Inter- and intrarater reliability of measuring lengthening of magnetically controlled growing rods on digital radiographs.

PURPOSE: The aim of this study was to determine inter- and intraobserver reliability of delta rod extension, and total rod length measured on digital x-rays in patients with early onset scoliosis (EOS) treated with magnetically controlled growing rods (MCGR). For the last decade, patients with EOS have been treated with MCGR. Replacement of MCGR relies heavily on the measurement done at every lengthening session. Only a few studies have looked at inter- and intraobserver reliability of rod lengthening, and none have used the delta extension before. METHODS: 202 radiographs presented in random order were rated and measured twice with at least a 14-day interval and differing order of the radiographs. The measuring was done at both rods. All x-rays came from 15 patients diagnosed with EOS and treated with MCGR from 2009 until 2019. The total extension length and the delta extension (the difference in total extension length between two lengthening in succession) were measured, and the intraclass correlation coefficient (ICC) calculated for both measurements RESULTS: Intrarater ICC scores varied from moderate to good, but non-significantly. Interrater reliability increased significantly from moderate (ICC 0.72 [0.68; 0.76] and 0.73 [0.69; 0.77] to excellent (ICC 0.91 [0.88; 0.93] and 0.97 [0.96: 0.98]), when examining delta extension every sixth instead of every second month. CONCLUSION: Measuring rod lengthening on x-rays can be done every 6 months, with an ample reliability. The ICC's for the delta extension with 2-3 months interval were only moderately precise, compared to the near perfect ICC's for the total extension length.

Comparison of interventions for lumbar disc herniation: a systematic review with network meta-analysis.

BACKGROUND: Implants for use in disc herniation surgery have been commercially available for some time. Several clinical trials have shown promising results. There are now a wide variety of surgical methods for treating lumbar disc herniation. PURPOSE: The objective of this systematic review was to compare all current surgical methods for disc herniation, including newer methods with implants for annulus repair and dynamic stabilization. STUDY DESIGN: Systematic review and network meta-analysis. METHODS: PRISMA-P guidelines were followed in this review. Literature search in PubMed, Embase, and Cochrane library databases identified eligible randomized controlled trials (RCT) studies comparing interventions for lumbar disc surgery. The investigated outcomes were: changes in pain score, disability score and reoperation rate with a minimum follow-up of 1 year. Risk of bias was assessed in concordance with Cochrane Neck and Back Review Group recommendation. A network meta-analysis was performed using gemtc and BUGSnet software, and each outcome evaluated using Confidence in Network Meta-Analysis (CINeMA). RESULTS: Thirty-two RCT studies, with 4,877 participants, and eight different interventions were identified. A significant difference was seen in change of pain score, as all treatments were superior to conservative treatment and percutaneous discectomy. This difference was only found to be of clinically importance when comparing conservative treatment and dynamic stabilization. There was no significant difference in reoperation rates or change in disability score, regardless of treatment. However, SUCRA plots showed a trend in ranking annulus repair and dynamic stabilization highest. Risk of bias assessment showed that 15 studies had a high overall risk of bias. Meta-regression with risk of bias as covariate did not indicate any influence in risk of bias on the model. Confidence in Network Meta-Analysis evaluation showed a high level of confidence for all treatment comparisons. CONCLUSIONS: With this network meta-analysis, we have aimed to compare all treatments for herniated lumbar disc in one large comprehensive systematic review and network meta-analysis. We have compared across the three main outcomes: disability score, pain score and reoperation rate. We were not able to rank one single treatment as the best. Most of the treatment performed at the same level. However percutaneous discectomy and conservative treatment consistently performed worse than the other treatments. In general, the CINeMA evaluation according to the GRADE recommendations gave a high level of confidence for the study comparisons.

Temporary axial rotation stabilization for lumbar disc herniation surgery with the ARO® spinal system: a prospective analysis of safety and clinical efficacy.

BACKGROUND: Decompressive surgery has a failure rate of between 25% and 32% based on patient reported improvement in clinical symptoms. Significant back pain is associated with 53% of failures of decompressive surgery, while also being associated with abnormal axial rotation motion. We report on the clinical performance of subjects receiving a novel axial rotation stabilization implant (ARO Spinal System, ARO Medical), while undergoing a surgical decompression for a herniated lumbar disc, a condition associated with low back pain and abnormal movement. METHODS: This Danish Medicines Agency and Ethics Committee approved clinical trial prospectively investigated the use of the ARO® Spinal System as part of lumbar discectomy surgery in 20 patients. All subjects had a single level posterolateral lumbar herniation with symptoms lasting more than 6 weeks. They underwent an open discectomy at the symptomatic level, and received the implant. RESULTS: No complications with the implant were observed. Four serious adverse events not related to the devices were reported, one subject had reoperation at 3 months. Leg pain median VAS score decreased from 70 to 2 at 1 year (P=0.01) back pain median VAS score from 48 to 6 (P=0.04). Satisfaction with surgery was 88%. Oswestry Disability Index scored likewise improvement going from 38 pre-operative to 5 at 1 year. Follow-up rate was excellent 100%. CONCLUSIONS: Discectomy with the ARO Spinal System proves equally safe as a standard discectomy at 1 year follow-up. The subjects had significant improvements in both leg and back pain. In addition, they did better than historical controls, though not statistically so in this patient sample.