The Neurological Compromised Spine Due to Ewing Sarcoma. What First: Surgery or Chemotherapy? Therapy, Survival, and Neurological Outcome of 15 Cases With Primary Ewing Sarcoma of the Vertebral Column.

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The Neurological Compromised Spine Due to Ewing Sarcoma. What First: Surgery or Chemotherapy? Therapy, Survival, and Neurological Outcome of 15 Cases With Primary Ewing Sarcoma of the Vertebral Column.

Neurosurgery. 2015 Nov;77(5):718-24; discussion 724-5

Authors: Mirzaei L, Kaal SE, Schreuder HW, Bartels RH

Abstract
BACKGROUND: The vertebral column is an infrequent site of primary involvement in Ewing sarcoma. Yet when Ewing sarcoma is found in the spine, the urge for decompression is high because of the often symptomatic compression of neural structures. It is unclear in alleviating a neurological deficit whether chemotherapy is preferred over decompressive laminectomy.
OBJECTIVE: To underline, in this case series, the efficiency of initial chemotherapy before upfront surgery in the setting of high-grade spinal cord or cauda equina compression of primary Ewing sarcoma.
METHODS: Fifteen patients with Ewing sarcoma primarily located in the spine were treated at our institution between 1983 and 2015. Localization, neurological deficit expressed as Frankel grade, and outcome expressed as Rankin scale before and after initial chemotherapy, the recurrence rate, and overall survival were evaluated. The multidisciplinary approach of 1 case will be discussed in detail.
RESULTS: Nine patients (60%) were female. The age at presentation was 15.0 ± 5.5 years (range: 0.9-22.8 years). Ten patients (67%) were initially treated with chemotherapy, and 1 patient (7%) was treated primarily with radiotherapy followed by chemotherapy. The remaining 4 patients (27%) were initially treated with decompressive surgery. All patients treated primarily nonsurgically improved neurologically at follow-up, showing the importance of chemotherapy as an effective initial treatment option.
CONCLUSION: Adequate and quick decompression of neural structures with similar results can be achieved by chemotherapy and radiotherapy, avoiding the local spill of malignant cells.

PMID: 26308634 [PubMed – indexed for MEDLINE]

Comparison of peri-operative and 12-month lifestyle outcomes in minimally invasive transforaminal lumbar interbody fusion versus conventional lumbar fusion.

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Comparison of peri-operative and 12-month lifestyle outcomes in minimally invasive transforaminal lumbar interbody fusion versus conventional lumbar fusion.

Br J Neurosurg. 2016 Jun 22;:1-5

Authors: Virdee JS, Nadig A, Anagnostopoulos G, George KJ

Abstract
AIM: To compare the results of minimally invasive transforaminal lumbar interbody fusion (MI-TLIF) versus conventional lumbar interbody fusion in terms of peri-operative and long-term outcome measures.
DESIGN: Retrospective secondary data analysis.
SUBJECTS: The study involved patients who had primary single-level spinal interbody fusion between October 2012 and May 2014 with 1-year follow-up, resulting in 36 patients for MI-TLIF and 60 patients for open surgery.
METHOD: Patients responded to Euro-Spine (TANGO) forms 12-month post-surgery, which provided the lifestyle factors. Peri-operative factors were retrieved from hospital notes. Operating time, length of post-operative stay, peri-operative complications, mobility, self-care, ability to perform daily activities, pain and discomfort, anxiety and depression, back and leg pain were observed in the study.
RESULTS: On average, MI-TLIF patients spent 3.25 days (±0.38) in hospital with conventional surgery patients staying for 6.92 days (±1.13). The average surgical time for MI-TLIF was 260.44 min (±9.95) compared to 297.05 min (±9.28) for open patients. Patients undergoing open surgery were more prone to post-operative complications than MI-TLIF patients (open 43.3%, MI-TLIF 16.7% p = 0.004). The TANGO data show statistical differences in severe pain (open 29%, MI-TLIF 17% p = 0.039), moderate mobility (open 69%, MI-TLIF 53% p = 0.011), and anxiety (open 14%, MI-TLIF 3% p = 0.034).
CONCLUSION: MI-TLIF appears to have significant advantages over conventional surgery with statistically significant differences in length of stay, perioperative complications and pain, mobility and anxiety levels.

PMID: 27331649 [PubMed – as supplied by publisher]

Long-Term Clinical Outcomes of Cervical Disc Arthroplasty: A Prospective, Randomized, Controlled Trial.

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Long-Term Clinical Outcomes of Cervical Disc Arthroplasty: A Prospective, Randomized, Controlled Trial.

