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Angled bony-increased offset and metal-augmented baseplate have recently been used to achieve neutral to inferior inclination of the glenoid implant. Nonetheless, bone incorporation is difficult to evaluate using computed tomography or other conventional methods owing to the presence of metal artifacts; therefore, whether bone incorporation between the grafted bone and glenoid or between the graft and baseplate implant can be achieved remains unclear. Several studies have reported the effectiveness of tomosynthesis in reducing metal artifacts for the evaluation of implant loosening, bone resorption, and spot welds. We aimed to evaluate and compare the bone incorporation rates between angled bony-increased offset and metal-augmented implants using tomosynthesis with metal artifact reduction technology. We hypothesized that a high bone incorporation rate would be obtained with angled bony-increased offset and a metal-augmented baseplate. A total of 52 patients who underwent reverse total shoulder arthroplasty (TSA) with angled bony-increased offset and 42 patients who underwent reverse total shoulder arthroplasty with metal-augmented baseplate were assessed and followed up for a minimum of 2 years. The bone incorporation and implant loosening rates were compared between the 2 groups, and the sites of spot welds and trabeculation were recorded according to zones. Bone incorporation between the bone and prosthesis was defined as a confirmation of spot welds connecting the porous area and bone in more than three zones. Bone incorporation between the native bone and grafted bone was defined as an observation of trabeculation. Glenoid loosening was defined as the presence of at least 1 mm radiolucency around the prosthesis in more than 2 zones. Both the angled bony-increased offset and metal-augmented baseplate groups achieved sufficient bone incorporation rates (98% [51/52 cases] vs. 100% [42/42 cases], P = 1.0) and low implant loosening rates (2% [1/52 cases] vs. 0% [0/42 cases], P = 1.0). Spot welds and trabeculation were likely to be confirmed in the lower parts of the glenoid. The two groups did not show any significant differences regarding bone incorporation rates. Considering the complexity of performing the procedure with angled bony-increased offset, the use of a metal-augmented baseplate can serve as an alternative treatment to avoid superior inclination in reverse total shoulder arthroplasty. [ABSTRACT FROM AUTHOR]

Both bone morphogenetic protein 2 (BMP-2) and abaloparatide are used to promote bone formation. However, there is no consensus about their optimal administration. We investigated the optimal administration theory for the pairing of BMP-2 and abaloparatide in a rat spinal fusion model. Group I was only implanted in carriers and saline. Carriers with 3 µg of recombinant human BMP-2 (rhBMP-2) were implanted in other groups. Abaloparatide injections were administered three times a week for group III (for a total amount of 120 µg/kg in a week) and six times a week for group IV (for a total amount of 120 µg/kg in a week) after surgery. They were euthanized 8 weeks after the surgery, and we explanted their spines at that time. We assessed them using manual palpation tests, radiography, high-resolution micro-computed tomography (micro-CT), and histological analysis. We also analyzed serum bone metabolism markers. The fusion rate in Groups III and IV was higher than in Group I, referring to the manual palpation tests. Groups III and IV recorded greater radiographic scores than those in Groups I and II, too. Micro-CT analysis showed that Tbs. Sp in Groups III and IV was significantly lower than in Group I. Tb. N in Group IV was significantly higher than in Group I. Serum marker analysis showed that bone formation markers were higher in Groups III and IV than in Group I. On the other hand, bone resorption markers were lower in Group IV than in Group I. A histological analysis showed enhanced trabecular bone osteogenesis in Group IV. Frequent administration of abaloparatide may be suitable for the thickening of trabecular bone structure and the enhancement of osteogenesis in a rat spinal fusion model using BMP-2 in insufficient doses. [ABSTRACT FROM AUTHOR]

Study Design: Retrospective case series. Objectives: To investigate the influence of screw size on achieving bone fusion in posterior lumbar interbody fusion (PLIF). Methods: In total, 137 consecutive patients with L4 degenerative spondylolisthesis who underwent single-level PLIF at L4-L5 were evaluated. Factors investigated for their contribution to bone fusion included: 1) age, 2) sex, 3) body mass index, 4) bone mineral density, 5) intervertebral mobility, 6) screw diameter, 7) screw length, 8) screw fitness in the pedicle (%fill), 9) screw depth in the vertebra (%depth), 10) screw angle, 11) facetectomy, 12) crosslink connector, and 13) cage material. Results: Bone fusion was confirmed in 88.2% of patients. The comparison between fusion (+) and fusion (-) groups showed no significant differences in screw size. The %fill and %length were significantly greater in the fusion (+) group than in the fusion (-) group (%fill: 58.5% ± 7.5% vs 52.3% ± 7.3%, respectively, P =.005; %depth: 59.8% ± 9.7% vs 50.3% ± 13.8%, respectively, P =.025). Multivariate logistic regression analysis revealed that %fill (odds ratio [OR]= 1.11, P =.025) and %depth (OR = 1.09, P =.003) were significant independent factors affecting bone fusion. Receiver operating characteristic curve analyses identified a %fill of 60.0% and a %depth of 54.2% as optimal cutoff values for achieving bone fusion Conclusions: Screw size should be determined based on the screw fitness in the pedicle (%fill > 60%) and screw insertion depth in the vertebral body (%depth > 54.2%) according to individual vertebral anatomy in L4-L5 PLIF. [ABSTRACT FROM AUTHOR]

Objective: In surgical correction of frontoethmoidal encephalocele with transcranial approach, advanced facilities are required. While with extracranial approach, though deemed as a safe option in area with limited facilities, procedure was associated with cerebrospinal fluid (CSF) leakage. In this case series, we evaluate the results of transcele reconstruction of frontoethmoidal encephalocele, our approach to reduce the incidence of CSF leaks by focusing on the closure of layers by its embryological derivatives, by its bone fusion. Methods: A case series of 14 patients with various types of frontoethmoidal encephalocele who underwent surgery for defect closure using transcele approach between June 2015 and December 2018 was carried out. Surgery was done by a single surgeon in the Department of Neurosurgery of Cipto Mangunkusumo Hospital in Jakarta, Indonesia. We collected the data of intraoperative blood loss and any signs of infection and CSF leak during the patients' one-year follow up. Bone fusion in the defect was evaluated from 3D rendering of head CT scan that was performed before and in 1 year after surgery. Results: The median percentage of intraoperative blood loss was 5.9% (0.5-18.7%). All 3D rendering of head CT post-surgery during 1 year follow up showed bone fusion and no patient experienced CSF leaks or CNS infections. Conclusions: This study showed that using transcele approach in frontoethmoidal reconstruction could give good bone fusion with minimal blood loss and no CSF leaks. We assumed that closure of the layers by its embryological derivative played an important part in bone fusion and in reducing the incidence of CSF leaks, although this finding has to be validated with large-scale studies. [ABSTRACT FROM AUTHOR]

Lactoferrin (LF) is a potent antiviral, anti-inflammatory, and antibacterial agent found in cow and human colostrum which acts as an osteogenic growth factor. This study aimed to investigate whether LF-anchored tannylated mesoporous silica nanomaterials (TA-MSN-LF) function as a bone fusion material in a rat model. In this study, we created TA-MSN-LF and measured the effects of low (1 μg) and high (100 μg) TA-MSN-LF concentrations in a spinal fusion animal model. Rats were assigned to four groups in this study: defect, MSN, TA-MSN-LF-low (1 μg/mL), and TA-MSN-LF-high (100 μg/mL). Eight weeks after surgery, a greater amount of radiological fusion was identified in the TA-MSN-LF groups than in the other groups. Hematoxylin and eosin staining showed that new bone fusion was induced in the TA-MSN-LF groups. Additionally, osteocalcin, a marker of bone formation, was detected by immunohistochemistry, and its intensity was induced in the TA-MSN-LF groups. The formation of new vessels was induced in the TA-MSN-LF-high group. We also confirmed an increase in the serum osteocalcin level and the mRNA expression of osteocalcin and osteopontin in the TA-MSN-LF groups. TA-MSN-LF showed effective bone fusion and angiogenesis in rats. We suggest that TA-MSN-LF is a potent material for spinal bone fusion. [ABSTRACT FROM AUTHOR]

Abstract Background This study aimed to analyze the clinical efficacy of one-stage anterior debridement of lower cervical tuberculosis using iliac crest bone graft fusion and internal fixation. Materials and methods A retrospective analysis was performed on 48 patients with lower cervical tuberculosis admitted to multiple medical centers from June 2018 to June 2021. Among them, 36 patients had lesions involving two vertebrae and 12 patients had lesions involving more than three vertebrae. All patients were treated with quadruple antituberculosis drugs for more than 2 weeks before the operation, and then treated with one-stage anterior debridement and autogenous iliac bone graft fusion combined with titanium plate internal fixation. After the operation, antituberculosis drugs were continued for 12–18 months. The patients were followed-up to observe the improvement in clinical symptoms, bone graft fusion, Cobb angle, visual analog score (VAS), erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), wound healing, and neurological function. Results The patients were followed-up for 13–43 months, with an average of 21.46 ± 1.52 months. The clinical symptoms significantly improved after the operation. The bone graft was completely fused in all patients, and the bone fusion time was 3–6 months, with an average of 4.16 ± 0.47 months. At the last follow-up, the Cobb angle, VAS, ESR, and CRP level were significantly lower than those before surgery (P

