Endplate Abnormalities in Cervical Spondylotic Myelopathy and Association with Pre- and Post-operative(Single-level ACDF with a Zero-P Implant)Sagittal Parameters and Clinical Outcomes.

Abstract Background:Endplate abnormalities in cervical spine were closed related to pre- and post-operative symptoms, and might lead to a certain complication. However, the related researches are few, and the associations between endplate abnormalities and clinical outcomes need more evidence. Correlations between endplate abnormalities and pre- and post-operative cervical sagittal parameters also remain unknown. The purpose of this study was to explore endplate abnormalities in cervical spondylotic myelopathy, and to find potential associations of endplate abnormalities with preoperative cervical sagittal parameters, disc degeneration and symptoms, and clinical outcomes after ACDF.Method:We enrolled 65 patients (34 males, 31 females) who were diagnosed with CSM and were subjected to single-level ACDF with a Zero-P implant at our hospital from 2015 to 2018. The patients were divided into two groups according to whether the endplate was abnormal.We conducted a retrospective study to compare the clinical and radiological results among the two groups.Results:The average age in endplate abnormality group was higher than it in no abnormality group (P<0.001). T1S was significantly higher in abnormality group than in the normal group of preoperative (P<0.05) and kept significantly different from postoperative and 1 year follow up (P<0.05). No significantly different was found between the two groups as for CA, cSVA, intervertebral height and preventable soft-tissue thickness. The incidence rate of interbody cage subsidence was 25.9% in 2 years follow up, which was significantly higher than that in the normal group (P<0.05). The fusion rate in endplate abnormality group was 89%. No significantly difference was found between the two groups. The Miyazaki grade of the disc in endplate abnormality group was significantly higher than it in the normal group (P<0.01).Significant difference was detected on NDI between the two groups.Conclusions: Endplate abnormalities in cervical spondylotic myelopathy were associated with older age, disc degeneration, decrease of intervertebral height and increase of TS before cervical surgery. Patients in endplate abnormality group showed increase in NDI pre- and post-operation, and more phenomenon of subsidence.

Download Full-text

Factors Affecting Titanium Mesh Cage Subsidence in Single-level Anterior Cervical Corpectomy and Fusion for Ossification of the Posterior Longitudinal Ligament

10.21203/rs.3.rs-1078721/v1 ◽

2021 ◽

Author(s):

Yifan Tang ◽

Fengning Li ◽

Xiangwu Geng ◽

Lianshun Jia ◽

Shengyuan Zhou ◽

...

Keyword(s):

Posterior Longitudinal Ligament ◽

Titanium Mesh ◽

Titanium Mesh Cage ◽

Cervical Corpectomy ◽

Single Level ◽

Significant Difference ◽

Cage Subsidence ◽

Mesh Cage ◽

Anterior Cervical Corpectomy

Abstract Background: To analyze risk factors of titanium mesh cage (TMC) subsidence in single-level anterior cervical corpectomy and fusion (ACCF) for cervical ossification of the posterior longitudinal ligament (OPLL). Methods: Patients with cervical OPLL who were treated with single-level ACCF between January 2019 to December 2019 were retrospectively analyzed in two groups: patients with TMC subsidence as Group S, and patients with no TMC subsidence as Group N during the one-year follow-up period. The degree of distraction between decompression of the vertebral bodies and correction of the cervical curvature was measured to analyze their relationship with TMC subsidence. Results: There was no significant difference in patient demographics and complications between the two groups. The degree of distraction in Group S was significantly higher than that in Group N. The change of C2 to C7 Cobb angle (α) in Group S was significantly greater than that in Group N, and the interspinous process distance (SPD) in Group S was also significantly greater than that in Group N. The JOA score and JOA recovery rate were not statistically different between the two groups.Conclusions: Intraoperative selection of overlength TMC in single-level ACCF for OPLL, over-distraction, and excessive correction of the cervical curvature may cause TMC subsidence after surgery. No significant impact of TMC subsidence on the surgical outcome was observed during the 1-year follow-up period.

Download Full-text

Lower Hounsfield units on CT are associated with cage subsidence after anterior cervical discectomy and fusion

Journal of Neurosurgery Spine ◽

10.3171/2020.3.spine2035 ◽

2020 ◽

Vol 33 (4) ◽

pp. 425-432

Author(s):

Minghao Wang ◽

Praveen V. Mummaneni ◽

Zhuo Xi ◽

Chih-Chang Chang ◽

Joshua Rivera ◽

...

