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Lambrechts MJ, Schroeder GD, Karamian BA, Canseco JA, Bransford R, Oner C, Benneker LM, Kandziora F, Shanmuganathan R, Kanna R, Joaquim AF, Chapman JR, Vialle E, El-Sharkawi M, Dvorak M, Schnake K, Kepler CK, Vaccaro AR. Global Validation of the AO Spine Upper Cervical Injury Classification: Geographic Region Affects Reliability and Reproducibility. Global Spine J 2024; 14:821-829. [PMID: 36036763 DOI: 10.1177/21925682221124100] [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: 11/16/2022] Open
Abstract
STUDY DESIGN Global Survey. OBJECTIVE To determine the accuracy, interobserver reliability, and intraobserver reproducibility of the AO Spine Upper Cervical Injury Classification System based on surgeons' AO Spine region of practice (Africa, Asia, Central/South America, Europe, Middle East, and North America). METHODS A total of 275 AO Spine members assessed 25 upper cervical spine injuries and classified them according to the AO Spine Upper Cervical Injury Classification System. Reliability, reproducibility, and accuracy scores were obtained over two assessments administered at three-week intervals. Kappa coefficients (ƙ) determined the interobserver reliability and intraobserver reproducibility. RESULTS On both assessments, participants from Europe and North America had the highest classification accuracy, while participants from Africa and Central/South America had the lowest accuracy (P < .0001). Participants from Africa (assessment 1 (AS1):ƙ = .487; AS2:0.491), Central/South America (AS1:ƙ = .513; AS2:0.511), and the Middle East (AS1:0.591; AS2: .599) achieved moderate reliability, while participants from North America (AS1:ƙ = .673; AS2:0.648) and Europe (AS1:ƙ = .682; AS2:0.681) achieved substantial reliability. Asian participants obtained substantial reliability on AS1 (ƙ = .632), but moderate reliability on AS2 (ƙ = .566). Although there was a large effect size, the low number of participants in certain regions did not provide adequate certainty that AO regions affected the likelihood of participants having excellent reproducibility (P = .342). CONCLUSIONS The AO Spine Upper Cervical Injury Classification System can be applied with high accuracy, interobserver reliability, and intraobserver reproducibility. However, lower classification accuracy and reliability were found in regions of Africa and Central/South America, especially for severe atlas injuries (IIB and IIC) and atypical hangman's type fractures (IIIB injuries).
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Affiliation(s)
- Mark J Lambrechts
- Rothman Institute at Thomas Jefferson University, Philadelphia, PA, USA
| | | | - Brian A Karamian
- Rothman Institute at Thomas Jefferson University, Philadelphia, PA, USA
| | - Jose A Canseco
- Rothman Institute at Thomas Jefferson University, Philadelphia, PA, USA
| | - Richard Bransford
- Department of Orthopaedicand Sports Medicine, Harborview Medical Center, University of Washington, Seattle, WA, USA
| | - Cumhur Oner
- Department of Orthopedic Surgery, University Medical Center, University of Utrecht, Utrecht, the Netherlands
| | - Lorin M Benneker
- Spine Unit, Sonnenhof Spital Bern, University of Bern, Bern, Switzerland
| | | | | | - Rishi Kanna
- Department of Orthopedics and Spine Surgery, Ganga Hospital, Coimbatore, India
| | - Andrei F Joaquim
- Department of Neurology, Neurosurgery Division, State University of Campinas, Campinas, Sao Paulo, Brazil
| | - Jens R Chapman
- Swedish Medical Center, Swedish Neuroscience Institute, Seattle, WA, USA
| | - Emiliano Vialle
- Cajuru University Hospital, Catholic University of Paraná, Curitiba, Brazil
| | | | - Marcel Dvorak
- University of British Columbia, Vancouver, BC, Canada
| | - Klaus Schnake
- Center for Spinal and Scoliosis Surgery, Malteser Waldkrankenhaus St. Marien, Erlangen, Germany
- Department of Orthopedics and Traumatology, Paracelsus Private Medical University Nuremberg, Nuremberg, Germany
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Albuquerque LAF, de Macêdo Filho LJM, Borges FS, Diógenes GS, Pessoa FC, Rocha CJV, Almeida JP, Ghizoni E, Joaquim AF. Performance of intraoperative neurocognitive tests during awake surgery for patients with diffuse low-grade glioma. Neurosurg Rev 2024; 47:129. [PMID: 38532178 DOI: 10.1007/s10143-024-02364-6] [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: 12/01/2023] [Revised: 02/17/2024] [Accepted: 03/16/2024] [Indexed: 03/28/2024]
Abstract
Despite great advancements and the diffusion of awake surgery for brain tumors, the literature shows that the tests applied during the procedure are heterogeneous and non-standardized. This prospective, observational, descriptive study collected data on intraoperative brain mapping and the performance of multiple neurocognitive tests in 51 awake surgeries for diffuse low-grade glioma. Frequency of use and rate of intraoperative findings of different neurocognitive tests were analyzed. Patients mean age at the time of surgery was 35.1 (20-57) years. We performed 26 (51.0%) surgeries on the left hemisphere (LH) and 25 (49.0%) on the right hemisphere (RH). Significant differences were observed between the total number of functional findings (cortical and subcortical) identified in the LH and RH (p = 0.004). In subcortical findings alone, the differences remained significant (p = 0.0004). The RH subcortical region showed the lowest number of intraoperative findings, and this was correlated with functional outcome: Karnofsky performance scale at five days (p = 0.022), three months (p = 0.002) and one year (p = 0.002) post-surgery. On average, more tests were used to map the RH, with a lower frequency of both cortical and subcortical functional findings. Even though subcortical findings were less frequent than cortical findings, they were crucial to defining the resection margins. Based on the intraoperative findings, frequency of use, and rate of findings per use of the tests analyzed, the most relevant tests for each hemisphere for awake brain mapping were identified.
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Affiliation(s)
- Lucas Alverne F Albuquerque
- Department of Neurosurgery, Hospital Geral de Fortaleza, Fortaleza, Ceará, Brazil.
- Department of Neurology, Universidade de Campinas, Campinas, São Paulo, Brazil.
| | | | - Felipe Silva Borges
- Department of Anesthesiology, Hospital Geral de Fortaleza, Fortaleza, Ceará, Brazil
| | | | - Fátima C Pessoa
- Speech Therapist, Hospital Geral de Fortaleza, Fortaleza, Ceará, Brazil
| | | | | | - Enrico Ghizoni
- Division of Neurosurgery, Department of Neurology, Universidade de Campinas, Campinas, São Paulo, Brazil
| | - Andrei F Joaquim
- Division of Neurosurgery, Department of Neurology, Universidade de Campinas, Campinas, São Paulo, Brazil
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Camino-Willhuber G, Bigdon S, Dandurand C, Dvorak MF, Öner CF, Schnake K, Muijs S, Benneker LM, Vialle E, Tee JW, Keynan O, Chhabra HS, Joaquim AF, Popescu EC, Canseco JA, Holas M, Kanna RM, Aly MM, Fallah N, Schroeder GD, Spiegl U, El-Skarkawi M, Bransford RJ, Rajasekaran S, Vaccaro AR. Expert Opinion, Real-World Classification, and Decision-Making in Thoracolumbar Burst Fractures Without Neurologic Deficits? Global Spine J 2024; 14:49S-55S. [PMID: 38324602 PMCID: PMC10867532 DOI: 10.1177/21925682231194456] [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] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/09/2024] Open
Abstract
STUDY DESIGN Retrospective analysis of prospectively collected data. OBJECTIVES To compare decision-making between an expert panel and real-world spine surgeons in thoracolumbar burst fractures (TLBFs) without neurological deficits and analyze which factors influence surgical decision-making. METHODS This study is a sub-analysis of a prospective observational study in TL fractures. Twenty two experts were asked to review 183 CT scans and recommend treatment for each fracture. The expert recommendation was based on radiographic review. RESULTS Overall agreement between the expert panel and real-world surgeons regarding surgery was 63.2%. In 36.8% of cases, the expert panel recommended surgery that was not performed in real-world scenarios. Conversely, in cases where the expert panel recommended non-surgical treatment, only 38.6% received non-surgical treatment, while 61.4% underwent surgery. A separate analysis of A3 and A4 fractures revealed that expert panel recommended surgery for 30% of A3 injuries and 68% of A4 injuries. However, 61% of patients with both A3 and A4 fractures received surgery in the real world. Multivariate analysis demonstrated that a 1% increase in certainty of PLC injury led to a 4% increase in surgery recommendation among the expert panel, while a .2% increase in the likelihood of receiving surgery in the real world. CONCLUSION Surgical decision-making varied between the expert panel and real-world treating surgeons. Differences appear to be less evident in A3/A4 burst fractures making this specific group of fractures a real challenge independent of the level of expertise.
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Affiliation(s)
- Gaston Camino-Willhuber
- Institute of Orthopedics "Carlos E. Ottolenghi", Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - Sebastian Bigdon
- Department of Orthopaedic Surgery and Traumatology, Inselspital, University Hospital, University of Bern, Bern, Switzerland
| | - Charlotte Dandurand
- Combined Neurosurgical and Orthopaedic Spine Program, Department of Orthopaedic Surgery, University of British Columbia, Vancouver, BC, Canada
| | - Marcel F Dvorak
- Combined Neurosurgical and Orthopaedic Spine Program, Department of Orthopaedic Surgery, University of British Columbia, Vancouver, BC, Canada
| | - Cumhur F Öner
- University Medical Centers, Utrecht, The Netherlands
| | - Klaus Schnake
- Center for Spinal and Scoliosis Surgery, Malteser Waldkrankenhaus St. Marien, Erlangen, Germany
- Department of Orthopedics and Traumatology, Paracelsus Private Medical University Nuremberg, Nuremberg, Germany
| | - Sander Muijs
- University Medical Centers, Utrecht, The Netherlands
| | - Lorin M Benneker
- Spine Unit, Sonnenhof Spital, University of Bern, Bern, Switzerland
| | - Emiliano Vialle
- Cajuru Hospital, Catholic University of Paraná, Curitiba, Brazil
| | - Jin W Tee
- Department of Neurosurgery, National Trauma Research Institute (NTRI), Melbourne, VIC, Australia
| | - Ory Keynan
- Rambam Health Care Campus, Haifa, Israel
| | - Harvinder S Chhabra
- Department of Spine Service, Indian Spinal Injuries Centre, Sector C, Vasant Kunj, New Delhi, India
| | - Andrei F Joaquim
- Department of Neurology, State University of Campinas, Campinas-Sao Paulo, Brazil
| | | | - Jose A Canseco
- Department of Orthopaedic Surgery, Rothman Institute, Thomas Jefferson University Hospital, Philadelphia, PA, USA
| | - Martin Holas
- Klinika Úrazovej Chirurgie SZU a FNsP F.D.Roosevelta, Banská Bystrica, Slovakia
| | - Rishi M Kanna
- Department of Orthopaedics and Spine Surgery, Ganga Hospital, Coimbatore, Tamil Nadu, India
| | - Mohamed M Aly
- Department of Neurosurgery, Prince Mohammed Bin Abdulaziz Hospital, Riyadh, Saudi Arabi
- Department of Neurosurgery, Mansoura University, Mansoura, Egypt
| | - Nader Fallah
- Combined Neurosurgical and Orthopaedic Spine Program, Department of Orthopaedic Surgery, University of British Columbia, Vancouver, BC, Canada
| | - Gregory D Schroeder
- Department of Orthopaedic Surgery, Rothman Institute, Thomas Jefferson University Hospital, Philadelphia, PA, USA
| | - Ulrich Spiegl
- Klinik für Orthopädie, Unfallchirurgie und plastische Chirurgie, Universitätsklinik Leipzig, Leipzig, Germany
| | - Mohammad El-Skarkawi
- Department of Orthopaedic and Trauma Surgery, Assiut University Medical School, Assiut, Egypt
| | - Richard J Bransford
- Department of Orthopaedics and Sports Medicine, University of Washington Harborview Medical Center, Seattle, WA, USA
| | | | - Alexander R Vaccaro
- Department of Orthopaedic Surgery, Rothman Institute, Thomas Jefferson University Hospital, Philadelphia, PA, USA
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Kweh BTS, Tee JW, Dandurand C, Vaccaro AR, Lorin BM, Schnake K, Vialle E, Rajasekaran S, El-Skarkawi M, Bransford RJ, Kanna RM, Aly MM, Holas M, Canseco JA, Muijs S, Popescu EC, Camino-Willhuber G, Joaquim AF, Chhabra HS, Bigdon SF, Spiegel U, Dvorak M, Öner CF, Schroeder G. The AO Spine Thoracolumbar Injury Classification System and Treatment Algorithm in Decision Making for Thoracolumbar Burst Fractures Without Neurologic Deficit. Global Spine J 2024; 14:32S-40S. [PMID: 38324601 PMCID: PMC10867534 DOI: 10.1177/21925682231195764] [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] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/09/2024] Open
Abstract
STUDY DESIGN Prospective Observational Study. OBJECTIVE To determine the alignment of the AO Spine Thoracolumbar Injury Classification system and treatment algorithm with contemporary surgical decision making. METHODS 183 cases of thoracolumbar burst fractures were reviewed by 22 AO Spine Knowledge Forum Trauma experts. These experienced clinicians classified the fracture morphology, integrity of the posterior ligamentous complex and degree of comminution. Management recommendations were collected. RESULTS There was a statistically significant stepwise increase in rates of operative management with escalating category of injury (P < .001). An excellent correlation existed between recommended expert management and the actual treatment of each injury category: A0/A1/A2 (OR 1.09, 95% CI 0.70-1.69, P = .71), A3/4 (OR 1.62, 95% CI 0.98-2.66, P = .58) and B1/B2/C (1.00, 95% CI 0.87-1.14, P = .99). Thoracolumbar A4 fractures were more likely to be surgically stabilized than A3 fractures (68.2% vs 30.9%, P < .001). A modifier indicating indeterminate ligamentous injury increased the rate of operative management when comparing type B and C injuries to type A3/A4 injuries (OR 39.19, 95% CI 20.84-73.69, P < .01 vs OR 27.72, 95% CI 14.68-52.33, P < .01). CONCLUSIONS The AO Spine Thoracolumbar Injury Classification system introduces fracture morphology in a rational and hierarchical manner of escalating severity. Thoracolumbar A4 complete burst fractures were more likely to be operatively managed than A3 fractures. Flexion-distraction type B injuries and translational type C injuries were much more likely to have surgery recommended than type A fractures regardless of the M1 modifier. A suspected posterior ligamentous injury increased the likelihood of surgeons favoring surgical stabilization.
