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Arun-Kumar V, Corluka S, Buser Z, Wu Y, El-Sharkawi M, Carazzo CA, Ponugoti N, Wang JC, Meisel HJ. Do Osteobiologics Augment Fusion in Anterior Cervical Discectomy and Fusion Surgery Performed With Mechanical Interbody Devices (Polyether ether ketone, Carbon Fiber, Metal Cages) and is the Fusion Rate Comparable to that With Autograft? A Systematic Review. Global Spine J 2024; 14:24S-33S. [PMID: 38421330 PMCID: PMC10913910 DOI: 10.1177/21925682231188626] [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: 03/02/2024] Open
Abstract
STUDY DESIGN Systematic Review of the Literature. OBJECTIVE The purpose of this study was to perform a systematic review describing fusion rates for anterior cervical discectomy and fusion (ACDF) using autograft vs various interbody devices augmented with different osteobiologic materials. METHODS A systematic review limited to the English language was performed in Medline, Embase and Cochrane library using Medical Subject Heading (MeSH) terms. Studies that evaluated fusion after ACDF using autografts and osteobiologics combined with PEEK, carbon fibre, or metal cages were searched for. Articles in full text that met the criteria were included in the review. The main outcomes evaluated were the time taken to merge, the definition of the fusion assessment, and the modality of the fusion assessment. The risk of bias of each article was assessed by the MINORS score or ROB 2.0 depending on the randomisation process. RESULTS The total number of references reviewed was six hundred and eighty-two. After applying the inclusion criteria, 54 were selected for the retrieval of the full text. Eight studies were selected and included for final analysis in this study. Fusion rates were reported between 83.3% and 100% for autograft groups compared to 46.5% and 100% for various interbody device/osteobiological combinations. The overall quality of the evidence in all radiographic fusion studies was considered insufficient due to a serious risk of bias. CONCLUSION Mechanical interbody devices augmented with osteobiologics performed similarly to autografts in terms of reliability and efficacy. Their time to fusion and fusion rate were comparable to autografts at the end of the final follow-up.
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Affiliation(s)
| | - Stipe Corluka
- Spinal Surgery Division, Department of Traumatology, University Hospital Centre Sestre Milosrdnice, Zagreb, Croatia
- Department of Anatomy and Physiology, University of Applied Health Sciences, Zagreb, Croatia
| | - Zorica Buser
- Gerling Institute, Brooklyn, NY, USA
- Department of Orthopedic Surgery, NYU Grossman School of Medicine, New York, NY, USA
| | - Yabin Wu
- Research Department, AO Spine, AO Foundation, Davos, Switzerland
| | - Mohammad El-Sharkawi
- Professor of Orthopaedic and Trauma Surgery, Faculty of Medicine, Assiut University, Assiut, Egypt
| | - Charles André Carazzo
- Professor of Neurosurgery, Faculty of Medicine, Passo Fundo University, Passo Fundo, Brazil
| | - Nikhil Ponugoti
- Orthopaedic Registrar, Hampshire Hospital NHS Foundation Trust, Hampshire, UK
| | - Jeffrey C Wang
- USC Spine Center, Los Angeles, CA, USA
- Department of Orthopaedic Surgery and Neurological Surgery, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Hans Jörg Meisel
- Department of Neurosurgery, BG Klinikum Bergmannstrost Halle, Germany
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Pereira-Duarte M, Gagliardi M, Carazzo CA, Camino-Willhuber G, Gotfryd A, Rogers M, Guiroy A. Comparison of complication rates between anterior versus posterior approaches for treating unstable Hangman's fracture. A systematic review and meta-analysis. World Neurosurg X 2024; 21:100245. [PMID: 38221952 PMCID: PMC10787285 DOI: 10.1016/j.wnsx.2023.100245] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2023] [Accepted: 10/05/2023] [Indexed: 01/16/2024] Open
Abstract
Study design Systematic Review and Meta-analysis. Objective To compare the complication rates associated with anterior and posterior approaches for the surgical treatment of unstable hangman's fractures. Methods A systematic review and meta-analysis were performed following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines in PubMed, Web of Science, and Scopus databases to identify comparative studies reporting complications of anterior versus posterior approaches for the treatment of unstable hangman's fractures. Results The search yielded 1163 papers from which 5 studies were fully included. One hundred fifteen (115) patients were operated on using an anterior approach versus 65 through a posterior approach. The average complication rates for the anterior and posterior approaches were 26.1 % and 13.8 %, respectively. No complications following the anterior approach required pharmacological or surgical intervention (Clavien-Dindo, Grade 1), while 88.9 % of complications following the posterior approach did (Clavien-Dindo, Grade 2). Conclusion No significant differences in the complication rates were found when comparing anterior versus posterior surgery for treating a C2 traumatic spondylolisthesis. However, most of the complications presented in the posterior surgery group were more severe.