Keyword(s):

Anterior Cervical Discectomy ◽

Height Loss ◽

Foraminal Stenosis ◽

Hounsfield Units ◽

Cervical Discectomy ◽

Single Level ◽

Significant Difference ◽

Cage Subsidence ◽

Preoperative Ct

OBJECTIVEA consequence of anterior cervical discectomy and fusion (ACDF) is graft subsidence, potentially leading to kyphosis, nonunion, foraminal stenosis, and recurrent pain. Bone density, as measured in Hounsfield units (HUs) on CT, may be associated with subsidence. The authors evaluated the association between HUs and subsidence rates after ACDF.METHODSA retrospective study of patients treated with single-level ACDF at the University of California, San Francisco, from 2008 to 2017 was performed. HU values were measured according to previously published methods. Only patients with preoperative CT, minimum 1-year follow-up, and single-level ACDF were included. Patients with posterior surgery, tumor, infection, trauma, deformity, or osteoporosis treatment were excluded. Changes in segmental height were measured at 1-year follow-up compared with immediate postoperative radiographs. Subsidence was defined as segmental height loss of more than 2 mm.RESULTSA total of 91 patients met inclusion criteria. There was no significant difference in age or sex between the subsidence and nonsubsidence groups. Mean HU values in the subsidence group (320.8 ± 23.9, n = 8) were significantly lower than those of the nonsubsidence group (389.1 ± 53.7, n = 83, p < 0.01, t-test). There was a negative correlation between the HU values and segmental height loss (Pearson’s coefficient −0.735, p = 0.01). Using receiver operating characteristic curves, the area under the curve was 0.89, and the most appropriate threshold of HU value was 343.7 (sensitivity 77.1%, specificity 87.5%). A preoperative lower HU is a risk factor for postoperative subsidence (binary logistic regression, p < 0.05). The subsidence rate and distance between allograft and polyetheretherketone (PEEK) materials were not significantly different (PEEK 0.9 ± 0.7 mm, allograft 1.0 ± 0.7 mm; p > 0.05).CONCLUSIONSLower preoperative CT HU values are associated with cage subsidence in single-level ACDF. Preoperative measurement of HUs may be useful in predicting outcomes after ACDF.

Download Full-text

288. Follow-Up Blood Cultures in Gram-Negative Bacteremia: How Do They Impact Outcomes

Open Forum Infectious Diseases ◽

10.1093/ofid/ofaa439.331 ◽

2020 ◽

Vol 7 (Supplement_1) ◽

pp. S144-S144

Author(s):

Azza Elamin ◽

Faisal Khan ◽

Ali Abunayla ◽

Rajasekhar Jagarlamudi ◽

aditee Dash

Keyword(s):

Clinical Outcomes ◽

Antibiotic Treatment ◽

Readmission Rate ◽

Blood Cultures ◽

Categorical Variables ◽

Gram Negative ◽

Number Of Patients ◽

Significant Difference ◽

The Impact

Abstract Background As opposed to Staphylococcus. aureus bacteremia, there are no guidelines to recommend repeating blood cultures in Gram-negative bacilli bacteremia (GNB). Several studies have questioned the utility of follow-up blood cultures (FUBCs) in GNB, but the impact of this practice on clinical outcomes is not fully understood. Our aim was to study the practice of obtaining FUBCs in GNB at our institution and to assess it’s impact on clinical outcomes. Methods We conducted a retrospective, single-center study of adult patients, ≥ 18 years of age admitted with GNB between January 2017 and December 2018. We aimed to compare clinical outcomes in those with and without FUBCs. Data collected included demographics, comorbidities, presumed source of bacteremia and need for intensive care unit (ICU) admission. Presence of fever, hypotension /shock and white blood cell (WBC) count on the day of FUBC was recorded. The primary objective was to compare 30-day mortality between the two groups. Secondary objectives were to compare differences in 30-day readmission rate, hospital length of stay (LOS) and duration of antibiotic treatment. Mean and standard deviation were used for continuous variables, frequency and proportion were used for categorical variables. P-value < 0.05 was defined as statistically significant. Results 482 patients were included, and of these, 321 (67%) had FUBCs. 96% of FUBCs were negative and 2.8% had persistent bacteremia. There was no significant difference in 30-day mortality between those with and without FUBCs (2.9% and 2.7% respectively), or in 30-day readmission rate (21.4% and 23.4% respectively). In patients with FUBCs compared to those without FUBCs, hospital LOS was longer (7 days vs 5 days, P < 0.001), and mean duration of antibiotic treatment was longer (14 days vs 11 days, P < 0.001). A higher number of patients with FUBCs needed ICU care compared to those without FUBCs (41.4% and 25.5% respectively, P < 0.001) Microbiology of index blood culture in those with and without FUBCs Outcomes in those with and without FUBCs FUBCs characteristics Conclusion Obtaining FUBCs in GNB had no impact on 30-day mortality or 30-day readmission rate. It was associated with longer LOS and antibiotic duration. Our findings suggest that FUBCs in GNB are low yield and may not be recommended in all patients. Prospective studies are needed to further examine the utility of this practice in GNB. Disclosures All Authors: No reported disclosures

