1
|
Ricciardi GA, Cabrera JP, Martínez O, Matta J, Vilchis H, Perez Ríos JJ, Carazzo CA, Dittmar M, Yurac R. Predicting early complications in patients with spinal gunshot wounds: A multicenter study. Brain Spine 2024; 4:102766. [PMID: 38510628 PMCID: PMC10951780 DOI: 10.1016/j.bas.2024.102766] [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] [Subscribe] [Scholar Register] [Received: 12/22/2023] [Revised: 01/17/2024] [Accepted: 02/14/2024] [Indexed: 03/22/2024]
Abstract
Introduction There is a wide variation in the clinical presentation of spinal gunshot wounds ranging from isolated minor stable fractures to extremely severe injuries with catastrophic neurological damage. Research question we aim to analyze the risk factors for early complications and impact of surgical treatment in patients with spinal gunshot wounds. Material and methods This is a multicentre retrospective case-control study to compare patients with spinal gunshot wounds who had early complications with those who did not. The following matching criteria were used: sex (1:1), injury level (1:1) and age (±5 years). Univariate and multivariate analyses were performed using logistic regression. Results Results: Among 387 patients, 36.9 % registered early complications, being persistent pain (n = 32; 15 %), sepsis/septic shock (n = 28; 13 %), pneumonia (n = 27; 13 %) and neurogenic bladder (n = 27; 12 %) the most frequently reported. After case-control matched analysis, we obtained 133 patients who suffered early complications (cases) and 133 patients who did not as control group, not differing significantly in sex (p = 1000), age (p = 0,535) and injury level (p = 1000), while the 35 % of complications group required surgical treatment versus 15 % of the non-complication group (p < 0.001). On multivariable analysis, significant predictors of complications were surgical treatment for spinal injury (OR = 3.50, 95 % CI = 1.68-7.30), dirty wound (3.32, 1.50-7.34), GCS ≤8 (3.56, 1.17-10.79), hemodynamic instability (2.29, 1.07-4.88), and multiple bullets (1.97, 1.05-3.67). Discussion and conclusion Spinal gunshot wounds are associated with a high risk of early complications, especially when spinal surgery is required, and among patients with dirty wound, low level of consciousness, hemodynamic instability, and multiple bullets.
Collapse
Affiliation(s)
- Guillermo A. Ricciardi
- Orthopaedics and Traumatology, Centro Médico Integral Fitz Roy, Acevedo 865, C1414, Buenos Aires, Argentina
| | - Juan P. Cabrera
- Department of Neurosurgery, Hospital Clínico Regional de Concepción, San Martín 1436, 4070022, Concepción, Bío Bío, Chile
- Faculty of Medicine, University of Concepción, Janequeo esquina, Av. Chacabuco S/N, Concepción, Bío Bío, Chile
| | - Oscar Martínez
- Hospital Universitario Dr. José E. González, Av. Dr. José Eleuterio González S/N, Mitras Centro, 64460, Monterrey, N.L., Mexico
| | - Javier Matta
- Hospital Militar Central, v. 3C No. 49 – 02, CP 110231, Bogotá, Colombia
| | - Hugo Vilchis
- Unidad Médica de Alta Especialidad, Hospital de Traumatología y Ortopedia, Lomas Verdes IMSS, Avenida Lomas Verdes 52, Sta Cruz Acatlan, 53150, Naucalpan de Juárez, Méx., Mexico
| | - Jeasson Javier Perez Ríos
- Clínica de Columna “Dr. Manuel Dufoo Olvera”, Calz. San Juan de Aragón 285, Granjas Modernas, Gustavo A. Madero, 07460, Ciudad de México CDMX, Mexico
| | - Charles A. Carazzo
- Neurosurgery, University of Passo Fundo, São Vicente de Paulo Hospital, R. Teixeira Soares, 808 - Centro, Passo Fundo, RS, 99010-080, Brazil
| | - Michael Dittmar
- Centro Médico Puerta de Hierro, Av. Empresarios, Puerta de Hierro, 45116, Zapopan, Jal., Mexico
| | - Ratko Yurac
- Department of Orthopedic and Traumatology, Universidad del Desarrollo, Av Plaza 680, 7610658, Las Condes, Región Metropolitana, Chile
- Spine Unit, Department of Traumatology, Clínica Alemana, Av Vitacura 5951, Vitacura, Región Metropolitana, Santiago, Chile
| | - the AO Spine Latin America Trauma Study Group
- Orthopaedics and Traumatology, Centro Médico Integral Fitz Roy, Acevedo 865, C1414, Buenos Aires, Argentina
- Department of Neurosurgery, Hospital Clínico Regional de Concepción, San Martín 1436, 4070022, Concepción, Bío Bío, Chile
- Faculty of Medicine, University of Concepción, Janequeo esquina, Av. Chacabuco S/N, Concepción, Bío Bío, Chile
- Hospital Universitario Dr. José E. González, Av. Dr. José Eleuterio González S/N, Mitras Centro, 64460, Monterrey, N.L., Mexico
- Hospital Militar Central, v. 3C No. 49 – 02, CP 110231, Bogotá, Colombia
- Unidad Médica de Alta Especialidad, Hospital de Traumatología y Ortopedia, Lomas Verdes IMSS, Avenida Lomas Verdes 52, Sta Cruz Acatlan, 53150, Naucalpan de Juárez, Méx., Mexico
- Clínica de Columna “Dr. Manuel Dufoo Olvera”, Calz. San Juan de Aragón 285, Granjas Modernas, Gustavo A. Madero, 07460, Ciudad de México CDMX, Mexico
- Neurosurgery, University of Passo Fundo, São Vicente de Paulo Hospital, R. Teixeira Soares, 808 - Centro, Passo Fundo, RS, 99010-080, Brazil
- Centro Médico Puerta de Hierro, Av. Empresarios, Puerta de Hierro, 45116, Zapopan, Jal., Mexico
- Department of Orthopedic and Traumatology, Universidad del Desarrollo, Av Plaza 680, 7610658, Las Condes, Región Metropolitana, Chile
- Spine Unit, Department of Traumatology, Clínica Alemana, Av Vitacura 5951, Vitacura, Región Metropolitana, Santiago, Chile
| |
Collapse
|
2
|
Ricciardi G, Cabrera JP, Martínez Ó, Cabrera J, Matta J, Dávila V, Jiménez JM, Vilchis H, Tejerina V, Pérez J, Yurac R. Spinal gunshot wounds: A retrospective, multicenter, cohort study. Rev Esp Cir Ortop Traumatol (Engl Ed) 2024:S1888-4415(24)00049-3. [PMID: 38325575 DOI: 10.1016/j.recot.2024.01.022] [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: 04/12/2023] [Revised: 05/27/2023] [Accepted: 07/02/2023] [Indexed: 02/09/2024] Open
Abstract
INTRODUCTION AND OBJECTIVE To describe the demographic and clinical characteristics and treatment of patients with spinal gunshot wounds across Latin America. MATERIAL AND METHODS Retrospective, multicenter cohort study of patients treated for gunshot wounds to the spine spanning 12 institutions across Latin America between January 2015 and January 2022. Demographic and clinical data were recorded, including the time of injury, initial assessment, characteristics of the vertebral gunshot injury, and treatment. RESULTS Data on 423 patients with spinal gunshot injuries were extracted from institutions in Mexico (82%), Argentina, Brazil, Colombia, and Venezuela. Patients were predominantly male civilians in low-risk-of-violence professions, and of lower/middle social status, and a sizeable majority of gunshots were from low-energy firearms. Vertebral injuries mainly affected the thoracic and lumbar spine. Neurological injury was documented in 320 (76%) patients, with spinal cord injuries in 269 (63%). Treatment was largely conservative, with just 90 (21%) patients treated surgically, principally using posterior open midline approach to the spine (79; 87%). Injury features distinguishing surgical from non-surgical cases were neurological compromise (P = 0.004), canal compromise (P < 0.001), dirty wounds (P < 0.001), bullet or bone fragment remains in the spinal canal (P < 0.001) and injury pattern (P < 0.001). After a multivariate analysis through a binary logistic regression model, the aforementioned variables remained statistically significant except neurological compromise. CONCLUSIONS In this multicenter study of spinal gunshot victims, most were treated non-surgically, despite neurological injury in 76% and spinal injury in 63% of patients.
