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Study Design: Systematic review and meta-analysis., Objective: To compare radiographic outcomes across lumbar interbody fusion (LIF) techniques, assessing segmental and global lumbar lordosis restoration., Summary of Background Data: LIF is a commonly utilized procedure to treat various spinal conditions, including degenerative pathology and adult spinal deformity. Common approaches include posterior LIF (PLIF), transforaminal LIF (TLIF), anterior LIF (ALIF), oblique LIF (OLIF), and lateral LIF (LLIF)., Methods: A systematic review and meta-analysis were carried out using PRISMA guidelines with appropriate MeSH terms. Papers were included based on relevance, number of patients, and a minimum of 1-year radiographic follow-up. Radiographic outcomes included segmental lordosis (SL) and lumbar lordosis (LL). Only papers directly comparing SL restoration between two or more LIF techniques were utilized in the systematic review, while all articles meeting the aforementioned criteria were used in the meta-analysis., Results: Nineteen studies were included in the final systematic review, and 88 papers were included in the meta-analysis. Seven studies in the systematic review showed a significantly higher increase in SL with ALIF versus TLIF, and two showed significantly higher SL gain with ALIF compared with LLIF. When comparing ALIF versus OLIF, one study favored ALIF, while another favored OLIF for SL restoration. OLIF likewise demonstrated superior restoration of SL compared with TLIF. LLIF demonstrated improved SL restoration compared with TLIF in 2 of the 3 studies comparing the 2 procedures. Furthermore, both ALIF and OLIF demonstrated superior LL restoration compared with TLIF in 4 and 3 studies, respectively. The meta-analysis results demonstrated that ALIF provided significantly better restoration of SL than TLIF, LLIF, and OLIF, while TLIF conferred significantly lower SL restoration than ALIF and OLIF. Similarly, LL restoration was significantly reduced with TLIF relative to OLIF and LLIF (all P <0.05)., Conclusions: The included studies demonstrated superior SL and LL restoration with ALIF, OLIF, and LLIF compared with TLIF. ALIF improved SL to a greater extent when directly compared with all other interbody techniques., Competing Interests: J.C.W. has received intellectual property royalties from Zimmer Biomet, NovApproach, SeaSpine, and DePuy Synthes. R.J.H. has received grant funding from SI Bone, consulting fees from NuVasive, and support from the North American Spine Society to attend meetings. R.K.A. has received grant funding from NIH, consulting fees from HIA Technologies, and payment from Eccentrial Robotics for lectures and presentations​​​. The remaining authors declare no conflict of interest., (Copyright © 2024 Wolters Kluwer Health, Inc. All rights reserved.)

Study Design: Retrospective cohort study., Objectives: The aim was to compare the minimally clinically important difference (MCID) across multiple patient-reported outcomes (PROs) in patients undergoing cervical disc replacement (CDR) for cervical spondylotic radiculopathy versus myeloradiculopathy., Summary of Background Data: To date, a limited number of studies have demonstrated mostly similar results in patients with cervical spondylotic radiculopathy or myeloradiculopathy undergoing CDR. However, each of these previous studies have focused on statistically significant differences, which may not correlate with patient perceived improvements in outcomes or success., Methods: Patients who underwent 1 or 2-level CDR with radiculopathy versus myeloradiculopathy were identified, and prospectively collected data was retrospectively reviewed. Demographic variables, preoperative diagnosis, and operative variables were collected for each patient. The following PROs were prospectively collected: Neck Disability Index (NDI), visual analog scale (VAS)-Neck, VAS-Arm, Short Form-12 Health Survey (SF-12) Physical Component Score (PCS), SF-12 Mental Component Score (MCS), PROMIS Physical Function (PF). An MCID analysis of PROs for each diagnosis group was performed and the percentage of patients achieving the MCID was compared between the two diagnosis groups., Results: Eight-five patients, of which 56% had radiculopathy and 44% had myeloradiculopathy. MCID analysis demonstrated that at 6-week, 12-week, and final postoperative follow-up there was no significant difference in the percentage of patients with radiculopathy or myeloradiculopathy achieving the MCID for each PRO assessed. In both diagnosis groups the percentage of patients achieving the MCID for each PRO continued to increase from the 6-week to final postoperative follow-up except for the SF-12 MCS in patients with myeloradiculopathy., Conclusions: The percentage of patients achieving the MCID was not significantly different at each postoperative period assessed in the radiculopathy and myeloradiculopathy groups treated with CDR. In addition, the percentage of patients achieving the MCID continued to increase from 6 weeks to final follow-up in both groups for almost all PROs assessed., Competing Interests: The authors declare no conflict of interest., (Copyright © 2022 Wolters Kluwer Health, Inc. All rights reserved.)