Objective There is lack of an internal fixation following resection of a dumbbell tumor by hemi‐laminectomy and facetectomy that achieves adequate stability with less trauma. Unilateral fixation and reconstruction (unilateral pedicle screw and contralateral lamina screw fixation combined with lateral mass reconstruction, UPS + CLS + LM) may be an ideal technique to address this problem. A biomechanical comparison and a case report were designed to evaluate its spinal stability and clinical effect. Methods Seven fresh‐frozen human subcervical specimens were used for the biomechanical testing. The conditions tested were: (1) intact; (2) injured (single‐level hemi‐laminectomy and facetectomy); (3) unilateral pedicle screw (UPS) fixation; (4) UPS fixation combined with lateral mass (LM) reconstruction (UPS + LM); (5) UPS fixation and contralateral lamina screw fixation (UPS + CLS); (6) UPS + CLS + LM; (7) UPS fixation and contralateral transarticular screw fixation (UPS + CTAS); (8) bilateral pedicle screw (BPS) fixation. Range of motion (ROM) and neutral zone (NZ) were obtained at C5‐C7 segment under eight conditions. In addition, we report the case of a patient with a C7‐T1 dumbbell tumor that was treated by UPS + CLS + LM technique. Results Except left/right lateral bending and right axial rotation (all, p 0.05). There was no significant difference between UPS + CLS + LM and the UPS + CTAS condition in other directions of ROM (all, p > 0.05), except in left/right axial rotation (both, p 0.05). There was no significant difference between UPS + CLS + LM and UPS + CTAS condition in NZ in all directions (all, p > 0.05). Axial rotation NZ of UPS + CLS + LM condition was significantly reduced compared to UPS + CLS condition (p

Background: This study aims to investigate the postoperative improvement of paralysis, fusion rate and risk factors for kyphosis progression in adults affected with spinal caries. Methods: Overall, 134 patients with spinal caries from the thoracic to lumbar spine from 1992 to 2021 were included in this study. Data concerning the affected level (thoracic, thoracolumbar, lumbar, and lumbosacral), bone fusion rate, and progression of the postoperative local kyphosis angle were collected. The risk factors for the progression of local kyphosis angle after anterior spinal fixation (ASF) were determined using linear regression analysis. Results: Preoperatively, the degree of spinal cord paralysis was D and E on Frankel classification. Improvement of paralysis was good with surgery, especially from C, D. The overall bone fusion rate was 83.2%. The only factor influencing the progression of local kyphosis angle after ASF was the level of the affected vertebra. Progression of kyphosis angle after ASF was very advanced in the thoracolumbar transition area. Conclusions: Surgical improvement in paraplegia and the fusion rate of ASF with only grafted bone was good. However, in patients affected in the thoracolumbar spine region, posterior instrumentation is desirable because of local kyphosis progression risk after surgery.

Background: This study aimed to analyze the clinical efficacy of one-stage anterior debridement of lower cervical tuberculosis using iliac crest bone graft fusion and internal fixation. Materials and methods: A retrospective analysis was performed on 48 patients with lower cervical tuberculosis admitted to multiple medical centers from June 2018 to June 2021. Among them, 36 patients had lesions involving two vertebrae and 12 patients had lesions involving more than three vertebrae. All patients were treated with quadruple antituberculosis drugs for more than 2 weeks before the operation, and then treated with one-stage anterior debridement and autogenous iliac bone graft fusion combined with titanium plate internal fixation. After the operation, antituberculosis drugs were continued for 12–18 months. The patients were followed-up to observe the improvement in clinical symptoms, bone graft fusion, Cobb angle, visual analog score (VAS), erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), wound healing, and neurological function. Results: The patients were followed-up for 13–43 months, with an average of 21.46 ± 1.52 months. The clinical symptoms significantly improved after the operation. The bone graft was completely fused in all patients, and the bone fusion time was 3–6 months, with an average of 4.16 ± 0.47 months. At the last follow-up, the Cobb angle, VAS, ESR, and CRP level were significantly lower than those before surgery (P < 0.05). None of the patients had loosening, detachment, or rupture of the internal fixation, and no recurrence occurred. All surgical incisions healed in one stage without infection or sinus formation. The preoperative Frankel neurological function classification was grade B in 7 cases, grade C in 13, grade D in 18, and grade E in 10. At the last follow-up, 8 cases recovered to grade D and 40 recovered to grade E. Conclusions: For patients with lower cervical tuberculosis, based on oral treatment with quadruple antituberculosis drugs, direct decompression through anterior debridement, followed by autologous iliac bone graft fusion combined with internal fixation can completely remove tuberculosis foci, rebuild the stability of the cervical spine, and obtain good clinical efficacy. Level of evidence Level 3. [ABSTRACT FROM AUTHOR]

Objective: There is lack of an internal fixation following resection of a dumbbell tumor by hemi‐laminectomy and facetectomy that achieves adequate stability with less trauma. Unilateral fixation and reconstruction (unilateral pedicle screw and contralateral lamina screw fixation combined with lateral mass reconstruction, UPS + CLS + LM) may be an ideal technique to address this problem. A biomechanical comparison and a case report were designed to evaluate its spinal stability and clinical effect. Methods: Seven fresh‐frozen human subcervical specimens were used for the biomechanical testing. The conditions tested were: (1) intact; (2) injured (single‐level hemi‐laminectomy and facetectomy); (3) unilateral pedicle screw (UPS) fixation; (4) UPS fixation combined with lateral mass (LM) reconstruction (UPS + LM); (5) UPS fixation and contralateral lamina screw fixation (UPS + CLS); (6) UPS + CLS + LM; (7) UPS fixation and contralateral transarticular screw fixation (UPS + CTAS); (8) bilateral pedicle screw (BPS) fixation. Range of motion (ROM) and neutral zone (NZ) were obtained at C5‐C7 segment under eight conditions. In addition, we report the case of a patient with a C7‐T1 dumbbell tumor that was treated by UPS + CLS + LM technique. Results: Except left/right lateral bending and right axial rotation (all, p < 0.05), ROM of UPS + CLS + LM condition in other directions was similar to that of BPS condition (all, p > 0.05). There was no significant difference between UPS + CLS + LM and the UPS + CTAS condition in other directions of ROM (all, p > 0.05), except in left/right axial rotation (both, p < 0.05). Compared to UPS + CLS condition, left/right lateral bending ROM of UPS + CLS + LM condition were significantly reduced (both, p < 0.05). UPS + CLS + LM condition significantly reduced ROM in all directions compared to UPS and UPS + LM condition (all, p < 0.05). Similarly, except lateral bending (p < 0.05), there was no difference in NZ in other directions between UPS + CLS + LM and BPS condition (both, p > 0.05). There was no significant difference between UPS + CLS + LM and UPS + CTAS condition in NZ in all directions (all, p > 0.05). Axial rotation NZ of UPS + CLS + LM condition was significantly reduced compared to UPS + CLS condition (p < 0.05). Compared to UPS and UPS + LM condition, NZ of UPS + CLS + LM condition was significantly reduced in all directions (all, p < 0.05). The patient's imaging examination at 3 months postoperatively indicated that the internal fixation did not move and the graft bone was seen with fusion. Conclusion: After resection of a dumbbell tumor in the cervical spine, UPS + CLS + LM technique is a reliable internal fixation method to provide sufficient immediate stability and promote postoperative bone fusion. [ABSTRACT FROM AUTHOR]

Introduction: Long-term spinal stability after total en bloc spondylectomy (TES) is challenging. The aim of this study was to examine whether the new method could reduce the incidence of instrumentation failure (IF). Methods: We retrospectively compared 116 patients with spinal tumors who underwent TES between 2010 and 2019 and were followed up for >1 year. IF, cage subsidence, and complications were evaluated. Propensity score matching between conventional and new method groups was performed for age, sex, body mass index, preoperative radiotherapy, number of resected vertebrae, number of instrumented vertebrae, tumor level, and follow-up period. There were 25 cases each in the conventional and new method groups. The conventional method used a titanium mesh cage for anterior reconstruction and 5.5-mm-diameter titanium alloy rods for posterior fixation. The new method used a more robust cage for anterior reconstruction, bone grafting was performed around the cage, and 6.0-mm-diameter cobalt chromium rods were used for posterior fixation. We compared the incidence of IF and cage subsidence after TES between the conventional and new method groups. Results: While 5 out of 25 patients (20.0%) in the conventional method group experienced IF, none from the new method group experienced IF. Three-year implant survival rates were 87.3% in the conventional and 100% in the new method groups. The new method group had a significantly higher implant survival rate (p

