Why X-rays? The importance of radiographs in spine surgery

Despite the advances made in high-resolution spinal imaging, plain films (radiographs or x-rays) remain a cornerstone of evaluating and caring for spine patients in the preoperative, intraoperative, and postoperative settings. Although often undervalued when compared with more advanced imaging such as MRIs or CT scans, plain films provide surgeons invaluable information that other imaging modalities oftentimes cannot. In addition to their use during surgery for localization or evaluation of hardware placement, x-rays provide an overall image of a patient's spine, are useful in evaluating hardware complications, allow detailed assessment of alignment and stability and allow for repeated images in clinic during follow-up. Plain films continue to provide critical information that cannot be obtained with other imaging modalities, and they remain central to providing optimal care for spine patients.     

A systematic review of the safety and efficacy of non-operative management in patients with high grade liver injury

IntroductionThe liver is the most frequently damaged organ in blunt abdominal trauma. It is widely accepted that hemodynamically stable patients with low-grade liver trauma should be treated with non-operative management, however there is controversy surrounding its safety and efficacy in high-grade trauma. The purpose of this review is to investigate the role of non-operative management in patients with high-grade liver trauma.MethodsPubMed and reference lists of PubMed articles were searched to find studies that examined the efficacy of non-operative management in high-grade liver injury patients, and compare it to operative management. Non-operative management was considered successful if rescue surgery was avoided. Outcomes considered were success, mortality, and complication rates.ResultsThe electronic search revealed 2662 records, 8 of which met the inclusion criteria. All 8 studies contained results suggesting that non-operative management was safe and effective in hemodynamically stable patients with high-grade liver trauma. By combining the outcomes of the different studies, non-operative management had a high success rate of 92.4% (194/210) in high-grade liver trauma patients, which was near the overall 95.0% non-operative management success rate. Non-operative management also had mortality and complication rates of 4.6% (9/194) and 9.7% (7/72) in high-grade injury patients, respectively, compared to operative management's 17.6% (26/148) and 45.5% (5/11).ConclusionNon-operative management of liver trauma is safe and effective in hemodynamically stable patients with high-grade liver injury. It is associated with significantly lower mortality compared with operative management. More studies are required to evaluate complications of non-operative management in high-grade liver injury.     

Editorial Commentary: Stem Cells in Rotator Cuff Surgery: In Search of the Holy Grail

The use of stem cells in orthopaedics remains a controversial topic, stem cells remain experimental, and significant concerns exist. Studies evaluating diagnoses that may spontaneously resolve could be of low value absent a control group. Only same-day harvest of minimally manipulated stem cells is approved for use in the United States, and these minimally manipulated products may contain insufficient cells to affect outcomes. Extensively cultured cells do not qualify for use in the United States outside of an approved Investigational New Drug Application. Moreover, in other arenas, significant, serious adverse events have been reported after the use of manipulated stem cells. Both the US Food and Drug Administration and American Academy of Orthopaedic Surgeons have recognized the potential for abuse regarding this evolving technology. Published results using stems cells to treat rotator cuff disease are inconsistent, and the optimum source and preparation of the stem cells remains unknown.     

Spondylophyte classification based on biomechanical effects on segmental stiffness

BACKGROUND CONTEXTThe biomechanical impact of spondylophytes on segmental stiffness is largely unknown, despite their high incidence.PURPOSEThe aim of this study was to quantify the biomechanical contribution according to location and cranio-caudal extent of spondylophytes and to create a clinically applicable radiological classification system.STUDY DESIGNBiomechanical cadaveric study.METHODSTwenty-six cadaveric human lumbar spinal segments with spondylophytes were tested with a displacement-controlled stepwise reduction method. The reduction in load required for the same motion after spondylophyte dissection was used to calculate the biomechanical contribution in flexion, extension, axial rotation, lateral bending, anterior, posterior and lateral shear. The spondylophytes were categorized by assessment of their anatomical position and cranio-caudal extent in computed tomography images (grade 1: spondylophytes spanning less than 50% of the disc-height, grade 2:>50%, grade 3:>90%, grade 4: bony bridging between the vertebrae) by two experienced radiologists. Cohen's kappa (κ) was used to report interreader reliability.RESULTSThe largest biomechanical effect of non-bridging spondylophytes (grade 1–3) was recorded during contralateral bending with a grade-dependent contribution of up to 35%. Other loading directions including ipsilateral bending and translational loading were affected with values below 13%. Spondylophytes with osseous bridging (grade 4) show large contribution to the segmental stiffness in most loading conditions with values reaching over 80%. Interreader agreement for the spondylophyte grading was “substantial” (κ=0.73, p<.001).CONCLUSIONSThe location and cranio-caudal extent of spondylophytes are essential parameters for their biomechanical effect. A reproducible classification has been validated biomechanically and helps evaluate the effect of specific spondylophyte configurations on segmental stiffness.CLINICAL SIGNIFICANCENon-bridging spondylophytes primarily act as tensile structures and do not provide relevant propping. A classification system is presented to support understanding of the biomechanical consequences of different spondylophyte configuration for clinical decision making in surgical planning.     

A systematic review of combined pelvic and acetabular injuries

PurposeInjuries of both pelvic ring and acetabulum as rare very few articles are available in literature. There are no set protocols in defining the injury let alone defining early and definitive management strategies. This article is an attempt to encompass all available data to give us guidelines in managing these injuries.MethodsAn extensive literature review was carried out on PubMed/Medline, google scholar and Embase databases was done with the eligibility criteria of 1) Case series with a minimum of 20 cases. 2) The patient’s outcome reported. 3) Full article available. 4) Article in English. 5) Minimum Jadad score of 3. As per PRISMA guidelines the search was done and gradually filtered down to relevant articles which were 8 in number.ResultsThe incidence of these injuries range from 5 to 16%. The transverse acetabular fracture pattern is the commonest followed by associated both column fractures. There is equal propensity of Anteroposterior compression and lateral compression injuries. The injury mechanism appears to transmitted lateral force from the greater trochanter inwards with an implosion injury causing acetabular and pelvic injury as a continuum. The initial management is similar to managing pelvic ring injuries with focus on patient resuscitation, hemodynamic stabilization and temporary stabilization. The injury severity score and the mortality rates are comparable to isolated unstable pelvic ring injuries. Definitive management focuses on fixing the posterior pelvic ring first followed by the acetabular fracture and then the anterior pelvic ring. The displacement rates and outcome is worse than isolated acetabular injuries or pelvic injuries.ConclusionCombined Pelvic and acetabular injuries are complex injuries which need to be managed initially as we manage pelvic injury and later as we fix as an acetabular fracture meticulously.     

Effects of a yoga nidra on the life stress and self-esteem in university students

ObjectivesTo assess the effects of a yoga nidra on life stress and self-esteem in university students.MethodsThis study is a non-equivalent control group pretest-posttest design. Forty university students were selected by convenience sampling, with 20 assigned to a yoga nidra group and 20 to a control group. The yoga group participated in bi-weekly, 1-h sessions of yoga nidra for 8 weeks. Life stress intensity level was measured using a 10 cm Visual Analog Scale. Self-esteem score was measured by Rosenberg's Self-Esteem Scale.ResultsThe yoga nidra group showed significantly decreased life stress intensity levels compared to the control group. The yoga group also showed significantly increased self-esteem scores compared to the control group.ConclusionsThese findings indicate that yoga nidra could alleviate the life stress intensity level and increase the self-esteem in university students.