Study Design: Retrospective cohort study., Objective: The aim was to compare clinical outcomes in patients with significant cervical spondylosis treated with cervical disc replacement (CDR) compared with anterior cervical discectomy and fusion (ACDF)., Summary of Background Data: As CDR utilization has increased over the past decade, recent studies have investigated the outcomes of CDR in patients with more significant spondylotic changes and demonstrated improved postoperative patient-reported outcomes (PROs). However, no prior study has investigated clinical outcomes of patients with significant spondylotic changes treated with CDR in comparison to ACDF., Methods: Patients who underwent 1-level or 2-level CDR or ACDF with significant cervical spondylosis, quantified using a validated grading scale, were identified, and prospectively collected data was retrospectively reviewed. The following PROs were analyzed: Neck Disability Index (NDI), visual analog scale-Neck, visual analog scale-Arm, and PROMIS Physical Function (PROMIS-PF) Computer Adaptive Test Score. Demographic, operative, and radiographic variables, and achievement of minimum clinically important difference (MCID) for each PRO were compared between the 2 groups., Results: A total of 66 patients were included in the present study, of which 35 (53%) were treated with CDR and 31 (47%) with ACDF. The preoperative cervical spondylotic grade was similar between the 2 groups (1.8 vs. 2.2, P=0.27). At final follow-up, there was no significant difference in the absolute value for each PRO between the 2 groups (P>0.19) and both groups demonstrated significant improvement in each PRO compared with preoperative values (P<0.01). There was no significant difference in the percentage of patients achieving the MCID for each PRO when comparing CDR to ACDF (P>0.09)., Conclusions: A similar percentage of patients with significant degenerative cervical spondylosis achieved the MCID across multiple PROs when treated with CDR or ACDF. Patients in both treatment groups demonstrated significant improvement in all PROs assessed when compared with preoperative values., Level of Evidence: Level III., Competing Interests: T.A.A: Royalties from Zimmer Biomet, DePuy Synthes Spine; Consulting Fees from Nuvasive, DePuy Synthes; Book Royalties from JP Medical Publishers, Thieme Medical Publishers, Springer, Elsevier Inc.; Ownership Interests in Innovative Surgical Designs Inc., Bonovo Orthopedics Inc., InVivo Therapeutics, Spinicity, CytoDyn Inc., Paradigm Spine, HS2 LLC, Strathspey Crown, Surg.IO LLC, Augmedics, Morphogenesis, Precision Orthopedics, Pulse Equity, Physician Recommended Neutriceuticals, Parvizi Surgical Innovations; Board member/Other office: Back Story LLC, Scoliosis Research Society, Spine Universe, American Orthopaedic Association. S.A.Q.: Consulting: Globus Medical, Inc., Stryker K2M, Paradigm Spine (Past relationship); Royalties: Globus Medical Inc., Stryker K2M; Private Investments: Tissue Differentiation Intelligence, Vital 5 (Past relationship); Scientific Advisory Board: Healthgrades (Past relationship), Lifelink.Com Inc., Spinal Simplicity, LLC; Speaking and/or Teaching Arrangements: AMopportunities, Globus Medical, Inc., RTI Surgical Inc.; Trips/Travel: Globus Medical, Inc., Integrity Implants Inc., Medical Device Business Services, Medtronic USA, Inc., Nuvasive, Inc., Paradigm Spine, Stryker K2M; Board of Directors: Society Of Minimally Invasive Spine Surgery; Other Office: Annals Of Translational Medicine (Editorial Board Member), Association Of Bone And Joint Surgeons (Committee Member), Cervical Spine Research Society (Committee Member), Contemporary Spine Surgery (Editorial Board Member), International Society For The Advancement Of Spine Surgery (Committee Member), Lumbar Spine Research Society (Committee Member), Minimally Invasive Spine Study Group (Board Member), North American Spine Society (Committee Member), Simplify Medical, Inc. (Clinical Events Committee Member), Society Of Minimally Invasive Spine Surgery (Committee Member, Board Member). The remaining authors declare no conflict of interest., (Copyright © 2021 Wolters Kluwer Health, Inc. All rights reserved.)

