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Teles AR, Aldebeyan S, Aoude A, Swamy G, Nicholls FH, Thomas KC, Jacobs WB. Mechanical Complications in Adult Spinal Deformity Surgery: Can Spinal Alignment Explain Everything? Spine (Phila Pa 1976) 2022; 47:E1-E9. [PMID: 34468439 DOI: 10.1097/brs.0000000000004217] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN Cohort study. OBJECTIVE Our goal was to verify the validity of the global alignment and proportion (GAP) score, SRS-Schwab, and Roussouly theoretical apex of lordosis in predicting mechanical complications in adult spinal deformity (ASD). SUMMARY OF BACKGROUND DATA Achieving adequate sagittal alignment is critical to obtain favorable outcomes in ASD surgery. It has been proposed that mechanical complications are largely secondary to postoperative spinal alignment. METHODS Retrospective review of consecutive primary ASD cases that underwent deformity correction in the same institution over a 5-year period. Association between the 6-week postoperative spinal alignment classification and occurrence of mechanical complications on the last follow-up was assessed using logistic regressions. The discriminant capacity was assessed using the receiver operating characteristic (ROC) curve analysis. RESULTS 58.3% (N = 49/84) of patients presented with mechanical complications and 32.1% (N = 27/84) underwent revision surgery. GAP score did not show discriminant ability to predict complications (AUC = 0.53, 95% confidence interval [CI] = 0.40-0.66, P = 0.58). Conversely, the SRS-Schwab sagittal modifier score demonstrated a statistically significant (although modest) predictive value for mechanical complications (AUC = 0.67, 95% CI = 0.54-0.79, P = 0.008). There was a significant association between pelvic tilt (PT) (P = 0.03) and sagittal vertical axis (SVA) (P = 0.01) at 6 weeks postoperatively and the occurrence of later mechanical complications. There was no significant association between matched Roussouly theoretical apex of lordosis and final outcome (P = 0.47). CONCLUSION The results point to the complexity of mechanical failure and the high likelihood that causative factors are multifactorial and not limited to alignment measures. GAP score should be used with caution as it may not explain or predict mechanical failure based on alignment in all populations as originally expected. Future studies should focus on etiology, surgical technique, and patient factors in order to generate a more universal score that can be applied to all populations.Level of Evidence: 4.
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Affiliation(s)
- Alisson R Teles
- Neurosurgery and Spine Program, Hospital Beneficente São Carlos, Farroupilha - RS, Brazil
| | - Sultan Aldebeyan
- National Neuroscience Institute, King Fahad Medical City, Riyadh, Saudi Arabia
| | - Ahmed Aoude
- Spine Program, University of Calgary, Calgary, Alberta, Canada
| | - Ganesh Swamy
- Spine Program, University of Calgary, Calgary, Alberta, Canada
| | - Fred H Nicholls
- Spine Program, University of Calgary, Calgary, Alberta, Canada
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Ramos MB, Matté Dagostini C, Rabau O, Navarro-Ramirez R, Ouellet JA, Falavigna A, Teles AR. Publication rate of abstracts presented at the annual meetings of the AANS/CNS Section on Disorders of the Spine and Peripheral Nerves. J Neurosurg Spine 2020; 33:854-861. [PMID: 32823260 DOI: 10.3171/2020.5.spine20466] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2020] [Accepted: 05/11/2020] [Indexed: 11/06/2022]
Abstract
OBJECTIVE The objective of this study was to determine the publication rate of abstracts presented at the annual meetings of the AANS/CNS Section on Disorders of the Spine and Peripheral Nerves (Spine Summit). METHODS The authors used a search algorithm in PubMed to determine the publication rate of abstracts presented at the Spine Summit from 2007 to 2012. The variables assessed were presentation modality, topic, meeting year, publication year, destiny journal and its 5-year impact factor (IF), country, and citation count (retrieved from the Scopus database). RESULTS One thousand four hundred thirty-six abstracts were analyzed; 502 were oral presentations and 934 were digital poster presentations. The publication rate was 53.97% (775/1436). The mean time from presentation to publication was 1.35 ± 1.97 years (95% CI 1.21-1.49 years). The mean citation count of published articles was 40.55 ± 55.21 (95% CI 36.66-44.44). Oral presentations had a higher publication rate (71.51%, 359/502) than digital posters (44.54%, 416/934; OR 3.13, 95% CI 2.48-3.95, p < 0.001). Oral presentations had a higher number of citations (55.51 ± 69.00, 95% CI 48.35-62.67) than digital posters (27.64 ± 34.88, 95% CI 24.28-31.00, p < 0.001). The mean IF of published articles was 3.48 ± 2.91 (95% CI 3.27-3.70). JNS: Spine (191/775, 24.64%), Spine (103/775, 13.29%), and Neurosurgery (56/775, 7.23%) had the greatest number of published articles. The US represented the highest number of published articles (616/775, 79.48%). CONCLUSIONS The publication rate of the Spine Summit is among the highest compared to other spine meetings. Many of the abstracts initially presented at the meeting are further published in high-IF journals and had a high citation count. Therefore, the Spine Summit maintains its high standards of scientific papers, which reflects the high quality of the research performed in the spine surgery field in North America.
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Affiliation(s)
- Miguel Bertelli Ramos
- 1Department of Neurosurgery, Universidade de Caxias do Sul, Caxias do Sul-Rio Grande do Sul, Brazil
| | - Carolina Matté Dagostini
- 1Department of Neurosurgery, Universidade de Caxias do Sul, Caxias do Sul-Rio Grande do Sul, Brazil
| | - Oded Rabau
- 2McGill Scoliosis and Spine Group, Montreal, Quebec, Canada; and
| | | | - Jean A Ouellet
- 2McGill Scoliosis and Spine Group, Montreal, Quebec, Canada; and
| | - Asdrubal Falavigna
- 1Department of Neurosurgery, Universidade de Caxias do Sul, Caxias do Sul-Rio Grande do Sul, Brazil
- 3Neurosurgery and Spine Program, Hospital Beneficente São Carlos, Farroupilha, Rio Grande do Sul, Brazil
| | - Alisson R Teles
- 2McGill Scoliosis and Spine Group, Montreal, Quebec, Canada; and
- 3Neurosurgery and Spine Program, Hospital Beneficente São Carlos, Farroupilha, Rio Grande do Sul, Brazil
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St-Georges M, Teles AR, Rabau O, Saran N, Ouellet JA, Ferland CE. Adolescent idiopathic scoliosis: evaluating perioperative back pain through a simultaneous morphological and biomechanical approach. BMC Musculoskelet Disord 2020; 21:466. [PMID: 32677928 PMCID: PMC7367237 DOI: 10.1186/s12891-020-03462-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2020] [Accepted: 06/24/2020] [Indexed: 11/18/2022] Open
Abstract
Background Adolescent idiopathic scoliosis (AIS) has been associated with diminished postural stability and a greater prevalence of back pain. Currently, the literature is lacking information on the effect of spinal fusion on both postural stability and its association with back pain. Our objectives were to evaluate the postsurgical effect of spinal morphological changes on static standing balance and assess the influence of these alterations on reported pain throughout the perioperative period. Methods Twenty consecutive AIS patients schedule to undergo spinal fusion surgery were recruited and followed prospectively at the Shriners Hospitals for Children-Canada. Data was collected at the preoperative, 6 weeks and 6 months postoperative visits. Spinal morphology data was collected through 3D reconstructed simultaneous standing biplanar radiographs using the SterEOS software. Postural balance was assessed through Moticon© sensor insoles and analyzed through their software. The data was simultaneously collected as part of the Global Biomechanical and morphological Assessment. Pain was evaluated through self-reported questionnaires. Results Morphological curve parameters were significantly reduced after surgery. Balance parameters did not change significantly throughout the perioperative period with the exception of the Center of Pressure of the left foot medial/lateral transient shift (P = 0.017) at 6 weeks. Of note, preoperative balance parameters were associated with the degree of right thoracic Cobb angles (P = 0.029 R = 0.528). Pain scores significantly improved 6 weeks and 6 months after the surgery. Pain intensity diminished in the thoracic and lumbar spine but worsen in the neck region at the 6 weeks and 6 months postoperative time points (P = 0.044). Greater residual Cobb angle difference between Mid thoracic and Thoracolumbar/Lumbar curves was associated with greater pain severity at 6 weeks postop (P < 0.005). In addition, greater residual thoracic deformity was associated with significant pain severity 6 months after surgery (P < 0.05). Conclusions Improved spinal morphology of postsurgical AIS patients has no significant impact on their static standing balance. Suggesting that other factors apart from the spinal morphology may contribute to AIS patients’ balance during stance. Although balance did not influence pain severity, spinal morphology and its correction appear to have influenced the intensity and location of back pain.
