UNASSIGNED: Adjacent segment disease (ASD) is a late complication of lumbar fusion characterized by persistent symptoms correlating to radiographic changes in the levels immediately above or below the prior fusion. Lateral interbody fusion (LIF) through a direct lateral approach is a minimally invasive and effective surgical treatment for ASD. Biomechanically, LIF for ASD provides significantly decreased motion in multiple planes. While hardware failure and injury to the lumbar plexus are potential complications, these risks may be outweighed by decreased blood loss, shorter operating room (OR) times, and possibly superior patient reported visual analog scale (VAS) scores compared to traditional posterior spinal fusion (PSF) alone. The purpose of this review is to summarize the history, uses, outcomes, and future directions of LIF for ASD.
UNASSIGNED: A review of national databases (PubMed and SCOPUS) was performed using literature from 1900 to 2022. Keywords included terms \"LATERAL\" and \"LUMBAR\" and \"INTERBODY\" and \"FUSION\" and \"ADJACENT\" and \"SEGMENT\" and \"DISEASE\". Studies that aimed to describe the biomechanical, clinical course and complications, radiological outcomes, biomechanical aspects, need for revision surgery, and/or patient reported outcomes of the XLIF/LIF technique were included.
UNASSIGNED: This review includes a brief overview of the natural history of ASD and current approaches to address it. It then summarizes the main indications and utilization of LIF to address ASD, summarizing reported outcomes in regard to biomechanical, clinical, and radiographic outcomes.
UNASSIGNED: LIF has emerged as a minimally invasive and effective surgical treatment for ASD. This mini-review suggests that LIF provides a solid foundational biomechanical construct that has been paired with good patient-reported, clinical, and radiographic outcomes. While further research is required, current literature suggests that LIF for ASD results in fewer complications, decreased morbidity, and decreased need for subsequent surgery compared to other commonly utilized techniques.

BACKGROUND: Despite their precarious behavioral classification (benign and low grade on histopathology yet behaviorally malignant), great strides have been taken to improve prognostication and treatment paradigms for patients with skull base chordoma. With respect to surgical techniques, lateral transcranial (TC) approaches have traditionally been used, however endoscopic endonasal approaches (EEA) have been advocated for midline lesions. Nonetheless, due to the rarity of this pathology (0.2% of all intracranial neoplasms), investigations within the literature remain limited to small retrospective series. Furthermore, radiotherapeutic treatments investigated to date have proven largely ineffective.
METHODS: Accordingly, we performed a systematic review in order to profile surgical and survival outcomes for skull base chordoma. Fixed and random-effect meta-analyses were performed for categorical variables including GTR, STR, 5-year OS, 10-year OS, 5-year PFS, and 10-year PFS. Additionally, we pooled eligible studies for formal meta-analysis to compare outcomes by surgical approach (lateral versus midline). Statistical analyses were performed using R Studio \'metafor\' package or Cochrane Review Manager. Furthermore, meta-analysis of pooled mortality rates and sub-analyses of operative margin and surgical complications were used to compare midline versus lateral approaches via the Mantel-Haenszel method. We considered all p-values < 0.05 to be statistically significant.
RESULTS: Following the systematic search and screen, 55 studies published between 1993 and 2022 reporting data for 2453 patients remained eligible for analysis. Sex distribution was comparable between males and females, with a slight predominance of male-identifying patients (0.5625 [95% CI: 0.5418; 0.3909]). Average age at diagnosis was 42.4 ± 12.5 years, while average age of treatment initiation was 43.0 ± 10.6 years. Overall, I2 value indicated notable heterogeneity across the 55 studies [I2 = 56.3% (95%CI: 44.0%; 65.9%)]. With respect to operative margins, the rate of GTR was 0.3323 [95% CI: 0.2824; 0.3909], I2 = 91.9% [95% CI: 90.2%; 93.4%], while the rate of STR was significantly higher at 0.5167 [95% CI: 0.4596; 0.5808], I2 = 93.1% [95% CI: 91.6%; 94.4%]. The most common complication was CSF leak (5.4%). In terms of survival outcomes, 5-year OS rate was 0.7113 [95% CI: 0.6685; 0.7568], I2 = 91.9% [95% CI: 90.0%; 93.5%]. 10-year OS rate was 0.4957 [95% CI: 0.4230; 0.5809], I2 = 92.3% [95% CI: 89.2%; 94.4%], which was comparable to the 5-year PFS rate of 0.5054 [95% CI: 0.4394; 0.5813], I2 = 84.2% [95% CI: 77.6%; 88.8%] and 10-yr PFS rate of 0.4949 [95% CI: 0.4075; 0.6010], I2 = 14.9% [95% CI: 0.0%; 87.0%]. There were 55 reported deaths for a perioperative mortality rate of 2.5%. The relative risk for mortality in the midline group versus the lateral approach group did not indicate any substantial difference in survival according to laterality of approach (-0.93 [95% CI: -1.03, -0.97], I2 = 95%, (p < 0.001).
CONCLUSIONS: Overall, these results indicate good 5-year survival outcomes for patients with skull base chordoma; however, 10-year prognosis for skull base chordoma remains poor due to its radiotherapeutic resistance and high recurrence rate. Furthermore, mortality rates among patients undergoing midline versus lateral skull base approaches appear to be equivocal.

