OKOJ, Volume 14, No. 1

Tips and Tricks to Improve Outcomes in Anatomic Total Shoulder Arthroplasty

Replacement of the glenohumeral joint with an anatomic prosthesis has the potential to provide pain relief, satisfactory function, and a durable reconstruction in the treatment of various shoulder conditions. However, a number of technical aspects of this procedure, if performed improperly, may lead to a poor clinical result, complications, or mechanical implant failure. Appropriate patient selection, a clear understanding of various implant features, adequate surgical exposure, meticulous bone preparation, balancing of the soft tissues, and postoperative management tailored to the patient are key elements to obtaining the best possible outcome in anatomic shoulder arthroplasty. For most surgeons, glenoid exposure, preparation, and implantation are the most demanding portions of the procedure. Obtaining adequate soft-tissue balance at the conclusion of the procedure is straightforward in some shoulders, but can be extremely difficult to achieve in others. This review summarizes a variety of tips and tricks learned or developed over time to help optimize outcomes when performing anatomic total shoulder arthroplasty.

    • Keywords:
    • shoulder arthroplasty

    • glenoid

    • surgical technique

    • Subspecialty:
    • Shoulder and Elbow

Cervical Laminoplasty: Technique Update

Laminoplasty is a versatile, nonfusion procedure for posterior decompression of the spinal cord. It can be used to treat myelopathy and myeloradiculopathy caused by multilevel cervical stenosis by expanding the area available for the spinal cord. It is appropriate for the treatment of myelopathy and myeloradiculopathy resulting from spondylotic and congenital cervical stenosis and cervical stenosis resulting from ossification of the posterior longitudinal ligament. With particular attention to detail regarding indications for surgery, dissection, soft-tissue handling, and adequate decompression of central and foraminal stenosis, laminoplasty can yield excellent results.

    • Keywords:
    • laminoplasty

    • laminectomy

    • spinal stenosis

    • myelopathy

    • myeloradiculopathy

    • Subspecialty:
    • Spine

Current Controversies in Minimally Invasive Versus Open Transforaminal Lumbar Interbody Fusion

Transforaminal lumbar interbody fusion (TLIF) is an effective tool for correcting foraminal pathology, allowing both direct and indirect decompression of spinal stenosis and the visualization of far-lateral osteophytes. However, significant controversy exists regarding the utility and efficacy of the minimally invasive surgical (MIS) approach for TLIF compared with open TLIF techniques. Critical review of the available literature suggests that the MIS TLIF procedure compares favorably with the open approach, with demonstrated improvements in short-term clinical outcomes and reduced costs with MIS TLIF, and largely similar rates of fusion and complication between the two approaches. However, implementation of MIS TLIF is associated with a significant surgeon learning curve. Ultimately, the decision to implement MIS TLIF depends on the surgeon, and requires an investment in time and resources to learn and perfect it, so as to minimize complications and maximize clinical and functional outcomes.

    • Keywords:
    • minimally invasive spine surgery

    • TLIF

    • PLIF

    • spinal fusion

    • spinal stenosis

    • spondylolisthesis

    • lumbar fusion

    • Subspecialty:
    • Spine