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Affiliation(s)
- Maxime St-Georges
- McGill Scoliosis and Spine Research Group, Montreal, Canada.,Shriners Hospitals for Children-Canada, 1003, boul. Décarie, Montreal, Quebec, H4A 0A9, Canada.,Department of Experimental Surgery, McGill University, Montreal, Canada
| | - Alisson R Teles
- McGill Scoliosis and Spine Research Group, Montreal, Canada.,Shriners Hospitals for Children-Canada, 1003, boul. Décarie, Montreal, Quebec, H4A 0A9, Canada.,Integrated Program in Neurosciences, McGill University, Montreal, Canada
| | - Oded Rabau
- McGill Scoliosis and Spine Research Group, Montreal, Canada.,Shriners Hospitals for Children-Canada, 1003, boul. Décarie, Montreal, Quebec, H4A 0A9, Canada.,Department of Surgery, Division of Orthopedics, McGill University, Montreal, Canada
| | - Neil Saran
- McGill Scoliosis and Spine Research Group, Montreal, Canada.,Shriners Hospitals for Children-Canada, 1003, boul. Décarie, Montreal, Quebec, H4A 0A9, Canada.,Department of Surgery, Division of Orthopedics, McGill University, Montreal, Canada
| | - Jean A Ouellet
- McGill Scoliosis and Spine Research Group, Montreal, Canada.,Shriners Hospitals for Children-Canada, 1003, boul. Décarie, Montreal, Quebec, H4A 0A9, Canada.,Department of Experimental Surgery, McGill University, Montreal, Canada.,Department of Surgery, Division of Orthopedics, McGill University, Montreal, Canada
| | - Catherine E Ferland
- McGill Scoliosis and Spine Research Group, Montreal, Canada. .,Shriners Hospitals for Children-Canada, 1003, boul. Décarie, Montreal, Quebec, H4A 0A9, Canada. .,Department of Experimental Surgery, McGill University, Montreal, Canada. .,Integrated Program in Neurosciences, McGill University, Montreal, Canada. .,Department of Anesthesia, McGill University, Montreal, Canada.
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Tarchala M, Charbonneau M, Aduljabbar FH, Teles AR, Weber M. Pre-education Enhances the Success of Manual Training for Orthopedic Surgery Residents. J Surg Educ 2019; 76:1433-1439. [PMID: 30975601 DOI: 10.1016/j.jsurg.2019.03.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/12/2018] [Revised: 11/12/2018] [Accepted: 03/08/2019] [Indexed: 06/09/2023]
Abstract
INTRODUCTION Surgical skill training is difficult due to limited resources and the associated risks in the clinical setting. There have been many studies that have looked at optimizing resident skill techniques out of the operating room to optimize intraoperative teaching. Specifically, as seen in spine surgery performing a laminectomy with a high-speed drill is difficult and requires many hours of training and guidance before a resident can feel comfortable to adequately complete the laminectomy with minimal risk of adverse effects. OBJECTIVE The objective of this study is to assess if pre-education of residents prior to using the high-speed drill will significantly increase their comfort level, as well as increase the success of laminectomy. DESIGN, SETTING AND PARTICIPANTS This was done by a prospective cohort study in evaluating 20 orthopedic surgical residents via the objective structured assessment of technical skills and global rating scale. RESULTS Results showed that residents who had pre-education were in fact more successful in completing the laminectomy with the high-speed drill. CONCLUSIONS Pre-education, whether via a didactic or simulator-based model are both beneficial to resident's knowledge and surgical skill attainment however the simulator based model did not deem the group more successful in completing the laminectomy with the high-speed drill. Certain technical skills still require unreplaceable hands-on practice to become proficient.
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Affiliation(s)
- Magdalena Tarchala
- Division of Orthopaedic Surgery, McGill University Health Centre, Montreal, Quebec, Canada.
| | - Maxime Charbonneau
- Division of Orthopaedic Surgery, McGill University Health Centre, Montreal, Quebec, Canada
| | - Fahad H Aduljabbar
- Division of Orthopaedic Surgery, McGill University Health Centre, Montreal, Quebec, Canada; Department of Orthopedic Surgery, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Alisson R Teles
- Division of Orthopaedic Surgery, McGill University Health Centre, Montreal, Quebec, Canada
| | - Michael Weber
- Division of Orthopaedic Surgery, McGill University Health Centre, Montreal, Quebec, Canada
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Ramos MB, Falavigna A, Abduljabbar F, Rabau O, Ferland CE, Weber MH, Ouellet JA, Teles AR. Assessing publication rate of abstracts presented in spine conferences as a quality benchmark: the example of the Canadian Spine Society Annual Meetings. World Neurosurg 2019; 131:e339-e345. [PMID: 31356976 DOI: 10.1016/j.wneu.2019.07.146] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2019] [Revised: 07/18/2019] [Accepted: 07/19/2019] [Indexed: 11/21/2022]
Abstract
INTRODUCTION Publication rate can indirectly assess the quality of research presented in scientific meetings. Considering presentations at orthopedic surgery and neurosurgery meetings, 10.5-66% of abstracts are published in scientific journals. Publication rate of abstracts presented at CSS Meetings is unknown. The objective of this study was to evaluate the publication rate of abstracts presented at the Canadian Spine Society(CSS) Annual Meetings from 2005to2014. METHODS In October2018, a systematic PubMed search was performed using title and authors of all abstracts presented at CSS Meetings from 2005 to 2014. The following information was retrieved from the articles and abstracts: year, type of presentation, publication in PubMed, time from presentation to final publication, journal and its impact factor(IF). RESULTS A total of 621 abstracts were presented at CSS meetings from 2005 to 2014. Publication rate in PubMed was 54.8%(N=340/621). Oral presentations were more likely to be published than poster presentations(63.8%vs44.0%; OR=1.45; CI95%=1.20-1.75; P<0.0001). The mean time from presentation to publication was 1.76 years(±1.93). The 340 identified articles were published in 87 different journals. Most common journals were Spine(N=75; 22.1%), The Spine Journal(N=40;11.8%), and Journal of Neurosurgery:Spine(N=28;8.2%). IF ranged from 0.18 to 47.66(mean=3.73±4.68). IF of articles presented orally were higher than those presented as poster(P=0.038). CONCLUSIONS The CSS scientific meeting maintain along the years a steady high quality research presentations as manifested by its significant publication rate(54.8%) in medical journals with mean IF of 3.73. In comparison with other spine scientific meetings, publication rates of abstracts presented at CSS meeting is amongst the highest.
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Affiliation(s)
| | - Asdrubal Falavigna
- Department of Neurosurgery, University of Caxias do Sul, Caxias do Sul, RS, Brazil
| | - Fahad Abduljabbar
- Department of Orthopedic Surgery, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Oded Rabau
- McGill Scoliosis & Spine Group, McGill University, Montreal, Quebec, Canada
| | | | - Michael H Weber
- McGill Scoliosis & Spine Group, McGill University, Montreal, Quebec, Canada
| | - Jean A Ouellet
- McGill Scoliosis & Spine Group, McGill University, Montreal, Quebec, Canada
| | - Alisson R Teles
- McGill Scoliosis & Spine Group, McGill University, Montreal, Quebec, Canada.