Both bone morphogenetic protein 2 (BMP-2) and abaloparatide are used to promote bone formation. However, there is no consensus about their optimal administration. We investigated the optimal administration theory for the pairing of BMP-2 and abaloparatide in a rat spinal fusion model. Group I was only implanted in carriers and saline. Carriers with 3 µg of recombinant human BMP-2 (rhBMP-2) were implanted in other groups. Abaloparatide injections were administered three times a week for group III (for a total amount of 120 µg/kg in a week) and six times a week for group IV (for a total amount of 120 µg/kg in a week) after surgery. They were euthanized 8 weeks after the surgery, and we explanted their spines at that time. We assessed them using manual palpation tests, radiography, high-resolution micro-computed tomography (micro-CT), and histological analysis. We also analyzed serum bone metabolism markers. The fusion rate in Groups III and IV was higher than in Group I, referring to the manual palpation tests. Groups III and IV recorded greater radiographic scores than those in Groups I and II, too. Micro-CT analysis showed that Tbs. Sp in Groups III and IV was significantly lower than in Group I. Tb. N in Group IV was significantly higher than in Group I. Serum marker analysis showed that bone formation markers were higher in Groups III and IV than in Group I. On the other hand, bone resorption markers were lower in Group IV than in Group I. A histological analysis showed enhanced trabecular bone osteogenesis in Group IV. Frequent administration of abaloparatide may be suitable for the thickening of trabecular bone structure and the enhancement of osteogenesis in a rat spinal fusion model using BMP-2 in insufficient doses.

Objective: This study aimed to compare the outcomes of sternotomy closure using conventional and hybrid techniques and investigate their associated complications in patients undergoing cardiac surgery. Methods: A retrospective observational study was conducted, analyzing data from medical records and surgical databases. The study included a cohort of patients who underwent sternotomy closure using conventional and hybrid techniques at a tertiary care hospital. Patient demographics, surgical details, intraoperative factors, postoperative outcomes, and follow-up information were collected. Descriptive statistics were used to summarize the data. Results: A total of 50 patients and 25 in each group. The majority of cases are off pump (42 patients) and on pump (8 patients) .Analysis of postoperative outcomes showed that 92% of patients achieved satisfactory sternal healing, and bone fusion was observed in 98% of cases. The rate of sternal dehiscence was 2%, with no statistically significant difference between the two closure techniques (p=0.62). Surgical site infections occurred in 9% of patients, with no significant difference between the closure groups (p=0.88) Conclusion: Both conventional and hybrid techniques demonstrated comparable efficacy in achieving successful sternal union after sternotomy closure. The rates of sternal dehiscence and surgical site infections were similar between the closure techniques. Further research is needed to identify risk factors and develop preventive strategies to reduce complications associated with sternotomy closure. [ABSTRACT FROM AUTHOR]

Abstract Background Transforaminal Lumbar Interbody Fusion (TLIF) is commonly associated with higher complications and longer operative time. This study aims to evaluate the effectiveness, safety, and usability of a novel minimally invasive surgery (MIS) bone graft delivery device. Methods 73 consecutive patients with lumbar spondylosis, degenerative disc disease, spondylolisthesis, scoliosis or trauma were enrolled in this randomized controlled trial. Group 1 comprised 39 patients treated with the novel MIS bone graft delivery device. Group 2 consisted of 34 patients treated with the conventional system. The primary objective of the study was the assessment of the amount of bone graft delivery using the device. The secondary objectives were the effect of the device on operative time, pain relief, disability improvement, and bone fusion grade. Results Bone delivery amount was significantly higher in the MIS device group (6.7 ± 2.9 mL) compared to the conventional group (2.3 ± 0.5 mL), p

Introduction: Fibrin glue is widely used in spine surgery. Nevertheless, no report has demonstrated the feasibility of completely autologous fibrin glue (CAFG) in spine surgery. This study aims to investigate the safety, efficacy, and effect of bone fusion of CAFG on spine surgery. Methods: We retrospectively extracted data of patients who underwent primary spine surgery with preoperatively prepared CAFG. Primary outcomes were the incidence of wound-related unplanned reoperations within 90 days following primary surgery and the occurrence of reoperation for the management of cerebrospinal fluid (CSF) leakage in patients who had been treated with CAFG used as dural sealants. The effect of CAFG on bone fusion was also assessed by detecting implant failure at one year postoperatively in patients aged 25 years or less undergoing primary fusion for idiopathic scoliosis. Results: We identified 131 eligible patients (47 males and 84 females) with a mean age of 32.3 years. CAFG was used most frequently as an adhesive for fixation of graft bone (110 patients), followed by as a dural sealant for CSF leakage in 17 patients, and as a local hemostatic agent in four patients. Wound-related reoperations were identified in four patients (3.1%), which included three for surgical site infection, and one for postoperative epidural hematoma. There was no reoperation required for the management of CSF leakage among 17 patients with dural incision or incidental durotomy. Compared with the control cohort, the use of CAFG was not associated with early wound-related reoperations or implant failure in patients with spinal deformity. Conclusions: We demonstrated the clinical feasibility of CAFG in spine surgery. The use of CAFG was not associated with the incidence of reoperations for wound-related complications. CAFG worked effectively as a dural sealant for preventing CSF leakage. CAFG had no beneficial or adverse effect on spinal bone fusion.

Lactoferrin (LF) is a potent antiviral, anti-inflammatory, and antibacterial agent found in cow and human colostrum which acts as an osteogenic growth factor. This study aimed to investigate whether LF-anchored tannylated mesoporous silica nanomaterials (TA-MSN-LF) function as a bone fusion material in a rat model. In this study, we created TA-MSN-LF and measured the effects of low (1 μg) and high (100 μg) TA-MSN-LF concentrations in a spinal fusion animal model. Rats were assigned to four groups in this study: defect, MSN, TA-MSN-LF-low (1 μg/mL), and TA-MSN-LF-high (100 μg/mL). Eight weeks after surgery, a greater amount of radiological fusion was identified in the TA-MSN-LF groups than in the other groups. Hematoxylin and eosin staining showed that new bone fusion was induced in the TA-MSN-LF groups. Additionally, osteocalcin, a marker of bone formation, was detected by immunohistochemistry, and its intensity was induced in the TA-MSN-LF groups. The formation of new vessels was induced in the TA-MSN-LF-high group. We also confirmed an increase in the serum osteocalcin level and the mRNA expression of osteocalcin and osteopontin in the TA-MSN-LF groups. TA-MSN-LF showed effective bone fusion and angiogenesis in rats. We suggest that TA-MSN-LF is a potent material for spinal bone fusion.

Introduction: Anterior cervical discectomy and fusion (ACDF) is widely accepted as the gold standard surgical procedure for treating cervical radiculopathy and myelopathy. However, there is concern about the low fusion rate in the early period after ACDF surgery using the Zero-P fusion cage. We creatively designed an assembled uncoupled joint fusion device to improve the fusion rate and solve the implantation difficulties. This study aimed to assess the biomechanical performance of the assembled uncovertebral joint fusion cage in single-level ACDF and compare it with the Zero-P device.Methods: A three-dimensional finite element (FE) of a healthy cervical spine (C2−C7) was constructed and validated. In the one-level surgery model, either an assembled uncovertebral joint fusion cage or a zero-profile device was implanted at the C5–C6 segment of the model. A pure moment of 1.0 Nm combined with a follower load of 75 N was imposed at C2 to determine flexion, extension, lateral bending, and axial rotation. The segmental range of motion (ROM), facet contact force (FCF), maximum intradiscal pressure (IDP), and screw−bone stress were determined and compared with those of the zero-profile device.Results: The results showed that the ROMs of the fused levels in both models were nearly zero, while the motions of the unfused segments were unevenly increased. The FCF at adjacent segments in the assembled uncovertebral joint fusion cage group was less than that that of the Zero-P group. The IDP at the adjacent segments and screw–bone stress were slightly higher in the assembled uncovertebral joint fusion cage group than in those of the Zero-P group. Stress on the cage was mainly concentrated on both sides of the wings, reaching 13.4–20.4 Mpa in the assembled uncovertebral joint fusion cage group.Conclusion: The assembled uncovertebral joint fusion cage provided strong immobilization, similar to the Zero-P device. When compared with the Zero-P group, the assembled uncovertebral joint fusion cage achieved similar resultant values regarding FCF, IDP, and screw–bone stress. Moreover, the assembled uncovertebral joint fusion cage effectively achieved early bone formation and fusion, probably due to proper stress distributions in the wings of both sides.