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Affiliation(s)
- Matias Pereira-Duarte
- Adult Spine Unit, Hospital Italiano de Buenos Aires, Pte. Peron st. 4190, ZC 1199, Ciudad Autónoma de Buenos Aires, Argentina
| | | | | | - Gaston Camino-Willhuber
- Adult Spine Unit, Hospital Italiano de Buenos Aires, Ciudad Autónoma de Buenos Aires, Argentina
| | - Alberto Gotfryd
- Santa Casa of São Paulo Medical School and Hospitals, Sao Paulo, Brazil
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Piovesan EC, Silva WP, Mallmann AB, Guiroy AJ, Carazzo CA. Intramedullary histoplasmosis of the thoracic cord as an isolated lesion: A rare case report and literature review. Surg Neurol Int 2023; 14:197. [PMID: 37404516 PMCID: PMC10316131 DOI: 10.25259/sni_399_2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2023] [Accepted: 05/19/2023] [Indexed: 07/06/2023] Open
Abstract
Background Disseminated histoplasmosis involving the central nervous system occurs in 5-10% of cases. However, intramedullary spinal cord lesions are extremely rare. Here, 45-year-old female with a T8-9 intramedullary lesion did well following surgical extirpation. Case Description For 2 weeks, a 45-year-old female experienced progressive lower back pain, paresthesias, and paraparesis. The magnetic resonance imaging showed an intramedullary expansive lesion at the T8-T9 level that markedly enhanced with contrast. Surgery, consisting of T8-T10 laminectomies performed using neuronavigation, an operating microscope, and intraoperative monitoring, revealed a well-demarcated lesion that proved to be a focus of histoplasmosis; it was readily completely excised. Conclusion Surgery is the gold standard for treating spinal cord compression attributed to intramedullary histoplasmosis unresponsive to medical management.
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Affiliation(s)
| | - Werner Petry Silva
- Department of Neurosurgery, São Vicente de Paulo Hospital, Passo Fundo, Rio Grande do Sul, Brazil
| | | | | | - Charles André Carazzo
- Department of Neurosurgery, University of Passo Fundo, Passo Fundo, Rio Grande do Sul, Brazil
- Department of Neurosurgery, São Vicente de Paulo Hospital, Passo Fundo, Rio Grande do Sul, Brazil
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Piovesan EC, Freitas BZD, Lemanski FCB, Carazzo CA. Alzheimer's disease: an epidemiological analysis over the number of hospitalizations and deaths in Brazil. Arq Neuropsiquiatr 2023; 81:577-584. [PMID: 37379869 DOI: 10.1055/s-0043-1767827] [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] [Subscribe] [Scholar Register] [Indexed: 06/30/2023]
Abstract
BACKGROUND Alzheimer's disease (AD) is a neurodegenerative condition characterized by impaired cognitive function. It results in high morbidity, including a large number of hospitalizations, and mortality, generating high costs to health systems. OBJECTIVE The present epidemiological analysis evaluated the number of hospitalizations and deaths by AD as the main diagnosis in Brazil between 2010 and 2020. This endeavor should contribute to a better understanding of the disease and its implications. METHODS The present analytical, observational, longitudinal, and retrospective study used data extracted from the Department of Informatics of the Brazilian Unified Health System (DATASUS, in the Portuguese acronym). The variables include the number of hospitalizations, the total cost spent, the average cost per hospitalization, the average length of hospital stay, the number of deaths during hospitalization, the mortality rate per hospitalization, sex, age group, region, and race. RESULTS From 2010 to 2020, there were 188,811 deaths and 13,882 hospitalizations for AD, with a total expenditure of BRL 25,953,019.40 in hospitalizations. The average length of hospital stay was 25 days. Over the considered period, mortality, the number of hospitalizations, and the total cost increased while the average length of stay decreased. CONCLUSION From 2010 to 2020, AD represented a large portion of hospital admissions, generating a significant cost to the health system and a large number of deaths. These data are important to undertake joint efforts to prevent hospitalizations of these patients in order to minimize impacts on the health system.
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Affiliation(s)
| | | | | | - Charles André Carazzo
- Universidade de Passo Fundo, Faculdade de Medicina, Passo Fundo RS, Brazil
- Instituto de Neurologia e Neurocirurgia de Passo Fundo, Passo Fundo RS, Brazil
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Piovesan EC, Petry Silva W, Mallmann AB, Lanzini FS, Zanatta de Freitas B, Lemanski FCB, Carazzo CA. Intramedullary hemangioblastoma of the thoracic cord with a microsurgical approach: A case report and literature review. Surg Neurol Int 2023; 14:137. [PMID: 37151462 PMCID: PMC10159297 DOI: 10.25259/sni_252_2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2023] [Accepted: 03/30/2023] [Indexed: 05/09/2023] Open
Abstract
Background Spinal cord hemangioblastomas (HBs) account for 2-15% of all spinal cord neoplasms. They are the third most common primary intramedullary tumor (1-5%). Here, 72-year-old female presented with a thoracic intramedullary spinal HB that responded well to surgery. Case Description A 72-year-old female presented with a 3-4 years of progressive paresthesias and paraparesis. On examination, she exhibited diffuse distal weakness of the lower extremities. The magnetic resonance scan showed an intramedullary expansive lesion at the T1-T2 level that markedly enhanced with contrast with both proximal and distal hydromyelia. Surgery included a C7 partial and T1-T2 total laminectomies performed under microscope visualization with intraoperative monitoring. At surgery, there was a well-documented cleavage plane between the tumor and the cord; excision was facilitated using the cavitron ultrasonic surgical aspirator device. Conclusion Surgery is the gold standard treatment for treating/resecting HBs and should include utilization of an operating microscope and intraoperative monitoring.
