Intramedullary Spine Disease

One of the most significant impacts of magnetic resonance (MRI) has been its ability to exquisitely depict normal and pathologic anatomy of the spine. This unit presents a that deals with intramedullary disease, i.e., that involving the cord. An is presented for cases of extramedullary‐intradural disease.Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/145323/1/cpmia0901.pd

Cervical spine disease in Asian populations

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Patient‑Reported Outcomes in Lumbar Spine Surgery

Introduction: Lumbar spine spondylosis is a significant cause of morbidity worldwide. Surgical treatment is increasingly being used inpatients who do not respond to conservative treatment. Although the outcome of these surgeries is subjective, patient‑oriented  questionnaires are considered to give a less biased assessment of surgical outcomes. The aim of this study was to use the Oswestry Disability Index (ODI) to assess the early outcome of lumbar spine surgery in patients with lumbar degenerative spine disease. Methodology: This was a retrospective study carried out over a period of one year, recruiting twenty patients who had lumbar spine surgeries (both instrumented and non‑instrumented surgeries) for degenerative lumbar spine disease. Results: The age range of the subjects was 40–80 years, with a mean age of 55.9 ± 9.2 years. A majority of the patients had lumbar disc prolapse (70%). There was a statistically significant correlation between preoperative ODI and postoperative ODI, with postoperative patients having a lower ODI score (which signifies improved outcome). Conclusion: Lumbar surgeries for degenerative lumbosacral spine disease lead to a high level of patient satisfaction

Tourniquetless Total Knee Arthroplasty With Modern Perioperative Protocols Decreases Pain and Opioid Consumption in Women

Background This study examined whether a modern total knee arthroplasty (TKA) protocol without a tourniquet results in less patient-reported pain and in-hospital opioid consumption compared to TKA with a tourniquet. Methods A retrospective study of 203 primary unilateral cemented TKAs consecutively performed with or without tourniquet was performed. Identical perioperative pain and blood loss protocols were used in all cases. In tourniquetless TKAs, the tourniquet was not inflated at any time, and sterile CO2 gas compression maximized cement interdigitation. Results After exclusions for scientific confounds, 184 TKAs (93 with tourniquet; 91 tourniquetless) were analyzed. Controlling for multiple covariates, females with a tourniquet reported significantly more pain (P = .002) and opioid consumption (P < .001) the first 24 hours after surgery compared to females without a tourniquet. There were no differences in pain (P = .192) or amount of opioids consumed (P = .203) among males with and without a tourniquet. Tourniquet use resulted in a significant reduction in blood loss for both females (P ≤ .040) and males (P ≤ .020), although the total blood savings of approximately 200 mL is of unknown clinical significance. Conclusion Avoiding tourniquet use during TKA for females may be a relatively risk-free adjunct to minimize opioid consumption during hospitalization. Further study is warranted to elucidate the factors accounting for different outcomes in females and males

A Systematic Review of the Current Role of Minimally Invasive Spine Surgery in the Management of Metastatic Spine Disease

Although increasingly aggressive decompression and resection methods have resulted in improved outcomes for patients with metastatic spine disease, these aggressive surgeries are not feasible for patients with numerous comorbid conditions. Such patients stand to benefit from management via minimally invasive spine surgery (MIS), given its association with decreased perioperative morbidity. We performed a systematic review of literature with the goal of evaluating the clinical efficacy and safety of MIS in the setting of metastatic spine disease. Results suggest that MIS is an efficacious means of achieving neurological improvement and alleviating pain. In addition, data suggests that MIS offers decreased blood loss, operative time, and complication rates in comparison to standard open spine surgery. However, due to the paucity of studies and low class of available evidence, the ability to draw comprehensive conclusions is limited. Future investigations should be conducted comparing standard surgery versus MIS in a prospective fashion

Static vs. Expandable PEEK Interbody Cages: A Comparison of One-Year Clinical and Radiographic Outcomes for One-Level TLIF