Collapse
Affiliation(s)
| | - J P Cabrera
- Hospital Clínico Regional de Concepción, Chile
| | - Ó Martínez
- Hospital Universitario Dr. José E. González, México
| | - J Cabrera
- Hospital de Traumatología Dr. Victorio de la Fuente Narvaez, IMSS, México
| | - J Matta
- Hospital Militar Central, Colombia
| | - V Dávila
- Hospital Universitario Dr. Manuel Nuñez Tovar, Venezuela
| | - J M Jiménez
- Instituto Mexicano del Seguro Social, México
| | - H Vilchis
- Unidad Médica de Alta Especialidad, Hospital de Traumatología y Ortopedia Lomas Verdes IMSS, México
| | - V Tejerina
- Hospital Traumatología y Ortopedia Magdalena de las Salinas, México
| | - J Pérez
- Clínica de columna Dr. Manuel Dufoo Olvera, México
| | - R Yurac
- Departamento de Ortopedia y Traumatología, Universidad del Desarrollo, Santiago, Chile; Unidad de Columna Vertebral, Departamento de Traumatología, Clínica Alemana, Santiago, Chile
| |
Collapse
|
3
|
Cabrera JP, Muthu S, Mesregah MK, Rodrigues-Pinto R, Agarwal N, Arun-Kumar V, Wu Y, Vadalà G, Martin C, Wang JC, Meisel HJ, Buser Z. Complications With Demineralized Bone Matrix, Hydroxyapatite and Beta-Tricalcium Phosphate in Single and Two-Level Anterior Cervical Discectomy and Fusion Surgery. Global Spine J 2024; 14:78S-85S. [PMID: 38421333 PMCID: PMC10913904 DOI: 10.1177/21925682231157320] [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 literature review. OBJECTIVES To analyze the evidence available reporting complications in single or two-level anterior cervical discectomy and fusion (ACDF) using a demineralized bone matrix (DBM), hydroxyapatite (HA), or beta-tricalcium phosphate (β-TCP). METHODS A systematic review of the literature using PubMed, EMBASE, Cochrane Library, and ClinicalTrials.gov databases was performed in August 2020 to identify studies reporting complications in one or two-level ACDF surgery using DBM, HA, or β-TCP. The study was reported following the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines. RESULTS A total of 1857 patients were included, 981 male and 876 female, across 17 articles; 5 prospective, and 12 retrospectives. We noted heterogeneity among the included studies concerning the study design and combination of graft materials utilized in them. However, we noted a higher incidence of adjacent segment disease (17.7%) and pseudoarthrosis (9.3%) in fusion constructs using DBM. Studies using β-TCP reported a higher incidence of pseudoarthrosis (28.2%) and implant failures (17.9%). CONCLUSIONS Degenerative cervical conditions treated with one or two-level ACDF surgery using DBM, HA, or β-TCP with or without cervical plating are associated with complications such as adjacent segment disease, dysphagia, and pseudarthrosis. However, consequent to the study designs and clinical heterogeneity of the studies, it is not possible to correlate these complications accurately with any specific graft material employed. Further well-designed prospective studies are needed to correctly know the related morbidity of each graft used for achieving fusion in ACDF.
Collapse
Affiliation(s)
- Juan P Cabrera
- Department of Neurosurgery, Hospital Clínico Regional de Concepción, Concepción, Chile
- Faculty of Medicine, University of Concepción, Concepción, Chile
| | - Sathish Muthu
- Department of Orthopaedics, Government Medical College, Dindigul, India
- Orthopaedic Research Group, Coimbatore, India
| | - Mohamed Kamal Mesregah
- Department of Orthopaedic Surgery, Menoufia University Faculty of Medicine, Shebin El-Kom, Egypt
| | - Ricardo Rodrigues-Pinto
- Spinal Unit/Unidade Vertebro-Medular (UVM), Department of Orthopaedics, Centro Hospitalar Universitário do Porto, Porto, Portugal
| | - Neha Agarwal
- Department of Neurosurgery, BG Klinikum Bergmannstrost Halle, Germany
| | | | - Yabin Wu
- Research Department, AO Spine, AO Foundation, Davos, Switzerland
| | - Gianluca Vadalà
- Campus Bio-Medico University of Rome and Fondazione Policlinico Universitario Campus Bio-Medico, Rome, Italy
| | - Christopher Martin
- Department of Orthopaedic Surgery, University of Minnesota, Minneapolis, MN, USA
| | - Jeffrey C Wang
- USC Spine Center, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Hans Jörg Meisel
- Department of Neurosurgery, BG Klinikum Bergmannstrost Halle, Germany
| | - Zorica Buser
- Gerling Institute, Brooklyn, NY, USA
- Department of Orthopedic Surgery, NYU Grossman School of Medicine, New York, NY, USA
| |
Collapse
|
4
|
Cabrera JP, Agarwal N, Mesregah MK, Rodrigues-Pinto R, Wu Y, Martin C, Buser Z, Wang JC, Meisel HJ. Analysis of Complications in Multilevel Anterior Cervical Discectomy and Fusion Using Osteobiologics Other than Bone Morphogenetic Protein: A Systematic Review. Global Spine J 2024; 14:86S-93S. [PMID: 38421321 PMCID: PMC10913906 DOI: 10.1177/21925682231168083] [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. OBJECTIVES The aim of this study is to analyze the complications related to multilevel anterior cervical discectomy and fusion (ACDF) using osteobiologics other than bone morphogenetic protein (BMP). METHODS A systematic review of the literature was conducted using PubMed, EMBASE, Cochrane Library, and ClinicalTrials.gov databases. The search to identify studies reporting complications in multilevel ACDF surgery using osteobiologics other than bone morphogenetic protein was performed in August 2020. The study was reported in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA). RESULTS A total of 584 articles were found after searching the databases and removing duplicates. Next, screening was performed in a double reviewer process, and 153 eligible articles-with 4 retrospective studies-in full-text were selected; these met all inclusion criteria. A total of 197 patients received 3-level ACDF, while 72 patients received 4-level ACDF. Osteobiologics were used in all selected articles, allograft was used in 4 studies, autologous bone graft was utilized in 3 articles, and hydroxyapatite was used in 1 article. The main complications reported were dysphagia, adjacent segment disease, and pseudarthrosis. CONCLUSIONS Given the limited evidence, no conclusions on complications in multilevel ACDF using osteobiologics other than BMP could be made. However, descriptively, the most common complications found were dysphagia, adjacent segment disease, and pseudoarthrosis. Further prospective studies separately analyzing complications in multilevel ACDF by osteobiologics and a number of treated levels are needed.
