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Manzetti M, Ruffilli A, Barile F, Viroli G, Traversari M, Vita F, Cerasoli T, Arceri A, Artioli E, Mazzotti A, Faldini C. Correction to: Is there a skeletal age index that can predict accurate curve progression in adolescent idiopathic scoliosis? A systematic review. Pediatr Radiol 2024; 54:662. [PMID: 38311683 DOI: 10.1007/s00247-024-05871-2] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2024]
Affiliation(s)
- Marco Manzetti
- DIBINEB Dipartimento di scienze biomediche e neuromotorie, University of Bologna, Bologna, Italy.
- 1st Orthopaedic and Traumatologic Clinic, IRCCS Istituto Ortopedico Rizzoli, Via Giulio Cesare Pupilli 1, 40136, Bologna, Italy.
| | - Alberto Ruffilli
- DIBINEB Dipartimento di scienze biomediche e neuromotorie, University of Bologna, Bologna, Italy
- 1st Orthopaedic and Traumatologic Clinic, IRCCS Istituto Ortopedico Rizzoli, Via Giulio Cesare Pupilli 1, 40136, Bologna, Italy
| | - Francesca Barile
- DIBINEB Dipartimento di scienze biomediche e neuromotorie, University of Bologna, Bologna, Italy
- 1st Orthopaedic and Traumatologic Clinic, IRCCS Istituto Ortopedico Rizzoli, Via Giulio Cesare Pupilli 1, 40136, Bologna, Italy
| | - Giovanni Viroli
- DIBINEB Dipartimento di scienze biomediche e neuromotorie, University of Bologna, Bologna, Italy
- 1st Orthopaedic and Traumatologic Clinic, IRCCS Istituto Ortopedico Rizzoli, Via Giulio Cesare Pupilli 1, 40136, Bologna, Italy
| | - Matteo Traversari
- 1st Orthopaedic and Traumatologic Clinic, IRCCS Istituto Ortopedico Rizzoli, Via Giulio Cesare Pupilli 1, 40136, Bologna, Italy
| | - Fabio Vita
- 1st Orthopaedic and Traumatologic Clinic, IRCCS Istituto Ortopedico Rizzoli, Via Giulio Cesare Pupilli 1, 40136, Bologna, Italy
| | - Tosca Cerasoli
- 1st Orthopaedic and Traumatologic Clinic, IRCCS Istituto Ortopedico Rizzoli, Via Giulio Cesare Pupilli 1, 40136, Bologna, Italy
| | - Alberto Arceri
- 1st Orthopaedic and Traumatologic Clinic, IRCCS Istituto Ortopedico Rizzoli, Via Giulio Cesare Pupilli 1, 40136, Bologna, Italy
| | - Elena Artioli
- DIBINEB Dipartimento di scienze biomediche e neuromotorie, University of Bologna, Bologna, Italy
- 1st Orthopaedic and Traumatologic Clinic, IRCCS Istituto Ortopedico Rizzoli, Via Giulio Cesare Pupilli 1, 40136, Bologna, Italy
| | - Antonio Mazzotti
- DIBINEB Dipartimento di scienze biomediche e neuromotorie, University of Bologna, Bologna, Italy
- 1st Orthopaedic and Traumatologic Clinic, IRCCS Istituto Ortopedico Rizzoli, Via Giulio Cesare Pupilli 1, 40136, Bologna, Italy
| | - Cesare Faldini
- DIBINEB Dipartimento di scienze biomediche e neuromotorie, University of Bologna, Bologna, Italy
- 1st Orthopaedic and Traumatologic Clinic, IRCCS Istituto Ortopedico Rizzoli, Via Giulio Cesare Pupilli 1, 40136, Bologna, Italy
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Viroli G, Ruffilli A, Ialuna M, Barile F, Manzetti M, Traversari M, Vita F, Faldini C. Restoration of Spinopelvic Alignment After Reduction of High-grade Spondylolisthesis: Myth or Reality? A Systematic Review of the literature and Meta-analysis. Clin Spine Surg 2024:01933606-990000000-00284. [PMID: 38531831 DOI: 10.1097/bsd.0000000000001593] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2023] [Accepted: 01/22/2024] [Indexed: 03/28/2024]
Abstract
STUDY DESIGN Systematic review and meta-analysis of literature. OBJECTIVE The aim of the presented study is to assess whether the reduction of high-grade spondylolisthesis (HGS) through the correction of lumbosacral kyphosis leads to a decrease in the sagittal spinopelvic compensatory mechanisms. SUMMARY OF BACKGROUND DATA HGS is as an anterior translation of a vertebra, >50%. It is also characterized by a kyphotic deformity of the affected level. This combination of translation and kyphosis leads to compensatory mechanisms on the sagittal plane [pelvic retroversion, increased lumbar lordosis (LL), reduction in thoracic kyphosis (TK)]. METHODS A systematic search of electronic databases was conducted. Inclusion criteria were diagnosis of HGS (Meyerding >II, Slip% >50%), partial or complete reduction surgery (with a significant decrease in Slip%), and report of spinopelvic parameters (pelvic incidence, pelvic tilt, or sacral slope). Clinical and radiographic outcomes were extracted and summarized. Meta-analyses were performed to estimate the differences between preoperative and postoperative spinopelvic alignment measures. P<0.05 was considered significant. RESULTS Eighteen studies were included. PT showed a statistically significant decrease of -2.1217 (95% CI: -3.4803 to -0.7630), while SS showed a significant increase of 4.8349 (95% CI: 2.7462-6.9236). Conversely, both LL and TK showed nonsignificant changes, -4.7043 (95% CI: -10.4535 to 1.0449) and 6.3881 (95% CI: -0.8344 to 13.6106), respectively. VAS significantly decreased by -3.1950 (95% CI: -4.9462 to -1.4439). CONCLUSIONS The meta-analysis showed mild, yet statistically significant, decrease of PT and an increase in SS after HGS reduction. Conversely, nonstatically significant decrease in LL and an increase in TK occurred. The clinical significance of these results remains questionable. LEVEL OF EVIDENCE Level IV.
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Affiliation(s)
- Giovanni Viroli
- Department of Biomedical and Neuromotor Science, IRCCS Istituto Ortopedico Rizzoli, DIBINEM, 1st Orthopaedic and Traumatologic Clinic, University of Bologna, Bologna, Italy
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Ruffilli A, Traversari M, Viroli G, Manzetti M, Ialuna M, Morandi Guaitoli M, Mazzotti A, Artioli E, Zielli SO, Arceri A, Faldini C. Similar Short-Term Outcomes of Adolescent Idiopathic Scoliosis Surgery with or without Drainage: A Systematic Review of the Literature and Meta-Analysis. J Pers Med 2024; 14:339. [PMID: 38672966 PMCID: PMC11051329 DOI: 10.3390/jpm14040339] [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: 02/11/2024] [Revised: 03/18/2024] [Accepted: 03/20/2024] [Indexed: 04/28/2024] Open
Abstract
The use of closed suction drains post posterior spinal fusion for adolescent idiopathic scoliosis (AIS) is common practice, although evidence on its impact is limited compared to that for knee and hip arthroplasty. This study aimed to assess the effect of closed suction drainage on short-term post-operative outcomes in AIS surgery. A systematic review following PRISMA guidelines was conducted, including studies comparing outcomes with and without drainage. Data on blood loss, transfusions, hospital stay, and complications were collected and subjected to meta-analysis. Five studies involving 772 patients were analyzed. The meta-analysis found no significant difference in blood transfusion rates (p = 0.107) or hospital stay (p = 0.457) between groups. Complications, including surgical site infections, were more common without drainage, though not statistically significant (p = 0.356). Reintervention rates were higher in the no-drainage group, but not significantly (p = 0.260). Overall, this review found no significant short-term outcome differences, suggesting clinical judgment should guide drainage decisions. Further research, particularly with enhanced recovery protocols, is warranted to clarify drainage's role in AIS surgery.
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Affiliation(s)
- Alberto Ruffilli
- IRCCS Istituto Ortopedico Rizzoli, 1st Orthopaedics and Traumatology Clinic, University of Bologna, 40136 Bologna, Italy; (A.R.); (M.T.); (G.V.); (M.M.); (M.I.); (M.M.G.); (S.O.Z.); (A.A.)
- Department of Biomedical and Neuromotor Sciences, University of Bologna, 40123 Bologna, Italy
| | - Matteo Traversari
- IRCCS Istituto Ortopedico Rizzoli, 1st Orthopaedics and Traumatology Clinic, University of Bologna, 40136 Bologna, Italy; (A.R.); (M.T.); (G.V.); (M.M.); (M.I.); (M.M.G.); (S.O.Z.); (A.A.)
| | - Giovanni Viroli
- IRCCS Istituto Ortopedico Rizzoli, 1st Orthopaedics and Traumatology Clinic, University of Bologna, 40136 Bologna, Italy; (A.R.); (M.T.); (G.V.); (M.M.); (M.I.); (M.M.G.); (S.O.Z.); (A.A.)
- Department of Biomedical and Neuromotor Sciences, University of Bologna, 40123 Bologna, Italy
| | - Marco Manzetti
- IRCCS Istituto Ortopedico Rizzoli, 1st Orthopaedics and Traumatology Clinic, University of Bologna, 40136 Bologna, Italy; (A.R.); (M.T.); (G.V.); (M.M.); (M.I.); (M.M.G.); (S.O.Z.); (A.A.)
- Department of Biomedical and Neuromotor Sciences, University of Bologna, 40123 Bologna, Italy
| | - Marco Ialuna
- IRCCS Istituto Ortopedico Rizzoli, 1st Orthopaedics and Traumatology Clinic, University of Bologna, 40136 Bologna, Italy; (A.R.); (M.T.); (G.V.); (M.M.); (M.I.); (M.M.G.); (S.O.Z.); (A.A.)
| | - Manuele Morandi Guaitoli
- IRCCS Istituto Ortopedico Rizzoli, 1st Orthopaedics and Traumatology Clinic, University of Bologna, 40136 Bologna, Italy; (A.R.); (M.T.); (G.V.); (M.M.); (M.I.); (M.M.G.); (S.O.Z.); (A.A.)
| | - Antonio Mazzotti
- IRCCS Istituto Ortopedico Rizzoli, 1st Orthopaedics and Traumatology Clinic, University of Bologna, 40136 Bologna, Italy; (A.R.); (M.T.); (G.V.); (M.M.); (M.I.); (M.M.G.); (S.O.Z.); (A.A.)
- Department of Biomedical and Neuromotor Sciences, University of Bologna, 40123 Bologna, Italy
| | - Elena Artioli
- IRCCS Istituto Ortopedico Rizzoli, 1st Orthopaedics and Traumatology Clinic, University of Bologna, 40136 Bologna, Italy; (A.R.); (M.T.); (G.V.); (M.M.); (M.I.); (M.M.G.); (S.O.Z.); (A.A.)
