Percutaneous vertebroplasty: multi-centric results from EVEREST experience in large cohort of patients.

By London Spine
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Percutaneous vertebroplasty: multi-centric results from EVEREST experience in large cohort of patients.

Eur J Radiol. 2012 Dec;81(12):4083-6

Authors: Anselmetti GC, Marcia S, Saba L, Muto M, Bonaldi G, Carpeggiani P, Marini S, Manca A, Masala S

Abstract
PURPOSE: The purpose of this study was to prospectively evaluate results and complications of percutaneous vertebroplasty (PV) performed in 6 different Italian Centres belonging to the European VErtebroplasty RESearch Team (E.VE.RES.T) in a large series of patients.
MATERIALS AND METHODS: Follow-up was obtained in 4547 patients (3211 females and 1336 males; mean age 70.2 years) that underwent PV for a total of 13.437 treated vertebrae. Procedures were performed by using fluoroscopic guidance or combined CT-fluoroscopic guidance. All patients underwent PV in local anaesthesia except for second cervical vertebrae treated with a trans-oral approach that required general anaesthesia.
RESULTS: 4004 out of 4547 (88.0%) patients reported significant pain relief (difference>or=2 point in pain evaluated with an 11-point visual analogue scale; p<0.0001) within 48 h: an average of 7.7 ± 0.4 dropped to 1.8 ± 0.6 in the osteoporotic patients; 8.3 ± 0.4 to 2.4 ± 0.4 in metastases; 8.3 ± 0.4 to 1.7 ± 1.0 in myeloma; 6.2 ± 3.5 to 0.3 ± 0.2 in angioma and 7.4 ± 0.4 to 1.4 ± 0.9 in trauma. 430 osteoporotic patients (13%) were retreated for a subsequent fracture; in 302/430 patients (70.2%), the new fracture occurred in the contiguous vertebra. No major neurologic complications were reported and the most frequent minor complication was venous leakage (20.5%).
CONCLUSIONS: This large series of patients confirms that percutaneous vertebroplasty is an effective and safe procedure in the treatment of vertebral fractures. Best results are obtained in the treatment of myeloma and trauma.

PMID: 22902407 [PubMed – indexed for MEDLINE]

Selective Anterior Thoracolumbar Fusion in Adolescent Idiopathic Scoliosis. Long-Term Results After 17-Year Follow-Up.

By Kamruz Zaman
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Selective Anterior Thoracolumbar Fusion in Adolescent Idiopathic Scoliosis. Long-Term Results After 17-Year Follow-Up.

Spine (Phila Pa 1976). 2016 Nov 9;

Authors: Delfino R, Pizones J, Ruiz C, Sánchez-Mariscal F, Zúñiga L, Izquierdo E

Abstract
STUDY DESIGN: Prospectively-updated long-term data and retrospective case series analysis.
OBJECTIVE: To report the long-term results of selective anterior instrumented thoracolumbar (ThL) fusion in adolescent idiopathic scoliosis (AIS).
SUMMARY OF BACKGROUND DATA: The results of anterior selective fusion in AIS have been reported up to 2 and 5 years follow-up. However, there is a lack of evidence of long-term results of this surgical approach.
METHODS: Forty-two consecutive patients with main thoracolumbar/lumbar AIS who had undergone surgery for a selective anterior ThL instrumented fusion with more than 12 years of follow-up met inclusion criteria. Preoperative, postoperative (1-yr) and final updated radiographic parameters were recorded. Final ODI and SRS-22 questionnaires were evaluated.
RESULTS: Thirty-five patients were finally recruited (5 were lost and 2 refused). The mean age at surgery was 16.6 years. The mean final follow-up was 17.3 years (12-24 years).The ThL preoperative Cobb was 49.5°±9, obtaining a postoperative correction of 79%±13 and final correction of 72%±18. The preoperative thoracic curve (31.4°±14.2), obtained a spontaneous postoperative correction to 18.4°±11.9, maintained at final follow-up (17.8°±10.8). Apical vertebral rotation improved from 25.8°±7.8 to 9.2°±5.5 and finally to 8°±5.2 (P = 0.001). Sagittal parameters (T5-T12 = 27.2° and L1-S1=56.9°) did not change significantly postoperatively nor by final follow-up. Coronal balance improved from 2.4 cm to 1.6 cm postoperatively and 0.8 cm at final follow-up (P = 0.006). The disc angulation below the last instrumented vertebra improved with follow-up from 7.6° to 5.7° (P = 0.012).There were no revision surgeries or infections. One patient showed a symptomatic lower disc degeneration requiring lumbar pain surgery. Final SRS-22 global score was 4.3/5. The final ODI scored 6/100.
CONCLUSIONS: In the long term, selective anterior thoracolumbar instrumentation with a single solid rod in AIS maintained good corrections on the 3 planes with no major complications or infections, no revision surgeries, and with satisfactory final functional and clinical outcomes.
LEVEL OF EVIDENCE: 4.

