What Is the Evidence Supporting Osteobiologic Use in Revision Anterior Cervical Discectomy and Fusion?

STUDY DESIGN: Systematic literature review. OBJECTIVE: To analyze the literature and describe the evidence supporting osteobiologic use in revision anterior cervical discectomy and fusion (ACDF) surgery. METHODS: A systematic search of PubMed/MEDLINE, EMBASE, Cochrane library, and ClinicalTrials.gov databases was conducted for literature reporting the use of osteobiologics in revision ACDF. We searched for studies reporting outcomes of using any osteobiologic use in revision ACDF surgeries (independently of the number of levels) in the above databases. RESULTS: There are currently no studies in the literature describing the outcome and comparative efficacy of diverse osteobiologic agents in the context of revision ACDF surgery. A majority of the current evidence is based only upon studies involving primary ACDF surgery. CONCLUSION: The current study highlights the paucity of literature evidence on the role of diverse osteobiologics in revision ACDF, and foregrounds the need for high-quality evidence on this subject.

Simple and inexpensive synovial fluid biomarkers for the diagnosis of prosthetic joint infection according to the new EBJIS definition.

Introduction: diagnosis of periprosthetic joint infection (PJI) is challenging, as no single test has absolute accuracy. The purpose of this study was to assess the utility of different simple synovial biomarkers in the diagnosis of PJI as defined by the European Bone and Joint Infection Society (EBJIS). Methods: we retrospectively identified all patients undergoing revision hip or knee arthroplasty from 2013 to 2019 on our prospectively maintained database. Only patients with minimum required infection diagnostic workup were included in the study. Patients with comorbidities that may influence the accuracy of synovial biomarkers were excluded. Receiver operator characteristic (ROC) curves were utilised to assess the diagnostic utility of synovial fluid white blood cell (WBC) count, polymorphonuclear leukocyte percentage (PMN %), C-reactive protein (CRP), adenosine deaminase (ADA), and alpha-2-microglobulin (A2M). Results: in total, 102 patients met the inclusion criteria. Of these, 58 were classified as infection unlikely, 8 as infection likely, and 36 as infection confirmed. Synovial WBC count (area under the curve (AUC) 0.94) demonstrated the best utility for the diagnosis of PJI, followed by PMN % (AUC 0.91), synovial CRP (AUC 0.90), ADA (AUC 0.82), and A2M (AUC 0.76). We found added value in the combined interpretation of different biomarkers. We calculated high sensitivity and negative predictive value if at least two of them are negative and high specificity and positive predictive value if at least two are elevated. Conclusion: current results show that synovial fluid investigation is a useful tool for the diagnosis of PJI, and the combined interpretation of simple and inexpensive biomarkers demonstrated improved diagnostic accuracy.

Asymmetric Bilateral Chronic Shoulder Dislocation in a Young Patient - A Rare Case Report.

Introduction: Chronic shoulder dislocations are infrequent and can be easily overlooked unless a carefully clinical history, physical examination, and radiographic evaluation are undertaken. Bilateral simultaneous instability is almost pathognomonic for a convulsive disorder. To the best of our knowledge, we describe the first case of asymmetric bilateral chronic dislocation. Case Report: A 34-year-old male patient with a history of epilepsy and schizophrenia and multiple seizure episodes, suffered a bilateral asymmetric shoulder dislocation. Radiological examination revealed a posterior shoulder dislocation of the right shoulder with a severe reverse Hill-Sachs lesion comprising more than 50% of the humeral head surface, while on the left shoulder, a chronic anterior shoulder dislocation with a Hill-Sachs lesion of moderate dimension. On the right shoulder, a hemiarthroplasty was performed, and on the left, a stabilization with Remplissage Technique, subscapularis plication, and temporary trans-articular Steinmann pin fixation was done. After bilateral rehabilitation, the patient showed residual pain in the left shoulder and slight range of motion limitation. There were no new episodes of shoulder instability. Conclusion: Our aim is to emphasize the importance of being alert to flag patients and make a prompt and accurate diagnosis of acute shoulder instability episodes, to avoid unnecessary morbidity, as well as of a high index of suspicion when a history of seizures is present. Despite the uncertain prognosis of a bilateral chronic shoulder dislocation functional results, the surgeon must take into consideration the patient's age, functional demand, and expectations to define the best treatment strategy.

Postoperative impact of rod bending in the lumbar spine fusion surgery with polyaxial screws - Validation of a study.

Introduction: In 2019, Moufid and Gille published a study in which they proposed certain radiological parameters that may justify the mismatch between the lordosis of the lumbar segment and the lordosis of the rod bar using polyaxial screws. The aim of this study is to reproduce the measurements performed by Moufid and Gille and try to validate their findings. Material and methods: A retrospective study was performed including patients submitted to L3-L5 posterior fusion with or without interbody devices using polyaxial screws and titanium rods, for degenerative disease. Radiological parameters were analysed:the distance between the posterior wall and the rod for each vertebra(the standard deviation of the three distances was called Alpha); the angle between the screw and the rod for each screw(mean of the three was called Theta); the angle between screws and superior endplate for each instrumented vertebra(mean of the three was called Lambda). The difference between post-operative segmental lordosis and the lordosis of the rod was called DiffL. Results: A total of 58 cases were included. The most frequent fusion surgery was posterolateral fusion(77.6%). The mean value of lumbar lordosis, fused segmental lordosis, pelvic incidence, Alpha, Theta, Lambda and DiffL were 48.7 ± 12.7°, 28.4 ± 9.2°, 60.7 ± 11.9°, 3.4 ± 1.6 mm, 90.5 ± 1.8°, 3.9 ± 1.8° e 9.9 ± 9.5° respectively. The mean value of rod lordosis was 20.5 ± 8.1°. DiffL varied between 0.1° (practically no mismatch) and 30.5° of mismatch. DiffL didn't correlate with gender, fusion type, age, PI and Alpha, Theta or Lambda. There was a significant positive correlation between lumbar lordosis and DiffL(ρ = 0.28; p = 0.03). No correlation was found between the radiological parameters for the cut-off point proposed by Moufid and Gille(Alpha 4.7 mm, Theta 86°, Lambda 2.8°) and the DiffL value. Conclusion: No significant factors were identified in this study to aid in achieving an ideal match between rod and segmental spine lordosis, therefore not validating the study by Moufid and Gille.