Vascularized Bone Grafting for Reconstruction of Oncologic Defects in the Spine: A Systematic Review and Pooled Analysis of the Literature

Background Resection of primary spinal tumors requires reconstruction for restoration of spinal column stability. Traditionally, some combination of bone grafting and instrumentation is implemented. However, delayed healing environments are associated with pseudoarthrodesis and failure. Implementation of vascularized bone grafting (VBG) to complement hardware may present a solution. We evaluated the use of VBG in oncologic spinal reconstruction via systematic review and pooled analysis of literature. Methods We searched PubMed/MEDLINE, Embase, Cochrane, and Scopus for studies published through September 2017 according to the PRISMA guidelines and performed a pooled analysis of studies with n > 5. Additionally, we performed retrospective review of patients at the Johns Hopkins Hospital that received spinal reconstruction with VBG. Results We identified 21 eligible studies and executed a pooled analysis of 12. Analysis indicated an 89% (95% confidence interval [CI]: 0.75–1.03) rate of successful union when VBG is employed after primary tumor resection. The overall complication rate was 42% (95% CI: 0.23–0.61) and reoperation rate was 27% (95% CI: 0.12–0.41) in the pooled cohort. Wound complication rate was 18% (95% CI: 0.11–0.26). Fifteen out of 209 patients (7.2%) had instrumentation failure and mean time-to-union was 6 months. Consensus in the literature and in the patients reviewed is that introduction of VBG into irradiated or infected tissue beds proves advantageous given decreased resorption, increased load bearing, and faster consolidation. Downsides to this technique included longer operations, donor-site morbidity, and difficulty in coordinating care. Conclusions Our results demonstrate that complication rates using VBG are similar to those reported in studies using non-VBG for similar spinal reconstructions; however, fusion rates are better. Given rapid fusion and possible hardware independence, VBG may be useful in reconstructing defects in patients with longer life expectancies and/or with a history of chemoradiation and/or infection at the site of tumor resection.

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The 25th anniversary of the retrograde suction decompression technique (Dallas technique) for the surgical management of paraclinoid aneurysms: historical background, systematic review, and pooled analysis of the literature

Journal of Neurosurgery ◽

10.3171/2017.11.jns17546 ◽

2019 ◽

Vol 130 (3) ◽

pp. 902-916 ◽

Cited By ~ 1

Author(s):

Bruno C. Flores ◽

Jonathan A. White ◽

H. Hunt Batjer ◽

Duke S. Samson

Keyword(s):

