzed. A learning curve subanalysis was also performed to compare the first 12 patients to the remainder of the 13 patients, with a T-test (P ≤ .05).

RESULTS

Of the 25 patients treated, there was 1 intraoperative event: After performing lumbar DSC, the contralateral DSC was abandoned due to unexpected pleural scarring and staged selective thoracic fusion was performed. We observed 4 postoperative complications: 2 patients had recurrent pleural effusions, 1 patient was diagnosed with pneumonia, and 1 patient had a minor pulmonary embolism without cardiopulmonary consequences (after an international 24 hour flight). All patients recovered well. We observed a significant influence of learning curve on surgical time (328 vs 280 min, P = .03) and blood loss (480 vs 197 mL, P = .03).

CONCLUSION

Data suggests that bilateral, single-stage surgery for DSC is feasible albeit with an elevated complication rate that may partially attributable to the learning curve. Future research should focus on the cause of pulmonary complications and include a matched comparative analysis with traditional posterior fusion.