Minimally Invasive Posterior Stabilization Improved Ambulation and Pain Scores in Patients with Plasmacytomas and/or Metastases of the Spine

Background. The incidence of spine metastasis is expected to increase as the population ages, and so is the number of palliative spinal procedures. Minimally invasive procedures are attractive options in that they offer the theoretical advantage of less morbidity. Purpose. The purpose of our study was to evaluate whether minimally invasive posterior spinal instrumentation provided significant pain relief and improved function. Study Design. We compared pre- and postoperative pain scores as well as ambulatory status in a population of patients suffering from oncologic conditions in the spine. Patient Sample. A consecutive series of patients with spine tumors treated minimally invasively with stabilization were reviewed. Outcome Measures. Visual analog pain scale as well as pre- and postoperative ambulatory status were used as outcome measures. Methods. Twenty-four patients who underwent minimally invasive posterior spinal instrumentation for metastasis were retrospectively reviewed. Results. Seven (29%) patients were unable to ambulate secondary to pain and instability prior to surgery. All patients were ambulating within 2 to 3 days after having surgery (P = 0.01). The mean visual analog scale value for the preoperative patients was 2.8, and the mean postoperative value was 1.0 (P = 0.001). Conclusion. Minimally invasive posterior spinal instrumentation significantly improved pain and ambulatory status in this series

Minimal Invasive Percutaneous Fixation of Thoracic and Lumbar Spine Fractures

We studied 122 patients with 163 fractures of the thoracic and lumbar spine undergoing the surgical treatment by percutaneous transpedicular fixation and stabilization with minimally invasive technique. Patient followup ranged from 6 to 72 months (mean 38 months), and the patients were assessed by clinical and radiographic evaluation. The results show that percutaneous transpedicular fixation and stabilization with minimally invasive technique is an adequate and satisfactory procedure to be used in specific type of the thoracolumbar and lumbar spine fractures

Diagnosis and Planning in the Management of Musculoskeletal Tumors: Surgical Perspective

The evaluation of musculoskeletal tumors requires a close interaction between the orthopedic oncologist, radiologist, and the pathologist. Successful outcome can be achieved in a considerable number of patients by following the appropriate diagnostic strategies and staging studies. The aim of this article is to outline the presentation, imaging, and staging of the primary and metastatic bone and soft tissue tumors. Some of the image-guided interventions for these tumors are also presented

Vertebral body spread in thoracolumbar burst fractures can predict posterior construct failure

Background Context: The load sharing classification (LSC) laid foundations for a scoring system able to indicate which thoracolumbar fractures, after short-segment posterior-only fixations, would need longer instrumentations or additional anterior supports. Purpose: We analyzed surgically treated thoracolumbar fractures, quantifying the vertebral body's fragment displacement with the aim of identifying a new parameter that could predict the posterior-only construct failure. Study Design: This is a retrospective cohort study from a single institution. Patient Sample: One hundred twenty-one consecutive patients were surgically treated for thoracolumbar burst fractures. Outcome Measures: Grade of kyphosis correction (GKC) expressed radiological outcome; Oswestry Disability Index and visual analog scale were considered. Methods: One hundred twenty-one consecutive patients who underwent posterior fixation for unstable thoracolumbar burst fractures were retrospectively evaluated clinically and radiologically. Supplementary anterior fixations were performed in 34 cases with posterior instrumentation failure, determined on clinic-radiological evidence or symptomatic loss of kyphosis correction. Segmental kyphosis angle and GKC were calculated according to the Cobb method. The displacement of fracture fragments was obtained from the mean of the adjacent end plate areas subtracted from the area enclosed by the maximum contour of vertebral fragmentation. The "spread" was derived from the ratio between this subtraction and the mean of the adjacent end plate areas. Analysis of variance, Mann-Whitney, and receiver operating characteristic were performed for statistical analysis. The authors report no conflict of interest concerning the materials or methods used in the present study or the findings specified in this paper. No funds or grants have been received for the present study. Results: The spread revealed to be a helpful quantitative measurement of vertebral body fragment displacement, easily reproducible with the current computed tomography (CT) imaging technologies. There were no failures of posterior fixations with preoperative spreads 62.7% required supplementary anterior supports whenever LOC>10° were recorded. Most of the patients in a "gray zone," with spreads between 42% and 62.7%, needed additional anterior supports because of clinical-radiological evidence of impending mechanical failures, which developed independently from the GKC. Preoperative kyphosis (p<.001), load sharing score (p = 002), and spread (p<.001) significantly affected the final surgical treatment (posterior or circumferential). Conclusions: Twenty-two years after the LSC, both improvements in spinal stabilization systems and software imaging innovations have modified surgical concepts and approach on spinal trauma care. Spread was found to be an additional tool that could help in predicting the posterior construct failure, providing an objective preoperative indicator, easily reproducible with the modern viewers for CT images

3D Printing in Surgical Planning and Intra-Operative Assistance: A Case Report on Cervical Deformity Correction Surgery

Three-dimensional (3D)-printed anatomical models of the bones play a key role in complex surgical procedures. These subject-specific physical models are valuable in pre-operative planning and may also offer assistance during surgery by improving the visibility of inaccessible anatomical structures, particularly in spine surgery. Starting from medical imaging, virtual 3D bone models are reconstructed, and these can also be used for quantifying original, planned, and achieved bone-to-bone alignments. The purpose of this study is to report on an original exploitation of these techniques on a patient with a severe cervical deformity to undergo corrective and stabilizing surgery. A virtual anatomical model of the cervical spine before surgery was obtained from computer tomography to assess the original deformity and for surgical planning. The corresponding 3D model was printed in acrylonitrile-butadiene-styrene and used to simulate the surgery by performing bone cuts, implanting the screws, and placing and shaping the fixation elements. During surgery, this physical 3D-printed model was used as a reference for each surgical action. The comparisons between pre- and post-operative virtual models confirmed that the planned correction was achieved. Virtual and 3D-printed anatomical models of the cervical spine offer advantages in the planning and execution of personalized complex surgeries, in addition to improving surgical safety

Pharyngo-esophageal perforations after anterior cervical spine surgery: management and outcomes

To report about the diagnosis, surgical treatment and post-operative management of pharyngo-esophageal perforations (PEP) after anterior cervical spine (ACS) surgery in 17 patients

Use of the SpineJack direct reduction for treating type A2, A3 and A4 fractures of the thoracolumbar spine: a retrospective case series

Compression injuries of the thoracolumbar spine without neurological impairment are usually treated with minimally invasive procedures. Intravertebral expandable implants represent an alternative strategy in fractures with low fragments' displacement