Vertebral Endplate Cavities (VEC) with titanium cages in posterior lumbar interbody fusion (PLIF).

BACKGROUND: Vertebral endplate cavities (VEC) have been reported with the use of Ti cages. Only few articles have recently demonstrated unfavorable radiographic changes in the form of cysts or cavities which may predispose to nonunion. METHODS: The aim was to assess the prevalence of VEC in posterior lumbar interbody fusion (PLIF) using Titanium (Ti) cages, and to estimate their impact on fusion. The term "cavity" was used to describe the endplate changes. CT analysis of the VEC and fusion status following PLIFs with Ti cages was conducted by two observers. VEC were assessed according to the size, multiplicity, location, and presence of sclerosis. RESULTS: 42 consecutive patients with surgeries conducted on 52 levels were enrolled. There were 20 males and 22 females. The mean age was 43.6 ±10.89 years. The mean follow-up was 20.85±8.49 months. Definite union was seen in 48 levels (92.3%) by observer 1 and in 40 levels (76.9%) by observer 2. The strength of agreement was moderate. The presence of VEC was observed in 9 levels (17.3%) by observer 1 and in 12 levels (23.1%) by observer 2. The strength of agreement was moderate. The majority of VEC in the endplates were <5mm. The strength of agreement was high. The strength of agreement for location and multiplicity were moderate. The VEC was significantly correlated with the fusion status. CONCLUSIONS: Our study confirmed that VEC were observed following Ti cage placement after PLIF procedures. They tend to be small and might be associated with non-union. Furthermore, it reflected the limited inter-rater reliability of the assessment of both the fusion status and VEC morphology after Ti PLIF cage placement.

Incidence and geographic characteristics of the population with osteoporotic hip fracture in Egypt- by the Egyptian Academy of Bone Health.

This work studies the epidemiology of hip fracture in Egypt. While the incidence of hip fracture in Egypt matches that of the Mediterranean region, there was geographic variation in osteoporotic hip fracture incidence between the north and south of Egypt. PURPOSE: To assess the incidence of hip fracture in Egypt, with special emphasis on the geographic and demographic variation among the Egyptian population. METHODS: The incidence of hip fractures treated in two Egyptian FLS centers was calculated for the period of February 2022-February 2023. Demographic information was recorded for every patient on the national register. All patients completed a baseline questionnaire, had clinical evaluation, fracture risk, falls, and sarcopenia risk assessment. A DXA scan was carried out for every patient. RESULTS: The annual incidence of low-energy hip fracture in individuals aged 40 years or more in Egypt in 2022-2023 was 123.34 per 100,000 in women and 55.19 per 100,000 in men. The incidence of hip fractures was higher in south Egypt (113.62) versus north Egypt (64.8). This was consistent for both genders. Bone mineral density was significantly (p < 0.01) lower in south Egypt at both the spine, distal forearm, as well as hip trochanters, whereas there was no significant difference between both locations in terms of the total hip and neck of the femur. Yet, falls risk, sarcopenia, as well as functional disability rates were significantly (p < 0.001) higher in the north. CONCLUSION: In Egypt, the hip fracture incidence was higher in the south compared to the north. Several modifiable factors contribute to fragility fracture risk independent of BMD, creating complex interrelationships between BMD, risk factors, and fracture risk.

Negative versus natural drainage after single-level posterior lumbar interbody fusion. A prospective randomized study.

Introduction: Despite of their extensive use, drains remain controversial without clear guidelines, and there is unclear evidence on drain use in spine procedures. Negative pressure drainage is theoretically more effective in preventing postoperative hematomas. On the contrary, it may result in excessive drainage and blood loss.The aim of this study was to compare the outcome between the uses of negative versus natural drainage in single level posterior lumbar interbody fusion (PLIF). Research question: The aim is to compare between negative versus natural drainage after single-level PLIF as regard to postoperative wound infection, wound healing, temperature, pain and neurological deficits. Materials and methods: A prospective randomized study of consecutive PLIF patients at a single level for lumbar disc prolapse was performed between January 2019 and January 2020. The patients were randomly assigned to either the negative suction drainage group or natural drainage group. Negative suction was created by maximum compression of the reservoir to create negative pressure. In the other group, natural pressure drainage was kept without any negative pressure.Our study included a total of 62 patients who met the inclusion criteria. They were divided into two groups; 33 patients had negative suction drains and 29 patients had natural drainage. There were 32 female (51.6%) and 30 male (48.4%). Their ages ranged between of 23-69 years, with a mean age of 42.11 â€‹± â€‹8.89 years. Results: Drainage volume was statistically higher in the negative group on the day of surgery (day 0) as well as the 1st and second days after. However, no significant differences were observed as regards to postoperative temperature, pain, wound infection, temperature, or neurological deficits. Discussion &conclusion: In this prospective randomized study, our results revealed that natural drainage in short term can reduce the total amount of blood in the drain, and therefore the blood loss without significant differences in postoperative wound infection, wound healing, temperature, pain, or neurological deficits in single-level PLIF.

Prevalence of Bertolotti's Syndrome in Lumbosacral Surgery Procedures.

