Acute pancreatitis after spine surgery: a case report and review of literature.

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Acute pancreatitis after spine surgery: a case report and review of literature.

Eur J Orthop Surg Traumatol. 2013 Dec 8;

Authors: Tauchi R, Imagama S, Ito Z, Ando K, Hirano K, Ukai J, Kobayashi K, Shinjo R, Muramoto A, Nakashima H, Matsumoto T, Ishiguro N

Abstract
Although acute postoperative pancreatitis is a relatively frequent complication after open biliary tract surgery and gastric surgery, acute pancreatitis after spine surgery is a rare complication. We report the first case of acute pancreatitis after posterior lumbar interbody fusion (PLIF) for spondylolisthesis that resolved with conservative treatment. A 53-year-old female patient received a PLIF from L3 to L5. The patient presented with persistent mild abdominal pain, nausea and vomiting several hours after the surgery. An abdominal CT revealed swelling of the head of the pancreas and free fluid around the pancreas. A gastroenterologist diagnosed acute pancreatitis and prescribed nafamostat mesilate, antibiotics and intravenous fluid therapy. The patient recovered gradually, and clinical symptoms disappeared. At 6 months after the operation, she had experienced no recurrence of abdominal symptoms, and solid spinal fusion was achieved. In previous studies, acute pancreatitis was reported as a complication after spine surgery for various spine diseases such as scoliosis and lumbar disorders. The procedures performed included anterior/posterior scoliosis surgery and anterior/posterior lumbar fusion surgery. We must consider the possibility of acute pancreatitis when unusual abdominal symptoms with elevated serum amylase levels occur after spine surgery. Prompt diagnosis and supportive therapy are essential to minimize morbidity and mortality.

PMID: 24318308 [PubMed – as supplied by publisher]

Stabilizing osteoporotic thoracolumbar fractures through an anterior or posterior approach: what works best?

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Stabilizing osteoporotic thoracolumbar fractures through an anterior or posterior approach: what works best?

Spine J. 2013 Dec 1;13(12):1733-5

Authors: Verlaan JJ

Abstract
COMMENTARY ON: Sudo H, Ito M, Kaneda K, et al. Anterior decompression and strut graft versus posterior decompression and pedicle screw fixation with vertebroplasty for osteoporotic thoracolumbar vertebral collapse with neurological deficits. Spine J 2013;13:1726-32 (in this issue).

PMID: 24315555 [PubMed – in process]

Vertebral compression fractures in patients under treatment with denosumab: A Contra-indication for percutaneous vertebroplasty?

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Vertebral compression fractures in patients under treatment with denosumab: A Contra-indication for percutaneous vertebroplasty?

Spine J. 2013 Dec 5;

Authors: Mattei TA, Mendel E, Bourekas EC

Abstract
BACKGROUND CONTEXT: Denosumab is a RANK-ligand antibody that was approved by the FDA in 2010 for the prevention of skeletal fractures in patients with bone metastases from solid tumors. Although the widespread use of such drug in patients under risk of pathological fractures, the compatibility of denosumab therapy with percutaneous vertebroplasty (an interventional procedure commonly used for pain control in such population) has not yet been established.
PURPOSE: To present the serial imaging findings and technical report of an attempted percutaneous vertebroplasty in a patient with refractory pain and a lytic pathological fracture due to small cell lung cancer who was actively under medical treatment with denosumab.
STUDY DESIGN: Retrospective review and case report.
METHODS: The authors present the imaging findings and technical report of an attempted percutaneous vertebroplasty in the only patient found to be actively under treatment with denosumab after a retrospective review of the databank of patients with pathological fractures referred to the Department Radiology of the Ohio State University for percutaneous vertebroplasty (a total sample of 20 patients) since the FDA approval of denosumab (November 2010) until June of 2013 (a 30-month period).
RESULTS: Although the CT-scan of the thoracic spine performed 6 weeks after the initiation of treatment with denosumab (XGeva®) presented a remarkable remodeling of the previously lytic vertebral lesion (which became markedly sclerotic in appearance), the clinical response in terms of pain improvement was not satisfactory. During the performance of the percutaneous vertebroplasty which was indicated for pain control, after advancing the 11-gauge needle through the pedicle with extreme difficulty, the needle repeatedly deviated laterally and, despite several attempts, it was not possible to penetrate the vertebral body and perform the injection of cement.
CONCLUSIONS: This is the first report of the technical peculiarities of percutaneous vertebroplasty in patients under medical treatment with denosumab. According to our experience, due to its RANK ligand-mediated effects on osteoclast activity, denosumab has been shown to induce a fast and marked sclerotic response on vertebral bodies, which may not be accompanied by a satisfactory improvement in pain control (especially in patients with mechanical type of pain), and which may actually prevent the successful performance of percutaneous vertebroplasty. Therefore, it is of paramount importance that future studies evaluating patients with vertebral fractures under treatment with denosumab include long-term pain outcomes measures. Additionally further investigation is warranted in order to determine the optimal order of treatment as well as the best timeframe for combining percutaneous vertebroplasty and denosumab therapy in patients presenting with acute vertebral compression fractures and refractory axial pain.

PMID: 24316116 [PubMed – as supplied by publisher]

Obese class III patients at significantly greater risk of multiple complications after lumbar surgery: an analysis of 10,387 patients in the ACS-NSQIP database.

