RESUMEN
STUDY DESIGN: Systematic Review and Meta-Analysis. OBJECTIVES: To compare complication incidence in patients with or without the use of recombinant human Bone Morphogenic Protein-2 (BMP2) undergoing anterior cervical discectomy and fusion (ACDF) for degenerative conditions. METHODS: A systematic search of eight online databases was conducted using PRISMA guidelines. Inclusion criteria included English language studies with a minimum of 10 adult patients undergoing instrumented ACDF surgery for a degenerative spinal condition in which BMP2 was used in all patients or one of the treatment arms. Studies with patients undergoing circumferential fusions, with non-degenerative indications, or which did not report post-operative complication data were excluded. Patients with and without BMP2 were compared in terms of the incidence of dysphagia/dysphonia, anterior soft tissue complications (hematoma, seroma, infection, dysphagia/dysphonia), nonunion, medical complications, and new neurologic deficits. RESULTS: Of 1832 preliminary search results, 27 manuscripts were included. Meta-analysis revealed the relative risk of dysphagia or dysphonia (RR = 1.39, CI 95% 1.18 - 1.64, P = <.001), anterior soft tissue complications (RR = 1.43, CI 95% 1.25-1.64, P = <.001), and medical complications (RR = 1.32, CI 95% 1.06-1.66, P = .013) were statistically significant in the BMP2 group while the relative risk of non-union (RR = .5, CI 95% .23 - 1.13, P = .09) trended lower in the BMP2 group. Neurological deficit (RR = 1.06, CI 95% .82-1.37, P = .66), and additional medical complications (RR = 1.53, CI 95% .98-2.38, P = .06) were not found to be statistically different between the groups. CONCLUSIONS: This meta-analysis identified a high rate of arthrodesis when BMP2 was used in ACDF, but confirmed increased rates of dysphagia and anterior soft tissue complications. Surgeons may consider reserving BMP2 implementation for cases with a high risk of non-union, and should be aware of the risk of airway compromise.
RESUMEN
BACKGROUND: Fusion of the sacroiliac (SI) joint as a treatment for low back pain remains controversial. The purpose of this manuscript is to review the current literature and clinical outcomes of SI joint fusion surgery. METHODS: We conducted a literature review and included studies with the term "sacroiliac joint fusion" that had at least 12 months of clinical follow-up, reported on minimally invasive techniques, and included patient-reported outcome measures. RESULTS: Two approach types (dorsal and lateral) and numerous different implant manufacturers were identified. Most studies included level 4 data, with a small number of level 2 prospective cohort studies and 2 prospective level 1 studies. Every reviewed study reported clinical benefit in terms of improved pain scores or improvement in validated disability measures. Complication rates were low. CONCLUSIONS: Minimally invasive SI joint fusion provides clinically significant improvement in pain scores and disability in most patients, across multiple studies and implant manufacturers. LEVEL OF EVIDENCE: 5. CLINICAL RELEVANCE: Emerging evidence in support of SI joint fusion indicates that clinicians should examine the SI joint and include SI joint pain in their differential diagnosis for low back pain patients.
RESUMEN
BACKGROUND: Stress radiography provides an objective tool to measure posterior knee instability. Intraobserver and interobserver reliability has been reported for the Telos device, but it has not been studied using the kneeling technique. PURPOSE: This study was conducted to evaluate the intraobserver and interobserver reliability of measurements made using kneeling stress radiography to quantify posterior knee instability. STUDY DESIGN: Case series (diagnosis); Level of evidence, 4. METHODS: One hundred thirty-two stress radiographs in 44 patients with suspected posterior knee instability were prospectively taken using the kneeling technique. The amount of posterior displacement on the radiographs was then measured independently by 3 blinded testers (an orthopaedic sports medicine faculty member, an orthopaedic chief resident, and a medical student) on 2 separate occasions. Changes in mean and intraclass correlation coefficients (ICCs) were examined to assess the intraobserver and interobserver reliability of the measurements. RESULTS: Intraobserver changes in displacement means were small (-0.307 mm, -0.294 mm, and +0.035 mm) and only significant for observer 1. The combined intraobserver ICC was 0.973 for the 3 observers (0.976, 0.959, and 0.981). Interobserver comparisons revealed significant differences in trial 1 between observers 2 and 3 (0.675 mm), no differences in trial 2, and significant differences between observers 1 and 2 (0.333 mm) and observers 2 and 3 (0.510 mm) in the combined trial data. The combined interobserver ICC was 0.955 for the 3 observers (0.959 and 0.951 for the 2 trials). CONCLUSIONS: The kneeling technique for posterior cruciate ligament stress radiography provides a reproducible method to quantify posterior knee instability.