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Li MM, Ocay DD, Teles AR, Ingelmo PM, Ouellet JA, Pagé MG, Ferland CE. Acute postoperative opioid consumption trajectories and long-term outcomes in pediatric patients after spine surgery. J Pain Res 2019; 12:1673-1684. [PMID: 31190974 PMCID: PMC6536124 DOI: 10.2147/jpr.s191183] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2018] [Accepted: 04/11/2019] [Indexed: 12/19/2022] Open
Abstract
Background: The days following surgery are a critical period where the use of opioids predicts long-term outcomes in adults. It is currently unknown as to whether opioid consumption throughout the acute postoperative period is associated with long-term outcomes in pediatric patients. The aims of this study were to characterize opioid consumption trajectories in the acute postoperative period, identify predictors of trajectory membership and determine associations between opioid consumption trajectories and long-term patient outcomes. Materials and methods: Medication use, pain and mental health status were assessed at baseline in adolescents with idiopathic scoliosis who were scheduled for spinal fusion surgery. Cumulative 6-hr opioid consumption was recorded for up to 5 days after spinal surgery. At 6 months after surgery, medication use, pain and functional activity were evaluated. Growth mixture modeling was used to identify opioid trajectories. Results: One hundred and six patients were included in the study. Mean cumulative 6-hr opioid consumption in the acute postoperative period was 13.23±5.20 mg/kg. The model with the best fit contained 5 acute postoperative trajectories and a quadratic term (AIC =6703.26, BIC =6767.19). Two types of patient behaviors were identified: high opioid consumers (trajectories 4 and 5) and low opioid consumers (trajectories 1, 2 and 3). Intraoperative intrathecal morphine dose was a predictor of trajectory membership (p=0.0498). Opioid consumption during the acute postoperative period was not significantly associated with pain, functional activity or pain medication use at 6 months after surgery. Conclusion: In pediatric patients, intraoperative intrathecal morphine dose predicts opioid consumption in the acute postoperative period. Importantly, opioid consumption during this period does not affect long-term outcomes in pediatric patients after a spine surgery.
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Affiliation(s)
- Mandy Mj Li
- Faculty of Medicine, McGill University, Montreal, Quebec, Canada.,Department of Clinical Research, Shriners Hospitals for Children-Canada, Montreal, Quebec, Canada
| | - Don Daniel Ocay
- Department of Clinical Research, Shriners Hospitals for Children-Canada, Montreal, Quebec, Canada.,Department of Experimental Surgery, McGill University, Montreal, Quebec, Canada
| | - Alisson R Teles
- Department of Clinical Research, Shriners Hospitals for Children-Canada, Montreal, Quebec, Canada.,Integrated Program in Neurosciences, McGill University, Montreal, Quebec, Canada
| | - Pablo M Ingelmo
- Chronic Pain Services, Montreal Children's Hospital, Montreal, Quebec, Canada.,Department of Anesthesia, McGill University, Montreal, Quebec, Canada
| | - Jean A Ouellet
- Faculty of Medicine, McGill University, Montreal, Quebec, Canada.,Department of Clinical Research, Shriners Hospitals for Children-Canada, Montreal, Quebec, Canada.,Division of Orthopaedic Surgery, McGill University, Montreal, Quebec, Canada
| | - M Gabrielle Pagé
- Département d'anesthésiologie, Université de Montréal, Montreal, Quebec, Canada.,Carrefour de l'innovation et de l'évaluation en santé, Centre de recherche du Centre hospitalier de l'Université de Montréal (CRCHUM), Montreal, Quebec, Canada
| | - Catherine E Ferland
- Department of Clinical Research, Shriners Hospitals for Children-Canada, Montreal, Quebec, Canada.,Integrated Program in Neurosciences, McGill University, Montreal, Quebec, Canada.,Chronic Pain Services, Montreal Children's Hospital, Montreal, Quebec, Canada.,Department of Anesthesia, McGill University, Montreal, Quebec, Canada.,Child Health and Human Development Research Axis, Research Institute-McGill University Health Centre, Montreal, Quebec, Canada
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Teles AR, Ocay DD, Bin Shebreen A, Tice A, Saran N, Ouellet JA, Ferland CE. Evidence of impaired pain modulation in adolescents with idiopathic scoliosis and chronic back pain. Spine J 2019; 19:677-686. [PMID: 30343045 DOI: 10.1016/j.spinee.2018.10.009] [Citation(s) in RCA: 38] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2018] [Revised: 10/12/2018] [Accepted: 10/15/2018] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT Although 40% of adolescent idiopathic scoliosis (AIS) patients present with chronic back pain, the pathophysiology and underlying pain mechanisms remain poorly understood. We hypothesized that development of chronic pain syndrome in AIS is associated with alterations in pain modulatory mechanisms. PURPOSE To identify the presence of sensitization in nociceptive pathways and to assess the efficacy of the diffuse noxious inhibitory control in patients with AIS presenting with chronic back pain. STUDY DESIGN Cross-sectional study. PATIENT SAMPLE Ninety-four patients diagnosed with AIS and chronic back pain. OUTCOME MEASURES Quantitative sensory testing (QST) assessed pain modulation and self-reported questionnaires were used to assess pain burden and health-related quality of life. METHODS Patients underwent a detailed pain assessment using a standard and validated quantitative sensory testing (QST) protocol. The measurements included mechanical detection thresholds (MDT), pain pressure threshold (PPT), heat pain threshold (HPT), heat tolerance threshold (HTT), and a conditioned pain modulation (CPM) paradigm. Altogether, these tests measured changes in regulation of the neurophysiology underlying the nociceptive processes based on the patient's pain perception. Funding was provided by The Louise and Alan Edwards Foundation and The Shriners Hospitals for Children. RESULTS Efficient pain inhibitory response was observed in 51.1% of patients, while 21.3% and 27.7% had sub-optimal and inefficient CPM, respectively. Temporal summation of pain was observed in 11.7% of patients. Significant correlations were observed between deformity severity and pain pressure thresholds (p=.023) and CPM (p=.017), neuropathic pain scores and pain pressure thresholds (p=.015) and temporal summation of pain (p=.047), and heat temperature threshold and pain intensity (p=.048). CONCLUSIONS Chronic back pain has an impact in the quality of life of adolescents with idiopathic scoliosis. We demonstrated a high prevalence of impaired pain modulation in this group. The association between deformity severity and somatosensory dysfunction may suggest that spinal deformity can be a trigger for abnormal neuroplastic changes in this population contributing to chronic pain syndrome.