Introduction: Degenerative spine disease is a disabling condition affecting many worldwide. Transoforaminal lumbar interbody fusion (TLIF) procedures help stabilize the spine, while improving back and/or leg pain. With the introduction of new implant designs and modifications, focus has shifted to optimizing spinopelvic alignment, fusion rates, and more. This study aims to explore the effect of static versus expandable polyetheretherketone (PEEK) cages on patient-reported outcomes (PROMs) and radiographic outcomes (subsidence, disk height, and alignment parameters). Materials/Methods: A retrospective cohort study was conducted using a database of patients in a single, high volume academic center. Patient outcomes were obtained from charts and radiographic outcomes were measured using standing, lateral radiographs. Data were analyzed using mean sample t-tests or categorical chi-squared tests, and multiple linear regression where appropriate. Results: Our results showed improved Oswestry Disability Index (ODI) scores perioperatively in the expandable cage group compared to the static cage group at the three-month and one-year time periods. In addition, there were a significantly greater proportion of patients that reached minimal clinically important difference (MCID) in the expandable group compared to the static cage group. There were no significant changes in subsidence or alignment parameters between the two groups at the one-year time period. Conclusion: Overall, our results show that TLIF patients treated with expandable PEEK cages had significantly greater improvement in one-year outcomes compared to patients with static cages. Expandable cages confer the advantage of more precise insertion into the intervertebral disk space, while providing a way to tailor the cage height for better distraction and spinal alignment. Further prospective studies are warranted to get a better idea of the impact of interbody design on clinical/radiographic outcomes

Role of mTOR and VEGFR Inhibition in Prevention of Metastatic Tumor Growth in the Spine

Objective: Spinal metastatic disease remains a major problem of oncological diseases. Patients affectedmay suffer pain, spinal instability, and severe neurological deficits. Today, palliative surgery and radiotherapy are the mainstays of therapy. In contrast, preventive treatment strategies or treatment concepts for an early stage are lacking. Here, we have used a syngeneic, experimental spine metastases model in the mouse to test the efficacy of mTOR inhibition and anti-angiogenesis on the formation and progression of spinal melanoma metastases. Methods: We used our previously established syngeneic spinal metastases mouse model by injecting luciferin-transfected B16 melanoma cells into the common carotid artery. Following injection, mice were treated with everolimus, an inhibitor of the mammalian target of rapamycin (mTOR) complex, axitinib, a tyrosine kinase inhibitor, that blocks vascular endothelial growth factor receptors (VEGFR) 1-3, as well as placebo. Animals were followed-up daily by neurological assessment and by repeat in vivo bioluminescence imaging. With occurrence of neurological deficits, a spinal MRI was performed, and mice were sacrificed. The whole spine was dissected free and analyzed by immunohistochemical techniques. Results: Overall survival was 23 days in the control group, significantly prolonged to 30 days (p = 0.04) in the everolimus group, and to 28 days (p = 0.04) in the axitinib group. While 78% of mice in the placebo group developed symptomatic metastatic epidural spinal cord compression, only 50% did so in the treatment groups. The mean time to manifestation of paralysis was 22 days in the control group, 26 days (p = 0.10) in the everolimus group, and 27 days (p = 0.06) in the axitinib group. Screening for spinal metastases by bioluminescence imaging on two different time points showed a decrease in metastatic tumor formation in the treatment groups compared to the controls. Immunohistochemical analysis confirmed the bioactivity of the two compounds: The Ki67 proliferation labeling index was reduced in the everolimus group and numbers of CD31 positive endothelial cells were reduced in the axitinib group. Conclusion: Both, the mTOR inhibitor everolimus as well as antiangiogenetic effects by the VEGFR inhibitor axitinib showed potential to prevent and retard formation of symptomatic spinal metastases. However, the therapeutic efficacy was only mild in this experimental model