Introduction: Both total ankle replacement (TAR) and tibiotalar arthrodesis (TTA) are used in the surgical management of ankle arthritis. Over the past decade, TAR instrumentation, techniques, and implants have improved, making the procedure more reliable and reproducible, thus making TAR more common., Methods: The Nationwide Inpatient Sample database from 2007 to 2013 was used to obtain data on patients elder than 50 years who underwent either TAR or TTA. Differences in temporal, demographic, and diagnosis trends between TAR and TTA were analyzed., Results: Between 2007 and 2013, 15,060 patients underwent TAR and 35,096 underwent TTA. Patients undergoing TTA had significantly more comorbidities (2.17 versus 1.55; P < 0.001). The share of TAR performed increased significantly from 2007 (14%) to 2013 (45%) (P < 0.001). From 2007 to 2013, we found a 12-fold increase in the odds of having a TAR for patients with posttraumatic osteoarthritis (P < 0.001), a 4.9-fold increase for those with primary osteoarthritis, and a 3.1-fold increase for patients with rheumatoid arthritis (P < 0.001)., Conclusions: Over the past decade, the frequency of TAR has increased, particularly in patients with posttraumatic arthritis and osteoarthritis. Surgeons still perform TAR in healthier patients compared with TTA; however, because surgeons become more experienced with the technique, patients are undergoing TAR at a markedly higher rate., Level of Evidence: Level III: retrospective comparative study.

Background: The purpose of this study was to identify temporal trends in the management of pediatric femoral shaft fractures in 4- and 5-year-old children., Methods: The Kids' Inpatient Database was used to extract data on patients aged 4 and 5 years with closed femoral shaft fractures. The frequency of nonsurgical and surgical management was calculated, and temporal trends were evaluated., Results: Between 1997 and 2012, the absolute increase in surgical fixation was 35% and 58% in 4- and 5-year-old patients, respectively. The surgical rate increased every 3 years by 13.8% in 4-year-old patients and 7.6% in 5-year-old patients. Significant associations were noted based on demographics, comorbidities, and hospital characteristics with management decisions., Conclusions: A clear and significant increase was noted in internal fixation for pediatric femoral shaft fractures in 4- and 5-year-old children, and the lower age limit for surgical management of these fractures is decreasing., Level of Evidence: Level III. Retrospective comparative study.

Introduction: Postdischarge disposition after shoulder replacement lacks uniform guidelines. The goal of this study was to identify complication and readmission rates by discharge disposition and determine whether disposition was an independent risk factor for adverse events, using a statewide database., Methods: Data from the California Office of Statewide Health Planning and Development discharge database were used. Patient information was assessed, and 30- and 90-day complication rates were identified. Univariate and multivariate analyses were used to determine the complication risk., Results: From 2011 to 2013, 10,660 procedures were identified, with 7,709 patients discharged home, 1,858 discharged home with home health support, and 1,093 discharged to postacute care (PAC) facilities. Patients discharged to PAC facilities or to home with health support tended to be older, female, and using Medicare. After controlling for confounders, at 30 and 90 days, patients discharged to PAC facilities were found to be more likely to experience a complication., Discussion: Discharge to a PAC facility was an independent risk factor for complications and readmission., Level of Evidence: Level III, retrospective cohort design, observational study.