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Affiliation(s)
- Alisson R Teles
- Integrated Program in Neurosciences, McGill University, Montreal, Québec, Canada; McGill Scoliosis and Spine Group, Montreal, Québec, Canada; Shriners Hospital for Children-Canada, Montreal, Québec, Canada; McGill University Health Centre, Montreal, Québec, Canada; Alan Edwards Centre for Research on Pain, Montreal, Québec, Canada
| | - Don Daniel Ocay
- McGill Scoliosis and Spine Group, Montreal, Québec, Canada; Shriners Hospital for Children-Canada, Montreal, Québec, Canada; McGill University Health Centre, Montreal, Québec, Canada; Alan Edwards Centre for Research on Pain, Montreal, Québec, Canada
| | - Abdulaziz Bin Shebreen
- McGill Scoliosis and Spine Group, Montreal, Québec, Canada; Shriners Hospital for Children-Canada, Montreal, Québec, Canada; McGill University Health Centre, Montreal, Québec, Canada
| | - Andrew Tice
- McGill Scoliosis and Spine Group, Montreal, Québec, Canada; Shriners Hospital for Children-Canada, Montreal, Québec, Canada; McGill University Health Centre, Montreal, Québec, Canada
| | - Neil Saran
- McGill Scoliosis and Spine Group, Montreal, Québec, Canada; Shriners Hospital for Children-Canada, Montreal, Québec, Canada; McGill University Health Centre, Montreal, Québec, Canada; Division of Pediatric Orthopaedics, McGill University, Montreal, Québec, Canada
| | - Jean A Ouellet
- McGill Scoliosis and Spine Group, Montreal, Québec, Canada; Shriners Hospital for Children-Canada, Montreal, Québec, Canada; McGill University Health Centre, Montreal, Québec, Canada; Alan Edwards Centre for Research on Pain, Montreal, Québec, Canada; Division of Pediatric Orthopaedics, McGill University, Montreal, Québec, Canada
| | - Catherine E Ferland
- Integrated Program in Neurosciences, McGill University, Montreal, Québec, Canada; McGill Scoliosis and Spine Group, Montreal, Québec, Canada; Shriners Hospital for Children-Canada, Montreal, Québec, Canada; McGill University Health Centre, Montreal, Québec, Canada; Alan Edwards Centre for Research on Pain, Montreal, Québec, Canada; Department of Anesthesia, McGill University, Montreal, Québec, Canada.
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Teles AR, Montgomery S, Thomas KC. Necrotizing Fasciitis Involving Spine: Unusual Medical Emergency for Spine Surgeon. World Neurosurg 2018; 121:124-126. [PMID: 30321674 DOI: 10.1016/j.wneu.2018.10.031] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2018] [Revised: 10/01/2018] [Accepted: 10/03/2018] [Indexed: 01/22/2023]
Abstract
BACKGROUND Necrotizing fasciitis (NF) is a surgical diagnosis characterized by a rapidly progressive soft tissue infection, widespread tissue necrosis, and associated systemic illness. Friability of the superficial fascia, dishwater-gray exudate, and absence of pus are surgical characteristics of this diagnosis. Due to rapid progression of the infection, early recognition and aggressive surgical debridement are crucial to reduce mortality. Despite being commonly seen by general, plastic, and orthopedic surgeons, NF is an extremely rare spine surgery emergency. Our objective is to report on a case of NF involving the spine and highlight this unusual surgical emergency for the spine surgeon. CASE DESCRIPTION We present a rare case of a 61-year-old woman who presented to the emergency department in septic shock. She had a 1-week history of increasing back pain before presenting to us. Computed tomography revealed extensive soft tissue emphysema with involvement of the L3 vertebral body and spina canal. She underwent emergency surgical debridement. Despite maximal medical and surgical therapies, the patient died secondary to multisystem organ failure within 36 hours of initial presentation. CONCLUSIONS To the best of our knowledge, the literature presents only 1 previous case reported involving the spine. Necrotizing fasciitis is an unusual surgical spine surgery emergency. Spine surgeons should be aware of this diagnosis in order to provide timely aggressive surgical debridement.
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Affiliation(s)
- Alisson R Teles
- McGill Scoliosis & Spine Group, McGill University, Montreal, Quebec.
| | - Spencer Montgomery
- Department of Surgery, Section of Orthopedic Surgery, University of Calgary, Alberta, Canada
| | - Kenneth C Thomas
- Department of Surgery, Section of Orthopedic Surgery, University of Calgary, Alberta, Canada
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Teles AR, Kraemer JL. Management of chronic subdural hematoma in Brazil. Arq Neuropsiquiatr 2018; 76:570-571. [PMID: 30231134 DOI: 10.1590/0004-282x20180082] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/20/2017] [Accepted: 06/06/2018] [Indexed: 11/21/2022]
Affiliation(s)
- Alisson R Teles
- McGill University, Department of Neurology and Neurosurgery, McGill Scoliosis & Spine Group, Montreal, Quebec, Canada
| | - Jorge L Kraemer
- Hospital São José, Santa Casa de Porto Alegre, Porto Alegre RS, Brasil
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Ferland CE, Teles AR, Ingelmo P, Saran N, Marchand S, Ouellet JA. Blood monoamines as potential biomarkers for conditioned pain modulation efficacy: An exploratory study in paediatrics. Eur J Pain 2018; 23:327-340. [DOI: 10.1002/ejp.1307] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2018] [Revised: 08/04/2018] [Accepted: 08/12/2018] [Indexed: 12/18/2022]
Affiliation(s)
- Catherine E. Ferland
- McGill Scoliosis and Spine Group; Montreal Québec Canada
- Shriners Hospitals for Children-Canada; Montreal Québec Canada
- McGill University Health Centre; Montreal Québec Canada
- Alan Edwards Centre for Research on Pain; Montreal Québec Canada
- Department of Anesthesia; McGill University; Montreal Québec Canada
| | - Alisson R. Teles
- McGill Scoliosis and Spine Group; Montreal Québec Canada
- Shriners Hospitals for Children-Canada; Montreal Québec Canada
- McGill University Health Centre; Montreal Québec Canada
- Alan Edwards Centre for Research on Pain; Montreal Québec Canada
- Division of Pediatric Orthopaedics; McGill University; Montreal Québec Canada
| | - Pablo Ingelmo
- McGill University Health Centre; Montreal Québec Canada
- Alan Edwards Centre for Research on Pain; Montreal Québec Canada
- Department of Anesthesia; McGill University; Montreal Québec Canada
| | - Neil Saran
- McGill Scoliosis and Spine Group; Montreal Québec Canada
- Shriners Hospitals for Children-Canada; Montreal Québec Canada
- McGill University Health Centre; Montreal Québec Canada
- Division of Pediatric Orthopaedics; McGill University; Montreal Québec Canada
| | - Serge Marchand
- Department of Surgery; Université de Sherbrooke; Sherbrooke Québec Canada
| | - Jean A. Ouellet
- McGill Scoliosis and Spine Group; Montreal Québec Canada
- Shriners Hospitals for Children-Canada; Montreal Québec Canada
- McGill University Health Centre; Montreal Québec Canada
- Alan Edwards Centre for Research on Pain; Montreal Québec Canada
- Division of Pediatric Orthopaedics; McGill University; Montreal Québec Canada
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Teles AR, Yavin D, Zafeiris CP, Thomas KC, Lewkonia P, Nicholls FH, Swamy G, Jacobs WB. Fractures After Removal of Spinal Instrumentation: Revisiting the Stress-Shielding Effect of Instrumentation in Spine Fusion. World Neurosurg 2018; 116:e1137-e1143. [PMID: 29870838 DOI: 10.1016/j.wneu.2018.05.187] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2018] [Revised: 05/24/2018] [Accepted: 05/25/2018] [Indexed: 12/23/2022]
Abstract
BACKGROUND Many practicing spine surgeons believe that instrumentation can be removed during revision surgery in successful posterolateral or anterior spinal fusions, confirmed by computed tomography and intraoperative exploration. The stress-shielding effect of spinal instrumentation was well described in the late 1980s and 1990s but has not received recent attention. Despite the paucity of recent literature, concepts underlying the biology and biomechanics of the spinal fusion mass remain particularly salient given the increasing incidence of revision spinal fusion surgery. The aim of this study was to highlight a potential complication of instrumentation removal owing to stress shielding of instrumentation on the spinal column and fusion mass. METHODS A retrospective review was performed, and a small case series was described. RESULTS In 3 cases, despite apparent solid fusion demonstrated on preoperative computed tomography and confirmed by intraoperative exploration, new fractures developed after removal of instrumentation. In these cases, fracture occurred at the transition zone between the newly rigid instrumented area and previous fusion. This highlights the relative weakness of the fusion and may be explained by the stress-shielding effect of instrumentation within the fusion mass. CONCLUSIONS Spinal instrumentation revision requires careful consideration, and routine implant removal should not be performed. The presence of a solid fusion on computed tomography and/or at intraoperative exploration may not justify implant removal in these cases. In cases of extension of a fusion, use of a bridging connection to the new implants should be considered. The cases presented demonstrate the consequences of the stress-shielding effect of implants on the spine and fusion mass.
