Purpose: Previous studies have reported on the outcomes of autologous chondrocyte implantation (ACI) versus matrix‐induced ACI (MACI) and microfracture. Specific clinical outcomes of ACI, MACI, osteochondral autograft transplantation (OAT) and osteochondral allograft (OCA) have not been well studied. The purpose of this systematic review and meta‐analysis was to analyze the outcomes of these regenerative surgical techniques with an emphasis on comparing their effectiveness using the International Knee Documentation Committee (IKDC) subjective score, the Lysholm Knee Scoring Scale, the Tegner Activity Scale and the Visual Analogue Scale (VAS) score for the surgical treatment of tibiofemoral joint cartilage defects.Methods: An electronic search of MEDLINE, Embase and Cochrane Library was performed to identify studies that reported clinical outcomes for ACI, MACI, OAT and OCA procedures. The literature review was conducted following Preferred Reporting Items for Systematic Reviews and Meta‐Analyses guidelines and only studies involving cartilage defects in the tibiofemoral joint were included. Outcomes were measured with the IKDC evaluation, Lysholm Knee Scoring Scale, Tegner Activity Scale and the VAS. Outcomes were compared to the minimal clinically important difference (MCID) and patient acceptable symptom state (PASS). The methodological quality of the included studies was analyzed by the Methodological Index for Nonrandomized Studies and the Jadad scale.Results: Forty‐seven studies were included representing a total of 1993 patients with a mean follow‐up time of 57.2 ± 40.3 months (range: 4.0–160.0 months). The location of cartilage defects was reported in 46 studies, with a total of 1922 cartilage defects. There were 1277 medial femoral condyle cartilage defects, 488 lateral femoral condyle cartilage defects, 139 unspecified femoral condyle cartilage defects and 18 tibial plateau cartilage defects. All four procedures reported significant improvements in the Lysholm, IKDC, Tegner and VAS scores with no significant differences between them. The OAT technique surpassed the PASS threshold for the IKDC score while all four techniques surpassed the PASS threshold for Tegner and Lysholm scores. Additionally, all procedures met the MCID for each clinical outcome.Conclusion: This systematic review and meta‐analysis indicate that ACI, MACI, OAT and OCA all result in significant improvements in knee function and pain for cartilage defects of the tibiofemoral joint. When selecting a procedure, patient and cartilage defect characteristics should be assessed to determine the best technique for each individual patient.Study Design: Systematic review and meta‐analysis.Level of Evidence: Level III.

Study Design.: Retrospective cohort study. Objective.: Assess the impact of inadequate correction of L4-S1 lordosis during transforaminal lumber interbody fusion (TLIF) on adjacent segment disease and revision rates. Background.: Restoring alignment is an important consideration in spinal fusions. Failure to correct to level-specific alignment goals could promote the development of adjacent segment disease. As such, it is crucial to investigate the role of sagittal segmental alignment on clinical outcomes following short segment lumbar fusion. Materials and Methods.: Patients who underwent 1- to 3-level transforaminal lumbar interbody fusion (TLIF) and had two-year outcomes data were included in this retrospective cohort study. Segmental lumbar lordosis was assessed in all patients with L3-L4, L4-L5, and L5-S1 constructs. Demographics, radiographic spinopelvic alignment, and complications were compared in a subgroup of patients fused at L4-S1 with adequate (i.e. within 35°–45°) and inadequate (i.e. 0.05). Two-year postoperatively, 32.7% developed adjacent segment disease, and 19.6% underwent revisions. After stratification by adequate (N=15) or inadequate (N=54) restoration of L4-S1 lordosis following initial TLIF surgery, adequately restored patients had higher preoperative L4-S1 lordosis (adequately restored=39.3° vs. inadequately restored=29.5°, P<0.001) and lower two-year postoperative adjacent segment disease (6.7% vs. 33.3%, P=0.032) and revision (5.7% vs. 25.9%, P=0.l33) rates. Adjacent segment disease patients had higher implant-related complications (adjacent segment disease=36.8% vs. no adjacent segment disease=8.0%, P=0.008) and subsequent revisions (61.1% vs. 8.7%, P<0.001). Conclusions.: Adjacent segment disease and revisions after degenerative lumbar spinal fusion are common. In this cohort, suboptimal restoration of L4-S1 lordosis was associated with higher rates of adjacent segment disease and subsequent revisions, thus highlighting the importance of restoring sagittal alignment in degenerative spine surgery. Level of Evidence.: Level III.

