Does the Current State of Evidence Justify the Broad Use of Cross-Links in Dorsal Instrumentation? A Systematic Review
Abstract
:1. Introduction
- (1)
- Does the use of cross-links in dorsal instrumentation affects the radiological outcome, clinical outcome or rate of complication?
- (2)
- Are cross-links necessary in spinal fusion, if laminectomy is not performed?
- (3)
- Overall, does the current state of evidence justify the broad use of cross-links in spinal surgery? Alternatively, in which spinal disorders should cross-links be recommended?
2. Materials and Methods
2.1. Study Design
- (1)
- Cochrane library [Title Abstract Keyword]: “cross-link OR cross-links OR crosslink OR crosslinks OR <cross link> OR <cross links> OR <transverse connector> OR <transverse connectors>”.
- (2)
- Medline [All text]: “(crosslink OR crosslinks OR cross-link OR cross-links OR crosslinking OR <cross linking> OR cross-linking OR <transverse connector> OR <transverse connectors> OR connector OR connectors OR <rod connector> OR <rod connectors> OR transfixator OR transfixators OR <trans fixations>) AND (spine OR fusion OR stiffness OR fixation OR stability OR spondylodesis OR instrumentation) AND (randomized OR rct OR <clinical study> OR retrospective OR prospective OR <single center> OR single-center OR multi-center OR multicenter)”.
2.2. Inclusion and Exclusion Criteria
2.3. Data Collection and Statistical Analysis
3. Results
3.1. Scoliosis
3.2. Atlantoaxial Fusion
3.3. Adult Short-Segment Fusion
3.4. Adult Long-Segment Fusion
4. Discussion
5. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
References
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Author (Year) | Study Design | N | Minimum Follow-up (Months) | Level of Evidence | Risk of Bias |
---|---|---|---|---|---|
Scoliosis | |||||
Usmani et al. (2019) | Retrospective | 256 | 24 | III | High |
Garg et al. (2015) | Retrospective | 500 | 24 | III | High |
Chen et al. (2015) | Retrospective | 34 | 24 | III | High |
Garg et al. (2014) | Retrospective | 100 | 24 | IV | High |
Dhawale et al. (2013) | Retrospective | 75 | 24 | III | High |
Atlantoaxial Fusion | |||||
Wang et al. (2019) | Retrospective | 317 | 12 | III | High |
Mizutani et al. (2018) | Retrospective | 35 | 36 | IV | High |
Author (Year) | Number of Patients | Sex | Age (Years) |
---|---|---|---|
N (XL/NXL) | Female/Male | Mean (±1 SD/Range) | |
Scoliosis | |||
Usmani et al. (2019) | 256 (94/162) | 123/33 | 14.0 (±2.7) |
Garg et al. (2015) | 500 (377/123) | 413/83 (4 unknown) | 14.9 |
Chen et al. (2015) | 34 (24/19) | 14/20 | 3.1 (1.8–4.8) |
Garg et al. (2014) | 100 | 38/62 | 13.8 (7–21) |
Dhawale et al. (2013) | 75 (25/50) | 61/14 | 14.0 (±2.3) |
Atlantoaxial Fusion | |||
Wang et al. (2019) | 317 (149/168) | 206/111 | 38.6 (13–74) |
Mizutani et al. (2018) | 35 (18/17) | 27/8 | 56.1 (32–77) |
Author (Year) | N | Treated Disease | Radiological Parameters Assesed | Results |
---|---|---|---|---|
Scoliosis | ||||
Usmani et al. (2019) | 256 | Neuromuscular scoliosis | Major Cobb angle, pelvic obliquitiy, thoracal kyphosis, lumbar lordosis | No sign. difference at 24 months follow-up |
Garg et al. (2015) | 500 | AIS | Coronal and saggital balance, shoulder high difference, trunk shift, coronal plane deformity measurements (Cobb angle) | Sign. less improvement in sagittal balance and sign. greater improvement in thoracolumbar Cobb angle in XL-group |
Chen et al. (2015) | 34 | Congenital scoliosis | Spinal canal parameters (a.p./transverse), area of the spinal canal, screw-angle, distance between bilateral screws | No sign. negative effect on the develeopement of the spinal canal |