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Affiliation(s)
- Alisson R Teles
- McGill Scoliosis & Spine Group, McGill University, Montreal, Quebec, Canada.
| | - Daniel Yavin
- Division of Neurosurgery Spine Program, Department of Clinical Neurosciences, University of Calgary, Calgary, Alberta, Canada
| | - Christos P Zafeiris
- Section of Orthopedic Surgery Spine Program, Department of Surgery, University of Calgary, Calgary, Alberta, Canada
| | - Kenneth C Thomas
- Section of Orthopedic Surgery Spine Program, Department of Surgery, University of Calgary, Calgary, Alberta, Canada
| | - Peter Lewkonia
- Section of Orthopedic Surgery Spine Program, Department of Surgery, University of Calgary, Calgary, Alberta, Canada
| | - Fred H Nicholls
- Section of Orthopedic Surgery Spine Program, Department of Surgery, University of Calgary, Calgary, Alberta, Canada
| | - Ganesh Swamy
- Section of Orthopedic Surgery Spine Program, Department of Surgery, University of Calgary, Calgary, Alberta, Canada
| | - W Bradley Jacobs
- Division of Neurosurgery Spine Program, Department of Clinical Neurosciences, University of Calgary, Calgary, Alberta, Canada
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Abstract
STUDY DESIGN Cross-sectional study. OBJECTIVES To continue the line of a previous publication using steroid for acute spinal cord injury (SCI) by spine surgeons from Latin America (LA) and assess the current status of methylprednisolone (MP) prescription in Europe (EU), Asia Pacific (AP), North America (NA), and Middle East (ME) to determine targets for educational activities suitable for each region. METHODS The English version of a previously published questionnaire was used to evaluate opinions about MP administration in acute SCI in LA, EU, AP, NA, and ME. This Internet-based survey was conducted by members of AOSpine. The questionnaire asked about demographic features, background with management of spine trauma patients, routine administration of MP in acute SCI, and reasons for MP administration. RESULTS A total of 2659 responses were obtained for the electronic questionnaire from LA, EU, AP, NA, and ME. The number of spine surgeons that treat SCI was 2206 (83%). The steroid was used by 1198 (52.9%) surgeons. The uses of MP were based predominantly on the National Acute Spinal Cord Injury Study III study (n = 595, 50%). The answers were most frequently given by spine surgeons from AP, ME, and LA. These regions presented a statistically significant difference from North America (P < .001). The number of SCI patients treated per year inversely influenced the use of MP. The higher the number of patients treated, the lower the administration rates of MP observed. CONCLUSIONS The study identified potential targets for educational campaigns, aiming to reduce inappropriate practices of MP administration.
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Affiliation(s)
- Asdrubal Falavigna
- Universidade de Caxias do Sul, Caxias do Sul, Rio Grande do Sul, Brazil,Asdrubal Falavigna, Universidade de Caxias do Sul, Rua General Arcy da Rocha Nóbrega, 401/602 Caxias do Sul, RS, Brazil.
| | | | | | | | | | | | - Abdulaziz Al-Mutair
- Alrazi Hospital, Ministry of Health & Kuwait Institute for Medical Specialization, Adailiya, Kuwait
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Ocay DD, Otis A, Teles AR, Ferland CE. Safety of Patient-Controlled Analgesia After Surgery in Children And Adolescents: Concerns And Potential Solutions. Front Pediatr 2018; 6:336. [PMID: 30460217 PMCID: PMC6232305 DOI: 10.3389/fped.2018.00336] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2018] [Accepted: 10/17/2018] [Indexed: 01/08/2023] Open
Abstract
Patient-controlled analgesia (PCA) is common practice for acute postoperative pain management. Postoperative PCA use decreases pain intensity and improves patient satisfaction when compared to non-PCA routes of medication administration. Although PCA has several advantages regarding efficacy and safety, adverse events remain a concern. Programming errors and protocols, patient monitoring, and PCA by proxy or with continuous infusion are recurring silent dangers of PCA use in children and adolescents. Innovative considerations need to be emphasized for future improvement of PCA devices for elective surgical patients. With technology within the healthcare setting advancing at a fast pace, smart pump technology is something to look forward to.
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Affiliation(s)
- Don Daniel Ocay
- Department of Experimental Surgery, McGill University, Montreal, QC, Canada.,Shriners Hospitals for Children-Canada, Montreal, QC, Canada
| | - Annik Otis
- Department of Anesthesia, McGill University, Montreal, QC, Canada.,Department of Anesthesia, Montreal Children's Hospital, Montreal, QC, Canada
| | - Alisson R Teles
- Shriners Hospitals for Children-Canada, Montreal, QC, Canada.,Integrated Program in Neuroscience, McGill University, Montreal, QC, Canada
| | - Catherine E Ferland
- Department of Experimental Surgery, McGill University, Montreal, QC, Canada.,Shriners Hospitals for Children-Canada, Montreal, QC, Canada.,Department of Anesthesia, McGill University, Montreal, QC, Canada.,Department of Anesthesia, Montreal Children's Hospital, Montreal, QC, Canada.,Integrated Program in Neuroscience, McGill University, Montreal, QC, Canada.,Child Health and Human Development, Research Institute-McGill University Health Centre, Montreal, QC, Canada
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14
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Abduljabbar FH, Teles AR, Bokhari R, Weber M, Santaguida C. Laminectomy with or Without Fusion to Manage Degenerative Cervical Myelopathy. Neurosurg Clin N Am 2018; 29:91-105. [DOI: 10.1016/j.nec.2017.09.017] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
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Teles AR, Paci M, Gutman G, Abduljabbar FH, Ouellet JA, Weber MH, Golan JD. Anatomical and technical factors associated with superior facet joint violation in lumbar fusion. J Neurosurg Spine 2017; 28:173-180. [PMID: 29219780 DOI: 10.3171/2017.6.spine17130] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE The aim of this study was to evaluate the anatomical and surgical risk factors for screw-related facet joint violation at the superior level in lumbar fusion. METHODS The authors conducted a retrospective review of a consecutive series of posterior lumbar instrumented fusions performed by a single surgeon. Inclusion criteria were primary lumbar fusion of 1 or 2 levels for degenerative disorders. The following variables were analyzed as possible risk factors: surgical technique (percutaneous vs open screw placement), depth of surgical field, degree of anterior slippage of the superior level, pedicle and facet angle, and facet degeneration of the superior level. Postoperative CT scans were evaluated by 2 independent reviewers. Axial, sagittal, and coronal views were reviewed. Pedicle screws were graded as intra-articular if they clearly interposed between the superior and inferior facet joints of the superior level. Multivariate logistic regression analyses were conducted to assess the factors associated with this complication. RESULTS One hundred thirty-one patients were included. Interobserver reliability for facet joint violation assessment was high (κ = 0.789). The incidence of superior facet joint violation was 12.59% per top-level screw (33 of 262 proximal screws). The rate of facet violation was 28.0% in the percutaneous technique group (14 of 50 patients) and 12.3% in the open surgery group (10 of 81 patients) (OR 2.26, 95% CI 1.09-4.21; p = 0.024). In multivariate logistic regression analysis, independent predictors of facet violation were percutaneous screw placement (adjusted OR 3.31, 95% CI 1.42-7.73; p = 0.006), right-side pedicle screw (adjusted OR 3.14, 95% CI 1.29-7.63; p = 0.011), and facet angle > 45° (adjusted OR 10.95, 95% CI 4.64-25.84; p < 0.0001). CONCLUSIONS The incidence of facet joint violation was higher in percutaneous minimally invasive than in open technique for posterior lumbar spine surgery. Also, coronal orientation of the facet joint is a significant risk factor independent of the surgical technique.
