Clinical Orthopaedics & Related Research最新文献

{"title":"CORR Insights®: Is Delayed Time to Surgery Associated with Increased Short-term Complications in Patients with Pathologic Hip Fractures?","authors":"M. Ghert","doi":"10.1097/CORR.0000000000001064","DOIUrl":"https://doi.org/10.1097/CORR.0000000000001064","url":null,"abstract":"Because so many patients with cancer now are living longer as a result of targeted systemic therapies [4], skeletal metastases [7] and the pathological fractures they cause—especially to the hip—should force us to focus on how to improve the care of patients with this problem. In the current study, Varady and colleagues [18] do exactly this; they found that taking the time to medically prepare such complex patients for surgery does not compromise their postoperative outcomes in terms of surgical complications and perioperative mortality. This may be different than what we (think we) know about patients with osteoporotic hip fractures; studies suggest that delayed surgery in those patients is associated with a greater risk of complications and death [11], but whether that delay causes the excess complications remains controversial. However, what is most striking is that Varady and colleagues [18] have shown that the presence of disseminated disease is associated with increased morbidity and mortality. In other words, patients with disseminated disease are high-risk surgical fixation patients and prophylactic fixation is likely to be safer for them. Although one can say this is intuitive, it does bring to light the imperative of identifying patients at risk for fracture, as surgery is safer for those undergoing prophylactic fixation compared to undergoing fixation after a fracture has occurred [15]. Based on this, healthcare systems can introduce policies that prioritize patients with cancer and disseminated disease into screening programs to identify fractures before they occur.","PeriodicalId":10465,"journal":{"name":"Clinical Orthopaedics & Related Research","volume":"8 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-11-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"74254586","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"CORR Insights®: Women Are at Higher Risk for Concussions Due to Ball or Equipment Contact in Soccer and Lacrosse.","authors":"R. Dale Blasier","doi":"10.1097/CORR.0000000000001063","DOIUrl":"https://doi.org/10.1097/CORR.0000000000001063","url":null,"abstract":"The general public’s awareness of concussive injuries in sports may be at an all-time high. Recent coverage in the lay media [8, 13] has emphasized the risks and long-term sequelae of sports-related concussion in athletes. It is well-known that contact sports, like American football, with its frequent collisions between players, are associated with the highest incidence of concussive injuries [4, 5, 9]. One study found that in a convenience sample of 202 deceased players of American football from a brain donation program, the neurodegenerative disease chronic traumatic encephalopathy was neuropathologically diagnosed in 177 players across all levels of play (87%), including 110 of 111 former National Football League players (99%) [10]. Although women athletes are less likely to incur a head injury caused by contact with another player than are men athletes, women athletes are more likely to incur a concussive injury from a playing surface or an apparatus than men [1]. In the current meta-analysis, Ling and colleagues [7] found that women athletes have a lower risk of playercontact-induced concussions in lacrosse, basketball, ice hockey, and soccer than do men, but are more likely to experience concussions because of ball or equipment contact in lacrosse and soccer compared to men playing those same sports. These results held true in spite of rules differences between the men’s and women’s lacrosse games. Injury is a part of sport, and participating athletes and the supporting public are willing to accept nominal risk. But the prospect of late dementia, accelerated by repetitive microtrauma to the brain, looms over all participants in contact sports, as well as the sports themselves.","PeriodicalId":10465,"journal":{"name":"Clinical Orthopaedics & Related Research","volume":"53 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-11-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"76478252","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Editorial: Thanking CORR's Peer Reviewers.","authors":"S. Leopold","doi":"10.1097/CORR.0000000000001014","DOIUrl":"https://doi.org/10.1097/CORR.0000000000001014","url":null,"abstract":"","PeriodicalId":10465,"journal":{"name":"Clinical Orthopaedics & Related Research","volume":"65 