Spine (Phila Pa 1976). 2016 Jun 21;

Authors: Sasso WR, Smucker JD, Sasso MP, Sasso RC

Abstract
STUDY DESIGN: Prospective, Randomized, Single-Center, Clinical Trial.
OBJECTIVE: To prospectively examine the 7 and 10-year outcomes of cervical arthroplasty to anterior cervical discectomy and fusion (ACDF).
SUMMARY OF BACKGROUND DATA: Degeneration of the cervical discs causing radiculopathy is a frequent source of surgical intervention, commonly treated with ACDF. Positive clinical outcomes are associated with arthrodesis techniques, yet there remains a long-term concern for adjacent segment change. Cervical disc arthroplasty has been designed to mitigate some of the challenges associated with arthrodesis while providing for a similar positive neurological outcome. As data has been collected from numerous prospective U.S. FDA IDE trials, longer term outcomes regarding adjacent segment change may be examined.
METHODS: As part of an FDA IDE trial, a single center collected prospective outcomes data on 47 patients randomized in a 1:1 ratio to ACDF or arthroplasty.
RESULTS: Success of both surgical interventions remained high at the 10-year interval. Both arthrodesis and arthroplasty demonstrated statistically significant improvements in NDI, VAS neck and arm pain scores at all intervals including 7 and 10-year periods. Arthroplasty demonstrated an advantage in comparison to arthrodesis as measured by final 10-year NDI score (8 vs 16, p = 0.0485). Patients requiring re-operation were higher in number in the arthrodesis cohort (32%) in comparison to arthroplasty (9%) (p = 0.055).
CONCLUSIONS: At 7 and 10 years, cervical arthroplasty compares favorably to ACDF as defined by standard outcomes scores in a highly selected population with radiculopathy.
LEVEL OF EVIDENCE: 1.

PMID: 27333341 [PubMed – as supplied by publisher]

Surgical treatment for lumbar tuberculosis by posterior transforaminal lumbar debridement, interbody fusion, and instrumentation in the aged.

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Surgical treatment for lumbar tuberculosis by posterior transforaminal lumbar debridement, interbody fusion, and instrumentation in the aged.

Springerplus. 2016;5:615

Authors: Yu B, He Y

Abstract
OBJECT: To evaluate the clinical efficacy and feasibility of single-stage posterior debridement, interbody fusion and posterior instrumentation for the treatment of lumbar tuberculosis in the aged and to discuss the surgical strategies of this intervention.
METHODS: From January 2006 to January 2012, 28 elderly patients who suffered from lumbar tuberculosis underwent one-stage posterior debridement, interbody fusion and posterior instrumentation. Radiographic data which included correction of local kyphosis, loss of correction and bone fusion were carefully collected pre and postoperatively to evaluate the efficacy of surgery. Perioperative and postoperative complications were also registered. All patients were asked to fill out Oswestry Disability Index questionnaire before the surgery and at the last follow-up.
RESULTS: All patients (12M/16F) were followed for at least 24 months. The average kyphotic angle decreased to 11.3° ± 7.0° postoperatively from 26.4° ± 5.7° preoperatively. Meanwhile, average loss of 2.0° ± 1.5° was observed at last visit. Bone fusion occurred at 4-6 months. Neither mortalities nor any neurological complications were found in the series. 16 cases who suffered neurologic insults before surgery, the majority of patients recovered after surgery. The mean Oswestry Disability Index was significantly improved from 28.6 ± 4.9 before surgery to 10.4 ± 3.8 at last visit.
CONCLUSIONS: The outcomes of follow-up showed that single-stage posterior debridement, interbody fusion and instrumentation is an effective method for the treatment of lumbar tuberculosis in the aged.

PMID: 27330881 [PubMed]

Patients’ expectations of lumbar spine surgery.

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Patients’ expectations of lumbar spine surgery.

Eur Spine J. 2015 Nov;24(11):2362-9

Authors: Mancuso CA, Duculan R, Stal M, Girardi FP

Abstract
PURPOSE: Patients undergoing lumbar spine surgery are a heterogeneous population and their expectations of surgery are likely to vary depending on individual and group characteristics. Our goal was to assess associations between expectations and demographic, psychological, and clinical characteristics in patients undergoing lumbar spine surgery.
METHODS: Shortly before surgery (mean 7 ± 3 days) 420 patients completed the valid and reliable Hospital for Special Surgery, Lumbar Spine Surgery Expectations Survey, which encompasses physical and psychological expectations; scores range from 0 to 100, higher scores reflect greater expectations. Patients completed additional surveys addressing multiple variables, including disability due to pain with a modified version of the Oswestry Disability Index (ODI).
RESULTS: The mean age was 55 ± 15 years, 57 % were men, and most surgery was for painful conditions. The mean Expectations Survey score was 72 ± 20 (range 2.5-100). In multivariate analysis, patients had higher scores (i.e., greater expectations) if they were younger (OR 1.02, CI 1.01, 1.04; p = .002), were not widowed (OR 4.9; CI 1.5, 15.5; p = .007), had prior chiropractic care (OR 1.8; CI 1.1, 2.8; p = .02), had worse ODI scores (OR 2.3; CI 1.5, 3.5; p = .0001), and had worse mental health scores (OR 1.8; CI 1.2, 2.8; p = .006). In additional multivariate analyses, worse ODI score was the clinical variable most closely associated with expecting more Expectations Survey items and expecting more improvement per item.
CONCLUSIONS: There were wide variations in expectations among patients. Multiple demographic, psychological, and clinical characteristics were associated with expectations, with disability due to pain being the most consistently associated variable.

PMID: 25291976 [PubMed – indexed for MEDLINE]