Treatment of degenerative cervical spondylosis with radiculopathy. Clinical practice guidelines endorsed by The Polish Society of Spinal Surgery

Introduction Degenerative cervical spondylosis (DCS) with radiculopathy is the most common indication for cervical spine surgery despite favorable natural history. Advances in spinal surgery in conjunction with difficulties in measuring the outcomes caused the paucity of uniform guidelines for the surgical management of DCS. Aims The aim of this paper is to develop guidelines for surgical treatment of DCS. For this purpose the available up-to-date literature relevant on the topic was critically reviewed. Methods and results Six questions regarding most important clinical questions encountered in the daily practice were formulated. They were answered based upon the systematic literature review, thus creating a set of guidelines. The guidelines were categorized into four tiers based on the level of evidence (I–III and X). They were designed to assist in the selection of optimal and effective treatment leading to the most successful outcome. Conclusions The evidence based medicine (EBM) is increasingly popular among spinal surgeons. It allows making unbiased, optimal clinical decisions, eliminating the detrimental effect of numerous conflicts of interest. The key role of opinion leaders as well as professional societies is to provide guidelines for practice based on available clinical evidence. The present work contains a set of guidelines for surgical treatment of DCS officially endorsed by the Polish Spine Surgery Society

Treatment of lumbar disc herniation with radiculopathy. Clinical practice guidelines endorsed by The Polish Society of Spinal Surgery

Introduction Herniated lumbar disc (HLD) is arguably the most common spinal disorder requiring surgical intervention. Although the term is fairly straightforward, the exact pathology and thus the clinical picture and natural history may vary. Therefore, it is immensely difficult to formulate universal guidelines for surgical treatment. Aim The aim of this paper is to organize the terminology and clear the inconsistencies in phraseology, review treatment options and gather available published evidence to address the clinical questions to create a set of clinical guidelines in relevant to the topic. Methods and results Twelve queries, addressing optimal surgical treatment of the HLD have been formulated. The results, based on the literature review are described in the present work. The final product of the analysis was a set of guidelines for the surgical treatment of symptomatic HLD. Categorized into four tiers based on the level of evidence (I–III and X), they have been designed to assist in the selection of optimal, effective treatment leading to the successful outcome. Conclusions The evidence based medicine (EBM) is becoming ever more popular among spinal surgeons. Unfortunately this is not always feasible. Lack of uniform guidelines and numerous conflicts of interest introduce flaws in the decision making process. The key role of experts and professional societies is to provide high value recommendation based on the most current literature. Present work contains a set of guidelines for the surgical treatment of HLD officially endorsed by the Polish Spine Surgery Society

Renal interstitial mast cell counts differ across classes of proliferative lupus nephritis

Systemic lupus erythematosus frequently involves the kidneys leading to significant morbidity and mortality. It is classified according to glomerular involvement pattern but tubulointerstitial lesions are also important for progression and prognosis, as seen in other kidney glomerular diseases. One of the cell types which participate in this process are mast cells. The aim of the study was to analyze the counts of tryptase-positive and chymase-positive mast cells in lupus nephritis classes II, III and IV. Material consisted of 42 renal biopsies from patients with lupus nephritis; 11 class II, 9 class III and 22 class IV. Chymase- and tryptase-containing cells were stained by immunohistochemistry and counted microscopically. Mean count of chymase-positive mast cells was 9.8/10 high power fields (hpf) for the whole group, 4.66 for class II, 11.89 for class III, and 11.51 for class IV. The mean count of tryptase-positive cells was 18.6/10 hpf for the whole group, 7.65 for class II, 25.57 for class III, and 21.23 for class IV. The differences between lupus nephritis classes were significant both for chymase- and tryptase-positive cells. Tryptase- but not chymase-positive cell counts showed a correlation with the creatinine level (R = 0.35). These results suggest that mast cells are involved to a different degree in the pathogenesis of lupus nephritis depending on the class of the disease

Feasibility and accuracy of new insertion technique of S1 transpedicular screw. Computed tomography-based morphometric analysis

