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Introduction: A variety of biodegradable implants (screws, rods, plates and cages) are available which are composed of many different biodegradable polymers with varying characteristics. The present review of animal and clinical studies examines the efficacy and safety of biodegradable implants in spinal fracture intervention., Methods: A review of the literature through March 2018 was performed using PubMed and Cochrane databases. Success rates were calculated according to sufficient tissue biocompatibility, solid clinical fusion and propensity for osseointegration., Results: 49 articles (24 animal and 25 human studies) were included. In animal experiments, the overall success rate for spinal fusion was 60.3%, while the mean success rate regarding the cervical spine was 51.8% compared to 68.1% for the lumbar spine (p = 0.002). In studies involving control group(s): the mean bioabsorbable implant success rate for spinal fusion was 42% compared to 57% for conventional implants (p = 0.0016). In the lumbar spine pL-lactide acid (PLLA) had 75.2% success rate compared to poly (L-lactide-co-DL-lactide) (PLDLLA) at 53.4% (p = 0.003). In clinical studies, the overall mean success rate was 89%, while the mean success rate regarding the cervical spine was 92%, as compared to 83.6% for the lumbar spine (p = 0.001). In studies involving control group(s): the mean bioabsorbable implant success rate was 75% compared to a conventional implant mean success rate of 97% (p<0.0001). In the cervical spine PLLA had a 98.7% success rate compared to 90% with PLDLLA (p = 0.015). In the lumbar spine PLDLLA had 84.7% success rate compared to 63.6% for poly-glycolic acid (PGA) (p = 0.085)., Discussion: Studies combined biodegradable and conventional implants. Polymers were used in various combinations and surface modification of the implants also varied. Comparison studies were of small sample size. Animal and clinical studies diverged. The current data are not encouraging. The end-point of assessing osseointegration varies in the studies and is indeterminate. In early stages the structure comparison of osseous restoration using biodegradable implants appears inferior to utilization of conventional cages and instrumentation. There is no statistically significant evidence supporting the efficacy of biodegradable implants replacing traditional instrumentation. There is a lack of prospective clinical trials with long-term follow-up regarding utilization of biodegradable implants and the available data does not support their routine use in spinal fracture intervention., (Copyright © 2018. Published by Elsevier Ltd.)

Introduction: This paper describes surgical options for Osteoporotic vertebral compression fracture (OVCF) with acute flexible or chronic rigid kyphosis, and pseudarthrosis complicated with pain and neurologic deficit., Methods: This study has two components. a) A prospective clinical study of surgical treatment of 31 patients (age: 69±11 years) with either acute flexible or progressive pseudarthrotic kyphosis manifested with severe pain or neurological deficit between 2010 and 2014. Eleven patients exhibited neurocompression (Frankel B, C, D). Surgery consisted in indirect reduction, kyphoplasty, and short posterior instrumentation in 28 patients and multilevel instrumentation in three. b) The second component involved a literature search of OVCF complicated with acute or painful chronic deformities and neurologic deficit, managed with open surgical approach., Results: Indirect reduction, kyphoplasty and short posterior stabilization can restore satisfactory anatomic alignment and neurological deficit. Multilevel instrumentation was used for rigid long kyphosis. Complications were related to a) screw pull out and junctional kyphosis (4 patients) one of the patients also developed anterior migration of cement, b) cement leakage (4 patients). L5 radiculopathy occurred in one patient. The others remained asymptomatic. The literature review concluded that corpectomy with anterior, posterior or combined instrumentations is indicated for burst fractures, or rigid kyphosis with neurocompression. Prompt decompression with anatomical alignment may restore paraplegia. Complications were germane to osteoporotic bone predisposing to hardware loosening or cut out and dislodgement of instrumentation., Discussion: Neurologic deficit associated with fractures or progressive pseudarthrotic kyphosis effectively may respond to indirect postural reduction, kyphoplasty and posterior percutaneous short segment transpedicle instrumentation. For burst fractures and rigid chronic kyphosis corpectomy reconstructed with cages and anterior, or posterior or combined instrumentations can restore and maintain normal anatomy. The following guidelines for optimal surgical instrumentation have been established: To prevent screw loosening and junctional kyphosis the instrumentation should not end within the kyphotic segment. Screws for anterior instrumentation should penetrate the contralateral cortex. Multiple site of fixation or combined anterior and posterior instrumentations dissipate stresses at any one site. Augmentation of transpedicle screw fixation with cement is a sound technical principle. Cement should inserted in a doughy state with minimal pressure to prevent cement complications., (Copyright © 2017 Elsevier Ltd. All rights reserved.)

PubMed and Ovid Medline were searched to investigate the role of intramedullary nailing in the treatment of diaphyseal humeral non-union. Of 474 abstracts, 9 retrieved articles fulfilled our inclusion criteria and described management in 166 cases of humeral shaft non-union using several types of intramedullary nails. Union ranged from 40 to 100%; part of the variation could be explained by the quality index of the selected articles. Exchange nailing alone was not effective. Exposure of the fracture site and use of bone grafting were key to successful treatment. The total incidence of severe complications, including radial nerve damage, was very low. Thus, intramedullary nailing in the treatment of humeral shaft non-unions can lead to successful outcomes when associated with autologous bone grafting.