Download Full-text

The radiological outcome in lumbar interbody fusion among rheumatoid arthritis patients: a 20-year retrospective study

BMC Musculoskeletal Disorders ◽

10.1186/s12891-021-04531-y ◽

2021 ◽

Vol 22 (1) ◽

Author(s):

Kuan-Kai Tung ◽

Yun-Che Wu ◽

Kun-Hui Chen ◽

Chien-Chou Pan ◽

Wen-Xian Lu ◽

...

Keyword(s):

Rheumatoid Arthritis ◽

Interbody Fusion ◽

Fusion Rate ◽

Substantial Improvement ◽

Lumbar Interbody Fusion ◽

Subsidence Rate ◽

Radiographic Outcomes ◽

Significant Difference ◽

Cage Subsidence

Abstract Background Clinical outcomes amongst Rheumatoid Arthritis (RA) patients have shown satisfactory results being reported after lumbar surgery. The increased adoption of the interbody fusion technique has been due to a high fusion rate and less invasive procedures. However, the radiographic outcome for RA patients after receiving interbody fusion has scarcely been addressed in the available literature. Methods Patients receiving interbody fusion including ALIF, OLIF, and TLIF were examined for implant cage motion and fusion status at two-year follow-up. Parameters for the index correction level including ADH, PDH, WI, SL, FW, and FH were measured and compared at pre-OP, post-OP, and two-year follow-up. Results We enrolled 64 RA patients at 104 levels (mean 64.0 years old, 85.9% female) received lumbar interbody fusion. There were substantial improvement in ADH, PDH, WI, SL, FW, and FH after surgery, with both ADH and PDH having significantly dropped at two-year follow up. The OLIF group suffered from a higher subsidence rate with no significant difference in fusion rate when compared to TLIF. The fusion rate and subsidence rate for all RA patients was 90.4 and 28.8%, respectively. Conclusions We revealed the radiographic outcomes of lumbar interbody fusions towards symptomatic lumbar disease in RA patients with good fusion outcome despite the relative high subsidence rate amongst the OLIF group. Those responsible for intra-operative endplate management should be more cautious to avoid post-OP cage subsidence.

Download Full-text

A meta-analysis indicating extra-short implants (≤ 6 mm) as an alternative to longer implants (≥ 8 mm) with bone augmentation

Scientific Reports ◽

10.1038/s41598-021-87507-1 ◽

2021 ◽

Vol 11 (1) ◽

Author(s):

Xiaoran Yu ◽

Ruogu Xu ◽

Zhengchuan Zhang ◽

Yang Yang ◽

Feilong Deng

Keyword(s):