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Affiliation(s)
- Eduardo Cattapan Piovesan
- Department of Neurosurgery, University of Passo Fundo, Passo Fundo, Rio Grande do Sul, Brazil
- Corresponding author: Eduardo Cattapan Piovesan, Department of Neurosurgery, University of Passo Fundo, Passo Fundo, Rio Grande do Sul, Brazil.
| | - Werner Petry Silva
- Department of Neurosurgery, São Vicente de Paulo Hospital, Passo Fundo, Rio Grande do Sul, Brazil
| | | | - Felipe Severo Lanzini
- Department of Neurosurgery, University of Passo Fundo, Passo Fundo, Rio Grande do Sul, Brazil
| | | | | | - Charles André Carazzo
- Department of Neurosurgery, University of Passo Fundo, Passo Fundo, Rio Grande do Sul, Brazil
- Department of Neurosurgery, São Vicente de Paulo Hospital, Passo Fundo, Rio Grande do Sul, Brazil
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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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Biasi PR, Mallmann AB, Crusius PS, Seibert CA, Crusius MU, Crusius CU, Espanhol RA, Brunet MP, Carazzo CA. Sequestered lumbar disc herniation mimicking spinal tumor. Arq Bras Neurocir 2018. [DOI: 10.1055/s-0038-1626029] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
AbstractThe occurrence of herniated disc simulating diseases in neuroimaging it's an uncommon situation. However, due to changes that occur in sequestered disc fragment, some cases can mimic spinal neoplasms. Thus, we present the case of a female patient, 60 year-old, with left back pain and left leg weakness. Left lower limb presented with strength grade IV, positive 45 degress Lasègue's signal and patellar areflexia. Lumbar spine magnetic resonance imaging (MRI) showed an expansive left centro-lateral lesion at L4-L5 level, hypointense on T1W, hyperintense on T2W, with peripheral contrast uptake, causing compression of the dural sac and L5 nerve root. A hemilaminectomy was performed, with complete excision of the lesion. Histological analisys confirmed discal hernia. Disc herniation is a condition characterized by the displacement of the disc content to the spinal canal, predominantly in the lumbar region, and manifesting as radiculopathy. The fragment sequestration occurs in 30% of the cases and is characterized by loss of continuity with remaining disc. MRI exams generally allow diagnostic confirmation; however, there may be diagnostic confusion with tumors, arachnoid cysts and abscesses. The inflammatory reaction occurred in the disc fragment produces the differences in MRI signal. The fragment is hypointense on T1W, hyperintense on T2W, with peripheral enhancement after contrast. Malignancies and Schwannomas have homogeneous or heterogeneous uptake. The epidural abscess is isointense on T1W and hyperintense on T2W, with homogeneous or peripheral enhancement, similar to discal herniation. Thus, sequestered disc herniation can mimic other space-occupying lesions, being necessary a surgical approach to obtain material for histopathological analysis and diagnostic confirmation.
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Carazzo CA, Guirado VMDP, Meluzzi A, Liberti EA, Dias MRP, Fontes RBDV, Taricco MA. Características morfológicas da pars de C2 de humanos. Coluna/Columna 2009. [DOI: 10.1590/s1808-18512009000300008] [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: 11/22/2022] Open
Abstract
OBJETIVO: avaliar a morfometria da pars da segunda vértebra cervical, verificar as variações existentes e predizer sua segurança para a colocação de parafusos por meio de uma abordagem cervical posterior. MÉTODOS: 58 vértebras foram obtidas para estudo anatômico (116 pars de C2) e foram medidas a altura e largura da pars, além do comprimento eixo-pedículo, largura e comprimento do pedículo, angulação sagital e medial. Todas as medidas foram separadas quanto aos seus lados direito e esquerdo; foi realizado o cálculo da média, variação, desvio padrão e a médica foi comparada com os estudos prévios. RESULTADOS: a largura média da pars de C2 foi de 9,5 mm; a altura, 9,5 mm; não houve diferença significativa entre os lados esquerdo e direito. O comprimento médio do pedículo foi de 10,5 mm; a medida média encontrada para o comprimento eixo-pedículo foi de 24,9 mm; a largura do pedículo foi de 2,8 mm. A angulação sagital encontrada foi de 19,6º e a horizontal foi de 28,5º. CONCLUSÕES: este estudo demonstra a viabilidade para a colocação de parafuso na pars de C2 em uma população caucasiana, destacando-se, porém, a grande variabilidade anatômica encontrada nas referidas medidas.
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