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Affiliation(s)
- Barry T S Kweh
- National Trauma Research Institute, Melbourne, VIC, Australia
- Department of Neurosurgery, The Alfred Hospital, Melbourne, VIC, Australia
- Department of Neurosurgery, Royal Melbourne Hospital, Parkville, VIC, Melbourne
| | - Jin Wee Tee
- National Trauma Research Institute, Melbourne, VIC, Australia
- Department of Neurosurgery, The Alfred Hospital, Melbourne, VIC, Australia
- Central Clinical School, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, VIC, Australia
| | - Charlotte Dandurand
- Combined Neurosurgical and Orthopedic Spine Program, Vancouver General Hospital, University of British Columbia, Vancouver, BC, Canada
| | - Alexander R Vaccaro
- Department of Orthopaedic Surgery, Rothman Institute, Thomas Jefferson University Hospital, Philadelphia, PA, USA
| | - Benneker M Lorin
- Spine Unit, Sonnenhof Spital, University of Bern, Bern, Switzerland
| | - Klaus Schnake
- Center for Spinal and Scoliosis Surgery, Malteser Waldkrankenhaus St. Marien, Erlangen, Germany
- Department of Orthopedics and Traumatology, Paracelsus Private Medical University Nuremberg, Nuremberg, Germany
| | - Emiliano Vialle
- Cajuru Hospital, Catholic University of Paraná, Curitiba, Brazil
| | | | - Mohammad El-Skarkawi
- Department of Orthopaedic and Trauma Surgery, Faculty of Medicine, Assiut University, Assiut, Egypt
| | - Richard J Bransford
- Department of Orthopaedics and Sports Medicine, Harborview Medical Center, University of Washington, Seattle, WA, USA
| | - Rishi M Kanna
- Department of Orthopaedics and Spine Surgery, Ganga Hospital, Coimbatore, India
| | - Mohamed M Aly
- Department of Neurosurgery, Prince Mohammed Bin Abdulaziz Hospital, Riyadh, Saudi Arabi
- Department of Neurosurgery, Mansoura University, Mansoura, Egypt
| | - Martin Holas
- Klinika Úrazovej Chirurgie SZU a FNsP F.D.Roosevelta, Banská Bystrica, Slovakia
| | - Jose A Canseco
- Department of Orthopaedic Surgery, Rothman Institute, Thomas Jefferson University Hospital, Philadelphia, PA, USA
| | - Sander Muijs
- University Medical Centers, Utrecht, The Netherlands
| | | | - Gaston Camino-Willhuber
- Orthopaedic and Traumatology Department, Institute of Orthopedics "Carlos E. Ottolenghi" Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - Andrei F Joaquim
- Neurosurgery Division, Department of Neurology, State University of Campinas, Campinas-Sao Paulo, Brazil
| | | | - Sebastian Frederick Bigdon
- Department of Orthopaedic Surgery and Traumatology, Inselspital, University Hospital, University of Bern, Bern, Switzerland
| | - Ulrich Spiegel
- Department of Orthopaedics, Trauma Surgery and Plastic Surgery, University of Leipzig, Leipzig, Germany
| | - Marcel Dvorak
- Combined Neurosurgical and Orthopedic Spine Program, Vancouver General Hospital, University of British Columbia, Vancouver, BC, Canada
| | - Cumhur F Öner
- University Medical Centers, Utrecht, The Netherlands
| | - Gregory Schroeder
- Department of Orthopaedic Surgery, Rothman Institute, Thomas Jefferson University Hospital, Philadelphia, PA, USA
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de Almeida RAA, da Silva PGS, Wanderley BG, Ghizoni E, Joaquim AF. Modified Posterior Transdural Approach for Calcified Thoracic Midline Disc Herniations: Case Report and Illustrative 2-D Video. Neurol India 2023; 71:1146-1149. [PMID: 38174448 DOI: 10.4103/0028-3886.391376] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2024]
Affiliation(s)
| | - Paulo G S da Silva
- Department of Neurosurgery, Universidade Estadual de Campinas (Unicamp), Campinas, SP, Brazil
| | - Bianca G Wanderley
- Department of Neurosurgery, Universidade Estadual de Campinas (Unicamp), Campinas, SP, Brazil
| | - Enrico Ghizoni
- Department of Neurosurgery, Universidade Estadual de Campinas (Unicamp), Campinas, SP, Brazil
| | - Andrei F Joaquim
- Department of Neurosurgery, Universidade Estadual de Campinas (Unicamp), Campinas, SP, Brazil
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De Gendt EE, Benneker LM, Joaquim AF, El-Sharkawi M, Dhakal GR, Kandziora F, Tee J, Bransford RJ, Vialle EN, Vaccaro AR, Popescu EC, Kanna RM, Polly DW, Schnake KJ, Berjano P, Ryabykh S, Neva M, Lamartina C, Rothenfluh DA, Lewis SJ, Muijs SP, Oner FC. The Diagnostic Process of Spinal Post-traumatic Deformity: An Expert Survey of 7 Cases, Consensus on Clinical Relevance Does Exist. Clin Spine Surg 2023; 36:E383-E389. [PMID: 37363830 PMCID: PMC10521791 DOI: 10.1097/bsd.0000000000001478] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2022] [Accepted: 05/09/2023] [Indexed: 06/28/2023]
Abstract
STUDY DESIGN Survey of cases. OBJECTIVE To evaluate the opinion of experts in the diagnostic process of clinically relevant Spinal Post-traumatic Deformity (SPTD). SUMMARY OF BACKGROUND DATA SPTD is a potential complication of spine trauma that can cause decreased function and quality of life impairment. The question of when SPTD becomes clinically relevant is yet to be resolved. METHODS The survey of 7 cases was sent to 31 experts. The case presentation was medical history, diagnostic assessment, evaluation of diagnostic assessment, diagnosis, and treatment options. Means, ranges, percentages of participants, and descriptive statistics were calculated. RESULTS Seventeen spinal surgeons reviewed the presented cases. The items' fracture type and complaints were rated by the participants as more important, but no agreement existed on the items of medical history. In patients with possible SPTD in the cervical spine (C) area, participants requested a conventional radiograph (CR) (76%-83%), a flexion/extension CR (61%-71%), a computed tomography (CT)-scan (76%-89%), and a magnetic resonance (MR)-scan (89%-94%). In thoracolumbar spine (ThL) cases, full spine CR (89%-100%), CT scan (72%-94%), and MR scan (65%-94%) were requested most often. There was a consensus on 5 out of 7 cases with clinically relevant SPTD (82%-100%). When consensus existed on the diagnosis of SPTD, there was a consensus on the case being compensated or decompensated and being symptomatic or asymptomatic. CONCLUSIONS There was strong agreement in 5 out of 7 cases on the presence of the diagnosis of clinically relevant SPTD. Among spine experts, there is a strong consensus to use CT scan and MR scan, a cervical CR for C-cases, and a full spine CR for ThL-cases. The lack of agreement on items of the medical history suggests that a Delphi study can help us reach a consensus on the essential items of clinically relevant SPTD. LEVEL OF EVIDENCE Level V.
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Affiliation(s)
- Erin E.A. De Gendt
- Department of Orthopedics, University Medical Center Utrecht, Utrecht, The Netherlands
| | | | - Andrei F. Joaquim
- Department of Neurosurgery, State University of Campinas, Campinas, Brazil
| | - Mohammad El-Sharkawi
- Department of Orthopaedic and Trauma Surgery, Assiut University Medical School, Assiut, Egypt
| | - Gaurav R. Dhakal
- National Trauma Center, Bir Hospital, National Academy of Medical Sciences, Kathmandu, Nepal
| | - Frank Kandziora
- Center for Spinal Surgery and Neurotraumatology, BG Unfallklinik Frankfurt am Main gGmbH, Frankfurt, Germany
| | - Jin Tee
- Departement of Neurosurgery, The Alfred Hospital, Melbourne, Australia
| | | | - Emiliano N. Vialle
- Department of Orthopaedics, Cajuru Hospital, Catholic University of Paraná, Curitiba, Brazil
| | - Alex R. Vaccaro
- Department of Orthopaedic Surgery, Rothman Institute, Thomas Jefferson University, Philadelphia, PA
| | | | - Rishi M. Kanna
- Department of Orthopaedic and Spine Surgery, Ganga Hospital, Coimbatore, India
| | - David W. Polly
- Department of Orthopaedic Surgery, University of Minnesota, Minneapolis, MN
| | - Klaus J. Schnake
- Center for Spinal and Scoliosis Therapy, Malteser Waldkrankenhaus St. Marien, Erlangen
| | | | - Sergey Ryabykh
- National Ilizarov Medical Research Center for Traumatology and Ortopaedics, Russia
| | - Marko Neva
- Theater and Spine Surgery, Tampere University Hospital, Finland Unit, Tampere, Finland
| | | | | | - Stephan J. Lewis
- Toronto Western Hospital, University Health Network, Toronto, ON, Canada
| | - Sander P.J. Muijs
- Department of Orthopedics, University Medical Center Utrecht, Utrecht, The Netherlands
| | - F. Cumhur Oner
- Department of Orthopedics, University Medical Center Utrecht, Utrecht, The Netherlands
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7
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Albuquerque LAF, Filho LJMM, Borges FS, Pessoa FC, Diógenes GS, Rocha CJV, Almeida JP, Joaquim AF. Awake Craniotomy for Diffuse Low Grade Gliomas in a Resource Limited Setting - Lessons learned with a consecutive series of 51 surgeries. World Neurosurg 2023:S1878-8750(23)00879-3. [PMID: 37385443 DOI: 10.1016/j.wneu.2023.06.096] [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: 03/15/2023] [Revised: 06/19/2023] [Accepted: 06/20/2023] [Indexed: 07/01/2023]
Abstract
OBJECTIVE Despite benefits of awake craniotomy (AC) many centers do not have access to it. We demonstrated the oncological and functional results of our initial experience in implementing AC in a context of resource limited setting. METHODS This prospective, observational, descriptive study collected the first 51 AC for Diffuse Low Grade Glioma, classified according to the 2016 World Health Organization. RESULTS Mean age was 35.09 ± 9.91 years-old. The most common clinical presentation was seizure (89.58%). The average segmented volume was 69.8 cc; with 51% of lesions with more than 6 cm in the largest diameter. Resection of more than 90% of the lesion was achieved in 49% of cases, and greater than 80% in 66.6% of cases. The mean follow-up was 835 days (2.29 years). Satisfactory Karnofsky performance status (KPS) (80 to 100) was observed in 90.1% pre-surgery, 50.9% at 5 days, 93.7% at 3 months, and 89.7% at 1-year post-op. At multivariate analysis, tumor volume, new postoperative deficit and extent of resection were related to KPS at 1 year of follow up. CONCLUSIONS Functional decline was clearly observed in the immediate postoperative period, but excellent recovery of functional status was observed in the medium and long term. The data presented indicate the benefits of this mapping in both cerebral hemispheres, addressing several cognitive functions in addition to motricity and language.The proposed AC model is a reproducible technique, resource sparing, that can be performed safely and with good functional outcomes.
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Affiliation(s)
- Lucas Alverne F Albuquerque
- General Hospital of Fortaleza, Department of Neurosurgery, Fortaleza, Ceará, Brazil; University of Campinas, Department of Neurology, Campinas, São Paulo, Brazil.
| | | | - Felipe S Borges
- General Hospital of Fortaleza, Department of Anesthesiology, Fortaleza, Ceará, Brazil
| | - Fátima C Pessoa
- Speech Therapist, Department of Neurosurgery, Hospital Geral de Fortaleza, Fortaleza - Ceará, Brazil
| | - Gabryella S Diógenes
- Neuropsychologist, Department of Neurosurgery, Hospital Geral de Fortaleza, Fortaleza - Ceará, Brazil
| | - Cicera Jairlly V Rocha
- Neuropsychologist, Department of Neurosurgery, Hospital Geral de Fortaleza, Fortaleza - Ceará, Brazil
| | | | - Andrei F Joaquim
- University of Campinas, Division of Neurosurgery, Department of Neurology, Campinas, São Paulo, Brazil
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Cabrera JP, Carazzo CA, Guiroy A, White KP, Guasque J, Sfreddo E, Joaquim AF, Yurac R. In Reply to the Letter to the Editor Regarding “Risk Factors for Postoperative Complications After Surgical Treatment of Type B and C Injuries of the Thoracolumbar Spine”. World Neurosurg 2023; 172:121. [PMID: 37012723 DOI: 10.1016/j.wneu.2023.01.116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2023] [Accepted: 01/30/2023] [Indexed: 03/31/2023]
Affiliation(s)
- Juan P Cabrera
- Department of Neurosurgery, Hospital Clínico Regional de Concepción, Concepción, Chile, Faculty of Medicine, University of Concepción, Concepción, Chile.
| | - Charles A Carazzo
- Neurosurgery, University of Passo Fundo, São Vicente de Paulo Hospital, Passo Fundo, RS, Brazil
| | - Alfredo Guiroy
- Spine Unit, Orthopedic Department, Hospital Español de Mendoza, Mendoza, Argentina
| | - Kevin P White
- ScienceRight Research Consulting, London, Ontario, Canada
| | | | - Ericson Sfreddo
- Department of Neurosurgery, Hospital Cristo Redentor, Porto Alegre, Brazil
| | - Andrei F Joaquim
- Department of Neurosurgery, University of Campinas (UNICAMP), Campinas, SP, Brazil
| | - Ratko Yurac
- Department of Orthopedic and Traumatology, University del Desarrollo, Santiago, and Spine Unit, Department of Traumatology, Clínica Alemana, Santiago, Chile
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Abstract
STUDY DESIGN Cross-sectional survey. OBJECTIVES Assessment of subaxial cervical facet injuries using the AO Spine Subaxial Cervical Spine Injury Classification System is based on CT scan findings. However, additional radiological evaluations are not directly considered. The aim of this study is to determine situations in which spine surgeons request additional radiological exams after a facet fracture. METHODS A survey was sent to AO Spine members from Latin America. The evaluation considered demographic variables, routine use of the Classification, as well as the timepoint at which surgeons requested a cervical MRI, a vascular study, and/ or dynamic radiographs before treatment of facet fractures. RESULTS There was 229 participants, mean age 42.9 ± 10.2 years; 93.4% were men. Orthopedic surgeons 57.6% with 10.7 ± 8.7 years of experience in spine surgery. A total of 86% used the Classification in daily practice. An additional study (MRI/vascular study/and dynamic radiographs) was requested in 53.3%/9.6%/43.7% in F1 facet injuries; 76.0%/20.1%/50.2% in F2; 89.1%/65.1%/28.4% in F3; and 94.8%/66.4%/16.6% in F4. An additional study was frequently required: F1 72.5%, F2 86.9%, F3 94.7%, and F4 96.1%. CONCLUSIONS Spine surgeons generally requested additional radiological evaluations in facet injuries, and MRI was the most common. Dynamic radiographs had a higher prevalence for F1/F2 fractures; vascular studies were more common for F3/F4 especially among surgeons with fewer years of experience. Private hospitals had a lower spine trauma cases/year and requested more MRI and more dynamic radiographs in F1/F2. Neurosurgeons had more vascular studies and dynamic radiographs than orthopedic surgeons in all facet fractures.
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Affiliation(s)
- Juan P. Cabrera
- Department of Neurosurgery, Hospital
Clínico Regional de Concepción, Concepción, Chile,Faculty of Medicine, University of
Concepción, Concepción, Chile,Juan P. Cabrera, Department of Neurosurgery,
Hospital Clínico Regional de Concepción, San Martín 1436, Concepción, Chile.
| | - Ratko Yurac
- Department of Orthopedic and
Traumatology, University del Desarrollo, Santiago, Chile,Spine Unit, Department of Traumatology,
Clínica Alemana, Santiago, Chile
| | - Andrei F. Joaquim
- Department of Neurosurgery, University
of Campinas (UNICAMP), Campinas-SP, Brazil
| | - Alfredo Guiroy
- Spine Unit, Orthopedic Department,
Hospital Español de Mendoza, Mendoza, Argentina
| | - Charles A. Carazzo
- Neurosurgery, University of Passo Fundo,
São Vicente de Paulo Hospital – Passo Fundo – RS, Brazil
| | - Juan J. Zamorano
- Department of Orthopedic and
Traumatology, University del Desarrollo, Santiago, Chile,Spine Unit, Department of Traumatology,
Clínica Alemana, Santiago, Chile
| | - Marcelo Valacco
- Department of Orthopedic and
Traumatology, Hospital Churruca Visca, Buenos Aires, Argentina
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10
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Gagliardi MJ, Guiroy AJ, Camino-Willhuber G, Joaquim AF, Carazzo CA, Yasuda E, Cabrera JP, Morales Ciancio AR. Is Indirect Decompression and Fusion More Effective than Direct Decompression and Fusion for Treating Degenerative Lumbar Spinal Stenosis With Instability? A Systematic Review and meta-Analysis. Global Spine J 2023; 13:499-511. [PMID: 35486409 PMCID: PMC9972259 DOI: 10.1177/21925682221098362] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [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] [Indexed: 11/16/2022] Open
Abstract
Study design: Systematic Review and Meta-analysis.Objective: Surgical alternatives to treat lumbar spinal stenosis and instability include indirect (ALIF, OLIF, and LLIF) and direct (TLIF or posterior lumbar interbody fusion) decompression and fusion interventions. Although both approaches have proven to be effective in reducing symptoms, it is unknown if there is any difference in effectiveness between them. In this systematic review and meta-analysis, we aimed to evaluate postoperative pain and disability in patients treated whit indirect vs direct decompression and fusion approaches.Methods: We conducted a systematic review of the literature consulting several databases and identified studies that enrolled patients diagnosed with degenerative lumbar spinal stenosis and instability treated with indirect or direct decompression and fusion techniques. Our primary endpoints were the visual analogue scale, Oswestry Disability Index, and the Japanese Orthopedics Association Back Pain Evaluation Questionnaire 1 year after the procedure. Secondary outcomes included complication rate, blood loss, and surgical time.Results: Nine retrospective and comparative studies were included enrolling a total of 1004 participants. Both surgical strategies had satisfactory clinical outcomes with no significant difference at 1 year. Although the complication rate was similar for both groups, the profile of the adverse events was different. In addition, patients treated with indirect decompression and fusion had significantly less blood loss and operative times.Conclusions: Indirect and direct decompression and fusion techniques are similarly effective in treating patients with lumbar spinal stenosis and instability. The ID group had significantly lower intraoperative blood loss and surgical time values.