Collapse
Affiliation(s)
- Juan P Cabrera
- Department of Neurosurgery, Hospital Clínico Regional de Concepción, Concepción, Chile
- Faculty of Medicine, University of Concepción, Concepción, Chile
| | - Neha Agarwal
- Department of Neurosurgery, BG Klinikum Bergmannstrost Halle, Halle, Germany
| | - Mohamed Kamal Mesregah
- Department of Orthopaedic Surgery, Menoufia University Faculty of Medicine, Shebin El-Kom, Menoufia, Egypt
| | - Ricardo Rodrigues-Pinto
- Spinal Unit (UVM). Department of Orthopaedics, Centro Hospitalar Universitário de Santo António; ICBAS - School of Medical and Biomedical Sciences; Hospital CUF Trindade, Porto, Portugal
| | - Yabin Wu
- Research Department, AO Spine, AO Foundation, Davos, Switzerland
| | - Christopher Martin
- Department of Orthopaedic Surgery, University of Minnesota, Minneapolis, MN, USA
| | - Zorica Buser
- Gerling Institute, Brooklyn, NY, USA
- Department of Orthopedic Surgery, NYU Grossman School of Medicine, New York, NY, USA
| | - Jeffrey C Wang
- Department of Orthopaedic Surgery, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Hans Jörg Meisel
- Department of Neurosurgery, BG Klinikum Bergmannstrost Halle, Halle, Germany
| |
Collapse
|
5
|
Muthu S, Viswanathan VK, Rodrigues-Pinto R, Cabrera JP, Ćorluka S, Martin CT, Collins MJ, Agarwal N, Wu Y, Wang JC, Meisel HJ, Buser Z. Do the Choice of Fusion Construct With and Without Autograft Influence the Fusion and Complication Rates in Patients Undergoing 1 or 2-Level Anterior Cervical Discectomy and Fusion Surgery? A PRISMA-Compliant Network Meta-Analysis. Global Spine J 2024; 14:59S-69S. [PMID: 36723507 PMCID: PMC10913905 DOI: 10.1177/21925682231154488] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
Abstract
STUDY DESIGN Network meta-analysis. OBJECTIVES To compare the fusion outcome and complications of different 1 or 2-level anterior cervical decompression and fusion (ACDF) constructs performed with and without the application of autografts. METHODS We performed an independent and duplicate search in electronic databases including PubMed, Embase, Web of Science, Cochrane, and Scopus for relevant articles published between 2000 and 2020. We included comparative studies reporting fusion rate and complications with and without the use of autografts in ACDF across 5 different fusion constructs. A network meta-analysis was performed in Stata, categorized based on the type of fusion constructs utilized. Fusion constructs were ranked based on p-score approach and surface under cumulative ranking curve (SUCRA) scores. The confidence of results from the analysis was appraised with Cochrane's CINeMA approach. RESULTS A total of 2216 patients from 22-studies including 6 Randomized Controlled Trials (RCTs) and 16 non-RCTs were included in network analysis. The mean age of included patients was 49.3 (±3.62) years. Based on our meta-analysis, we could conclude that use of autograft in 1- or 2-level ACDF did not affect the fusion and mechanical implant-related complications. The final fusion and mechanical complication rates were also not significantly different across the different fusion constructs. The use of plated constructs was associated with a significant increase in post-ACDF dysphagia rates [OR 3.42; 95%CI (.01,2.45)], as compared to stand-alone constructs analysed. CONCLUSION The choice of fusion constructs and use of autografts does not significantly affect the fusion and overall complication rates following 1 or 2-level ACDF surgery.
Collapse
Affiliation(s)
- Sathish Muthu
- Department of Orthopaedics, Government Medical College, Dindigul, India
- Orthopaedic Research Group, Coimbatore, India
| | - Vibhu Krishnan Viswanathan
- Orthopaedic Research Group, Coimbatore, India
- Department of Musculoskeletal Oncology, University of Calgary, Calgary, AB, Canada
| | - Ricardo Rodrigues-Pinto
- Spinal Unit (UVM), Department of Orthopaedics, Centro Hospitalar Universitário do Porto, Porto, Portugal
- Portugal Instituto de Ciências Biomédicas Abel Salazar, Universidade do Porto, Porto, Portugal
- Hospital CUF Trindade, Porto, Portugal
| | - Juan P Cabrera
- Department of Neurosurgery, Hospital Clínico Regional de Concepción, Concepción, Chile
| | - Stipe Ćorluka
- 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
| | - Christopher T Martin
- Department of Orthopaedic Surgery, University of Minnesota, Minneapolis, MN, USA
| | - Michael J Collins
- Department of Orthopedic Surgery, Tulane University, New Orleans, LA, USA
- Department of Neurosurgery, Tulane University, New Orleans, LA, USA
| | - Neha Agarwal
- Department of Neurosurgery, BG Klinikum Bergmannstrost Halle, Germany
| | - Yabin Wu
- Research Department, AO Spine, AO Foundation, Davos, Switzerland
| | - Jeffrey C Wang
- Department of Orthopaedic Surgery, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
- Department of Neurosurgery, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Hans Jörg Meisel
- Department of Neurosurgery, BG Klinikum Bergmannstrost Halle, Germany
| | - Zorica Buser
- Gerling Institute, Brooklyn, NY, USA
- Department of Orthopedic Surgery, NYU Grossman School of Medicine, New York, NY, USA
| |
Collapse
|
6
|
Wang D, Wang W, Han D, Muthu S, Cabrera JP, Hamouda W, Ambrosio L, Cheung JPY, Le HV, Vadalà G, Buser Z, Wang JC, Cho S, Yoon ST, Lu S, Chen X, Diwan AD. Clinical effectiveness of reduction and fusion versus in situ fusion in the management of degenerative lumbar spondylolisthesis: a systematic review and meta-analysis. Eur Spine J 2023:10.1007/s00586-023-08041-4. [PMID: 38043128 DOI: 10.1007/s00586-023-08041-4] [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] [Subscribe] [Scholar Register] [Received: 10/02/2023] [Revised: 10/02/2023] [Accepted: 11/03/2023] [Indexed: 12/05/2023]
Abstract
PURPOSE To compare the clinical effectiveness of reduction and fusion with in situ fusion in the management of patients with degenerative lumbar spondylolisthesis (DLS). METHODS The systematic review was conducted following the PRISMA guidelines. Relevant studies were identified from PubMed, Embase, Scopus, Cochrane Library, ClinicalTrials.gov, and Google Scholar. The inclusion criteria were: (1) comparative studies of reduction and fusion versus in situ fusion for DLS patients, (2) outcomes reported as VAS/NRS, ODI, JOA score, operating time, blood loss, complication rate, fusion rate, or reoperation rate, (3) randomized controlled trials and observational studies published in English from the inception of the databases to January 2023. The exclusion criteria included: (1) reviews, case series, case reports, letters, and conference reports, (2) in vitro biomechanical studies and computational modeling studies, (3) no report on study outcomes. The risk of bias 2 (RoB2) tool and the Newcastle-Ottawa scale was conducted to assess the risk of bias of RCTs and observational studies, respectively. RESULTS Five studies with a total of 704 patients were included (375 reduction and fusion, 329 in situ fusion). Operating time was significantly longer in the reduction and fusion group compared to in situ fusion group (weighted mean difference 7.20; 95% confidence interval 0.19, 14.21; P = 0.04). No additional significant intergroup differences were noted in terms of other outcomes analyzed. CONCLUSION While the reduction and fusion group demonstrated a statistically longer operating time compared to the in situ fusion group, the clinical significance of this difference was minimal. The findings suggest no substantial superiority of lumbar fusion with reduction over without reduction for the management of DLS.