暂无摘要。

\"Failure\" is a term that is frequently used to describe an unfavorable outcome for patients who undergo surgical treatment for lateral ankle instability (LAI). A standard definition of failure for the surgical treatment of ankle instability has not been established by clinicians and researchers.
To identify the definitions of ankle instability treatment failure that are currently in the literature and to work toward the standardization of the definition.
Systematic review; Level of evidence, 4.
A systematic search of MEDLINE, SPORTDiscus, CINAHL, Embase, and Web of Science was conducted to identify clinical studies that included patients who underwent surgical treatment for LAI and included information about surgical failure. Studies with level of evidence 1 to 4 were included in this review. Animal studies, biomechanical studies, cadaveric studies, review articles, and expert opinions were excluded. The included studies were then reviewed for definitions of failure of any surgical procedure that was performed to correct LAI.
Of the 1200 studies found, 3.5% (42/1200) published between 1984 and 2021 met the inclusion criteria and were analyzed. After reviewing the data, we found numerous definitions were reported in the literature for LAI surgical failure. The most common was recurrent instability (40% [17/42]), followed by rerupture (19% [8/42]). For the original surgical procedure, the anatomic Broström-Gould technique was used most frequently (57% [24/42]). The failure rate of the Broström-Gould technique ranged from 1.1% to 45.2% depending on the definition of failure.
There were multiple definitions of failure for the surgical treatment of LAI, which is one of the reasons why the rate of failure can vary greatly. The literature would benefit greatly from the standardization of the definition of ankle instability treatment failure. This definition should include specific, objective physical examination findings that eliminate the ambiguity surrounding failure.

Lateral unicompartmental knee arthroplasty (UKA) is a surgical option for patients with isolated lateral osteoarthritis however, the procedure has higher revision rates than medial UKA. The reason for this remains unclear; therefore, a better understanding of the indications for lateral UKA revision is needed.
The primary aim of this systematic review was to identify revision indications for lateral UKA. Secondary aims were to further investigate if revision indications were influenced by implant design and time from surgery.
A systematic literature review was performed according to the PRISMA 2020 guidelines. Search was performed in January 2022 in MedLine, EMBASE, CINAHL and the Cochrane Library using the keywords \"knee arthroplasty\", \"unicompartmental\", \"reoperation\", synonyms and abbreviations. Articles published in 2000-2021 that were at least level III retrospective cohort studies with at least 10 lateral UKAs and reported all failure modes were included. Risk of bias was assessed using the ROBINS-I tool. Revision indications, patient characteristics, study design, implant types and time to failure were extracted from the selected studies. Collated data were tabulated and differences were tested using Chi-square or Fisher\'s exact test.
A total of 29 cohort and 4 registry studies that included 7,668 UKAs met the inclusion criteria. Studies were judged as having moderate or severe risk of bias; this was associated with the retrospective nature of studies required to investigate long-term outcomes of knee arthroplasty. The main indications for lateral UKA revision were OA progression (35%), aseptic loosening (17%) and bearing dislocation (14%). The incidence of revision was similar for mobile-bearing implants (7.6%) and fixed-bearing (6.4%). For mobile-bearing implants, there was introduction of bearing dislocations as an additional mode of failure (24% cf. 0%, p < 0.001). For fixed-bearing implants, the incidence of revision was higher for all-poly-ethylene (13.9%) than metal-backed (1.8%) tibial components. Early lateral UKA failures were associated with bearing dislocations (sequential decrease from 69% under 6 months to 0% 10+ years, p < 0.001), whereas late failures were associated with OA progression (sequential increase from 0% under 6 months to 100% > 10+ years, p < 0.01). Compared with medial UKA, OA progression (41% cf. 30%, p = 0.004), malalignment (2.7% cf. 0.8%, p = 0.02), instability (4% cf. 1%, p = 0.02) and bearing dislocations (20% cf. 10%, p < 0.001) were more common for lateral UKA.
OA progression, aseptic loosening and bearing dislocation were the three main revision indications for lateral UKA. Compared to medial UKA, OA progression, malalignment, instability and bearing dislocations were more common revision indications for lateral UKA. Higher survivorship of metal-backed fixed-bearing implants was found. The findings suggest that the outcomes of lateral UKA may be improved with more optimal alignment, gap balancing and patient selection.
Level III systematic review.