Objective To assess feasibility and accuracy of a new insertion technique of S1 transpedicular screw. Summary of background data Transpedicular stabilization in the first sacral vertebra (S1) is a technically demanding surgical procedure with inherent risk of loosening of the implant. A modification of the technique was recently proposed, along with the analytical verification which was performed based on the available literature. In the study, we performed radiological assessment of screws inserted into the S1 using the classical and modified techniques. Methods The analysis was performed in two parts. The first part was performed on eight cadaver specimens after implantation of the screws. In the second part, we used computed tomography images of patients with degenerative disk disease with a superimposed representation of screws. The thickness of the posterior cortex adherent to the screws, screw trajectory and their position with regard to the spinal canal was measured. The area of posterior cortex in contact with the screws was also calculated. Results The contact length and area was found to be two times greater for screws introduced with the modified technique. The convergence angle was comparable between the techniques, despite the shift of entry point. There was no canal breach, although with the modified technique the screws passed closer to the spinal canal. Conclusions The modified technique is considered safe. In this technique, the screws pass through a thicker portion of the posterior cortex compared to the classical technique that aims at improving the stability of the fixation

Niesteroidowe leki przeciwzapalne a powikłania sercowo-naczyniowe i gastroenterologiczne — algorytm wyboru

Niesteroidowe leki przeciwzapalne (NLPZ) wykazują wysoką skuteczność w terapii przeciwzapalnej i przeciwbólowej. Leki z tej grupy są obarczone dość licznymi działaniami niepożądanymi, często również poważnymi. Działanie NLPZ wiąże się z blokowaniem cyklooksygenaz. Mechanizm ten stanowi podstawę występowania większości działań niepożą-danych NLPZ. Przez lata podejmowano próby opracowania algorytmu wyboru NLPZ, zależnie od ryzyka rozwoju powikłań związanych z lekami z tej grupy, w indywidualnych przypadkach. Niniejsze opracowanie stanowi kolejną próbę podsumo-wania tego zagadnienia przy zaktualizowanym stanie wiedzy wynikającym z opublikowania wyników badania PRECISION i przedstawiono w nim algorytm wyboru NLPZ w zależności od ryzyka gastroenterologicznego i sercowo-naczyniowego, z wykorzystaniem tak zwanej koncepcji NLPZ „złotego środka” oraz z uwzględnieniem interakcji między niektórymi NLPZ a kwasem acetylosalicylowym stosowanym kardioprotekcyjnie

Niesteroidowe leki przeciwzapalne a powikłania sercowo-naczyniowe i gastroenterologiczne — algorytm wyboru

Non-steroidal anti-inflammatory drugs (NSAID) are characterized by high efficacy both in anti-inflammatory and analgesic therapy. Unfortunately this group of medications is burdened with numerous side effects, including severe. Main mechanism of action is through blockade of cyclooxygenase which is also a basis for majority of their side effects. Through years attempts have been made in order to establish algorithm of choosing the best NSAID in individual situations according to the risk of side effects. Following elaboration is a review of current knowledge on the subject including the results of the newest PRECISION study and presents an algorithm of choice of the NSAID depending on gastroenterological and cardiovascular risk using a concept of so called “golden mean” NSAID and taking into account the interaction between some NSAID and acetylsalicylic acid in cardioprotective dose.Niesteroidowe leki przeciwzapalne (NLPZ) wykazują wysoką skuteczność w terapii przeciwzapalnej i przeciwbólowej. Leki z tej grupy są obarczone dość licznymi działaniami niepożądanymi, często również poważnymi. Działanie NLPZ wiąże się z blokowaniem cyklooksygenaz. Mechanizm ten stanowi podstawę występowania większości działań niepożądanych NLPZ. Przez lata podejmowano próby opracowania algorytmu wyboru NLPZ, zależnie od ryzyka rozwoju powikłań związanych z lekami z tej grupy, w indywidualnych przypadkach. Niniejsze opracowanie stanowi kolejną próbę podsumowania tego zagadnienia przy zaktualizowanym stanie wiedzy wynikającym z opublikowania wyników badania PRECISION i przedstawiono w nim algorytm wyboru NLPZ w zależności od ryzyka gastroenterologicznego i sercowo-naczyniowego, z wykorzystaniem tak zwanej koncepcji NLPZ „złotego środka” oraz z uwzględnieniem interakcji między niektórymi NLPZ a kwasem acetylosalicylowym stosowanym kardioprotekcyjnie