Operative Techniques in Orthopaedics最新文献

Achieving adequate hemostasis in spine surgery is critical for both the patient and surgeon. Currently, there are 2 major topical hemostatic matrix agents used in spine surgery—Floseal (Baxter Healthcare, Deerfield, Illinois, USA) and Surgiflo (Ethicon Inc., Raritan, New Jersey, USA). While both products have been shown to be effective at achieving hemostasis, there is no consensus supporting the use of one agent over another in spine surgery. There are studies comparing outcomes and cost between Floseal and Surgiflo, but a significant portion of the studies have industry affiliations. Generally, existing literature reports low to moderate cost savings in favor of one agent or the other, with no clinically significant differences in patient-based outcomes such as postoperative hematomas. Animal model studies also suggest unique complications, including epidural fibrosis and associated nerve root compression with use of a flowable topical hemostatic agent. Further nonindustry-affiliated studies are warranted to compare efficacy, patient outcomes, cost analyses, and possible unique complications associated with the two hemostatic agents.

Cervical disc arthroplasty (CDA) is a motion-preserving treatment option for managing cervical radiculopathy and myelopathy. While CDA may be an excellent surgical technique for select patients, there are many technical challenges that make this procedure less forgiving than anterior cervical discectomy and fusion. The purpose of this article is to provide a brief overview of cervical disc arthroplasty, indications, surgical technique, surgical considerations, implant selection, and complications.

In recent years, augmented reality (AR) has emerged as a promising technology in spine surgery. Its benefits are numerous, including enhanced surgical accuracy, improved anatomic approximation, and uninterrupted visualization. It has proven particularly valuable in spinal fusion, allowing for meticulous planning of screw trajectories and precise alignment of screws, plates, and implants, resulting in low complication rates. Additionally, AR reduces radiation exposure by minimizing the need for intraoperative fluoroscopy. The technology has also been utilized for surgical education and training, enabling real-time feedback through telementoring. However, challenges exist. Discomfort and wearability issues are reported with current AR models, and the need for 3D image rendering prolongs procedure time. Accuracy is compromised in patients with larger body habitus, necessitating improvements in calibration to individual anatomies. Cost is another significant challenge as it requires advanced imaging capabilities in operating rooms, along with expenses for AR hardware, software, training, and personnel. Ongoing research is necessary to evaluate the sustained benefits and potential complications of AR in spine surgery. While AR demonstrates advantages in terms of patient outcomes and surgical accuracy, continued optimization is essential to enhance accessibility and success in spine surgery and orthopaedic surgery as a whole.

Cannabinoids have gained attention for their potential therapeutic effects in various fields, including pain control, augmenting fusion, neuroprotection, wound healing, inflammation, mental health, and clinical outcomes/complications. We explore the history and mechanism of action of cannabinoids, as well as their role in each of these areas. By examining existing research, the potential benefits and limitations of incorporating cannabinoids into spine nonoperative and operative protocols are highlighted. Ultimately, this review aims to contribute to the understanding of cannabinoids as a viable option for optimizing patient outcomes in the context of spine surgery.

To describe a modification to the traditional Smith-Petersen Osteotomy, which involves removing the posterior column of bone at a single level, however, instead of gaining approximately 10° of correction, this modification results in 20°-25° of sagittal correction with the use of helper rods. The Super-Smith Petersen Osteotomy is a modification of the Smith-Petersen Osteotomy that is a single-level osteotomy, that with the use of helper rods, one can obtain a larger degree of correction than the traditional Smith Petersen Osteotomy, with less technical demand compared to a pedicle subtraction osteotomy or vertebral column resection.

Care of the patient with spinal deformity has evolved over centuries, from initially relying on traction, bracing, and casting, to now having the ability to directly treat and correct the pathology. The history of management of this condition is rich in innovation and creativity. Here we pay tribute to the advances in our field from the early Grecian times to modern surgical techniques, allowing us now the opportunity to better care for and serve our patients with spinal deformity.