Most Influential Literature in Spinal Tuberculosis: A Global Disease Without Global Evidence

A comparison of anterior reconstruction of spinal defect using nano-hydroxyapatite/polyamide 66 cage and autologous iliac bone for thoracolumbar tuberculosis: a stepwise propensity score matching analysis

Purpose

Previous studies have confirmed the advantages and disadvantages of autogenous iliac bone and nano-hydroxyapatite/polyamide 66 (n-HA/PA66) cage. However, there is no conclusive comparison between the efficacy of the two implant materials in spinal tuberculosis bone graft fusion. The aim of this study was to analyze the mid-to long-term clinical and radiologic outcomes between n-HA/PA66 cage and autogenous iliac bone for anterior reconstruction application of spinal defect for thoracolumbar tuberculosis.

Methods

We retrospectively reviewed all patients who underwent anterior debridement and strut graft with n-HA/PA66 cage or iliac bone combined with anterior instrumentations between June 2009 and June 2014. One-to-one nearest-neighbor propensity score matching (PSM) was used to match patients who underwent n-HA/PA66 cage to those who underwent iliac bone. Clinical outcomes were assessed using the Japanese Orthopaedic Association (JOA) and visual analogue score (VAS). Radiographic evaluations included cage subsidence and segmental angle.

Results

At the end of the PSM analysis, 16 patients from n-HA/PA66 cage group were matched to 16 patients in Iliac bone group. The C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR) values in the n-HA/PA66 group decreased significantly from 33.19 ± 10.89 and 46.63 ± 15.65 preoperatively, to 6.56 ± 2.48 and 9.31 ± 3.34 at the final follow-up, respectively (p < 0.001). There were no significant differences in the CRP and ESR values between the two groups at the final follow-up. The VAS and JOA scores in the iliac bone and n-HA/PA66 group were significantly improved at the 3-month follow-up postoperatively (both p < 0.001). Then, improvements of VAS and JOA scores continue long at final follow-up. However, there were no significant differences in the VAS and JOA scores at any time point between the two groups (p > 0.05). Although the segmental angle (SA) significantly increased after surgery in both groups, there was no significant difference at any time point after surgery (p > 0.05). There were no significant differences in the cage subsidence and fusion time between the two groups.

Conclusion

Overall, our data suggest that the n-HA/PA66 cage outcomes are comparable to those in the autogenous iliac bone, with a similar high fusion rate as autogenous iliac bone.

Global research trends in central nervous system tuberculosis - A bibliometric analysis

Background

Central Nervous System Tuberculosis (CNS-TB) is a serious public health concern causing significant morbidity and mortality, especially in high TB burden countries. Despite the expanding research landscape of CNS-TB, there is no comprehensive map of this field. This work aims to (1) obtain a current and comprehensive overview of the CNS-TB research landscape, (2) investigate the intellectual and social structure of CNS-TB publications, and (3) detect geographical discrepancies in scientific production, highlighting regions requiring increased research focus.

Methods

We conducted a bibliometric analysis on CNS-TB literature indexed in Web of Science from 2000 to 2022, evaluating 2130 articles. The dataset was analyzed in R for descriptive statistics. We used R-bibliometrix and VOSViewer for data visualization.

Findings

Publication output grew annually at an average rate of 6·88%, driven primarily by India and China. International collaborations comprised 16·44% of total publications but contributed to 11 of the 15 top-cited papers. Additionally, we identified discrepancies of CNS-TB research in many low- and middleincome countries relative to their TB incidence.

Interpretation

Our findings reveal a growing interest in CNS-TB research from China and India, countries with rapidly developing economies, high TB burdens, and a recent increase in research funding. Furthermore, we found that international collaborations are correlated with high impact and accessibility of CNS-TB research. Finally, we identified disparities in CNS-TB research in specific countries, particularly in many low- and middle-income countries, emphasizing the need for increased research focus in these regions.