PMID: 27831964 [PubMed – as supplied by publisher]

Minimally invasive surgery through endoscopic laminotomy and foraminotomy for the treatment of lumbar spinal stenosis.

By London Spine
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Minimally invasive surgery through endoscopic laminotomy and foraminotomy for the treatment of lumbar spinal stenosis.

J Orthop. 2013;10(1):13-6

Authors: Polikandriotis JA, Hudak EM, Perry MW

Abstract
BACKGROUND: Lumbar spinal stenosis is a common cause of radicular and generalized back pain among older adults. Endoscopic minimally invasive surgery, in contrast to open decompression, may provide the opportunity for a less invasive surgical intervention. Thus, the purpose of this study is to evaluate the safety (operative complications, estimated blood loss, operative room time) and effectiveness (pre- versus postoperative level of disability and pain severity) of minimally invasive surgery using endoscopic laminotomy and foraminotomy among a large sample of patients with lumbar spinal stenosis.
METHODS: This study is composed of 320 consecutive patients with lumbar spinal stenosis who underwent posterior lumbar laminotomy and foraminotomy between 2008 and 2011. Outcome measures consisted of perioperative complications, estimated blood loss, operative room time, level of disability, and pain severity. Pain severity and level of disability were prospectively analyzed to an average of 18 months (12-36 months) post-surgery.
RESULTS: There was an average estimated blood loss of 39.3 cc and a mean operative room time of 74 min. Seven patients experienced minor operative complications. All patients were discharged the same day as surgery and reported a significantly lower level of disability (p = 0.00) and pain severity (p = 0.00) postoperative compared to preoperative.
CONCLUSIONS: Minimally invasive surgery using endoscopy for the treatment of lumbar spinal stenosis has a short operative time, a low operative complication rate, and minimal estimated blood loss. This study also indicates that MIS for the treatment of LSS can significantly reduce pain and disability level. Thus, minimally invasive surgery using endoscopic laminotomy and foraminotomy appears to be a safe and effective alternative surgical treatment for open decompression surgery in adult patients with lumbar spinal stenosis.

PMID: 24403742 [PubMed]

The 2-Year Cost-Effectiveness of 3 options to Treat Lumbar Spinal Stenosis Patients.

By London Spine
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The 2-Year Cost-Effectiveness of 3 options to Treat Lumbar Spinal Stenosis Patients.

Pain Pract. 2014 Jan 3;

Authors: Udeh BL, Costandi S, Dalton JE, Ghosh R, Yousef H, Mekhail N

Abstract
Lumbar spinal stenosis (LSS) may result from degenerative changes of the spine, which lead to neural ischemia, neurogenic claudication, and a significant decrease in quality of life. Treatments for LSS range from conservative management including epidural steroid injections (ESI) to laminectomy surgery. Treatments vary greatly in cost and success. ESI is the least costly treatment may be successful for early stages of LSS but often must be repeated frequently. Laminectomy surgery is more costly and has higher complication rates. Minimally invasive lumbar decompression (mild(®) ) is an alternative. Using a decision-analytic model from the Medicare perspective, a cost-effectiveness analysis was performed comparing mild(®) to ESI or laminectomy surgery. The analysis population included patients with LSS who have moderate to severe symptoms and have failed conservative therapy. Costs included initial procedure, complications, and repeat/revision or alternate procedure after failure. Effects measured as change in quality-adjusted life years (QALY) from preprocedure to 2 years postprocedure. Incremental cost-effectiveness ratios were determined, and sensitivity analysis conducted. The mild(®) strategy appears to be the most cost-effective ($43,760/QALY), with ESI the next best alternative at an additional $37,758/QALY. Laminectomy surgery was the least cost-effective ($125,985/QALY).

PMID: 24393198 [PubMed – as supplied by publisher]