Backgrounds: A common sequela of hip fracture is loss of ambulation capacity. Prediction of postoperative ambulation capacity is important for surgical and rehabilitation decision making. Handgrip strength is a quick and convenient tool for evaluating postoperative functional ability and outcome in variety of clinical conditions for the elderly and is associated with the use of walking aids. We propose that handgrip strength may be a good predictor for postoperative early ambulation. The purpose of our study was to investigate the contribution of handgrip strength in the prediction of postoperative early ambulation capacity in elderly hip fracture patients. Methods: Clinical data of patients with low-energy hip fractures who received surgery from Jan 2018 to Dec 2019 were prospectively collected. The correlations of ambulation time with complication rate, age, gender, injured side, fracture classifications, surgical procedure, body mass index (BMI), and handgrip strength were analyzed. Results: Sixty-three hip fracture patients were included in this study. Patients whose ambulation time was less than 3 days after the operation had significantly fewer postoperative complications (P = 0.006). Handgrip strength showed the strongest correlation with postoperative early ambulation capacity (P = 0.004). The handgrip strength threshold value for early ambulation was found to be 20.5 kg for male patients and 11.5 kg for female patients. Conclusion: Handgrip strength testis a quick and convenient tool for predicting postoperative early ambulation capacity. In elderly Asians, male patients with a handgrip strength above 20.5 kg and female patients with a handgrip strength above 11.5 kg suggest a high likelihood of early postoperative ambulation and a lower risk of complications after the hip surgery.

The aim of our study was to investigate failure rates of reconstruction plate and non-reconstruction plate, and find the best strategy for implant selection for different fracture types for midshaft clavicular fractures. Two hundred twenty-six consecutive patients with midshaft clavicular fractures who received open reduction and plate fixation during Jan 2012 to July 2017 were reviewed. The correlations between implant failure rates and risk factors including demographic data, fracture classifications, and implant types were analyzed. AO/OTA fracture classification and plate types are the most important factors affecting implant failure for midshaft clavicular fractures. Reconstruction plate had a significantly higher failure rate (53%) than that of non-reconstruction plates (3%) in comminuted midshaft clavicular (AO/OTA 15-2C) fractures (P value < 0.01). However, the difference was not significant in AO/OTA 15-2A and 2B classifications. Patients with comminuted midshaft clavicular (AO/OTA 15-2C) fractures treated with reconstruction plates had very high implant failure rates compared to non-reconstruction plates. We suggested that patients with comminuted midshaft clavicular (AO/OTA 15-2C) fractures treated with reconstruction plates need more protection and more frequent follow-up in the postoperative period.

Robot-assisted pedicle screw placement for spine surgery has become popular in recent years. This study compares clinical, radiographic outcomes and the screw loosening rate between robot-assisted and fluoroscopy-guided pedicle screw placement in patients who underwent transforaminal lumbar interbody fusion (TLIF). We retrospectively examined 108 patients with the degenerative lumbar disease who underwent TLIF. According to whether the robotic system was used, patients were assigned to either the robot-assisted (Ro TLIF, n = 29) or fluoroscopy-guided TLIF (FG TLIF, n = 79) group. Radiographic parameters and patient-reported outcomes, including leg and back pain visual analog scale (VAS) and Oswestry Disability Index (ODI), were assessed. Loosening signs were noted in 48 out of 552 pedicle screws. The screw loosening rate was higher in the FG TLIF (10.2%) than Ro TLIF group (4.3%). A significant correlation was found between screw loosening and age, the number of level(s) fused, and the ratio of the average distance from the pedicle screw to the upper endplate to vertebral body height. VAS-leg, VAS-back, and ODI showed significant improvements in both groups postoperatively (all p < 0.05). These results indicated that robot-assisted pedicle screw placement in TLIF had a lower screw loosening rate and similar patient-reported outcomes compared with the fluoroscopy-guided technique.