Bibliometric analysis of the top 100 most-cited articles on the treatment of osteoporosis

PURPOSE

To perform a bibliometric analysis of the top 100 (T100) most-cited articles on the treatment of osteoporosis published between 1980 and 2021 to reveal major developments and trends in the field and to contribute to the methodologies and hypotheses of future studies.

METHODS

On 15.12.2021, a search was conducted on the Web of Science database using the keyword "osteoporosis treatment" to screen articles published between 1980 and 2021. The title of the article, year of publication, total number and names of the authors, total number of citations and citation index, name and Q index of the journals, H-index, impact factor, country of authors, types of articles, and sources of funding were recorded.

RESULTS

The most-cited article was "Osteoporosis Prevention, Diagnosis, And Therapy." The article with the highest citation index was "Clinician's Guide to Prevention and Treatment of Osteoporosis.. The majority of the articles were randomized controlled clinical trials. The journal with the highest number of articles included in the T100 was The New England Journal of Medicine, with 19 articles. The USA had the highest number of articles. There was a strong correlation between the number of citations and citation index of articles (p < 0.001).

CONCLUSIONS

This study, which examined the T100 most-cited articles on the treatment of osteoporosis, found that the articles primarily focused on the prevention, diagnosis, and follow-up of osteoporosis; search for antiresorptive and anabolic pharmacological agents; investigation of the efficacy and reliability of these agents on specific subpopulations; and surgical treatment options.

A Bibliometric Analysis of Fragility Fractures: Top 50

Background and Objectives: The population is aging and fragility fractures are a research topic of steadily growing importance. Therefore, a systematic bibliometric review was performed to identify the 50 most cited articles in the field of fragility fractures analyzing their qualities and characteristics. Materials and Methods: From the Core Collection database in the Thomson Reuters Web of Knowledge, the most influential original articles with reference to fragility fractures were identified in February 2021 using a multistep approach. Year of publication, total number of citations, average number of citations per year since year of publication, affiliation of first and senior author, geographic origin of study population, keywords, and level of evidence were of interest. Results: Articles were published in 26 different journals between 1997 and 2020. The number of total citations per article ranged from 12 to 129 citations. In the majority of publications, orthopedic surgeons and traumatologists (66%) accounted for the first authorship, articles mostly originated from Europe (58%) and the keyword mostly used was “hip fracture”. In total, 38% of the articles were therapeutic studies level III followed by prognostic studies level I. Only two therapeutic studies with level I could be identified. Conclusions: This bibliometric review shows the growing interest in fragility fractures and raises awareness that more high quality and interdisciplinary studies are needed.

The 100 Most-Cited Publications in Endoscopic Spine Surgery Research

STUDY DESIGN

A bibliometric review of the literature.

OBJECTIVE

Our objective was to identify and analyze the 100 most-cited publications in the field of endoscopic spine surgery (ESS).

METHODS

In order to determine the top cited 100 articles, a 3-step approach was employed. First, the 100 most-cited ESS studies were identified using the key phrase "endoscopic spine surgery." Then, 8 keywords were identified from the 100 studies of step 1 were used to conduct a second round searching in all databases of the Web of Science. Finally, when the results of the first and second steps were overlapped, duplicated studies were removed. The 100 top-cited articles were used for further analysis.

RESULTS

The citation number of the top 100 most-cited articles ranged from 44 to 236 with a mean value of 84.4. The most productive periods were from 2001 to 2010. The majority of publications came from Spine and Neurosurgery, where Spine holds the largest number of 35 articles, followed by Neurosurgery with 13 articles. Overall, 10 countries contributed to the 100 articles, with the most productive country being the United States, followed by Germany and Korea.

CONCLUSION

This bibliometric study is meant to produce a list of intellectual milestones in the field of ESS. This article's identification of the most influential articles in the field of ESS gives us a unique and comprehensive insight into the development of ESS in the past several decades.