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-11-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"90365190","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"CORR Insights®: Does Curve Regression Occur During Underarm Bracing in Patients with Adolescent Idiopathic Scoliosis?","authors":"D. Armstrong","doi":"10.1097/CORR.0000000000001048","DOIUrl":"https://doi.org/10.1097/CORR.0000000000001048","url":null,"abstract":"Underarm bracing can prevent 25° to 40° curves in patients with adolescent idiopathic scoliosis (AIS) from progressing to the point where surgery may be indicated [2, 7]. While the main goal of bracing for AIS is to prevent the need for surgery, the study by Cheung and colleagues [1] provides the best evidence so far that curve regression can sometimes occur. The authors found that some scoliosis curves may be partially reversed with bracing, and that, in some patients, reversal of vertebral wedging may occur at the apical vertebrae of major curves, which implies that the vertebrae were sufficiently relieved of axial load to allow recovery of their native growth potential. This is an important and rather exciting finding because it definitively demonstrates that bracing may potentially reverse one of the primary elements of the spine deformity which constitutes scoliosis [6]. In the current study, patients wore a brace for mean 3.8 years and SRS 22r scores were better for those who experienced correction. Notably, the authors’ practice setting is a dedicated scoliosis clinic including an orthotist who fits their patients with customized braces, a physical therapist who assists with exercise training and a psychologist [1]. A multidisciplinary team such as theirs could potentially influence patient perceptions and behavior. While many have an orthotist immediately available, few, if any scoliosis practices have immediate access to a psychologist and a therapist. Cheung and colleagues [1] also found that the benefits of bracing were not dependent on sex. This is an important and new finding because no previous studies have unequivocally demonstrated brace efficacy in males. Where Do We Need To Go?","PeriodicalId":10465,"journal":{"name":"Clinical Orthopaedics & Related Research","volume":"14 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-11-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"75501940","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Is Isolated Mobile Component Exchange an Option in the Management of Intraprosthetic Dislocation of a Dual Mobility Cup?","authors":"J. Wegrzyn, M. Malatray, V. Pibarot, G. Anania, J. Béjui-Hugues","doi":"10.1097/CORR.0000000000001055","DOIUrl":"https://doi.org/10.1097/CORR.0000000000001055","url":null,"abstract":"BACKGROUND\u0000Intraprosthetic dislocation is a specific complication of dual mobility cups, although it occurs less frequently with the latest generations of implants. Intraprosthetic dislocation is related to long-term polyethylene wear of the mobile component chamfer and retentive area, leading to a snap-out of the femoral head. With the increased use of dual mobility cups, even in younger and active patients, the management of intraprosthetic dislocation should be defined according to its type. However, no previous studies, except for case reports, have described the strategy to manage long-term wear-related intraprosthetic dislocation, particularly when a dual mobility cup is not loose.\u0000\u0000\u0000QUESTIONS/PURPOSES\u0000This study aimed to (1) determine the prevalence of intraprosthetic dislocation in this patient population and the macroscopic findings at the time of surgical revision and (2) evaluate whether isolated mobile component exchange could be an option to manage intraprosthetic dislocation occurring with a well-fixed dual mobility cup metal shell.\u0000\u0000\u0000METHODS\u0000From January 1991 to December 2009, a continuous series of 5274 THAs with dual mobility cups (4546 patients; 2773 women; mean [range] age 58 years [22-87]; bilateral THA = 728) were prospectively enrolled in our institutional total joint registry. A cementless, hemispherical dual mobility cup was systematically implanted, regardless of the patient's age or indication for THA. At the latest follow-up examination, the registry was queried to isolate each occurrence of intraprosthetic dislocation, which was retrospectively analyzed regarding the patient's demographics, indication for THA, radiographs, intraoperative findings (polyethylene wear and lesion patterns on the mobile component, periarticular metallosis, and implant damage because of intraprosthetic impingement of the femoral neck), management of intraprosthetic dislocation (isolated exchange of the mobile component or revision of the dual mobility cup), and outcome.