To perform a narrative review of the biomechanics of lumbar pedicle subtraction osteotomies (L-PSO) and associated surgical constructs. A non-systematic literature search was performed. PubMed was queried for investigations published between 2010 and 2025 with the following search terms: “lumbar”, “PSO”, “biomechanics, “finite element analysis”, “cadaver”. Studies evaluating biomechanical properties of L-PSO (L1-L5) constructs were included. Clinical studies and non-lumbar level (cervical/thoracic) PSOs were excluded. L-PSOs create a highly destabilized environment, particularly in axial rotation. Two-rod constructs significantly reduce range of motion (ROM) relative to the uninstrumented spine but are associated with high rod stresses. Multi-rod constructs (satellite and accessory rods) consistently reduce ROM and primary rod stresses, although the magnitude of benefit varies across studies and configurations. Rod material (cobalt chrome) and increased rod diameter further enhance construct rigidity but may increase stress shielding. Cross-links may increase rod stress when placed near a L-PSO site, while monoaxial screws increase construct stiffness compared to polyaxial screws. Interbody cages placed adjacent to L-PSOs improve load sharing and reduce posterior rod strains, particularly when used in a “sandwich” configuration. Biomechanical improvements, such as reduced rod strain and ROM, have not been directly linked to clinical outcomes, including fusion rates or rod fractures. While biomechanical studies demonstrate multi-rod constructs and adjunct techniques improve construct stability, the relationship between these biomechanical advantages and clinical outcomes, including osseous healing and rod fractures, remains unclear. In L-PSOs, increasing construct rigidity alone is not the primary goal; instead, optimal load sharing across the osteotomy site is a critical biomechanical consideration. As such, future work should focus on elucidating the optimal balance between protecting posterior instrumentation through construct rigidity and preserving adequate compressive forces across L-PSOs, integrating biomechanical findings with clinical data, and developing patient-specific biomechanical modeling to further refine L-PSO instrumentation techniques.
OBJECTIVE:To evaluate the prevalence and predictors of no residual disease on wide local excision (WLE) specimens in patients with shave biopsy-confirmed head and neck basal cell carcinoma (BCC). STUDY DESIGN:Retrospective cohort study of patients in an integrated healthcare system referred from dermatology to otolaryngology-head and neck surgery. SETTING:Otolaryngology-head and neck surgery clinic. METHODS:We reviewed medical records of adults with shave biopsy-confirmed BCC referred for WLE between January 2022 and December 2023. Data included patient demographics, comorbidities, histologic subtype, and timing of excision. Bivariate and multivariate analyses assessed associations with residual disease status on final pathology. RESULTS:Among 243 cases, 66 (27.2%) WLE specimens had no residual tumor found on pathologic analysis. Patients with no residual disease were younger on average compared to those with residual cancer (65.4 ± 14.2 years vs 72.6 ± 13.0 years, P < .001). Of the 97 female patients, 39 (40.2%) had no residual disease and female sex was independently associated with no residual disease (odds ratio 3.398, 95% confidence interval 1.80-6.42, P < .001). Histologic subtype, diabetes, transplant history, and prior radiation showed no significant associations. CONCLUSION:Over one-quarter of patients had no residual tumor at excision, particularly younger individuals and women. These findings underscore the value of individualized risk assessment during preoperative counseling, especially for elderly or frail patients and those with lesions in cosmetically sensitive regions. Predictive models incorporating patient-level factors may help reduce overtreatment and improve decision-making in BCC management.
(1) Background: Large diaphragmatic defects following thoracic oncologic resection often require mesh reconstruction. Data regarding biologic mesh for this application remain limited. We evaluated clinical outcomes and durability of Strattice™, a non-cross-linked porcine acellular dermal matrix, for diaphragmatic reconstruction. (2) Methods: In this single-center, retrospective cohort study without a synthetic mesh comparator, we reviewed health records of 65 adults who underwent diaphragmatic reconstruction with Strattice™ mesh at a high-volume thoracic surgery center between 2014 and 2024. (3) Results: Mean hospital length of stay was 13.2 days. Atrial fibrillation was the most common post-operative complication, occurring in 44.6% of the patients. No diaphragmatic reconstruction recurrence or mesh replacement was observed during the available follow-up. (4) Conclusions: No reconstruction recurrence or mesh replacement was identified during the available follow-up, and wound infection was rare, supporting the feasibility of Strattice™ mesh for diaphragmatic reconstruction in this single-center cohort study. Strattice™ provided durable diaphragmatic reconstruction with a low observed wound infection rate and no identified reconstruction failure, supporting its feasibility for complex thoracic oncologic reconstruction.
BACKGROUND:Clinical guidelines recommend treating acute heart failure with intravenous diuretic agents at 1 to 2.5 times the equivalent daily oral loop diuretic dose, although emergency department (ED) outcome data are limited. OBJECTIVES:This study aimed to assess the association between initial ED diuretic dose and hospital admission or acute kidney injury (AKI) at 48 hours and, secondarily, persistent AKI at hospital discharge. METHODS:A retrospective cohort study of adult patients with acute heart failure receiving intravenous diuretic agents from January 1, 2023, to December 31, 2024, across 21 EDs was conducted. Patients were categorized as receiving low (<1× daily outpatient diuretic dose), medium (1-2× daily dose), or high (≥2× daily dose) diuretic dosing, relative to the bioequivalent oral home dose. The authors used inverse propensity treatment weights to balance treatment groups and report risk differences. RESULTS:This study included 14,983 ED encounters. The median age was 79 years; 7,664 (51.2%) patients were women; and 5,436 (36.3%), 5,329 (35.6%), and 4,218 (28.2%) received a low, medium, and high dose, respectively. Compared with the low-dose group, hospital admission was lower in both the medium- and high-dose groups (risk difference: -2.6%; 95% CI: -4.4% to -0.9% and -1.2%; 95% CI: -3.1% to -0.7%, respectively). Although shorter-term AKI was higher at 48 hours in the high-dose group (2.9%; 95% CI: 1.4%-4.5%), there were no significant differences in persistent AKI at hospital discharge in the higher-dose groups. CONCLUSIONS:Use of higher-dose diuretic agents was associated with lower hospital admissions without evidence of persistent AKI. Future studies should explore adherence to guideline-recommended diuretic dosing.