Collapse
Affiliation(s)
- Dongfan Wang
- Department of Orthopedics, Xuanwu Hospital, Capital Medical University, No.45 Changchun Street, Xicheng District, Beijing, China
- National Center for Clinical Research on Geriatric Diseases, No.45 Changchun Street, Xicheng District, Beijing, China
| | - Wei Wang
- Department of Orthopedics, Xuanwu Hospital, Capital Medical University, No.45 Changchun Street, Xicheng District, Beijing, China
- National Center for Clinical Research on Geriatric Diseases, No.45 Changchun Street, Xicheng District, Beijing, China
| | - Di Han
- Department of Orthopedics, Xuanwu Hospital, Capital Medical University, No.45 Changchun Street, Xicheng District, Beijing, China
- National Center for Clinical Research on Geriatric Diseases, No.45 Changchun Street, Xicheng District, Beijing, China
| | - Sathish Muthu
- Orthopaedic Research Group, Coimbatore, Tamil Nadu, India
- Department of Orthopaedics, Government Medical College, Karur, Tamil Nadu, India
- Department of Biotechnology, Faculty of Engineering, Karpagam Academy of Higher Education, Coimbatore, Tamil Nadu, India
| | - Juan P Cabrera
- Department of Neurosurgery, Hospital Clínico Regional de Concepción, Concepción, Chile
- Faculty of Medicine, University of Concepción, Concepción, Chile
| | - Waeel Hamouda
- Department of Neurosurgery, Kasr Alainy Faculty of Medicine, Research and Teaching Hospitals, Cairo University, Cairo, Egypt
- Neurological & Spinal Surgery Service, Security Forces Hospital, Dammam, Saudi Arabia
| | - Luca Ambrosio
- Operative Research Unit of Orthopaedic and Trauma Surgery, Fondazione Policlinico Universitario Campus Bio-Medico, Rome, Italy
- Research Unit of Orthopaedic and Trauma Surgery, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Rome, Italy
| | - Jason P Y Cheung
- Department of Orthopaedics and Traumatology, The University of Hong Kong, Hong Kong SAR, China
| | - Hai V Le
- Department of Orthopaedic Surgery, University of California, Davis, CA, USA
| | - Gianluca Vadalà
- Operative Research Unit of Orthopaedic and Trauma Surgery, Fondazione Policlinico Universitario Campus Bio-Medico, Rome, Italy
- Research Unit of Orthopaedic and Trauma Surgery, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Rome, Italy
| | - Zorica Buser
- Department of Orthopedic Surgery, NYU Grossman School of Medicine, New York, NY, USA
| | - Jeffrey C Wang
- Department of Orthopaedic Surgery and Neurological Surgery, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Samuel Cho
- Department of Orthopedic Surgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - S Tim Yoon
- Department of Orthopaedics, Emory University, Atlanta, GA, USA
| | - Shibao Lu
- Department of Orthopedics, Xuanwu Hospital, Capital Medical University, No.45 Changchun Street, Xicheng District, Beijing, China.
- National Center for Clinical Research on Geriatric Diseases, No.45 Changchun Street, Xicheng District, Beijing, China.
- Xuanwu Hospital of Capital Medical University, No.45 Changchun Street, Beijing, 100053, China.
| | - Xiaolong Chen
- Department of Orthopedics, Xuanwu Hospital, Capital Medical University, No.45 Changchun Street, Xicheng District, Beijing, China.
- National Center for Clinical Research on Geriatric Diseases, No.45 Changchun Street, Xicheng District, Beijing, China.
- Xuanwu Hospital of Capital Medical University, No.45 Changchun Street, Beijing, 100053, China.
| | - Ashish D Diwan
- Spine Service, Department of Orthopaedic Surgery, St. George Hospital Campus, Sydney, NSW, Australia.
- St. George & Sutherland Clinical School, University of New South Wales, Level 3, WR Pitney Building, Kogarah, Sydney, NSW, 2217, Australia.
| |
Collapse
|
7
|
Ricciardi GA, Cirillo Totera JI, Cabrera JP, Guiroy A, Carazzo CA, Yurac R. Minimally Invasive Surgery for Traumatic Thoracolumbar Fractures: A Cross-Sectional Study of Spine Surgeons. World Neurosurg 2023; 180:e706-e715. [PMID: 37827430 DOI: 10.1016/j.wneu.2023.10.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2023] [Revised: 10/02/2023] [Accepted: 10/03/2023] [Indexed: 10/14/2023]
Abstract
OBJECTIVE To describe the perceived feasibility of minimally invasive surgical treatment of thoracolumbar fractures among spine surgeons in Latin American centers. METHODS This is a cross-sectional study on minimally invasive surgical treatment for unstable thoracolumbar fractures. We conducted an online survey of spine surgeons working in Latin American centers, administered between December 16, 2022 and January 15, 2023. A nonprobabilistic sample was selected (snowball sampling). A questionnaire was sent by email and other messaging applications. RESULTS Data were extracted from 134 surgeons. The majority of the respondents were from Brazil (n = 30, 22.4%), Mexico (n = 24, 17.9%), Argentina (n = 22, 16.4%), and Chile (n = 15, 11.2%). Their mean age was 46.53 years (standard deviation, 9.7; range 31-67) and almost all were males (n = 128, 95.5%). Most respondents were orthopedists (n = 85, 63.4%) or neurosurgeons (n = 49, 36.9%). Most of the respondents (n = 110, 82.1%) reported at least some difficulty using minimally invasive techniques for thoracolumbar fractures. It should be noted that there were significant regional differences between the surgeons' responses (P = 0.017). Chilean surgeons reported better results than others. CONCLUSION Spinal surgeons from Latin American centers have identified challenges and obstacles to performing minimally invasive surgery for thoracolumbar trauma. The survey found that a majority of respondents experienced some level of difficulty, with regional variations. The most frequently reported difficulties were the high cost of the procedure, patient insurance restrictions, and long insurance approval times.