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Affiliation(s)
- Alisson R Teles
- 1McGill Scoliosis and Spine Group, McGill University Health Centre.,4Department of Neurosciences, Jewish General Hospital, Montreal, Quebec, Canada; and
| | | | - Gabriel Gutman
- 1McGill Scoliosis and Spine Group, McGill University Health Centre.,4Department of Neurosciences, Jewish General Hospital, Montreal, Quebec, Canada; and
| | - Fahad H Abduljabbar
- 1McGill Scoliosis and Spine Group, McGill University Health Centre.,Departments of2Orthopedic Surgery and.,5Department of Orthopedic Surgery, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Jean A Ouellet
- 1McGill Scoliosis and Spine Group, McGill University Health Centre.,Departments of2Orthopedic Surgery and
| | - Michael H Weber
- 1McGill Scoliosis and Spine Group, McGill University Health Centre.,Departments of2Orthopedic Surgery and
| | - Jeff D Golan
- 1McGill Scoliosis and Spine Group, McGill University Health Centre.,3Neurosurgery, McGill University.,4Department of Neurosciences, Jewish General Hospital, Montreal, Quebec, Canada; and
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Falavigna A, Dozza DC, Teles AR, Wong CC, Barbagallo G, Brodke D, Al-Mutair A, Ghogawala Z, Riew KD. Current Status of Worldwide Use of Patient-Reported Outcome Measures (PROMs) in Spine Care. World Neurosurg 2017; 108:328-335. [DOI: 10.1016/j.wneu.2017.09.002] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2017] [Revised: 08/30/2017] [Accepted: 09/01/2017] [Indexed: 11/28/2022]
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17
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Weber MH, Sivakumaran L, Fortin M, Teles AR, Golan JD, Santaguida C, Jarzem P, Pauyo T. Utility and costs of radiologist interpretation of perioperative imaging in patients with traumatic single-level thoracolumbar fractures. J Neurosurg Spine 2017; 27:578-583. [PMID: 28885126 DOI: 10.3171/2017.4.spine16923] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE The cost of spine management is rising. As diagnostic imaging accounts for approximately 10% of total patient care spending, there is interest in determining if economies could be made with regard to the routine consultation of radiology for image interpretation. In the context of spine trauma, both the spine surgeon and the radiologist interpret perioperative imaging. Authors of the present study investigated the impact of radiologist interpretation of perioperative imaging from patients with traumatic single-level thoracolumbar fractures given that spine surgeons are expected to be comfortable interpreting pathologies of the musculoskeletal system. METHODS The authors conducted a retrospective review of all patients presenting with a single-level thoracolumbar fracture treated at the McGill University Health Centre in the period from January 2003 to December 2010. The time between image capture and radiologist interpretation as well as the number of extraskeletal and/or incidental findings was extracted from the radiology reports on all perioperative images including radiographic, fluoroscopic, and CT images. The cost of interpretation was obtained from the provincial health insurance entity of Quebec. RESULTS Eighty-two patients met the study inclusion criteria. Radiologists took a median of 1 day (IQR 0-5.5 days) to interpret preoperative radiographs. Intraoperative fluoroscopic images and postoperative radiographs were read by the radiologist a median of 19 days (IQR 4-56.75 days) and 34 days (IQR 1-137.5 days) after capture, respectively (p < 0.05). Preoperative radiologist dictations reported extraskeletal and/or incidental findings for 8.1% of radiographs; there were no intraoperative or postoperative extraskeletal findings beyond those previously reported on the preoperative radiographs. Radiologists took a median of 1 day (IQR 0-1 day) to read both preoperative and postoperative CT scans; extraskeletal and/or incidental findings were present in 46.2% of preoperative reports and 4.5% of postoperative reports. There were no intraoperative or postoperative radiological findings that provoked reoperation. A total of 66 intraoperative fluoroscopy images and 225 postoperative radiographs were read for a cost of $1399.20 and $1867.50 (Canadian dollars), respectively, for radiologist interpretation. This cost amounted to 40.3% of all perioperative image interpretation spending. CONCLUSIONS In the management of single-level thoracolumbar fractures, radiologists add information to the diagnostic picture when interpreting preoperative radiographs and perioperative CT scans; however, the interpretation of intraoperative fluoroscopic images and postoperative radiographs comes with significant delay, does not add additional information, and represents an area of potential cost and professional-resource reduction.
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Affiliation(s)
| | | | | | - Alisson R Teles
- Neurosurgery, McGill University Health Centre, Montreal, Quebec, Canada
| | - Jeff D Golan
- Neurosurgery, McGill University Health Centre, Montreal, Quebec, Canada
| | - Carlo Santaguida
- Neurosurgery, McGill University Health Centre, Montreal, Quebec, Canada
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Mattei TA, Beer J, Teles AR, Rehman AA, Aldag J, Dinh D. Clinical Outcomes of Total Disc Replacement Versus Anterior Lumbar Interbody Fusion for Surgical Treatment of Lumbar Degenerative Disc Disease. Global Spine J 2017; 7:452-459. [PMID: 28811990 PMCID: PMC5544164 DOI: 10.1177/2192568217712714] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
STUDY DESIGN The authors performed a retrospective controlled study of patients diagnosed with lumbar degenerative disc disease who received surgical intervention (either total disc replacement [TDR]/Activ-L or anterior lumbar interbody fusion [ALIF]) at a single tertiary-care hospital from 2007-2010. OBJECTIVES To investigate the clinical outcomes after TDR in comparison with ALIF for surgical treatment of lumbar degenerative disc disease (DDD). METHODS Analyzed data included intra-operative blood loss, time to return to work, and clinical outcomes as evaluated through the Oswestry Disability Index (ODI) and the Visual Analog Scale (VAS) pain questionnaires pre-operatively and at 6 weeks, 3 months, 6 months, and 1 year postoperative follow-up. RESULTS At the univariate analysis, patients submitted to TDR presented significantly lower VAS pain scores than patients who received ALIF starting at 6 weeks (P < .001) and continuing through one year postoperatively (P = .007). Patients submitted to TDR also presented significantly lower ODI disability scores at all time points. There was a significant difference in the number of days to return to work, with TDR patients returning to work on average 65 days sooner than ALIF patients (P = .011). There was no significant difference in the total blood loss between both groups. CONCLUSIONS The results of this retrospective controlled study suggest that, in comparison with patients submitted to ALIF, patients submitted to TDR present quicker return to work, less back pain, and lower disability scores at 1 year follow-up.
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Affiliation(s)
- Tobias A. Mattei
- Neurosurgery & Spine Specialists – Eastern Maine Medical Center, Bangor, ME, USA,Tobias A. Mattei, Neurosurgery & Spine Specialists, Eastern Maine Medical Center, 417 State St, Suite 221, Bangor, ME 04401, USA.
| | - Jennifer Beer
- University of Illinois College of Medicine at Peoria, IL, USA
| | - Alisson R. Teles
- Department of Clinical Neurosciences – Neurosurgery, University of Calgary, Calgary, Alberta, Canada
| | - Azeem A. Rehman
- University of Illinois College of Medicine at Peoria, IL, USA
| | - Jean Aldag
- University of Illinois College of Medicine at Peoria, IL, USA
| | - Dzung Dinh
- University of Illinois College of Medicine at Peoria, IL, USA
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Abstract
STUDY DESIGN Systematic review. OBJECTIVE There is a need for synthesizing data on effectiveness of treatments for patients with adult spinal deformity (ASD) due to its increasing prevalence and health care costs for these patients. The objective of this review was to estimate the effectiveness of surgery versus nonoperative care in patients with ASD. METHODS A systematic review of articles in published in English using PubMed between 2005 and 2015. Surgical and nonsurgical series that reported baseline and follow-up health-related quality of life measures of patients with ASD with a minimum 2 years of follow-up were selected. Independent extraction of articles by 2 authors using predefined data fields, including risk of bias assessment. RESULTS Surgery significantly reduces disability, pain, and improves patients' quality of life. The average postoperative improvement in Oswestry Disability Index was -19.1 (±9.0), Numerical Rating Scale back pain -4.14 (±1.38), Numerical Rating Scale leg pain -3.36 (±1.33), Short-Form Health Survey 36-SF36-Physical Component score 11.2 (±5.07), and Short-Form Health Survey 36-Mental Component score 9.93 (±4.96). The complication rate ranged from 9.52% to 81.52% (mean = 39.62%), and the need for revision surgery ranged from 1.72% to 40.0% (mean = 15.71%). The best existing evidence about nonoperative care of ASD is provided from observational studies with very high risk of bias. Quantitative analyses of nonsurgical cohorts did not demonstrate significant changes in quality of life of patients after 2 years of observation. CONCLUSIONS This data may assist clinicians to counsel patients, as well as to inform health care providers and policymakers about what to expect from the treatment for ASD.