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Obese class III patients at significantly greater risk of multiple complications after lumbar surgery: an analysis of 10,387 patients in the ACS-NSQIP database.

Spine J. 2013 Dec 5;

Authors: Buerba RA, Fu MC, Gruskay JA, Long WD, Grauer JN

Abstract
BACKGROUND CONTEXT: Prior studies on the impact of obesity on spine surgery outcomes have focused mostly on lumbar fusions, do not examine lumbar discectomies or decompressions, and have shown mixed results regarding complications. Differences in sample sizes as well as differences in the BMI thresholds for the definition of the obese vs. comparison cohorts could account for the inconsistencies in the literature.
PURPOSE: To analyze whether different degrees of obesity influence the complication rates in patients undergoing lumbar spine surgery.
STUDY DESIGN/SETTING: Retrospective cohort analysis of prospectively collected data using the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) database from 2005 to 2010.
PATIENT SAMPLE: Patients in the de-identified, risk-adjusted, and multi-institutional ACS-NSQIP database undergoing lumbar anterior fusion, posterior fusion, TLIF/PLIF, discectomy, or decompression.
OUTCOME MEASURES: Primary outcome measures were 30-day post-surgical complications, including PE, DVT, death, system-specific complications (wound, pulmonary, urinary, CNS, cardiac), septic complications and having ≥ 1 complication overall. Secondary outcomes were time spent in the operating room, blood transfusions, length of stay, and re-operation within 30 days.
METHODS: Patients undergoing lumbar anterior fusion, posterior fusion, TLIF/PLIF, discectomy, or decompression in the ACS-NSQIP, 2005-2010 were categorized into 4 BMI groups: non-obese (18.5-29.9 kg/m(2)), obese I (30-34.9 kg/m(2)), obese II (35-39.9 kg/m(2)), obese III (≥40 kg/m(2)). Obese I-III patients were compared to patients in the non-obese category using χ(2) and ANOVA. Multivariate linear/logistic regression models were used to adjust for preoperative risk factors. The authors report no sources of funding or conflicts of interest related to this study.
RESULTS: Data was available for 10,387 patients undergoing lumbar surgery. Of these, 4.5% underwent anterior fusion, 17.9% posterior fusion, 6.3% TLIF/PLIF, 40.7% discectomy, 30.5% decompression. Among all patients, 25.6% were obese I, 11.5% obese II, and 6.9% obese III. On multivariate analysis, obese I and III had a significantly increased risk of urinary complications and obese II and III patients had a significantly increased risk of wound complications. Only obese III patients, however, had a statistically increased risk of having increased time spent in the operating room, an extended length of stay, pulmonary complications and of having ≥ 1 complication (all p < .05).
CONCLUSIONS: Patients with high BMI appear to have higher complication rates after lumbar surgery than patients who are non-obese. However, the complication rates seem to increase substantially for obese III patients. These patients have longer times spent in the operating room, extended hospitals stays and an increased risk for wound, urinary, pulmonary complications and for having at least one or more complication overall. Surgeons should be aware of the increased risk of multiple complications for patients with BMI ≥ 40 kg/m(2).

PMID: 24316118 [PubMed – as supplied by publisher]

All-trans retinoic acid prevents epidural fibrosis through NF-?B signaling pathway in post-laminectomy rats.

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All-trans retinoic acid prevents epidural fibrosis through NF-κB signaling pathway in post-laminectomy rats.

Neuropharmacology. 2013 Dec 3;

Authors: Zhang C, Kong X, Ning G, Liang Z, Qu T, Chen F, Cao D, Wang T, Sharma HS, Feng S

Abstract
Laminectomy is a widely accepted treatment for lumbar disorders, and epidural fibrosis (EF) is a common complication. EF is thought to cause post-operative pain recurrence after laminectomy or discectomy. All-trans retinoic acid (ATRA) has shown anti-fibrotic, anti-inflammatory, and anti-proliferative functions. The object of this study was to investigate the effects of ATRA on the prevention of EF in post-laminectomy rats. In vitro, the anti-fibrotic effect of ATRA was demonstrated with cultured fibroblasts count, which comprised of those that were cultured with/without ATRA. In vivo, rats underwent laminectomy at the L1-L2 levels. We first demonstrated the beneficial effects using 0.05% ATRA compared to vehicle (control group). We found that a higher concentration of ATRA (0.1%) achieved dose-dependent results. Hydroxyproline content, Rydell score, vimentin-positive cell density, fibroblast density, inflammatory cell density and inflammatory factor expression levels all suggested better outcomes in the 0.1% ATRA rats compared to the other three groups. Presumably, these effects involved ATRA’s ability to suppress transforming growth factor (TGF-β1) and interleukin (IL)-6 which was confirmed with reverse-transcriptase polymerase chain reaction (RT-PCR). Finally we demonstrated that ATRA down-regulated nuclear factor (NF)-κB by immunohistochemistry and western blotting for p65 and inhibition of κB (IκBα), respectively. Our findings indicate that topical application of ATRA can inhibit fibroblast proliferation, decrease TGF-β1 and IL-6 expression level, and prevent epidural scar adhesion in rats. The highest concentration employed in this study (0.1%) was the most effective. ATRA suppressed EF through down-regulating NF-κB signaling, whose specific mechanism is suppression of IκB phosphorylation and proteolytic degradation.

PMID: 24316159 [PubMed – as supplied by publisher]