\u0000\u0000\u0000RESULTS\u0000At a mean (range) follow-up duration of 14 years (3-26), 3% of intraprosthetic dislocations (169 of 5274) were reported, with a mean (range) time from THA of 18 years (13-22). Intraprosthetic dislocation occurred predominantly in younger men (mean [range] age at THA, 42 years [22-64] versus 61 years [46-87]; p < 0.001, and sex ratio (male to female, 1:32 [96 male and 73 female] versus 0.62 [1677 male and 2700 female]; p < 0.001) in patients with intraprosthetic dislocation and those without, respectively, but was not influenced by the indication for THA (105 patients with intraprosthetic dislocation who underwent THA for primary hip osteoarthritis and 64 with other diagnoses versus 3146 patients without who underwent THA for primary hip osteoarthritis and 1959 for other diagnoses (p = 0.9)). In all patients with intraprosthetic dislocation, a macroscopic analysis of the explanted mobile component revealed circumferential polyethylene wear and damage to the chamfer a","PeriodicalId":10465,"journal":{"name":"Clinical Orthopaedics & Related Research","volume":"104-B 4 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-11-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"86854111","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Are There Gender-based Differences in Language in Letters of Recommendation to an Orthopaedic Surgery Residency Program?","authors":"Audrey N Kobayashi, R. Sterling, S. Tackett, Brant Chee, D. Laporte, C. Humbyrd","doi":"10.1097/CORR.0000000000001053","DOIUrl":"https://doi.org/10.1097/CORR.0000000000001053","url":null,"abstract":"BACKGROUND\u0000Letters of recommendation are considered one of the most important factors for whether an applicant is selected for an interview for orthopaedic surgery residency programs. Language differences in letters describing men versus women candidates may create differential perceptions by gender. Given the gender imbalance in orthopaedic surgery, we sought to determine whether there are differences in the language of letters of recommendation by applicant gender.\u0000\u0000\u0000QUESTIONS/PURPOSES\u0000(1) Are there differences in word count and word categories in letters of recommendation describing women and men applicants, regardless of author gender? (2) Is author gender associated with word category differences in letters of recommendation? (3) Do authors of different academic rank use different words to describe women versus men applicants?\u0000\u0000\u0000METHODS\u0000Using a linguistic analysis in a retrospective study, we analyzed all letters of recommendation (2834 letters) written for all 738 applicants with completed Electronic Residency Application Service applications submitted to the Johns Hopkins Orthopaedic Surgery Residency program during the 2018 to 2019 cycle to determine differences in word category use among applicants by gender, authors by gender, and authors by academic rank. Thirty nine validated word categories from the Linguistic Inquiry and Word Count dictionary along with seven additional word categories from previous publications were used in this analysis. The occurrence of words in each word category was divided by the number of words in the letter to obtain a word frequency for each letter. We calculated the mean word category frequency across all letters and analyzed means using non-parametric tests. For comparison of two groups, a p value threshold of 0.05 was used. For comparison of multiple groups, the Bonferroni correction was used to calculate an adjusted p value (p = 0.00058).\u0000\u0000\u0000RESULTS\u0000Letters of recommendation for women applicants were slightly longer compared with those for men applicants (366 ± 188 versus 339 ± 199 words; p = 0.003). When comparing word category differences by applicant gender, letters for women applicants had slightly more \"achieve\" words (0.036 ± 0.015 versus 0.035 ± 0.018; p < 0.0001). Letters for men had more use of their first name (0.016 ± 0.013 versus 0.014 ± 0.009; p < 0.0001), and more \"young\" words (0.001 ± 0.003 versus 0.000 ± 0.001; p < 0.0001) than letters for women applicants. These differences were very small as each 0.001 difference in mean word frequency was equivalent to one more additional word from the word category appearing when comparing three letters for women to three letters for men. For differences in letters by author gender, there were no word category differences between men and women authors. Finally, when looking at author academic rank, letters for men applicants written by professors had slightly more \"research\" terms (0.011 ± 0.010) than letters written by associate professors (0.010 ±","PeriodicalId":10465,"journal":{"name":"Clinical Orthopaedics & Related Research","volume":"3 