- Department of Biomedical and Neuromotor Sciences, University of Bologna, 40123 Bologna, Italy
| | - Simone Ottavio Zielli
- IRCCS Istituto Ortopedico Rizzoli, 1st Orthopaedics and Traumatology Clinic, University of Bologna, 40136 Bologna, Italy; (A.R.); (M.T.); (G.V.); (M.M.); (M.I.); (M.M.G.); (S.O.Z.); (A.A.)
| | - Alberto Arceri
- IRCCS Istituto Ortopedico Rizzoli, 1st Orthopaedics and Traumatology Clinic, University of Bologna, 40136 Bologna, Italy; (A.R.); (M.T.); (G.V.); (M.M.); (M.I.); (M.M.G.); (S.O.Z.); (A.A.)
| | - Cesare Faldini
- IRCCS Istituto Ortopedico Rizzoli, 1st Orthopaedics and Traumatology Clinic, University of Bologna, 40136 Bologna, Italy; (A.R.); (M.T.); (G.V.); (M.M.); (M.I.); (M.M.G.); (S.O.Z.); (A.A.)
- Department of Biomedical and Neuromotor Sciences, University of Bologna, 40123 Bologna, Italy
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Faldini C, Barile F, Viroli G, Manzetti M, Ialuna M, Traversari M, Paolucci A, Rinaldi A, D'Antonio G, Ruffilli A. Freehand power-assisted pedicle screw placement in scoliotic patients: results on 5522 consecutive pedicle screws. Musculoskelet Surg 2024; 108:63-68. [PMID: 35943693 PMCID: PMC10881638 DOI: 10.1007/s12306-022-00754-x] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Accepted: 07/19/2022] [Indexed: 10/15/2022]
Abstract
Pedicle screws is the current gold standard in spine surgery, achieving a solid tricolumnar fixation which is unreachable by wires and hooks. The freehand technique is the most widely adopted for pedicle screws placing. While freehand technique has been classically performed with manual tools, there has been a recent trend toward the use of power tools. However, placing a pedicle screw remains a technically demanding procedure with significant risk of complications. The aim of this article is to retrospectively evaluate safety and accuracy of free-hand power-assisted pedicle screw placement in a cohort of patients who underwent correction and fusion surgery for scoliosis (both idiopathic and non-idiopathic) in our department. A retrospective review of all patients with scoliosis who underwent surgery and received a postoperative CT scan in our department in a 9-year period was undertaken. Screw density, number and location of pedicle screws were measured using pre and postoperative full-length standing and lateral supine side-bending radiographs. Then, postoperative CT scan was used to assess the accuracy of screw placement according to Gertzbein-Robbins scale. Malpositioned screws were divided according to their displacement direction. Finally, intra and postoperative neurological complications and the need for revision of misplaced screws were recorded. A total of 205 patients were included, with a follow-up of 64.9 ± 38.67 months. All constructs were high density (average density 1.97 ± 0.04), and the average number of fusion levels was 13.72 ± 1.97. A total of 5522 screws were placed: 5308 (96.12%) were grade A, 141 (2.5%) grade B, 73 (1.32%) grade C. Neither grade D nor grade E trajectories were found. The absolute accuracy (grade A) rate was 96.12% (5308/5522) and the effective accuracy (within the safe zone, grade A + B) was 98.6% (5449/5522). Of the 73 misplaced screws (grade C), 59 were lateral (80.80%), 8 anterior (10.95%) and 6 medial (8.22%); 58 were in convexity, while 15 were in concavity (the difference was not statistically significant, p = 0.33). Intraoperatively, neither neurological nor vascular complications were recorded. Postoperatively, 4 screws needed revision (0.072% of the total): Power-assisted pedicle screw placing may be a safe an accurate technique in the scoliosis surgery, both of idiopathic and non-idiopathic etiology. Further, and higher quality, research is necessary in order to better assess the results of this relatively emerging technique.
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Affiliation(s)
- C Faldini
- IRCCS Istituto Ortopedico Rizzoli, Via Giulio Cesare Pupilli 1, 40136, Bologna, Italy
| | - F Barile
- IRCCS Istituto Ortopedico Rizzoli, Via Giulio Cesare Pupilli 1, 40136, Bologna, Italy
| | - G Viroli
- IRCCS Istituto Ortopedico Rizzoli, Via Giulio Cesare Pupilli 1, 40136, Bologna, Italy
| | - M Manzetti
- IRCCS Istituto Ortopedico Rizzoli, Via Giulio Cesare Pupilli 1, 40136, Bologna, Italy.
| | - M Ialuna
- IRCCS Istituto Ortopedico Rizzoli, Via Giulio Cesare Pupilli 1, 40136, Bologna, Italy
| | - M Traversari
- IRCCS Istituto Ortopedico Rizzoli, Via Giulio Cesare Pupilli 1, 40136, Bologna, Italy
| | - A Paolucci
- IRCCS Istituto Ortopedico Rizzoli, Via Giulio Cesare Pupilli 1, 40136, Bologna, Italy
| | - A Rinaldi
- IRCCS Istituto Ortopedico Rizzoli, Via Giulio Cesare Pupilli 1, 40136, Bologna, Italy
| | - G D'Antonio
- IRCCS Istituto Ortopedico Rizzoli, Via Giulio Cesare Pupilli 1, 40136, Bologna, Italy
| | - A Ruffilli
- IRCCS Istituto Ortopedico Rizzoli, Via Giulio Cesare Pupilli 1, 40136, Bologna, Italy
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Faldini C, Barile F, D'Antonio G, Rinaldi A, Manzetti M, Viroli G, Vita F, Traversari M, Cerasoli T, Ruffilli A. Incidental dural tears do not affect the overall patients' reported outcome of spine surgery at long-term follow-up: results of a systematic review. Musculoskelet Surg 2024; 108:47-61. [PMID: 36877336 DOI: 10.1007/s12306-023-00777-y] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Accepted: 02/12/2023] [Indexed: 03/07/2023]
Abstract
To conduct a systematic review of the literature in order to establish if there is an overall adverse effect of accidental durotomy on the long-term patients' reported outcome after elective spine surgery. A systematic literature search was carried out according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Data about pre- and postoperative clinical outcomes of patients with accidental durotomy and patients without were extracted and analysed. After screening, eleven studies were included with a total of 80,541 patients. About 4112 of these patients (5.10%) had incidental dural tear. When comparing patients with dural tear to patients without, 9/11 authors found no patients' reported differences at last follow-up. One author found a slightly worse VAS back pain in dural tear patients, and another author found inferior SF-36 and ODI scores in dural tear patients (both below minimal clinically important difference). Accidental dural tear did not have a significant adverse effect on clinical outcome of elective spine surgery. More studies are needed to better demonstrate this result.
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Affiliation(s)
- C Faldini
- 1St Orthopaedics and Traumatology Clinic, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy, via G.C. Pupilli, 1, 40136
- Department of Biomedical and Neuromotor Science-DIBINEM, University of Bologna, Bologna, Italy
| | - F Barile
- 1St Orthopaedics and Traumatology Clinic, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy, via G.C. Pupilli, 1, 40136
- Department of Biomedical and Neuromotor Science-DIBINEM, University of Bologna, Bologna, Italy
| | - G D'Antonio
- 1St Orthopaedics and Traumatology Clinic, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy, via G.C. Pupilli, 1, 40136
| | - A Rinaldi
- 1St Orthopaedics and Traumatology Clinic, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy, via G.C. Pupilli, 1, 40136
| | - M Manzetti
- 1St Orthopaedics and Traumatology Clinic, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy, via G.C. Pupilli, 1, 40136
| | - G Viroli
- 1St Orthopaedics and Traumatology Clinic, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy, via G.C. Pupilli, 1, 40136
| | - F Vita
- 1St Orthopaedics and Traumatology Clinic, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy, via G.C. Pupilli, 1, 40136
| | - M Traversari
- 1St Orthopaedics and Traumatology Clinic, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy, via G.C. Pupilli, 1, 40136.
| | - T Cerasoli
- 1St Orthopaedics and Traumatology Clinic, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy, via G.C. Pupilli, 1, 40136
| | - A Ruffilli
- 1St Orthopaedics and Traumatology Clinic, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy, via G.C. Pupilli, 1, 40136
- Department of Biomedical and Neuromotor Science-DIBINEM, University of Bologna, Bologna, Italy
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Manzetti M, Ruffilli A, Viroli G, Traversari M, Ialuna M, Salamanna F, Neri S, Faldini C. Frailty Influence on Postoperative Surgical Site Infections After Surgery for Degenerative Spine Disease and Adult Spine Deformity. Can a Frailty Index be a Valuable Summary Risk Indicator? A Systematic Review and Metanalysis of the Current Literature. Global Spine J 2024:21925682241235605. [PMID: 38382093 DOI: 10.1177/21925682241235605] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/23/2024] Open
Abstract
STUDY DESIGN Metanalysis. OBJECTIVE Surgical site infections (SSI) is one of the commonest postoperative adverse events after spine surgery. Frailty has been described as a valuable summary risk indicator for SSI in spine surgery. The aim of this metanalysis is to evaluate the influence of frailty on postoperative SSI in this cohort and provide hints on which index can predict the risk of SSI. METHODS Papers describing the postoperative SSI rate in adult degenerative spine disease or adult spine deformity patients with varying degrees of frailty were included in the analysis. The SSI rate in different grades of frailty was considered for outcome measure. Meta-analysis was performed on studies in whom data regarding patients with different levels of frailty and occurrence of postoperative SSI could be pooled. P < .05 was considered significant. RESULTS 16 studies were included. The frailty prevalence measured using mFI-11 ranged from 3% to 17.9%, these values were inferior to those measured with mFI-5. Significant difference was found between frail and non-frail patients in postoperative SSI rate at metanalysis (z = 5.9547, P < .0001 for mFI-5 and z = 3.8334, P = .0001 for mFI-11). CONCLUSION This is the first meta-analysis to specifically investigate the impact of frailty, on occurrence of SSI. We found a relevant statistical difference between frail and non-frail patients in SSI occurrence rate. This is a relevant finding, as the ageing of population increases alongside with spine surgery procedures, a better understanding of risk factors may advance our ability to treat patients while minimizing the occurrence of SSI.