To evaluate surgical outcomes and fusion rate following spinal fusion surgery in patients with chronic kidney disease and assess the impact of kidney function. From March 2017 to February 2021, 54 consecutive adult patients with chronic kidney disease who underwent spinal fusion surgery were enrolled. According to the glomerular filtration rate (GFR) categories, 35 and 19 patients were classified into the non-end-stage renal disease (ESRD) group (GFR categories 3a–4; eGFR, 15–59 mL/min/1.73 m2) and ESRD group (GFR category 5; eGFR, <15 mL/min/1.73 m2), respectively. Baseline characteristics did not differ between the groups. The lumbar and thoracolumbar spines were the most operated. The mean number of fused vertebrae (4.9 ± 2.3 vs. 4.1 ± 2.0, P = 0.122), operative time (228.4 ± 129.6 min vs. 160.5 ± 87.5 min, P = 0.113), and surgical bleeding (743.1 ± 630.5 mL vs. 539.5 ± 384.4 mL, P = 0.354) did not differ between the groups. However, occurrence rates of medical complications (25.7% vs. 52.6%, P = 0.048) and 3-month readmission (8.6% vs. 35.3%, P = 0.045) were significantly different between the groups. While the 3-month mortality (10.5% vs. 2.9%, P = 0.28) and pseudarthrosis rates (35.3% vs. 9.1%, P = 0.047) were higher in the ESRD group, the difference was not statistically significant for the former entity. Surgeons should consider the possibility of high morbidity and pseudarthrosis associated with spine surgeries when operating on patients with ESRD. [ABSTRACT FROM AUTHOR]

Age estimation is essential for the identification of skeletal remains in Forensic Anthropology. Numerous studies have been performed on diverse regions of the skeleton, including the synostosis of the sternal segments. In this sense, the fusion of the different sternal segments was assessed to analyze whether it had a correlation with age-at-death in a Mediterranean population. A total of 189 sternums which belonged to individuals between the ages of 20 and 98 from both sexes (56.6% males; 43.4% females), from the San José's Cemetery of Granada Contemporary Collection (Spain), were selected. Scores ranging from 1 to 3 were assigned in accordance with the degree of manubrio-sternal fusion and sterno-xyphoidal fusion. Cohen's kappa coefficient for intra- and inter-observer error was performed and then chi-square test was run to analyze any correlation between the stage of synostosis and the skeletal age. Only the sterno-xyphoidal fusion, which starts between 30 and 39 years old, provided a predictable result, as the manubrium and the sternal body usually remain without fusion. This study demonstrates a direct correlation between fusion of the xyphoid process and chronological age. [ABSTRACT FROM AUTHOR]

This study focused on the effects of teriparatide (CinnoPar) on healing and postoperative complications in mandibular bone fractures. In this single-blind randomized controlled trial, 30 patients with a mandibular fracture hospitalized for open reduction internal fixation were randomly assigned to the intervention (I) (n = 15) and control (C) (n = 15) groups. Both groups received daily acetaminophen and cephalexin for 1 week. For 1 month, Group I received daily subcutaneous teriparatide injections. The Radiographic Union Scale of the Mandible (RUSM) was used to assess mandibular bone fusion subjectively, and the Hounsfield unit (HU) was used to objectively assess radiodensity in a computed tomography (CT) scan. In both groups, the visual analog scale (VAS) score was used to assess postoperative complications such as pain, swelling, wound opening, pus secretion, and bitter taste. There was no significant difference in bone repair between the two groups in this study (P > 0.05). Teriparatide also had no effect on the postoperative complication rate in the control group (P > 0.05). Within the limitations of the study it seems that in mandibular fractures, teriparatide did not affect bone fusion or postoperative complications, so its use is not recommended for better bone fusion and fewer postoperative complications of mandibular fracture during the first month. [ABSTRACT FROM AUTHOR]

Background: Transforaminal Lumbar Interbody Fusion (TLIF) is commonly associated with higher complications and longer operative time. This study aims to evaluate the effectiveness, safety, and usability of a novel minimally invasive surgery (MIS) bone graft delivery device.Methods: 73 consecutive patients with lumbar spondylosis, degenerative disc disease, spondylolisthesis, scoliosis or trauma were enrolled in this randomized controlled trial. Group 1 comprised 39 patients treated with the novel MIS bone graft delivery device. Group 2 consisted of 34 patients treated with the conventional system. The primary objective of the study was the assessment of the amount of bone graft delivery using the device. The secondary objectives were the effect of the device on operative time, pain relief, disability improvement, and bone fusion grade.Results: Bone delivery amount was significantly higher in the MIS device group (6.7 ± 2.9 mL) compared to the conventional group (2.3 ± 0.5 mL), p < 0.001. Regarding the operation time, the MIS device group was associated significantly lower duration than the conventional group (p < 0.001). After a 3-month follow-up, 39.5% of the patients in the MIS device group and 3.5% of the patients in the conventional group were observed to achieve grade I fusion (complete fusion). There was a significant difference in fusion success rates (p < 0.01).Conclusion: The novel MIS bone graft delivery device was associated with successful bone delivery. Our MIS device provides promising modality with less operative time and higher bone fusion rates than conventional modalities. Trial Registration This trial was retrospectively registered on ClinicalTrials.gov (Registration date: 11/19/2021; Registration number: NCT05190055). [ABSTRACT FROM AUTHOR]

Objective: When using the cortical bone trajectory (CBT) technique, two technical countermeasures are recommended to promote bone fusion: taking a long CBT screw path directed more anteriorly and improving the stability of the spinal construct by facet joint preservation, cross-link augmentation, and rigid anterior interbody reconstruction. However, there has been no report on how these surgical procedures, which are heavily dependent on the surgeon's preference, contribute to successful bone fusion. The aim of the present study was to investigate the progression of lumbar spinal fusion using the long CBT technique and identify factors contributing to the time taken to achieve bone fusion, with a particular focus on the involvement of surgical procedures., Methods: A total of 167 consecutive patients with L4 degenerative spondylolisthesis who underwent single-level posterior lumbar interbody fusion at L4-5 using the long CBT technique were included (mean follow-up 42.8 months). Bone fusion was assessed to identify factors contributing to the time to achieve bone fusion. Investigated factors were 1) age, 2) sex, 3) BMI, 4) bone mineral density, 5) intervertebral mobility, 6) screw depth in the vertebra, 7) extent of facetectomy, 8) cross-link augmentation, 9) cage material, 10) cage design, 11) number of cages, and 12) contact area of cages with the vertebral endplate., Results: The bone fusion rate was 89.2% at 2 years postoperatively and 95.8% at the last follow-up, with a mean period to bone fusion of 16.6 ± 9.6 months. Multivariate regression analysis revealed that age (standardized regression coefficient [β] = 0.25, p = 0.002), female sex (β = -0.22, p = 0.004), and BMI (β = 0.15, p = 0.045) were significant independent factors affecting the time to achieve bone fusion. There was no significant effect of surgical procedures (p ≥ 0.364)., Conclusions: This is the first study to investigate the progression of lumbar spinal fusion using the long CBT technique and identify factors contributing to the time taken to achieve bone fusion. Patient factors such as age, sex, and BMI affected the progression of bone fusion, and surgical factors had only weak effects.

Background: The healing process after C1-C2 posterior screw fixation (C1-C2 PSF) for odontoid fractures is not well understood. Here, we evaluated such processes and identified factors potentially contributing to pseudoarthroses following fusions for Type II odontoid fractures. Methods: Pre- and post-operative cervical radiographs and computed tomography (CT) images from 15 patients with preoperative Type II odontoid fractures who underwent C1-C2 PSF were retrospectively reviewed. Results: CT images identified three areas of bone fusion: The primary fracture site in the dens (9/15 patients, 60%), the atlanto-dental interspace (ADI) (10/15, 67%), and C1-C2 interlaminar space after onlay bone grafting (4/15, 27%). All patients showed bone fusion in at least one of three areas, while only one patient (6.7%) achieved bone fusion in all three areas. With these overall criteria, nine of 15 patients (60%) were considered fused, while six patients (40%) were determined to exhibit pseudoarthroses. Univariate analyzes showed that the preoperative C2-C7 SVA for the nonunion group was significantly larger versus the union group, and bone fusion at the level of the ADI was significantly more common in the nonunion versus the union group. Conclusion: CT studies identified three anatomical areas where bone fusion likely occurs after C1-C2 PSF. Increased sagittal balance in the cervical spine may negatively impact the fusion of odontoid fractures. Further, bone fusion occurring at other sites, not the primary fracture location, through stress shielding may contribute to delayed or failed fusions. [ABSTRACT FROM AUTHOR]

The primate skull hosts a unique combination of anatomical features among mammals, such as a short face, wide orbits, and big braincase. Together with a trend to fuse bones in late development, these features define the anatomical organization of the skull of primates—which bones articulate to each other and the pattern this creates. Here, I quantified the anatomical organization of the skull of 17 primates and 15 non-primate mammals using anatomical network analysis to assess how the skulls of primates have diverged from those of other mammals, and whether their anatomical differences coevolved with brain size. Results show that primates have a greater anatomical integration of their skulls and a greater disparity among bones than other non-primate mammals. Brain size seems to contribute in part to this difference, but its true effect could not be conclusively proven. This supports the hypothesis that primates have a distinct anatomical organization of the skull, but whether this is related to their larger brains remains an open question. [ABSTRACT FROM AUTHOR]

Abstract Background There have been several reports of instrumentation failure after three-column resections such as total en bloc spondylectomy (TES) for spinal tumors; however, clinical outcomes of revision surgery for instrumentation failure after TES are seldom reported. Therefore, this study assessed the clinical outcomes of revision surgery for instrumentation failure after TES. Methods This study employed a retrospective case series in a single center and included 61 patients with spinal tumors who underwent TES between 2010 and 2015 and were followed up for > 2 years. Instrumentation failure rate, back pain, neurological deterioration, ambulatory status, operation time, blood loss, complications, bone fusion after revision surgery, and re-instrumentation failure were assessed. Data were collected on back pain, neurological deterioration, ambulatory status, and management for patients with instrumentation failure, and we documented radiological bone fusion and re-instrumentation failure in cases followed up for > 2 years after revision surgery. Results Of the 61 patients, 26 (42.6%) experienced instrumentation failure at an average of 32 (range, 11–92) months after TES. Of these, 23 underwent revision surgery. The average operation time and intraoperative blood loss were 204 min and 97 ml, respectively. Including the six patients who were unable to walk after instrumentation failure, all patients were able to walk after revision surgery. Perioperative complications of reoperation were surgical site infection (n = 2) and delayed wound healing (n = 1). At the final follow-up, bone fusion was observed in all patients. No re-instrumentation failure was recorded. Conclusion Bone fusion was achieved by revision surgery using the posterior approach alone.