Survival Rate ◽

Clinical Outcomes ◽

Meta Analysis ◽

Risk Of Bias ◽

Bone Augmentation ◽

Moderate Quality ◽

Short Implants ◽

Significant Difference ◽

Complications Rate

AbstractExtra-short implants, of which clinical outcomes remain controversial, are becoming a potential option rather than long implants with bone augmentation in atrophic partially or totally edentulous jaws. The aim of this study was to compare the clinical outcomes and complications between extra-short implants (≤ 6 mm) and longer implants (≥ 8 mm), with and without bone augmentation procedures. Electronic (via PubMed, Web of Science, EMBASE, Cochrane Library) and manual searches were performed for articles published prior to November 2020. Only randomized controlled trials (RCTs) comparing extra-short implants and longer implants in the same study reporting survival rate with an observation period at least 1 year were selected. Data extraction and methodological quality (AMSTAR-2) was assessed by 2 authors independently. A quantitative meta-analysis was performed to compare the survival rate, marginal bone loss (MBL), biological and prosthesis complication rate. Risk of bias was assessed with the Cochrane risk of bias tool 2 and the quality of evidence was determined with the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) approach. 21 RCTs were included, among which two were prior registered and 14 adhered to the CONSORT statement. No significant difference was found in the survival rate between extra-short and longer implant at 1- and 3-years follow-up (RR: 1.002, CI 0.981 to 1.024, P = 0.856 at 1 year; RR: 0.996, CI 0.968 to 1.025, P = 0.772 at 3 years, moderate quality), while longer implants had significantly higher survival rate than extra-short implants (RR: 0.970, CI 0.944 to 0.997, P < 0.05) at 5 years. Interestingly, no significant difference was observed when bone augmentations were performed at 5 years (RR: 0.977, CI 0.945 to 1.010, P = 0.171 for reconstructed bone; RR: 0.955, CI 0.912 to 0.999, P < 0.05 for native bone). Both the MBL (from implant placement) (WMD: − 0.22, CI − 0.277 to − 0.164, P < 0.01, low quality) and biological complications rate (RR: 0.321, CI 0.243 to 0.422, P < 0.01, moderate quality) preferred extra-short implants. However, there was no significant difference in terms of MBL (from prosthesis restoration) (WMD: 0.016, CI − 0.036 to 0.068, P = 0.555, moderate quality) or prosthesis complications rate (RR: 1.308, CI 0.893 to 1.915, P = 0.168, moderate quality). The placement of extra-short implants could be an acceptable alternative to longer implants in atrophic posterior arch. Further high-quality RCTs with a long follow-up period are required to corroborate the present outcomes.Registration number The review protocol was registered with PROSPERO (CRD42020155342).

Download Full-text

Transient asymptomatic pulmonary opacities and interstitial lung disease in EGFR-mutated non-small cell lung cancer treated with osimertinib

Tumori Journal ◽

10.1177/03008916211047888 ◽

2021 ◽

pp. 030089162110478

Author(s):

Gianluca Taronna ◽

Alessandro Leonetti ◽

Filippo Gustavo Dall’Olio ◽

Alessandro Rizzo ◽

Claudia Parisi ◽

...

Keyword(s):

Lung Cancer ◽

Small Cell Lung Cancer ◽

Clinical Outcomes ◽

Cell Lung Cancer ◽

Small Cell ◽

Clinical Variable ◽

Small Cell Lung ◽

Significant Difference ◽

Egfr Mutated

Introduction: Osimertinib is a third-generation epidermal growth factor receptor (EGFR) tyrosine kinase inhibitor (TKI) approved as first-line therapy for advanced EGFR-mutated non-small cell lung cancer (NSCLC). Some osimertinib-related interstitial lung diseases (ILDs) were shown to be transient, called transient asymptomatic pulmonary opacities (TAPO)—clinically benign pulmonary opacities that resolve despite continued osimertinib treatment—and are not associated with the clinical manifestations of typical TKI-associated ILDs. Methods: In this multicentric study, we retrospectively analyzed 92 patients with EGFR-mutated NSCLC treated with osimertinib. Computed tomography (CT) examinations were reviewed by two radiologists and TAPO were classified according to radiologic pattern. We also analyzed associations between TAPO and patients’ clinical variables and compared clinical outcomes (time to treatment failure and overall survival) for TAPO-positive and TAPO-negative groups. Results: TAPO were found in 18/92 patients (19.6%), with a median follow-up of 114 weeks. Median onset time was 16 weeks (range 6–80) and median duration time 14 weeks (range 8–37). The most common radiologic pattern was focal ground-glass opacity (54.5%). We did not find any individual clinical variable significantly associated with the onset of TAPO or significant difference in clinical outcomes between TAPO-positive and TAPO-negative groups. Conclusions: TAPO are benign pulmonary findings observed in patients treated with osimertinib. TAPO variability in terms of CT features can hinder the differential diagnosis with either osimertinib-related mild ILD or tumor progression. However, because TAPO are asymptomatic, it could be reasonable to continue therapy and verify the resolution of the CT findings at follow-up in selected cases.