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-11-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"74237388","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"CORR Insights®: What Range of Motion is Achieved Five Years After an External Rotationplasty of the Shoulder in Infants with Obstetric Brachial Plexus Injury?","authors":"Selina R Silva","doi":"10.1097/CORR.0000000000001049","DOIUrl":"https://doi.org/10.1097/CORR.0000000000001049","url":null,"abstract":"There is abundant work on brachial plexus birth palsies and I want to highlight current literature on the indications and results of soft-tissue releases and tendon transfers. While the subscapularis is the most commonly released tendon in this setting, other soft-tissue structures that can be released include the anterior capsule, the coracohumeral ligament, and the pectoralis major (usually as a z-plasty); resection of the coracoid sometimes is done to achieve improvement of global abduction and external rotation of the shoulder. A meta-analysis published in 2013 showed open release of the subscapularis was superior to arthroscopic release to improve global abduction of the shoulder, but improvement of external rotation between the two groups was the same [5]. In contrast, another study found that arthroscopic release of the subscapularis was superior to open z-plasty of the pectoralis major when measuring abduction, Mallet scores, active external rotation and hand-to-head motion. All the children in this study also had latissimus dorsi and teres major tendon transfers done at the same time as the soft-tissue release. It is important to note that this study demonstrated improvement in all children, but recommended consideration of arthroscopic soft-tissue release since it is less invasive [9]. Finally, two studies found remodeling of the glenohumeral joint if the mechanics of the shoulder are restored early. They used MRI or CT to demonstrate a more-central position of the humeral head on the glenoid and improvement of the glenoid retroversion [1, 4]. Surgeons need to know that remodeling is possible if these procedures are done early enough and not to delay treatment. Two studies looking specifically at the child’s age at the time of procedure and remodeling potential found that performing soft-tissue releases and tendon transfers on children up to 5 years of age will produce sufficient remodeling over time [3, 4], which tends to decrease the likelihood that humeral osteotomy will be indicated. There is at least agreement that the most helpful tendon transfers include the latissimus dorsi and the teres major [1, 6, 7, 9, 11]. This helps researchers in the field focus on the questions that we do not have answered yet. In the current study, Sarac and colleagues [10] found that young children with obstetric brachial plexus palsies can benefit from soft-tissue release and when there is a lack of active external rotation, a tendon transfer should be added. While these results echo the findings in earlier studies [1, 4, 6, 8], the current study is unique because it had a large number of children and 5-year follow-up. Indeed, the majority of the literature on this topic are small case series or small retrospective reviews.","PeriodicalId":10465,"journal":{"name":"Clinical Orthopaedics & Related Research","volume":"125 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-11-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"85105220","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"CORR Insights®: Do External Supports Improve Dynamic Balance in Patients with Chronic Ankle Instability? A Network Meta-analysis.","authors":"G. Guyton","doi":"10.1097/CORR.0000000000001047","DOIUrl":"https://doi.org/10.1097/CORR.0000000000001047","url":null,"abstract":"The paradox of the lateral ankle sprain is not that so many patients do poorly following this injury, but rather that so many do well. The likelihood of recovery is remarkable given that perceived stability of the ankle requires the contribution of many factors including foot shape, passive mechanics of the ankle in the mortise, peroneal musculature, integrity of the ankle ligaments, and the patient’s chosen activities. If there is a lesson in all this, it is that no single factor entirely determines a pain-free and stable return to full activity. Consider an athlete with completely absent lateral ankle ligaments. When her ankle is suddenly inverted, a protective reflex arc activates the peroneal muscles. No amount of physical strengthening, however vigorous, can alter the speed of nerve conduction. The normal latency for the analogous Achilles reflex arc is 35 milliseconds—more than enough time for mechanical deformation to occur [3]. Some sports and