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Affiliation(s)
- Marco Manzetti
- 1st Orthopaedic and Traumatologic Clinic, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
- Department of Biomedical and Neuromotor Science - DIBINEM, University of Bologna, Bologna, Italy
| | - Alberto Ruffilli
- 1st Orthopaedic and Traumatologic Clinic, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
- Department of Biomedical and Neuromotor Science - DIBINEM, University of Bologna, Bologna, Italy
| | - Giovanni Viroli
- 1st Orthopaedic and Traumatologic Clinic, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
- Department of Biomedical and Neuromotor Science - DIBINEM, University of Bologna, Bologna, Italy
| | - Matteo Traversari
- 1st Orthopaedic and Traumatologic Clinic, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Marco Ialuna
- 1st Orthopaedic and Traumatologic Clinic, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Francesca Salamanna
- Surgical Science and Technology, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Simona Neri
- Medicine and Rheumatology Unit, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Cesare Faldini
- 1st Orthopaedic and Traumatologic Clinic, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
- Department of Biomedical and Neuromotor Science - DIBINEM, University of Bologna, Bologna, Italy
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Viroli G, Ruffilli A, Barile F, Manzetti M, Traversari M, Faldini C. Pedicle Dysplasia in Proximal Thoracic Adolescent Idiopathic Scoliosis Curves: What are We Missing and What are its Possible Surgical Implications? An Observational Retrospective Study on 104 Patients. Global Spine J 2024:21925682241230964. [PMID: 38321714 DOI: 10.1177/21925682241230964] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2024] Open
Abstract
STUDY DESIGN Retrospective cohort study. OBJECTIVES To assess if pedicle dysplasia is present in proximal thoracic (PT), both structural and nonstructural, compared to main thoracic (MT) curves; and to assess if it is predictive of radiographic outcomes at minimum 2 years of follow-up. METHODS A retrospective review of surgically-treated Adolescent Idiopathic Scoliosis (AIS) patients with Lenke 1-2-3-4 curves was performed. On preoperative CT-scan, at the apical vertebra, pedicle width on the concavity (PWc) and on the convexity (PWv) and Pedicle Dysplasia Index (PDI, defined as PWc/PWv) were measured. Preoperative and last follow-up (at least 2 years) x-rays were reviewed. RESULTS 104 patients meeting the inclusion criteria were divided into Structural-PT (S-PT) and Nonstructural-PT (NS-PT) groups based on Lenke criteria. PWc (P < .001). And PDI (P < .001 for S-PT, P = .004 for NS-PT) were significantly smaller in the PT than in MT curves for both groups. PT-PWc significantly correlated with follow-up PT Cobb for both groups (P < .001 and P = .015 respectively). PT-PDI significantly correlated with follow-up PT-Cobb (P < .001), CA (P < .040) and T1 tilt (P < .002), only for NS-PT group. NS-PT patients with PWc PT <1 mm had higher RSHD (P = .021) and T1 tilt (P = .025) at follow-up. NS-PT patients with PDI PT <.3 had higher RSHD (P < .001), CA (P = .002) and T1 tilt (P = .003) at follow-up. CONCLUSION S-PT and NS-PT curves show significant pedicle dysplasia on the concavity. Pedicle dysplasia significantly correlated with shoulder balance at follow-up, for NS-PT patterns. Patients with a PWc <1 mm or PDI <.30 are at particular risk of postoperative shoulder imbalance.
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Affiliation(s)
- Giovanni Viroli
- Department of Biomedical and Neuromotor Science - DIBINEM, University of Bologna, 1st Orthopaedic and Traumatologic Clinic, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Alberto Ruffilli
- Department of Biomedical and Neuromotor Science - DIBINEM, University of Bologna, 1st Orthopaedic and Traumatologic Clinic, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Francesca Barile
- Department of Biomedical and Neuromotor Science - DIBINEM, University of Bologna, 1st Orthopaedic and Traumatologic Clinic, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Marco Manzetti
- Department of Biomedical and Neuromotor Science - DIBINEM, University of Bologna, 1st Orthopaedic and Traumatologic Clinic, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Matteo Traversari
- Department of Biomedical and Neuromotor Science - DIBINEM, University of Bologna, 1st Orthopaedic and Traumatologic Clinic, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Cesare Faldini
- Department of Biomedical and Neuromotor Science - DIBINEM, University of Bologna, 1st Orthopaedic and Traumatologic Clinic, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
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Manzetti M, Ruffilli A, Barile F, Viroli G, Traversari M, Vita F, Cerasoli T, Arceri A, Artioli E, Mazzotti A, Faldini C. Is there a skeletal age index that can predict accurate curve progression in adolescent idiopathic scoliosis? A systematic review. Pediatr Radiol 2024; 54:299-315. [PMID: 38158439 DOI: 10.1007/s00247-023-05834-z] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2023] [Revised: 12/06/2023] [Accepted: 12/07/2023] [Indexed: 01/03/2024]
Abstract
BACKGROUND The diagnosis of adolescent idiopathic scoliosis requires clinical and radiographic evaluation; the management options vary depending on the severity of the curve and potential for progression. Identifying predictors of scoliosis progression is crucial to avoid incorrect management; clinical and radiographic factors have been studied as potential predictors. The present study aims to review the literature on radiological indexes for the peak height velocity or curve acceleration phase to help clinicians manage treatment of patients with adolescent idiopathic scoliosis. METHODS This systematic review was carried out in accordance with Preferential Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines. The search was carried out including only peer-reviewed articles written in English that described the radiological indexes assessing skeletal maturity in patients with adolescent idiopathic scoliosis and evaluated their correlation with curve progression, expressed as peak height velocity and/or curve acceleartion phase. RESULTS Thirteen studies were included and showed promising results in terms of reliable radiological indexes. Risser staging gives a general measure of skeletal maturity, but it cannot be used as a primary index for driving the treatment of patients with adolescent idiopathic scoliosis since more reliable indexes are available. CONCLUSION Skeletal maturity quantification for adolescent idiopathic scoliosis has the potential to significantly modify disease management. However, idiopathic scoliosis is a complex and multifactorial disease: therefore, it is unlikely that a single index will ever be sufficient to predict its evolution. Therefore, as more adolescent idiopathic scoliosis progression-associated indexes are identified, a collective scientific effort should be made to develop a therapeutic strategy based on reliable and reproducible algorithms.
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Affiliation(s)
- Marco Manzetti
- DIBINEB Dipartimento di scienze biomediche e neuromotorie, University of Bologna, Bologna, Italy.
- 1st Orthopaedic and Traumatologic Clinic, IRCCS Istituto Ortopedico Rizzoli, Via Giulio Cesare Pupilli 1, 40136, Bologna, Italy.
| | - Alberto Ruffilli
- DIBINEB Dipartimento di scienze biomediche e neuromotorie, University of Bologna, Bologna, Italy
- 1st Orthopaedic and Traumatologic Clinic, IRCCS Istituto Ortopedico Rizzoli, Via Giulio Cesare Pupilli 1, 40136, Bologna, Italy
| | - Francesca Barile
- DIBINEB Dipartimento di scienze biomediche e neuromotorie, University of Bologna, Bologna, Italy
- 1st Orthopaedic and Traumatologic Clinic, IRCCS Istituto Ortopedico Rizzoli, Via Giulio Cesare Pupilli 1, 40136, Bologna, Italy
| | - Giovanni Viroli
- DIBINEB Dipartimento di scienze biomediche e neuromotorie, University of Bologna, Bologna, Italy
- 1st Orthopaedic and Traumatologic Clinic, IRCCS Istituto Ortopedico Rizzoli, Via Giulio Cesare Pupilli 1, 40136, Bologna, Italy
| | - Matteo Traversari
- 1st Orthopaedic and Traumatologic Clinic, IRCCS Istituto Ortopedico Rizzoli, Via Giulio Cesare Pupilli 1, 40136, Bologna, Italy
| | - Fabio Vita
- 1st Orthopaedic and Traumatologic Clinic, IRCCS Istituto Ortopedico Rizzoli, Via Giulio Cesare Pupilli 1, 40136, Bologna, Italy
| | - Tosca Cerasoli
- 1st Orthopaedic and Traumatologic Clinic, IRCCS Istituto Ortopedico Rizzoli, Via Giulio Cesare Pupilli 1, 40136, Bologna, Italy
| | - Alberto Arceri
- 1st Orthopaedic and Traumatologic Clinic, IRCCS Istituto Ortopedico Rizzoli, Via Giulio Cesare Pupilli 1, 40136, Bologna, Italy
| | - Elena Artioli
- DIBINEB Dipartimento di scienze biomediche e neuromotorie, University of Bologna, Bologna, Italy
- 1st Orthopaedic and Traumatologic Clinic, IRCCS Istituto Ortopedico Rizzoli, Via Giulio Cesare Pupilli 1, 40136, Bologna, Italy
| | - Antonio Mazzotti
- DIBINEB Dipartimento di scienze biomediche e neuromotorie, University of Bologna, Bologna, Italy
- 1st Orthopaedic and Traumatologic Clinic, IRCCS Istituto Ortopedico Rizzoli, Via Giulio Cesare Pupilli 1, 40136, Bologna, Italy
| | - Cesare Faldini
- DIBINEB Dipartimento di scienze biomediche e neuromotorie, University of Bologna, Bologna, Italy
- 1st Orthopaedic and Traumatologic Clinic, IRCCS Istituto Ortopedico Rizzoli, Via Giulio Cesare Pupilli 1, 40136, Bologna, Italy
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Faldini C, Viroli G, Traversari M, Manzetti M, Ialuna M, Sartini F, Cargeli A, Parisi SC, Ruffilli A. Ponte Osteotomies in the Surgical Treatment of Adolescent Idiopathic Scoliosis: A Systematic Review of the Literature and Meta-Analysis of Comparative Studies. Children (Basel) 2024; 11:92. [PMID: 38255405 PMCID: PMC10814379 DOI: 10.3390/children11010092] [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] [Subscribe] [Scholar Register] [Received: 12/21/2023] [Revised: 01/09/2024] [Accepted: 01/10/2024] [Indexed: 01/24/2024]
Abstract
The purpose of the present paper is to assess if Ponte osteotomies (POs) allow for a better correction in adolescent idiopathic scoliosis (AIS) surgery and to investigate their safety profile. A systematic search of electronic databases was conducted. Inclusion criteria: comparative studies that reported the outcomes of AIS patients who underwent surgical correction through posterior-only approach with and without POs. Clinical and radiographic outcomes were extracted and summarized. Meta-analyses were performed to estimate the differences between patients treated with and without POs. p < 0.05 was considered significant. In total, 9 studies were included. No significant difference in thoracic kyphosis (TK) change between patients treated with and without POs was found (+3.8°; p = 0.06). Considering only hypokyphotic patients, a significant difference in TK change resulted in POs patients (+6.6°; p < 0.01), while a non-significant TK change resulted in normokyphotic patients (+0.2°; p = 0.96). No significant difference in coronal correction (2.5°; p = 0.10) was recorded. Significant estimated blood loss (EBL) (142.5 mL; p = 0.04) and surgical time (21.5 min; p = 0.04) differences were found with POs. Regarding complications rate, the meta-analysis showed a non-significant log odds ratio of 1.1 (p = 0.08) with POs. In conclusion, POs allow for the restoration of TK in hypokyphotic AIS, without a significantly greater TK change in normokyphotic patients, nor a significantly better coronal correction. Considering the significantly greater EBL and the trend toward a higher complications rate, the correct indication for POs is crucial.
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Affiliation(s)
- Cesare Faldini
- Department of Biomedical and Neuromotor Science—DIBINEM, University of Bologna, 40126 Bologna, Italy; (G.V.); (M.T.); (M.M.); (M.I.); (F.S.); (A.C.); (S.C.P.); (A.R.)
