Background: Accumulating evidence supports the long-term safety and effectiveness of minimally invasive sacroiliac joint fusion (SIJF) for sacroiliac joint dysfunction.Objective: To report 5-year clinical and radiographic follow-up in patients undergoing SIJF using triangular titanium implants (TTI).Methods: One hundred and three subjects at 12 centers treated with SIJF using TTI in two prospective clinical trials (NCT01640353 and NCT01681004) were enrolled and followed in the current study (NCT02270203) with clinic visits at 3, 4 and 5 years.CT scans performed at 5 years were compared to prior CT scans (at 1 or 2 years) by an independent radiologist.Results: Compared to baseline scores, SIJ pain scores at 5 years decreased by a mean of 54 points, disability scores (Oswestry Disability Index) decreased by 26 points, and quality of life scores (EuroQOL-5D time trade-off index) increased by 0.29 points (0-1 scale) (all p<0.0001).Satisfaction rates were high and the proportion of subjects taking opioids decreased from 77% at baseline to 41% at 5-year follow-up.Independent radiographic analysis showed a high rate (98%) of bone apposition to implants on both the sacral and iliac sides of the SI joint, with a high rate of bony bridging (87%) and a low rate of radiolucencies suggestive of loosening (5%).Conclusion: A 5-year follow-up showed continued excellent clinical responses in patients with SIJ pain treated with SIJF using triangular titanium implants along with a high rate (88%) of joint fusion.Level of evidence: Level II.
Vaccaro, Alexander R. MD, PhD; Fisher, Charles G. MD, MHSc; Whang, Peter G. MD; Patel, Alpesh A. MD; Thomas, Ken C. MD, MHSc; Mulpuri, Kishore MBBS, MHSc; Chi, John MD, MPH; Prasad, Srinivas K. MS, MD Author Information
Fisher, Charles G. MD; Vaccaro, Alexander R. MD, PhD, MBA; Mahtabfar, Aria MD; Mulpuri, Kishore MBBS, MHSc; Evanview, Nathan MD, PhD, FRCSC; Dea, Nicolas MD, MSc, FRCSC; Makanji, Heeren MD; Whang, Peter G. MD, FACS; Heller, Joshua E. MD, MBA Author Information
In Brief Study Design. The Thoracolumbar Injury Severity Score (TLISS) and the Thoracolumbar Injury Classification and Severity Score (TLICS) were prospectively evaluated. Objectives. To compare the reliability and validity of the TLISS and TLICS schemes to determine the importance of injury mechanism and morphology to the identification and treatment of thoracolumbar fractures. Summary of Background Data. Two novel algorithms have been developed for the categorization and management of thoracolumbar injuries: the TLISS system emphasizing injury mechanism and the TLICS scheme involving injury morphology. Methods. The clinical and radiographic findings of 25 patients with thoracolumbar fractures were prospectively presented to 5 groups of surgeons with disparate levels of training and experience with spinal trauma. These injuries were consecutively scored, first using the TLISS and then 3 months later with the TLICS. The recommended treatments proposed by the 2 schemes were compared with the actual management of each patient. Results. For both algorithms, the interrater kappa statistics of all subgroups (mechanism/morphology, status of the posterior ligaments, total score, predicted management) were within the range of moderate to substantial reproducibility (0.45–0.74), and there were no statistically significant differences noted between the respective kappa values. Interrater correlation was higher for the TLISS paradigm on mechanism/morphology, integrity of the posterior ligaments, and proposed management (P ≤ 0.01). The TLISS and TLICS schemes both exhibited excellent overall validity. Conclusions. Although both schemes were noted to have substantial reproducibility and validity, our results indicate the TLISS is more reliable than the TLICS, suggesting that the mechanism of trauma may be a more valuable parameter than fracture morphology for the classification and treatment thoracolumbar injuries. Since these injury characteristics are interrelated and are critical to the maintenance of spinal stability, we think that both concepts should be considered during the assessment and management of these patients. The reliability and validity of 2 thoracolumbar injury classification systems were prospectively compared. The TLISS system, which emphasizes injury mechanism, was shown to be slightly more reliable than the TLICS scheme, which emphasizes injury morphology. However, both TLISS and TLICS algorithms exhibited excellent overall reproducibility and validity.
Laboratory biomechanical experiment.To evaluate how different anterior cervical collar heights restrict full, active range of motion (ROM), and functional ROM during 15 activities of daily living.Hard cervical collars are commonly used in the clinical setting. Collar fit is presumed to affect immobilization, making neck height an important variable. No prior study has evaluated how different collar heights affect full, active and functional ROM.A previously validated electrogoniometer device was employed to quantify both full, active, and functional ROM. For each of 10 subjects, these ROM measurements were repeated without a collar and with an adjustable, hard collar (Aspen Vista) at each of 6 collar neck height settings.For each increase in collar height, there was a corresponding decrease in mean full, active ROM of 3.7% (3°) in the sagittal plane (R2 = 0.91, P = 0.003), 3.9% (3°) in the coronal plane (R2 = 0.88, P = 0.005), and 2.8% (4°) in the rotational plane (R2 = 0.86, P = 0.006). For each increase in collar height, there was a corresponding decrease in mean functional ROM across all of the tested activities of daily living of 1.1% (1°) in the sagittal plane (R2 = 0.90, P = 0.004), 0.4% (0.4°) in the coronal plane (R2 = 0.86, P = 0.007), and 0.6% (0.5°) in the rotational plane (R2 = 0.81, P = 0.014). For each increase in collar height, there was a 1.7° increase in mean neck extension while in the neutral position (R2 = 0.99, P < 0.001).This study suggests that greater cervical collar height for hard cervical collars will better restrict full, active, and functional cervical ROM. However, the change in functional ROM was only about one quarter to that of full active ROM and the clinical significance of this may be questioned. This must be balanced by the fact that this increased collar height forces the neck into greater extension which may not be the most clinical desired or functional position and may cause skin-related issues at the jaw or chest.
This study examined mRNA and protein expressions of neuronal (nNOS), inducible (iNOS), and endothelial nitric oxide synthases (eNOS) in peripheral nerve after ischemia-reperfusion (I/R). Sixty-six rats were divided into the ischemia only and I/R groups. One sciatic nerve of each animal was used as the experimental side and the opposite untreated nerve as the control. mRNA levels in the nerve were quantitatively measured by competitive PCR, and protein was determined by Western blotting and immunohistochemical staining. The results showed that, after ischemia (2 h), both nNOS and eNOS protein expressions decreased. After I/R (2 h of ischemia followed by 3 h of reperfusion), expression of both nNOS and eNOS mRNA and protein decreased further. In contrast, iNOS mRNA significantly increased after ischemia and was further upregulated (14-fold) after I/R, while iNOS protein was not detected. The results reveal the dynamic expression of individual NOS isoforms during the course of I/R injury. An understanding of this modulation on a cellular and molecular level may lead to understanding the mechanisms of I/R injury and to methods of ameliorating peripheral nerve injury.