Midterm surgical results of the lamina with spinous process in treating one-level thoracic or lumbar tuberculosis: a retrospective study

A retrospective study investigated the results of the lamina with spinous process (LSP) as a bone graft in one-level thoracic or lumbar spinal tuberculosis with the one-stage posterior approach of debridement, fusion and internal instrumentation. Data from 35 patients from January 2013 to December 2015 were analysed. Surgery time, blood loss, hospitalization time, drainage volume, and follow-up (FU) duration were recorded. The visual analogue scale (VAS), Oswestry Disability Index (ODI), erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), American Spinal Injury Association (ASIA) grade, segmental angle, and bone fusion were compared between preoperative and final FU. All of the patients were followed up for a mean 43.90 ± 10.39 months. The mean age, surgery time, blood loss, hospitalization time, hospital cost and drainage volume were 33.65 ± 11.06 years, 182.40 ± 23.82 min, 280.80 ± 76.82 mL, 14.05 ± 3.58 days, 74,382.00 ± 11,938.00 yuan, and 340.00 ± 167.20 mL, respectively. VAS and ODI were significantly improved at the final FU. The ESR and CRP recovered to normal. The mean angle of 24.35 ± 5.74°preoperatively showed a significant difference between 1 week, postoperatively and final FU. Although there were the loss of angle at final FU comparing with the 1 week postoperatively, it still maintain the good alignment and the segmental stability. All patients achieved bony fusion with a mean time of 12.90 ± 3.91 months. In conclusion, the LSP as a structural bone graft is reliable, safe and effective for segmental stability reconstruction, which could be one choice for surgical management of thoracic or lumbar spinal TB.

Trending Literature in Spinal Tuberculosis: Bibliographic Analysis of Top 250 Cited Articles

BACKGROUND

This bibliographic analysis aims to identify the top 250 cited articles on spinal tuberculosis (TB) and report on their impact on the spinal field.

METHODS

All databases included in the Thomson Reuters Web of Science were searched for publications on spinal TB. The most cited articles published between 1950 and 2019, with the main focus on orthopaedic surgery, were identified using a multistep approach, and a total of 250 articles were included and analyzed for title, year of publication, total citations, citations in 2019, citation density, article age, journal, first author, senior author, geographic origin, and level of evidence.

RESULTS

The number of citations ranged from 31 to 257, with an average of 65.38. Studies were published from 31 different countries and published in 83 different journals. The top 3 countries, India, United States, and China published a total of 57.8% (n = 145) of all articles. Indian and Chinese researchers seem to be the most resourceful, as 17 of the 31 (54.8%) prospective studies were conducted by them. African centers produced only 3.2% (n = 8) of all included articles. Only 3.2% (n = 8) were of Level 1 evidence on the subject. A total of 37.8% (n = 95) were on diagnosis, while 46.6% (n = 117) dealt with surgery, and only 15.1% (n = 38) were about conservative management. Anil K Jain followed by S Rajasekaran were the most published authors on the subject.

CONCLUSIONS

Indian and Chinese researchers dominate evidence in spinal TB. Regions with high disease burden, such as Africa, do not contribute their data to the literature. Though these are the top cited articles in the subject, their level of evidence needs improvement for better impact of their results.

Transverse process strut and titanium mesh cages in the stability reconstruction of thoracic single segment tuberculosis: a retrospective single-center cohort study

BACKGROUND

A retrospective and comparative study of transverse process strut (TPS, Group A) compared with titanium mesh cages (TMCs, Group B) in the reconstruction of thoracic stability through the one-stage posterior approach to treat single-segment tuberculosis.

METHODS

Sixty patients from January 2013 to December 2016 were analyzed and divided into two groups. The following data of clinical and radiographical assessments were observed preoperatively, postoperatively and during follow-up (FU).