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Affiliation(s)
- Alisson R. Teles
- Department of Clinical Neurosciences – Neurosurgery, University of Calgary, Calgary, Alberta, Canada,Alisson R. Teles, Foothills Medical Centre, 12Fl, 1403 29th Street NW, Calgary, Alberta T2N 2T9, Canada.
| | - Tobias A. Mattei
- Neurosurgery & Spine Specialists, Eastern Maine Medical Center, Bangor, Maine, USA
| | - Orlando Righesso
- Department of Orthopedics, Universidade de Caxias do Sul, Caxias do Sul, Rio Grande do Sul, Brazil
| | - Asdrubal Falavigna
- Department of Neurosurgery, Universidade de Caxias do Sul, Caxias do Sul, Rio Grande do Sul, Brazil
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Mattei TA, Teles AR. Letter to the Editor. The ancient "apples and oranges" conundrum: a call for methodological precision. J Neurosurg Spine 2017; 26:765-768. [PMID: 28338453 DOI: 10.3171/2016.10.spine161185] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Tobias A Mattei
- Brain & Spine Specialists, Eastern Maine Medical Center, Bangor, ME.,McGill University, Montreal, Quebec, Canada
| | - Alisson R Teles
- Brain & Spine Specialists, Eastern Maine Medical Center, Bangor, ME.,McGill University, Montreal, Quebec, Canada
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R. Teles A, R. Roxo M, V.M. Collares M, R. Neves K, Cambruzzi E, P. Ferreira M. Recurrent Scalp Lesions from Glioblastoma: Case Report and Literature Review. CCTR 2016. [DOI: 10.2174/1573394712666160926100147] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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22
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Brasil AVB, Teles AR, Roxo MR, Schuster MN, Zauk EB, Barcellos GDC, Costa PRFD, Ferreira NP, Kraemer JL, Ferreira MP, Gobbato PL, Worm PV. A simple scoring system for predicting early major complications in spine surgery: the cumulative effect of age and size of surgery. Arq Neuro-Psiquiatr 2016; 74:803-809. [DOI: 10.1590/0004-282x20160127] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/27/2016] [Accepted: 06/20/2016] [Indexed: 11/22/2022]
Abstract
ABSTRACT Objective To analyze the cumulative effect of risk factors associated with early major complications in postoperative spine surgery. Methods Retrospective analysis of 583 surgically-treated patients. Early “major” complications were defined as those that may lead to permanent detrimental effects or require further significant intervention. A balanced risk score was built using multiple logistic regression. Results Ninety-two early major complications occurred in 76 patients (13%). Age > 60 years and surgery of three or more levels proved to be significant independent risk factors in the multivariate analysis. The balanced scoring system was defined as: 0 points (no risk factor), 2 points (1 factor) or 4 points (2 factors). The incidence of early major complications in each category was 7% (0 points), 15% (2 points) and 29% (4 points) respectively. Conclusions This balanced scoring system, based on two risk factors, represents an important tool for both surgical indication and for patient counseling before surgery.
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Teles AR. Basic Statistical Shortcomings Can Induce Mistaken Interpretation of Neurosurgical Articles. World Neurosurg 2016; 92:577-578. [DOI: 10.1016/j.wneu.2015.12.090] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2015] [Accepted: 12/26/2015] [Indexed: 10/22/2022]
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Mattei TA, Rehman AA, Teles AR, Aldag JC, Dinh DH, McCall TD. The ‘Lumbar Fusion Outcome Score’ (LUFOS): a new practical and surgically oriented grading system for preoperative prediction of surgical outcomes after lumbar spinal fusion in patients with degenerative disc disease and refractory chronic axial low back pain. Neurosurg Rev 2016; 40:67-81. [DOI: 10.1007/s10143-016-0751-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2015] [Revised: 03/06/2016] [Accepted: 04/09/2016] [Indexed: 10/21/2022]
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Teles AR, Cabrera J, Riew KD, Falavigna A. Steroid Use for Acute Spinal Cord Injury in Latin America: A Potentially Dangerous Practice Guided by Fear of Lawsuit. World Neurosurg 2016; 88:342-349. [DOI: 10.1016/j.wneu.2015.12.045] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2015] [Accepted: 12/14/2015] [Indexed: 10/22/2022]
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Falavigna A, Scheverin N, Righesso O, Teles AR, Gullo MC, Cheng JS, Riew KD. Economic value of treating lumbar disc herniation in Brazil. J Neurosurg Spine 2016; 24:608-14. [DOI: 10.3171/2015.7.spine15441] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
OBJECT
Lumbar discectomy is one of the most common surgical spine procedures. In order to understand the value of this surgical care, it is important to understand the costs to the health care system and patient for good results. The objective of this study was to evaluate for the first time the cost-effectiveness of spine surgery in Latin America for lumbar discectomy in terms of cost per quality-adjusted life year (QALY) gained for patients in Brazil.
METHODS
The authors performed a prospective cohort study involving 143 consecutive patients who underwent open discectomy for lumbar disc herniation (LDH). Patient-reported outcomes were assessed utilizing the SF-6D, which is derived from a 12-month variation of the SF-36. Direct medical costs included medical reimbursement, costs of hospital care, and overall resource consumption. Disability losses were considered indirect costs. A 4-year horizon with 3% discounting was applied to health-utilities estimates. Sensitivity analysis was performed by varying utility gain by 20%. The costs were expressed in Reais (R$) and US dollars ($), applying an exchange rate of 2.4:1 (the rate at the time of manuscript preparation).
RESULTS
The direct and indirect costs of open lumbar discectomy were estimated at an average of R$3426.72 ($1427.80) and R$2027.67 ($844.86), respectively. The mean total cost of treatment was estimated at R$5454.40 ($2272.66) (SD R$2709.17 [$1128.82]). The SF-6D utility gain was 0.044 (95% CI 0.03197–0.05923, p = 0.017) at 12 months. The 4-year discounted QALY gain was 0.176928. The estimated cost-utility ratio was R$30,828.35 ($12,845.14) per QALY gained. The sensitivity analysis showed a range of R$25,690.29 ($10,714.28) to R$38,535.44 ($16,056.43) per QALY gained.
CONCLUSIONS
The use of open lumbar discectomy to treat LDH is associated with a significant improvement in patient outcomes as measured by the SF-6D. Open lumbar discectomy performed in the Brazilian supplementary health care system provides a cost-utility ratio of R$30,828.35 ($12,845.14) per QALY. The value of acceptable cost-effectiveness will vary by country and region.
