Research Appraisals
Evidence-based critical appraisals of the latest medical research, systematically evaluated using Oxford CEBM methodology.
Showing 4 appraisals
Child's nervous system : ChNS : official journal of the International Society for Pediatric Neurosurgery
Non-operative management of traumatic occipitocervical distraction injuries in children: a systematic review
PURPOSE: Existing guidelines for the management of atlanto-occipital dislocation (AOD) recommend occipitocervical fusion (OCF) for these low frequency, high-consequence injuries. Recent literature has questioned this guidance and provided case examples of successful non-operative management of a more inclusive and broadly defined spectrum of injuries to the occipitocervical junction (OCJ) termed occipitocervical distraction injuries (OCDI). A systematic review of existing literature on this topic would inform efforts to investigate the safety and efficacy of non-operative management of these injuries. METHODS: We performed a systematic review based on preferred reporting items for systematic reviews (PRISMA) guidelines of English language publications to define and map literature related to non-operative management of pediatric traumatic OCDI. RESULTS: We identified 40 patients in 21 manuscripts meeting defined inclusion and exclusion criteria. 82.5% of patients were successfully managed with non-operative management alone. No patient declined neurologically during orthotic treatment or in relation to crossover to surgical management through a minimum of 3-month follow-up. CONCLUSIONS: This review supports the contention that non-operative management is both safe and effective in the management of OCDI. Further research to develop standardized diagnostic and treatment protocols for non-operative management of OCDI through registries and multi-center research efforts is needed.
31 July 2026
Read appraisal →Spine
Differentiating Spinal Deformity Versus Leg Length Discrepancy in Patients With Pelvic Obliquity : Systematic Review of Diagnostic Methods, Imaging, and Clinical Management
STUDY DESIGN: Systematic review, PROSPERO ID: (CRD42023112392). OBJECTIVE: We aim to provide physicians with an evidence-based stepwise approach to distinguishing the primary cause of plane pelvic obliquity (PO) to guide treatment. SUMMARY OF BACKGROUND DATA: PO is a frequent clinical finding in both spinal deformity (SD) and leg length discrepancy (LLD) but distinguishing between these etiologies remains challenging due to overlapping clinical and radiographic features and potential multifactorial origins. Misdiagnosis may delay care and worsen patient outcomes. MATERIALS AND METHODS: PubMed, Embase, Scopus, and Web of Science were searched from inception to July 2025 for English-language studies evaluating coronal PO in the context of LLD and/or SD that explicitly compared or differentiated limb-origin from spine-origin obliquity using radiographic, advanced imaging, or validated clinical assessments and reported diagnostic accuracy, discriminative features, or management impact. Two reviewers independently screened studies, extracted data, and performed ROBINS-I risk assessment and Newcastle-Ottawa Scale quality assessment. Owing to marked heterogeneity in populations, measurement protocols, and thresholds, findings were synthesized qualitatively with stratification by age group where possible. RESULTS: Of 436 records, 24 cohort studies met the inclusion criteria. Standing anteroposterior (AP) radiographs reliably quantified both LLD and PO, while advanced imaging provided high reproducibility for subtle or ambiguous cases. Radiographic block or shoe lift correction tests distinguished limb-origin and spine-origin PO through immediate postural correction. Key discriminators included a lumbar curve or PO resolving with block/lift correction suggesting LLD, versus persistent deformity despite correction suggesting spinal etiology. Difficulty remains in diagnosing and treating mixed etiology patients. CONCLUSION: Accurate differentiation of spinal versus limb-driven PO begins with a structured diagnostic approach. AP radiographs, followed by functional block tests, and advanced imaging, may increase diagnostic confidence and decrease unnecessary interventions. Particularly in patients with both LLD and coronal plane SD, prospective studies are required to standardize measurement protocols and improve long-term outcomes. LEVEL OF EVIDENCE: Level IV.
16 June 2026
Read appraisal →Stem cells (Dayton, Ohio)
Quiescence in the resting zone of the growth plate: a systematic review
Postnatal skeletal growth in childhood and adolescence depends on cartilage organs called (epiphyseal) growth plates. Studies in the last decade have identified populations of skeletal stem cells within mouse growth plates' resting zones. While cellular quiescence is vital for the maintenance of many tissue-resident stem cell populations, the resting zone chondrocytes have been labeled "quiescent" for decades. However, the features of cellular quiescence that have been reported in the postnatal resting zone, how they were defined or experimentally assessed, and knowledge gaps relative to other quiescent cell types, remain to be well described. To address this, we conducted a systematic review, using the PRISMA guidelines, to identify studies of resting zone chondrocytes including the prefix "quiescen*." Definitions, keywords, chronological data and experimental findings were extracted. Our analysis demonstrated that, compared to those in other well-studied tissues, features of cellular quiescence in RZ chondrocytes remain poorly reported and underexplored, with limited molecular and functional characterization. Furthermore, while most identified studies reported changes in cell division parameters, integration between cues controlling resting zone cell quiescence is incomplete and heterogeneity among the various sub-populations of RZ cells/potential quiescent states is yet to be fully determined. This review identifies consensuses and knowledge gaps between studies and between quiescent RZ cells and those in other tissues and can act to enhance consistency and comparability in future studies of "quiescence" in the RZ chondrocytes.
30 Apr 2026
Read appraisal →European journal of orthopaedic surgery & traumatology : orthopedie traumatologie
Radiological and surgical outcomes after graduation to posterior spinal fusion surgery following magnetically controlled growing rod treatment for early-onset scoliosis: a systematic review and single-arm meta-analysis
PURPOSE: Early-onset scoliosis (EOS) is a challenging condition for spinal surgeons. Growing rods represent the standard treatment for patients requiring surgery, and magnetically controlled growing rods (MCGR) are increasingly adopted. Many patients ultimately transition to posterior spinal fusion (PSF), although the necessity of definitive fusion remains debated. This systematic review and single-arm meta-analysis aimed to evaluate radiographic and surgical outcomes of PSF following MCGR treatment. METHODS: A systematic literature search was conducted in PubMed, Google Scholar, Medline, Scopus, Embase, and the Cochrane Library up to April 2025, following PRISMA guidelines. Eligible studies were identified using a PIO (Population, Intervention, Outcome) framework. Extracted data included demographic, radiographic, and surgical outcomes, including complications. A single-arm meta-analysis compared pre- and post-PSF radiographic parameters (main curve magnitude, thoracic kyphosis (TK), T1-T12 and T1-S1 lengths). Risk of bias was assessed using the MINORS tool. RESULTS: Eight retrospective studies were included (370 patients), of which six were eligible for quantitative synthesis. The meta-analysis demonstrated significant improvements in all radiographic parameters (main curve magnitude, TK, T1-T12 and T1-S1 lengths, p < 0.05). The pooled overall postoperative complication rate after PSF was 17.2%. CONCLUSIONS: PSF appears to be a viable treatment option following MCGR, providing significant deformity correction with a relatively acceptable complication rate. Nevertheless, the current evidence is limited by small, retrospective cohorts. Larger, prospective studies with standardized reporting of surgical variables and clinical outcomes are needed to better define the role of final fusion and to optimize treatment protocols.
4 Apr 2026
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