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Affiliation(s)
- Martin J. Gagliardi
- Department of Neurosurgery, St Michael’s Hospital, University of
Toronto, Toronto, ON, Canada,Department of Orthopedics, Hospital Español de
Mendoza, Mendoza, Argentina,Martin J. Gagliardi, M.D, Department of
Neurosurgery, St Michael’s Hospital, University of Toronto, 36 Queen Street,
Toronto, ON M5B 1W8, Canada.
| | - Alfredo J. Guiroy
- Department of Orthopedics, Hospital Español de
Mendoza, Mendoza, Argentina,The Paley Orthopedics and Spine
Institute, Saint Mary’s Medical
Center, West Palm Beach, FL, USA
| | | | - Andrei F. Joaquim
- Department of Neurosurgery, University of Campinas, Campinas, Brazil
| | - Charles A. Carazzo
- Department of Neurosurgery, São
Vicente de Paulo Hospital, University of Passo
Fundo, Passo Fundo, Brazil
| | - Ezequiel Yasuda
- Department of Neurosurgery,
Hospital de Clinicas, University of Buenos
Aires, Buenos Aires, Argentina
| | - Juan P. Cabrera
- Department of Neurosurgery, Hospital Clinico Regional de
Concepción, Concepción, Chile
| | - Alejandro R. Morales Ciancio
- Department of Orthopedics, Hospital Español de
Mendoza, Mendoza, Argentina,Department of Orthopaedics, Great Ormond Street
Hospital, London, UK
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11
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Joaquim AF, Evangelista Santos Barcelos AC, Daniel JW, Botelho RV. Chamberlain's Line Violation in Basilar Invagination Patients Compared with Normal Subjects: A Systematic Literature Review and Meta-Analysis. World Neurosurg 2023; 173:e364-e370. [PMID: 36822399 DOI: 10.1016/j.wneu.2023.02.057] [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: 02/06/2023] [Accepted: 02/10/2023] [Indexed: 02/24/2023]
Abstract
OBJECTIVE To compare the measured odontoid tip violation above Chamberlain's line described in the literature to diagnose basilar invagination (BI) and to establish the normal placement of the dens tip defining individuals without BI (normal subjects). METHODS A systematic literature review was performed to identify clinical or radiological studies that expressed the amount of odontoid violation above Chamberlain's line in patients with a BI diagnosis. In addition, a meta-analysis was performed to evaluate normal subjects' values of Chamberlain's line violation (CLV). RESULTS There were 23 studies included (13 radiological and 10 clinical). Most studies used computed tomography and/or magnetic resonance imaging. Eight different cutoff values were used to measure dislocated odontoid apexes above Chamberlain's line regardless of the radiological modality. The mean measured amount of CLV was 3.95 mm (median 5 mm; range, 0-9 mm). The meta-analysis included 8 studies (1233 patients) with a normal sample population with a mean normal CLV of -0.63 mm (below the line) (95% confidence interval [-0.8, 1.18 mm], random effects model). CONCLUSIONS Different values were found in the assessed studies used for CLV in BI diagnosis. This variability is especially important for type B BI, as type A BI has other craniocervical diagnostic parameters. Considering the results obtained in this meta-analysis, BI should be diagnosed in the case of any dens violation >1.18 mm.
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Affiliation(s)
- Andrei F Joaquim
- Department of Neurology, Discipline of Neurosurgery, University of Campinas (UNICAMP), Campinas, São Paulo, Brazil.
| | | | - Jefferson Walter Daniel
- Division of Neurosurgery, Santa Casa de Sao Paulo - School of Medical Sciences, Sao Paulo, São Paulo, Brazil
| | - Ricardo Vieira Botelho
- Department of Neurosurgery, Hospital Servidor Público Estadual (IAMSPE-SP), São Paulo, São Paulo, Brazil
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12
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Florez WA, Martinez-Perez R, Deora H, Joaquim AF, García-Ballestas E, Quiñones-Ossa GA, Rivas-Palacios C, Agrawal A, Serrato SA, Jabbour P, Moscote-Salazar LR. An update of predictors of cerebral infarction after aneurysmal subarachnoid hemorrhage: systematic review and meta-analysis. J Neurosurg Sci 2023; 67:1-9. [PMID: 36112119 DOI: 10.23736/s0390-5616.22.05445-5] [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: 11/08/2022]
Abstract
INTRODUCTION Evidence about predictors of poor outcomes such as cerebral infarction (CI) after aneurysmal subarachnoid hemorrhage (aSAH) has not been fully elucidated. EVIDENCE ACQUISITION We performed a systematic review and meta-analysis on studies with adults with aSAH considering RCT and non-RCT, prospective, and retrospective cohort studies describing clinical, imaging as well as angiographic studies in patients with aSAH. EVIDENCE SYNTHESIS After reviewing the complete text, 11 studies were considered eligible, out of which four were ruled out. Degree of clinical severity was the most predictive factor with a higher degree at the presentation on different severity scales being associated with a statistically significant increasing the risk of suffering a CI following aSAH (OR 2.49 [95% CI 1.38-4.49] P=0.0003). Aneurysm size increased the risk of CI (OR 1.49 [95% CI 1.20-1.85] P=0.0003; I2=4%). In six studies analyzed, it was found that an important factor for the subsequent development of CI is vasospasm (OR 7.62 [2.19, 26.54], P=0.0001). CONCLUSIONS The development of vasospasm is a risk factor for CI development after aSAH. In our review, three factors were associated with an increased risk of CI: clinical severity at presentation, vasospasm, and aneurysm size. The major limitation of this meta-analysis is that included studies were conducted retrospectively or were post hoc analyses of a prospective trial.
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Affiliation(s)
- William A Florez
- Consejo Latinoamericano de Neurointensivismo- CLaNi, Cartagena, Colombia.,Faculty of Medicine, Universidad Surcolombiana, Neiva, Colombia
| | - Rafael Martinez-Perez
- Department of Neurosurgery, Wexner Medical Center, The Ohio State University, Columbus, OH, USA.,Division of Neurosurgery, Institute of Neurosciences, Austral University of Chile, Valdivia, Chile
| | - Harsh Deora
- Department of Neurosurgery, National Institute of Mental Health and Neurosciences, Bangalore, India
| | - Andrei F Joaquim
- Department of Neurosurgery. University of Campinas (UNICAMP), São Paulo, Brazil
| | - Ezequiel García-Ballestas
- Consejo Latinoamericano de Neurointensivismo- CLaNi, Cartagena, Colombia.,Centro De Investigaciones Biomédicas (CIB), Faculty of Medicine, University of Cartagena, Cartagena, Colombia
| | - Gabriel A Quiñones-Ossa
- Consejo Latinoamericano de Neurointensivismo- CLaNi, Cartagena, Colombia - .,Faculty of Medicine, El Bosque University, Bogotá, Colombia
| | - Claudio Rivas-Palacios
- Centro De Investigaciones Biomédicas (CIB), Faculty of Medicine, University of Cartagena, Cartagena, Colombia
| | - Amit Agrawal
- Department of Neurosurgery, All India Institute of Medical Sciences, Bhopal, India
| | | | - Pascal Jabbour
- Department of Neurological Surgery, Thomas Jefferson University Hospital, Philadelphia, PA, USA
| | - Luis R Moscote-Salazar
- Consejo Latinoamericano de Neurointensivismo- CLaNi, Cartagena, Colombia.,Faculty of Medicine, Universidad Surcolombiana, Neiva, Colombia
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13
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Joaquim AF, de Oliveira SA, Appenzeller S, Patel AA. Spine Surgery and Ankylosing Spondylitis: Optimizing Perioperative Management. Clin Spine Surg 2023; 36:8-14. [PMID: 35249972 DOI: 10.1097/bsd.0000000000001306] [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] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Accepted: 02/02/2022] [Indexed: 02/07/2023]
Abstract
Ankylosing spondylitis (AS) is a common form of axial spondyloarthritis, characterized by inflammatory back pain, radiographic sacroiliitis, excess spinal bone formation, and a high prevalence of HLA-B27. Commonly, AS patients require spinal surgery for kyphotic deformities, spinal trauma, and spinal infections. For preoperative management, proper interruption considering each specific half-lives of disease-modifying antirheumatic drugs are necessary to avoid complications, such as infections. When feasible, bone quality assessment before surgery is mandatory. For intraoperative measurements, airway management should be carefully evaluated, especially in patients with severe cervical deformities. Cardiac, renal, and pulmonary assessment should be made considering specific pathologic characteristics involved in AS patients, such as pulmonary restrictive disease and chronic anti-inflammatory drugs use. Multimodal neurophysiological intraoperative monitoring is recommended once these patients had a high risk for neurological deterioration. At the postoperative period, early oral intake, early mobilization, and aggressive pain control may decrease complications and enhance recovery. AS presents several unique challenges that require specific attention around spine surgery. This includes handling preoperative and postoperative pharmacotherapeutics, intraoperative airway management, and the mitigation of postoperative complications. In this paper, we provide a literature review of optimal strategies for the perioperative management for patients with AS.
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Affiliation(s)
| | | | - Simone Appenzeller
- Department of Orthopedics, Rheumatology, and Traumatology, School of Medical Science, University of Campinas (UNICAMP), Campinas-SP, Brazil
| | - Alpesh A Patel
- Department of Orthopaedic Surgery & Neurosurgery, Northwestern Spine Health, Northwestern University School of Medicine, Chicago, IL
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14
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Cabrera JP, Carazzo CA, Guiroy A, White KP, Guasque J, Sfreddo E, Joaquim AF, Yurac R, Picard N, Donato M, Gorgas A, Peña E, González Ó, Mandiola S, Remondino R, Ortiz PN, Jiménez J, Gonzalez JDJ, Martinez O, Reyes P, Jara J, Burgos J, Gagliardi M, Ciancio AM, Uruchi D, Martínez R, Mireles N, Meira PH, Astur N, Meves R, Vieira R, Borges R, Chaves J, Guimaraes R, Balen M, Zamorano JJ, Zanini GR, Senna G, Cabrera PR, Ordoñez F, Vásquez FA, Daniel J, Veiga JC, Del Santoro P, Sebben AL, Orso V, Penteado R, Pino C, Velarde E, Jacob C, Dias W, Ujhelly JI, Estay A, Noleto G, de Sousa I, Amorim R, Carneiro M, Montoya F, Flórez D, Corrêa RA, Santiago B, Gonzalez AS. Risk Factors for Postoperative Complications After Surgical Treatment of Type B and C Injuries of the Thoracolumbar Spine. World Neurosurg 2023; 170:e520-e528. [PMID: 36402303 DOI: 10.1016/j.wneu.2022.11.059] [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: 11/08/2022] [Accepted: 11/13/2022] [Indexed: 11/18/2022]
Abstract
BACKGROUND Unstable thoracolumbar spinal injuries benefit from surgical fixation. However, perioperative complications significantly affect outcomes in surgicallytreated spine patients. We evaluated associations between risk factors and postoperative complications in patients surgically treated for thoracolumbar spine fractures. METHODS We conducted a retrospective multicenter study collating data from 21 spine centers across 9 countries on the treatment of AOSpine types B and C injuries of the thoracolumbar spine treated via a posterior approach. Comparative analysis was performed between patients with postoperative complications and those without. Univariate and multivariable analyses were performed. RESULTS Among 535 patients, at least 1 complication occurred in 43%. The most common surgical complication was surgical-site infection (6.9%), while the most common medical complication was urinary tract infection (13.8%). Among 136 patients with American Spinal Injury Association (ASIA) Impairment Scalelevel A disability, 77.9% experienced at least 1 complication. The rate of complications also rose sharply among patients waiting >3 days for surgery (P<0.001), peaking at 68.4% among patients waiting ≥30 days. On multivariable analysis, significant predictors of complications were surgery at a governmental hospital (odds ratio = 3.38, 95% confidence interval = 1.73-6.60), having ≥1 comorbid illness (2.44, 1.61-3.70), surgery delayed due to health instability (2.56, 1.50-4.37), and ASIA Impairment Scalelevel A (3.36, 1.78-6.35), while absence of impairment (0.39, 0.22-0.71), ASIAlevel E (0.39, 0.22-0.67) and, unexpectedly, delay caused by operating room unavailability (0.60, 0.36-0.99) were protective. CONCLUSIONS Types B and C thoracolumbar spine injuries are associated with a high risk of postoperative complications, especially common at governmental hospitals, and among patients with comorbidity, health instability, longer delays to surgery, and worse preoperative neurologic status.
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Affiliation(s)
- Juan P Cabrera
- Department of Neurosurgery, Hospital Clínico Regional de Concepción, and Faculty of Medicine, University of Concepción, Concepción, Chile.
| | - Charles A Carazzo
- Neurosurgery, University of Passo Fundo, São Vicente de Paulo Hospital, Passo Fundo, RS, Brazil
| | - Alfredo Guiroy
- Spine Unit, Orthopedic Department, Hospital Español de Mendoza, Mendoza, Argentina
| | - Kevin P White
- Science Right Research Consulting, London, Ontario, Canada
| | | | - Ericson Sfreddo
- Department of Neurosurgery, Hospital Cristo Redentor, Porto Alegre, Brazil
| | - Andrei F Joaquim
- Department of Neurosurgery, University of Campinas (UNICAMP), Campinas-SP, Brazil
| | - Ratko Yurac
- Department of Orthopedic and Traumatology, University del Desarrollo, and Spine Unit, Department of Traumatology, Clínica Alemana, Santiago, Chile
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15
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Vaccaro AR, Lambrechts MJ, Karamian BA, Canseco JA, Oner C, Vialle E, Rajasekaran S, Dvorak MR, Benneker LM, Kandziora F, El-Sharkawi M, Tee JW, Bransford R, Joaquim AF, Muijs SPJ, Holas M, Takahata M, Hamouda WO, Kanna RM, Schnake K, Kepler CK, Schroeder GD. AO Spine upper cervical injury classification system: a description and reliability study. Spine J 2022; 22:2042-2049. [PMID: 35964830 DOI: 10.1016/j.spinee.2022.08.005] [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] [Received: 06/16/2022] [Revised: 07/20/2022] [Accepted: 08/04/2022] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT Prior upper cervical spine injury classification systems have focused on injuries to the craniocervical junction (CCJ), atlas, and dens independently. However, no previous system has classified upper cervical spine injuries using a comprehensive system incorporating all injuries from the occiput to the C2-3 joint. PURPOSE To (1) determine the accuracy of experts at correctly classifying upper cervical spine injuries based on the recently proposed AO Spine Upper Cervical Injury Classification System (2) to determine their interobserver reliability and (3) identify the intraobserver reproducibility of the experts. STUDY DESIGN/SETTING International Multi-Center Survey. PATIENT SAMPLE A survey of international spine surgeons on 29 unique upper cervical spine injuries. OUTCOME MEASURES Classification accuracy, interobserver reliability, intraobserver reproducibility. METHODS Thirteen international AO Spine Knowledge Forum Trauma members participated in two live webinar-based classifications of 29 upper cervical spine injuries presented in random order, four weeks apart. Percent agreement with the gold-standard and kappa coefficients (ƙ) were calculated to determine the interobserver reliability and intraobserver reproducibility. RESULTS Raters demonstrated 80.8% and 82.7% accuracy with identification of the injury classification (combined location and type) on the first and second assessment, respectively. Injury classification intraobserver reproducibility was excellent (mean, [range] ƙ=0.82 [0.58-1.00]). Excellent interobserver reliability was found for injury location (ƙ = 0.922 and ƙ=0.912) on both assessments, while injury type was substantial (ƙ=0.689 and 0.699) on both assessments. This correlated to a substantial overall interobserver reliability (ƙ=0.729 and 0.732). CONCLUSIONS Early phase validation demonstrated classification of upper cervical spine injuries using the AO Spine Upper Cervical Injury Classification System to be accurate, reliable, and reproducible. Greater than 80% accuracy was detected for injury classification. The intraobserver reproducibility was excellent, while the interobserver reliability was substantial.