Study Design.: Meta-analysis. Objective.: This meta-analysis investigates the outcomes of laminoplasty (LP) and laminectomy with fusion (LF) to guide effective patient selection for these 2 procedures. Background.: Although LF traditionally offers the ability for excellent posterior decompression, it may alter cervical spine biomechanics and increase the risk of adjacent segment degeneration. LP aims to preserve the natural kinematics of the spine but has not been universally accepted, and may be associated with inadequate decompression, neck pain, and recurrent stenosis. Materials and Methods.: PubMed, Cochrane, and Google Scholar (pages 1–20) were searched up until March 2024. The outcomes studied were surgery-related outcomes [operative time (OR) time, estimated blood loss (EBL), and length of stay], adverse events (overall complications, C5 palsy, and reoperations), radiographic outcomes (cervical lordosis, cervical sagittal vertical axis, and T1 slope angle), and patient-reported outcome measures (Neck Disability Index, Visual Analog Scale for neck pain, and Japanese Orthopaedic Association). Results.: Twenty-two studies were included in this meta-analysis, of which 19 were retrospective studies, 2 were prospective nonrandomized studies, and 1 was a randomized controlled trial. A total of 2128 patients were included, with 1025 undergoing LP and 1103 undergoing LF. Patients undergoing LP experienced significantly shorter operative time (P = 0.009), less EBL (P = 0.02), a lower rate of overall complications (P < 0.00001) and C5 palsy (P = 0.003), a lower T1 slope angle (P = 0.02), and a lower Neck Disability Index (P = 0.0004). No significant difference was observed in the remaining outcomes. Conclusion.: This meta-analysis demonstrates that for cervical myelopathy, LP has the benefits of shorter operative time time, less EBL, and reduced incidence of C5 palsy as well as overall complication rate. Given these findings, LP remains an important surgical option with a favorable complication profile in patients with cervical myelopathy, although careful patient selection is still paramount in choosing the right procedure for individual patients. Level of Evidence.: 4.

Background: Surgical site infections (SSIs) represent a major challenge in spine surgery, leading to severe morbidity, mortality, and increased costs. The local application of antibiotics, particularly vancomycin, has emerged as a potential strategy. Individual randomized controlled trials (RCTs) have disagreed about the efficacy of topical vancomycin in preventing SSIs after spine surgery, and so a meta-analysis that pools data from those RCTs might be helpful to inform clinicians’ decisions on the topic. Questions/purposes: This meta-analysis of RCTs asked: Does intrawound topical vancomycin reduce the risk of (1) SSIs, (2) deep SSIs, and (3) superficial SSIs in patients undergoing spine surgery? Methods: PubMed, Cochrane, and Google Scholar (pages 1-20) were searched up through March 13, 2024 (search performed on March 13, 2024). Inclusion criteria consisted of English or non-English-language RCTs comparing the implementation of topical vancomycin in spine surgery to its nonuse and assessing its efficacy in preventing SSI, while exclusion criteria consisted of nonrandomized comparative studies, single-arm noncomparative studies, comparative studies based on national databases or from the same center as other included studies, studies posted to preprint servers, studies reporting incomplete/nonrelevant outcomes, and studies adding another SSI preventive measure. The studies were assessed using the Cochrane Risk of Bias tool. Heterogeneity was evaluated by Q tests and I² statistics. We used a random-effects model when considerable heterogeneity was observed (all SSIs, deep SSIs); otherwise, a fixed-effects model was used (all SSIs subanalysis, superficial SSIs). Furthermore, the fragility index was calculated for each of the assessed outcomes when there was no difference between the two groups to assess how many patients were needed to experience the outcomes for a difference to become present. The studied outcomes were the risks of SSIs, deep SSIs, and superficial SSIs. Deep SSIs were defined by the included trials as SSIs underneath the fascia, otherwise they were considered superficial. Six RCTs representing a total of 2140 patients were included, with 1053 patients in the vancomycin group and 1087 in the control group. Using an alpha of 0.05, our meta-analysis had 80% power to detect a risk difference of 1.5% for the primary outcome between patients who did and did not receive vancomycin. The age of the patients in the vancomycin group ranged from 37 to 52 years, while the age in the control group ranged from 34 to 52 years. The surgical procedures consisted of both instrumented and noninstrumented spinal procedures. Overall, the risk of bias in the included studies was either low or unclear, with none of the studies having a high risk of bias in any of the assessed categories (selection bias, performance bias, detection bias, attrition bias, and reporting bias). Results: We found no difference in the risk of SSI between the vancomycin and control groups (3.0% [32 of 1053] versus 3.9% [42 of 1087], relative risk 0.74 [95% CI 0.35 to 1.57]; p = 0.43). Ten additional patients (4.8% infection risk) in the control group would need to experience an SSI for a difference to be observed between the two groups. We found no difference in the risk of deep SSI between the vancomycin and control groups (1.8% [15 of 812] versus 2.7% [23 of 860], relative risk 0.69 [95% CI 0.24 to 2.00]; p = 0.50). Seven additional patients (3.5% infection risk) in the control group would need to experience a deep SSI for a difference to be observed between the two groups. We found no difference in the risk of superficial SSI between the vancomycin and control groups (1.0% [6 of 620] versus 1.4% [9 of 662], relative risk 0.68 [95% CI 0.25 to 1.89]; p = 0.46). Seven additional patients (2.4% infection risk) in the control group would need to experience a superficial SSI for a difference to be observed between the two groups. Conclusion: This meta-analysis of randomized trials examining use of topical vancomycin in spine surgery failed to show efficacy in reducing infection, and thus we do not recommend routine use of topical vancomycin for this indication. Future large-scale trials would be needed if surgeons believe that between-group differences smaller than those for which we were powered here (this meta-analysis had 80% power to detect a between-group difference of 1.5% in infection risk) are clinically important, and large database surveys may be informative in terms of assessing for postoperative adverse events associated with the use of vancomycin powder. Level of Evidence: Level I, therapeutic study.