Outcome of minimal invasive surgery approach for spine infection: a systematic review

The concept of minimally invasive surgery has gained increasing popularity in the last several decades, are being introduced as an alternative to limit the surgical complications while achieving best possible outcome. While minimally invasive spine surgery holds promise for lower blood loss, faster patient recovery, shorter hospital stays, and the potential to transition procedures to the ambulatory setting, safety in spinal surgery remains paramount and has (appropriately) tempered some of the enthusiasm for the results of aggressive early adapters. Until now, there has been no literature summarizing the evidence of MIS outcome in treating spondylitis TB of the bone. The purpose of this systematic review was to investigate the outcome of minimal invasive surgery approach for spine infection. authors comprehensively searched PubMed, EMBASE, and Cochrane Library to search for studies about minimally invasive surgery as management of tuberculous spondylitis up to June 7th, 2019. The selection of appropriate studies was performed by independent investigators based on PRISMA guideline. Given the limited number of studies, there was no restriction in terms of patient’s demographics, the specific minimal invasive surgical method, and publication status. Authors identified the method for minimally invasive approach and open approach, the functional outcome, intraoperative outcome, radiological outcome, length of stay, follow up period, and complication. Authors found 81 articles from database. After evaluating full text, 8 articles (346 patients) were found to be eligible. More than 110 patients were treated with open spine surgery, while more than 270 patients were treated using minimally invasive spine surgery the minimal invasive methods were posterior pedicle screws fixation, plate fixation, lateral nail bar fixation, and bilateral pedicle screw fixation. The visualization methods include C-arm fluoroscopy, X-ray fluoroscopy. The follow-up period ranges from 1 to 40 months. The functional outcome were found to be satisfying with minimal complications. MIS yielded satisfactory result in comparison to conventional open surgery for spine infection. More long term future studies should be conducted to in order to search for more solid evidence regarding this claim

The relationship between tourniquet time and Il-6, D-Dimer and visual analogue scale in total knee arthroplasty

Background: The use of tourniquet during TKA aside from having several advantages, is also accompanied by several risks. This study was performed to prove the relation between the duration of tourniquet application to inflammatory response, pro-thrombotic condition, and pain response of the patients undergoing TKA procedures.Methods: This study is a cross-sectional analytical experimental research. A femoral tourniquet was applied to 34 primary osteoarthritis (OA) patients undergoing the standard procedure of TKA and the duration of tourniquet application data was noted and collected. Pain assessment was performed by using Visual Analogue Scale (VAS), whereas blood samples are taken from the patients and IL-6 cytokine and D-dimer levels were identified at 12 hours and 24 hours post-operatively. Statistical analysis (Pearson correlation) was performed to see the correlation of tourniquet duration to the VAS, IL-6, and D-dimer serum level at 12 hours and 24 hours post-operatively.Results: The result of this study showed a positive correlation between the duration of tourniquet use with IL-6 at 12 hours post operation (r=0.359) and 24 hours post operation (r=0.658); with D-dimer at 12 hours post operation (r=0.491) and 24 hours post operation (r=0.483); and with VAS at 12 hours post operation (r=0.647) and 24 hours post operation (r=0.507) with p<0,05. A positive correlation was found between tourniquet time and IL-6, D-dimer and VAS.Conclusions: The duration of tourniquet cut-off time of more than 122.5 minutes elevates IL-6 and D-Dimer which increases the risk for SIRS and DVT

High expression levels of bone morphogenetic protein-2 and p-glycoprotein related with progressivity in patient with osteosarcoma

Background: Osteosarcoma progression characterized by the presence of metastasis dan local recurrence. Several studies focused on bone morphogenetic protein-2 (BMP-2) and P-glycoprotein as protein that influence the progression of osteosarcoma, which are characterized by metastasis and local recurrence.Methods: This study was a cross sectional analytic study. This study looks at the relationship level of BMP-2 and P-glycoprotein with metastasis and local recurrence in osteosarcoma. Twenty three research subjects are paraffin blocks of osteosarcoma patients and secondary data was conducted through medical records to determine metastasis and local recurrence that occurs in these patients.Results: The result showed significant correlation between BMP-2 and P-glycoprotein with metastasis and local reccurence.Conclusions: BMP-2 and P-glycoprotein positivity as determined by immunohistochemistry, was a strong correlate of more rapid disease progression. It should be taken into consideration to identify a subgroup of osteosarcoma patients with poor outcome at the time of diagnosis. So it might be an important marker in planning innovative chemotherapeutic regimens