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Affiliation(s)
| | - Mark J Lambrechts
- Rothman Institute at Thomas Jefferson University, Philadelphia, PA, USA.
| | - Brian A Karamian
- Rothman Institute at Thomas Jefferson University, Philadelphia, PA, USA
| | - Jose A Canseco
- Rothman Institute at Thomas Jefferson University, Philadelphia, PA, USA
| | - Cumhur Oner
- Department of Orthopedic Surgery, University Medical Center, University of Utrecht, Utrecht, Netherlands
| | - Emiliano Vialle
- Spine Surgery Group, Department of Orthopaedics, Cajuru University Hospital, Catholic University of Parana, Curitaba, Brazil
| | | | - Marcel R Dvorak
- Division of Spine, University of British Columbia, BC, Canada
| | - Lorin M Benneker
- Department of Orthopaedic Surgery, Inselspital, University of Bern, Bern, Switzerland
| | | | | | - Jin Wee Tee
- Department of Neurosurgery, The Alfred, Melbourne, VIC, Australia
| | - Richard Bransford
- Department of Orthopaedic Surgery, University of Washington, Harborview Medical Center, Seattle, WAS, USA
| | - Andrei F Joaquim
- Department of Neurology, Neurosurgery Division, State University of Campinas, Campinas, SP, Brazil
| | - Sander P J Muijs
- Department of Orthopedic Surgery, University Medical Center, University of Utrecht, Utrecht, Netherlands
| | - Martin Holas
- Klinika Úrazovej Chirurgie SZU FNsP F.D.Roosevelta, Banská Bystrica, Slovakia
| | - Masahiko Takahata
- Department of Orthopaedic Surgery, Hokkaido University Graduate School of Medicine, Sapporo, Japan
| | - Waeel O Hamouda
- Department of Neurosurgery, Cairo University Medical School and Teaching Hospitals, Cairo, Egypt
| | - Rishi M Kanna
- Department of Orthopedics and Spine Surgery, Ganga Hospital, Coimbatore, India
| | - Klaus Schnake
- Center for Spinal and Scoliosis Surgery, Malteser Waldkrankenhaus St. Marien, Erlangen, Germany; Department of Orthopedics and Traumatology, Paracelsus Private Medical University Nuremberg, Nuremberg, Germany
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16
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Lambrechts MJ, Schroeder GD, Karamian BA, Canseco JA, Bransford R, Oner C, Benneker LM, Kandziora F, Shanmuganathan R, Kanna R, Joaquim AF, Chapman JR, Vialle E, El-Sharkawi M, Dvorak M, Schnake K, Kepler CK, Vaccaro AR. The AO spine upper cervical injury classification system: Do work setting or trauma center affiliation affect classification accuracy or reliability? Injury 2022; 53:3248-3254. [PMID: 36038389 DOI: 10.1016/j.injury.2022.08.030] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2022] [Accepted: 08/14/2022] [Indexed: 02/02/2023]
Abstract
PURPOSE To assess the accuracy and reliability of the AO Spine Upper Cervical Injury Classification System based on a surgeons' work setting and trauma center affiliation. METHODS A total of 275 AO Spine members participated in a validation of 25 upper cervical spine injuries, which were evaluated by computed tomography (CT) scans. Each participant was grouped based on their work setting (academic, hospital-employed, or private practice) and their trauma center affiliation (Level I, Level II or III, and Level IV or no trauma center). The classification accuracy was calculated as percent of correct classifications, while interobserver reliability, and intraobserver reproducibility were evaluated based on Fleiss' Kappa coefficient. RESULTS The overall classification accuracy for surgeons affiliated with a level I trauma center was significantly greater than participants affiliated with a level II/III center or a level IV/no trauma center on assessment one (p1<0.0001) and two (p2 = 0.0003). On both assessments, surgeons affiliated with a level I or a level II/III trauma center were significantly more accurate at identifying IIIB injury types (p1 = 0.0007; p2 = 0.0064). Academic surgeons and hospital employed surgeons were significantly more likely to correctly classify type IIIB injuries on assessment one (p1 = 0.0146) and two (p2 = 0.0015). When evaluating classification reliability, the largest differences between work settings and trauma center affiliations was identified in type IIIB injuries. CONCLUSION Type B injuries are the most difficult injury type to correctly classify. They are classified with greater reliability and classification accuracy when evaluated by academic surgeons, hospital-employed surgeons, and surgeons associated with higher-level trauma centers (I or II/III).
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Affiliation(s)
- Mark J Lambrechts
- Rothman Institute at Thomas Jefferson University, Philadelphia, PA, USA..
| | | | - Brian A Karamian
- Rothman Institute at Thomas Jefferson University, Philadelphia, PA, USA
| | - Jose A Canseco
- Rothman Institute at Thomas Jefferson University, Philadelphia, PA, USA
| | - Richard Bransford
- Department of Orthopaedicand Sports Medicine, Harborview Medical Center, University of Washington, Seattle, WA, USA
| | - Cumhur Oner
- Department of Orthopedic Surgery, University Medical Center, University of Utrecht, Utrecht, The Netherlands
| | - Lorin M Benneker
- Spine Unit, Sonnenhof Spital Bern, University of Bern, Bern, Switzerland
| | | | | | - Rishi Kanna
- Department of Orthopedics and Spine Surgery, Ganga Hospital, Coimbatore, India
| | - Andrei F Joaquim
- Department of Neurology, Neurosurgery Division, State University of Campinas, Campinas, Sao Paulo, Brazil
| | - Jens R Chapman
- Swedish Neuroscience Institute, Swedish Medical Center, Seattle, WA, USA
| | - Emiliano Vialle
- Cajuru University Hospital, Catholic University of Paraná, Curitiba, Brazil
| | | | - Marcel Dvorak
- University of British Columbia, Vancouver, BC, Canada
| | - Klaus Schnake
- Center for Spinal and Scoliosis Surgery, Malteser Waldkrankenhaus St. Marien, Erlangen, Germany; Department of Orthopedics and Traumatology, Paracelsus Private Medical University Nuremberg, Nuremberg, Germany
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17
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Lee NJ, Joaquim AF, Boddapati V, Mathew J, Park P, Kim JS, Sardar ZM, Lehman RA, Riew KD. Revision Anterior Cervical Disc Arthroplasty: A National Analysis of the Associated Indications, Procedures, and Postoperative Outcomes. Global Spine J 2022; 12:1338-1344. [PMID: 33464126 PMCID: PMC9393989 DOI: 10.1177/2192568220979140] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [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: 11/24/2022] Open
Abstract
STUDY DESIGN Retrospective study. OBJECTIVE To examine the associated indications, procedures, and postoperative outcomes after revision ACDA. METHODS We utilized a national database to identify adult(≥18 years) patients who underwent either a primary ACDA or removal of ACDA over a 10-year period(2008-2017). An in-depth assessment of the reasons for revision surgery and the subsequent procedures performed after the removal of ACDA was done by using both Current Procedural Terminology(CPT) and International Statistical Classification of Diseases (ICD-9,10) coding. RESULTS From 2008 to 2017, a total of 3,350 elective, primary ACDA cases were performed. During this time, 69 patients had a revision surgery requiring the removal of ACDA. The most common reasons for revision surgery included cervical spondylosis(59.4%) and mechanical complications(27.5%). After removal of ACDA, common procedures performed included anterior cervical fusion with or without decompression(69.6%), combined anterior/posterior fusion/decompression (11.6%), and replacement of ACDA (7.2%). The indications for surgery did not vary significantly among the different procedures performed (p = 0.318). Patients requiring revision surgery for mechanical complications or those who underwent a combined surgical approach were at significantly higher risk for subsequent short-term complications (p<0.05). CONCLUSION Over a 10-year period, the rate of revision surgery for ACDA was low (2.1%). Nearly 90% of revision cases were due to either cervical spondylosis or mechanical complications. These indications for surgery did not vary significantly among the different procedures performed. These findings will be important during the shared-decision making process for patients undergoing primary or revision ACDA.
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Affiliation(s)
- Nathan J. Lee
- Department of Orthopaedics, Columbia University Medical Center, The Och Spine Hospital at New York-Presbyterian, New York, NY, USA,Nathan J. Lee, MD, Columbia University Medical Center, 161 Fort Washington Avenue, New York, NY 10032, USA.
| | - Andrei F. Joaquim
- Department of Neurosurgery, University of Campinas (Unicamp), Campinas, São Paulo, Brazil
| | - Venkat Boddapati
- Department of Orthopaedics, Columbia University Medical Center, The Och Spine Hospital at New York-Presbyterian, New York, NY, USA
| | - Justin Mathew
- Department of Orthopaedics, Columbia University Medical Center, The Och Spine Hospital at New York-Presbyterian, New York, NY, USA
| | - Paul Park
- Department of Orthopaedics, Columbia University Medical Center, The Och Spine Hospital at New York-Presbyterian, New York, NY, USA
| | - Jun S. Kim
- Department of Orthopaedics, Columbia University Medical Center, The Och Spine Hospital at New York-Presbyterian, New York, NY, USA
| | - Zeeshan M. Sardar
- Department of Orthopaedics, Columbia University Medical Center, The Och Spine Hospital at New York-Presbyterian, New York, NY, USA
| | - Ronald A. Lehman
- Department of Orthopaedics, Columbia University Medical Center, The Och Spine Hospital at New York-Presbyterian, New York, NY, USA
| | - K. Daniel Riew
- Department of Orthopaedics, Columbia University Medical Center, The Och Spine Hospital at New York-Presbyterian, New York, NY, USA
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18
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Cabrera JP, Guiroy A, Carazzo CA, Yurac R, Valacco M, Vialle E, Joaquim AF. Unstable Thoracolumbar Injuries: Factors Affecting the Decision for Short-Segment vs Long-Segment Posterior Fixation. Int J Spine Surg 2022; 16:772-778. [PMID: 35977752 PMCID: PMC10151419 DOI: 10.14444/8337] [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] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND Factors influencing the length of spinal instrumentation have been mostly evaluated in burst fractures, receiving more attention than other unstable thoracolumbar injuries. We aimed to evaluate clinical factors affecting surgical decision-making and associated complications. METHODS This was a multicentric retrospective cohort study. Outcomes of patients with AO Spine injury classification types B2, B3, and C operated through an open posterior-only approach were analyzed. Length of instrumentation was correlated with age, type of injury, comorbidities, level of injury, neurological status, and complications. RESULTS Among 439 patients, 30.3% underwent short-segment fixation (SSF) and 69.7% underwent long-segment fixation (LSF). Type C injuries were treated with LSF in 89.4% of cases (P < 0.001). On multivariate analysis, age ≤39 years (OR: 2.06), AO spine type B2 (OR: 3.58), and type B3 (OR: 7.48) were statistically significant predictors for SSF, while hypertension (OR: 4.07), upper thoracic injury (OR: 9.48), midthoracic injury (OR: 6.06), and American Spinal Injury Association Impairment Scale A (OR: 3.14) were significantly associated with LSF. Patients with SSF had fewer overall complications (27.1% vs 50.9%, P < 0.001) and were less likely to develop pneumonia (6.0% vs 18.3%, P < 0.001) and urinary tract infections (6.8% vs 16.3%, P < 0.007). CONCLUSIONS Unstable thoracolumbar injuries were mostly treated by LSF. Length of instrumentation was affected by the type of spinal injury, location of the injury, and neurological status. SSF was associated with lower rates of early complications than LSF. CLINICAL RELEVANCE The decision on the length of fixation in the surgical treatment of unstable thoracolumbar injuries is affected by different factors, and it will impact the rate of postoperative complications. LEVEL OF EVIDENCE: 3
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Affiliation(s)
- Juan P Cabrera
- Department of Neurosurgery, Hospital Clínico Regional de Concepción, Concepción, Chile .,Faculty of Medicine, University of Concepción, Concepción, Chile
| | - Alfredo Guiroy
- Spine Unit, Orthopedic Department, Hospital Español de Mendoza, Mendoza, Argentina
| | - Charles A Carazzo
- Neurosurgery, University of Passo Fundo, São Vicente de Paulo Hospital - Passo Fundo - RS, Brazil
| | - Ratko Yurac
- Department of Orthopedic and Traumatology, University del Desarrollo, Santiago, Chile.,Spine Unit, Department of Traumatology, Clínica Alemana, Santiago, Chile
| | - Marcelo Valacco
- Department of Orthopedic and Traumatology, Hospital Churruca Visca, Buenos Aires, Argentina
| | - Emiliano Vialle
- Orthopedic Department, Hospital Universitário Cajuru, Curitiba, Brazil
| | - Andrei F Joaquim
- Department of Neurosurgery, University of Campinas (UNICAMP), Campinas-SP, Brazil
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19
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De Gendt EEA, Vercoulen TFG, Joaquim AF, Guo W, Vialle EN, Schroeder GD, Schnake KS, Vaccaro AR, Benneker LM, Muijs SPJ, Oner FC. The Current Status of Spinal Posttraumatic Deformity: A Systematic Review. Global Spine J 2021; 11:1266-1280. [PMID: 33280414 PMCID: PMC8453678 DOI: 10.1177/2192568220969153] [Citation(s) in RCA: 3] [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] [Indexed: 11/15/2022] Open
Abstract
STUDY DESIGN Systematic Review. OBJECTIVE To systematically analyze the definitions and descriptions in literature of "Spinal Posttraumatic Deformity" (SPTD) in order to support the development of a uniform and comprehensive definition of clinically relevant SPTD. METHODS A literature search in 11 international databases was performed using "deformity" AND "posttraumatic" and its synonyms. When an original definition or a description of SPTD (Patient factors, Radiological outcomes, Patient Reported Outcome Measurements and Surgical indication) was present the article was included. The retrieved articles were assessed for methodological quality and the presented data was extracted. RESULTS 46 articles met the inclusion criteria. "Symptomatic SPTD" was mentioned multiple times as an entity, however any description of "symptomatic SPTD" was not found. Pain was mentioned as a key factor in SPTD. Other patient related parameters were (progression of) neurological deficit, bone quality, age, comorbidities and functional disability. Various ways were used to determine the amount of deformity on radiographs. The amount of deformity ranged from not deviant for normal to >30°. Sagittal balance and spinopelvic parameters such as the Pelvic Incidence, Pelvic Tilt and Sacral Slope were taken into account and were used as surgical indicators and preoperative planning. The Visual Analog Scale for pain and the Oswestry Disability Index were used mostly to evaluate surgical intervention. CONCLUSION A clear-cut definition or consensus is not available in the literature about clinically relevant SPTD. Our research acts as the basis for international efforts for the development of a definition of SPTD.
