Temporary liver and stomach necrosis after lateral approach for interbody fusion and deformity correction of lumbar spine: report of two cases and review of the literature.

Temporary liver and stomach necrosis after lateral approach for interbody fusion and deformity correction of lumbar spine: report of two cases and review of the literature.

Eur Spine J. 2016 Apr 6;

Authors: Vasiliadis HS, Teuscher R, Kleinschmidt M, Marrè S, Heini P

Abstract
INTRODUCTION: Corrections of spinal deformities have been associated with a potential of postoperative vessel-originating complications. Reports of occlusions of celiac artery seem though to be very rare.
CASE REPORTS: We present two cases that developed acute arterial supply impairment and subsequent liver and gastric necrosis due to an occlusion of celiac artery, after a spine deformity correction. In both patients a lateral surgical approach to the superior lumbar spine, lateral placement of cages and then a subsequent posterior fixation were performed.
REVIEW: The literature search reveals the report of three similar cases, with potentially different pathogenetic mechanisms and with a different prognosis. This complication is assumed to occur due to a Medial Arcuate Ligament syndrome (MALS) developed postoperatively that leaded to compression of the celiac artery against the Medial Arcuate Ligament. The pathogenesis though remains unclear and two theories are assumed to explain the acute appearance of the syndrome; the alteration of the anatomic relationship between the vessels and the surrounding tissues due to the spine deformity correction and an intraoperative direct or indirect traction injury of the celiac trunk that caused or increased its pressure against the medial arcuate ligament.
CONCLUSION: The spine surgeon should be aware of the possibility of postoperative ischemia of the liver and stomach by occlusion of the celiac artery or its supplying branches. Specifically when a large correction of a kyphotic/kyphoscoliotic spine is planed, the surgeon should be alert for an appearance of a MALS.

PMID: 27052404 [PubMed – as supplied by publisher]

Study on anterior and posterior approaches for spinal tuberculosis: a meta-analysis.

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Study on anterior and posterior approaches for spinal tuberculosis: a meta-analysis.

Eur J Orthop Surg Traumatol. 2015 Jul;25 Suppl 1:S69-76

Authors: Muheremu A, Niu X, Wu Z, Tian W

Abstract
BACKGROUND: Timely and appropriate surgical intervention can enhance the stability of spine, eliminate the compression on spinal cord and prevent the further development the complications that may follow. However, there is no optimum surgical approach that has been agreed by surgeons.
OBJECTIVE: Incidence rate of spinal tuberculosis is still high in many developing countries. Except from chemotherapy, some patients require surgical treatment at certain phases of disease development. However, there is still not a standard operative procedure for spinal tuberculosis in the current research, and we studied the differences of anterior and posterior approach for spinal tuberculosis, to provide guidance for the further operative treatments.
METHODS: We searched “Pubmed” (2000.1-2014.7), “Medline” (2000.1-2014.7), “Elseveir” (2000.1-2014.7), Cochrane library (2008.1-2014.7), Wanfang (2000.1-2014.7), and CNKI (2000.1-2014.7) databases with the key words of “thoracolumbar tuberculosis”, “controlled randomized trial”, “RCT”, “anterior” “posterior”, and searched for randomized controlled trials for spinal tuberculosis. We compared the operative time, total blood loss, correction of Cobb angle, loss of Cobb angle at final follow-up, fusion time of allograft, time of total hospital stay, and the effectiveness of operative treatment between the anterior and posterior surgical approaches by Revman5.3 software.
RESULTS: From 1,523 papers found, we chose eight randomized controlled trials comparing different surgical approaches for the treatment of spinal tuberculosis. The total number of patients was 754, in which 377 were treated with anterior approach and 377 were treated with posterior approach correction of Cobb angle (P < 0.05), and no significant differences were found regarding operation time, loss of correction of Cobb angle in the last follow-up, time of total hospital stay, and fusion time of bone graft (P > 0.05).
CONCLUSIONS: There are significant differences between the two operative approaches regarding the correction of Cobb angle, but no significant differences regarding operation time, blood loss, loss of Cobb angle at the last follow-up, total fusion time, and length of total stay in the hospital.

PMID: 25047733 [PubMed – indexed for MEDLINE]

A matched-pair analysis comparing 5×4 Gy and 10×3 Gy for metastatic spinal cord compression (MSCC) in patients with favorable survival prognoses.

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A matched-pair analysis comparing 5×4 Gy and 10×3 Gy for metastatic spinal cord compression (MSCC) in patients with favorable survival prognoses.