To evaluate the long-term biological and clinical results of anterior cervical corpectomy and fusion (ACCF) with a synthesized nano-graphene oxide (nano-GO) loaded hydroxyapatite/polyamide (HAp/PA) strut in the implantation treatment of cervical reconstruction. Bio-ceramic Hydroxyapatite (HAp) combined with suitable polymer matrix is one of the furthermost naturally occurring biomaterial form for hard tissues and dental regeneration therapies due to their bone-like chemical compositional structure and biocompatibility similarity to native bone of the human body. In the present investigation, the development of nano-GO loaded HAp/PA composite strut for anterior cervical reform and fusion properties after corpectomy is studied. Forty patients who suffered from first or second level ACCF, treated with nano-GO loaded HAp/PA strut, were investigated. At final follow-up period, the fusion rate was 99%, and the subsidence value of the prepared strut was 5%. The results of cell viability and proliferation analyses indicated that the prepared nanocomposites did not exhibit non-cytotoxicity with the human cells. In summary, the satisfactory consequences in this research work designated that the nano-GO loaded HAp/PA strut was an active implant in the treatment of cervical reconstruction. Furthermore, the osteoconductive and osseointegration properties of the prepared struts need to be analyzed and optimized for future bio-medical usages.

Background : This study aims to investigate the postoperative improvement of paralysis, fusion rate and risk factors for kyphosis progression in adults affected with spinal caries. Methods : Overall, 134 patients with spinal caries from the thoracic to lumbar spine from 1992 to 2021 were included in this study. Data concerning the affected level (thoracic, thoracolumbar, lumbar, and lumbosacral), bone fusion rate, and progression of the postoperative local kyphosis angle were collected. The risk factors for the progression of local kyphosis angle after anterior spinal fixation (ASF) were determined using linear regression analysis. Results : Preoperatively, the degree of spinal cord paralysis was D and E on Frankel classification. Improvement of paralysis was good with surgery, especially from C, D. The overall bone fusion rate was 83.2%. The only factor influencing the progression of local kyphosis angle after ASF was the level of the affected vertebra. Progression of kyphosis angle after ASF was very advanced in the thoracolumbar transition area. Conclusions : Surgical improvement in paraplegia and the fusion rate of ASF with only grafted bone was good. However, in patients affected in the thoracolumbar spine region, posterior instrumentation is desirable because of local kyphosis progression risk after surgery.

Introduction: Both bone morphogenetic protein 2 (BMP‐2) and teriparatide (parathyroid hormone [PTH] 1‐34) are used to enhance bone healing. There is still no established opinion regarding the optimum dose and administration method. We investigated the optimal administration method for the combination of BMP‐2 and PTH 1‐34 in a rat spinal fusion model. Methods: Group I was implanted with a control carrier. Groups II, III, and IV were implanted with a carrier containing 3 μg of recombinant human BMP‐2 (rhBMP‐2). In addition, following implantation, PTH 1‐34 injections were administered to Group III thrice a week (total, 180 μg/kg/week) and Group IV six times a week (total, 180 μg/kg/week). The rats were euthanized after 8 weeks, and their spines were explanted; assessed by manual palpation, radiographs, and high‐resolution micro‐computed tomography (micro‐CT); and subjected to histological analysis. Serum markers of bone metabolism were also analyzed. Results: Manual palpation tests showed that the fusion rates in Groups III and IV were considerably higher than those in Group I. They also had higher radiographic scores than Group I and II. Micro‐CT analysis revealed Tb.Th in the Group IV had higher values than that in the Group I, II, III with significant differences and Tb.Sp in the Group IV had lower values than that in the Group I, II, III with significant differences. Serum marker analysis revealed that Group IV had higher osteocalcin and lower tartrate‐resistant acid phosphatase‐5b than Group III. Histological analysis indicated that Group IV had enhanced trabecular bone structure. Conclusions: Frequent administration of PTH may be better in making thicker and strengthening the trabecular bone structure in newly formed bone in the rat spinal fusion model using insufficient BMP‐2. [ABSTRACT FROM AUTHOR]

BACKGROUND: Adequate bone grafting is very necessary during spinal fusion. However, due to the limited number of osteoblasts and the function of the bone microenvironment in elderly patients, as well as the in vivo application of bone morphogenetic protein 2 will cause adverse effects such as ectopic bone. The current method can cause nonunion and other complications. In this case, Nel-like molecule-1 (Nell-1) has entered the field of vision of researchers. Nell-1 is not only equivalent to BMP-2 in osteogenic activity, but also has anti-fat, anti-inflammatory, and pro-vascular properties. These laid the foundation for clinical trial approval of Nell-1 in promoting spinal fusion. OBJECTIVE: To review the effect and mechanism of Nell-1 on bone fusion after spinal fusion. METHODS: Relevant documents were retrieved in Baidu Academic, PubMed, Web of Science, Wanfang, and CNKI. The Chinese and the English search terms were “Nell-1, spinal fusion, bone fusion, pre-osteoblast differentiation, neovascularization, progenitor cell migration”. Finally, 68 articles were included for review. RESULTS AND CONCLUSION: Autologous bone grafting has complications and supply problems related to bone grafting. Bone graft replacement therapy represented by bone morphogenetic protein 2 will produce many non-target effects. Therefore, neither can meet the increasing demand for spinal fusion. In this context, the emergence of Nell-1 provides the possibility to solve this dilemma. Although the role of Nell-1 in promoting bone fusion after spinal fusion is still in the preliminary stage of research, there are still deficiencies in the lack of an optimal route of administration; the molecular mechanism is not fully understood; and whether there are adverse reactions related to the application. Nevertheless, it has the triple effect of promoting progenitor cell migration, pre-osteoblast differentiation, and vascularization, so it has great potential for promoting bone fusion after spinal fusion. Future research should further reveal the detailed underlying mechanism, optimize the dosage and schedule, explore the combined effect with other osteogenic growth factors and stem cells, and translate the potential of Nell-1 for promoting spinal fusion into clinical practice. [ABSTRACT FROM AUTHOR]

The degree of sutural closure between bones generally allows for the classification of skeleton maturity in tetrapods. In mammals, the sutural closure of skull bones was previously used as proxy to evaluate the ontogenetic stage of single individuals. However, due to temporal variation, this process can be only applied among mammalian subclades, but not for all mammals in general. In contrast, the process of sutural closures in bird skulls could be a more reliable ontogenetic proxy for this clade as adult birds commonly show a generally high degree of bone fusion. To test this, we studied the process of sutural closure in ontogenetic series of 18 extant bird species regarding the presence of an ontogenetic signal and compared the results with changes in skull size and proportions. Univariate analyses indicate that bone fusion happens faster in altricial than in precocial birds. However, the use of PCoA and multivariate regressions reveal that the skull bone fusion follows a common pattern among birds and thus can be used as proxy to identify different ontogenetic stages. In general, the process of sutural closure spreads from posterior to anterior and from ventral to dorsal. In contrast, skull measurements reflect rather interspecific allometry than ontogeny. The used of bone fusion as proxy will help to better identify and compare different stages of maturation in birds, including historical material from osteological collections.

