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Purpose: Lumbar interlaminar decompression with interspinous fixation is an established safe and effective treatment for spinal stenosis. Early maintenance of improvements in pain intensity and function are critical for durability of symptom relief. The purpose of this study was to investigate the efficacy of minimally invasive treatments for low back pain during the early period after treatment and their utility in setting the course for longer term success.Patients and Methods: This study utilized patient evaluations at 3- and 6-months following treatment and is part of an actively enrolling, institutional review board (IRB) approved, single-arm, multicenter, prospective, open-label 12-month study. Clinical efficacy was assessed primarily using the change from baseline in Oswestry Disability Index (ODI), Visual Analog Scale (VAS) of the back and leg pain during walking and standing, and Zurich Claudication Questionnaire (ZCQ), and secondarily using the Patient Global Impression of Change (PGIC) and Patient-Reported Outcomes Measurement Information System (PROMIS) 29 v2.1. The safety endpoints were the adverse events and reoperations or revisions at the index level(s).Results: At 6-month post-op, 76%, 62%– 64%, and 64% of patients demonstrated clinical meaningful, and statistically significant improvement in their pain as defined by ZCQ, VAS (back and leg), and ODI, respectively. In addition, 78% of patients noted improvement in PGIC. Two procedure-related adverse events were noted which fully resolved without surgical intervention.Conclusion: This 6-month interim analysis at 42% enrollment of patients was conducted to determine prolonged safety and efficacy of the interspinous fusion device. Our analysis showed a sustained improvement in clinical efficacy, and safety endpoints, when compared to the 3-months evaluations, across both interventional pain and neurosurgery specialties. [ABSTRACT FROM AUTHOR]

Background: Posterior and lateral techniques have been described as approaches to sacroiliac joint arthrodesis. The purpose of this study was to compare the stabilizing effects of a novel posterior stabilization implant and technique to a previously published lateral approach in a cadaveric multidirectional bending model. We hypothesized that both approaches would have an equivalent stabilizing effect in flexion–extension and that the posterior approach would exhibit better performance in lateral bending and axial rotation. We further hypothesized that unilateral and bilateral posterior fixation would stabilize both the primary and secondary joints. Methods: Ranges of motion (RoMs) of six cadaveric sacroiliac joints were evaluated by an optical tracking system, in a multidirectional flexibility pure moment model, between ± 7.5 N-m applied moment in flexion–extension, lateral bending, and axial rotation under intact, unilateral fixation, and bilateral fixation conditions. Results: Intact RoMs were equivalent between both samples. For the posterior intra-articular technique, unilateral fixation reduced the RoMs of both primary and secondary joints in all loading planes (flexion–extension RoM by 45%, lateral bending RoM by 47%, and axial RoM by 33%), and bilateral fixation maintained this stabilizing effect in both joints (flexion–extension at 48%, lateral bending at 53%, and axial rotation at 42%). For the lateral trans-articular technique, only bilateral fixation reduced mean RoM of both primary and secondary sacroiliac joints, and only under flexion–extension loads (60%). Conclusion: During flexion–extension, the posterior approach is equivalent to the lateral approach, while producing superior stabilization during lateral bend and axial rotation. [ABSTRACT FROM AUTHOR]

