Sagittal correction after short percutaneous fixation for thoracolumbar compression fractures: comparison of the combination of SpineJack® kyphoplasty and fractured vertebra screw fixation.

PURPOSE: The aim of this study was to compare two percutaneous pedicle fixations for the treatment of thoracolumbar fractures: one associating a jack kyphoplasty (SpineCut) and the other using intermediate screws (Trident). METHODS: All adult patients treated for single-level Magerl/AO type A thoracolumbar traumatic fractures in four orthopaedic departments, with SpineCut or Trident, with a one year minimum follow-up, were retrospectively included. Neurological disorders and osteoporotic fractures were not included. The following data were collected: age, sex, Magerl/AO type, type of surgery, and complications. Radiological parameters were analyzed on pre-operative CT scan, and on standing X-rays before discharge, at three months and one year post-operative: vertebral wedge angle (VWA), regional kyphosis angle (RKA), and traumatic regional angulation (TRA: difference between RKA and physiological values for each vertebra). RESULTS: Eighty patients were included, with 42 patients in SpineCut group and 38 in Trident group. Mean age was 41 ± 15.7 years. TRA correction did not differ between the groups: respectively 11.2 ± 8.1° in SpineCut versus 10.2 ± 9.1° in Trident group (p = 0.52). TRA loss of correction between early post-operative and three months was statistically higher in Trident group: -4 ± 5.1° versus -1.5 ± 3.8° (p = 0.03). After 3 months, TRA correction loss was comparable between the groups. Multivariate analysis demonstrated that pre-operative VWA was the only factor significantly associated with early TRA correction loss (p = 0.01). VWA correction and loss of correction did not differ significantly between the groups. No complications were observed. CONCLUSION: Percutaneous pedicle fixations of traumatic thoracolumbar fractures associating jack kyphoplasty and intermediate screws are both safe and efficient techniques.

Implant removal after short percutaneous pedicle fixation associated with SpineJack® kyphoplasty: is correction sustained?

PURPOSE: This study objective was to evaluate sagittal correction loss after instrumentation removal in patients treated for thoracic or lumbar compression fractures treated with SpineJack® kyphoplasty associated with short percutaneous pedicle screw fixation. METHODS: This retrospective multicenter study was carried out in three major French trauma centers. All patients with a single type A thoracic or lumbar fracture, treated by the studied technique between 2017 and 2020, have been included. Demographic data, fracture type, removal procedure achievement and term were collected. Radiological parameters were measured at five timepoints: pre-operative, intra-operative, immediate post-operative, early post-operative (< 3 months) and at follow-up (1 year). Vertebral wedge angle (angle between the two endplates of the fractured vertebra) and traumatic regional angulation (TRA-calculated by subtracting regional kyphosis from the physiological reference values). RESULTS: 150 patients were included. Mean age was 48.6 ± 17.8 years. Average follow-up was 14.4 ± 3 months. 82 patients had secondary instrumentation removal. Mean time to removal was 6.4 ± 2.4 months. TRA correction loss between immediate post-operative and last follow-up was greater in removal group: 5.1 ± 5.6° versus 2.7 ± 4.7° (p = 0.01). Material was removed earlier in younger patients (p = 0.002). TRA correction loss was similar in the early and late removal groups (p = 0.83). Multivariate analysis identified only Magerl/AO A3 fractures as risk factor for loss of TRA correction (p = 0.007). CONCLUSION: Instrumentation removal was associated with good radiological outcomes with a non-significant loss of vertebral wedge angle and tolerable loss of traumatic regional angulation (+ 2.4° compared to the no-removal group), even if performed early.

Safety of simultaneous versus staged bilateral opening-wedge high tibial osteotomy with locked plate and immediate weight bearing.

PURPOSE: With advances in technology and particularly locked screws, patients with high tibial osteotomy (HTO) are frequently allowed full weight bearing for a  unilateral procedure. We are aware of no reports comparing the safety of a simultaneous bilateral HTO with staged bilateral HTO. The purpose of this study was to retrospectively compare these two strategies. MATERIAL AND METHODS: Ninety patients were treated with bilateral HTO surgery for osteoarthritis from 2009 to 2013; they had opening-wedge HTO and fixed with the same plate fixation and locked screws. A comparison of the outcomes after simultaneous bilateral HTO (35 patients) and after sequential staged bilateral HTO (55 patients) was performed. We considered four measures of medical safety: hypotension, serious intra-operative adverse event, heterologous blood transfusion, and thrombophlebitis. We considered also four measures of orthopaedic safety: infection, patient's inability to walk full weight bearing, changes in correction, and nonunion. RESULTS: For the same duration of operation, the duration of anaesthesia and the time in the operating room were 35% longer for patients having a staged bilateral HTO. Blood loss was higher in patients undergoing simultaneous bilateral HTO compared with those who underwent a staged bilateral HTO. For patients undergoing simultaneous bilateral HTO, thrombophlebitis frequency and length of anticoagulation were lower than the sum of each event in the staged bilateral HTO. The patients with simultaneous bilateral HTO had a longer total period of time for crutches than patients with staged bilateral HTO. Patients in the simultaneous bilateral cohort did not develop an infection within one year as patients in the planned-stage cohort. The simultaneous bilateral cohort had a lower rate of delayed union than the planned-stage cohort did. CONCLUSION: On the basis of this analysis, simultaneous bilateral HTO is a reasonable treatment option. Individuals who undergo staged bilateral HTO face the risk of complications twice, in addition to two hospitalizations. Patients who undergo simultaneous bilateral HTO have a higher risk of blood transfusion.