Garg et al. (2014) | 100 | Neuromuscular scoliosis | Levels fused, coronal plane deformity, pelvic obliquity, distal fixation point, presence of implant failure/screw lucency > 2 mm | No predictor for pelvic fixation failure |
Dhawale et al. (2013) | 75 | AIS | Thoracic/lumbar/lateral Cobb angle, correction rate, apical vertebral translation/rotation, Risser grade, Lenke classification | No sign. difference at 24 months follow-up |
Atlantoaxial fusion | ||||
Wang et al. (2019) | 317 | Atlantoaxial dislocation and basilar invagination | Ant./post. atlantodental interval, Chamberlain line, cervicomedullary angle, fusion rate | Sign. higher fusion rate in XL-group at 3/6/12 months follow-up |
Mizutani et al. (2018) | 35 | Atlantoaxial subluxation | Fusion rate—bony union C1 posterior arch and C2 lamina, ankyosis lateral C1/2 joint | Sign. higher fusion rate in XL-group at 6/12/24 months follow-up without sign. difference 3 years after surgery |
Author (Year) | N | Treated Disease | Clinical Parameters Assessed | Results |
---|---|---|---|---|
Scoliosis | ||||
Usmani et al. (2019) | 256 | Neuromuscular scoliosis | NA | NA |
Garg et al. (2015) | 500 | AIS | SRS-22r score (SRS-score), SAQ | Sign. improvement in health domain of SRS-score in XL-group. No sign. difference in SRS- or SAQ-score at 24 months follow-up |
Chen et al. (2015) | 34 | Congenital scoliosis | NA | NA |
Garg et al. (2014) | 100 | Neuromuscular scoliosis | NA | NA |
Dhawale et al. (2013) | 75 | AIS | SRS 22r-score | No sign. difference in SRS-score at 24 months follow-up |
Atlantoaxial fusion | ||||
Wang et al. (2019) | 317 | Atlantoaxial dislocation and basilar invagination | Japanese Orthopaedic Association Score (JOA) | Sign. higher JOA-score in XL-group at 12 months follow-up |
Mizutani et al. (2018) | 35 | Atlantoaxial subluxation | NA | NA |
Author (Year) | N | Treated Disease | N Complication XL- vs. NXL-Group (%) | ||
---|---|---|---|---|---|
All | Surgical Side Infection | Reoperation | |||
Scoliosis | |||||
Usmani et al. (2019) | 256 | Neurom. Scoliosis | 14 (16)/23 (14) | 11 (12)/13 (8) | 3 (3.2)/4 (2.5) |
Garg et al. (2015) | 500 | AIS | 21 (6)/9 (7) | 2 (0.5)/0 (0) | 4 (1.1)/(0) |
Chen et al. (2015) | 34 | Congenital scoliosis | NA | NA | NA |
Garg et al. (2014) | 100 | Neurom. Scoliosis | NA | NA | NA |
Dhawale et al. (2013) | 75 | AIS | 1 (4)/1 (2) | 1 (4)/0 (0) | 1 (4)/1 (2) |
Atlantoaxial Fusion | |||||
Wang et al. (2019) | 317 | Atlantoaxial dislocation and basilar invagination | 7 (4.7)/9 (5.4) | NA | NA |
Mizutani et al. (2018) | 35 | Atlantoaxial subluxation | NA | NA | NA |
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Heck, V.J.; Oikonomidis, S.; Prasse, T.; Meyer, C.; Scheyerer, M.J.; Wetsch, W.A.; Eysel, P.; Bredow, J. Does the Current State of Evidence Justify the Broad Use of Cross-Links in Dorsal Instrumentation? A Systematic Review. BioMed 2021, 1, 1-10. https://0-doi-org.brum.beds.ac.uk/10.3390/biomed1010001
Heck VJ, Oikonomidis S, Prasse T, Meyer C, Scheyerer MJ, Wetsch WA, Eysel P, Bredow J. Does the Current State of Evidence Justify the Broad Use of Cross-Links in Dorsal Instrumentation? A Systematic Review. BioMed. 2021; 1(1):1-10. https://0-doi-org.brum.beds.ac.uk/10.3390/biomed1010001
Chicago/Turabian StyleHeck, Vincent J., Stavros Oikonomidis, Tobias Prasse, Carolin Meyer, Max J. Scheyerer, Wolfgang A. Wetsch, Peer Eysel, and Jan Bredow. 2021. "Does the Current State of Evidence Justify the Broad Use of Cross-Links in Dorsal Instrumentation? A Systematic Review" BioMed 1, no. 1: 1-10. https://0-doi-org.brum.beds.ac.uk/10.3390/biomed1010001