Radiat Oncol. 2015;10:90

Authors: Rades D, Huttenlocher S, Veninga T, Bajrovic A, Bremer M, Rudat V, Schild SE

Abstract
BACKGROUND: It is currently not possible to get an approval of our ethics committee for a randomized trial cmparing 5×4 Gy and 10×3 Gy for MSCC that includes patients with favorable survival prognoses. Therefore, this matched-pair study following strict matching criteria was perfomed instead.
METHODS: In this study, 142 receiving 5×4 Gy were retrospectively matched (1:1) to 142 patients receiving 10×3 Gy with respect to ten characteristics. These characteristics included age, gender, performance status, tumor type, involved vertebrae, other bone metastases, visceral metastases, interval between tumor diagnosis and MSCC, pre-RT ambulatory status, and time developing motor deficits.
RESULTS: On multivariate analysis, post-RT motor function was associated with performance status (p<0.001), tumor type (p < 0.001), and time developing motor deficits (p<0.001). RT was successful in 76% of patients receiving 5×4 Gy and 69% receiving 10×3 Gy (p=0.14). Pre.RT ambulatory status showed a strong trend with respect to local control (LC) of MSCC in the multivariate analysis (p=0.058). 1-year LC rates were 87% after 5×4 Gy and 93% after 10×3 Gy (p=0.16). On multivariate analysis, survival (OS) was associated with performance score (p<0.001), visceral metastases (p<0.001), and pre-RT ambulatory status (p=0.004). 1-year OS rates were 68% after 5×4 Gy and 73% after 10×3 Gy (p = 0.64).
CONCLUSIONS: In patients irradiated for MSCC who had favorable survival prognoses, post-RT motor function, LC and OS were not significantly different after 5×4 Gy and after 10×3 Gy.

PMID: 25889036 [PubMed – indexed for MEDLINE]

Can anti-osteoporotic therapy reduce adjacent fracture in magnetic resonance imaging-proven acute osteoporotic vertebral fractures?

Can anti-osteoporotic therapy reduce adjacent fracture in magnetic resonance imaging-proven acute osteoporotic vertebral fractures?

BMC Musculoskelet Disord. 2016;17(1):151

Authors: Chen YC, Lin WC

Abstract
BACKGROUND: Adjacent fracture of the cemented vertebrae result from crushed fragile trabeculae during follow-up, suggesting impaired bone marrow integrity. This study aimed to determine if anti-osteoporotic therapy can decrease the risk of adjacent fracture in patients after vertebroplasty.
METHODS: This retrospective study reviewed of cases of osteoporotic patients with magnetic resonance imaging (MRI)-proven acute vertebral fractures between 2001 and 2007. Osteoporotic patients were investigated as determined by pre-operative MRI with subsequent adjacent fracture of the cemented vertebrae and for the possibility of anti-osteoporotic therapy decreasing the progression of collapse after a minimum of 6 months follow-up. All associated co-morbidities were recorded, as well as the use of anti-osteoporotic drugs (i.e., bisphosphonate, raloxifen, calcitonin, and teriparatide). Cox regression analysis was also performed.
RESULTS: The 192 vertebral fractured patients who underwent vertebroplasty and anti-osteoporotic therapy had a mean age of 74.40 ± 6.41. The basic characteristics of patients with and without adjacent fracture differed in age, body mass index, rheumatoid arthritis, and use of glucocorticoids and anti-osteoporotic drugs (Table 1). Using the Kaplan-Meier curve, anti-osteoporotic therapy after vertebroplasty had a significant effect on adjacent fracture (p = 0.037, by log rank text). After adjusting for potential confounders, patients with anti-osteoporotic therapy still had a lower adjacent fracture rate than patients without anti-osteoporotic therapy (p = 0.006; HR: 2.137, 95 % CI: 1.1238-3.690). The adjacent fracture rate also increased in old age (p = 0.019; HR: 1.049; 95 % CI:1.008-1.039) and among smokers (p = 0.026; HR: 3.891; 95 % CI: 1.175-12.890).
CONCLUSIONS: In this study, adjacent fracture of cemented vertebrae is inevitable after vertebroplasty but can be mitigated by anti-osteoporotic therapy to increase bone mass.

PMID: 27052323 [PubMed – in process]

Reply: the letter to the editor of Dr. Yan Hu entitled “Re: Gao F, Mao T, Sun W, Guo W, Wang Y, Li Z et al. An Updated Meta-Analysis Comparing Artificial Cervical Disc Arthroplasty (CDA) Versus Anterior Cervical Discectomy and Fusion (ACDF) for the Treatment of Cervical Degenerative Disc Disease (CDDD). Spine (Phila Pa 1976) 2015;40(23): 1816-23.”

Reply: the letter to the editor of Dr. Yan Hu entitled “Re: Gao F, Mao T, Sun W, Guo W, Wang Y, Li Z et al. An Updated Meta-Analysis Comparing Artificial Cervical Disc Arthroplasty (CDA) Versus Anterior Cervical Discectomy and Fusion (ACDF) …