Abstract Introduction Both bone morphogenetic protein 2 (BMP‐2) and teriparatide (parathyroid hormone [PTH] 1‐34) are used to enhance bone healing. There is still no established opinion regarding the optimum dose and administration method. We investigated the optimal administration method for the combination of BMP‐2 and PTH 1‐34 in a rat spinal fusion model. Methods Group I was implanted with a control carrier. Groups II, III, and IV were implanted with a carrier containing 3 μg of recombinant human BMP‐2 (rhBMP‐2). In addition, following implantation, PTH 1‐34 injections were administered to Group III thrice a week (total, 180 μg/kg/week) and Group IV six times a week (total, 180 μg/kg/week). The rats were euthanized after 8 weeks, and their spines were explanted; assessed by manual palpation, radiographs, and high‐resolution micro‐computed tomography (micro‐CT); and subjected to histological analysis. Serum markers of bone metabolism were also analyzed. Results Manual palpation tests showed that the fusion rates in Groups III and IV were considerably higher than those in Group I. They also had higher radiographic scores than Group I and II. Micro‐CT analysis revealed Tb.Th in the Group IV had higher values than that in the Group I, II, III with significant differences and Tb.Sp in the Group IV had lower values than that in the Group I, II, III with significant differences. Serum marker analysis revealed that Group IV had higher osteocalcin and lower tartrate‐resistant acid phosphatase‐5b than Group III. Histological analysis indicated that Group IV had enhanced trabecular bone structure. Conclusions Frequent administration of PTH may be better in making thicker and strengthening the trabecular bone structure in newly formed bone in the rat spinal fusion model using insufficient BMP‐2.

Background: Recently, arthroscopic double-button Latarjet (AL) has provided an alternative to conventional open Latarjet (OL) in the treatment of anterior shoulder instability with glenoid bone loss. Therefore, theoretically, the faster fusion is obtained, the sooner return to sports under safe conditions can occur. The emerging flexible fixation of the bone block has clearly offered a new approach to achieve bone fusion. However, the period required to achieve this goal remains controversial. Purpose/Hypothesis: The purpose was to compare computed tomography (CT) scan results of AL and OL in the early postoperative period. It was hypothesized that the bone block fusion with AL would require a longer time than that with OL. Study Design: Cohort study; Level of evidence, 3. Methods: In a retrospective 1-year study, the authors compared 17 primary double-button AL to 22 primary 2-screw OL procedures indicated for anterior shoulder instability in patients with an Index Severity Instability Score >3 points. These patients were reviewed with a CT scan at 1 day, 3 months, and 6 months postoperatively. The characteristics for the 2 groups were comparable. CT scans aimed to analyze graft position, bone contact area with the scapula, and fusion at 3 and 6 months. Clinical assessment was based on the Walch-Duplay and Rowe scores. Results: The mean preoperative Index Severity Instability Score was 5.3 ± 1.9 points, with a mean anterior glenoid bone loss of 9.1% ± 4.6%. At 3 months, the rates of fusion were 41% and 100% for the AL and OL groups, respectively (P <.001). This rate increased to 70% in the AL group at 6 months (P =.006). In the axial and sagittal planes, there was no difference in graft position between the AL group and the OL group. The bone block was longer and there was a more extensive bone contact area in the OL group (AL, 131 mm2 vs OL, 223 mm2; P <.001). At 6 months of follow-up, no significant difference in clinical scores was noted between the groups: Walch-Duplay score, 93.0 ± 10.9 points versus 91.8 ± 12.5 points (P =.867); and Rowe score, 99.0 ± 2.2 points versus 95.0 ± 8.4 points (P =.307) for the AL and OL groups, respectively. Conclusion: AL required more time to achieve bone block fusion than OL. This finding should be taken into account when considering this procedure for patients in a hurry to return to sports involving the shoulder. [ABSTRACT FROM AUTHOR]

Although the development of the avian skeleton has attracted considerable attention, most of the studies have been concentrated on the embryonic period, while studies on the postnatal period are rare. We studied the postnatal development of the skeleton in two phylogenetically distant birds, an altricial passerine Acrocephalus scirpaceus and a semiprecocial charadriiform Chroicocephalus ridibundus. The neonates of the former, despite being altricial, have well‐ossified skeleton—the degree of development approaches that of the semiprecocial gull. However, after hatching the limb bones (particularly those of the hind limb) ossify earlier in the gull which is probably related to faster acquisition of locomotor abilities. We have observed that, in contrast to previous reports from neognathous birds, in the ankle of the gull, the ascending process fuses with the astragalus rather than with the calcaneum. This type of development is present in palaeognaths and nonavian dinosaurs but has not yet been reported in neognaths. This indicates a greater diversity within Neognathae and suggests a more complex scenario for the evolution of the avian ankle. However, data from a greater number of species are needed to establish the developmental sequence ancestral for neognathous birds. Furthermore, the sequence of bone fusions in the wrist of Acrocephalus is similar to the fossil‐documented evolutionary sequence observed in the phylogeny of early birds, with the semilunate carpal and major metacarpal fusing first, followed by the alular metacarpal fusing with the major metacarpal and then the major and minor metacarpal fusing proximally. These data underscore the importance of developmental studies for reconstructing the evolutionary history. [ABSTRACT FROM AUTHOR]

BACKGROUND: Currently, pedicle screw fixation is widely used in posterior lumbar interbody fusion. However, due to its shortcomings such as the need of extensive muscle dissection, and invasion of adjacent joints, since 2009, cortical screws were introduced to administrate posterior lumbar interbody fusion in order to reduce intraoperative blood loss and related surgical complications. At present, there are some shortages in the meta-analyses comparing cortical screws with pedicle screws in the use of posterior lumbar interbody fusion, such as including studies with the inconsistent operative methods, or including studies with relatively short follow-up time, or analyses with a rather small sample sizes. OBJECTIVE: To compare the clinical efficacy of cortical bone trajectory screw and pedicle screw fixation in posterior lumbar interbody fusion. METHODS: The computer was used to search for studies of comparing clinical efficacy of cortical bone trajectory screw fixation and pedicle screw fixation in posterior lumbar interbody fusion in PubMed, Embase, Web of Science, China Biology Medicine disc, China National Knowledge Infrastructure and Wanfang database from January 2009 to January 1, 2020. The data in each research were extracted and sorted into tables. The research data were meta-analyzed and synthesized by RevMan 5.3 software. RESULTS AND CONCLUSION: (1) A total of 12 articles that met the study criteria, including 2 randomized controlled trials and 10 cohort studies with 929 patients were included in the analysis database. Quality assessment indicated that the included studies had relatively high quality. (2) Meta-analysis results indicated that compared with pedicle screw group, intraoperative blood loss (MD=-68.77, 95%CI: -84.33 to -53.21), operation time (MD=-28.96, 95%CI: -53.11 to -4.82), hospitalization time (MD=-1.59, 95%CI: -2.58 to -0.59) and perioperative complications (OR=-1.95, 95%CI: -4.11-0.20) were statistically significant in the cortical bone trajectory screw group (P < 0.05). Postoperative visual analogue scale back pain score, visual analogue scale leg pain score, Oswestry Dysfunction Index, Japanese orthopaedic association score, long-term complications and fusion rate were not statistically significant. (3) Above data verified that compared with pedicle screw, cortical bone trajectory screw in posterior lumbar interbody fusion can reduce intraoperative blood loss, shorten the operation time and hospitalization time and reduce perioperative complications. However, more prospective, large-scale randomized controlled trials are still needed to provide first-class evidence for verification. [ABSTRACT FROM AUTHOR]

BACKGROUND: Different bone graft substitutes are widely used in clinical bone repair and tissue reconstruction. However, it remains unclear what bone graft substitute can acquire good bone fusion. OBJECTIVE: To investigate the clinical efficacy of different bone grafts filled in Zero-P cage for single-segment anterior cervical discectomy and fusion to treat cervical radiculopathy. METHODS: Seventy-seven patients with cervical radiculopathy who received treatment in the Second Hospital of Shanxi Medical University between January 2017 and January 2019 were included in this study. All included patients underwent single-segment anterior cervical discectomy and fusion and were divided into three groups according to bone graft materials: calcium sulphate/demineralized bone matrix group (n=27), allogeneic bone group (n=24), and autologous bone group (n=26). After surgery, 1-year follow up was performed. The Japanese Orthopedic Association (JOA) score, Visual Analog Scale tyAS) score, and Neck Disability Index (NDI) were evaluated. Changes in bone fusion, cervical curvature, and the height of intervertebral space were observed by imaging examination. This study was approved by the Hospital Ethics Committee, Second Hospital of Shanxi Medical University, China. RESULTS AND CONCLUSION: (1) Compared with before surgery, JOA score was significantly increased, VAS score, and NDI were significantly decreased in each group at 1 year after surgery (P < 0.05). There were no significant differences in JOA score, VAS score, and NDI among three groups at 1 year after surgery (P > 0.05). (2) Compared with before surgery, cervical curvature and the height of intervertebral space were significantly increased in each group at 1 year after surgery (P < 0.05). There were no significant differences in cervical curvature and the height of intervertebral space between groups (P > 0.05). (3) At. 6 months after surgery, bone fusion was observed in each group, and the degree of bone fusion in the calcium sulphate/demineralized bone matrix group was similar to that in the autologous bone group (P > 0.05), and the degree of bone fusion in the alloganeic bone group was lower than that in the autologous bone group (P < 0.05). (4) These results suggest that calcium sulphate/demineralized bone matrix for anterior cervical discectomy and fusion can acquire good bone fusion, and the clinical efficacy of calcium sulphate/demineralized bone matrix is similar to that of autologous bone and superior to that of allogenic bone. [ABSTRACT FROM AUTHOR]