- 1st Orthopaedic and Traumatologic Clinic, IRCCS Istituto Ortopedico Rizzoli, 40136 Bologna, Italy
| | - Giovanni Viroli
- Department of Biomedical and Neuromotor Science—DIBINEM, University of Bologna, 40126 Bologna, Italy; (G.V.); (M.T.); (M.M.); (M.I.); (F.S.); (A.C.); (S.C.P.); (A.R.)
- 1st Orthopaedic and Traumatologic Clinic, IRCCS Istituto Ortopedico Rizzoli, 40136 Bologna, Italy
| | - Matteo Traversari
- Department of Biomedical and Neuromotor Science—DIBINEM, University of Bologna, 40126 Bologna, Italy; (G.V.); (M.T.); (M.M.); (M.I.); (F.S.); (A.C.); (S.C.P.); (A.R.)
- 1st Orthopaedic and Traumatologic Clinic, IRCCS Istituto Ortopedico Rizzoli, 40136 Bologna, Italy
| | - Marco Manzetti
- Department of Biomedical and Neuromotor Science—DIBINEM, University of Bologna, 40126 Bologna, Italy; (G.V.); (M.T.); (M.M.); (M.I.); (F.S.); (A.C.); (S.C.P.); (A.R.)
- 1st Orthopaedic and Traumatologic Clinic, IRCCS Istituto Ortopedico Rizzoli, 40136 Bologna, Italy
| | - Marco Ialuna
- Department of Biomedical and Neuromotor Science—DIBINEM, University of Bologna, 40126 Bologna, Italy; (G.V.); (M.T.); (M.M.); (M.I.); (F.S.); (A.C.); (S.C.P.); (A.R.)
- 1st Orthopaedic and Traumatologic Clinic, IRCCS Istituto Ortopedico Rizzoli, 40136 Bologna, Italy
| | - Francesco Sartini
- Department of Biomedical and Neuromotor Science—DIBINEM, University of Bologna, 40126 Bologna, Italy; (G.V.); (M.T.); (M.M.); (M.I.); (F.S.); (A.C.); (S.C.P.); (A.R.)
- 1st Orthopaedic and Traumatologic Clinic, IRCCS Istituto Ortopedico Rizzoli, 40136 Bologna, Italy
| | - Alessandro Cargeli
- Department of Biomedical and Neuromotor Science—DIBINEM, University of Bologna, 40126 Bologna, Italy; (G.V.); (M.T.); (M.M.); (M.I.); (F.S.); (A.C.); (S.C.P.); (A.R.)
- 1st Orthopaedic and Traumatologic Clinic, IRCCS Istituto Ortopedico Rizzoli, 40136 Bologna, Italy
| | - Stefania Claudia Parisi
- Department of Biomedical and Neuromotor Science—DIBINEM, University of Bologna, 40126 Bologna, Italy; (G.V.); (M.T.); (M.M.); (M.I.); (F.S.); (A.C.); (S.C.P.); (A.R.)
- 1st Orthopaedic and Traumatologic Clinic, IRCCS Istituto Ortopedico Rizzoli, 40136 Bologna, Italy
| | - Alberto Ruffilli
- Department of Biomedical and Neuromotor Science—DIBINEM, University of Bologna, 40126 Bologna, Italy; (G.V.); (M.T.); (M.M.); (M.I.); (F.S.); (A.C.); (S.C.P.); (A.R.)
- 1st Orthopaedic and Traumatologic Clinic, IRCCS Istituto Ortopedico Rizzoli, 40136 Bologna, Italy
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Faldini C, Barile F, Ialuna M, Manzetti M, Viroli G, Vita F, Traversari M, Rinaldi A, Cerasoli T, Paolucci A, D’Antonio G, Ruffilli A. Correction to: High-grade dysplastic spondylolisthesis: surgical technique and case series. Musculoskelet Surg 2023; 107:333-335. [PMID: 36350495 PMCID: PMC10432344 DOI: 10.1007/s12306-022-00766-7] [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: 06/16/2023]
Affiliation(s)
- C. Faldini
- IRCCS Istituto Ortopedico Rizzoli, 1st Orthopaedics and Traumatology Clinic, University of Bologna, Bologna, Italy
| | - F. Barile
- IRCCS Istituto Ortopedico Rizzoli, 1st Orthopaedics and Traumatology Clinic, University of Bologna, Bologna, Italy
| | - M. Ialuna
- IRCCS Istituto Ortopedico Rizzoli, 1st Orthopaedics and Traumatology Clinic, University of Bologna, Bologna, Italy
| | - M. Manzetti
- IRCCS Istituto Ortopedico Rizzoli, 1st Orthopaedics and Traumatology Clinic, University of Bologna, Bologna, Italy
| | - G. Viroli
- IRCCS Istituto Ortopedico Rizzoli, 1st Orthopaedics and Traumatology Clinic, University of Bologna, Bologna, Italy
| | - F. Vita
- IRCCS Istituto Ortopedico Rizzoli, 1st Orthopaedics and Traumatology Clinic, University of Bologna, Bologna, Italy
| | - M. Traversari
- IRCCS Istituto Ortopedico Rizzoli, 1st Orthopaedics and Traumatology Clinic, University of Bologna, Bologna, Italy
| | - A. Rinaldi
- IRCCS Istituto Ortopedico Rizzoli, 1st Orthopaedics and Traumatology Clinic, University of Bologna, Bologna, Italy
| | - T. Cerasoli
- IRCCS Istituto Ortopedico Rizzoli, 1st Orthopaedics and Traumatology Clinic, University of Bologna, Bologna, Italy
| | - A. Paolucci
- IRCCS Istituto Ortopedico Rizzoli, 1st Orthopaedics and Traumatology Clinic, University of Bologna, Bologna, Italy
| | - G. D’Antonio
- IRCCS Istituto Ortopedico Rizzoli, 1st Orthopaedics and Traumatology Clinic, University of Bologna, Bologna, Italy
| | - A. Ruffilli
- IRCCS Istituto Ortopedico Rizzoli, 1st Orthopaedics and Traumatology Clinic, University of Bologna, Bologna, Italy
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Faldini C, Barile F, Ialuna M, Manzetti M, Viroli G, Vita F, Traversari M, Rinaldi A, Cerasoli T, Paolucci A, D’Antonio G, Ruffilli A. High-grade dysplastic spondylolisthesis: surgical technique and case series. Musculoskelet Surg 2023; 107:323-331. [PMID: 36183053 PMCID: PMC10432321 DOI: 10.1007/s12306-022-00763-w] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2022] [Accepted: 09/22/2022] [Indexed: 10/07/2022]
Abstract
PURPOSE The aim of the present study is to evaluate the results of our all posterior-one stage surgical technique for the reduction and fusion of high-grade high-dysplastic spondylolisthesis. METHODS Patients over 11 years old with high-grade spondylolisthesis treated by reduction and circumferential fusion with a posterior-only approach were reviewed. Data about operative time, blood loss, length of stay, intra- and postoperative complications were collected. Meyerding grade (M), lumbar lordosis (LL), thoracic kyphosis (TK), pelvic incidence (PI), pelvic tilt (PT), lumbosacral angle (LSA), slip angle (SLIP), lumbar index (LI) and severity index were measured on preoperative and last follow-up. Sagittal vertical axis (SVA) was used to assess sagittal balance. RESULTS Of the 14 included patients, L5-S1 arthrodesis was performed in 12 cases, and L4-S1 was performed in 2 cases. Average surgical time was 275 ± 65 min; average blood loss was 635 ± 375 mL. Average length of stay of was 3.9 ± 1.5 days. The SLIP angle improves from 33.8° ± 7.3° to 6.4° ± 2.5°, (p = 0.002); the lumbosacral angle improves from 68.8° ± 18.6° to 100.7° ± 13.2°, (p = 0.01); and the SVA decreased from 49.4 ± 22.1 mm to 34.4 ± 8.6 mm (p = 0.02). No significant changes were observed in PI, PT and SS. Thoracic kyphosis (TK) and lumbar lordosis (LL) did not change significantly. At last follow-up, no patient had surgical site infection or mechanical complications; no pseudoarthrosis was observed. No revision surgery was performed. CONCLUSION Although technically demanding, reduction and fusion with one stage all posterior approach prove to be a safe and effective.
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Affiliation(s)
- C. Faldini
- IRCCS Istituto Ortopedico Rizzoli, 1st Orthopaedics and Traumatology Clinic, University of Bologna, Bologna, Italy
| | - F. Barile
- IRCCS Istituto Ortopedico Rizzoli, 1st Orthopaedics and Traumatology Clinic, University of Bologna, Bologna, Italy
| | - M. Ialuna
- IRCCS Istituto Ortopedico Rizzoli, 1st Orthopaedics and Traumatology Clinic, University of Bologna, Bologna, Italy
| | - M. Manzetti
- IRCCS Istituto Ortopedico Rizzoli, 1st Orthopaedics and Traumatology Clinic, University of Bologna, Bologna, Italy
| | - G. Viroli
- IRCCS Istituto Ortopedico Rizzoli, 1st Orthopaedics and Traumatology Clinic, University of Bologna, Bologna, Italy
| | - F. Vita
- IRCCS Istituto Ortopedico Rizzoli, 1st Orthopaedics and Traumatology Clinic, University of Bologna, Bologna, Italy
| | - M. Traversari
- IRCCS Istituto Ortopedico Rizzoli, 1st Orthopaedics and Traumatology Clinic, University of Bologna, Bologna, Italy
| | - A. Rinaldi
- IRCCS Istituto Ortopedico Rizzoli, 1st Orthopaedics and Traumatology Clinic, University of Bologna, Bologna, Italy
| | - T. Cerasoli
- IRCCS Istituto Ortopedico Rizzoli, 1st Orthopaedics and Traumatology Clinic, University of Bologna, Bologna, Italy
| | - A. Paolucci
- IRCCS Istituto Ortopedico Rizzoli, 1st Orthopaedics and Traumatology Clinic, University of Bologna, Bologna, Italy
| | - G. D’Antonio
- IRCCS Istituto Ortopedico Rizzoli, 1st Orthopaedics and Traumatology Clinic, University of Bologna, Bologna, Italy
| | - A. Ruffilli
- IRCCS Istituto Ortopedico Rizzoli, 1st Orthopaedics and Traumatology Clinic, University of Bologna, Bologna, Italy
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12
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Basoli S, Cosentino M, Traversari M, Manfrini M, Tsukamoto S, Mavrogenis AF, Bordini B, Donati DM, Errani C. The Prognostic Value of Serum Biomarkers for Survival of Children with Osteosarcoma of the Extremities. Curr Oncol 2023; 30:7043-7054. [PMID: 37504371 PMCID: PMC10378558 DOI: 10.3390/curroncol30070511] [Citation(s) in RCA: 1] [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: 04/28/2023] [Revised: 06/28/2023] [Accepted: 07/21/2023] [Indexed: 07/29/2023] Open
Abstract
BACKGROUND Osteosarcoma is a highly aggressive malignant bone tumor that affects mainly adolescents and young adults. We analyzed serum biomarkers for their prognostic significance in children with osteosarcoma. METHODS In this retrospective study, we investigated the prognostic factors in 210 children who were treated for appendicular osteosarcoma, including patient age and sex, tumor site and size (≥8 cm or <8 cm), presence of metastasis, chemotherapy-induced tumor necrosis, serum levels of alkaline phosphatase (AP), C-reactive protein, serum hemoglobin, lactate dehydrogenase, erythrocyte sedimentation rate (ESR), leukocyte counts, platelet count, and neutrophil-lymphocyte ratio. RESULTS A multivariate Cox regression model showed that high level of AP [HR of 1.73; 95% CI, 1.02 to 2.94], poor chemotherapy-induced tumor necrosis [HR of 2.40; 95% CI, 1.41 to 4.08] and presence of metastases at presentation [HR of 3.71; 95% CI, 2.19 to 6.29] were associated with poor prognosis at 5 years (p < 0.05). Inadequate surgical margins [HR 11.28; 95% CI, 1.37 to 92.79] and high levels of ESR [HR 3.58; 95% CI, 1.29 to 9.98] showed a greater risk of local recurrence at 5 years follow-up (p < 0.05). CONCLUSIONS AP and ESR can identify osteosarcoma-diagnosed children with a greater risk of death and local recurrence, respectively.