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Affiliation(s)
- Erin E. A. De Gendt
- Department of Orthopedics, University Medical Center Utrecht, the Netherlands,Erin E. A. De Gendt, Department of Orthopedics, University Medical Centre Utrecht, Postbus 85500, 3508 GA Utrecht, the Netherlands.
| | | | - Andrei F. Joaquim
- Department of Neurosurgery, State University of Campinas, Campinas, Cidade Universitária Zeferino Vaz—Barão Geraldo, Campinas—SP, Brazil
| | - Wei Guo
- Department of Orthopedics, Sun Yat-sen University, Guangzhou, Haizhu District, Guangdong Province, China
| | - Emiliano N. Vialle
- Department of Orthopaedics, Cajuru Hospital, Catholic University of Paraná, Curitiba, Av. São José, Brazil
| | - Gregory D. Schroeder
- Department of Orthopaedic Surgery, Rothman Institute, Thomas Jefferson University, PA, USA
| | | | - Alexander R. Vaccaro
- Department of Orthopaedic Surgery, Rothman Institute, Thomas Jefferson University, PA, USA
| | | | - Sander P. J. Muijs
- Department of Orthopedics, University Medical Center Utrecht, the Netherlands
| | - F. Cumhur Oner
- Department of Orthopedics, University Medical Center Utrecht, the Netherlands
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20
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Cabrera JP, Camino-Willhuber G, Guiroy A, Carazzo CA, Gagliardi M, Joaquim AF. Vertebral augmentation plus short-segment fixation versus vertebral augmentation alone in Kümmell's disease: a systematic review and meta-analysis. Neurosurg Rev 2021; 45:1009-1018. [PMID: 34596773 DOI: 10.1007/s10143-021-01661-8] [Citation(s) in RCA: 2] [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: 07/27/2021] [Revised: 08/27/2021] [Accepted: 09/27/2021] [Indexed: 12/23/2022]
Abstract
Osteoporotic vertebral compression fractures of the thoracolumbar spine can progress to Kümmell's disease, an avascular vertebral osteonecrosis. Vertebral augmentation (VA)-vertebroplasty and/or kyphoplasty-is the main treatment modality, but additional short-segment fixation (SSF) has been recommended concomitant to VA. The aim is to compare clinical and radiological outcomes of VA + SSF versus VA alone. Systematic review, including comparative articles in Kümmell's disease, was performed. This study assessed the following outcome measurements: visual analog scale (VAS), Oswestry Disability Index (ODI), anterior vertebral height (AVH), local kyphotic angle (LKA), operative time, blood loss, length of stay, and cement leakage. Six retrospective studies were included, with 126 patients in the VA + SSF group and 152 in VA alone. Pooled analysis showed the following: VAS, non-significant difference favoring VA + SSF: MD -0.61, 95% CI (-1.44, 0.23), I2 91%, p = 0.15; ODI, non-significant difference favoring VA + SSF: MD -9.85, 95% CI (-19.63, -0.07), I2 96%, p = 0.05; AVH, VA + SSF had a non-significant difference over VA alone: MD -3.21 mm, 95% CI (-7.55, 1.14), I2 92%, p = 0.15; LKA, non-significant difference favoring VA + SSF: MD -0.85°, 95% CI (-5.10, 3.40), I2 95%, p = 0.70. There were higher operative time, blood loss, and hospital length of stay for VA + SSF (p < 0.05), but with lower cement leakage (p < 0.05). VA + SFF and VA alone are effective treatment modalities in Kümmell's disease. VA + SSF may provide superior long-term results in clinical and radiological outcomes but required a longer length of stay.
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Affiliation(s)
- Juan P Cabrera
- Department of Neurosurgery, Hospital Clínico Regional de Concepción, San Martín 1436, Concepción, Chile.
- Faculty of Medicine, University of Concepción, Concepción, Chile.
| | - Gastón Camino-Willhuber
- Department of Orthopaedic and Traumatology, Institute of Orthopedics "Carlos E. Ottolenghi" Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - Alfredo Guiroy
- Spine Unit, Orthopedic Department, Hospital Español de Mendoza, Mendoza, Argentina
| | - Charles A Carazzo
- Department of Neurosurgery, São Vicente de Paulo Hospital, University of Passo Fundo, Passo Fundo, Rio Grande do Sul, Brazil
| | - Martin Gagliardi
- Spine Unit, Orthopedic Department, Hospital Español de Mendoza, Mendoza, Argentina
| | - Andrei F Joaquim
- Department of Neurosurgery, University of Campinas (UNICAMP), Campinas, São Paulo, Brazil
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21
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Carazzo CA, Yurac R, Guiroy A, Zamorano JJ, Cabrera JP, Joaquim AF. Minimally Invasive Versus Open Surgery for the Treatment of Types B and C Thoracolumbar Injuries: A PRISMA Systematic Review. Int J Spine Surg 2021; 15:803-810. [PMID: 34266931 DOI: 10.14444/8103] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023] Open
Abstract
BACKGROUND Thoracic and lumbar spine injuries may require surgical management, particularly AO Spine types B and C injuries. Open reduction and fixation using pedicle screws, with or without fusion and/or decompression, is the gold standard surgical treatment for unstable injuries. Recent advances in instrumentation design have resulted in less-invasive surgeries. However, the literature is sparse about the effectiveness of these procedures for types B and C injuries. The objective is to compare the outcomes of conventional open surgery versus minimally invasive spine surgery (MISS) for the treatment of AO Spine types B and C thoracolumbar injuries. METHODS A systematic review of published literature in PubMed, Web of Science, and Scopus was performed to identify studies comparing outcomes achieved with open versus minimally invasive surgery in AO Spine types B and C thoracolumbar injury patients. Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines were used. RESULTS Five retrospective case-control studies and 3 prospective studies met selection criteria. In general, most of the studies demonstrated that minimally invasive spine surgery is feasible for types B and C injuries, and associated with potential advantages like reduced blood loss, postoperative pain, and muscle injury, and shorter hospital stays. However, no differences were detected in major outcomes, like neurological status or disability. CONCLUSIONS Published literature currently suggests that minimally invasive spine surgery is a valid alternative for treating types B and C thoracolumbar injuries. However, further comparative prospective randomized clinical trials are necessary to establish the superiority of one approach over the other. LEVEL OF EVIDENCE 3.
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Affiliation(s)
| | - Ratko Yurac
- Department of Orthopedics and Traumatology, University del Desarrollo, Santiago, Chile.,Spine Unit, Department of Traumatology, Clínica Alemana, Santiago, Chile
| | - Alfredo Guiroy
- Spine Unit, Orthopedics Department, Hospital Español de Mendoza, Mendoza, Argentina
| | - Juan J Zamorano
- Department of Orthopedics and Traumatology, University del Desarrollo, Santiago, Chile.,Spine Unit, Department of Traumatology, Clínica Alemana, Santiago, Chile
| | - Juan P Cabrera
- Department of Neurosurgery, Hospital Clínico Regional de Concepción, Concepción, Chile
| | - Andrei F Joaquim
- Department of Neurosurgery, University of Campinas, Campinas, SãoPaulo, Brazil
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22
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Florez-Perdomo WA, García-Ballestas E, Martinez-Perez R, Agrawal A, Deora H, Joaquim AF, Quiñones-Ossa GA, Moscote-Salazar LR. Hemoglobin levels as a transfusion criterion in moderate to severe traumatic brain injury: a systematic review and meta-analysis. Br J Neurosurg 2021; 37:1-7. [PMID: 34148446 DOI: 10.1080/02688697.2021.1940850] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [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: 01/10/2021] [Accepted: 06/07/2021] [Indexed: 12/28/2022]
Abstract
BACKGROUND Several factors can influence the outcome of severe head injuries including the patient's hemoglobin levels. There has often been a dilemma regarding levels of hemoglobin at which red cell blood transfusion (RCBT) should be performed. OBJECTIVE To systematically review the literature to determine the usefulness of management protocols that have hemoglobin levels <10 g/dL vs <7 g/dL as an RCBT criterion. METHODS Following the PRISMA statement, the search was constructed using terms and descriptors of the Medical Subject Heading (MeSH), combined with Boolean operators. Full text of these articles was studied, and outcome measures at 3-6 months were considered for patients who were given a RCBT at <10 g/dL or at 7 g/dL hemoglobin levels. RESULTS A total of 4 articles were found suitable for inclusion in the meta-analysis. RCBT below 7 g/dL was not associated with an increased risk of mortality as compared to RCBT using the value of less than 10 g/dL. RCBT at lower levels of hemoglobin was also not associated with a poor neurological outcome (GOS 4-5) but rather RCBT at lower levels lead to better outcomes (GOS 1-3) and the association was significant. CONCLUSION Allogenic RCBT was associated with poorer neurological outcomes, within a wide range of reported differences in the hemoglobin threshold to decide for RCBT in TBI patients. Restrictive RCBT strategy may be useful in moderate to severe TBI cases although the risk of anemia-induced cerebral injury needs further investigation regarding the risks and complications inherent to RCBT.
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Affiliation(s)
| | - Ezequiel García-Ballestas
- Latin American Council of Neurocritical Care- CLaNi, Cartagena, Colombia
- Faculty of Medicine, Centro De Investigaciones Biomédicas (CIB), University of Cartagena, Cartagena, Colombia
| | - Rafael Martinez-Perez
- Department of Neurological Surgery, University of Colorado, Aurora, CO, USA
- Institute of Neurosciences, Division of Neurosurgery, Universidad Austral de Chile, Valdivia, Chile
| | - Amit Agrawal
- Department of Neurosurgery, All India Institute of Medical Sciences, Bhopal, India
| | - Harsh Deora
- Department of Neurosurgery, NIMHANS, Bangalore, India
| | - Andrei F Joaquim
- Department of Neurosurgery, University of Campinas (UNICAMP), São Paulo, Brazil
| | - Gabriel A Quiñones-Ossa
- Latin American Council of Neurocritical Care- CLaNi, Cartagena, Colombia
- Faculty of Medicine, University El Bosque, Bogotá, Colombia
| | - Luis Rafael Moscote-Salazar
- Latin American Council of Neurocritical Care- CLaNi, Cartagena, Colombia
- Faculty of Medicine, Centro De Investigaciones Biomédicas (CIB), University of Cartagena, Cartagena, Colombia
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23
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Karamian BA, Schroeder GD, Holas M, Joaquim AF, Canseco JA, Rajasekaran S, Benneker LM, Kandziora F, Schnake KJ, Öner FC, Kepler CK, Vaccaro AR. Variation in global treatment for subaxial cervical spine isolated unilateral facet fractures. Eur Spine J 2021; 30:1635-1650. [PMID: 33797624 DOI: 10.1007/s00586-021-06818-z] [Citation(s) in RCA: 2] [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] [Subscribe] [Scholar Register] [Received: 11/11/2020] [Revised: 02/23/2021] [Accepted: 03/14/2021] [Indexed: 02/07/2023]
Abstract
PURPOSE To determine the variation in the global treatment practices for subaxial unilateral cervical spine facet fractures based on surgeon experience, practice setting, and surgical subspecialty. METHODS A survey was sent to 272 members of the AO Spine Subaxial Injury Classification System Validation Group worldwide. Questions surveyed surgeon preferences with regard to diagnostic work-up and treatment of fracture types F1-F3, according to the AO Spine Subaxial Cervical Spine Injury Classification System, with various associated neurologic injuries. RESULTS A total of 161 responses were received. Academic surgeons use the facet portion of the AO Spine classification system less frequently (61.6%) compared to hospital-employed and private practice surgeons (81.1% and 81.8%, respectively) (p = 0.029). The overall consensus was in favor of operative treatment for any facet fracture with radicular symptoms (N2) and for any fractures categorized as F2N2 and above. For F3N0 fractures, significantly less surgeons from Africa/Asia/Middle East (49%) and Europe (59.2%) chose operative treatment than from North/Latin/South America (74.1%) (p = 0.025). For F3N1 fractures, significantly less surgeons from Africa/Asia/Middle East (52%) and Europe (63.3%) recommended operative treatment than from North/Latin/South America (84.5%) (p = 0.001). More than 95% of surgeons included CT in their work-up of facet fractures, regardless of the type. No statistically significant differences were seen in the need for MRI to decide treatment. CONCLUSION Considerable agreement exists between surgeon preferences with regard to unilateral facet fracture management with few exceptions. F2N2 fracture subtypes and subtypes with radiculopathy (N2) appear to be the threshold for operative treatment.
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Affiliation(s)
- Brian A Karamian
- Department of Orthopaedic Surgery, Rothman Institute at Thomas Jefferson University Hospital, 925 Chestnut St, 5th Floor, Philadelphia, PA, 19107, USA.
| | - Gregory D Schroeder
- Department of Orthopaedic Surgery, Rothman Institute at Thomas Jefferson University Hospital, 925 Chestnut St, 5th Floor, Philadelphia, PA, 19107, USA
| | - Martin Holas
- Klinika Úrazovej Chirurgie SZU a FNsP F.D.Roosevelta, Banská Bystrica, Slovakia
| | - Andrei F Joaquim
- Neurosurgery Division, Department of Neurology, State University of Campinas, Campinas-Sao Paulo, Brazil
| | - Jose A Canseco
- Department of Orthopaedic Surgery, Rothman Institute at Thomas Jefferson University Hospital, 925 Chestnut St, 5th Floor, Philadelphia, PA, 19107, USA
| | | | - Lorin M Benneker
- Spine Service, Orthopaedic Department, Sonnenhofspital, Bern, Switzerland
| | - Frank Kandziora
- FK- Center for Spine Surgery and Neurotraumatology, BG Unfallklinik Frankfurt am Main, Frankfurt, Germany
| | - Klaus J Schnake
- Center for Spinal Surgery, Malteser Waldkrankenhaus St. Marien, Erlangen, Germany
| | | | - Christopher K Kepler
- Department of Orthopaedic Surgery, Rothman Institute at Thomas Jefferson University Hospital, 925 Chestnut St, 5th Floor, Philadelphia, PA, 19107, USA
| | - Alexander R Vaccaro
- Department of Orthopaedic Surgery, Rothman Institute at Thomas Jefferson University Hospital, 925 Chestnut St, 5th Floor, Philadelphia, PA, 19107, USA
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24
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Vasquez HE, Murlimanju BV, Shrivastava A, Durango-Espinosa YA, Joaquim AF, Garcia-Ballestas E, Moscote-Salazar LR, Agrawal A. Intracranial collateral circulation and its role in neurovascular pathology. Egypt J Neurosurg 2021. [DOI: 10.1186/s41984-020-00095-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Collateral circulation is a vascular network which maintains the blood flow after the partial blockage of primary vascular pathways. This acts as potential vascular supplementary system and plays important role in the cerebral ischemia.
Main body
Collateral circulation has implications in the management especially related to cerebral endovascular treatment and thrombolytic therapy. It is considered as subsidiary network of vascular channels, which is highly variable. Insufficient arterial supply is due to the hemodynamic compromise because of thromboembolism. Apart from the collaterals, there is additional existence of a group of vessels known as venous collaterals. Their function is variable and they contribute to the augmentation of venous drainage in venous ischemias. Various pharmacological interventions are used to modulate the collaterals, these can prove to be a complementary alternative to the invasive intracerebral interventions.
Conclusions
The aim of this review article is to highlight the importance of cerebral collateral circulation and to discuss the various available pharmacological alternatives available and their current relevance in the management of various neurovascular pathologies.
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25
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Florez-Perdomo WA, Laiseca Torres EF, Serrato SA, Janjua T, Joaquim AF, Moscote-Salazar LR. A Systematic Review and Meta-Analysis on Effect of Beta-Blockers in Severe Traumatic Brain Injury. Neurol Res 2021; 43:609-615. [PMID: 33478359 DOI: 10.1080/01616412.2020.1866385] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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: 10/22/2022]
Abstract
OBJECTIVES Systematically review the medical literature for the impact of beta-blockers on mortality and functional capacity in patients who suffered severe traumatic brain injury. DATA SOURCES The search included MEDLINE, EMBASE, and Ovid Evidence-Based Medicine, clinical trial registries, and bibliographies. STUDY SELECTION All articles that reported outcome in TBI patients treated with beta-blockers. DATA EXTRACTION Publication year, number of patients, outcome and follow-up. We performed a meta-analysis for each variable for which there were sufficient data to estimate mean differences. DATA SYNTHESIS 12 studies were included, which involved retrospectively and prospectively collected data on 14,057 patients. The treatment with beta-blockers was associated with a reduction in mortality in patients who were treated with beta-blockers compared to the control group (OR 0.40, 95% CI 0.30-0.54p = <0.00001), with acceptable heterogeneity between studies (I2 = 65% p = 0.00008). Beta-blocker therapy decreases the risk of negative neurological and functional outcomes (OR 0.59, 95% CI 0.38-0.92 p = <0.00001), a very high statistical heterogeneity between the included studies (I2 = 80% p = 0.00004), being able to influence the results. An increase in favorable neurological and functional outcomes is shown (OR 1.19, 95% CI 1.07-1.31 p = 0.001) with acceptable heterogeneity (I2 = 52% p = 0.08). CONCLUSIONS The beta-blockers therapy is associated with significantly improves outcome in patients with TBI. Treatment with beta-blockers in patients with TBI is a promising frontier in neurotrauma. ABBREVIATIONS CI: confidence interval; BB: Beta-Blockers; OR = odds ratio; TBI: Traumatic Brain Injury SD: Standard deviation; SNS: Sympathetic nervous system.