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Affiliation(s)
- Asdrubal Falavigna
- 1Department of Neurosurgery, Laboratory of Clinical Studies and Basic Models of Spinal Disorders and
| | - Nicolas Scheverin
- 2Department of Orthopaedics, Hospital Dr. Diego E. Thompson, Buenos Aires, Argentina
| | - Orlando Righesso
- 1Department of Neurosurgery, Laboratory of Clinical Studies and Basic Models of Spinal Disorders and
| | - Alisson R. Teles
- 1Department of Neurosurgery, Laboratory of Clinical Studies and Basic Models of Spinal Disorders and
| | - Maria Carolina Gullo
- 3Accountancy and Economic Sciences Center, University of Caxias do Sul, Caxias do Sul, Rio Grande do Sul, Brazil
| | - Joseph S. Cheng
- 4Department of Neurosurgery, Vanderbilt University School of Medicine, Nashville, Tennessee
| | - K. Daniel Riew
- 5Department of Neurological Surgery, Washington University School of Medicine, Saint Louis, Missouri
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Teles AR, Righesso O, Gullo MCR, Ghogawala Z, Falavigna A. Perspective of Value-Based Management of Spinal Disorders in Brazil. World Neurosurg 2016; 87:346-54. [DOI: 10.1016/j.wneu.2015.11.047] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2015] [Revised: 11/12/2015] [Accepted: 11/14/2015] [Indexed: 01/22/2023]
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Mattei TA, Teles AR, Dinh DH. Vertebral body fracture after anterior cervical discectomy and fusion with zero-profile anchored cages in adjacent levels: a cautionary tale. Eur Spine J 2016; 29:943-952. [PMID: 26733015 DOI: 10.1007/s00586-015-4358-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/28/2015] [Revised: 12/03/2015] [Accepted: 12/03/2015] [Indexed: 11/29/2022]
Abstract
BACKGROUND CONTEXT Zero-profile (also called self-locking, anchored or stand-alone cages) have been recently proposed as an interesting alternative for anterior cervical discectomy and fusion (ACDF), as they are supposed to reduce the rates of post-operative cage extrusion without necessarily incurring in the additional surgical time and increased rates of dysphagia associated with plating. Nevertheless, the exact indications of zero-profile anchored cages have not yet been established in the literature. PURPOSE To report the first case of a vertebral body fracture between the blades of zero-profile anchored cages after ACDFs in adjacent levels and to review the available literature on hardware-related complications after multi-level ACDFs with zero-profile anchored cages. STUDY DESIGN Case report and systematic literature review. METHODS The authors report the first case of a vertebral body fracture between the blades of zero-profile anchored cages after ACDFs in adjacent levels. The patient presented with refractory mechanical neck pain at the 1-month post-operative follow-up, ultimately requiring a posterior instrumented fusion. A comprehensive systematic literature review on the available data regarding the safety, complications as well as radiological and clinical outcomes of zero-profile anchored cages is also performed. RESULTS In the reported case, the use of zero-profile anchored cages in adjacent levels on the cervical spine led to a fracture of the vertebral body between the cages at the 1-month follow-up, with anterior avulsion of the part of the vertebral body where the blades from the two cages converged. According to the systematic literature review which included 409 patients from 10 different clinical series (with a total cumulative follow-up of approximately 535 patients-year), there were only two reported hardware-related complications after ACDF with zero-profile anchored cages, none of them involving fracture at the level of convergence of blades or screws. CONCLUSIONS Although hardware-related complications after the use of zero-profile anchored cages seem to be rare events, future biomechanical and clinical studies are warranted in order to evaluate the safety of employing such devices for the treatment of multilevel degenerative disc disease in the cervical spine.
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Affiliation(s)
- Tobias A Mattei
- Department of Neurosurgery, Brain and Spine Center/InvisionHealth, 400 International Drive, Buffalo, NY, 14221, USA.
| | - Alisson R Teles
- Neurosurgery Unit, Hospital São José-Santa Casa de Porto Alegre, Porto Alegre, Brazil
| | - Dzung H Dinh
- Department of Neurosurgery, The University of Illinois at Peoria, Peoria, IL, USA
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Tai P, Koul R, Vu K, Edwards T, Buwembo J, Teles AR, Salim M. A Simplified Supine Technique Expedites the Delivery of Effective Craniospinal Radiation to Medulloblastoma - Comparison with Other Techniques in the Literature. Cureus 2015; 7:e404. [PMID: 26819866 PMCID: PMC4723302 DOI: 10.7759/cureus.404] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
A 28-year-old man presented to the emergency room with a severe headache of one day's duration. A computerized tomography scan showed a hemorrhagic tumor measuring 3.9 x 4.4 cm in the left cerebellar hemisphere. The resection specimen revealed medulloblastoma. He had two episodes of rebleeding and multiple postoperative issues preventing the use of prone craniospinal radiotherapy. We designed a supine technique for this tall man, which was not complicated to set up. The rapid safe implementation of this technique allowed us to avoid further rebleeding and successfully treat the residual tumor. This technique is the described technique in this case report and is compared to other techniques. At 7.5 years after surgery, he is alive without cancer and with only a mild residual deficit. This case is unusual since the majority of patients with the diagnosis of hemorrhagic medulloblastoma died.
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Affiliation(s)
- Patricia Tai
- Department of Radiation Oncology, Allan Blair Cancer Center, University of Saskatchewan
| | - Rashmi Koul
- Radiation Oncology, CancerCare Manitoba, University of Manitoba
| | - Khanh Vu
- Department of Radiation Oncology, Maisonneuve-Rosemont Hospital
| | - Trent Edwards
- Department of Radiation Oncology, Allan Blair Cancer Center, University of Saskatchewan
| | | | - Alisson R Teles
- Department of Neurosurgery / Laboratory of Clinical Studies and Basic Models of Spinal Disorders, Universidade de Caxias do Sul
| | - Muhammad Salim
- Department of Medical Oncology, Allan Blair Cancer Center, University of Saskatchewan
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Mattei TA, Teles AR, Mendel E. Modern surgical techniques for management of soft tissue sarcomas involving the spine: outcomes and complications. J Surg Oncol 2014; 111:580-6. [PMID: 25413665 DOI: 10.1002/jso.23805] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2014] [Accepted: 07/29/2014] [Indexed: 01/10/2023]
Abstract
Several types of soft tissue sarcomas may locally extend to the spine. The best therapeutic strategy for such lesions strongly depends on the histological diagnosis. In this article the authors provide an up-to-date review of current guidelines regarding the management of soft tissue sarcomas involving the spine. Special attention is given to outcomes and complications of modern surgical series in order to highlight current challenges in the management of such lesions.
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Affiliation(s)
- Tobias A Mattei
- Department of Neurosurgery, The Brain & Spine Center, Invision Health, Buffalo, New York
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Falavigna A, Righesso O, Volquind D, Bueno Salgado K, Teles AR. Intraosseous sacral paraganglioma with extradural extension: case report. Acta Neurochir (Wien) 2010; 152:475-80. [PMID: 19730780 DOI: 10.1007/s00701-009-0362-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2008] [Accepted: 03/31/2009] [Indexed: 10/20/2022]
Abstract
BACKGROUND Paragangliomas are tumors that arise from the paraganglion system, which is a component of the neuroendocrine system. Approximately 10% are located in the extra-adrenal paraganglion system. Paragangliomas of the spine, however, are rare. They usually present as an intradural tumor in the cauda equina. There are only three reports of primary intraosseous paragangliomas of the sacrum. CASE DESCRIPTION A 69-year-old man presented with low back pain and urinary incontinence. Imaging revealed a large intraosseous mass at S2, S3 and S4. Surgical resection was accomplished through a posterior midline incision exposing the spine from L5 to the coccyx. The tumor was located in the extradural space. It was friable, grayish and bleeding. Total tumor removal was performed, with normal bone margins. Follow-up at 2 years showed complete resolution of the preoperative symptoms and no evidence of local recurrence. CONCLUSION Although rare, the possibility of paraganglioma should be included in the differential diagnosis of sacral tumors. The majority of the spinal paragangliomas are benign, slowly growing tumors with low proliferative activity. Despite these characteristics, local recurrence has been reported in cases of both macroscopically total and subtotal resection. Postoperative radiation therapy for patients with incomplete excision may not prevent recurrence, so gross tumor removal should be the goal of surgery.
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