Download Full-text

Prospective Randomized Trial Comparing Mobile-bearing and Fixed-bearing Total Ankle Replacement

Foot & Ankle Orthopaedics ◽

10.1177/2473011418s00093 ◽

2018 ◽

Vol 3 (3) ◽

pp. 2473011418S0009

Author(s):

James Nunley ◽

Samuel Adams ◽

James DeOrio ◽

Mark Easley

Keyword(s):

Clinical Outcomes ◽

Mobile Bearing ◽

Cyst Formation ◽

Total Ankle Replacement ◽

Fixed Bearing ◽

Ankle Arthritis ◽

Ankle Replacement ◽

Significant Difference ◽

End Stage

Category: Ankle Arthritis Introduction/Purpose: Outcomes of total ankle replacement for the treatment of end-stage ankle arthritis continue to improve. Debate continues whether a mobile-bearing total ankle replacement (MB-TAR) or a fixed-bearing total ankle replacement (FB-TAR) is superior, with successful outcomes reported longterm for MB-TAR and at intermediate-to-longterm follow-up for newer generation FB-TAR. Although comparisons between the two total ankle designs have been reported, to our knowledge, no investigation has compared the two designs with a high level of evidence. This prospective, randomized controlled trial conducted at a single institution compares patient satisfaction, functional outcomes and radiographic results of the mobile-bearing STAR and the fixed-bearing Salto-Talaris in the treatment of end-stage ankle arthritis. Methods: This investigation was approved by our institution’s IRB committee. Between November 2011 and November 2014, adult patients with end-stage ankle osteoarthritis failing nonoperative treatment were introduced to the study. With informed consent, 100 patients (31 male and 69 female, average age 65, range 35 to 85) were enrolled; demographic comparison between the two cohorts was similar. Exclusion criteria included inflammatory arthropathy, neuropathy, weight exceeding 250 pounds, radiographic coronal plane deformity greater than 15 degrees or extensive talar dome wear pattern (“flat top talus”). Prospective patient-reported outcomes, physical exam and standardized weightbearing ankle radiographs were obtained preoperatively, at 6 and 12 months postoperatively, and then at yearly intervals. Data collection included visual analog pain score (VAS), short form 36 (SF-36), foot and ankle disability index (FADI), short musculoskeletal functional assessment (SMFA) and AOFAS ankle-hindfoot score. Surgeries were performed by non-design team orthopaedic foot and ankle specialists with total ankle replacement expertise. Statistically analysis was performed by a qualified statistician. Results: At average follow-up of 4.5 years (range 2-6 years) complete clinical data and radiographs were available for 84 patients; 7 had incomplete data, one had died, 4 were withdrawn after enrolling but prior to surgery and 4 were lost to follow-up. In all outcome measures, the entire cohort demonstrated statistically significant improvements from preoperative evaluation to most recent follow-up. There was no statistically significant difference in improvement in clinical outcomes between the two groups. Radiographically, tibial lucency/cyst formation was 26.8% and 20.9% for MB-TAR and FB-TAR, respectively. Tibial settling/subsidence occurred in 7.3% of MB-TAR. Talar lucency/cyst formation occurred in 24.3% and 2.0% of MB-TAR and FB-TAR, respectively. Talar subsidence was observed in 21.9% and 2.0% of MB-TAR and FB-TAR, respectively. Re-operations were performed in 8 MB-TAR and 3 FB-TAR, with the majority of procedures being to relieve impingement or treat cysts and not to revise or remove metal implants. Conclusion: For the first time, with a high level of evidence, our study confirms that patient reported and clinical outcomes are favorable for both designs and that there is no significant difference in clinical improvement between the two implants. The incidence of lucency/cyst formation was similar for MB-TAR and FB-TAR for the tibial component, but the MB-TAR had greater talar lucency/cyst formation and tibial and talar subsidence. As has been suggested in previous studies, clinical outcomes do not correlate with radiographic findings. Re-operations were more common for MB-TAR and in the majority of cases were to relieve impingement or treat cysts rather than revise or remove metal implants.