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Affiliation(s)
- Stefano Basoli
- Clinica Ortopedica e Traumatologica III a Prevalente Indirizzo Oncologico, IRCCS Istituto Ortopedico Rizzoli, Via Pupilli 1, 40136 Bologna, Italy
| | - Monica Cosentino
- Laboratorio di Tecnologia Medica, IRCCS Istituto Ortopedico Rizzoli, Via Pupilli 1, 40136 Bologna, Italy
| | - Matteo Traversari
- Clinica Ortopedica e Traumatologica III a Prevalente Indirizzo Oncologico, IRCCS Istituto Ortopedico Rizzoli, Via Pupilli 1, 40136 Bologna, Italy
| | - Marco Manfrini
- Clinica Ortopedica e Traumatologica III a Prevalente Indirizzo Oncologico, IRCCS Istituto Ortopedico Rizzoli, Via Pupilli 1, 40136 Bologna, Italy
| | - Shinji Tsukamoto
- Department of Orthopaedic Surgery, Nara Medical University, 840, Shijo-cho, Kashihara 634-8521, Nara, Japan
| | - Andreas F Mavrogenis
- First Department of Orthopaedics, School of Medicine, National and Kapodistrian University of Athens, 41 Ventouri Street, Holargos, 15562 Athens, Greece
| | - Barbara Bordini
- Laboratorio di Tecnologia Medica, IRCCS Istituto Ortopedico Rizzoli, Via Pupilli 1, 40136 Bologna, Italy
| | - Davide Maria Donati
- Clinica Ortopedica e Traumatologica III a Prevalente Indirizzo Oncologico, IRCCS Istituto Ortopedico Rizzoli, Via Pupilli 1, 40136 Bologna, Italy
| | - Costantino Errani
- Clinica Ortopedica e Traumatologica III a Prevalente Indirizzo Oncologico, IRCCS Istituto Ortopedico Rizzoli, Via Pupilli 1, 40136 Bologna, Italy
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Faldini C, Viroli G, Barile F, Manzetti M, Ialuna M, Traversari M, Vita F, Ruffilli A. One stage correction via the Hi-PoAD technique for the management of severe, stiff, adolescent idiopathic scoliosis curves > 90°. Spine Deform 2023; 11:957-967. [PMID: 36811705 PMCID: PMC10260697 DOI: 10.1007/s43390-023-00663-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2022] [Accepted: 02/04/2023] [Indexed: 02/24/2023]
Abstract
STUDY DESIGN Retrospective cohort study. PURPOSE to assess the efficacy and safety of Hi-PoAD technique in patients with a major thoracic curve > 90°, < 25% of flexibility and deformity spread over more than five vertebral levels. METHODS retrospective review of AIS patients with a major thoracic curve (Lenke 1-2-3) > 90°, with < 25% of flexibility and deformity spread over more than five vertebral levels. All were treated via the Hi-PoAD technique. Radiographic and clinical score data were collected pre-operatively, operatively, at 1 year, 2 years and at last follow-up (2 years minimum). RESULTS 19 patients were enrolled. A 65.0% correction rate of the main curve was achieved, from 101.9° to 35.7° (p < 0.001). The AVR reduced from 3.3 to 1.3. The C7PL/CSVL reduced from 1.5 to 0.9 cm (p = 0.013). Trunk Height increased from 31.1 to 37.0 cm (p < 0.001). At the final follow-up no significant changes, except from an improvement in C7PL/CSVL (from 0.9 cm to 0.6 cm; p = 0.017). SRS-22 increased in all patients, from 2.1 to 3.9 at 1 year of follow-up (p < 0.001). 3 patients had a transient drop of MEP and SEP during maneuver and were managed with temporary rods and a second surgery after 5 days. 2 of these 3 cases (66.7%) had a Total-Deformity Angular Ratio (T-DAR) > 25; conversely, among patients who had a one-stage procedure, only 1 (6.2%) had a T-DAR > 25 (p = 0.008). CONCLUSIONS The Hi-PoAD technique proved to be a valid alternative for the treatment of severe, rigid AIS involving more than 5 vertebral bodies. STUDY DESIGN Retrospective comparative cohort study. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Cesare Faldini
- Department of Biomedical and Neuromotor Science-DIBINEM, 1st Orthopaedic and Traumatologic Clinic, IRCCS Istituto Ortopedico Rizzoli, University of Bologna, Via Giulio Cesare Pupilli 1, 40136, Bologna, Italy
| | - Giovanni Viroli
- Department of Biomedical and Neuromotor Science-DIBINEM, 1st Orthopaedic and Traumatologic Clinic, IRCCS Istituto Ortopedico Rizzoli, University of Bologna, Via Giulio Cesare Pupilli 1, 40136, Bologna, Italy.
| | - Francesca Barile
- Department of Biomedical and Neuromotor Science-DIBINEM, 1st Orthopaedic and Traumatologic Clinic, IRCCS Istituto Ortopedico Rizzoli, University of Bologna, Via Giulio Cesare Pupilli 1, 40136, Bologna, Italy
| | - Marco Manzetti
- Department of Biomedical and Neuromotor Science-DIBINEM, 1st Orthopaedic and Traumatologic Clinic, IRCCS Istituto Ortopedico Rizzoli, University of Bologna, Via Giulio Cesare Pupilli 1, 40136, Bologna, Italy
| | - Marco Ialuna
- Department of Biomedical and Neuromotor Science-DIBINEM, 1st Orthopaedic and Traumatologic Clinic, IRCCS Istituto Ortopedico Rizzoli, University of Bologna, Via Giulio Cesare Pupilli 1, 40136, Bologna, Italy
| | - Matteo Traversari
- Department of Biomedical and Neuromotor Science-DIBINEM, 1st Orthopaedic and Traumatologic Clinic, IRCCS Istituto Ortopedico Rizzoli, University of Bologna, Via Giulio Cesare Pupilli 1, 40136, Bologna, Italy
| | - Fabio Vita
- Department of Biomedical and Neuromotor Science-DIBINEM, 1st Orthopaedic and Traumatologic Clinic, IRCCS Istituto Ortopedico Rizzoli, University of Bologna, Via Giulio Cesare Pupilli 1, 40136, Bologna, Italy
| | - Alberto Ruffilli
- Department of Biomedical and Neuromotor Science-DIBINEM, 1st Orthopaedic and Traumatologic Clinic, IRCCS Istituto Ortopedico Rizzoli, University of Bologna, Via Giulio Cesare Pupilli 1, 40136, Bologna, Italy
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14
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Viroli G, Cerasoli T, Barile F, Modeo M, Manzetti M, Traversari M, Ruffilli A, Faldini C. Diagnosis and treatment of acute inflammatory sacroiliitis in pregnant or post-partum women: a systematic review of the current literature. Musculoskelet Surg 2023:10.1007/s12306-023-00786-x. [PMID: 37338751 DOI: 10.1007/s12306-023-00786-x] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2023] [Accepted: 05/04/2023] [Indexed: 06/21/2023]
Abstract
The aim of the present study is to systematically review the current literature about diagnosis and treatment of acute inflammatory sacroiliitis in pregnant or post-partum women. A systematic search was carried out according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Data about clinical presentation, diagnosis methods and treatment strategies were retrieved from included studies and reported in a table. After screening, five studies on 34 women were included; they were all affected by acute inflammatory sacroiliitis. Clinical examination and magnetic resonance imaging were used to confirm diagnosis. In four studies, patients were treated with ultrasound-guided sacroiliac injections of steroids and local anesthetics, while one study used only manual mobilization. Clinical scores improved in all patients. Ultrasound-guided injections proved to be a safe and effective strategy for inflammatory sacroiliitis treatment during pregnancy or post-partum.
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Affiliation(s)
- G Viroli
- IRCCS Istituto Ortopedico Rizzoli, 1st Orthopaedics and Traumatology Clinic, University of Bologna, Bologna, Italy
| | - T Cerasoli
- IRCCS Istituto Ortopedico Rizzoli, 1st Orthopaedics and Traumatology Clinic, University of Bologna, Bologna, Italy.
| | - F Barile
- IRCCS Istituto Ortopedico Rizzoli, 1st Orthopaedics and Traumatology Clinic, University of Bologna, Bologna, Italy
| | - M Modeo
- IRCCS Istituto Ortopedico Rizzoli, 1st Orthopaedics and Traumatology Clinic, University of Bologna, Bologna, Italy
| | - M Manzetti
- IRCCS Istituto Ortopedico Rizzoli, 1st Orthopaedics and Traumatology Clinic, University of Bologna, Bologna, Italy
| | - M Traversari
- IRCCS Istituto Ortopedico Rizzoli, 1st Orthopaedics and Traumatology Clinic, University of Bologna, Bologna, Italy
| | - A Ruffilli
- IRCCS Istituto Ortopedico Rizzoli, 1st Orthopaedics and Traumatology Clinic, University of Bologna, Bologna, Italy
| | - C Faldini
- IRCCS Istituto Ortopedico Rizzoli, 1st Orthopaedics and Traumatology Clinic, University of Bologna, Bologna, Italy
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15
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Tsukamoto S, Aiba H, Righi A, Nitta Y, Traversari M, Mavrogenis AF, Honoki K, Tanaka Y, Donati DM, Errani C. Giant cell tumor of bone with secondary aneurysmal bone cyst does not have a higher risk of local recurrence. J Surg Oncol 2023. [PMID: 37053028 DOI: 10.1002/jso.27283] [Citation(s) in RCA: 1] [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: 02/17/2023] [Revised: 03/10/2023] [Accepted: 04/02/2023] [Indexed: 04/14/2023]
Abstract
BACKGROUND Fluid-fluid levels (FFLs) is found in 10%-16% of giant cell tumor of bone (GCTB), and the presence of FFLs raises the suspicion of GCTB with secondary aneurysmal bone cyst (ABC), which can lead to increased intraoperative bleeding and, blurring the operative field, be associated with a risk of local recurrence. The first objective of this study is to determine whether secondary ABC is associated with a higher risk of local recurrence after curettage in patients with GCTB of the extremities. The second objective of this study is to investigate the sensitivity, specificity, positive predictive value, and negative predictive value of the presence of FFLs detected on magnetic resonance imaging (MRI) to diagnose secondary ABC associated with GCTB. METHODS Two hundred and eighty patients with GCTB of the extremities who underwent curettage at the authors' institutions between 1980 and 2021 were included in this study. RESULTS Secondary ABC was found in 36 of 280 patients (12.9%) and local recurrence occurred in 66 of 280 patients (23.6%). Multivariate analysis showed no significant correlation between secondary ABC and local recurrence (hazard ratio [HR]: 1.87 (95% confidence interval [CI]: 1.00-3.53]; p = 0.051). Preoperative MRI revealed FFLs in 13 of 82 patients (15.9%). Sensitivity, specificity, positive predictive value, and negative predictive value of FFLs detected on preoperative MRI to diagnose secondary ABC were 36.8%, 90.5%, 53.8%, and 82.6%, respectively. CONCLUSION The results of this study showed that secondary ABC does not increase the risk of local recurrence after curettage in patients with GCTB of the extremities. Although rare, FFLs were present in patients with GCTB and half of those with FFLs detected on preoperative MRI had secondary ABC.
