Enabling Technologies and the Development of Single Position Lateral Spine Surgery.

Technological advances have paved the way for surgical innovation in spine surgery. These advances have allowed for the creation of more accurate and less invasive surgical techniques. Spine surgeons play a critical role in the integration of new technology into the surgical workflow with the goal of improving safety, efficiency, and clinical outcomes. Navigation and robotic techniques are emerging technologies that have begun to revolutionize spine surgery. One particular advancement these technologies have recently enabled is single position prone lateral surgery. This review provides a history and brief overview of the different applications of new technologies in spine surgery. It will also discuss their enablement of single position prone lateral surgery in order to more critically evaluate their utilization.

No Clear Benefit of Chlorhexidine Use at Home Before Surgical Preparation.

INTRODUCTION: Several studies have evaluated the efficacy of home use of chlorhexidine before surgery to reduce bacterial colonization. However, these studies have provided conflicting evidence about the potential efficacy of this strategy in decreasing bacterial loads and infection rates across surgical populations, and no prior study has analyzed the benefit of this intervention before spine surgery. We prospectively analyzed the effectiveness of chlorhexidine gluconate wipes for decreasing bacterial counts on the posterior neck. METHODS: Sixteen healthy adults participated in this prospective study. The right side of each participant's neck was wiped twice (the night before and the morning of the experiment) with chlorhexidine gluconate wipes. The left side was used as the control region. Bacterial swabs were obtained as a baseline upon enrollment in the study, then upon arrival at the hospital, and, finally, after both sides of the neck had received standard preoperative scrubbing. RESULTS: All patients had positive baseline bacterial growth (median >1,000 colonies/mL). When chlorhexidine gluconate wipes were used, decreased bacterial counts were noted before the preoperative scrub, but this finding was not statistically significant (P = 0.059). All patients had zero bacteria identified on either side of their neck after completion of the preoperative scrub. CONCLUSION: At-home use of chlorhexidine gluconate wipes did not decrease the topical bacterial burden. Therefore, using chlorhexidine gluconate wipes at home before surgery may offer no added benefit.

Recovery room radiographs after total hip arthroplasty: tradition vs utility?

Routine inpatient radiographs after total hip arthroplasty can be taken in the recovery room immediately after surgery or in the radiology suite later in the hospital stay. In a review of 632 consecutive recovery room series, we found that 17% of series were inadequate to detect technical issues. We identified technical issues on 12 series (1.9%) and technical issues that impacted inpatient management on 2 series (0.3%). One of these 2 was a dislocation that was detected clinically before imaging. The other was a medial penetration of an acetabular screw that probably did not require the immediate revision that it received. Findings suggest that the single routine inpatient series should be taken in the radiology suite, rather than in the recovery room.

The efficacies of 2 ceramic bone graft extenders for promoting spinal fusion in a rabbit bone paucity model.

STUDY DESIGN: Prospective, randomized, controlled animal study. OBJECTIVE: To determine the efficacies of 2 ceramic composite bone graft extenders for promoting spinal fusion. SUMMARY OF BACKGROUND DATA: Although autogenous bone is still considered the "gold standard" graft material for fusion procedures, its use is associated with a number of limitations. Synthetic ceramic composites represent a class of osteoconductive materials that may be employed as supplements or even alternatives to autograft. In this study, we compared the fusion rates generated by 2 ceramic composite bone graft extenders (MasterGraft and Mozaik Strips) with that obtained with autograft in a rabbit bone paucity model. METHODS: Thirty-two New Zealand white rabbits undergoing noninstrumented posterolateral lumbar fusion were randomized to 1 of the following 4 groups: 100% autograft, 50% autograft, 50% autograft with Mozaik Strip, and 50% autograft with MasterGraft Strip. The rabbits were followed postoperatively for 8 weeks at which time the spinal segments were explanted and assessed for the presence of a solid fusion. RESULTS: The arthrodesis rates by manual palpation of the 100% and 50% autograft controls were 75% (6 of 8 animals) and 12.5% (1 of 8), respectively (P < 0.01). In the 50% autograft/Mozaik and 50% autograft/MasterGraft groups, 3/8 and 1/8 of the rabbits were determined to have fused successfully, respectively (P = 0.569). However, there were no significant differences between the fusion rate of the 50% autograft cohort and those exhibited by the Mozaik or MasterGraft animals (P = 0.569 and 1.00, respectively). CONCLUSION: This study provides further evidence that the quantity of autograft may influence the process of spinal fusion such that the arthrodesis rate was significantly lower when less bone was implanted. Neither of the ceramic composite scaffolds seemed to enhance the fusion response compared to an equivalent amount of autograft alone, suggesting that these substances may need to be combined with other osteogenic materials to optimize bone production.

Substantial variation in the interpretation of financial disclosure policies for orthopaedic society meetings.