Placement of dental implants has evolved to be an advantageous treatment option for rehabilitation of the fully or partially edentulous mandible. In case of extensive horizontal bone resorption, the bone volume needs to be augmented prior to or during implant placement in order to obtain dental rehabilitation and maximize implant survival and success.
Our aim was to systematically review the available data on lateral augmentation techniques in the horizontally compromised mandible considering all grafting protocols using xenogeneic, synthetic, or allogeneic material. A computerized and manual literature search was performed for clinical studies (published January 1995 to March 2021).
Eight studies ultimately met the inclusion criteria comprising a total of 276 procedures of xenogeneic, allogeneic, or autogenous bone graft applications in horizontal ridge defects. Particulate materials as well as bone blocks were used as grafts with a mean follow-up of 26.0 months across all included studies. Outcome measures, approaches and materials varied from study to study. A gain of horizontal bone width of the mandible with a mean of 4.8 mm was observed in seven of eight studies. All but one study, reported low bone graft failure rates of 4.4% in average.
Only limited data are available on the impact of different horizontal augmentation strategies in the mandible. The results show outcomes for xenogeneic as well as autologous bone materials for horizontal ridge augmentation of the lower jaw. The use of allogeneic bone-block grafts in combination with resorbable barrier membranes must be re-evaluated. Randomized controlled clinical trials are largely missing.

The thoracic phase of minimally invasive esophagectomy was initially performed in the lateral decubitus position (LDP); however, many experts have gradually transitioned to a prone position (PP) approach. The aim of the present systematic review and meta-analysis is to quantitatively compare the two approaches. A systematic literature search of the MEDLINE, Embase, Google Scholar, Web of Knowledge, China National Knowledge Infrastructure and ClinicalTrials.gov databases was undertaken for studies comparing outcomes between patients undergoing minimally invasive esophageal surgery in the PP versus the LDP. In total, 15 studies with 1454 patients (PP; n = 710 vs. LDP; n = 744) were included. Minimally invasive esophagectomy in the PP provides statistically significant reduction in postoperative respiratory complications (Risk ratios 0.5, 95% confidence intervals [CI] 0.34-0.76, P < 0.001), blood loss (weighted mean differences [WMD] -108.97, 95% CI -166.35 to -51.59 mL, P < 0.001), ICU stay (WMD -0.96, 95% CI -1.7 to -0.21 days, P = 0.01) and total hospital stay (WMD -2.96, 95% CI -5.14 to -0.78 days, P = 0.008). In addition, prone positioning increases the overall yield of chest lymph node dissection (WMD 2.94, 95% CI 1.54-4.34 lymph nodes, P < 0.001). No statistically significant difference in regards to anastomotic leak rate, mortality and 5-year overall survival was encountered. Subgroup analysis revealed that the protective effect of prone positioning against pulmonary complications was more pronounced for patients undergoing single-lumen tracheal intubation. A head to head comparison of minimally invasive esophagectomy in the prone versus the LDP reveals superiority of the former method, with emphasis on the reduction of postoperative respiratory complications and reduced length of hospitalization. Long-term oncologic outcomes appear equivalent, although validation through prospective studies and randomized controlled trials is still necessary.

