Role of Bone Marrow Mesenchymal Stem Cells Concentrate Using Selective Retention Cell Technology in Posterolateral Spinal Fusion

IntroductionWith increasing rate of spinal fusion, the problem of pseudarthrosis which contributes to recurrent pain with patient disability is considered to be the most common cause of revision lu..

"Delirium Day": A nationwide point prevalence study of delirium in older hospitalized patients using an easy standardized diagnostic tool

Background: To date, delirium prevalence in adult acute hospital populations has been estimated generally from pooled findings of single-center studies and/or among specific patient populations. Furthermore, the number of participants in these studies has not exceeded a few hundred. To overcome these limitations, we have determined, in a multicenter study, the prevalence of delirium over a single day among a large population of patients admitted to acute and rehabilitation hospital wards in Italy. Methods: This is a point prevalence study (called "Delirium Day") including 1867 older patients (aged 65 years or more) across 108 acute and 12 rehabilitation wards in Italian hospitals. Delirium was assessed on the same day in all patients using the 4AT, a validated and briefly administered tool which does not require training. We also collected data regarding motoric subtypes of delirium, functional and nutritional status, dementia, comorbidity, medications, feeding tubes, peripheral venous and urinary catheters, and physical restraints. Results: The mean sample age was 82.0 \ub1 7.5 years (58 % female). Overall, 429 patients (22.9 %) had delirium. Hypoactive was the commonest subtype (132/344 patients, 38.5 %), followed by mixed, hyperactive, and nonmotoric delirium. The prevalence was highest in Neurology (28.5 %) and Geriatrics (24.7 %), lowest in Rehabilitation (14.0 %), and intermediate in Orthopedic (20.6 %) and Internal Medicine wards (21.4 %). In a multivariable logistic regression, age (odds ratio [OR] 1.03, 95 % confidence interval [CI] 1.01-1.05), Activities of Daily Living dependence (OR 1.19, 95 % CI 1.12-1.27), dementia (OR 3.25, 95 % CI 2.41-4.38), malnutrition (OR 2.01, 95 % CI 1.29-3.14), and use of antipsychotics (OR 2.03, 95 % CI 1.45-2.82), feeding tubes (OR 2.51, 95 % CI 1.11-5.66), peripheral venous catheters (OR 1.41, 95 % CI 1.06-1.87), urinary catheters (OR 1.73, 95 % CI 1.30-2.29), and physical restraints (OR 1.84, 95 % CI 1.40-2.40) were associated with delirium. Admission to Neurology wards was also associated with delirium (OR 2.00, 95 % CI 1.29-3.14), while admission to other settings was not. Conclusions: Delirium occurred in more than one out of five patients in acute and rehabilitation hospital wards. Prevalence was highest in Neurology and lowest in Rehabilitation divisions. The "Delirium Day" project might become a useful method to assess delirium across hospital settings and a benchmarking platform for future surveys

Posterior dynamic neutralization and hybrid stabilization in degenerative spine diseases: long-term clinical and radiological outcomes

Dynamic spinal stabilization aims to reduce some of the problems inherent with traditional fusion. The aim of our study is to analyse clinical and radiological outcomes and to identify the causes of clinical failure in patients who underwent posterior dynamic neutralization or posterior hybrid stabilization because of degenerative lumbar spine diseases. We retrospectively analysed 80 patients at 7.1 years mean follow-up (Range: 5.1 - 8.3 years): 50 were treated with Dynamic Stabilization System (Dynesys) (mean age 47 years old) and 30 with Dynamic Transition Option (mean age 48 years old). We performed clinical pre-and post-operative evaluation using Visual Analogue Scale (VAS), Oswestry Low Back Pain Scale (ODI) and X-rays study. Results: we reported an important reduction of VAS from 7 to 2 (p<.001) and minimal disability in 65% of the patients, moderate disability in 18.2%, severe disability in 12.5% and crippling back pain in 4.3%. X-ray analysis showed a significative decrease of 3.5\ub0 with respect to the preoperative values, exactly 2\ub0 in neutral position postop, 1.2\ub0 in flexion postop and 2.5\ub0 in extension postop. Data showed greater reduction of extension than flexion in postoperative period. Dynamic neutralization limits more the extension than flexion. The correct preoperative planning, the careful selection of patients and the meticulous surgical technique are mandatory to avoid clinical failures. It is very important to identify the correct screw positioning and to avoid excessive pre-tensioning of the implant. Posterior dynamic neutralization and hybrid stabilization are valid alternative to spinal fusion in degenerative spine disease

