Study design This study is a comparative, literature review. Objective The aim of this study is to provide a comparative analysis of open vs. minimally invasive TLIF using a literature review and a meta-analysis. Summary of background data Lumbar interbody fusion is a well-established surgical procedure for treating several spinal disorders. Transforaminal lumbar interbody fusion (TLIF) was initially introduced in the early 1980s. To reduce approach-related morbidity associated with traditional open TLIF (OTLIF), minimally invasive TLIF (MITLIF) was developed. We aimed to provide a comparative analysis of open vs. minimally invasive TLIF using a literature review. Methods We searched the online database PubMed (2005–2017), which yielded an initial 194 studies. We first searched the articles’ abstracts. Based on our inclusion criteria, we excluded 162 studies and included 32 studies: 18 prospective, 13 retrospective, and a single randomized controlled trial. Operative time, blood loss, length of hospital stay, radiation exposure time, complication rate, and pain scores (visual analogue scale, Oswestry Disability Index) for both techniques were recorded and presented as means. We then performed a meta-analysis. Results The meta-analysis for all outcomes showed reduced blood loss ( P < 0.00001) and length of hospital stay ( P < 0.00001) for MITLIF compared with OTLIF, but with increased radiation exposure time with MITLIF ( P < 0.00001). There was no significant difference in operative time between techniques ( P = 0.78). The complication rate was lower with MITLIF (11.3%) vs. OTLIF (14.2%), but not statistically significantly different ( P = 0.05). No significant differences were found in visual analogue scores (back and leg) and Oswestry Disability Index scores between techniques, at the final follow-up. Conclusion MITLIF and OTLIF provide equivalent long-term clinical outcomes. MITLIF had less tissue injury, blood loss, and length of hospital stay. MITLIF is also a safe alternative in obese patients and, in experienced hands, can also be used safely in select cases of spondylodiscitis even with epidural abscess. MITLIF is also a cost-saving procedure associated with reduced hospital and social costs. Long-term studies are required to better evaluate controversial items such as operative time.

No abstract

BackgroundOne major concern in the treatment of ACL lesions in children and adolescents with open physes is the risk of iatrogenic damage to the physes and a possibly resulting growth disturbance.PurposeThe primary purpose of this article is to describe our technique of a transphyseal ACL reconstruction using quadriceps tendon-bone autograft in children and adolescents with open growth plates. The secondary aim is to report our early results in terms of postoperative growth disturbances which are considered to be a major concern in this challenging group of patients. It was our hypothesis that with our proposed technique no significant growth disturbances would occur.MethodsFrom January 1997 to December 2007 49 consecutive children and adolescents with open growth plates were treated for a torn ACL using the aforementioned surgical technique. The patients (28 males and 21 females) with a median age at surgery of 13 (range 8-15) years were retrospectively evaluated. Outcome measures were follow-up radiographs (weight-bearing long leg radiographs of the injured and uninjured knee, anteroposterior and lateral views, a tangential view of the patella and a tunnel view of the injured knee) and follow-up notes (6 weeks, 3, 6, 12 months and until closing of physes) for occurrence of any tibial and/or femoral growth changes.Results: All of the 49 patients had a sufficient clinical and radiological follow-up (minimum 5 years, rate 100%). 48 cases did not show any clinical and radiological growth disturbance. One case of growth disturbance in a 10.5 years old girl was observed. She developed a progressive valgus-flexion deformity which was attributed to a malplacement of the autograft bone block within the femoral posterolateral epiphyseal plate leading to an early localized growth stop. None of the patients were reoperated due to ACL graft failure. Five of the patients underwent revision ACL surgery due to another adequate sports trauma after the growth-stop. The tibial fixation screw had to be removed under local anaesthesia in 10 patients.ConclusionsThe described ACL reconstruction technique represents a promising alternative to previously described procedures in the treatment of children and adolescents with open growth plates. Using quadriceps tendon future graft availability is not compromised, as the most frequently used autograft-source, ipsilateral hamstring tendons, remains untouched.

Abstract. thymoquinone (tQ), the major compound of black seed oil, has been shown to induce pro-apoptotic signaling pathways in various human cancer models. although tQ is commonly used in traditional medicine, its use in humans is limited due to its chemical properties and poor membrane penetration capacity. We therefore attached saturated and unsaturated fatty acid residues to tQ and evaluated the effect on cell proliferation, apoptosis and underlying signaling pathways in hct116 and hct116 p53-/-colon cancer and hepG2 hepatoma cells in vitro. treatment with thymoquinone-4-α-linolenoylhydrazone (tQ-h-10) or thymoquinone-4-palmitoylhydrazone (tQ-h-11) induced a cytostatic effect, particularly in p53-competent hct116 cells, mediated by an up-regulation of p21 cip1/waf1 and a down-regulation of cyclin e, and associated with an S/G 2 arrest of the cell cycle. cells lacking p53 (hct116 p53-/-) or hepG2 liver cancer cells showed only a minor response to TQ-H-10. These findings demonstrate that derivatives of tQ inhibit cell proliferation dependent on p53 status by activating the cell cycle inhibitor p21 cip1/waf1 at lower concentrations than unmodified TQ. Structural modifications can therefore contribute to the further clinical development of tQ.

Epidemiological study, level V.