activities may lead to faster andmoreunpredictable loads on the ankle than others. Therefore, no simple mechanical or biologic algorithm by itself will ever determine which patients will benefit from reconstruction. The longdistance runner will always have a different likelihood of rehabilitation success than the basketball player.When physical therapy regimens help despite the presence of mechanical instability, they do so by focusing not only on strength, but also on proprioception. It is likely that the patient who copes with ankle instability does so by activating themuscles prior to ground contact or, as recent evidence suggests, by absorbing the mechanical load through adjacent joints [2]. The key to evaluating interventions and outcomes in such a complex system is agreeing upon common tests that each measure one component of the problem. The Star Excursion Balance Test (SEBT) has been established by our physical therapy colleagues as a reliable and reproducible test of dynamic ankle stability [6]. Think of it as a “model sport” that, in the appropriate research setting, avoids the unthinkable complexity of separately evaluating each individual sport and each individual player position or activity. In the current study, Tsikopoulos and colleagues [12] use the SEBT to answer the common question of the utility of external braces to improve dynamic ankle stability. Surprisingly, the authors did not find a benefit to isolated use of external supports in the setting of the performance laboratory. It is important to remember that this does not necessarily imply that supporting the ankle does not help avoid reinjury. Not only may the demands of any one sport differ from those of the This CORR Insights is a commentary on the article “Do External Supports Improve Dynamic Balance in Patients with Chronic Ankle Instability? A Network Meta-analysis” by Tsikopoulos and colleagues available at: DOI: 10.1097/CORR.0000000000000946. The author certifies that he (GPG) or a member of his immediate family, has re","PeriodicalId":10465,"journal":{"name":"Clinical Orthopaedics & Related Research","volume":"99 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-11-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"85903535","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Can Dynamic Contrast-Enhanced CT Quantify Perfusion in a Stimulated Muscle of Limited Size? A Rat Model.","authors":"John A. Walker, T. Walters, M. Parker, J. Wenke","doi":"10.1097/CORR.0000000000001045","DOIUrl":"https://doi.org/10.1097/CORR.0000000000001045","url":null,"abstract":"BACKGROUND\u0000Muscle injury may result in damage to the vasculature, rendering it unable to meet the metabolic demands of muscle regeneration and healing. Therefore, therapies frequently aim to maintain, restore, or improve blood supply to the injured muscle. Although there are several options to assess the vascular outcomes of these therapies, few are capable of spatially assessing perfusion in large volumes of tissue.\u0000\u0000\u0000QUESTIONS/PURPOSES\u0000Can dynamic contrast-enhanced CT (DCE-CT) imaging acquired with a clinical CT scanner be used in a rat model to quantify perfusion in the anterior tibialis muscle at spatially relevant volumes, as assessed by (1) the blood flow rate and tissue blood volume in the muscle after three levels of muscle stimulation (low, medium, and maximum) relative to baseline as determined by the non-stimulated contralateral leg; and (2) how do these measurements compare with those obtained by the more standard approach of microsphere perfusion?\u0000\u0000\u0000METHODS\u0000The right anterior tibialis muscles of adult male Sprague Dawley rats were randomized to low- (n = 10), medium- (n = 6), or maximum- (n = 3) level (duty cycles of 2.5%, 5.0%, and 20%, respectively) nerve electrode coupled muscle stimulation directly followed by DCE-CT imaging. Tissue blood flow and blood volume maps were created using commercial software and volumetrically measured using NIH software. Although differences in blood flow were detectable across the studied levels of muscle stimulation, a review of the evidence suggested the absolute blood flow quantified was underestimated. Therefore, at a later date, a separate set of adult male Sprague Dawley rats were randomized for microsphere perfusion (n = 7) to define blood flow in the animal model with an accepted standard. With this technique, intra-arterial particles sized to freely flow in blood but large enough to lodge in tissue capillaries were injected. Simultaneously, blood sampling at a fixed flow rate was simultaneously performed to provide a fixed blood flow rate sample. The tissues of interest were then explanted and assessed for the total number of particles per tissue volume. Tissue blood flow rate was then calculated based on the particle count ratio within the reference sample. Note that a tissue's blood volume cannot be calculated with this method. Comparison analysis to the non-stimulated baseline leg was performed using two-tailed paired student t-test. An ANOVA was used to compare difference between stimulation groups.