Journal club 20_sept


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  • a minimally invasive presacral surgical technique that damages neither the anulus fibrosus nor the anterior or posterior longitudinal ligaments
  • Journal club 20_sept

    1. 1. Results and complications after 2-level axial lumbar interbody fusion with a minimum 2-year follow-up Marchi L., Oliveira L., Coutinho E., Pimenta L. J Neurosurg Spine 17:187-192, 2012 Cristian Gragnaniello 20-9-2012 Journal Club Critical Appraisal EBS presentation 1
    2. 2. EBS presentation 2
    3. 3. EBS presentation 3
    4. 4. Significance/context and importanceof the study• The study was done as there are no studies evaluating 2 level axialif• It is original EBS presentation 4
    5. 5. Hypothesis or Objectives• To report on the outcome of 27 patients treated with 2 level AxiaLIF in a prospective nonrandomized fashion. EBS presentation 5
    6. 6. Internal Validity• Ethics committee approval• Participants – no selection bias as they were consecutive patients• Baseline data are reported and indications for surgery are clearly stated EBS presentation 6
    7. 7. • Design – prospective nonrandomized• Interventions – outcomes were measured with methods sound for lumbosacral spine surgery (VAS for back and leg pain) and ODI• Neurological examination and complications are also reported• Radiological evaluation was performed using standing anteroposterior and lateral plain radiographs, lateral flexion and extension radiographs, and CT scans with sagittal and coronal acquisitions. EBS presentation 7
    8. 8. • The intervertebral disc height was measured and expressed as an average of the sum of the measurements at the anterior and posterior regions of the disc. The disc space height was normalized with the anteroposterior diameter of the upper vertebral body.• Segmental lordosis values were obtained as the angle between lines tangent to the superior endplate of the superior vertebra and the inferior endplate of the inferior vertebra. EBS presentation 8
    9. 9. • Solid fusion was defined as less than 5° of angular motion, the absence of radiolucent lines covering at least 50% of the implant surfaces, and the presence of continuous trabecular bone growing through the disc space.• Bridging bone was defined as any bone formation or incomplete bony ingrowth between the endplates of the vertebral bodies.• Images were evaluated by 4 spine surgeons. EBS presentation 9
    10. 10. Statistical analysis• Student t-tests were used for comparing variables, with a level of significance of 95% (p < 0.05).• Good internal validity as t-test is best used when comparing 2 sets of data or a nominal variable and a measurement variable EBS presentation 10
    11. 11. Participant Flow Chart (if relevant) EBS presentation 11
    12. 12. Conclusions: External Validity orGeneralisability• All clinically important outcomes were considered• The likely treatment benefits ARE NOT worth the potential harms and costs EBS presentation 12
    13. 13. Presentation of Paper• Well written paper, good economy of words, paper well organized, probably better analysis of results/complications needed• Figures and tables are appropriate and summarizing key points• Bibliography is sound EBS presentation 13
    14. 14. Table SummaryObjective Evaluate TranS1 fusion at 2 levelsDesign Internal validity OKParticipants Internal validity OK, small series but seen the results it would be surprising if it was biggerFunding TranS1 BADInterventions OKResults ResultsOutcome ResultsConclusions External validity OK EBS presentation 14
    15. 15. Conclusion• Future, next steps: more laboratory testing needed, probably too soon to push the technique to 2 levels• TranS1 for 2 levels is biomechanically not sound• Application to my practice: I would not propose it to my patients EBS presentation 15
    16. 16. EBS presentation 16