BACKGROUND: Physician disclosure of potential conflicts of interest is currently controversial. To address this issue, orthopaedic societies have implemented a variety of guidelines related to potential conflict-of-interest disclosure. Transparency is crucial to address the concerns about potential conflict-of-interest disclosure. Nonetheless, prior studies have noted substantial discrepancies in disclosures to societies for individual authors who present their research work at multiple conferences. Our goal was to evaluate the ability of orthopaedic surgeons to interpret disclosure policy statements regarding project-specific or global disclosure instructions. METHODS: The disclosure policy statements of the ten conferences most frequently attended by this group were collected, and selected statements were compiled into a questionnaire survey that was administered to orthopaedic faculty and trainees at our institution. Subjects were asked to read each statement and identify whether they interpreted the policy to be requesting project-specific disclosures (potential conflict of interest related to the research work in the abstract being submitted) or global disclosure (inclusive of all potential conflicts of interest, including those not associated with the abstract being submitted). The correct responses were identified by communicating with the individual societies and determining the responses desired by the society. RESULTS: The study had a 100% return rate from seventeen orthopaedic faculty, twenty-five orthopaedic residents and fellows, and twenty-five medical students. The average number of incorrect responses to the ten questions was 2.8. Forty-six percent of respondents had three or more incorrect responses, 24% had two incorrect responses, 19% had one incorrect response, and 10% had no incorrect responses. There was no significant difference in responses between those of different training levels. Subjects were no more likely to answer a project-specific question incorrectly than they were to answer a global question incorrectly. CONCLUSIONS: This study clearly demonstrated a discrepancy between what societies intend to identify with disclosure policies and what the orthopaedist interprets is intended. Almost half of those completing the survey did not correctly understand the intention of three or more of the policies, even with expected study intent bias. This study showed that the language used in disclosure policy statements and the lack of a uniform policy may be a cause of substantial discrepancies in potential conflict-of-interest disclosure.

The effects of three different types of orthoses on the range of motion of the lumbar spine during 15 activities of daily living.

STUDY DESIGN: Prospective cohort study. OBJECTIVE: To quantify which 3 common lumbar orthoses of varying rigidity restrict both full, active range of motion (ROM) and functional ROM required for activities of daily living (ADL). SUMMARY OF BACKGROUND DATA: Spinal orthoses are implemented to restrict lumbar motion. Despite widespread prevalence of lumbar bracing, the efficacy of these appliances for immobilizing the spine has not been definitively established. METHODS: The full, active ROM of 10 asymptomatic individuals was quantified using an electrogoniometer that registered maximum rotation in all planes. Subjects subsequently completed 15 simulated ADLs during which time their functional ROM was measured; performed without a brace and while wearing a corset, semirigid lumbosacral orthosis (LSO), and rigid custom-molded LSO. RESULTS: For flexion/extension, the mean percentage decreases (with SDs) in full, active ROM that were recorded with corset, semirigid, and a custom orthosis were 24.1 ± 7.9%, 46.8 ± 7.1%, and 64.7 ± 8%, respectively (P < 0.001 relative to no brace). In the coronal plane, motion was restricted by 33.9 ± 8.8%, 51.9 ± 9.4%, and 49.1 ± 11.8%, respectively (P < 0.001). Finally, rotation was limited by 39.6 ± 8.8%, 59.2 ± 10.2%, and 70.6 ± 5.4%, respectively (P < 0.001). There were no significant discrepancies between the ROM recorded in the semirigid and custom LSOs for the ADLs. Likewise, functional ROM associated with corset and semirigid LSOs were only different for 2 ADLs whereas significant disparities between values with corset and custom LSOs were observed for 4 simulations. CONCLUSION: The full, active ROM allowed by lumbar braces evaluated was greater than employed during ADLs in absence of any brace. The motion decrease beyond actual restriction of the braces suggests they will act primarily as proprioceptive guides to regulate movement.

Quantifying the variability of financial disclosure information reported by authors presenting research at multiple sports medicine conferences.

In the study reported here, we compared self-reported industry relationships of authors who attended 3 major orthopedic sports medicine conferences during a single calendar year. Our goal was to calculate the variability between disclosure information over time. A significant percentage of authors who attended these meetings were inconsistent in submitting their disclosure information. In addition, most authors with irregularities had more than 1 discrepancy. We believe that the vast majority of the observed discrepancies did not result from intentional deception on the part of the authors but instead from ongoing confusion regarding which industry relationships should be acknowledged for particular meetings (some specialty societies require that all relationships be divulged, whereas others require only those affiliations directly applicable to research being presented). In the absence of a uniform disclosure policy that is widely adopted by many specialty societies, these findings suggest that the disclosure process will continue to be plagued by inconsistent reporting of financial conflicts of interest.

Contemporary management of symptomatic lumbar disc herniations.

Lumbar disc herniations are common clinical entities that may cause lumbar-related symptoms. The spectrum of treatment options is geared toward a patient's clinical presentation and ranges from nothing to surgical intervention. Many lumbar disc herniations cause no significant symptoms. In studies of asymptomatic individuals who have never experienced lumbar-related symptoms, 30% have been reported to have major abnormality on magnetic resonance imaging. The mainstay of treatment of patients with symptomatic disc herniations is accepted to be nonoperative (as long as there are no acute or progressive neurologic deficits); this includes medications, physical therapy, and potentially lumbar injection. For patients with symptomatic disc herniations who fail to respond appropriately to conservative measures, surgical intervention may be considered. For this population, lumbar discectomy is considered to be a good option.