Systematic Review ◽

Complication Rate ◽

Neurological Outcome ◽

Pooled Analysis ◽

Morbidity And Mortality ◽

Secondary Outcome ◽

25Th Anniversary ◽

Paraclinoid Aneurysms ◽

Temporary Occlusion ◽

The Mean

OBJECTIVEParaclinoid internal carotid artery (ICA) aneurysms frequently require temporary occlusion to facilitate safe clipping. Brisk retrograde flow through the ophthalmic artery and cavernous ICA branches make simple trapping inadequate to soften the aneurysm. The retrograde suction decompression (RSD), or Dallas RSD, technique was described in 1990 in an attempt to overcome some of those treatment limitations. A frequent criticism of the RSD technique is an allegedly high risk of cervical ICA dissection. An endovascular modification was introduced in 1991 (endovascular RSD) but no studies have compared the 2 RSD variations.METHODSThe authors performed a systematic review of MEDLINE/PubMed and Web of Science and identified all studies from 1990–2016 in which either Dallas RSD or endovascular RSD was used for treatment of paraclinoid aneurysms. A pooled analysis of the data was completed to identify important demographic and treatment-specific variables. The primary outcome measure was defined as successful aneurysm obliteration. Secondary outcome variables were divided into overall and RSD-specific morbidity and mortality rates.RESULTSTwenty-six RSD studies met the inclusion criteria (525 patients, 78.9% female). The mean patient age was 53.5 years. Most aneurysms were unruptured (56.6%) and giant (49%). The most common presentations were subarachnoid hemorrhage (43.6%) and vision changes (25.3%). The aneurysm obliteration rate was 95%. The mean temporary occlusion time was 12.7 minutes. Transient or permanent morbidity was seen in 19.9% of the patients. The RSD-specific complication rate was low (1.3%). The overall mortality rate was 4.2%, with 2 deaths (0.4%) attributable to the RSD technique itself. Good or fair outcome were reported in 90.7% of the patients.Aneurysm obliteration rates were similar in the 2 subgroups (Dallas RSD 94.3%, endovascular RSD 96.3%, p = 0.33). Despite a higher frequency of complex (giant or ruptured) aneurysms, Dallas RSD was associated with lower RSD-related morbidity (0.6% vs 2.9%, p = 0.03), compared with the endovascular RSD subgroup. There was a trend toward higher mortality in the endovascular RSD subgroup (6.4% vs 3.1%, p = 0.08). The proportion of patients with poor neurological outcome at last follow-up was significantly higher in the endovascular RSD group (15.4% vs 7.2%, p < 0.01).CONCLUSIONSThe treatment of paraclinoid ICA aneurysms using the RSD technique is associated with high aneurysm obliteration rates, good long-term neurological outcome, and low RSD-related morbidity and mortality. Review of the RSD literature showed no evidence of a higher complication rate associated with the Dallas technique compared with similar endovascular methods. On a subgroup analysis of Dallas RSD and endovascular RSD, both groups achieved similar obliteration rates, but a lower RSD-related morbidity was seen in the Dallas technique subgroup. Twenty-five years after its initial publication, RSD remains a useful neurosurgical technique for the management of large and giant paraclinoid aneurysms.

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Complication rates associated with antegrade use of vascular closure devices: a systematic review and pooled analysis

Journal of Vascular Surgery ◽

10.1016/j.jvs.2020.08.133 ◽

2020 ◽

Author(s):

Sean A. Kennedy ◽

Dheeraj K. Rajan ◽

Paul Bassett ◽

Kong Teng Tan ◽

Arash Jaberi ◽

...

Keyword(s):

Systematic Review ◽

Pooled Analysis ◽

Complication Rates ◽

Vascular Closure Devices

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Arthroscopic iliopsoas tenotomies: a systematic review of surgical technique and outcomes

Hip International ◽

10.1177/1120700020970519 ◽

2020 ◽

pp. 112070002097051

Author(s):

Remy Coulomb ◽

Bastien Nougarede ◽

Etienne Maury ◽

Philippe Marchand ◽

Olivier Mares ◽

...

Keyword(s):

Systematic Review ◽

Surgical Technique ◽

Complication Rate ◽

Data Extraction ◽

Central Compartment ◽

Direct Access ◽

Cochrane Library ◽

Complication Rates ◽

Lesser Trochanter ◽

Loss Of Strength

Purpose: To evaluate the technique, results and complications of arthroscopic iliopsoas tenotomies either on native hips or total hip arthroplasty (THA). Methods: A systematic review was performed using 3 databases: PubMed, EMBASE and the Cochrane library from January 2000 to December 2018 in accordance with the PRISMA procedure. The literature search, data extraction and quality assessment were conducted by 2 independent reviewers. Surgical technique, clinical outcomes, recurrences and complication rate were evaluated. Results: Out of 115 articles reviewed, 20 articles concerned native hips and 8 articles THA. 3 levels of release were described. For native hips, the recurrence rate was higher for central compartment than peripheral or lesser trochanter releases. Complication rates were similar for hip arthroscopy but remained low in all series. Loss of strength was evaluated mainly using the MRC muscle scale. Most studies noted strength recovery. MRI analysis of muscle atrophy was greater for lesser trochanter than for central compartment release but unrelated to loss of strength. The complication rate was low for tenotomy after THA, heterotopic ossification being the most common complication. Conclusions: Central compartment releases lead to the highest rate of recurrence due to incomplete release. Peripheral releases have a potential risk of vascular injury. The lesser trochanteric approach has the disadvantage of not having direct access to the joint. The main difficulty with THA lies in the diagnosis of cup/iliopsoas impingement. Diagnostic tests with infiltration should be made before iliopsoas release to prevent its failure. Cup protrusion of over 8mm is a potential indication for acetabular revision.