Collapse
Affiliation(s)
- Guillermo A Ricciardi
- Orthopedic and Traumatology, Centro Médico Integral Fitz Roy, Buenos Aires, Argentina; Orthopedic and Traumatology, Sanatorio Güemes, Buenos Aires, Argentina; Orthopedic and Traumatology, Hospital General de Agudos Dr. Teodoro Álvarez, Buenos Aires, Argentina.
| | - Juan Ignacio Cirillo Totera
- Department of Orthopedic and Traumatology, Hospital del Trabajador, Chile; Department of Orthopedic and Traumatology, Clínica Universidad de los Andes, Santiago, Chile
| | - 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, São José, Brazil
| | - Ratko Yurac
- Department of Orthopedic and Traumatology, University del Desarrollo, Santiago, Chile; Department of Traumatology, Spine Unit, Clínica Alemana, Santiago, Chile
| |
Collapse
|
8
|
Cabrera JP, Gary MF, Muthu S, Yoon ST, Kim HJ, Cho SK, Ćorluka S, Lewis SJ, Kato S, Buser Z, Wang JC, Hsieh PC. Surgeon Preferences Worldwide in Wound Drain Utilization in Open Lumbar Fusion Surgery for Degenerative Pathologies. Global Spine J 2023:21925682231210184. [PMID: 37897691 DOI: 10.1177/21925682231210184] [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: 10/30/2023] Open
Abstract
STUDY DESIGN Cross-sectional survey. OBJECTIVE Although literature does not recommend routine wound drain utilization, there is a disconnect between the evidence and clinical practice. This study aims to explore into this controversy and analyze the surgeon preferences related to drain utilization, and the factors influencing drain use and criterion for removal. METHODS A survey was distributed to AO Spine members worldwide. Surgeon demographics and factors related to peri-operative drain use in 1 or 2-level open fusion surgery for lumbar degenerative pathologies were collected. Multivariate analyses by drain utilization, and criterion of removal were conducted. RESULTS 231 surgeons participated, including 220 males (95.2%), orthopedics (178, 77.1%), and academic/university-affiliated (114, 49.4%). Most surgeons preferred drain use (186, 80.5%) and subfascial drains (169, 73.2%). Drains were removed based on duration by 52.87% of the surgeons, but 27.7% removed drains based on outputs. On multivariable analysis, significant predictors of drain use were surgeon's aged 35-44 (OR = 11.9, 95% CI = 1.2-117.2, P = .034), 45-54 (29.1, 3.1-269.6, P = .003), 55-64 (8.9, 1.4-56.5, .019), and wound closure using coaptive films (6.0, 1.2-29.0, P = .025). Additionally, surgeons from Asia Pacific (OR = 5.19, 95% CI = 1.65-16.38, P = .005), Europe (3.55, 1.22-10.31, P = .020), and Latin America (4.40, 1.09-17.83, .038) were more likely to remove drain based on time duration, but surgeons <5 years of experience (10.23, 1.75-59.71, P = .010) were more likely to remove drains based on outputs. CONCLUSIONS Most spine surgeons worldwide prefer to place a subfascial wound drain for degenerative open lumbar surgery. The choice for drain placement is associated with the surgeon's age and use of coaptive films for wound closure, while the criterion for drain removal is associated with the surgeons' region of practice and experience.
Collapse
Affiliation(s)
- Juan P Cabrera
- Department of Neurosurgery, Hospital Clínico Regional de Concepción, Concepción, Chile
- Faculty of Medicine, University of Concepción, Concepción, Chile
| | - Matthew F Gary
- Department of Neurosurgery, Emory University, Atlanta, GA, USA
| | - Sathish Muthu
- Orthopaedic Research Group, Coimbatore, India
- Department of Orthopaedics, Government Medical College, Karur, India
- Department of Biotechnology, Faculty of Engineering, Karpagam Academy of Higher Education, Coimbatore, India
| | - S Tim Yoon
- Department of Orthopedics, Emory University, Atlanta, GA, USA
| | - Ho-Joong Kim
- Spine Center and Department of Orthopedic Surgery, Seoul National University Bundang Hospital and Seoul National University College of Medicine, Seoul, Republic of South Korea
| | - Samuel K Cho
- Department of Orthopedic Surgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Stipe Ćorluka
- 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
| | - Stephen J Lewis
- Department of Orthopaedics, University of Toronto, University Health Network, Toronto Western Hospital, Toronto, ON, Canada
| | - So Kato
- Department of Orthopaedic Surgery, The University of Tokyo, Tokyo, Japan
| | - Zorica Buser
- Gerling Institute, Brooklyn, NY, USA
- Department of Orthopedic Surgery, NYU Grossman School of Medicine, New York, USA
| | - Jeffrey C Wang
- USC Spine Center, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Patrick C Hsieh
- Department of Neurological Surgery, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| |
Collapse
|
9
|
Ricciardi G, Martinez O, Cabrera J, Matta J, Davila V, Jimenez JM, Vilchis H, Tejerina V, Perez J, Cabrera JP, Yurac R. Spinal gunshot wounds: A retrospective, multicenter, cohort study. Rev Esp Cir Ortop Traumatol (Engl Ed) 2023:S1888-4415(23)00165-0. [PMID: 37423382 DOI: 10.1016/j.recot.2023.07.001] [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: 04/12/2023] [Revised: 05/27/2023] [Accepted: 07/02/2023] [Indexed: 07/11/2023] Open
Abstract
INTRODUCTION AND OBJECTIVE To describe the demographic and clinical characteristics and treatment of patients with spinal gunshot wounds across Latin America. MATERIAL AND METHODS Retrospective, multicenter cohort study of patients treated for gunshot wounds to the spine spanning 12 institutions across Latin America between January 2015 and January 2022. Demographic and clinical data were recorded, including the time of injury, initial assessment, characteristics of the vertebral gunshot injury, and treatment. RESULTS Data on 423 patients with spinal gunshot injuries were extracted from institutions in Mexico (82%), Argentina, Brazil, Colombia, and Venezuela. Patients were predominantly male civilians in low-risk-of-violence professions, and of lower/middle social status, and a sizeable majority of gunshots were from low-energy firearms. Vertebral injuries mainly affected the thoracic and lumbar spine. Neurological injury was documented in n=320 (76%) patients, with spinal cord injuries in 269 (63%). Treatment was largely conservative, with just 90 (21%) patients treated surgically, principally using posterior open midline approach to the spine (n=79; 87%). Injury features distinguishing surgical from non-surgical cases were neurological compromise (p=0.004), canal compromise (p<0.001), dirty wounds (p<0.001), bullet or bone fragment remains in the spinal canal (p<0.001) and injury pattern (p<0.001). After a multivariate analysis through a binary logistic regression model, the aforementioned variables remained statistically significant except neurological compromise. CONCLUSIONS In this multicenter study of spinal gunshot victims, most were treated non-surgically, despite neurological injury in 76% and spinal injury in 63% of patients.
