Safety and effectiveness of minimally invasive scoliosis surgery for adolescent idiopathic scoliosis: a retrospective case series of 84 patients.

PURPOSE: The aim of this study was to retrospectively evaluate a prospective series of patients with adolescent idiopathic scoliosis (AIS) who were treated with minimally invasive scoliosis surgery (MISS) technique with a minimum follow-up more than 1 year. MATERIALS AND METHODS: We retrospectively analyzed the prospectively collected data of 84 patients with AIS treated with MIS technique using two or three coin hole size incisions and a muscle-splitting approach. The clinical and radiological data such as the correction of deformity, coronal and sagittal profile and record of the perioperative morbidity of the patients were analyzed. RESULTS: The mean primary Cobb angle was corrected from 59.8° preoperatively to 18.6° postoperatively with a mean correction of 68.9% (p < 0.001). The mean kyphosis at T2 to T12 was maintained within normal range with an increase from 31.2° preoperatively to 35.3° postoperatively (p < 0.001). The 30-day perioperative complication rate was 7.14% with one deep infection and five cases of hemothorax. The mean operation time was 312.8 min; mean estimated blood loss was 846.6 ml (range 420-2800); and mean length of stay was 8.5 days (range 5 to 14). All data of postoperative SRS-22 questionnaire were significantly improved (p < 0.001). CONCLUSION: MISS used for AIS provides adequate correction in both planes and acceptable rate of perioperative complications, with a low estimated blood loss and short length of stay. Considering all the positives, the application of MISS technique for AIS seems meaningful and can become a valid alternative to posterior approach in the routine use. These slides can be retrieved under Electronic Supplementary Material.

Delayed presentation of infected common iliac artery pseudoaneurysm caused by malpositioned pedicle screw after minimally invasive scoliosis surgery.

PURPOSE: To report delayed onset common iliac artery perforation and infected pseudoaneurysm caused by malpositioned pedicle screw after minimally invasive scoliosis surgery (MISS). METHODS: A 21-year-old female was referred to our hospital with a 1-week history of abrupt right-sided low back pain, lower abdominal pain, and fever with a history of MISS using cannulated pedicle screws 18 months earlier. Paravertebral arterial erosion with pseudoaneurysm and retroperitoneal and paraspinal abscess were suspected. RESULTS: We performed resection of the pseudoaneurysm, vascular repair of right common iliac artery by angioplasty with a bovine patch and removal of implant. At 6 months after the last surgery, she had no limitations or problems in her daily activities with no recurrence of low back pain, abdominal pain, or fever as well as without loss of deformity. CONCLUSIONS: Our case showed that misplaced pedicle screws can cause potentially fatal complications, such as infected pseudoaneurysm, even in the late postoperative period.

Polyurethane meniscal scaffolds lead to better clinical outcomes but worse articular cartilage status and greater absolute meniscal extrusion.