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Affiliation(s)
- Shinji Tsukamoto
- Department of Orthopaedic Surgery, Nara Medical University, Nara, Japan
| | - Hisaki Aiba
- Department of Orthopaedic Oncology, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
- Department of Orthopedic Surgery, Nagoya City University, Nagoya, Aichi, Japan
| | - Alberto Righi
- Department of Pathology, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Yuji Nitta
- Department of Diagnostic Pathology, Nara Medical University, Kashihara-city, Nara, Japan
| | - Matteo Traversari
- Department of Orthopaedic Oncology, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Andreas F Mavrogenis
- First Department of Orthopaedics, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Kanya Honoki
- Department of Orthopaedic Surgery, Nara Medical University, Nara, Japan
| | - Yasuhito Tanaka
- Department of Orthopaedic Surgery, Nara Medical University, Nara, Japan
| | - Davide Maria Donati
- Department of Orthopaedic Oncology, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Costantino Errani
- Department of Orthopaedic Oncology, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
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16
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Errani C, Traversari M, Cosentino M, Manfrini M, Basoli S, Tsukamoto S, Mavrogenis AF, Bordini B, Donati DM. The Prognostic Value of the Serum Level of C-Reactive Protein for Survival of Children with Ewing's Sarcoma. Cancers (Basel) 2023; 15:cancers15051573. [PMID: 36900365 PMCID: PMC10000755 DOI: 10.3390/cancers15051573] [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: 01/19/2023] [Revised: 02/23/2023] [Accepted: 02/28/2023] [Indexed: 03/06/2023] Open
Abstract
The purpose of the present study was to evaluate the prognostic role of C-reactive protein (CRP) in children with Ewing's sarcoma. We conducted a retrospective study on 151 children undergoing multimodal treatment for Ewing's sarcoma in the appendicular skeleton from December 1997 to June 2020. Univariate Kaplan-Meier analyses of laboratory biomarkers and clinical parameters showed that CRP and metastatic disease at presentation were poor prognostic factors associated with overall survival and disease recurrence at 5 years (p < 0.05). A multivariate Cox regression model showed that pathological CRP (≥1.0 mg/dL) [HR of 3.67; 95% CI, 1.46 to 10.42] and metastatic disease [HR of 4.27; 95% CI, 1.58 to 11.47] were associated with a higher risk of death at 5 years (p < 0.05). In addition, pathological CRP (≥1.0 mg/dL) [HR of 2.66; 95% CI, 1.23 to 6.01] and metastatic disease [HR of 2.56; 95% CI, 1.13 to 5.55] were associated with a higher risk of disease recurrence at 5 years (p < 0.05). Our findings demonstrated that CRP was associated with the prognosis of children with Ewing's sarcoma. We recommend pre-treatment measurement of the CRP in order to recognize children with Ewing's sarcoma who are at greater risk of death or local recurrence.
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Affiliation(s)
- Costantino Errani
- Clinica Ortopedica e Traumatologica III a Prevalente Indirizzo Oncologico, IRCCS Istituto Ortopedico Rizzoli, 40136 Bologna, Italy
- Correspondence:
| | - Matteo Traversari
- Clinica Ortopedica e Traumatologica III a Prevalente Indirizzo Oncologico, IRCCS Istituto Ortopedico Rizzoli, 40136 Bologna, Italy
| | - Monica Cosentino
- Laboratorio di Tecnologia Medica, IRCCS Istituto Ortopedico Rizzoli, 40136 Bologna, Italy
| | - Marco Manfrini
- Clinica Ortopedica e Traumatologica III a Prevalente Indirizzo Oncologico, IRCCS Istituto Ortopedico Rizzoli, 40136 Bologna, Italy
| | - Stefano Basoli
- Clinica Ortopedica e Traumatologica III a Prevalente Indirizzo Oncologico, IRCCS Istituto Ortopedico Rizzoli, 40136 Bologna, Italy
| | - Shinji Tsukamoto
- Department of Orthopaedic Surgery, Nara Medical University, 840, Shijo-cho, Kashihara-city 634-8521, Japan
| | - Andreas F. Mavrogenis
- First Department of Orthopaedics, School of Medicine, National and Kapodistrian University of Athens, 41 Ventouri Street, Holargos, 15562 Athens, Greece
| | - Barbara Bordini
- Laboratorio di Tecnologia Medica, IRCCS Istituto Ortopedico Rizzoli, 40136 Bologna, Italy
| | - Davide Maria Donati
- Clinica Ortopedica e Traumatologica III a Prevalente Indirizzo Oncologico, IRCCS Istituto Ortopedico Rizzoli, 40136 Bologna, Italy
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Barile F, Ruffilli A, Paolucci A, Viroli G, Manzetti M, Traversari M, Ialuna M, Faldini C. Risk factors for postoperative coronal imbalance after surgical correction of adult spinal deformities: a systematic review with pooled analysis. J Neurosurg Spine 2023; 38:558-572. [PMID: 36806115 DOI: 10.3171/2023.1.spine22669] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2022] [Accepted: 01/11/2023] [Indexed: 02/23/2023]
Abstract
OBJECTIVE The aim of this study was to identify preoperative risk factors for postoperative coronal imbalance (CIB) in patients undergoing surgical correction for adult spinal deformity (ASD). METHODS A systematic search of articles about risk factors for postoperative CIB was conducted on electronic databases (PubMed, EMBASE, and Cochrane Library) according to the PRISMA guidelines. The methodological quality of the included articles was assessed using the Institute of Health Economics Quality Appraisal Checklist for Case Series Studies. Data regarding the patient population (demographics, diagnosis, and follow-up), pre- and postoperative radiographic and clinical data, surgical procedure details, and complications were extracted and summarized. Meta-analyses were performed when possible. RESULTS Nine studies comprising 838 patients were included. The pooled incidence of postoperative CIB was 26%; preoperative sagittal vertical axis (SVA) and type C imbalance (trunk shifted toward the convexity) were found to be the only primary risk factors for iatrogenic CIB (p < 0.001 and p = 0.012, respectively). CONCLUSIONS Baseline evaluation of a patient's global alignment is of outmost importance when planning surgery for ASD. Type C coronal imbalance (trunk shifted toward the convexity of the main curve) and increased preoperative SVA put the patient at risk of postoperative CIB. Intraoperatively, care should be taken to properly correct the lumbosacral fractional curve.
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Affiliation(s)
- Francesca Barile
- 1Department of Biomedical and Neuromotor Science (DIBINEM), University of Bologna, Bologna.,21st Orthopaedic and Traumatologic Clinic, IRCCS Rizzoli Orthopaedic Institute, Bologna, Italy
| | - Alberto Ruffilli
- 1Department of Biomedical and Neuromotor Science (DIBINEM), University of Bologna, Bologna.,21st Orthopaedic and Traumatologic Clinic, IRCCS Rizzoli Orthopaedic Institute, Bologna, Italy
| | - Azzurra Paolucci
- 1Department of Biomedical and Neuromotor Science (DIBINEM), University of Bologna, Bologna.,21st Orthopaedic and Traumatologic Clinic, IRCCS Rizzoli Orthopaedic Institute, Bologna, Italy
| | - Giovanni Viroli
- 1Department of Biomedical and Neuromotor Science (DIBINEM), University of Bologna, Bologna.,21st Orthopaedic and Traumatologic Clinic, IRCCS Rizzoli Orthopaedic Institute, Bologna, Italy
| | - Marco Manzetti
- 1Department of Biomedical and Neuromotor Science (DIBINEM), University of Bologna, Bologna.,21st Orthopaedic and Traumatologic Clinic, IRCCS Rizzoli Orthopaedic Institute, Bologna, Italy
| | - Matteo Traversari
- 1Department of Biomedical and Neuromotor Science (DIBINEM), University of Bologna, Bologna.,21st Orthopaedic and Traumatologic Clinic, IRCCS Rizzoli Orthopaedic Institute, Bologna, Italy
| | - Marco Ialuna
- 1Department of Biomedical and Neuromotor Science (DIBINEM), University of Bologna, Bologna.,21st Orthopaedic and Traumatologic Clinic, IRCCS Rizzoli Orthopaedic Institute, Bologna, Italy
| | - Cesare Faldini
- 1Department of Biomedical and Neuromotor Science (DIBINEM), University of Bologna, Bologna.,21st Orthopaedic and Traumatologic Clinic, IRCCS Rizzoli Orthopaedic Institute, Bologna, Italy
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18
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Ruffilli A, Neri S, Manzetti M, Barile F, Viroli G, Traversari M, Assirelli E, Vita F, Geraci G, Faldini C. Epigenetic Factors Related to Low Back Pain: A Systematic Review of the Current Literature. Int J Mol Sci 2023; 24:ijms24031854. [PMID: 36768184 PMCID: PMC9915125 DOI: 10.3390/ijms24031854] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Revised: 01/12/2023] [Accepted: 01/13/2023] [Indexed: 01/19/2023] Open
Abstract
Low back pain (LBP) is one of the most common causes of pain and disability. At present, treatment and interventions for acute and chronic low back pain often fail to provide sufficient levels of pain relief, and full functional restoration can be challenging. Considering the significant socio-economic burden and risk-to-benefit ratio of medical and surgical intervention in low back pain patients, the identification of reliable biomarkers such as epigenetic factors associated with low back pain could be useful in clinical practice. The aim of this study was to review the available literature regarding the epigenetic factors associated with low back pain. This review was carried out in accordance with Preferential Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The search was carried out in October 2022. Only peer-reviewed articles were considered for inclusion. Fourteen studies were included and showed promising results in terms of reliable markers. Epigenetic markers for LBP have the potential to significantly modify disease management. Most recent evidence suggests that epigenetics is a more promising field for the identification of factors associated with LBP, offering a rationale for further investigation in this field with the long-term goal of finding epigenetic biomarkers that could constitute biological targets for disease management and treatment.