Collapse
Affiliation(s)
| | - O Martinez
- Hospital Universitario Dr. José E. González, Mexico
| | - J Cabrera
- Hospital de Traumatología "Dr. Victorio de la Fuente Narvaez" IMSS, Mexico
| | - J Matta
- Hospital Militar Central, Colombia
| | - V Davila
- Hospital Universitario Dr. Manuel Nuñez Tovar, Venezuela
| | - J M Jimenez
- Instituto Mexicano del Seguro Social, Mexico
| | - H Vilchis
- Unidad Médica de Alta Especialidad Hospital de Traumatología y Ortopedia Lomas Verdes IMSS, Mexico
| | - V Tejerina
- Hospital Traumatología y Ortopedia Magdalena de las Salinas, Mexico
| | - J Perez
- Clínica de columna "Dr. Manuel Dufoo Olvera", Mexico
| | - J P Cabrera
- Hospital Clínico Regional de Concepción, Chile
| | - R Yurac
- Department of Orthopedic and Traumatology, University del Desarrollo, Santiago, Chile; Spine Unit, Department of Traumatology, Clinica Alemana, Santiago, Chile
| |
Collapse
|
10
|
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
| |
Collapse
|
11
|
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.
Collapse
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
| | | |
Collapse
|
12
|
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.
Collapse
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
| |
Collapse
|
13
|
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.
Collapse
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
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
14
|
Cabrera JP, Camino-Willhuber G, Muthu S, Guiroy A, Valacco M, Pola E. Percutaneous Versus Open Pedicle Screw Fixation for Pyogenic Spondylodiscitis of the Thoracic and Lumbar Spine: Systematic Review and Meta-Analysis. Clin Spine Surg 2023; 36:24-33. [PMID: 35344512 DOI: 10.1097/bsd.0000000000001325] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2021] [Accepted: 03/01/2022] [Indexed: 02/07/2023]
Abstract
STUDY DESIGN A systematic review and meta-analysis. OBJECTIVE This meta-analysis aimed to compare percutaneous (PPS) versus open pedicle screw (OPS) fixation for treatment of thoracic and lumbar spondylodiscitis. SUMMARY OF BACKGROUND DATA Pyogenic spondylodiscitis of the thoracic and lumbar spine can produce instability, deformity, and/or neurological compromise. When medical treatment is unsuccessful, surgical treatment is indicated, with the conventional open approach the usual standard of care. However, percutaneous techniques can be advantageous in medically vulnerable patients. MATERIALS AND METHODS A literature search was performed using the PubMed, Web of Science, and Scopus databases, looking for comparative articles on pyogenic spondylodiscitis requiring surgical stabilization with pedicle screws. This systematic review is reported according to PRISMA guidelines. RESULTS From 215 articles initially identified, 7 retrospective studies were analyzed, encapsulating an overall sample of 722 patients: 405 male (56.1%) and 317 female (43.9%). The treatment modality was PPS fixation in 342 patients (47.4%) and OPS fixation in 380 (52.6%). For PPS, operating time was 29.75 minutes ( P <0.0001), blood loss 390.18 mL ( P <0.00001), postoperative pain 1.54 points ( P <0.00001), and length of stay 4.49 days ( P =0.001) less than with OPS fixation, and wound infection 7.2% ( P =0.003) less frequent. No difference in screw misplacement ( P =0.94) or loosening ( P =0.33) rates was observed. CONCLUSION Employing PPS fixation to treat pyogenic spondylodiscitis of the thoracic and lumbar spine is associated with significantly reduced operating time, blood loss, postoperative pain, length of stay, and rates of wound infection than OPS fixation, with no difference between the 2 treatments in rates of screw misplacement or screw loosening.
Collapse
Affiliation(s)
- Juan P Cabrera
- Department of Neurosurgery, Hospital Clínico Regional de Concepción
- 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
| | - Sathish Muthu
- Department of Orthopaedics, Government Medical College & Hospital, Dindigul, Tamil Nadu, India
| | - Alfredo Guiroy
- Spine Unit, Orthopedic Department, Hospital Español de Mendoza, Mendoza
| | - Marcelo Valacco
- Department of Orthopedic and Traumatology, Hospital Churruca Visca, Buenos Aires, Argentina
| | - Enrico Pola
- Division of Spine Surgery, Department of Orthopaedics and Traumatology, Policlinico di Napoli University Hospital, Università della Campania "Luigi Vanvitelli", Naples, Italy
| |
Collapse
|
15
|
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
Collapse
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
| | | |
Collapse
|
16
|
Carelli LE, Almeida LE, Cabrera JP, Khan AA, Mendonça ML, Vital RT, Fonseca GV, Jardim MM. Correlation between Single-pulse and Pulse-train stimulation during Neuromonitoring of Thoracic Pedicle Screws in Scoliosis Surgery. World Neurosurg 2022; 164:e611-e618. [PMID: 35577202 DOI: 10.1016/j.wneu.2022.05.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Revised: 05/05/2022] [Accepted: 05/06/2022] [Indexed: 11/17/2022]
Abstract
BACKGROUND The use of thoracic pedicle screws (TPS) during scoliosis surgery entails an inherent risk of neurological deficit. Triggered electromyography (t-EMG) is an accurate neuromonitoring test for the detection of malpositioned TPS. However, single-pulse t-EMG (SP t-EMG) stimulation has shown variable capability for detecting medial pedicle breaches while pulse-train t-EMG (PT t-EMG) could be more accurate. The aim is to analyze the correlation between SP t-EMG and PT t-EMG. METHODS Retrospective study including 20 patients of scoliosis correction with 294 TPS placed. A total of 588 tests with both SP t-EMG and PT t-EMG were performed, analyzed, and compared. The results of both t-EMG techniques were stratified into three different groups according to threshold obtained: Group 1 (≤6 mA), Group 2 (6.1 - 11.9 mA) and Group 3 (=12 mA). Generalized Linear Model was performed to analyze the correlation between the methods. RESULTS SP t-EMG elicited response in 5 screws (1.7%) at ≤ 6 mA; 28 screws (9.5%) at 6.1 - 11.9 mA; and 261 screws (88.8%) at =12 mA. PT t-EMG elicited response in 16 screws (5.4%) at ≤6 mA; 30 screws (10.2%) at 6.1 - 11.9mA; and 248 screws (84.4%) at =12 mA. There is a strong positive and significant association between SP t-EMG and PT t-EMG with a decrease ratio of 2% (95% CI: 1% to 3%). CONCLUSIONS SP t-EMG and PT t-EMG stimulation techniques had similar results when the stimuli were applied the TPS, but PT t-EMG may have better efficacy in low-threshold group.