Download Full-text

Clinical Significance of PLIF in Restoring L4-S1 Segmental Lordosis of 2-level Isthmic Spondylolisthesis

10.21203/rs.3.rs-198135/v1 ◽

2021 ◽

Author(s):

Jing-Yu Wang ◽

Fu-Sheng Liu ◽

Jing Li ◽

Xiao-Bin Wang

Keyword(s):

Sagittal Plane ◽

Pearson Correlation ◽

Isthmic Spondylolisthesis ◽

Improvement Rate ◽

Clinical Prognosis ◽

Vas Score ◽

Score Improvement ◽

Significant Difference ◽

Sagittal Parameters

Abstract Background: Spinal and pelvic sagittal plane balance is closely related to good clinical prognosis, so in the treatment of 2-level isthmic spondylolisthesis, attention should be paid not only to adequate nerve decompression, but also to the correction of lumbosacral sagittal plane parameters. The purpose of this study was to observe the clinical prognosis and sagittal parameters of patients with isthmic spondylolisthesis treated with PLIF, and to find out the risk factors leading to poor prognosis. Methods: From January 2006 to August 2018, the clinical data of patients with 2-level isthmic spondylolisthesis treated with PLIF in the Second Xiangya Hospital of Central South University were retrospectively collected. The clinical symptoms (JOA score and VAS score) and the sagittal parameters of lumbosacral segment (PI, PT, LL, L4-S1 SL, LDI, PI-LL, LL and L4-S1 SL) were recorded before operation, immediately after operation and at the last follow-up. According to the improvement rate of JOA score, the patients were divided into two subgroups, poor(P) group and good(G) group. The parameters within and between the two subgroups were compared. Meanwhile, Pearson correlation analysis was conducted between sagittal parameters and JOA score improvement rate.Results: A total of 52 patients were enrolled in this study, the average age was (59.96 ±9.11) years, and the mean follow-up time was (31.88 ±8.37) months. Group G (n = 37) and group P (n = 15). In terms of clinical symptom improvement and sagittal plane parameters, except PI, the other parameters of the patients were improved compared with those before operation, and the difference was statistically significant. In the intra-group comparison, except PI, other indexes in group G were significantly improved, while in group P, there was no significant difference in PI, LL, L4-S1 SL, LDI, PI-LL before and after operation. In the comparison between groups, there was no significant difference in baseline data between group G and group P; postoperative VAS score(back pain) in group G was lower than that in group P, but there was no significant difference in VAS score( leg pain); in terms of JOA score and JOA score improvement rate, group G was significantly better; △L4-S1 SL ,L4-S1 SL and LDI were larger in group G, and the proportion of patients with normal LDI was higher than that in group P. Pearson correlation analysis showed that postoperative △L4-S1 SL, LDI and L4-S1 SL were positively correlated with JOA improvement rate. 2 patients with failed internal fixation occurred in group P, and the postoperative LDI was less than 50%. Conclusion: PLIF is an effective method for the treatment of 2-level isthmic spondylolisthesis. ΔL4-S1 SL, L4-S1 SL and good LDI may be important sagittal parameters affecting the clinical prognosis of L4 and L5 isthmus spondylolisthesis.

Download Full-text

Surgical Treatments for Lumbar Spine Diseases: A Systematic Review and Meta-Analysis

10.1101/2021.07.04.21259978 ◽

2021 ◽

Author(s):

Kanthika Wasinpongwanich ◽

Tanawin Nopsopon ◽

Krit Pongpirul

Keyword(s):

