report in conjunction with wound care and oral antibiotics. Suction may represent a less invasive and less painful alternative to surgical debridement. 1 Occlusive agents cause asphyxiation and emergence of maggots, allowing for subsequent mechanical removal. Ether followed by normal saline irrigation was described in one case report; there were no side effects reported and no evidence of local or systemic infection nor recurrence of maggots. 4 Turpentine oil was described in a similar fashion, but this treatment was associated with slower maggot shedding time and incomplete maggot resolution compared with administration of systemic therapy, ivermectin, along with mechanical extraction. 2 Among wound-cleansing agents, the effects of Dakin's solution (0.5% sodium hypochlorite), 70% isopropyl alcohol, povidone-iodine, and 3% hydrogen peroxide on maggot mortality were comparatively evaluated when applied daily to maggots in vitro for a total of 14 days. Maggot mortality among these solutions ranged between 33% and 46%, with Dakin's solution treatment associated with the highest mortality rate, suggesting the need for supplemental treatments to obtain complete clearance of wound myiasis. 5 The evidence to support a single most effective treatment strategy for wound myiasis is inconclusive. This case report presents a combination approach that demonstrated efficacy.There remains a need for additional studies to establish the comparative efficacy of treatment modalities and to develop standard guidelines for the management of wound myiasis.
OBJECTIVE
The aim of this study was to determine whether cage morphology influences clinical and radiographic outcomes following short-segment transforaminal lumbar interbody fusion (TLIF) procedures.
METHODS
The authors retrospectively reviewed one- and two-level TLIFs at a single tertiary care center between August 2012 and November 2019 with a minimum 1-year radiographic and clinical follow-up. Two cohorts were compared based on interbody cage morphology: steerable “banana” cage or straight “bullet” cage. Patient-reported outcome measures (PROMs), radiographs, and complications were analyzed.
RESULTS
A total of 135 patients with 177 interbody levels were identified; 45 patients had 52 straight cages and 90 patients had 125 steerable cages. Segmental lordosis increased with steerable cages, while it decreased with straight cages (+3.8 ± 4.6 vs −1.9 ± 4.3, p < 0.001). Conversely, the mean segmental lordosis of adjacent lumbar levels decreased in the former group, while it increased in the latter group (−0.52 ± 1.9 vs +0.52 ± 2.1, p = 0.004). This reciprocal relationship results in global sagittal parameters, including pelvic incidence minus lumbar lordosis and lumbar distribution index, which did not change after surgery with either cage morphology. Multivariate analysis confirmed that steerable cage morphology, anterior cage positioning, and less preoperative index-level segmental lordosis were associated with greater improvement in index-level segmental lordosis. PROMs were improved after surgery with both cage types, and the degree of improvement did not differ between cohorts (p > 0.05). Perioperative and radiographic complications were similar between cohorts (p > 0.05). Overall reoperation rates, as well as reoperation rates for adjacent-segment disease within 2 years of surgery, were not significantly different between cohorts.
CONCLUSIONS
Steerable cages are more likely to lie within the anterior disc space, thus increasing index-level segmental lordosis, which is accompanied by a reciprocal change in segmental alignment at the adjacent lumbar levels. The converse relationship occurs for straight cages, with a kyphotic change at the index levels and reciprocal lordosis occurring at adjacent levels.
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