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Proximal versus Distal Recipient Vessels in Lower Extremity Reconstruction: A Retrospective Series and Systematic Review

Journal of Reconstructive Microsurgery ◽

10.1055/s-0037-1621746 ◽

2018 ◽

Vol 34 (05) ◽

pp. 334-340 ◽

Cited By ~ 3

Author(s):

Zachary Borab ◽

William Rifkin ◽

Adam Jacoby ◽

Z-Hye Lee ◽

Lavinia Anzai ◽

...

Keyword(s):

Systematic Review ◽

Lower Extremity ◽

Free Flaps ◽

Pooled Analysis ◽

Perioperative Outcomes ◽

Complication Rates ◽

Recipient Vessel ◽

Lower Extremity Reconstruction ◽

Extremity Reconstruction ◽

The Impact

Background Recipient vessels proximal to the zone of injury have traditionally been preferred for lower extremity reconstruction. However, more recent data have shown mixed outcomes when performing anastomoses distal to the zone of injury. We investigated the impact of recipient vessel location on free flap outcomes. Methods Retrospective review (1979–2016); 312 soft tissue free flaps for open tibia fractures met inclusion criteria. Flap characteristics and perioperative outcomes were examined. Systematic review identified articles evaluating anastomosis location and flap outcomes; pooled data analysis was performed. Results More anastomoses were performed proximal to the zone of injury (80.7%) than distal (19.3%). Distal anastomoses were not associated with increased take back rates (19.6%) compared with proximal (23.8%) anastomoses (p = 0.356). Regression analysis comparing proximal and distal anastomoses found no difference in partial flap failures (7.4% vs 11.9%; p = 0.978) or total flap failures (9.3% vs 9.3%; p = 0.815) when controlling for the presence of arterial injury, flap type, and time from injury to coverage. Systematic review yielded 11 articles with 1,245 proximal and 127 distal anastomoses for comparison. Pooled analysis (p = 0.58) and weighted comparative analysis (p = 0.39) found no difference in flap failure rates between proximal and distal groups. Conclusion Our results are congruent with the current lower extremity literature and demonstrate no difference in perioperative complication rates between anastomoses performed proximal or distal to the zone of injury. These findings suggest that anastomotic location choice should be based primarily on recipient vessel quality/flow and ease of access/exposure rather than orientation relative to the zone of injury.

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Complications Related to Latarjet Shoulder Stabilization: A Systematic Review

The American Journal of Sports Medicine ◽

10.1177/03635465211042314 ◽

2021 ◽

pp. 036354652110423

Author(s):

Chul-Hyun Cho ◽

Sang Soo Na ◽

Byung-Chan Choi ◽

Du-Han Kim

Keyword(s):

Systematic Review ◽

Complication Rate ◽

Shoulder Instability ◽

Intraoperative Complications ◽

Cochrane Library ◽

Anterior Shoulder Instability ◽

Complication Rates ◽

Open Approach ◽

Latarjet Procedure ◽

Intraoperative Complication

Background: In cases of recurrent anterior shoulder instability with a glenoid defect, Latarjet procedures are widely used for stabilization. Although complications with this procedure have been reported, few studies have comprehensively analyzed issues related to the Latarjet procedure. Purpose: To identify the overall complication rate of the Latarjet procedure used for anterior shoulder instability and to compare the rate of complications between arthroscopic and open approaches. Study Design: Systematic review; Level of evidence, 4. Methods: PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines were followed by using the PubMed, EMBASE, Scopus, and Cochrane Library databases. Data on complications were extracted and classified as intraoperative, postoperative, or instability-related for further analysis. Quality assessments were performed with criteria from the Methodological Index for Nonrandomized Studies (MINORS). A quantitative synthesis of data was conducted to compare the complication rates between arthroscopic and open approaches. Results: A total of 35 articles were included in this analysis. The MINORS score was 11.89. A total 2560 Latarjet procedures (2532 patients) were included. The overall complication rate was 16.1% (n = 412). The intraoperative complication rate was 3.4% (n = 87) and included a 1.9% (n = 48) incidence of nerve injuries and a 1.0% (n = 25) incidence of iatrogenic fractures. Screw problems, vascular injuries, and conversion arthroscopic to open surgery each occurred at a rate of <1%. The postoperative complication rate was 6.5% (n = 166), and the most common complication was nonunion (1.3%; n = 33). The instability-related complication rate was 6.2% (n = 159) and included a 1.5% (n = 38) rate of redislocation, a 2.9% (n = 75) rate of positive apprehension test, and a 1.0% (n = 26) rate of instability. Overall, 2.6% (n = 66) of patients required an unplanned secondary operation after the initial surgery. The arthroscopic approach was associated with a higher rate of intraoperative complications compared with the open approach (5.0% vs 2.9%; P =.020) and a lower rate of instability-related complications (3.1% vs 7.2%; P < .001). Conclusion: The Latarjet procedure for anterior shoulder instability results in an overall complication rate of 16.1% and a reoperation rate of 2.6%. However, serious complications at short-term follow-up appear rare. When the arthroscopic approach was used, the rate of intraoperative complications was higher, although instability-related complications were lower when compared with the open approach.