PURPOSE: Implantation of polyurethane (PU) meniscal scaffolds has become a popular procedure to provide a scaffold for vessel ingrowth and meniscal tissue regeneration in patients with partial meniscal defects. However, it is unclear whether PU meniscal scaffolds lead to better clinical and magnetic resonance imaging (MRI) outcomes post-operatively. This meta-analysis compared the clinical and MRI outcomes in patients with partial meniscal defects treated with PU meniscal scaffolds. METHODS: This meta-analysis reviewed all studies that assessed Lysholm score, International Knee Documentation Committee (IKDC) score, visual analogue scale (VAS) for pain, Tegner score, Knee Injury and Osteoarthritis Outcomes Score (KOOS), articular cartilage (AC), absolute meniscal extrusion (AME), morphology and size (MS), signal intensity (SI) of meniscal implant, and interface of the implant-residual meniscus complex (IIRMC) in patients with partial meniscal defects treated with PU meniscal scaffolds. RESULTS: Eighteen studies were included in the meta-analysis. The proportion of patients who evaluated MS (OR 0.71, 95% CI 0.38-1.33; n.s.), SI (OR 1.07, 95% CI 0.53-2.18; n.s.), and IIRMC (OR 1.00, 95% CI 0.33-3.06; n.s.) did not differ significantly between baseline and final follow-up. However, AC (OR 0.31, 95% CI 0.11-0.84; P = 0.02) and AME (OR 0.05, 95% CI 0.01-0.18; P < 0.00001) worsened between baseline and final follow-up. Conversely, Lysholm score (95% CI -1.87 to -1.07; P < 0.00001), IKDC score (95% CI -2.19 to -1.08; P < 0.00001), VAS for pain (95% CI -2.29 to -1.07; P < 0.00001), Tegner score (95% CI -0.76 to -0.15; P = 0.003), and overall KOOS (95% CI -29.48 to -23.17; P < 0.00001) were significantly greater at final follow-up when compared to baseline. CONCLUSION: This meta-analysis found no significant differences in the tested MRI parameters, including MS, SI, and IIRMC. However, AC and AME worsened between baseline and final follow-up. Conversely, patients treated with PU meniscal scaffolds showed significant functional improvement and pain relief when compared with baseline scores. Thus, PU meniscal scaffolds appear to be a viable alternative for patients with partial meniscal defects, although further studies are needed to determine whether worsened AC and AME are clinically relevant. In particular, precise measurement of PU meniscal scaffolds in combination with thorough investigation of the baseline articular cartilage status and meniscal defect size may be effective for pain relief or functional improvement in patients with PU meniscal scaffold implantation. LEVEL OF EVIDENCE: III.

Intravenous versus topical tranexamic acid administration in primary total knee arthroplasty: a meta-analysis.

PURPOSE: This meta-analysis was designed to compare the effectiveness and safety of intravenous (IV) versus topical administration of tranexamic acid (TXA) in patients undergoing primary total knee arthroplasty (TKA) by evaluating the need for allogenic blood transfusion, incidence of postoperative complications, volume of postoperative blood loss, and change in haemoglobin levels. METHODS: Studies were included in this meta-analysis to check whether they assessed the allogenic blood transfusion rate, postoperative complications including pulmonary thromboembolism (PTE) or deep vein thrombosis (DVT), volume of postoperative blood loss via drainage, estimated blood loss, total blood loss, and change in haemoglobin levels before and after surgery in primary TKA with TXA administered through both the IV and topical routes. RESULTS: Ten studies were included in this meta-analysis. The proportion of patients requiring allogenic blood transfusion (OR 1.34, 95 % CI 0.63-2.81; n.s.) and the proportion of patients who developed postoperative complications including PTE or DVT (OR 0.85, 95 % CI 0.41 to 1.77; n.s.) did not significantly differ between the two groups. There was 52.3 mL less blood loss via drainage (95 % CI -50.74 to 185.66 mL; n.s.), 52.1 mL greater estimated blood loss (95 % CI -155.27 to 51.03 mL; n.s.), and 51.4 mL greater total blood loss (95 % CI -208.16 to 105.31 mL; n.s.) in the topical TXA group as compared to the IV TXA group. The two groups were also similar in terms of the change in haemoglobin levels (0.02 g/dL, 95 % CI -0.36 to 0.39 g/dL; n.s.). CONCLUSIONS: In primary TKA, there are no significant differences in the transfusion requirement, postoperative complications, blood loss, and change in haemoglobin levels between the IV and topical administration of TXA. In addition, results from subgroup analysis evaluating the effect of the times of TXA administration through the IV route suggested that double IV dose of TXA is more effective than single dose in terms of the transfusion requirements and blood loss via drainage. The current meta-analysis indicates that IV administration of 10 mg/kg of TXA 20 min before inflation of the tourniquet followed by 10 mg/kg of TXA 15 min before deflation of the tourniquet is effective and safe. The topical administration of 2 g of TXA mixed with 100 mL of normal saline after wound closure could be an alternative option in patients at greater risk of thromboembolic complications. LEVEL OF EVIDENCE: Meta-analysis, Level III.