\u0000\u0000\u0000RESULTS\u0000DCE-CT measured (mean ± SD) increasing tissue blood flow differences in stimulated anterior tibialis muscle at 2.5% duty cycle (32 ± 5 cc/100 cc/min), 5.0% duty cycle (46 ± 13 cc/100 cc/min), and 20% duty cycle (73 ± 3 cc/100 cc/min) compared with the paired contralateral non-stimulated anterior tibialis muscle (10 ± 2 cc/100 cc/min, mean difference 21 cc/100 cc/min [95% CI 17.08 to 25.69]; 9 ± 1 cc/100 cc/min, mean difference 37 cc/100 cc/min [95% CI 23.06 to 50.11]; and 11 ± 2 cc","PeriodicalId":10465,"journal":{"name":"Clinical Orthopaedics & Related Research","volume":"23 1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-11-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"75580505","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"CORR Insights®: Are There Differences Between Patients with Extreme Stenosis and Non-extreme Stenosis in Terms of Pain, Function or Complications After Spinal Decompression Using a Tubular Retractor System?","authors":"C. Reitman","doi":"10.1097/CORR.0000000000001052","DOIUrl":"https://doi.org/10.1097/CORR.0000000000001052","url":null,"abstract":"Single-level tubular decompressive minimally invasive surgery (MIS) for patients with stenosis is technically demanding, and therefore, the more severe the stenosis, the greater potential for residual symptoms and loss of function because of inadequate decompression. Among spine surgeons, we have seen an increased preference for minimally invasive procedures for spinal disorders [8] because MIS of the spine has been shown to decrease length of stay, offer higher suitability for outpatient procedures, decrease blood loss, lower narcotic requirements, and lower infection rates [5]. Having said that, once outside the early convalescent period, patients-reported outcomes scores following less-invasive surgery are not much different from those after more-conventional open procedures [4, 6]. One concern I have, though, is learning curve associated withMIS [7]. In the last 15 years, I have observed increased interest in MIS, and more publications about these approaches with each passing year. However, in my observation, most of these papers are written by designers, originators of techniques, consultants, or highvolume surgeons who are well outside their learning curves with these new approaches. As these techniques gain traction in the broader practice community, we should not assume that a surgeon just learning a lessinvasive technique will be able to replicate results achieved by a designer, originator, or experienced surgeon who has hundreds or even thousands of these procedures under his or her belt. Believing otherwise (or practicing without consideration of this fact) puts patients at risk. I also am concerned by the fact that many of these studies are selective case series or historically controlled studies, which suffer heavily in some instances from selection bias (the easier procedures being done MIS, and the morechallenging ones decanted into the “control” group, if there is a control group).This is one of the strengths of the current study by Kulkarni and Das [2]; although a small number of patients in this large series were lost to follow-up, it was a genuine all-comers study, with no exclusions. It also focused on some of the more-difficult single-level procedures we see, those with extreme stenosis, and despite this, none underwent conversion to an open procedure and no alternate forms of decompression procedure were used. Having said that, it is clearly the work of surgeons experienced in this technique, and we should not assume their results will generalize to surgeons who are new to this approach, as they probably will not. This CORR Insights is a commentary on the article “Are There Differences Between Patients with Extreme Stenosis and Nonextreme Stenosis in Terms of Pain, Function or Complications After Spinal Decompression Using a Tubular Retractor System?” by Kulkarni and Das available at:DOI: 10.1097/CORR.0000000000001004. The author certifies that neither he, nor any members of his immediate family, have any commercial associat","PeriodicalId":10465,"journal":{"name":"Clinical Orthopaedics & Related Research","volume":"28 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-11-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"89818443","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}