Objective: To investigate the bone fusion and clinical effect of laminoplasty combined with ARCH plate fixation in the treatment of lumbar intraspinal tumors. Methods: This was a clinical study. From June 2017 to January 2019, 24 patients (seven males and 17 females, average age 40 ± 16 years) with lumbar intraspinal tumors underwent laminoplasty combined with ARCH plate fixation in our hospital. The bone fusion was evaluated by X‐ray and computed tomography (CT) scans that were taken 15.2 ± 2.17 months postoperatively. Each segment showed a bone bridge on one side, which was classified as "segmental partial fusion." Each segment showed bilateral bone bridges, which were classified as "segmental complete fusion". When all segments of the patient showed bilateral bone bridging so that the replanted lamina and the host lamina became a unit on the CT scan, it was defined as "complete fusion". In addition, the operation time and blood loss were recorded. Fisher's exact test was used to analyze the potential influencing factors of bone healing, including age (≤40 years vs >40 years), gender, number of operated levels (single vs two). Paired t‐test was used to analyze pre‐ and postoperative Oswestry Disability Index (ODI) scale and low back and leg pain visual analog scale (VAS). Results: A total of 33 segments of laminoplasty were successfully performed in 24 patients. The average operation time was 128 ± 18 minutes. The average blood loss was 110 ± 19 mL. All patients were followed up at least 12 months after operation (average, 15.2 ± 2.17 months). At the final follow‐up, according to the definition of this study, the proportion of "segmental partial fusion" and "segmental complete fusion" were 30.3% (10/33) and 69.7% (23/33), respectively. And the proportion of patients with "complete fusion" was 70.8% (17/24). Age, gender, and number of operated levels were not associated with the fusion (P = 1.0, 0.37, and 0.06, respectively). ODI and VAS were much better at 1 month after operation and the final follow‐up than those before the operation (P < 0.01). At 6 months after operation, the results of magnetic resonance imaging (MRI) showed that the supraspinous ligament was repaired, and there were no complications, such as spinal epidural scar recompression. Conclusions: Laminoplasty combined with ARCH plate was a better surgical method, and 70.8% of the patients showed complete bone fusion and there was no case of bilateral nonunion. [ABSTRACT FROM AUTHOR]

Background: There have been several reports of instrumentation failure after three-column resections such as total en bloc spondylectomy (TES) for spinal tumors; however, clinical outcomes of revision surgery for instrumentation failure after TES are seldom reported. Therefore, this study assessed the clinical outcomes of revision surgery for instrumentation failure after TES.Methods: This study employed a retrospective case series in a single center and included 61 patients with spinal tumors who underwent TES between 2010 and 2015 and were followed up for > 2 years. Instrumentation failure rate, back pain, neurological deterioration, ambulatory status, operation time, blood loss, complications, bone fusion after revision surgery, and re-instrumentation failure were assessed. Data were collected on back pain, neurological deterioration, ambulatory status, and management for patients with instrumentation failure, and we documented radiological bone fusion and re-instrumentation failure in cases followed up for > 2 years after revision surgery.Results: Of the 61 patients, 26 (42.6%) experienced instrumentation failure at an average of 32 (range, 11-92) months after TES. Of these, 23 underwent revision surgery. The average operation time and intraoperative blood loss were 204 min and 97 ml, respectively. Including the six patients who were unable to walk after instrumentation failure, all patients were able to walk after revision surgery. Perioperative complications of reoperation were surgical site infection (n = 2) and delayed wound healing (n = 1). At the final follow-up, bone fusion was observed in all patients. No re-instrumentation failure was recorded.Conclusion: Bone fusion was achieved by revision surgery using the posterior approach alone. [ABSTRACT FROM AUTHOR]

Background: Occipitocervical and atlantoaxial instability in the pediatric population is a rare and challenging condition to treat. Variable surgical techniques have been employed to achieve fusion. The study aimed to assess bony fusion with rigid craniocervical fixation using an allograft bone block to serve as scaffold for bony fusion. Methods: This is a single center case series from a tertiary referral neurosurgical center. The series includes 12 consecutive pediatric patients with rigid craniocervical fusion between 2006 and 2014. The primary outcome was bony fusion as assessed by computed tomography and flexion-extension radiographs. The authors did not receive external funding for this study. Results: Twelve patients (age 1–15 years) were operated with a median imaging follow-up time of 22 months (range 6–69 m). A modified Gallie fusion technique with a tightly wired allograft bone block was used in 10 of 13 procedures. One patient underwent re-fixation due to screw breakage. Eleven out of 13 procedures resulted in a stable construct with bony fusion. All 10 patients operated with the modified Gallie fusion technique with sublaminar wiring of allograft bone block had bony fusion. No post-operative complications of the posterior fixation procedure were noted. Conclusions: The modified Gallie fusion technique with allograft bone block without post-operative immobilization achieved excellent fusion. We conclude there is no need to use autograft or BMPs in craniocervical fusion in the pediatric population, which avoids related donor-site morbidity. Level of evidence: Level IV—case series; therapeutic. [ABSTRACT FROM AUTHOR]

Background Context: Recombinant human bone morphogenic protein 2 (rhBMP2) has been used to induce bone fusion in patients with spinal fusion surgery. However, the effectiveness of rhBMP2 in the bone fusion process is limited in osteoporosis patients, and a high dose of rhBMP2 for enough bone fusion sometimes provokes side effects. Therefore, substitutes for rhBMP2 with a higher therapeutic potency are needed, and already several studies have published the effectiveness of Activin A/BMP2 chimera (AB204) in new bone formation process in vitro and in vivo.Purpose: In the present study, we provide evidence that bone fusion activity of AB204 is superior to that of rhBMP2 in osteoporotic rat models.Study Design/settings: An in vivo animal study was carried out.Methods: A total of 40 Sprague-Dawley rats underwent bilateral ovariectomy. At 6 weeks after ovariectomy, a lumbar spinal bone fusion model of bilateral intertransverse process was performed. All rats were randomly divided into four groups as follows: rats receiving 5 µg of rhBMP2 (Group I), rats receiving 10 µg of rhBMP2 (Group II), rats receiving 5 µg of AB204 (Group III), and rats receiving 10 µg of AB204 (Group IV). Simple radiographs were performed at 6 and 12 weeks after bone fusion, and direct palpation, micro-CT, and immunohistochemistry (hematoxylin-eosin stain and Masson's trichrome stain) were performed at 12 weeks after bone fusion. The qualitative degree of bone fusion was assessed as manual fusion score from direct palpation, and radio-histologic fusion score from simple radiographs, micro-CT, and immunohistochemistry. Also, the quantitative degree of bone fusion was assessed using fusion bone volume by micro-CT and serum osteocalcin level as bone turnover markers.Results: The change of body weight was not different among the groups during follow-up. The qualitative degree of bone fusion assessed by direct palpation, simple radiographs, micro-CT, and histologic evaluation was significantly different among the four groups. Also, the quantitative degree of bone fusion including fusion bone volume and serum osteocalcin was significantly different among the groups. Especially, in manual fusion score, radio-histologic fusion score, and fusion bone volume, the AB204 group revealed superior results to the rhBMP2 group when using the same dose. Furthermore, even the low-dose AB204 group (Group III) showed superior results to the high-dose rhBMP2 group (Group II) in radio-histologic fusion score and fusion bone volume.Conclusion: The effect of bone fusion in osteoporotic rats was significantly higher in the AB204 group than in the rhBMP2 group.Clinical Significance: If further organized animal studies and clinical trials are provided, AB204 may be a good substitute for rhBMP2 in osteoporotic spinal fusion surgery, as a superior osteogenesis inducer. [ABSTRACT FROM AUTHOR]

To evaluate the long-term biological and clinical results of anterior cervical corpectomy and fusion (ACCF) with a synthesized nano-graphene oxide (nano-GO) loaded hydroxyapatite/polyamide (HAp/PA) strut in the implantation treatment of cervical reconstruction. Bio-ceramic Hydroxyapatite (HAp) combined with suitable polymer matrix is one of the furthermost naturally occurring biomaterial form for hard tissues and dental regeneration therapies due to their bone-like chemical compositional structure and biocompatibility similarity to native bone of the human body. In the present investigation, the development of nano-GO loaded HAp/PA composite strut for anterior cervical reform and fusion properties after corpectomy is studied. Forty patients who suffered from first or second level ACCF, treated with nano-GO loaded HAp/PA strut, were investigated. At final follow-up period, the fusion rate was 99%, and the subsidence value of the prepared strut was 5%. The results of cell viability and proliferation analyses indicated that the prepared nanocomposites did not exhibit non-cytotoxicity with the human cells. In summary, the satisfactory consequences in this research work designated that the nano-GO loaded HAp/PA strut was an active implant in the treatment of cervical reconstruction. Furthermore, the osteoconductive and osseointegration properties of the prepared struts need to be analyzed and optimized for future bio-medical usages. [ABSTRACT FROM AUTHOR]