Accompanimeter 1.0: creation and initial field testing of a tool to assess the extent to which the principles and building blocks of accompaniment are present in community health worker programs.

Background: The strategic incorporation of community health workers (CHWs) into health system strengthening efforts is recognized as a critical and high-value approach for meeting the Sustainable Development Goals established by the United Nations in 2015. How to best build CHW programs, however, is prone to a wide variety of opinions and philosophies, many of which are often externally imposed. Partners in Health (PIH) is a non-governmental organization that pioneered an approach to healthcare system strengthening, called accompaniment, in which CHWs play a key role. Learning from PIH is a critical first step in replicating the organization's achievements beyond PIH. As such, PIH has developed a tool, referred to as the 'Accompanimeter 1.0,' that serves to evaluate existing CHW programs and guide adjustments in programming.Objective: To provide a standardized approach for defining, assessing, and implementing accompaniment in CHW programs using a tool called the Accompanimeter 1.0.Methods: Development of this tool included three stages: (1) desk review of literature relevant to the work of CHWs globally, (2) discussions among colleagues and initial field testing, (3) feedback from colleagues who are experts in community health and in the principles of accompaniment.Results: Three core principles of accompaniment in a CHW program were identified: professionalization, CHWs as bridges to institutional strength, and community proximity. These core principles direct five thematic areas that are found in successful CHW programs: Partnering (co-creating engagement with a continuous and intersectoral dialogue to improve the program); Choosing (identifying the right people for the right job); Educating (building CHWs´ capacity); Incentivizing (enabling CHWs to perform their work without financial sacrifice); Supervising (mentoring CHWs for personal growth).Conclusions: The Accompanimeter 1.0 can serve as a helpful tool for CHW program implementation and policy decisions that maximize system-side inputs, community engagement, and support for individuals with medical issues.

Risk factors of instrumentation failure and pseudarthrosis after stand-alone L5-S1 anterior lumbar interbody fusion: a retrospective cohort study.

OBJECTIVE: L5-S1 stand-alone anterior lumbar interbody fusion (ALIF) is a reliable technique to treat symptomatic degenerative disc disease but remains controversial for treatment of isthmic spondylolisthesis. In the present study the authors aimed to identify risk factors of instrumentation failure and pseudarthrosis after stand-alone L5-S1 ALIF and to evaluate whether instrumentation failure influenced the rate of fusion. METHODS: The study included 64 patients (22 [34.4%] male and 42 [65.6%] female, mean age 46.4 years [range 21-65 years]) undergoing stand-alone L5-S1 ALIF using radiolucent anterior cages with Vertebridge plating fixation in each vertebral endplate. Clinical and radiographic data were reviewed, including age, sex, pelvic parameters, segmental sagittal angle (SSA), C7/sacro-femoral distance (SFD) ratio, C7 sagittal tilt, lumbar lordosis (LL), segmental LL, percentage of L5 slippage, L5-S1 disc angle, and posterior disc height ratio. Univariate and multivariate analyses were used to identify risk factors of instrumentation failure and pseudarthrosis. RESULTS: At a mean follow-up of 15.9 months (range 6.6-27.4 months), fusion had occurred in 57 patients (89.1%). Instrumentation failure was found in 12 patients (18.8%) and pseudarthrosis in 7 patients (10.9%). The following parameters influenced the occurrence of instrumentation failure: presence of isthmic spondylolisthesis (p < 0.001), spondylolisthesis grade (p < 0.001), use of an iliac crest bone autograft (p = 0.04), cage height (p = 0.03), pelvic incidence (PI) (p < 0.001), sacral slope (SS) (p < 0.001), SSA (p = 0.003), and LL (p < 0.001). Instrumentation failure was statistically linked to the occurrence of L5-S1 pseudarthrosis (p < 0.001). On multivariate analysis, no risk factors were found. CONCLUSIONS: L5-S1 isthmic spondylolisthesis and high PI seem to be risk factors for instrumentation failure in case of stand-alone L5-S1 ALIF, findings that support the necessity of adding percutaneous posterior pedicle screw instrumentation in these cases.