Collapse
Affiliation(s)
- Luis E Carelli
- National Institute of Traumatology and Orthopaedics, Rio de Janeiro, Brazil; Spine Institute of Rio de Janeiro, Rio de Janeiro, Brazil; Department of Neurology, Federal University of the State of Rio de Janeiro, Rio de Janeiro, Brazil.
| | - Luiz E Almeida
- Spine Institute of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Juan P Cabrera
- National Institute of Traumatology and Orthopaedics, Rio de Janeiro, Brazil; Spine Institute of Rio de Janeiro, Rio de Janeiro, Brazil; Faculty of Medicine, University of Concepción, Concepción, Chile
| | - Ahsan Ali Khan
- National Institute of Traumatology and Orthopaedics, Rio de Janeiro, Brazil; Spine Institute of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Maria L Mendonça
- National Institute of Traumatology and Orthopaedics, Rio de Janeiro, Brazil
| | - Robson Teixeira Vital
- National Institute of Traumatology and Orthopaedics, Rio de Janeiro, Brazil; Department of Neurology, Federal University of the State of Rio de Janeiro, Rio de Janeiro, Brazil
| | | | - Marcia M Jardim
- Department of Neurology, Federal University of the State of Rio de Janeiro, Rio de Janeiro, Brazil
| |
Collapse
|
17
|
Quinteros G, Cabrera JP, Urrutia J, Carazzo CA, Guiroy A, Marré B, Joaquim A, Yurac R. Reliability Evaluation of the New AO Spine-DGOU Classification for Osteoporotic Thoracolumbar Fractures. World Neurosurg 2022; 161:e436-e440. [PMID: 35158101 DOI: 10.1016/j.wneu.2022.02.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2022] [Revised: 02/06/2022] [Accepted: 02/07/2022] [Indexed: 10/19/2022]
Abstract
OBJECTIVES To perform an interobserver and intraobserver agreement evaluation of the new AO Spine-DGOU classification system for osteoporotic thoracolumbar fractures (OFc). METHODS Complete imaging studies of 97 patients (radiographs, computed tomography scans, and magnetic resonance imaging) with osteoporotic thoracolumbar fractures were selected and classified using the OFc by 6 spine surgeons (3 senior surgeons with more than 15 years of experience and 3 surgeons with less than 15 years). After a 4-week interval, the same cases were presented to the same evaluators in a random sequence for a new classification assessment. The weighted kappa coefficient (wκ) was used to determine the interobserver and intraobserver agreement. RESULTS The interobserver agreement was moderate, wκ = 0.59 (95% confidence interval 0.54-0.64). The intraobserver agreement was fair, wκ = 0.35 (95% confidence interval 0.29-0.40). Interobserver agreement slightly improved for junior staff between first and second evaluation, suggesting a learning effect. Better agreement was obtained by senior staff at the interobserver and intraobserver agreement. CONCLUSIONS This independent assessment demonstrated that new OFc allows moderate interobserver agreement and fair intraobserver agreement. Further studies are necessary prior to its widespread adoption.
Collapse
Affiliation(s)
- Guisela Quinteros
- Spine Unit, Orthopedics Department, Hospital Regional de Talca, Talca, Chile; Facultad de Medicina, Universidad Católica del Maule, Talca, Chile.
| | - Juan P Cabrera
- Department of Neurosurgery, Hospital Clínico Regional de Concepción, Concepción, Chile
| | - Julio Urrutia
- Department of Orthopaedic Surgery, School of Medicine, Pontificia Universidad Catolica de Chile, Santiago, Chile
| | - Charles A Carazzo
- Department of Neurosurgery, University of Passo Fundo, São Vicente de Paulo Hospital, Passo Fundo, Rio Grande do Sul, Brazil
| | - Alfredo Guiroy
- Spine Unit, Orthopedic Department, Hospital Español de Mendoza, Mendoza, Argentina
| | - Bartolomé Marré
- Department of Orthopedic and Traumatology, University del Desarrollo, Santiago, Chile; Spine Unit, Department of Traumatology, Clínica Alemana, Santiago, Chile
| | - Andrei Joaquim
- Department of Neurosurgery, University of Campinas (UNICAMP), Campinas-SP, Brazil
| | - Ratko Yurac
- Department of Orthopedic and Traumatology, University del Desarrollo, Santiago, Chile; Spine Unit, Department of Traumatology, Clínica Alemana, Santiago, Chile
| |
Collapse
|
18
|
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.
Collapse
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
| |
Collapse
|
19
|
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.
Collapse
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
| | | |
Collapse
|
20
|
Cabrera JP, Vera F, López E, Luna F. Letter to the Editor regarding "Use of intra-operative stimulation of brainstem lesion target sites for frameless stereotactic biopsies". Childs Nerv Syst 2021; 37:2133-2135. [PMID: 33909084 DOI: 10.1007/s00381-021-05180-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Accepted: 04/19/2021] [Indexed: 10/21/2022]
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.
| | - Franco Vera
- Faculty of Medicine, University of Concepción, Concepción, Chile
| | - Eduardo López
- Department of Neurosurgery, Hospital Clínico Regional de Concepción, San Martín 1436, Concepción, Chile
| | - Francisco Luna
- Department of Neurosurgery, Hospital Clínico Regional de Concepción, San Martín 1436, Concepción, Chile.,Faculty of Medicine, University of Concepción, Concepción, Chile
| |
Collapse
|
21
|
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.
Collapse
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
| |
Collapse
|
22
|
Cabrera JP, Vigueras S, Muñoz R, López E. Double neurophysiological certification of the filum terminale during sectioning surgery in pediatric population. Surg Neurol Int 2020; 11:229. [PMID: 32874732 PMCID: PMC7451179 DOI: 10.25259/sni_222_2020] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Accepted: 07/18/2020] [Indexed: 11/26/2022] Open
Abstract
Background: Surgery of thickened-fibrolipoma filum terminale (FT) is performed routinely and without conflict but is not a risk-free surgical procedure. Intraoperative neurophysiological monitoring with mapping techniques can help to certify the FT before sectioning. However, a tailored surgical approach to cauda equina and a low threshold of surrounding nerve roots can confuse the final surgical decision. The aim is to demonstrate the usefulness of this double methodology for FT certification. Methods: A prospective study collected and reviewed retrospectively, from 2015 to 2018, 40 patients undergoing an FT surgery section were included in the study. After opening the dura mater and under the microscope, the cauda equina mapping is performed and the recording of muscles of the lower limbs and the external anal sphincter. In addition, a high-intensity stimulation of constant current of an isolated FT for a short period of time and in a dry surgical field, obtaining a bilateral-polyradicular-symmetrical response of cauda equina nerve roots. Results: Traditional motor mapping identified FT in 65% (26/40) of patients. Although, 35% (14/40) of the patients still have low-intensity stimuli response (<1 mA) of a muscle, especially anal sphincter. When this happens, the optimization of the dissection around FT is performed. After that, 25% (10/40) of the patients still having a muscle response in spite of seem isolated FT. Increasing the stimulation intensity up to 20 mA evoked a cauda equina response in all cases. No postoperative neurological impairment was observed in this series. Conclusion: This proposed methodology accurately confirms the FT so that it can be safely found and cut. The Double Neurophysiological Certification improves the gap of the traditional mapping techniques of cauda equina and can be used in a variety of more complex surgeries in this area.
