Systematic review and meta-analysis of en bloc vertebrectomy compared with intralesional resection for giant cell tumors of the mobile spine

Study Design Systematic review and meta-analysis. Objective To compare the recurrence and perioperative complication rate of en bloc vertebrectomy (EV) and intralesional resection (IR) in the giant cell tumor of the mobile spine (SGCT). Methods We systematically searched publications in the PubMed and Embase databases for reports of SGCTs, excluding the sacrum. Two reviewers independently assessed all publications. A meta-analysis was performed using local recurrence and postoperative complications as the primary outcomes of interest. Results There were four articles reporting recurrence and two articles reporting postoperative complications. All included articles were case series. In all, 91 patients were included; 49 were treated with IR and 42 were treated with EV. Local recurrence rates were 36.7 and 9.5% in the IR and EV groups, respectively. Rates of postoperative complications were 36.4% with IR and 11.1% with EV. Overall, patients treated with EV not only had a lower recurrence rate (relative risk [RR] 0.22; 95% confidence interval [CI] 0.09 to 0.52) but also had a lower postoperative complication rate (RR 0.34; 95% CI 0.07 to 1.52) compared with IR. Conclusions Based on the limited data obtained from systematic review, SGCT patients treated with EV had a lower recurrence rate and fewer postoperative complications than those treated with IR

The Efficacy of a Posterior Approach to Surgical Correction for Neglected Idiopathic Scoliosis: A Comparative Analysis According to Health-Related Quality of Life, Pulmonary Function, Back Pain and Sexual Function

Background: This study aimed to evaluate the treatment outcomes of severe idiopathic scoliosis (IS) and hypothesized that surgical treatment would have a superior impact on the health-related quality of life (HRQoL), pulmonary function (PF), back pain, and sexual function. Methods: We retrospectively reviewed 195 consecutive patients with IS classified into severe (SG) and moderate groups (MG) with a minimum follow-up of two years. Results: The mean preoperative curve was 131° and 60° in the SG and MG, respectively. The mean preoperative flexibility in the bending films averaged between 22% in the SG and 41% in the MG. After definitive surgery, the main curve was corrected to 61° and 18° in the SG and MG, respectively. The mean preoperative thoracic kyphosis was 83° in the SG and 25° in the MG, which was corrected to 35° in the SG and 25° in the MG. At baseline, the percentage of predicted lung volume (FVC) was significantly lower in the SG than that in the MG (51.2% vs. 83%). The baseline percentage of the predicted FEV1 values was also significantly lower in the SG than in the MG (60.8% vs. 77%). During the two-year follow-up, the percentage of predicted FVC showed significant improvement in the SG (69.9%) (p < 0.001), and the percentage of predicted FEV1 values during the follow-up improved significantly in the SG (76.9%) (p < 0.001) compared with the MG (81%), with no statistical difference observed during the two-year follow-up. The SRS-22r showed a clinically and statistically significant improvement in the preoperative results to those of the final follow-up (p < 0.001). Conclusions: Surgical treatment of severe scoliosis can be safe. It provided a mean correction of the deformity for 59% of patients and significantly improved respiratory function, with the percentage of predicted forced expiratory volume in 1 s improving by 60% and the forced vital capacity improving by 50%, resulting in clinically and statistically significant improvements in the SRS-22r, HRQoL outcome scores, and back pain (reduced from 36% to 8%), as well as improved sexual function. The planned surgical treatment can achieve a very significant deformity correction with a minimal risk of complications. The surgical treatment has a superior impact on the quality of life patients with severe spinal deformities and significantly improves function in every sphere of life

Utilization trends of pedicle subtraction osteotomies compared to posterior spinal fusion for deformity: A national database analysis between 2008–2011

BACKGROUND: Increased awareness regarding the importance of the sagittal spinal profile has led to more aggressive correction of sagittal malalignment. The utilization trends of pedicle subtraction osteotomy (PSO) for sagittal plane correction in spinal deformity surgery have not been well characterized. METHODS: A commercially available database (PearlDiver, Inc) was queried for both Private Payor and 5 % Medicare claims from 2008 to 2011. Revision and clarification of the coding guidelines for PSO were introduced in 2008. Patients who had a thoracic and/or lumbar PSO were identified using CPT codes (22206-22208). In order to appropriately interpret trends in PSO use, three comparison groups were identified. Patients who had a diagnosis of adult spine deformity were identified using ICD-9 codes. Patients who had fusion for spine deformity or posterior spine fusion were identified using CPT codes. Differences in annual utilization and demographics between these four groups were then compared. RESULTS: From the Private Payor database, 199 PSOs were identified with the number of PSOs increasing from 33 in 2008, to 61 in 2011, representing a 185 % increase. From the Medicare data, 102 PSOs were identified, increasing from 13 in 2008 to 32 in 2011, a 246 % increase. In contrast, from both databases, there was minimal to no increase in the incidence of adult spine deformity, fusion for spine deformity or posterior spine fusion over the study time interval. CONCLUSION: Over the study time interval, there was up to a 3.2-fold increase in the utilization of PSOs while the diagnosis of adult spine deformity, fusion for spine deformity and posterior spine fusions had minimal to no increase