Isolated lateral compartment osteoarthritis of the knee is a rare condition affecting approximately 1% of the population, which is ten times less common than osteoarthritis affecting only the medial compartment. Unicompartmental knee arthroplasty (UKA) has many potential advantages over total knee arthroplasty. The benefits of UKA include a smaller incision, preservation of more native tissue (including cruciate ligaments and bone), decreased blood loss, and better overall proprioception. When UKA was first introduced in the 1970s, the outcomes of medial UKA (MUKA) were poor, but the few cases of lateral UKA (LUKA) showed promise. Since that time, there has been a relative paucity of literature focused specifically on LUKA given it is a rare procedure. Refinements in patient selection criteria, implant design, and surgical technique have been made leading to increased popularity. A review of the recent literature reveals that LUKA is associated with excellent long-term clinical outcomes and implant survivorship when performed in properly selected patients. Implant design options include fixed vs mobile bearing as well as metal backed vs all polyethylene tibial component, with improved outcomes noted with fixed bearing designs. Three reasons cited for revision (i.e., fracture of the femoral component, fracture of the tibial component, and valgus malalignment) had been reported in past literature but not recently. Presently, while rare, the most common cause of failure and need for revision are osteoarthritis progression and aseptic loosening. Despite the need for an occasional revision procedure, the survivorship of LUKA is comparable to MUKA, although it should be noted that outcomes of MUKA have been notably varied. Continued pursuit of improved techniques and implant designs will continue to show LUKA to be an excellent procedure for appropriately indicated patients.

BACKGROUND: Bearing dislocation is a problem following mobile bearing Oxford lateral Unicompartmental Knee Replacement (UKR). Therefore, the design of the tibial component was changed from a flat tibial surface to a domed tibial surface with a biconcave bearing to increase bearing entrapment. This systematic review compared the dislocation and revision rates of the two designs.
METHODS: Two authors independently searched MEDLINE, EMBASE and ISI Web of Science, reference lists of retrieved articles, and the internet. Randomised, cohort, case-control and case studies of adult patients with lateral knee osteoarthritis treated with flat or domed Oxford lateral UKR and their outcomes were included. The overall dislocation rate and the annual revision rate (per 100 component years) were determined.
RESULTS: Nine studies (937 knees) met the inclusion criteria (3 flat, 6 domed). Four studies (all domed) had a low risk of bias and five had a high risk (3 flat, 2 domed), so data should be interpreted with caution. The bearing dislocation rate decreased from 17% (flat) to 3.7% (domed). Dislocations occurred on average at 16 months and medial dislocations were most common. The revision rate excluding dislocation decreased from 1.1%pa to 0.7%pa. PROSPERO registration: CRD42019139250.
CONCLUSIONS: Modifying the tibial component from a flat to a domed shape decreased the bearing dislocation rate to 3.7% and increased the 10 year survival rate excluding dislocation to 93%. The dislocation rate is still relatively high so bearing stability should be assessed intra-operatively and if unacceptable, a fixed bearing version of the Oxford lateral tibial component can be inserted.

OBJECTIVE: The purpose of this paper is to systematically review the available literature to understand the effectiveness, the survivorship, the clinical outcomes and the complications of lateral UKA.
METHODS: A review of the current literature available about lateral UKA was performed in March 2020, according to the PRISMA guidelines. Selection was based on the following inclusion criteria: (1) clinical reports of any level of evidence, (2) written in English language, (3) published from 1996 to 2020, (4) dealing with clinical data on lateral UKA. A total of 47 articles, published between 1996 and 2020, were included in the review. Quality of every article was assessed using the Modified Coleman Methodology Score.
RESULTS: A total of 47 studies were included. Mean mCMS was 45.27 (range 30-62). Mean age at surgery was 64.5 years (range 34.1-88.0 years). In 1741 patients (65.5%) a metal back implant was used and in 421 patients (15.8%) an all poly design was used. Several scores were used to evaluate clinical results (OKS, AKSS, IKS, KOOS, WOMAC, VAS). Range of motion improved with an overall mean value of 120.3° (range: 105.9°-143.3°). The mean follow-up was 60.7 months (range, 7-204 months), mean survivorship (absence of a revision) with a minimum 60 months of follow-up was 88.6% (range 74.5-100) and mean satisfaction of patients was 78.5% (range 41.0-97.9).
CONCLUSIONS: Lateral UKA seems to be an effective solution to manage lateral osteoarthritis (OA), based on preliminary results, with survivorship and satisfaction rate comparable to medial UKA and total knee arthroplasty (TKA). Nonetheless, this review highlights that the quality of studies available in current literature is low.
METHODS: Systematic review of level IV studies.