Collapse
Affiliation(s)
- Juan P Cabrera
- Department of Neurosurgery, Hospital Clínico Regional de Concepción, Concepción, Bío Bío, Chile
| | - Sebastián Vigueras
- Department of Neurosurgery, Hospital Clínico Regional de Concepción, Concepción, Bío Bío, Chile
| | - Rubén Muñoz
- Department of Neurosurgery, Hospital Clínico Regional de Concepción, Concepción, Bío Bío, Chile
| | - Eduardo López
- Department of Neurosurgery, Hospital Clínico Regional de Concepción, Concepción, Bío Bío, Chile
| |
Collapse
|
23
|
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
| | | |
Collapse
|
24
|
Cabrera JP, Yankovic W, Luna F, Torche E, Valdés G, López E, Chávez O. Traumatic spondyloptosis of L3 with incomplete neurological involvement: A case report. Trauma Case Rep 2019; 24:100248. [PMID: 31872021 PMCID: PMC6911902 DOI: 10.1016/j.tcr.2019.100248] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [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: 04/04/2019] [Revised: 08/17/2019] [Accepted: 09/19/2019] [Indexed: 12/01/2022] Open
Abstract
High-energy traumas frequently result in lumbar spine fractures such as spondyloptosis is the maximum expression of instability and severity. The management of spondyloptosis is complex and, essentially, surgical. It usually presents with irreversible neurological compromise. This paper aimed to present a case of lumbar spondyloptosis and its early confrontation, partial neurological involvement, and progressive postoperative retrieval. Clinical case A male patient aged 42 years had multiple injuries with asymmetric paraparesis and sphincter involvement. Computed tomography (CT) revealed L3 vertebral spondyloptosis detached from the rest of the spine, spinal canal stenosis, sagittal imbalance, and angular kyphosis. Surgical resolution was defined by performing an en bloc corpectomy through lumbotomy and the installation of an expandable cage with posterior transpedicular fixation of L2–L4, thereby recovering the spinal canal diameter, lumbar lordosis, sagittal balance, and improving motor function progressively. Conclusion Complex spinal injuries warrant an early resolution by a trained surgical team to ensure normal spinal parameters and to achieve a progressive neurological recovery.
Collapse
Affiliation(s)
- Juan P Cabrera
- Department of Neurosurgery, Hospital Clínico Regional de Concepción, San Martín 1436, Concepción, Chile.,University of Concepción, Chacabuco esquina Janequeo S/N, Concepción, Chile
| | - Willy Yankovic
- University of Concepción, Chacabuco esquina Janequeo S/N, Concepción, Chile.,Department of Vascular Surgery, Hospital Clínico Regional de Concepción, San Martín 1436, Concepción, Chile
| | - Francisco Luna
- Department of Neurosurgery, Hospital Clínico Regional de Concepción, San Martín 1436, Concepción, Chile.,University of Concepción, Chacabuco esquina Janequeo S/N, Concepción, Chile
| | - Esteban Torche
- Department of Neurosurgery, Hospital Clínico Regional de Concepción, San Martín 1436, Concepción, Chile.,University of Concepción, Chacabuco esquina Janequeo S/N, Concepción, Chile
| | - Guillermo Valdés
- Department of Neurosurgery, Hospital Clínico Regional de Concepción, San Martín 1436, Concepción, Chile
| | - Eduardo López
- University of Concepción, Chacabuco esquina Janequeo S/N, Concepción, Chile
| | - Oriana Chávez
- University of Concepción, Chacabuco esquina Janequeo S/N, Concepción, Chile
| |
Collapse
|
25
|
Cabrera JP, Torche E, Luna F, Alarcón E, Spencer ML, López E, Valdés G, Arévalo A. Upper thoracic dumbbell-shaped tumor resected in one stage posterior approach: case report. AME Case Rep 2019; 3:25. [PMID: 31463430 DOI: 10.21037/acr.2019.07.01] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2019] [Accepted: 06/26/2019] [Indexed: 11/06/2022]
Abstract
Upper thoracic tumors may develop spinal cord compression. By surgery at the time of diagnosis, a neurological deficit can be avoided. However, this particular localization requires a double approach to decompress the spinal cord and thoracic structures. The posterior extracavitary approach results in resection of the spinal canal, the foraminal component, and the extraspinal fragment, but is not routinely used by most neurosurgeons. A 56-year-old woman with a two-month history of axial thoracic pain and cough. The patient has a normal neurological examination. Thoracic computed tomography (CT) scan with contrast agent was performed, evincing a dumbbell-shaped tumor on the left T3-T4. Magnetic resonance imaging (MRI) confirms the diagnosis, showing a 4 cm diameter tumor that compresses the spinal cord without myelopathy. The surgery was performed posteriorly, with costotransversectomy, allowing complete resection under intraoperative neurophysiological monitoring. The patient developed no thoracic or neurological complications. One-stage posterior approach is possible and effective during the treatment of the upper thoracic dumbbell-shaped tumors, avoiding a change in surgical position, thoracic morbidity, and dependence on assisting surgeons.
Collapse
Affiliation(s)
- Juan P Cabrera
- Department of Neurosurgery, Regional Clinical Hospital of Concepción, Concepción, Chile.,Department of Surgery, University of Concepción, Concepción, Chile
| | - Esteban Torche
- Department of Neurosurgery, Regional Clinical Hospital of Concepción, Concepción, Chile.,Department of Surgery, University of Concepción, Concepción, Chile
| | - Francisco Luna
- Department of Neurosurgery, Regional Clinical Hospital of Concepción, Concepción, Chile.,Department of Surgery, University of Concepción, Concepción, Chile
| | - Emilio Alarcón
- Department of Surgery, University of Concepción, Concepción, Chile.,Department of Thoracic Surgery, Regional Clinical Hospital of Concepción, Concepción, Chile
| | - M Loreto Spencer
- Department of Pathology, Regional Clinical Hospital of Concepción, Concepción, Chile
| | - Eduardo López
- Department of Surgery, University of Concepción, Concepción, Chile
| | - Guillermo Valdés
- Department of Neurosurgery, Regional Clinical Hospital of Concepción, Concepción, Chile
| | - Antonela Arévalo
- Department of Surgery, University of Concepción, Concepción, Chile
| |
Collapse
|