The success of spinal fusion surgery relies on the precise placement of bone grafts and minimizing scatter. This study aims to optimize cage design and bone substitute filling methods to enhance surgical outcomes. A 3D printed lumbar spine model was utilized to implant 3D printed cages of different heights (8 mm, 10 mm, 12 mm, and 14 mm) filled with BICERA^® Bone Graft Substitute mixed with saline. Two filling methods, SG cage (side hole for grafting group, a specially designed innovative cage with side hole, post-implantation filling) and FP cage (finger-packing group, pre-implantation finger packing, traditional cage), were compared based on the weight of the implanted bone substitute. The results showed a significantly higher amount of bone substitute implanted in the SG cage group compared to the FP cage group. The quantity of bone substitute filled in the SG cage group increased with the height of the cage. However, in the FP cage group, no significant difference was observed between the 12 mm and 14 mm subgroups. Utilizing oblique lumbar interbody fusion cages with side holes for bone substitute filling after implantation offers several advantages. It reduces scatter and increases the amount of implanted bone substitute. Additionally, it effectively addresses the challenge of insufficient fusion surface area caused by gaps between the cage and endplates. The use of cages with side holes facilitates greater bone substitute implantation, ultimately enhancing the success of fusion. This study provides valuable insights for future advancements in oblique lumbar interbody fusion cage design, highlighting the effectiveness of using cages with side holes for bone substitute filling after implantation.

Adjacent segment disease (ASD) is troublesome condition that has proved to be highly related to spinal malalignment after spinal surgery. Hence, we aimed to evaluate the morphological changes after anterior lumbar interbody fusion (ALIF) and oblique LIF (OLIF) to establish the differences between the two surgical methods in terms of possible ASD avoidance. Fifty patients, half of whom received ALIF while the other half received OLIF, were analyzed with image studies and functional outcomes during the pre-operative and post-operative periods, and 2 years after surgery. Image measurements obtained included spinal-pelvic parameters, index lordosis (IL), segmental lordosis (SL), anterior disc height (ADH), posterior disc height (PDH) and adjacent segment disc angle (ASDA). The ADH and PDH in the adjacent segment decreased in the two groups while OLIF showed greater decrease without radiological ASD noted at 2-year follow-up. Both groups showed an increase in IL after surgery while ALIF showed greater improvement. No statistical difference was identified in functional outcomes between LIFs. We suggest that both ALIF and OLIF can restore adequate lordosis and prevent ASD after surgery. However, it should be noted that patient selection remains crucial when making any decision involving which of the two methods to use.

Backgrounds: Anterior lumbar interbody fusion (ALIF) is an attractive option for revision lumbar interbody fusion as it provides wide access for implant removal and accommodation of large interbody grafts for fusion. However, revision lumbar interbody fusion surgery has not been found to result in significantly better functional outcomes compared with other approaches. To date, no prognostic factors of anterior lumbar interbody fusion in revision lumbar interbody fusion have been reported. In this study, we investigated the surgical results and possible prognostic factors of anterior lumbar interbody fusion in revision lumbar interbody fusion. Methods: Patients who received revision interbody fusion surgery between January 2010 and May 2018 in our hospital were reviewed. Clinical outcomes were determined according to whether the VAS score improvement in back pain and leg pain reached the minimum clinically important difference (MCID) and Macnab criteria. Radiographic outcomes were assessed with fusion rate, preoperative, and postoperative lumbar lordosis. Operative-relative factors that may affect clinical outcomes, such as BMI, existence of cage migration, cage subsidence, pseudarthrosis, previous procedure, and number of fusion segments, were collected and analyzed. Results: A total of 22 consecutive patients who received ALIF for revision interbody fusion surgery were included and analyzed. There were 9 men and 13 women with a mean age at operation of 56 years (26–78). The mean follow-up was 73 months (20–121). The minimal clinically important difference (MCID) was reached in 11 (50%) of the patients for back pain and 14 (64%) for leg pain. According to the modified Macnab criteria, 73% of the patients in this study had successful outcomes (excellent or good). The pain and lumbar lordosis had significant improvement (P < 0.05). Preoperative fusion segment ≥ 2 was shown to be a poor prognostic factor for back pain improvement reaching MCID (P = 0.043). Conclusions: ALIF has proven effective for revision lumbar fusion surgery, yielding positive clinical and radiographic results. However, having two or more preoperative fusion segments can negatively impact back pain improvement. Level of evidence: IV.