Efficacy and tolerability of pregabalin versus topiramate in the prophylaxis of chronic daily headache with analgesic overuse: an open-label prospective study

Medication-overuse headache is one of the most disabling headaches. Antiepileptic drugs have been considered a promising strategy as prophylactic treatment in these patients, even if their use often has been limited by low tolerability or safety. The objective of this study was to evaluate the efficacy and safety of pregabalin compared with topiramate for the prophylaxis of chronic daily headache with medication overuse using an open-label prospective study

Sagittal balance in adolescent idiopathic scoliosis : radiographic study of spino-pelvic compensation after surgery

Abstract Study design Radiographic retrospective study of a consecutive series of 76 patients with adolescent idiopathic scoliosis (AIS) undergoing posterior only surgical correction and fusion

Trattamento chirurgico mini-invasivo delle fratture vertebrali toraco-lombari

Vertebroplastica (VP) e cifoplastica (CP) sono due procedure chirurgiche mini-invasive per il trattamento del dolore dorso-lombare provocato da fratture vertebrali in compressione. L\u2019indicazione principale all\u2019utilizzo di queste metodiche di augmentation vertebrale \ue8 rappresentata dal cedimento vertebrale patologico in osteoporosi, anche se il loro impiego pu\uf2 essere esteso al trattamento di alcune fratture traumatiche e dei secondarismi vertebrali osteolitici. La principale differenza tra le due tecniche consiste nella possibilit\ue0 da parte della cifoplastica di ridurre la cifosi vertebrale, con indubbi vantaggi sul ripristino del balance vertebrale sagittale. Da una casistica di 32 pazienti operati per frattura vertebrale patologica in osteoporosi ne sono stati rivalutati in modo retrospettivo 16 (follow-up minimo di un anno), per un totale di 37 vertebre trattate con vertebroplastica e cifoplastica. La cifoplastica \ue8 stata impiegata in 26 livelli (70,3%) mentre la vertebroplastica nei restanti 11 (29,7%). L\u2019obiettivo della revisione \ue8 stato quello di confrontare i risultati clinici e radiografici dei due gruppi CP e VP. In tutti i pazienti si \ue8 osservato un netto miglioramento del dolore calcolato con la scala analogica visuale (VAS) gi\ue0 nella prima giornata post-operatoria senza differenze tra i due gruppi; il miglioramento della sintomatologia algica si \ue8 poi mantenuto stabile durante i successivi controlli clinici. I risultati radiografici sono stati valutati statisticamente con il test T di Student, che ha evidenziato una differenza statisticamente significativa tra CP e VP per quanto riguarda sia il recupero dell\u2019altezza somatica che il miglioramento della cifosi vertebrale. In particolare, la CP ha consentito di ottenere valori di altezza somatica finale media pressoch\ue9 doppi rispetto alla VP (2,04 mm per la VP contro 4,20 mm per la CP) e un netto miglioramento della cifosi vertebrale media (1,69\ub0 nella VP contro 3,68\ub0 nella CP). In conclusione, \ue8 possibile affermare che entrambe le metodiche, VP e CP, permettono di trattare in modo analogo il dolore vertebrale causato dalle fratture somatiche in osteoporosi con una netta differenza a favore della CP per quanto concerne il recupero dell\u2019altezza somatica e il miglioramento della cifosi vertebraleSurgical Vertebroplasty (SV) and Kyphoplasty (KP) are minimally invasive procedures used for the treatment of focal back pain due to vertebral compression fractures. These vertebral augmentation methods are mainly indicated in osteoporotic pathological fractures, even if they can be sometimes employed to treat traumatic fractures and vertebral osteolytic metastasis. The main difference between the two techniques is that kyphoplasty allows the reduction of the kyphotic deformity, giving advantages in terms of restoration of the sagittal vertebral balance. Among a sample of 32 Patients that ubderwent a surgical treatment for a vertebral osteoporotic fracture, 16 were retrospectively re-evaluated (1 year minimum follow-up). The full number of vertebrae was 37, all treated with VP or KP. Kyphoplasty was employed for the treatment of 26 levels (70,3%), while vertebroplasty was employed in the remaining 11 levels (29,7%). The aim of this work is the comparison between the clinical and radiographic results of the two groups, KP and VP. All Patients showed a clear improvement of the pain, evaluated through the Visual Analogue Scale (VAS), already during the first post-operative day, without any difference between the two groups. The pain relief did not show any variation during the successive clinical check-ups. Radiographic results were statistically evaluated though a Student T-Test that showed a statistically significant difference between KP and VP concerning the vertebral body height restoration and the correction of the kyphotic spine deformity. In particular, the mean post-operative vertebral body height obtained through the employment of KP was almost twofold compared to VP (2.04 mm in VP vs 4.20 in KP); besides, KP showed an evident correction of the mean spinal Kyphosis (1.69\ub0 in VP vs 3.68\ub0 in KP). In summary, both techniques, VP and KP, can treat in a similar way the focal back pain due to vertebral osteoporotic fractures, but KP offers clear advantages in terms of vertebral body height restoration and correction of the spinal deformit

