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

Everyday cosmopolitanism in representations of Europe among young Romanians in Britain

The paper presents an analysis of everyday cosmopolitanism in constructions of Europe among young Romanian nationals living in Britain. Adopting a social representations approach, cosmopolitanism is understood as a cultural symbolic resource that is part of everyday knowledge. Through a discursively-oriented analysis of focus group data, we explore the ways in which notions of cosmopolitanism intersect with images of Europeanness in the accounts of participants. We show that, for our participants, representations of Europe are anchored in an Orientalist schema of West-vs.-East, whereby the West is seen as epitomising European values of modernity and progress, while the East is seen as backward and traditional. Our findings further show that representations of cosmopolitanism reinforce this East/West dichotomy, within a discourse of ‘Occidental cosmopolitanism’. The paper concludes with a critical discussion of the diverse and complex ideological foundations of these constructions of European cosmopolitanism and their implications

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

The incidence of bifid c7 spinous processes

For posterior cervical surgery, if the operation only involves the lower cervical area, counting from C2 is impractical and the level may not be visible on X-rays. In such cases, we usually place a marker at the top of the incision and also rely on the size and monofid shape of the C7 spinous process. Relying on the C7 morphology, however, we initially instrumented the wrong levels in a case where the patient had a bifid C7 spinous process. We therefore sought to determine the frequency of bifid cervicothoracic spinous processes. Computed tomography axial images of C6, C7, and T1 from 516 patients were evaluated. The spinous processes were classified into three categories: “bifid,” “partially bifid,” and “monofid.” C6 spinous process was monofid in 47.9% of cases, partially bifid in 4.2% of cases, and bifid in 47.9% of cases. C7 spinous process was monofid in 99.2% of cases, partially bifid in 0.5% of cases, and bifid in 0.3% of cases. T1 was monofid in all cases. A truly bifid C7 spinous process occurs 0.3% of the time and therefore is not a reliable landmark for choosing fusion levels. This knowledge hopefully helps prevent the type of wrong-level instrumentation that we performed