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Affiliation(s)
- William A Florez-Perdomo
- Department of Neurocritical Care, Latinamerican Council of Neurocritical Care, Cartagena, Colombia
| | | | - Sergio A Serrato
- Department of Medicine, SouthColombian University, Neiva, Colombia
| | - Tariq Janjua
- Critical Care Unit, Regions Hospital, Saint Paul, MN, USA
| | - Andrei F Joaquim
- Department of Neurosurgery, Universidade Estadual De Campinas, UNICAMP, Campinas, Brazil
| | - Luis Rafael Moscote-Salazar
- Centro de Investigaciones Biomédicas (CIB) Faculty of Medicine, University of Cartagena, Cartagena, Colombia.,Paracelsus Medical University, Salzburg, Austria
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26
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Guiroy A, Carazzo CA, Zamorano JJ, Cabrera JP, Joaquim AF, Guasque J, Sfredo E, White K, Yurac R, Falavigna A. Time to Surgery for Unstable Thoracolumbar Fractures in Latin America-A Multicentric Study. World Neurosurg 2021; 148:e488-e494. [PMID: 33444839 DOI: 10.1016/j.wneu.2021.01.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [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: 11/14/2020] [Revised: 01/02/2021] [Accepted: 01/04/2021] [Indexed: 11/29/2022]
Abstract
OBJECTIVE We sought to identify delays for surgery to stabilize unstable thoracolumbar fractures and the main reasons for them across Latin America. METHODS We reviewed the charts of 547 patients with type B or C thoracolumbar fractures from 21 spine centers across 9 Latin American countries. Data were collected on demographics, mechanism of trauma, time between hospital arrival and surgery, type of hospital (public vs. private), fracture classification, spinal level of injury, neurologic status (American Spinal Injury Association impairment scale), number of levels instrumented, and reason for delay between hospital arrival and surgical treatment. RESULTS The sample included 403 men (73.6%) and 144 women (26.3%), with a mean age of 40.6 years. The main mechanism of trauma was falls (44.4%), followed by car accidents (24.5%). The most frequent pattern of injury was B2 injuries (46.6%), and the most affected level was T12-L1 (42.2%). Neurologic status at admission was 60.5% intact and 22.9% American Spinal Injury Association impairment scale A. The time from admission to surgery was >72 hours in over half the patients and over a week in >25% of them. The most commonly reported reasons for surgical delay were clinical instability (22.9%), lack of operating room availability (22.7%), and lack of hardware for spinal instrumentation (e.g., screws/rods) (18.8%). CONCLUSIONS Timing for surgery in this sample of unstable fractures was over 72 hours in more than half of the sample and longer than a week in about a quarter. The main reasons for this delay were clinical instability and lack of economic resources. There is an apparent need for increased funding for the treatment of spinal trauma patients in Latin America.
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Affiliation(s)
- Alfredo Guiroy
- Spine Unit, Orthopedic Department, Hospital Español de Mendoza, Mendoza, Argentina.
| | - Charles A Carazzo
- Department of Neurosurgery, University of Passo Fundo, São Vicente de Paulo Hospital, Passo Fundo, Rio Grande do Sul
| | - Juan J Zamorano
- Orthopedic and Traumatology, University del Desarrollo, and Spine Unit, Department of Traumatology, Clínica Alemana, Santiago
| | - Juan P Cabrera
- Neurosurgery, Hospital Clínico Regional de Concepción, Concepción, Chile
| | - Andrei F Joaquim
- Department of Neurosurgery, University of Campinas (UNICAMP), Campinas, São Paulo, Brazil
| | | | | | - Kevin White
- ScienceRight Research Consulting, Ontario, Canada
| | - Ratko Yurac
- Orthopedic and Traumatology, University del Desarrollo, and Spine Unit, Department of Traumatology, Clínica Alemana, Santiago
| | - Asdrubal Falavigna
- Neurosurgery Department, University of Caxias do Sul, Caxias do Sul, Brazil
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Perdomo WAF, Joaquim AF, Moscote-Salazar LR. Letter: Protective Effects of Obstructive Sleep Apnea on Outcomes After Subarachnoid Hemorrhage: A Nationwide Analysis. Neurosurgery 2020; 87:E723. [DOI: 10.1093/neuros/nyaa431] [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: 11/14/2022] Open
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Garcia-Ballestas E, Murlimanju BV, Durango-Espinosa YA, Joaquim AF, Vasquez HE, Moscote-Salazar LR, Agrawal A. Collateral Circulation in Spinal Cord Injury: A Comprehensive Review. Indian Journal of Neurotrauma 2020. [DOI: 10.1055/s-0040-1713724] [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: 10/23/2022]
Abstract
AbstractSurgery is the most common cause of spinal cord ischemia; it is also caused by hemodynamic changes, which disrupt the blood flow. Direct ligation of the spinal arteries, especially the Adamkiewicz artery is involved as well. Other causes of spinal cord ischemia include arteriography procedures, thoracic surgery, epidural and rachianesthesia, foraminal infiltration, arterial dissection, systemic hypotension, emboligenic heart disease, thoracic disc herniation, and compression. Understanding the vascular anatomy of the spinal cord is essential to develop optimal strategies for preventing ischemic injuries to the spinal cord. During ischemia, a rich network of intra and paraspinal collaterals allow enough blood flow to compensate the intensity of spinal cord ischemia. In case of interruption of flow of a main artery, the collateral artery increases its flow to maintain perfusion to the tissues. Avoiding spinal cord ischemia by using collateral circulation is necessary to prevent the establishment of hypovolemia, hyperthermia and elevations in venous pressures. The objective of this narrative review is to present the current concepts of spinal collateral circulation and its role in the setting of ischemic events, affecting the vascular supply of the spinal cord.
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Affiliation(s)
- Ezequiel Garcia-Ballestas
- Faculty of Medicine, Center for Biomedical Research (CIB), University of Cartagena, Cartagena, Colombia
| | - B. V. Murlimanju
- Department of Anatomy, Kasturba Medical College, Mangalore, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | | | - Andrei F. Joaquim
- Neurosurgery Division, Cartagena de Indias, Bolivar Department of Neurology, State University of Campinas, Campinas-Sao Paulo, Brazil
| | - Harold E. Vasquez
- Universidad del Sinu, Cartagena de Indias, Consejo Latinoamericano de Neurointensivismo (CLaNi), Cartagena de Indias, Colombia
| | - Luis Rafael Moscote-Salazar
- Neurosurgeon-Critical Care, Center for Biomedical Research (CIB), Cartagena Neurotrauma Research Group, Faculty of Medicine, University of Cartagena, Cartagena, Colombia
| | - Amit Agrawal
- Department of Neurosurgery, All India Institute of Medical Sciences, Bhopal, Madhya Pradesh, India
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Formentin C, de Andrade EJ, Matias LG, Joaquim AF, Tedeschi H, Raposo-Amaral CE, Ghizoni E. Using the keystone design perforator island flap in large myelomeningocele closure. Neurosurg Focus 2020; 47:E19. [PMID: 31574473 DOI: 10.3171/2019.7.focus19383] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2019] [Accepted: 07/29/2019] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Many repair techniques have been proposed to treat large myelomeningocele (MMC), and although effective in many cases, some of these techniques can be complex and time consuming, with complications such as cerebrospinal fluid (CSF) leakage, flap loss, tip necrosis, and wound dehiscence. The purpose of this study was to analyze cases of large skin defects and the methods applied and to report the outcomes of the keystone design perforator island flap (KDPIF) technique for large MMC closure. METHODS The authors performed a retrospective review of all neonatal patients who had undergone KDPIF for MMC closure in the period from 2013 to 2018. All patients had a diagnosis of lumbosacral MMC based on obstetric ultrasound. The neurosurgeons and plastic surgeons had selected the cases after concluding that primary closure would be unlikely. The design of the flap is based on the randomly located vascular perforators, creating two identical opposing flaps to fashion a double keystone flap. During wound closure, V-Y advancement of each end of the double flap in the longitudinal axis creates redundancy in the central portion of the flap and reduces the horizontal tension. After discharge, both the neurosurgery and plastic surgery teams followed up all patients, tracking the results with photography. RESULTS No skin flap dehiscence or necrosis, infection, or CSF leakage was detected, proving the reliability of the flap. One of the patients required further surgery for the large skin defects after insufficient intrauterine closure of the MMC and successfully underwent KDPIF treatment. Another patient (14.3%) had severe neonatal sepsis, which ultimately led to death. A ventriculoperitoneal shunt was required after the skin defect repair in 5 (83.3%) of the 6 surviving patients. Exceptional aesthetic results were achieved for all patients during the follow-up. CONCLUSIONS The KDPIF technique is based on well-known vascular perforators of the intercostal, lumbar, and gluteal regions. Wound tension is widely distributed by the flap and, as a consequence, relevant tissue bulk, reliable vascularity, and important geometrical versatility are provided. In addition, most of the muscles and fascia are preserved, which is another advantage in terms of minimizing secondary morbidity to local tissue rearrangement. The use of KDPIF closure was successfully shown to be a viable alternative for more complex MMCs that present with large skin defects.
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Affiliation(s)
- Cleiton Formentin
- 1Neurosurgery Division-Department of Neurology, University of Campinas (UNICAMP); and
| | | | - Leo Gordiano Matias
- 1Neurosurgery Division-Department of Neurology, University of Campinas (UNICAMP); and
| | - Andrei F Joaquim
- 1Neurosurgery Division-Department of Neurology, University of Campinas (UNICAMP); and
| | - Helder Tedeschi
- 1Neurosurgery Division-Department of Neurology, University of Campinas (UNICAMP); and
| | | | - Enrico Ghizoni
- 1Neurosurgery Division-Department of Neurology, University of Campinas (UNICAMP); and.,2Plastic and Craniofacial Institute, Sobrapar Hospital, Campinas, São Paulo, Brazil
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Florez-Perdomo WA, Serrato-Vargas SA, Bosque-Varela P, Moscote-Salazar LR, Joaquim AF, Agrawal A, Soto-Angel ÁR, Tovar-Montenegro LT. Relationship between the history of cerebrovascular disease and mortality in COVID-19 patients: A systematic review and meta-analysis. Clin Neurol Neurosurg 2020; 197:106183. [PMID: 32919240 PMCID: PMC7446719 DOI: 10.1016/j.clineuro.2020.106183] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [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: 05/18/2020] [Revised: 06/09/2020] [Accepted: 08/23/2020] [Indexed: 01/08/2023]
Abstract
BACKGROUND AND OBJECTIVES Past history of stroke has been associated with an increased risk of a new ischemic stroke. Several studies have indicated increased prevalence of strokes among coronavirus patients. However, the role of past history of stroke in COVID19 patients is still unclear. The purpose of this systematic review is to evaluate and summarize the level of evidence on past history of stroke in COVID19 patients. METHODS A systematic review was performed according to the PRISMA guidelines was performed in PubMed, Embase, EBSCO Host, Scopus, Science Direct, Medline, and LILACS. Eligibility criteria: We evaluated studies including patients with diagnosis of COVID 19 and a past history of stroke. Risk of bias: was evaluated with the Newcastle- Ottawa Scale (NOS) and experimental studies were evaluated using the ROBINS-I scale. RESULTS Seven articles out of the total 213 articles were evaluated and included, involving 3244 patients with SARS VOC 2 Disease (COVID19) of which 198 had a history of cerebrovascular disease. Meta-analysis of the data was performed, observing an increase in mortality in patients with a history of cerebrovascular disease compared to those with different comorbidities or those without underlying pathology (OR 2.78 95 % CI [1.42-5.46] p = 0.007; I2 = 49 %) showing adequate heterogeneity. The presence of publication bias was evaluated using the Egger test in a funnel plot, showing adequate. Asymmetry, indicating that there is no publication bias; however, due to the low number of included studies, we could not rule out or confirm the presence of bias. CONCLUSIONS The history of cerebrovascular disease was associated with a 2.78-fold increased risk of mortality compared to patients with other comorbidities or without underlying pathologies.
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Affiliation(s)
| | | | | | | | | | - Amit Agrawal
- Department of Neurosurgery, All India Institute of Medical Sciences, Saket Nagar, Bhopal, 462020, Madhya Pradesh, India
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Vaccaro AR, Schroeder GD, Divi SN, Kepler CK, Kleweno CP, Krieg JC, Wilson JR, Holstein JH, Kurd MF, Firoozabadi R, Vialle LR, Oner FC, Kandziora F, Chapman JR, Schnake KJ, Benneker LM, Dvorak MF, Rajasekaran S, Vialle EN, Joaquim AF, El-Sharkawi MM, Dhakal GR, Popescu EC, Kanna RM, Muijs S, Tee JW, Bellabarba C. Description and Reliability of the AOSpine Sacral Classification System. J Bone Joint Surg Am 2020; 102:1454-1463. [PMID: 32816418 PMCID: PMC7508295 DOI: 10.2106/jbjs.19.01153] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Several classification systems exist for sacral fractures; however, these systems are primarily descriptive, are not uniformly used, have not been validated, and have not been associated with a treatment algorithm or prognosis. The goal of the present study was to demonstrate the reliability of the AOSpine Sacral Classification System among a group of international spine and trauma surgeons. METHODS A total of 38 sacral fractures were reviewed independently by 18 surgeons selected from an expert panel of AOSpine and AOTrauma members. Each case was graded by each surgeon on 2 separate occasions, 4 weeks apart. Intrarater reproducibility and interrater agreement were analyzed with use of the kappa statistic (κ) for fracture severity (i.e., A, B, and C) and fracture subtype (e.g., A1, A2, and A3). RESULTS Seventeen reviewers were included in the final analysis, and a total of 1,292 assessments were performed (646 assessments performed twice). Overall intrarater reproducibility was excellent (κ = 0.83) for fracture severity and substantial (κ = 0.71) for all fracture subtypes. When comparing fracture severity, overall interrater agreement was substantial (κ = 0.75), with the highest agreement for type-A fractures (κ = 0.95) and the lowest for type-C fractures (κ = 0.70). Overall interrater agreement was moderate (κ = 0.58) when comparing fracture subtype, with the highest agreement seen for A2 subtypes (κ = 0.81) and the lowest for A1 subtypes (κ = 0.20). CONCLUSIONS To our knowledge, the present study is the first to describe the reliability of the AOSpine Sacral Classification System among a worldwide group of expert spine and trauma surgeons, with substantial to excellent intrarater reproducibility and moderate to substantial interrater agreement for the majority of fracture subtypes. These results suggest that this classification system can be reliably applied to sacral injuries, providing an important step toward standardization of treatment.