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Preoperative embolization and intraoperative cryocoagulation as adjuncts in resection of hypervascular lesions of the thoracolumbar spine

Journal of Neurosurgery Spine ◽

10.3171/spi.2002.97.3.0294 ◽

2002 ◽

Vol 97 (3) ◽

pp. 294-300 ◽

Cited By ~ 6

Author(s):

Remi Nader ◽

Brent T. Alford ◽

Haring J. W. Nauta ◽

Wayne Crow ◽

Eric Vansonnenberg ◽

...

Keyword(s):

Spinal Cord ◽

Tumor Resection ◽

Thoracolumbar Spine ◽

Spinal Tumors ◽

Preoperative Embolization ◽

Physical Separation ◽

Content Type ◽

Spinal Reconstruction ◽

Estimated Blood Loss ◽

Fine Print

Object. The purpose of this study was twofold. First the authors evaluated preoperative embolization alone to reduce estimated blood loss (EBL) when resecting hypervascular lesions of the thoracolumbar spine. Second, they compared this experience with intraoperative cryotherapy alone or in conjunction with embolization to minimize further EBL. Methods. Twelve patients underwent 13 surgeries for hypervascular spinal tumors. In 10 cases the surgeries were augmented by preoperative embolization alone. In one patient, two different surgeries involved intraoperative cryocoagulation, and in one patient surgery involved a combination of preoperative embolization and intraoperative cryocoagulation for tumor resection. When cryocoagulation was used, its extent was controlled using intraoperative ultrasonography or by establishing physical separation of the spinal cord from the tumor. In the 10 cases in which embolization alone was conducted, intraoperative EBL in excess of 3 L occurred in five. Mean EBL was of 2.8 L per patient. In one patient, who underwent only embolization, excessive bleeding (> 8 L) required that the surgery be terminated and resulted in suboptimum tumor resection. In another three cases, intraoperative cryocoagulation was used alone (in two patients) or in combination with preoperative embolization (in one patient). In all procedures involving cryocoagulation of the lesion, adequate hemostasis was achieved with a mean EBL of only 500 ml per patient. No new neurological deficits were attributable to the use of cryocoagulation. Conclusions. Preoperative embolization alone may not always be satisfactory in reducing EBL in resection of hypervascular tumors of the thoracolumbar spine. Although experience with cryocoagulation is limited, its use, in conjunction with embolization or alone, suggests it may be helpful in limiting EBL beyond what can be achieved with embolization alone. Cryocoagulation may also assist resection by preventing spillage of tumor contents, facilitating more radical excision, and enabling spinal reconstruction. The extent of cryocoagulation could be adequately controlled using ultrasonography or by establishing physical separation between the tumor and spinal cord. Additionally, somatosensory evoked potential monitoring may provide early warning of spinal cord cooling.