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Affiliation(s)
- Alberto Ruffilli
- Department of Biomedical and Neuromotor Science—DIBINEM, 1st Orthopaedic and Traumatologic Clinic, IRCCS Istituto Ortopedico Rizzoli, University of Bologna, Via Giulio Cesare Pupilli 1, 40136 Bologna, Italy
| | - Simona Neri
- Medicine and Rheumatology Unit, IRCCS Istituto Ortopedico Rizzoli, Via Giulio Cesare Pupilli 1, 40136 Bologna, Italy
- Correspondence: ; Tel.: +39-(05)-16366807
| | - Marco Manzetti
- Department of Biomedical and Neuromotor Science—DIBINEM, 1st Orthopaedic and Traumatologic Clinic, IRCCS Istituto Ortopedico Rizzoli, University of Bologna, Via Giulio Cesare Pupilli 1, 40136 Bologna, Italy
| | - Francesca Barile
- Department of Biomedical and Neuromotor Science—DIBINEM, 1st Orthopaedic and Traumatologic Clinic, IRCCS Istituto Ortopedico Rizzoli, University of Bologna, Via Giulio Cesare Pupilli 1, 40136 Bologna, Italy
| | - Giovanni Viroli
- Department of Biomedical and Neuromotor Science—DIBINEM, 1st Orthopaedic and Traumatologic Clinic, IRCCS Istituto Ortopedico Rizzoli, University of Bologna, Via Giulio Cesare Pupilli 1, 40136 Bologna, Italy
| | - Matteo Traversari
- Department of Biomedical and Neuromotor Science—DIBINEM, 1st Orthopaedic and Traumatologic Clinic, IRCCS Istituto Ortopedico Rizzoli, University of Bologna, Via Giulio Cesare Pupilli 1, 40136 Bologna, Italy
| | - Elisa Assirelli
- Medicine and Rheumatology Unit, IRCCS Istituto Ortopedico Rizzoli, Via Giulio Cesare Pupilli 1, 40136 Bologna, Italy
| | - Fabio Vita
- Department of Biomedical and Neuromotor Science—DIBINEM, 1st Orthopaedic and Traumatologic Clinic, IRCCS Istituto Ortopedico Rizzoli, University of Bologna, Via Giulio Cesare Pupilli 1, 40136 Bologna, Italy
| | - Giuseppe Geraci
- Department of Biomedical and Neuromotor Science—DIBINEM, 1st Orthopaedic and Traumatologic Clinic, IRCCS Istituto Ortopedico Rizzoli, University of Bologna, Via Giulio Cesare Pupilli 1, 40136 Bologna, Italy
| | - Cesare Faldini
- Department of Biomedical and Neuromotor Science—DIBINEM, 1st Orthopaedic and Traumatologic Clinic, IRCCS Istituto Ortopedico Rizzoli, University of Bologna, Via Giulio Cesare Pupilli 1, 40136 Bologna, Italy
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19
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Tsukamoto S, Mavrogenis AF, Alvarado RA, Traversari M, Akahane M, Honoki K, Tanaka Y, Donati DM, Errani C. Association between Inflammatory Markers and Local Recurrence in Patients with Giant Cell Tumor of Bone: A Preliminary Result. Curr Oncol 2023; 30:1116-1131. [PMID: 36661734 PMCID: PMC9857827 DOI: 10.3390/curroncol30010085] [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] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Accepted: 01/11/2023] [Indexed: 01/15/2023] Open
Abstract
Giant cell tumor of bone (GCTB) has a high local recurrence rate of approximately 20%. Systemic inflammatory markers, such as neutrophil-lymphocyte ratio (NLR), modified Glasgow prognostic score (mGPS), prognostic nutritional index (PNI), lymphocyte-monocyte ratio (LMR), platelet-lymphocyte ratio (PLR), hemoglobin (Hb), alkaline phosphatase (ALP), and lactate dehydrogenase (LDH), have been reported as prognostic markers in patients with malignant tumors. This study aimed to investigate the correlation between these markers and the local recurrence rate of GCTB. In total, 103 patients with GCTB who underwent surgery at the authors' institutions between 1993 and 2021 were included. Thirty patients experienced local recurrence. Univariate and multivariate analysis showed that tumor site, preoperative and postoperative denosumab treatment, and surgery were significantly associated with local recurrence-free survival. LDH was associated with local recurrence-free survival on univariate analysis only. NLR, mGPS, PNI, LMR, and PLR score did not correlate with the local recurrence rate. In conclusion, NLR, mGPS, PNI, LMR, PLR score, Hb, ALP, and LDH levels are not correlated with the local recurrence rate of GCTB. However, due to the small number of patients included in this study, this result should be re-evaluated in a multicenter study with a larger sample size.
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Affiliation(s)
- Shinji Tsukamoto
- Department of Orthopaedic Surgery, Nara Medical University, 840, Shijo-cho, Kashihara 634-8521, Nara, Japan
| | - Andreas F. Mavrogenis
- First Department of Orthopaedics, National and Kapodistrian University of Athens, School of Medicine,41 Ventouri Street, 15562 Athens, Greece
| | - Rebeca Angulo Alvarado
- Department of Orthopaedic Oncology, IRCCS Istituto Ortopedico Rizzoli, Via Pupilli 1, 40136 Bologna, Italy
| | - Matteo Traversari
- Department of Orthopaedic Oncology, IRCCS Istituto Ortopedico Rizzoli, Via Pupilli 1, 40136 Bologna, Italy
| | - Manabu Akahane
- Department of Health and Welfare Services, National Institute of Public Health, 2-3-6 Minami, Wako-shi 351-0197, Saitama, Japan
| | - Kanya Honoki
- Department of Orthopaedic Surgery, Nara Medical University, 840, Shijo-cho, Kashihara 634-8521, Nara, Japan
| | - Yasuhito Tanaka
- Department of Orthopaedic Surgery, Nara Medical University, 840, Shijo-cho, Kashihara 634-8521, Nara, Japan
| | - Davide Maria Donati
- Department of Orthopaedic Oncology, IRCCS Istituto Ortopedico Rizzoli, Via Pupilli 1, 40136 Bologna, Italy
| | - Costantino Errani
- Department of Orthopaedic Oncology, IRCCS Istituto Ortopedico Rizzoli, Via Pupilli 1, 40136 Bologna, Italy
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Ruffilli A, Barile F, Cerasoli T, Manzetti M, Viroli G, Ialuna M, Traversari M, Salamanna F, Mazzotti A, Fini M, Faldini C. Sarcopenia and osteopenia are independent risk factors for proximal junctional disease after posterior lumbar fusion: Results of a retrospective study. J Craniovertebr Junction Spine 2023; 14:65-70. [PMID: 37213567 PMCID: PMC10198217 DOI: 10.4103/jcvjs.jcvjs_140_22] [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: 11/16/2022] [Accepted: 02/04/2023] [Indexed: 03/14/2023] Open
Abstract
Study Design This was a retrospective study. Objective Since a better understanding of modifiable risk factors for proximal junctional disease (PJD) may lead to improved postoperative outcomes and less need of revision surgery, the aim of the present study is to determine whether sarcopenia and osteopenia are independent risk factors for PJD in patients undergoing lumbar fusion. Summary of Background Data PJD is one of the most frequent complications following posterior instrumented spinal fusion. It is characterized by a spectrum of pathologies ranging from proximal junctional kyphosis (PJK) to proximal junctional failure (PJF). The etiology of PJD is multifactorial and currently not fully understood. Patient-specific factors, such as age, body mass index, osteoporosis, sarcopenia, and the presence of other comorbidities, can represent potential risk factors. Materials and Methods A retrospective review of patients, aging 50-85 years, who underwent a short (≤3 levels) posterior lumbar fusion for degenerative diseases was performed. Through magnetic resonance imaging (MRI), central sarcopenia and osteopenia were evaluated, measuring the psoas-to-lumbar vertebral index (PLVI) and the M-score. A multivariate analysis was performed to determine the independent risk factors for PJD, PJK, and PJF. Results A total of 308 patients (mean age at surgery 63.8 ± 6.2 years) were included. Ten patients (3.2%) developed a PJD and all required revision surgery. Multivariate regression identified PLVI (P = 0.02) and M-score (P = 0.04) as independent risk factors for both PJK (P = 0.02 and P = 0.04, respectively) and PJF (P = 0.04 and P = 0.01, respectively). Conclusions Sarcopenia and osteopenia, as measured by PLVI and M-score, proved to be independent risk factors for PJD in patients who undergo lumbar fusion for degenerative diseases. Clinical Trial Registration The present study was approved by the Institutional Review Board, CE AVEC 208/2022/OSS/IOR.
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Affiliation(s)
- Alberto Ruffilli
- Orthopaedic and Traumatologic Clinic, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Francesca Barile
- Orthopaedic and Traumatologic Clinic, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Tosca Cerasoli
- Orthopaedic and Traumatologic Clinic, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Marco Manzetti
- Orthopaedic and Traumatologic Clinic, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Giovanni Viroli
- Orthopaedic and Traumatologic Clinic, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Marco Ialuna
- Orthopaedic and Traumatologic Clinic, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Matteo Traversari
- Orthopaedic and Traumatologic Clinic, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Francesca Salamanna
- Complex Structure of Surgical Sciences and Technologies, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Antonio Mazzotti
- Orthopaedic and Traumatologic Clinic, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Milena Fini
- Scientific Direction, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Cesare Faldini
- Orthopaedic and Traumatologic Clinic, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
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21
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Faldini C, Barile F, Cerasoli T, Ialuna M, Viroli G, Manzetti M, Traversari M, Mazzotti A, Ruffilli A. Accuracy of Patient-Specific 3D-Printed Guides for Pedicle Screw Insertion in Spine Revision Surgery: Results of a Retrospective Study. Surg Technol Int 2022; 41:sti41/1642. [PMID: 36283694 DOI: 10.52198/22.sti.41.ns1642] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
PURPOSE This retrospective study was performed to evaluate the safety and efficacy of patient-specific 3D-printed guides (MySpine® Medacta, Switzerland) for pedicle screw placement in spine revision surgery. Overview of the Literature: Placement of pedicle screws in spine revision surgery can be challenging due to the loss of anatomical landmarks and the presence of a fusion mass. Nevertheless, only a few papers have dealt with this topic. Several strategies, ranging from the freehand technique to navigation and robotics, have been developed. However, they all have drawbacks, including the amount of radiation given to the patient, the complexity of the equipment with a consequent increase in surgical time or costs, and the need of extended surgical training. Therefore, no consensus has yet been found regarding the best choice for dealing with revisions. Recently, patient-specific 3D-printed guides for screw placement have been introduced. Prospective studies have demonstrated their superiority over the freehand technique in primary deformity cases, but there are no studies on their results in revisions. METHODS Patients who underwent revision surgery for adult spinal deformities with 3D-printed guides were included. Radiographical parameters and complications were collected. The accuracy of each screw was measured on postoperative CT scan and graded according to the Gertzbein-Robbins and Zdichavsky classifications. RESULTS Nine patients (mean age 34.6 years, mean follow-up 34.4 months) were included for a total of 203 screws. The relative accuracy (Gertzbein-Robbins A+B) was 94.7%. Of the 11 misplaced screws, 8 (72.7%) were lateral, 3 (27.3%) were anterior and 0 were medial. No perioperative complications were recorded, and no screw needed revision. CONCLUSIONS The present technology appears to be effective and safe for pedicle screw placement in spine revision surgery and does not require the costs, training and radiation exposure associated with navigation and robotics.