Lumbar Spine ◽

Clinical Outcomes ◽

Risk Ratio ◽

Literature Search ◽

Operative Time ◽

Meta Analysis ◽

Fusion Rate ◽

Significant Difference ◽

Spine Diseases

Purpose Surgical treatment is mandatory in some patients with lumbar spine diseases. To obtain spine fusion, many operative techniques were developed with different fusion rates and clinical results. This study aimed to collect randomized controlled trial (RCT) data to compare fusion rate, clinical outcomes, complications among Transforaminal Lumbar Interbody Fusion (TLIF), and other techniques for lumbar spine diseases. Methods A systematic literature search of PubMed, Embase, Scopus, Web of Science, and CENTRAL databases was searched for studies up to 13 February 2020. The meta-analysis was done using a random-effects model. Pooled risk ratio (RR) or mean difference (MD) with a 95% confidence interval of fusion rate, clinical outcomes, and complication in TLIF and other techniques for lumbar diseases. Results The literature search identified 3,682 potential studies, 15 RCTs (915 patients) were met our inclusion criteria and were included in the meta-analysis. Compared to other techniques, TLIF had slightly lower fusion rate (RR=0.84 [95% CI 0.72, 0.97], p=0.02, I2=0.0%) at 1-year follow-up while there was no difference on fusion rate at 2-year follow up (RR=1.06 [95% CI 0.96, 1.18], p=0.27, I2=69.0%). The estimated risk ratio of total adverse events (RR=0.90 [95% CI 0.59, 1.38], p=0.63, I2=0.0%) and revision rate (RR=0.78 [95%CI 0.34, 1.79], p=0.56, I2=39.0%) showed no difference. TLIF had approximately half an hour more operative time than other techniques (MD=31.88 [95% CI 5.33, 58.44], p=0.02, I2=92.0%). There was no significant difference between TLIF and other techniques in terms of the blood loss, and clinical outcomes. Conclusions Besides fusion rate at 1-year follow-up and operative time, our study demonstrated similar outcomes of TLIF with other techniques for lumbar diseases in regard to fusion rate, clinical outcomes, and complications.

Download Full-text

Abstract 12022: Long-Term Clinical Outcomes of Everolimus-Eluting Stents versus Sirolimus-Eluting Stents: Systematic Review and a Meta-Analysis of 14 Randomized Control Trials, Focused on Stent Thrombosis

Circulation ◽

10.1161/circ.130.suppl_2.12022 ◽

2014 ◽

Vol 130 (suppl_2) ◽

Author(s):

TOSHIAKI TOYOTA ◽

Hiroki Shiomi ◽

Takeshi Morimoto ◽

Takeshi Kimura

Keyword(s):

Clinical Outcomes ◽

Stent Thrombosis ◽

Controlled Trial ◽

Meta Analysis ◽

Target Lesion ◽

Pooled Analysis ◽

Significant Difference ◽

Artery Disease

Background: We sought to compare the long-term clinical outcomes between everolimus-eluting stent (EES) and sirolimus-eluting stents (SES) with a meta-analysis method. The long-term clinical outcomes, especially stent thrombosis (ST), after EES versus SES implantation has not been clearly defined among trials directly comparing the 2 types of stents. Methods: We searched PubMed, Cochrane database, and ClinicalTrials.gov. for trials comparing outcomes between EES (Xience V/Promus) and SES (Cypher select/Cypher select plus) in patients with native coronary artery disease using randomized controlled trial (RCT) design. We selected the article reporting the longest follow-up outcomes from each RCT. The outcome measure was all-cause death, myocardial infarction (MI), definite ST, and target-lesion revascularization (TLR). ST was further classified as those occurring early (<=30 days), late (30-365 days), or very late (<365 days). Results: We identified 14 RCT comparing EES and SES including 2 trials reporting the longest follow-up outcomes as a pooled analysis. We analyzed 13,434 randomly assigned patients with the weighted follow-up period of 2.1 years (Follow-up <=1-year: 7 trials, and 3191 patients; >1-year: 7 trials, and 10243 patients). EES as compared to SES was associated with significantly lower risks for overall ST, and early ST (pooled odds ratio (OR) 0.49, 95% confidence interval (CI) 0.30-0.81, P=0.01, and OR 0.42, 95% CI 0.18-0.99, P=0.046, respectively), while there was no significant difference in the risk for late ST and very late ST (OR 0.49, 95% CI 0.17-1.43, P=0.19, and OR 0.66, 95% CI 0.23-1.85, P=0.43, respectively). EES as compared to SES was also associated with significantly lower risks for TLR (OR 0.84, 95% CI 0.71-0.99, P=0.04). There was no significant difference in the risk for all-cause death, and MI between EES and SES. (OR 0.91, 95% CI 0.78-1.07, P=0.11, and OR 0.92, 95% CI 0.75-1.13, P=0.44, respectively). Conclusions: In the current meta-analysis of 14 RCT directly comparing EES with SES, implantation of EES as compared to SES implantation was associated with significantly lower risk for definite ST and TLR.

Download Full-text