RESULTS

The patients were followed up for an average of 50.20 ± 25.10 months (Group A) and 48.70 ± 27.30 months(Group B) without significant difference. No significant differences were found in the mean of operation time in minutes, blood loss, hospitalization time, drainage and follow-up duration between the groups. The VAS, ODI, ESR and CRP were reduced significantly at the final FU compared with the preoperation values and there was no significance between the groups. Neurological deficits were improved in all patients at the final FU without significant difference between the groups(P > 0.05). The bony fusion times were 5.85 ± 1.82 months and 8.4 ± 5.1 months with significant difference(P < 0.05). Comparing with the preoperative values, the kyphosis angle significantly improved, but at the final FU the significant difference was found between the groups (P < 0.05). The loss of the angular correction and the fused segmental height in group A was lower than that in group B (P < 0.05).

CONCLUSIONS

TPS had a better osseous fusion rate, effective maintenance of fused segment stability which is a good bone graft for surgical management of single-segment thoracic spinal tuberculosis.

One-stage posterior debridement with transverse process strut as bone graft in the surgical treatment of single-segment thoracic tuberculosis: A retrospective single-center study

This retrospective study investigated the effect of the novel bone graft transverse process strut (TPS) in single segmental thoracic spinal tuberculosis (TB) with the one-stage posterior approach of debridement, fusion, and internal instrumentation. Thirty patients treated in our department from March 2014 to October 2016 were retrospectively analyzed. Surgical time, blood loss, hospitalization time, drainage volume, and follow-up (FU) duration were recorded. The visual analog scale (VAS), Oswestry Disability Index (ODI), erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), American Spinal Injury Association (ASIA) grade, segmental angle, and bone fusion were compared between preoperative and final FU. All the patients were followed for a mean 50.10 ± 25.10 months; the mean age, surgical time in minutes, blood loss, hospitalization time, and drainage volume were 46.23 ± 17.20 years, 195.08 ± 24.0 minutes, 280.77 ± 189.90 mL, 17.31 ± 4.23 days, 436.92 ± 193.81 mL, respectively. VAS and ODI scores were significantly improved at the final FU. The ESR and CRP returned to normal. All patients achieved bony fusion with a mean time of 5.85 ± 1.82 months and a mean segmental angle of 18.77 ± 2.49° preoperatively, which significantly decreased to 9.31 ± 1.54° at the final FU (P < .05). No complications, such as bone graft failure, pleural effusion, fistula, or wound infection were recorded except for cerebrospinal fluid leakage (one case), water electrolyte imbalance (5 cases), superficial infection (1 case), and mild intestinal obstruction (1 case). TPS as a bone graft is reliable, safe, and effective for segmental stability reconstruction for surgical management of single-segment thoracic spinal TB.

Child and adult spinal tuberculosis at tertiary hospitals in the Western Cape, South Africa: 4-year burden and trend

The aim of this retrospective review was to assess the overall burden and trend in spinal tuberculosis (TB) at tertiary hospitals in the Western Cape Province of South Africa. All spinal TB cases seen at the province's three tertiary hospitals between 2012 and 2015 were identified and clinical records of each case assessed. Cases were subsequently classified as bacteriologically confirmed or clinically diagnosed and reported with accompanying clinical and demographic information. Odds ratios (OR) for severe spinal disease and corrective surgery in child vs. adult cases were calculated. A total of 393 cases were identified (319 adults, 74 children), of which 283 (72%) were bacteriologically confirmed. Adult cases decreased year-on-year (P = 0.04), however there was no clear trend in child cases. Kyphosis was present in 60/74 (81%) children and 243/315 (77%) adults with available imaging. Corrective spinal surgery was performed in 35/74 (47%) children and 80/319 (25%) adults (OR 2.7, 95% confidence interval 1.6-4.5, P = 0.0003). These findings suggest that Western Cape tertiary hospitals have experienced a substantial burden of spinal TB cases in recent years with a high proportion of severe presentation, particularly among children. Spinal TB remains a public health concern with increased vigilance required for earlier diagnosis, especially of child cases.