Background Context: The mechanical strength provided by internal fixation is crucial for maintaining reduction and facilitating bony fusion. Though satisfactory results with the C1-C2 technique have been acquired in most clinical reports, the related problems of fusion delay and pseudarthrosis still exist. To increase the chance of bony fusion, a transverse connector (TC) is frequently used to augment torsional stiffness of thoracolumbar screw/rod constructs. Nevertheless, the clinical implication of TC in the management of atlantoaxial dislocation (AAD) and basilar invagination (BI) remains largely unknown.Purpose: To evaluate the effects of TC application on C1-C2 screw-rod constructs based on consecutive adult patients with AAD and BI in a single institution over a 10-year period.Study Design: A retrospective study.Patient Sample: Patients with AAD and BI, who were treated with posterior C1-C2 screw-rod technique with or without TC usage from June 2007 to June 2017 at a single institution.Outcome Measures: The radiological measurements included the anterior atlantodental interval (AADI), posterior atlantodental interval (PADI), height of odontoid process above Chamberlain line, and cervicomedullary angle (CMA). Patients' neurologic status was evaluated with the Japanese Orthopaedic Association (JOA) score. Fusion status was evaluated at different follow-up periods.Methods: We compared the difference of clinical, radiological, and surgical outcomes between the TC and NTC groups postoperatively.Results: In total, there were 149 consecutive patients in the TC group and 168 patients in the NTC group. On average, 1.2 TCs per patient were used in the TC group. No significant differences were identified for operative time and blood loss between groups. There was also no statistical difference in the radiological measurements of AADI, PADI, Chamberlain line, and CMA between the TC and NTC groups preoperatively and postoperatively. A significantly higher JOA score was obtained in the TC group than that in the NTC group postoperatively. The fusion rates were higher in the TC group than those in the NCT group at the early stage postoperatively (3 and 6 months; p<.01).Conclusions: Use of TCs seems to improve bony fusion and neurologic outcomes in the treatment of AAD and BI with C1-C2 screw-rod technique. [ABSTRACT FROM AUTHOR]

In many vertebrate animals that run or leap, the metatarsals and/or metacarpals of the distal limb are fused into a single larger element, likely to resist fracture due to high ground‐reaction forces during locomotion. Although metapodial fusion evolved independently in modern birds, ungulates, and jerboas, the developmental basis has only been explored in chickens, which diverged from the mammalian lineage approximately 300 million years ago. Here, we use a bipedal rodent, the lesser Egyptian jerboa (Jaculus jaculus), to understand the cellular processes of metatarsal fusion in a mammal, and we revisit the developing chicken to assess similarities and differences in the localization of osteoblast and osteoclast activities. In both species, adjacent metatarsals align along flat surfaces, osteoblasts cross the periosteal membrane to unite the three elements in a single circumference, and osteoclasts resorb bone at the interfaces leaving a single marrow cavity. However, the pattern of osteoclast activity differs in each species; osteoclasts are highly localized to resorb bone at the interfaces of neighboring jerboa metatarsals and are distributed throughout the endosteum of chicken metatarsals. Each species, therefore, provides an opportunity to understand mechanisms that pattern osteoblast and osteoclast activities to alter bone shape during development and evolution. [ABSTRACT FROM AUTHOR]

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Objective: In surgical correction of frontoethmoidal encephalocele with transcranial approach, advanced facilities are required. While with extracranial approach, though deemed as a safe option in area with limited facilities, procedure was associated with cerebrospinal fluid (CSF) leakage. In this case series, we evaluate the results of transcele reconstruction of frontoethmoidal encephalocele, our approach to reduce the incidence of CSF leaks by focusing on the closure of layers by its embryological derivatives, by its bone fusion., Methods: A case series of 14 patients with various types of frontoethmoidal encephalocele who underwent surgery for defect closure using transcele approach between June 2015 and December 2018 was carried out. Surgery was done by a single surgeon in the Department of Neurosurgery of Cipto Mangunkusumo Hospital in Jakarta, Indonesia. We collected the data of intraoperative blood loss and any signs of infection and CSF leak during the patients' one-year follow up. Bone fusion in the defect was evaluated from 3D rendering of head CT scan that was performed before and in 1 year after surgery., Results: The median percentage of intraoperative blood loss was 5.9% (0.5-18.7%). All 3D rendering of head CT post-surgery during 1 year follow up showed bone fusion and no patient experienced CSF leaks or CNS infections., Conclusions: This study showed that using transcele approach in frontoethmoidal reconstruction could give good bone fusion with minimal blood loss and no CSF leaks. We assumed that closure of the layers by its embryological derivative played an important part in bone fusion and in reducing the incidence of CSF leaks, although this finding has to be validated with large-scale studies.

In this study, a novel 3D printed porous titanium cage (3D printed cage) with interconnected pores inside was designed and manufactured. Observations by scanning electron microscopy showed that the inside of the 3D printed cage had an octahedral porous structure, with the pores uniform in size and connected to each other. The mechanical properties analysis found that the Young's modulus and compressive strength of the porous structure were close to those of the bone structure, and the overall stiffness was slightly higher than that of the polyether ether ketone (PEEK) material, but was significantly lower than that of the titanium alloy solid module. Animal experiments indicated that the new 3D printed cage was equivalent to PEEK cage in fusion time. At 3 months, the new bone grew into the cage through the pores of the new 3D printed cage surface, which had a high bone contact rate. These results demonstrate that the 3D printed porous titanium cage has good biocompatibility and osseointegration, and has a potential clinical value as bone implants. © 2019 Wiley Periodicals, Inc. J Biomed Mater Res Part A, 2019. [ABSTRACT FROM AUTHOR]

Highlights • 22 patients operated with PTCIF technique for traumatic injury or degenerative disease. • PTCIF technique was performed in a similar manner to the PLIF technique. • All degenerative cases showed neurological improvement and no aggravation for trauma cases. • All patients showed successful bone fusion in CT at least 3–4 months after the surgery. Abstract Laminectomy followed by posterolateral fusion (PLF) is a standard procedure for thoracic and thoracolumbar (TL) compressive lesions. However, it is challenging to apply sufficient bone chips as the spinal cord is exposed after the laminectomy. Therefore, we performed posterior thoracic cage interbody fusion (PTCIF) as an alternative technique. A total of 25 patients operated with PTCIF technique between 2012 and 2017 were analyzed in our study. These patients required a posterior decompression and fusion in thoracic and TL spine for traumatic injury or degenerative disease. To evaluate the outcome of bone fusion, computed tomography (CT) was performed at least 3–4 months after PTCIF. The surgery was performed through insertion of screws and cages packed with autologous bone chips in a similar fashion to the posterior lumbar interbody fusion technique. Among 25 patients who underwent PTCIF, 22 patients were involved in our study. The mean age and follow-up interval were 58.6 (28–78) years and 27.1 (6–60) months, respectively. Traumatic spinal injury was diagnosed in 6 patients and degenerative disease in 16 patients. One level PTCIF was performed in 12 patients and 2 levels in 8 patients. After the operation, patients with degenerative disease showed neurological improvement, and trauma cases showed no neurological aggravation. Successful bone fusion was confirmed on CT for all patients. PTCIF is an effective treatment thereby we suggest this approach to be considered as an alternative procedure to decompression and fusion surgery in the thoracic and TL spine. [ABSTRACT FROM AUTHOR]

Exfoliated carbon nanofibers (ExCNFs) are expected to serve as excellent scaffolds for promoting and guiding bone‐tissue regeneration. We aimed to enhance the effects of ExCNFs using bone morphogenetic proteins (BMPs) and examined their feasibility and safety in clinical applications using a rat spinal fusion model. Group I (n = 15) animals were implanted with the control carrier; Group II (n = 16) animals were implanted with carrier containing 1 μg ExCNFs; Group III (n = 16) animals were implanted with carrier containing 1 μg recombinant human (rh) BMP‐2; and Group IV (n = 17) animals were implanted with carrier containing 1 μg rhBMP‐2 and 1 μg ExCNFs. The rats were euthanized after 4 or 8 weeks and their spines were explanted and assessed by manual palpation, radiographs, and high‐resolution microcomputerized tomography (micro‐CT); the spines were also subjected to histological analysis. The fusion rates in Group IV (25.0%: 4‐week, 45.5%: 8‐week) were considerably higher than in Groups I (0%: 4‐week, 0%: 8‐week), II (0%: 4‐week, 15.0%: 8‐week), and III (16.7%: 4‐week, 30.0%: 8‐week). These results demonstrated the enhancement of ExCNF bone fusion effects by BMP in a rat spinal fusion model. Our results suggest that the enhancement of ExCNFs effects by BMP makes this combination a possible attractive therapy for spinal fusion surgeries. © 2018 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 36:2892–2900, 2018. [ABSTRACT FROM AUTHOR]