Cement leakage : safety of minimally invasive surgical techniques in the treatment of multiple myeloma vertebral lesions

Purpose: To evaluate and address the safety of verteb-roplasty (VP) and kyphoplasty (KP) in terms of rate and type of cement leakage in the treatment of Multiple Myeloma (MM) vertebral fractures. Methods: A total number of 37 treated vertebrae were evaluated post-operatively by using standard X-rays and CT scan looking for a cement leakage. VP was done using a monoportal approach in all cases (18 treated levels, group A), while KP was done using a monopedicular approach in 9 levels (group B1) and using a bipedicular approach in the remaining 10 levels (group B2). A computed tomography was used to establish the presence of any cement leakage and to determine its localization. Results: Vertebral augmentation through VP and KP provides immediate pain relief and an improvement of the quality of life of patients affected by MM but it is gravated by high risk of cement leakage. Cement extravasation occurred in 27.7% of total VP procedures and in 21.05% of total KP procedures, but considering the whole number of treated levels, it was more common in multi-level VP and in bipedicular KP, in which a higher quantity of cement was employed. Conclusions: KP procedure in these patients is slightly less risky but we suggest doing it with a monopedicular approach. It's mandatory to use an high viscosity cement and we suggest not to use an amount of PMMA over 2 cc and a previous treatment with bone marrow transplant is related to a lower risk of cement leakage

Elastic stabilization alone or combined with rigid fusion in spinal surgery: a biomechanical study and clinical experience based on 82 cases

The authors report their experience with the treatment of lumbar instability by a kind of spine stabilization. The elastic stabilization, which follows a new philosophy, is obtained by an interspinous device, and should be used alone in degenerative disc disease, recurrent disc herniation and in very low grade instability, or in association with rigid fusion for the prevention of pathology of the border area. In collaboration with bioengineers, we carried out an experimental study on a lumbar spine model in order to calculate stresses and deformations of lumbar disc during simulation of motion, in physiological conditions and when elastic stabilization is combined with rigid fusion. Results suggest that elastic stabilization reduces stresses on the adjacent disc up to 28° of flexion. Based on this preliminary result, we began to use elastic stabilization alone or combined with fusion in 1994. To date, we have performed 82 surgical procedures, 57 using stabilization alone and 25 combined with fusion, in patients affected by degenerative disc disease, disc herniation, recurrence of disc herniation or other pathologies. Clinical results are satisfactory, especially in the group of patients affected by recurrent disc herniation, in whom the elastic device was used alone