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Proximal Interphalangeal Joint Arthrodesis Techniques: A Systematic Review

Hand ◽

10.1177/1558944721998019 ◽

2021 ◽

pp. 155894472199801

Author(s):

Harrison Faulkner ◽

Vincent An ◽

Richard D. Lawson ◽

David J. Graham ◽

Brahman S. Sivakumar

Keyword(s):

Systematic Review ◽

Complication Rate ◽

English Language ◽

Plate Fixation ◽

Proximal Interphalangeal Joint ◽

Interphalangeal Joint ◽

Complication Rates ◽

Sample Proportion ◽

The Mean ◽

End Stage

Proximal interphalangeal joint (PIPJ) arthrodesis is a salvage option in the management of end-stage PIPJ arthropathy. Numerous techniques have been described, including screws, Kirschner wires, tension band wiring, intramedullary devices, and plate fixation. There remains no consensus as to the optimum method, and no recent summary of the literature exists. A literature search was conducted using the MEDLINE, EMBASE, and PubMed databases. English-language articles reporting PIPJ arthrodesis outcomes were included and presented in a systematic review. Pearson χ2 and 2-sample proportion tests were used to compare fusion time, nonunion rate, and complication rate between arthrodesis techniques. The mean fusion time ranged from 5.1 to 12.9 weeks. There were no statistically significant differences in fusion time between arthrodesis techniques. Nonunion rates ranged from 0.0% to 33.3%. Screw arthrodesis demonstrated a lower nonunion rate than wire fusion (3.0% and 8.5% respectively; P = .01). Complication rates ranged from 0.0% to 22.1%. Aside from nonunions, there were no statistically significant differences in complication rates between arthrodesis techniques. The available PIPJ arthrodesis techniques have similar fusion time, nonunion rate, and complication rate outcomes. The existing data have significant limitations, and further research would be beneficial to elucidate any differences between techniques.

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A Critical Appraisal of Vascularized Bone Grafting for Scaphoid Nonunion

Journal of Wrist Surgery ◽

10.1055/s-0036-1597575 ◽

2016 ◽

Vol 06 (03) ◽

pp. 251-257 ◽

Cited By ~ 3

Author(s):

Ram Alluri ◽

Christine Yin ◽

Matthew Iorio ◽

Hyuma Leland ◽

Wendy Mack ◽

...

Keyword(s):

Systematic Review ◽

Bone Grafting ◽

Screw Fixation ◽

Kirschner Wire ◽

Surgical Techniques ◽

Scaphoid Nonunion ◽

Patient Centered ◽

Level Of Evidence ◽

Revision Procedure ◽

Vascularized Bone

Background Vascularized bone grafting (VBG) has the potential to yield reliable results in scaphoid nonunion; however, results across studies have been highly variable. This study critically evaluates surgical techniques, fracture location, and patient selection in relation to radiographic, clinical, and patient-centered outcomes after VBG for scaphoid nonunion. Methods We conducted a systematic review of the literature for the use of VBG in scaphoid nonunion. Physical examination, radiographic, and patient-centered outcomes were assessed. Four substratifications were performed: the location of scaphoid nonunion, pedicled versus free technique, Kirschner wire (K-wire) versus screw fixation, and VBG done as a primary versus revision procedure. Results A total of 41 publications were included in final analysis. VBG had an 84.7% union rate at 13 weeks after surgery. On an average, 89% of patients returned to preinjury activity levels by 18 weeks after surgery and 91% of patients reported satisfaction with the procedure. Proximal pole nonunions demonstrated similar union rates but lower functionality scores compared with nonunions across all regions of the scaphoid. Pedicled techniques demonstrated slightly improved range of motion compared with free technique. K-wire versus screw fixation demonstrated significantly higher union rates and faster union times. There were no differences in outcomes for VBG done as a primary versus revision procedure. Conclusion VBG serves as a viable option for the treatment of scaphoid nonunion, with consistent union rates in addition to significantly improved postoperative patient functionality. The fixation of these vascularized bone grafts with K-wires versus screw fixation may result in superior radiologic outcomes. Level of Evidence Therapeutic, Level III, systematic review.

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Surgical Management of Proximal Fifth Metatarsal Fractures in Elite Athletes: A Systematic Review

Orthopaedic Journal of Sports Medicine ◽

10.1177/23259671211037647 ◽

2021 ◽

Vol 9 (9) ◽

pp. 232596712110376

Author(s):

J. Brett Goodloe ◽

William M. Cregar ◽

Alexander Caughman ◽

Evan P. Bailey ◽

William R. Barfield ◽

...