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Affiliation(s)
- Cesare Faldini
- Department of Biomedical and Neuromotor Science - DIBINEM, 1st Orthopaedic and Traumatologic Clinic, IRCCS Istituto Ortopedico Rizzoli, University of Bologna, Italy
| | - Francesca Barile
- Department of Biomedical and Neuromotor Science - DIBINEM, 1st Orthopaedic and Traumatologic Clinic, IRCCS Istituto Ortopedico Rizzoli, University of Bologna, Italy
| | - Tosca Cerasoli
- 1st Orthopaedic and Traumatologic Clinic, IRCCS Istituto Ortopedico Rizzoli, University of Bologna, Italy
| | - Marco Ialuna
- 1st Orthopaedic and Traumatologic Clinic, IRCCS Istituto Ortopedico Rizzoli, University of Bologna, Italy
| | - Giovanni Viroli
- 1st Orthopaedic and Traumatologic Clinic, IRCCS Istituto Ortopedico Rizzoli, University of Bologna, Italy
| | - Marco Manzetti
- 1st Orthopaedic and Traumatologic Clinic, IRCCS Istituto Ortopedico Rizzoli, University of Bologna, Italy
| | - Matteo Traversari
- 1st Orthopaedic and Traumatologic Clinic, IRCCS Istituto Ortopedico Rizzoli, University of Bologna, Italy
| | - Antonio Mazzotti
- Department of Biomedical and Neuromotor Science - DIBINEM, 1st Orthopaedic and Traumatologic Clinic, IRCCS Istituto Ortopedico Rizzoli, University of Bologna, Italy
| | - Alberto Ruffilli
- Department of Biomedical and Neuromotor Science - DIBINEM, 1st Orthopaedic and Traumatologic Clinic, IRCCS Istituto Ortopedico Rizzoli, University of Bologna, Italy
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22
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Traversari M, Ruffilli A, Barile F, Viroli G, Manzetti M, Vita F, Faldini C. Surgical treatment of severe adolescent idiopathic scoliosis through one-stage posterior-only approach: A systematic review and meta-analysis. J Craniovertebr Junction Spine 2022; 13:390-400. [PMID: 36777910 PMCID: PMC9910130 DOI: 10.4103/jcvjs.jcvjs_80_22] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2022] [Accepted: 10/19/2022] [Indexed: 12/12/2022] Open
Abstract
The aim of this meta-analysis was to analyze the results of one-stage all-posterior spinal fusion for severe adolescent idiopathic scoliosis (AIS). A systematic search of articles about one-stage posterior spinal fusion for severe AIS was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Data about population, pre-and postoperative radiographical data, surgical procedure details, and complications were extracted. Meta-analyses were performed when possible. Fourteen studies (640 patients) were included. The mean Cobb angle of the major curve varied from 80.0 ± 7.3 to 110.8 ± 12.1. The meta analysis showed a comprehensive coronal correction rate of the major curve of 58.6%, a comprehensive operative time of 274.5 min, and a comprehensive estimated intraoperative blood loss of 866.5 mL (95% confidence interval: 659.3-1073.6, I 2 ≈ 0%). A total of 48 complications (5.4%) were reported. Overall, the meta-analysis showed a major complication rate of 4%. In seven cases, revision surgery was needed. Posterior-only approach is effective enough to correct severe curves and can spare the patient possible adverse events due to anterior approach. However, when choosing this approach for severe AIS, screw density needs to be high and posterior column osteotomies may need to be planned to mobilize the spine and maximize correction.
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Affiliation(s)
- Matteo Traversari
- IRCCS Istituto Ortopedico Rizzoli, 1 Orthopaedics and Traumatology Clinic, University of Bologna, Bologna, Italy
| | - Alberto Ruffilli
- IRCCS Istituto Ortopedico Rizzoli, 1 Orthopaedics and Traumatology Clinic, University of Bologna, Bologna, Italy
| | - Francesca Barile
- IRCCS Istituto Ortopedico Rizzoli, 1 Orthopaedics and Traumatology Clinic, University of Bologna, Bologna, Italy
| | - Giovanni Viroli
- IRCCS Istituto Ortopedico Rizzoli, 1 Orthopaedics and Traumatology Clinic, University of Bologna, Bologna, Italy
| | - Marco Manzetti
- IRCCS Istituto Ortopedico Rizzoli, 1 Orthopaedics and Traumatology Clinic, University of Bologna, Bologna, Italy
| | - Fabio Vita
- IRCCS Istituto Ortopedico Rizzoli, 1 Orthopaedics and Traumatology Clinic, University of Bologna, Bologna, Italy
| | - Cesare Faldini
- IRCCS Istituto Ortopedico Rizzoli, 1 Orthopaedics and Traumatology Clinic, University of Bologna, Bologna, Italy
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Ruffilli A, Manzetti M, Cerasoli T, Barile F, Viroli G, Traversari M, Salamanna F, Fini M, Faldini C. Osteopenia and Sarcopenia as Potential Risk Factors for Surgical Site Infection after Posterior Lumbar Fusion: A Retrospective Study. Microorganisms 2022; 10:1905. [PMID: 36296182 PMCID: PMC9607357 DOI: 10.3390/microorganisms10101905] [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] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2022] [Revised: 09/18/2022] [Accepted: 09/22/2022] [Indexed: 08/27/2023] Open
Abstract
Surgical site infection (SSI) is a feared complication in spinal surgery, that leads to lower outcomes and increased healthcare costs. Among its risk factors, sarcopenia and osteopenia have recently attracted particular interest. The purpose of this article is to evaluate the influence of sarcopenia and osteopenia on the postoperative infection rate in patients treated with posterior fusion for degenerative diseases of the lumbar spine. This retrospective study included data from 308 patients. Charts were reviewed and central sarcopenia and osteopenia were evaluated through magnetic resonance images (MRI), measuring the psoas to lumbar vertebral index (PLVI) and the M score. Multivariate linear regression was performed to identify independent risk factors for infection. The postoperative SSI rate was 8.4%. Patients with low PLVI scores were not more likely to experience postoperative SSI (p = 0.68), while low M-score patients were at higher risk of developing SSI (p = 0.04). However, they did not generally show low PLVI values (p = 0.5) and were homogeneously distributed between low and high PLVI (p = 0.6). Multivariate analysis confirmed a low M score to be an independent risk factor for SSI (p = 0.01). Our results suggest that osteopenia could have significant impact on spinal surgery, and prospective studies are needed to better investigate its role.
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Affiliation(s)
- Alberto Ruffilli
- 1st Orthopaedic and Traumatologic Clinic, IRCCS Istituto Ortopedico Rizzoli, 40136 Bologna, Italy
| | - Marco Manzetti
- 1st Orthopaedic and Traumatologic Clinic, IRCCS Istituto Ortopedico Rizzoli, 40136 Bologna, Italy
| | - Tosca Cerasoli
- 1st Orthopaedic and Traumatologic Clinic, IRCCS Istituto Ortopedico Rizzoli, 40136 Bologna, Italy
| | - Francesca Barile
- 1st Orthopaedic and Traumatologic Clinic, IRCCS Istituto Ortopedico Rizzoli, 40136 Bologna, Italy
| | - Giovanni Viroli
- 1st Orthopaedic and Traumatologic Clinic, IRCCS Istituto Ortopedico Rizzoli, 40136 Bologna, Italy
| | - Matteo Traversari
- 1st Orthopaedic and Traumatologic Clinic, IRCCS Istituto Ortopedico Rizzoli, 40136 Bologna, Italy
| | - Francesca Salamanna
- Complex Structure Surgical Sciences and Technologies, IRCCS Istituto Ortopedico Rizzoli, 40136 Bologna, Italy
| | - Milena Fini
- Scientific Direction, IRCCS Istituto Ortopedico Rizzoli, 40136 Bologna, Italy
| | - Cesare Faldini
- 1st Orthopaedic and Traumatologic Clinic, IRCCS Istituto Ortopedico Rizzoli, 40136 Bologna, Italy
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Barile F, Ruffilli A, Viroli G, Manzetti M, Traversari M, Faldini C. Transient L5 Nerve Root Palsy Caused by Subfascial Drain After Lumbar Surgery: Case Report and Literature Review. JBJS Case Connect 2022; 12:01709767-202206000-00035. [PMID: 36099522 DOI: 10.2106/jbjs.cc.22.00006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
CASE We describe the case of a 45-year-old woman who developed a transient L5 deficit after a posterior L4-L5 interbody fusion. A perfusion computed tomography scan ruled out all described causes of postoperative deficit and showed compression of the right L5 root by the subfascial drain. The deficit spontaneously resolved. CONCLUSION New neurological deficit after spine surgery is a complication that requires a quick diagnostic and therapeutic approach. This particular case is of interest not only because it describes a rarely reported complication (transient neurological motor deficit after posterior fusion) but also because the hypothesized cause has never been described before.
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Affiliation(s)
- Francesca Barile
- 1st Orthopaedic Clinic, Istituto Ortopedico Rizzoli, Bologna, Italy
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Traversari M, Rühli FJ, Gruppioni G, Galassi FM. The "Lost Caravaggio": a probable case of goiter in seventeenth-century Italy. J Endocrinol Invest 2016; 39:1203-4. [PMID: 27278438 DOI: 10.1007/s40618-016-0492-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2016] [Accepted: 05/25/2016] [Indexed: 10/21/2022]
Affiliation(s)
- M Traversari
- Laboratories of Physical Anthropology and Ancient DNA, Department of Cultural Heritage (DBC), University of Bologna, Via degli Ariani n 1, 48121, Ravenna, Italy
| | - F J Rühli
- Institute of Evolutionary Medicine, University of Zurich, Winterthurerstrasse 190, 8057, Zurich, Switzerland
| | - G Gruppioni
- Laboratories of Physical Anthropology and Ancient DNA, Department of Cultural Heritage (DBC), University of Bologna, Via degli Ariani n 1, 48121, Ravenna, Italy
| | - F M Galassi
- Institute of Evolutionary Medicine, University of Zurich, Winterthurerstrasse 190, 8057, Zurich, Switzerland.
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