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Affiliation(s)
- Alexander R. Vaccaro
- Department of Orthopaedic Surgery, Rothman Institute, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania
| | - Gregory D. Schroeder
- Department of Orthopaedic Surgery, Rothman Institute, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania
| | - Srikanth N. Divi
- Department of Orthopaedic Surgery, Rothman Institute, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania,Email address for S.N. Divi:
| | - Christopher K. Kepler
- Department of Orthopaedic Surgery, Rothman Institute, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania
| | - Conor P. Kleweno
- Department of Orthopaedic Surgery, Harborview Medical Center, University of Washington, Seattle, Washington
| | - James C. Krieg
- Department of Orthopaedic Surgery, Rothman Institute, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania
| | - Jefferson R. Wilson
- Division of Neurosurgery, Department of Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Jörg H. Holstein
- Department of Orthopaedic Surgery, Saarland University Medical Center, Homburg, Germany
| | - Mark F. Kurd
- Department of Orthopaedic Surgery, Rothman Institute, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania
| | - Reza Firoozabadi
- Department of Orthopaedic Surgery, Harborview Medical Center, University of Washington, Seattle, Washington
| | - Luiz R. Vialle
- Department of Orthopaedics, Catholic University of Parana, Curitiba, Brazil
| | | | - Frank Kandziora
- Center for Spine Surgery and Neurotraumatology, BG Unfallklinik Frankfurt am Main, Frankfurt, Germany
| | - Jens R. Chapman
- Swedish Neuroscience Institute, Swedish Medical Center, Seattle, Washington
| | - Klaus J. Schnake
- Center for Spine and Scoliosis Surgery, Schön Klinik Nürnberg Fürth, Fürth, Germany
| | - Lorin M. Benneker
- Spine Unit, Department of Orthopaedic Surgery and Traumatology, Insel Hospital and Bern University Hospital, Bern, Switzerland
| | - Marcel F. Dvorak
- Department of Orthopaedics, Vancouver General Hospital, Vancouver, British Columbia, Canada
| | | | - Emiliano N. Vialle
- Department of Orthopaedics, Catholic University of Parana, Curitiba, Brazil
| | - Andrei F. Joaquim
- Neurosurgery Division, Department of Neurology, State University of Campinas, Campinas-Sao Paulo, Brazil
| | | | | | | | - Rishi M. Kanna
- Department of Orthopaedics, Trauma, and Spine Surgery, Ganga Hospital, Coimbatore, India
| | - S.P.J. Muijs
- University Medical Center, Utrecht, the Netherlands
| | - Jin W. Tee
- Department of Neurosurgery, The Alfred Hospital, Melbourne, Victoria, Australia
| | - Carlo Bellabarba
- Department of Orthopaedic Surgery, Harborview Medical Center, University of Washington, Seattle, Washington
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Albuquerque LAF, Almeida JP, de Macêdo Filho LJM, Joaquim AF, Duffau H. Extent of resection in diffuse low-grade gliomas and the role of tumor molecular signature-a systematic review of the literature. Neurosurg Rev 2020; 44:1371-1389. [PMID: 32770298 DOI: 10.1007/s10143-020-01362-8] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [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: 03/17/2020] [Revised: 07/20/2020] [Accepted: 07/28/2020] [Indexed: 01/06/2023]
Abstract
There is a lack of class I evidence concerning the impact of surgery in the treatment of diffuse low-grade glioma; the early maximal resection with preservation of eloquent brain areas has been accepted as the first therapeutic option. We performed a systematic review of the literature using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines and protocol. Inclusion criteria: only case series with at least 100 patients containing supratentorial hemispheric diffuse low-grade glioma (according to any of the WHO classification used in papers published between 2000 to 2019), with pre- and postoperative MRI study were included in the qualitative and quantitative analyses. The extent of resection should be defined based on MRI at least in two categories and correlated with patients' outcomes (with univariate or multivariate analyses) using overall survival (OS) or malignant progression-free survival (MPFS). A total of 18 series with 4386 patients, published in 20 papers, were included in this systematic review. All the series that evaluates the relation between the extent of resection (EOR) and OS showed a statistically significant improvement of OS at univariate and/or multivariate analyzes with a greater EOR. Six studies showed a statistically significant improvement of MPFS with a greater EOR. We demonstrate that when a more rigorous analysis of EOR is performed, a benefit of a more aggressive resection on OS and MPFS is observed. Our review about EOR in different molecular groups of DLGG also suggests a benefit of maximum safe resection for all different subtypes, even though "radical surgery" may be associated with better OS and MPFS in tumors with a more aggressive signature.
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Affiliation(s)
- Lucas Alverne F Albuquerque
- Department of Neurosurgery, General Hospital of Fortaleza, Fortaleza, Ceará, Brazil. .,Department of Neurology, University of Campinas, Campinas, São Paulo, Brazil.
| | - João Paulo Almeida
- Department of Neurosurgery, Neurological Institute, Cleveland Clinic, Cleveland, OH, USA
| | | | - Andrei F Joaquim
- Department of Neurology, University of Campinas, Campinas, São Paulo, Brazil
| | - Hugues Duffau
- Department of Neurosurgery, Gui de Chauliac Hospital, Montpellier University Medical Center, Montpellier, France
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Iunes EA, Barletta EA, Belsuzarri TAB, Onishi FJ, Aihara AY, Cavalheiro S, Joaquim AF. Pseudarthrosis in anterior cervical discectomy and fusion with a self-locking, stand-alone cage filled with hydroxyapatite: a retrospective study with clinical and radiological outcomes of 98 levels with a minimum 2-year follow-up. J Neurosurg Spine 2020; 33:717-726. [PMID: 32736356 DOI: 10.3171/2020.4.spine20357] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [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: 03/13/2020] [Accepted: 04/22/2020] [Indexed: 11/06/2022]
Abstract
OBJECTIVE The goal of this study was to evaluate the incidence of pseudarthrosis after the treatment of cervical degenerative disc disease (CDDD) with anterior cervical discectomy and fusion (ACDF) in which self-locking, stand-alone intervertebral cages filled with hydroxyapatite were used. METHODS The authors performed a retrospective cohort study of 49 patients who underwent 1- to 3-level ACDF with self-locking, stand-alone intervertebral cages without plates, with a minimum 2 years of follow-up. The following data were extracted from radiological and clinical charts: age, sex, time and type of pre- and postoperative signs and symptoms, pain status (visual analog scale [VAS]), functional status (Neck Disability Index [NDI]), history of smoking, bone quality (bone densitometry), and complications. Pseudarthrosis was diagnosed by a blinded neuroradiologist using CT scans. Clinical improvement was assessed using pre- and postoperative comparison of VAS and NDI scores. The Wilcoxon test for paired tests was used to evaluate statistical significance using a p value of < 0.05. RESULTS Three patients (6%) developed symptomatic pseudarthrosis requiring reoperation, with only 1 patient showing clinical worsening due to pseudarthrosis, while the other 2 with pseudarthrosis had associated disc disease at an adjacent level. The rate of symptomatic pseudarthrosis according to the number of operated levels was 0% for 1 level, 8.7% (2/23 patients) for 2 levels, and 7.7% (1/13 patients) for 3 levels. The total pseudarthrosis rate (including both symptomatic and asymptomatic patients) was 16.4%. Considering the clinical outcomes, there was a significant improvement of 75.6% in neck pain and 95.7% in arm pain, as well as a 64.9% improvement in NDI scores. Complications were observed in 18.4% of patients, with adjacent-level degenerative disease being the most prevalent at 14.3%. CONCLUSIONS ACDF with self-locking, stand-alone cages filled with a hydroxyapatite graft can be used for the surgical treatment of 1- to 3-level CDDD with clinical and radiological outcomes significantly improved after a minimum 2-year follow-up period. Comparative studies are necessary.
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Affiliation(s)
- Eduardo A Iunes
- 1Department of Neurology, University of Campinas (Unicamp)
- 2Department of Neurosurgery, Federal University of São Paulo (Unifesp)
| | | | | | | | - André Y Aihara
- 6Diagnostic Imaging, Federal University of São Paulo (Unifesp) Medical School, São Paulo, Brazil
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Moscote-Salazar LR, Joaquim AF, Agrawal A. Letter: Ventricular Catheter Tract Hemorrhage as a Risk Factor for Ventriculostomy-Related Infection. Oper Neurosurg (Hagerstown) 2020; 18:E61. [PMID: 31642500 DOI: 10.1093/ons/opz338] [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: 11/13/2022] Open
Affiliation(s)
- Luis Rafael Moscote-Salazar
- Neurosurgeon-Critical Care Center for Biomedical Research (CIB) Faculty of Medicine - University of Cartagena Cartagena de Indias, Bolivar, Colombia
| | - Andrei F Joaquim
- Neurosurgery Division Department of Neurology State University of Campinas (UNICAMP) Campinas, Brazil
| | - Amit Agrawal
- Department of Neurosurgery Narayana Medical College and Hospital Nellore, India
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Cabrera JP, Yurac R, Guiroy A, Carazzo CA, Joaquim AF, Zamorano JJ, Valacco M. Letter to the Editor: Is COVID-19 the Cause of Delayed Surgical Treatment of Spine Trauma in Latin America? World Neurosurg 2020; 139:724-725. [PMID: 32426073 PMCID: PMC7233214 DOI: 10.1016/j.wneu.2020.05.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Accepted: 05/01/2020] [Indexed: 12/27/2022]
Affiliation(s)
- Juan P Cabrera
- Department of Neurosurgery, Hospital Clínico Regional de Concepción, Concepción, Chile.
| | - Ratko Yurac
- Department of Orthopedic and Traumatology, University del Desarrollo, Santiago, Chile; Spine Unit, Department of Traumatology, Clínica Alemana, Santiago, Chile
| | - Alfredo Guiroy
- Spine Unit, Orthopedic Department, Hospital Español de Mendoza, Mendoza, Argentina
| | - Charles A Carazzo
- Department of Neurosurgery, University of Passo Fundo, São Vicente de Paulo Hospital, Passo Fundo, Rio Grande do Sul, Brazil
| | - Andrei F Joaquim
- Department of Neurosurgery, University of Campinas, Campinas, São Paulo, Brazil
| | - Juan J Zamorano
- Department of Orthopedic and Traumatology, University del Desarrollo, Santiago, Chile; Spine Unit, Department of Traumatology, Clínica Alemana, Santiago, Chile
| | - Marcelo Valacco
- Department of Orthopedic and Traumatology, Hospital Churruca Visca, Buenos Aires, Argentina
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Moscote-Salazar LR, Joaquim AF, Agrawal A. Letter to the Editor. Propionibacterium acnes and aseptic bone graft resorption. J Neurosurg 2019; 133:939-940. [PMID: 31812147 DOI: 10.3171/2019.9.jns192495] [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)
| | | | - Amit Agrawal
- 3Narayana Medical College Hospital, Andhra Pradesh, India
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Moscote-Salazar LR, Joaquim AF, Agrawal A. Letter to the Editor. Ultrasonography of the optic nerve sheath and decompressive craniectomy. J Neurosurg 2019; 133:603-604. [PMID: 31756700 DOI: 10.3171/2019.8.jns192114] [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)
| | | | - Amit Agrawal
- 3Narayana Medical College Hospital, Andhra Pradesh, India
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Quintana-Pájaro LDJ, Ramos-Villegas Y, Cortecero-Sabalza E, Joaquim AF, Agrawal A, Narvaez-Rojas AR, Moscote-Salazar LR. The Effect of Statins in Epilepsy: A Systematic Review. J Neurosci Rural Pract 2019; 9:478-486. [PMID: 30271037 PMCID: PMC6126295 DOI: 10.4103/jnrp.jnrp_110_18] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Background and Objectives Statins are inhibitors of 3-hydroxy-3-methylglutaryl coenzyme A (HMG-CoA) reductase, used for the management of hypercholesterolemia and related atherosclerotic diseases. Several studies have indicated the neuroprotective effects of statins on several neuropathological conditions. However, the role of these medications in epilepsy is still unclear. The purpose is to evaluate and summarize the level of evidence on the efficacy of statins in neuronal hyperexcitability and the neuroinflammatory processes of epilepsy. Methods A systematic review was performed. Eligibility Criteria: This review involved studies conducted in humans and nonhuman experimental models, covering the use of an inhibitor of HMG-CoA reductase, alone or accompanied by another medication, in epilepsy. Information Sources: A systematic literature search was performed in PubMed, Embase, Ebsco Host, Scopus, Science Direct, Medline, and LILACS. Risk of Bias: It was evaluated with the Newcastle-Ottawa Scale and the experimental studies were evaluated using the GRADE tool. Results Twenty articles of the 183 evaluated were included. Sixteen studies were conducted in animal models and four studies in humans. Most studies in mice reported a reduction in epileptiform activity and reduction in systemic inflammation with the treatment of statins, potentially influencing epilepsy control. Few studies in humans were performed in the geriatric population with variable results (neuroinflammation, seizure prevention, cell death, prevention of kindling, increase in convulsive threshold, increase in latency, decrease in frequency of crisis, and reduction in mortality) related to reduction in the rate of hospitalizations, mortality, and prevention of epilepsy. Studies in mice found a decrease in interleukin-1β (IL-1β), IL-6, and tumor necrosis factor alpha and an increase in IL-10 and endothelial nitric oxide synthase. Conclusions The possible antiepileptic mechanism of statins may be related to the reduction in neuroinflammation mediated by a decrease in pro-inflammatory cytokines and action in the nitrergic system. Further studies evaluating the impact of statins on seizure control are necessary.
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Affiliation(s)
- Loraine De Jesús Quintana-Pájaro
- Department of Medicine, University of Cartagena, Cartagena de Indias, Colombia.,Centro de Investigaciones Biomédicas, Faculty of Medicine, University of Cartagena, Cartagena de Indias, Colombia
| | - Yancarlos Ramos-Villegas
- Department of Medicine, University of Cartagena, Cartagena de Indias, Colombia.,Centro de Investigaciones Biomédicas, Faculty of Medicine, University of Cartagena, Cartagena de Indias, Colombia
| | - Eileen Cortecero-Sabalza
- Department of Medicine, University of Cartagena, Cartagena de Indias, Colombia.,Centro de Investigaciones Biomédicas, Faculty of Medicine, University of Cartagena, Cartagena de Indias, Colombia
| | - Andrei F Joaquim
- Department of Neurology, Division of Neurosurgery, State University of Campinas, Campinas, Sao Paulo, Brazil
| | - Amit Agrawal
- Department of Neurosurgery, MM Institute of Medical Sciences and Research, Maharishi Markandeshwar University, Ambala, Haryana, India
| | | | - Luis Rafael Moscote-Salazar
- Department of Medicine, University of Cartagena, Cartagena de Indias, Colombia.,Centro de Investigaciones Biomédicas, Faculty of Medicine, University of Cartagena, Cartagena de Indias, Colombia.,Department of Neurosurgery, University of Cartagena, Cartagena de Indias, Colombia
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Abstract
STUDY DESIGN Systematic literature review. OBJECTIVES To evaluate risk factors, diagnosis, and management of sacral and pelvic fractures (SPFs) after instrumented fusions. METHODS A systematic review following the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines was performed using the PubMed database. Articles with patients with an SPF after a lumbar instrumented fusion were included. The articles addressing specifically proximal junctional kyphosis were excluded. Eleven small cases series (level of evidence IV) were reviewed. RESULTS The incidence of SPF was 1.86% in one study. The risk factors reported were elderly patients, multilevel surgery, long fusions stopping at L5 or S1 instead of the ilium, osteoporosis, obesity, and sagittal imbalance. Computed tomography scan was the preferential image modality for diagnosing. Nonsurgical treatment may be used in patients with tolerable pain and nondisplaced fracture. Persistent pain was an indication for surgery, as well as fracture displacement. The most common surgical treatment reported was an extension of the fusion to the iliac using iliac screws. CONCLUSION SPFs after lumbar instrumented fusion are rare but clinically meaningful complications. The risk factors, diagnosis, and management of SPFs are described in our review.
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Affiliation(s)
- Andrei F. Joaquim
- State University of Campinas (UNICAMP), Campinas, Sao Paulo, Brazil,Andrei F. Joaquim, Department of Neurology, State University of Campinas (UNICAMP), Campinas, Sao Paulo 13083-872, Brazil.
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Almeida JP, Sanchez MM, Karekezi C, Warsi N, Fernández-Gajardo R, Panwar J, Mansouri A, Suppiah S, Nassiri F, Nejad R, Kucharczyk W, Ridout R, Joaquim AF, Gentili F, Zadeh G. Pituitary Apoplexy: Results of Surgical and Conservative Management Clinical Series and Review of the Literature. World Neurosurg 2019; 130:e988-e999. [PMID: 31302273 DOI: 10.1016/j.wneu.2019.07.055] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [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: 05/08/2019] [Revised: 07/03/2019] [Accepted: 07/04/2019] [Indexed: 12/29/2022]
Abstract
OBJECTIVE Pituitary apoplexy is associated with visual, cranial nerve, and endocrine dysfunction. In this article, the results of surgical and conservative management of pituitary apoplexy in a single center are evaluated and a review of the literature is presented. METHODS A retrospective analysis was made of patients with pituitary apoplexy who underwent surgery or conservative management at our center between January 2007 and June 2017. Surgery was typically selected for patients who presented with acute deterioration of visual status and/or level of consciousness. Patients with no visual field deficit and those who had medical contraindications to undergo a surgical procedure because of previous comorbidities typically had conservative treatment. Baseline characteristics and clinical and radiologic outcomes were reviewed. A review of the literature (1990-2018) was performed according to PRISMA guidelines. Studies comparing the results of conservative and surgical management were identified. Visual, cranial nerve, and endocrine outcomes and tumor recurrence were analyzed. RESULTS Forty-nine patients (73.1%) were managed surgically and 18 (26.9%) conservatively. After careful case selection, patients underwent surgical or conservative treatment. Patients who underwent conservative treatment had fewer visual deficits. At diagnosis, visual deficit (38.8% vs. 75.5%; P = 0.008) and cranial nerve palsy (27.7% vs. 51%; P = 0.058) were less common in the conservative group. Conservative and surgical treatments had similar visual and cranial nerve improvement rates (75% vs. 58.3%, P = 0.63 and 75% vs. 69.2%, P = 1.0, respectively). In the conservative group, tumor shrinkage was observed in 76.4% of cases. The systematic review retrieved 11 studies. No significant difference between conservative and surgical treatment for clinical outcomes (visual field recovery, odds ratio [OR], 1.45; 95% confidence interval [CI], 0.72-2.92; cranial nerve recovery, OR, 2.30; 95% CI, 0.93-5.65; and hypopituitarism, OR, 1.05; 95% CI, 0.64-1.74) or tumor recurrence (OR, 0.68; 95% CI, 0.20-2.34) was observed. CONCLUSIONS A tailored approach to pituitary apoplexy, one that does not include an absolute need for surgery, is appropriate. Conservative management is appropriate in selected patients presenting without visual deficits.