Keyword(s):

Systematic Review ◽

Surgical Management ◽

Complication Rate ◽

Elite Athletes ◽

Return To Play ◽

Treatment Modalities ◽

Iliac Crest Bone Graft ◽

Complication Rates ◽

Exclusion Criteria ◽

Metatarsal Fractures

Background: As a result of the high physical demand in sport, elite athletes are particularly prone to fifth metatarsal fractures. These injuries are typically managed surgically to avoid high rates of delayed union and allow for quicker return to play (RTP). Purpose: To review studies showing clinical and radiographic outcomes, RTP rates, and complication rates after different surgical treatment modalities for fifth metatarsal fractures exclusively in elite-level athletes. Study Design: Systematic review; Level of evidence, 4. Methods: A systematic search was conducted within the PubMed, Scopus, and Cochrane databases from January 2000 to January 2020. Inclusion criteria consisted of clinical outcome studies after operative management of fifth metatarsal fractures in elite athletes. Exclusion criteria consisted of nonoperative management, high school or recreational-level athletic participation, nonclinical studies, expert opinions, and case series with <5 patients. Results: A total of 12 studies met inclusion and exclusion criteria, comprising 280 fifth metatarsal fractures treated surgically. Intramedullary screw fixation was the most common fixation construct (47.9%), and some form of intraoperative adjunctive treatment (calcaneal autograft, iliac crest bone graft, bone marrow aspirate concentrate, demineralized bone matrix) was used in 67% of cases. Radiographic union was achieved in 96.7% of fractures regardless of surgical construct used. The overall mean time to union was 9.19 weeks, with RTP at a mean of 11.15 weeks. The overall reported complication rate was 22.5%, with varying severity of complications. Refracture rates were comparable between the different surgical constructs used, and the overall refracture rate was 8.6%. Conclusion: Elite athletes appeared to have a high rate of union and reliably returned to the same level of competition after surgical management of fifth metatarsal fractures, irrespective of surgical construct used. Despite this, the overall complication rate was >20%. Specific recommendations for optimal surgical management could not be made based on the heterogeneity of the included studies.

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Role of available adjuvant therapies following surgical resection of atypical choroid plexus papilloma—a systematic review and pooled analysis

Neuro-Oncology Advances ◽

10.1093/noajnl/vdaa139 ◽

2020 ◽

Vol 2 (1) ◽

Author(s):

Amin Tavallaii ◽

Ehsan Keykhosravi ◽

Hamid Rezaee ◽

Camellia Kianbakht

Keyword(s):

Systematic Review ◽

Adjuvant Therapy ◽

Choroid Plexus ◽

Outcome Measures ◽

Tumor Resection ◽

Choroid Plexus Papilloma ◽

Pooled Analysis ◽

Adjuvant Therapies ◽

Atypical Choroid Plexus Papilloma ◽

Plexus Papilloma

Abstract Background Atypical choroid plexus papilloma is a recently introduced entity with intermediate pathological characteristics. These tumors are relatively rare and the optimal management of these tumors is a matter of debate. Therefore, we performed a systematic review and pooled analysis about the effects of adjuvant therapies on outcome measures of these patients. We also compared these effects on totally and partially resected tumors and pediatric and adult populations. Methods A systematic search of 3 databases based on inclusion/exclusion criteria was performed. Data extraction was separately performed by 2 authors, and the summarized data were presented in the form of tables. Pooled estimates of different outcome measures were calculated for each adjuvant therapy and presented separately for studies with pediatric, adult, or mixed populations. Results A review of 14 included studies consisting of 144 patients revealed the effect of adjuvant treatment on reduction of tumor recurrence, metastasis, and reoperation rates and increasing survival rates in patients with subtotal tumor resection. This advantage was not seen in the case of gross total tumor resection. Almost all outcome measures were more favorable in the pediatric population. Conclusions It can be concluded that whenever gross total resection is not feasible, the implementation of adjuvant therapy can improve the outcome and prognosis. In other cases, it should be decided on an individual basis. Also, more aggressive behavior and higher rates of recurrence and mortality in the adult population suggest the consideration of more aggressive adjuvant treatments for adult patients.

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