Introduction Bertolotti's syndrome (BS) describes the relationship between low back pain (LBP) and lumbosacral transitional vertebra (LSTV). It is a factor that is sometimes overlooked when it comes to evaluating and treating LBP.Because of the different diagnostic modalities and criteria used in the research, the LSTV incidence in the general population varies greatly, and hence the link between LSTV and LBP remains contentious. Some researchers found no link between low back pain and LSTV. As a result, the management of BS remains controversial and multiple treatments have been suggested, including locally injected steroid and various surgical approaches. Methods This retrospective cohort study included a total of 288 patients who underwent lumbosacral surgical procedures for disc prolapse, lumbar canal stenosis, spondylolithesis and post-laminectomy syndrome during the period between January 2016 and May 2020. Trauma, tumours and scoliotic patients were excluded. All data were collected from the departmental database. All cases were done by the same surgical team at El Hadra University Hospital Spine Unit, Egypt. The patients were divided into two groups. Group A consisted of 133 patients in whom LSTV was detected by radiologic findings. In contrast, Group B consisted of 155 patients in whom LSTV was not detected. Results In our study, the overall prevalence of LSTV among 288 patients who underwent lumbosacral surgical interventions was 46.2%. On comparing the incidence of surgical interventions between both groups, there was non-significant difference in most of surgical interventions. The incidence of L3-5 double-level posterior lumbar interbody fusion (PLIF) among LSTV patients was 16.5% compared to 4.61% in the other group. The incidence of L4-S1 double-level PLIF among LSTV patients was 15.04% compared to 7.24% in the other group. Regarding adjacent segment pathology, the incidence of lumbar canal stenosis and degenerative spondylolithesis was higher in the LSTV group (20.3% and 11.3%, respectively) compared to the non-LSTV group (9.7% and 5.2%, respectively). The incidence of disc prolapse was lower in the LSTV group (56.39%) compared to the non-LSTV group (71.0%). There was a non-significant difference between the incidence of lytic spondylolithesis and postlaminectomy syndrome between both groups. Conclusion The overall prevalence of LSTV among all cases who underwent lumbosacral surgical procedures at the El Hadra University Hospital was 46.2%. The incidence of lumbar canal stenosis and degenerative spondylolithesis was higher in the LSTV group compared to the non-LSTV group. However, the incidence of disc prolapse was lower in the LSTV group compared to the non-LSTV group. The incidence of disc prolapse and degenerative spondylolithesis at the L4-5 level was higher in the LSTV group compared to the non-LSTV group. In contrast, the incidence at L5-S1 was lower in the LSTV group compared to the non-LSTV group. Hence, LSTV is considered a risk factor for disc degenerative changes at the level above the transitional vertebra level.

Locking Plate Fixation System for Intracapsular Fracture Neck of Femur in Young Patients.

BACKGROUND: Intra-capsular fractures of the femoral neck in young patients are almost always treated with surgical fixation to preserve the native hip anatomy and biomechanics. Multiple Cannulated hip screws and the sliding hip screw have been the hallmark fixation devices for these injuries. The use of locking cannulated hip screws to a side plate was developed to mitigate the biological and mechanical downfalls of these devices. To report the outcome following the use of a locking plate fixation system in the management of intracapsular fractures of the femoral neck in young patients. MATERIAL AND METHODS: A case series study of all the patients treated in our institution between 2014 and 2017. All eligible patients with hip intracapsular fractures aged between 18 and 65 were treated with a proximal locking hip plate system. The main reported outcomes were union rate, failure of fixation, and development of avascular necrosis of the femoral head. RESULTS: Fifty-six patients (36 men and 20 women) at a mean age of 39.1 years (range 20-65 years) completed 24 months' follow-up. Mean time to surgery was 16 hours. No intraoperative complications were reported. The mean time to union was 15.9 weeks (range 12-23). Three patients (5.3%, one Garden type III, and two type IV) did not achieve union at 6 months. Two patients had revision surgery with valgus osteotomy and the third patient required total hip replacement because of screw penetration. Five patients (8.9%) developed avascular necrosis of the femoral head (2 patients Garden type III, and 3 patients Garden VI). Only two patients required conversion to total hip replacement. CONCLUSIONS: 1. The results in this study showed lower rates of non-union, AVN and secondary operation as compared to published data on both SCH and DHS. 2. It also compares favorably with results reported for dy-namic locking screw systems. 3. The study had few li-mitations, including lack of comparative groups. Also, when considering fracture classification subgroups, the unstable fracture pattern had higher rates of non-union and AVN. 4. This calls for a further larger number of studies dedicated to these fracture categories to ascertain long-term outcome with this type of fixation.

Lateral Compression Sacral Fractures Have Less Favourable Outcome Compared to Crescent Fractures in Patients Less Than 50 Years Old.

BACKGROUND: Lateral compression (LC) accounts for a wide spectrum of pelvic ring injuries (PRIs). The primary aim of this study was to assess the health-related quality of life outcomes of surgically fixed LC crescent versus sacral fractures in patients less than 50 years old after high energy trauma. MATERIAL AND METHODS: We retrospectively reviewed the database for PRIs treated surgically from Decem-ber 2011 to January 2019 at our tertiary level trauma centre. The EuroQoL-5D (EQ5D5L) questionnaire was elec-tronically sent to all patients. Multiple linear regression was conducted to determine the predictors of quality-adjusted life-years (QALYs). RESULTS: The study included 37 patients. The mean age was 26 SD 9.46 years. The mean duration of follow-up was 3.78 (r:1-9) years. Twenty-one (56.8%) and 16 (43.2%) patients sustained sacral fractures and crescent fractures, respectively. Multi-regression analysis showed that any patient with LC injury without a sacral fracture is expected to have a utility value of QALY= 0.876. A reduction of 0.072 units in QALYs is expected in the presence of sacral fracture. About 71% of patients with sacral fractures were able to return to work and this probability increased by 40% among patients with crescent fractures (RR=1.4, p=.015). CONCLUSIONS: 1. Younger patients with crescent fractures tend to have better quality of life (higher EQ5D and QALYs) compared to those with LC sacral fractures. 2. Moreover, patients with LC sacral fractures have less chan-ce to return to their pre-injury level of work compared to those with crescent fractures.