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Affiliation(s)
- Joao Paulo Almeida
- Division of Neurosurgery, Toronto Western Hospital, University of Toronto, Toronto, Ontario, Canada; Division of Neurosurgery, Department of Neurology, State University of Campinas (UNICAMP), Campinas, Brazil.
| | - Miguel Marigil Sanchez
- Division of Neurosurgery, Toronto Western Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Claire Karekezi
- Division of Neurosurgery, Toronto Western Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Nebras Warsi
- Division of Neurosurgery, Toronto Western Hospital, University of Toronto, Toronto, Ontario, Canada
| | | | - Jyoti Panwar
- Department of Radiology, University of Toronto, Toronto, Ontario, Canada
| | - Alireza Mansouri
- Division of Neurosurgery, Toronto Western Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Suganth Suppiah
- Division of Neurosurgery, Toronto Western Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Farshad Nassiri
- Division of Neurosurgery, Toronto Western Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Romina Nejad
- Division of Neurosurgery, Toronto Western Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Walter Kucharczyk
- Department of Radiology, University of Toronto, Toronto, Ontario, Canada
| | - Rowena Ridout
- Division of Endocrinology, Toronto Western Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Andrei F Joaquim
- Division of Neurosurgery, Department of Neurology, State University of Campinas (UNICAMP), Campinas, Brazil
| | - Fred Gentili
- Division of Neurosurgery, Toronto Western Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Gelareh Zadeh
- Division of Neurosurgery, Toronto Western Hospital, University of Toronto, Toronto, Ontario, Canada
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Abstract
CONTEXT Current treatment of TLST should consider injury morphology, neurological status, clinical status (pain and disability) and also multimodal radiological evaluation (MMRE) with CT, MRI and dynamic/ standing plain radiographs. METHODS A narrative literature review was performed to propose a treatment algorithm to guide the management of thoracolumbar spinal trauma (TLST). In order to classify injuries and surgical indications, we utilized the two most recent classification systems (TLICS and new AO spine classification) and related recent literature. RESULTS Injuries were categorized into three groups according to stability: 1) Stable injuries, 2) Potentially unstable injuries/ delayed instability or 3) Clearly unstable injuries. Stable injuries included most of AO type A fractures without neurological deficit, mild clinical symptoms and without risk factors for late deformity. Potentially unstable injuries generally included patients without neurological deficits but with some risk factors for late deformity or with severe clinical symptoms. Surgery may be recommended in this group. Finally, clearly unstable injuries are those with spinal dislocations and/ or with neurological deficits, especially in the setting of persistent neural tissue compression, requiring early surgical treatment. CONCLUSIONS The proposed treatment algorithm is intended to help surgeons select the best treatment modality for their patients, categorizing injuries according to their main characteristics into one of these three groups. Further studies addressing the reliability and safety of this algorithm are necessary.
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Affiliation(s)
- Andrei F. Joaquim
- Neurosurgery Division, State University of Campinas, Campinas-SP, Brazil,Correspondence to: Andrei F. Joaquim, Neurosurgeon. Department of Neurology. University of Campinas – UNICAMP, Campinas-SP, Brazil. andjoaquim@yahoo
| | - Alpesh A. Patel
- Department of Orthopaedic Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Gregory D. Schroeder
- Department of Orthopaedic Surgery and Neurosurgery at Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Alexander R. Vaccaro
- Department of Orthopaedic Surgery and Neurosurgery at Thomas Jefferson University, Philadelphia, Pennsylvania, USA
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Joaquim AF, Figueiredo EG. Commentary: Posterior Cervical Keyhole Laminoforaminotomy: A Cadaveric Comparative Study to Evaluate Limits of Bony Resection. Oper Neurosurg (Hagerstown) 2019; 16:E136-E137. [PMID: 30690587 DOI: 10.1093/ons/opy284] [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] [Received: 07/17/2018] [Accepted: 08/24/2018] [Indexed: 11/12/2022] Open
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Abstract
STUDY DESIGN Systematic literature review. OBJECTIVES Many studies have provided evidence that short-segment posterior fixation (SSPF-1 level above and 1 below) with screws at the fracture level (SFL) are enough to achieve stability in some injury patterns, such as burst fractures, avoiding the need for circumferential reconstruction and long-segment instrumented fusion (LSIF-at least 2 levels above and 2 below). Given the potential benefits of avoiding unnecessary fusion in mobile healthy spinal segments, we performed a systematic review of biomechanical studies comparing different spinal reconstruction techniques for fractures of the thoracolumbar spine. METHODS A systematic literature review was performed in the PubMed and OVID databases of biomechanical studies comparing biomechanical differences between techniques of spine reconstructions. RESULTS Eight studies were included and evaluated. Five of 6 studies reported stiffness improvement with SSPF and SFL, even comparable to circumferential fusion for a burst fracture. Two studies reported that LSPF has higher stiffness and restricts range of motion better than SSPF, but inclusion of screws in the fracture level is similar to LSPF (1 study). Finally, although SSPF is less stiff than anterior reconstruction, adding a SFL in SSPF results in similar stiffness than circumferential fusion for unstable burst fractures. CONCLUSIONS Biomechanical studies analyzed generally suggested that SFL in SSPF may improve construction stiffness, and can even be compared with long-segment fixation or circumferential reconstruction in some scenarios. This construct option may be used to enhance stiffness in selected injury patterns, avoiding the needs of an additional anterior approach.
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Affiliation(s)
- Andrei F. Joaquim
- Department of Neurology, Neurosurgery Division, State University of Campinas, Campinas, SP, Brazil,Andrei F. Joaquim, Department of Neurology, Neurosurgery Division, State University of Campinas, Campinas, SP 872, Brazil.
| | - Joseph P. Maslak
- Department of Orthopaedic Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Alpesh A. Patel
- Department of Orthopaedic Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
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Moscote-Salazar LR, Joaquim AF, Alcala-Cerra G, Agrawal A, Calderon-Miranda WG. Froin's Syndrome Mimicking Guillain-Barre Syndrome in a Patient with Spinal Epidural Abscess. Asian J Neurosurg 2019; 14:338-339. [PMID: 30937072 PMCID: PMC6417328 DOI: 10.4103/ajns.ajns_11_17] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Affiliation(s)
- Luis Rafael Moscote-Salazar
- Department of Neurosurgery, Red Latino, Latin American Trauma and Intensive Neuro-Care Organization, Bogota, Colombia
| | - Andrei F Joaquim
- Department of Neurosurgery, State University of Campinas, Campinas, SP, Brazil.,Department of Neurosurgery, Centro Infantil Boldrini, Campinas, SP, Brazil
| | | | - Amit Agrawal
- Department of Neurosurgery, Narayana Medical College Hospital, Nellore, Andhra Pradesh, India
| | - Willem Guillermo Calderon-Miranda
- Department of Radiology, Hospital General Dr. Manuel Gea González, National Autonomous University of Mexico, Ciudad de Mexico, Mexico, USA
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Formentin C, Andrade EJD, Maeda FL, Ghizoni E, Tedeschi H, Joaquim AF. Axis screws: results and complications of a large case series. ACTA ACUST UNITED AC 2019; 65:198-203. [PMID: 30892444 DOI: 10.1590/1806-9282.65.2.198] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2018] [Accepted: 05/27/2018] [Indexed: 11/22/2022]
Abstract
OBJECTIVE To present the surgical results of patients who underwent axis screw instrumentation, discussing surgical nuances and complications of the techniques used. METHODS Retrospective case-series evaluation of patients who underwent spinal surgery with axis instrumentation using screws. RESULTS Sixty-five patients were included in this study. The most common cause of mechanical instability was spinal cord trauma involving the axis (36 patients - 55.4%), followed by congenital craniocervical malformation (12 patients - 18.5%). Thirty-seven (57%) patients required concomitant C1 fusion. Bilateral axis fixation was performed in almost all cases. Twenty-three patients (35.4%) underwent bilateral laminar screws fixation; pars screws were used in twenty-two patients (33.8%), and pedicular screws were used isolated in only three patients (4.6%). In fourteen patients (21.5%), we performed a hybrid construction. There was no neurological worsening nor vertebral artery injury in this series. CONCLUSION Axis screw instrumentation proved to be a safe and efficient method for cervical stabilization. Laminar and pars screws were the most commonly used.
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Affiliation(s)
- Cleiton Formentin
- Resident - Neurosurgery Division - Department of Neurology, University of Campinas (UNICAMP), Campinas-SP, Brasil
| | - Erion Junior de Andrade
- Resident - Neurosurgery Division - Department of Neurology, University of Campinas (UNICAMP), Campinas-SP, Brasil
| | - Fernando Luis Maeda
- Resident - Neurosurgery Division - Department of Neurology, University of Campinas (UNICAMP), Campinas-SP, Brasil
| | - Enrico Ghizoni
- Assistant Professor - Neurosurgery Division - University of Campinas (UNICAMP), Campinas-SP, Brasil
| | - Helder Tedeschi
- Assistant Professor - Neurosurgery Division - University of Campinas (UNICAMP), Campinas-SP, Brasil
| | - Andrei F Joaquim
- Assistant Professor - Neurosurgery Division - University of Campinas (UNICAMP), Campinas-SP, Brasil
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Joaquim AF, Patel AA. Posterior L5-S1 transdiscal screws for high grade spondylolisthesis - a systematic review. Rev Assoc Med Bras (1992) 2018; 64:1147-1153. [PMID: 30569993 DOI: 10.1590/1806-9282.64.12.1147] [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] [Received: 02/20/2018] [Accepted: 03/24/2018] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE The surgical management of high-grade lumbar spondylolisthesis (HGLS) is complex and aims to achieve both a solid fusion that is able to support the high shear forces of the lumbosacral junction, as well as neural decompression. We performed a systematic literature review of the safety and efficacy of posterior transdiscal (PTD) screw fixation from L5S1 for HGLS and its variations. METHODS A systematic literature review following the PRISMA guidelines was performed in the PubMed database of the studies describing the use of PTD screw fixation for HGLS. Clinical and radiological data were extracted and discussed. Study quality was assessed with the Oxford Centre for Evidence-Based Medicine Levels of Evidence. RESULTS Seven studies were included and reviewed; all of them were level IV of evidence. Two of them had large case series comparing different surgical techniques: one concluded that PTD was associated with better clinical outcomes when compared with standard screw fixation techniques and the other suggesting that the clinical and radiological outcomes of PTD were similar to those when an interbody fusion (TLIF) technique was performed, but PTD was technically less challenging. The remaining five studies included small case series and case reports. All of them reported the successful useful of PTD with or without technical variations. CONCLUSIONS Our review concludes, with limited level of evidence that PTD fixation is a safe and efficient technique for treating HGLS patients. It is technically less demanding than a circumferential fusion, even though proper screw insertion is more demanding than conventional pedicle screw fixation.
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Affiliation(s)
- Andrei F Joaquim
- Professor of Neurosurgery - Department of Neurology, Neurosurgery Division, State University of Campinas, Campinas-SP, Brasil
| | - Alpesh A Patel
- Professor - Department of Orthopaedic Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
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Moscote-Salazar LR, Quintana-Pajaro L, Joaquim AF, Pacheco-Hernandez A. Letter to the editor regarding the manuscript "Lactate dehydrogenase as a prognostic marker in neoplastic meningitis". J Clin Neurosci 2018; 58:234. [PMID: 30279121 DOI: 10.1016/j.jocn.2018.08.025] [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] [Received: 04/10/2018] [Accepted: 08/13/2018] [Indexed: 11/28/2022]
Affiliation(s)
- Luis Rafael Moscote-Salazar
- Neurosurgeon-Critical Care, Cartagena Neurotrauma Research Group (CIB), University of Cartagena, Cartagena de Indias, Colombia.
| | - Loraine Quintana-Pajaro
- Cartagena Neurotrauma Research Group (CIB), University of Cartagena, Cartagena de Indias, Colombia
| | - Andrei F Joaquim
- Department of Neurology, Neurosurgery Division, State University of Campinas, Campinas-Sao Paulo, Brazil
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Moscote-Salazar LR, Calderon-Miranda WG, Deluquez Baute RV, Agrawal A, Satyarthee GD, Maraby-Salgado J, Padilla-Zambrano HS, Lopez-Cepeda D, Pacheco-Hernandez A, Joaquim AF. Aicardi-Goutières Syndrome: Brief Case Report. J Pediatr Neurosci 2018; 13:88-90. [PMID: 29899779 PMCID: PMC5982501 DOI: 10.4103/jpn.jpn_67_17] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
The case of a term newborn diagnosed with Aicardi-Goutières syndrome, a rare encephalopathy in our environment, with Mendelian inheritance pattern, characterized by a set of nonspecific neurological symptoms associated with typical findings of intracerebral calcifications. The case is presented with diagnostic imaging, in addition to elevated levels of interferon alpha and cerebrospinal fluid lymphocytosis.
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Affiliation(s)
| | | | | | - Amit Agrawal
- Department of Neurosurgery, MM Institute of Medical Sciences & Research, Maharishi Markandeshwar University, Ambala, Haryana, India
| | | | | | | | | | | | - Andrei F Joaquim
- Department of Neurology, Neurosurgery Division, State University of Campinas, Campinas-Sao Paulo, Brazil
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Moscote-Salazar LR, Gonzalez JB, Joaquim AF, Pacheco-Hernandez A. Neurosurgical Management of Spontaneous Intrauterine Depressed Skull Fracture. World Neurosurg 2018; 111:421. [DOI: 10.1016/j.wneu.2017.10.152] [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: 10/26/2017] [Accepted: 10/27/2017] [Indexed: 10/17/2022]
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Figueroa-Ángel V, Rodríguez-Aceves CA, Calderon-Miranda WG, Escobar-Hernandez N, Joaquim AF, Moscote-Salazar LR. Subfrontal Schwannoma: Case Report and Review of Literature. World Neurosurg 2017; 111:386-390. [PMID: 29054783 DOI: 10.1016/j.wneu.2017.10.045] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [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: 05/06/2017] [Revised: 10/07/2017] [Accepted: 10/09/2017] [Indexed: 10/18/2022]
Abstract
BACKGROUND Although attributing the origin of schwannomas from the olfactory nerve is nearly impossible, if they do not have Schwann cells, intracranial supratentorial schwannomas are mainly located in the anterior skull base. CASE DESCRIPTION We present the case of a 46-year-old female who presented with right tinnitus, dizziness, and bifrontal headache, progressive, starting 2 years before. Imaging studies revealed an incidentally neoplastic, extraaxial, homogeneously appearing tumor on the right anterior skull base. The patient underwent surgical treatment with total resection of the tumor by a bicoronal approach. The histopathologic study reported schwannoma. CONCLUSION We describe this case in detail and discuss the likely origin of this tumor, with a concomitant literature review.
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Affiliation(s)
| | | | | | | | - Andrei F Joaquim
- University of Cartagena, Cartagena de Indias, Bolivar, Colombia, USA
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