Purpose: To concurrently assess and compare the fixation efficacy, invasiveness, and fusion potential of a posterior integrated transfixation cage system to the posterolateral threaded implant and lateral triangular rod systems, in a cadaveric model., Methods and Materials: Twelve (12) cadaveric sacroiliac joint specimens were utilized and tested within the single-leg stance multidirectional pure moment bending model. Each specimen was tested in the intact, destabilized, treated (using posterior, posterolateral, and lateral systems), and post-fatigue conditions by applying 0 to ± 7.5 Nm of moment in flexion-extension, axial rotation, and lateral bending while measuring the angular range of motion between the sacrum and ilium. Computational models were reconstructed from Computed Tomography (CT) scans and manufacturer surgical technique guides. The models were utilized to quantify the volume of bone removed during implantation and the surface area available for fusion., Results: The posterior integrated transfixation cage system and the lateral triangular rods produced equivalent motion reduction in all motion planes ( P > 0.583). The posterolateral cylindrical threaded implant produced less motion reductions than the posterior and lateral implants in flexion-extension (6% ± 3% vs 37% ± 10% and 33% ± 11%, respectively, P <0.05). The posterior system removed 22%-60% less bone volume from the sacrum and ilium (P<0.10), introduced 200%-270% more implant surface to the joint space (P<0.01) and decorticated 75%-375% more joint surface area ( P <0.01)., Conclusion: The posterior integrated transfixation single-implant cage system is superior to the posterolateral cylindrical threaded single-implant system. Its performance in osteopenic bone is equivalent to the lateral triangular rod system in healthy bone; however, the posterior integrated transfixation cage system requires a single implant, while the lateral triangular rod system requires three. The posterior implant removes the least bone volume and has the most surface area for fusion, providing a significantly better opportunity for robust sacroiliac joint arthrodesis., Competing Interests: ORR, JHT, SM and JML are employees of Medical Device Development and their institution received supports from Nevro and Vrysa to conduct this research. AE is part of the medical advisory board of Nevro, Medtronic, Vertos and consultant for Painteq. BAH is a consultant for Nevro and Novo Source Orthopedics. DPB is a consultant for Nevro, Genesys, CornerLoc, Spinal Simplicity, PainTEQ, SI Bone, and Wenzel Spine and has received research funding from Nevro. He also reports non-financial supports from Medtronic, Merit Medical, Johnson & Johnson, IZI, Techlamed, Peterson Enterprises, Medical Metrics, Avanos, Boston Scientific, Simplify Medical, Stryker, Lenoss Medical, Spine BioPharma, Piramal, ReGelTec, Nanofuse, Spinal Simplicity, Pain Theory, Spark Biomedical, Bronx Medical, Smart Soft, Tissue Tech, RayShield, Stayble, Thermaquil, Vivex, Stratus Medical, Genesys, Abbott, Eliquence, SetBone Medical, Amber Implants, Cerapedics, Neurovasis, Varian Medical Systems, Companion Spine, DiscGenics, Discure, SpinaFX, PainTEQ, SI Bone, Orthoson, Choice Spine, Saluda Medical, Aurora Spine, Arts Surgical, AIS Healthcare, Wenzel Spine; grants from Medtronic, Medical Metrics, Avanos, Relievant, Boston Scientific, Stryker, Sollis Pharmaceuticals, Simplify Medical, Lenoss Medical, Spine BioPharma, Eliem Therapeutics, Smart Soft, Tissue Tech, Vivex, Stratus Medical, Restorative Therapies, Kolon TissueGene, Companion Spine, DiscGenics, SI Bone, Choice Spine. DLC is an employee of Nevro Corporation. The authors report no other conflicts of interest in this work., (© 2024 Raji et al.)

Introduction: Knowing the risk factors for poor outcomes following hip fracture surgery is necessary for appropriate patient care. The objective of this study was to determine if the first post-operative visit (POV) following hip fracture surgery is a risk factor for increased mortality, complications, and re-admissions., Methods: This was a retrospective review of 285 patients who underwent operative fixation of a hip fracture at an academic acute care hospital. Outcome measurements were 90-day and one year mortality, 90-day complications, and 90-day re-admission rates in patients who missed or attended their first post-operative visit following hip fracture surgery., Results: 279 patients met inclusion criteria and had sufficient data for analysis, of which 213 (76.3%) made their first post-operative visit. 90-day and one-year mortality were significantly higher in the patients who missed their first POV (31.8% vs. 4.2%; 51.5% vs. 12.7%). Independent risk factors for 90-day complications were missing the first POV, coronary artery disease, and lower pre-injury status (ORs = 10.65, 2.80, 7.89, respectively). Independent risk factors for 90-day re-admission were missing the first POV, chronic obstructive pulmonary disease on home oxygen, and lower re-injury status (ORs = 8.04, 5.44, 5.47, respectively)., Conclusion: Missing the first POV was the strongest independent risk factor for 90-day complications and 90-day readmission. Patients who miss their first POV have significantly higher 90-day and one year mortality rates., Competing Interests: None., (© 2022 Professor P K Surendran Memorial Education Foundation. Published by Elsevier B.V. All rights reserved.)