En bloc resection versus intralesional surgery in the treatment of giant cell tumor of the spine.

By Kamruz Zaman

En bloc resection versus intralesional surgery in the treatment of giant cell tumor of the spine.

Spine (Phila Pa 1976). 2017 Jan 31;:

Authors: Charest-Morin R, Fisher CG, Varga PP, Gokaslan ZL, Rhines LD, Reynolds JJ, Dekutoski MB, Quraishi NA, Bilsky MH, Fehlings MG, Chou D, Germscheid NM, Luzzati A, Boriani S, AOSpine Knowledge Forum Tumor

Abstract
STUDY DESIGN: Multicenter, ambispective observational study OBJECTIVE.: To quantify local recurrence and mortality rates after surgical treatment of spinal giant cell tumor and to determine whether en bloc resection with wide/marginal margins is associated with improved prognosis compared to an intra-lesional procedure.
SUMMARY OF BACKGROUND DATA: Giant cell tumor of the spine is a rare primary bone tumor known for its local aggressiveness. Optimal surgical treatment remains to be determined.
METHODS: The AOSpine Knowledge Forum Tumor developed a comprehensive multicenter database including demographics, presentation, diagnosis, treatment, mortality, and recurrence rate data for giant cell tumor of the spine. Patients were analysed based on surgical margins, including Enneking appropriateness.
RESULTS: Between 1991 and 2011, 82 patients underwent surgery for spinal giant cell tumor. According to the Enneking classification, 59 (74%) tumors were classified as S3-aggressive and 21 (26%) as S2-active. The surgical margins were wide/ marginal in 27 (36%) patients and intra-lesional in 48 (64%) patients. 39/77 (51%) underwent Enneking appropriate (EA) treatment and 38 (49%) underwent Enneking inappropriate (EI) treatment. Eighteen (22%) patients experienced local recurrence (LR). LR occurred in 11 (29%) EI-treated patients and 6 (15%) EA-treated patients (p = 0.151). There was a significant difference between wide/marginal margins and intra-lesional margins for LR (p = 0.029). Seven (9%) patients died. LR is strongly associated with death (RR 8.9, p < 0.001). Six (16%) EI-treated patients and one (3%) EA-treated patient died (p = 0.056). With regards to surgical margins, all patients who died underwent intra-lesional resection (p = 0.096).
CONCLUSION: En bloc resection with wide/marginal margins should be performed when technically feasible because it is associated with decreased LR. Intra-lesional resection is associated with increased LR, and mortality correlates with LR.

PMID: 28146024 [PubMed – as supplied by publisher]

Early Postoperative Magnetic Resonance Imaging in Detecting Radicular Pain After Lumbar Decompression Surgery: Retrospective Study of the Relationship Between Dural Sac Cross-sectional Area and Postoperative Radicular Pain.

By London Spine
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Early Postoperative Magnetic Resonance Imaging in Detecting Radicular Pain After Lumbar Decompression Surgery: Retrospective Study of the Relationship Between Dural Sac Cross-sectional Area and Postoperative Radicular Pain.

J Spinal Disord Tech. 2015 Nov 18;

Authors: Futatsugi T, Takahashi J, Oba H, Ikegami S, Mogami Y, Shibata S, Ohji Y, Tanikawa H, Kato H

Abstract
STUDY DESIGN: A retrospective analysis.
OBJECTIVE: To evaluate the association between early postoperative dural sac cross-sectional area (DCSA) and radicular pain.
SUMMARY OF BACKGROUND DATA: The correlation between postoperative magnetic resonance imaging (MRI) findings and postoperative neurological symptoms after lumbar decompression surgery is controversial.
METHODS: This study included 115 patients who underwent lumbar decompression surgery followed by MRI within 7 days postoperatively. There were 46 patients with early postoperative radicular pain, regardless of whether the pain was mild or similar to that before surgery. The intervertebral level with the smallest DCSA was identified on MRI and compared preoperatively and postoperatively. Risk factors for postoperative radicular pain were determined using univariate and multivariate analyses. Subanalysis according to absence/presence of a residual suction drain also was performed.
RESULTS: Multivariate regression analysis showed that smaller postoperative DCSA was significantly associated with early postoperative radicular pain (per -10 mm; odds ratio, 1.26). The best cutoff value for radicular pain was early postoperative DCSA of 67.7 mm. Even with a cutoff value of <70 mm, sensitivity and specificity are 74.3% and 75.0%, respectively. Early postoperative DCSA was significantly larger before suction drain removal than after (119.7±10.1 vs. 93.9±5.4 mm).
CONCLUSIONS: Smaller DCSA in the early postoperative period was associated with radicular pain after lumbar decompression surgery. The best cutoff value for postoperative radicular pain was 67.7 mm. Absence of a suction drain at the time of early postoperative MRI was related to smaller DCSA.

PMID: 26584199 [PubMed – as supplied by publisher]

Pessimistic back beliefs and lack of exercise: a longitudinal risk study in relation to shoulder, neck, and back pain.

By London Spine
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Pessimistic back beliefs and lack of exercise: a longitudinal risk study in relation to shoulder, neck, and back pain.

Psychol Health Med. 2015;20(7):767-80

Authors: Elfering A, Müller U, Rolli Salathé C, Tamcan Ö, Mannion AF

Abstract
This cross-lagged-panel study tested the validity of the German version of the back beliefs questionnaire (BBQ) in predicting pain in the shoulders, neck, and back. A random sample of 2860 individuals participated at baseline, and 73% responded at one-year follow-up. Structural equation modeling was used to carry out a model comparison to evaluate whether paths differed between individuals with and without initial back pain and between those who exercised at baseline and those who did not. Factor analysis showed eight of the nine original items loaded on the expected common factor. High BBQ scores at baseline significantly predicted an increase in shoulder, neck, and back pain in individuals with current back pain (β = .11, p < .05), but not in other respondents (β = .02, p = .259). Similarly, baseline BBQ scores predicted the increase in shoulder, neck, and back pain among those who did not exercise (β = .15, p < .05), but not in those who did (β = .04, ns). The risk of negative back beliefs preceding an increase in shoulder, neck, and back pain was greatest for those with current back pain who did not exercise (β = .29, p < .05). The findings confirmed the validity of the German BBQ. Cognitive behavioral interventions should address pessimistic back beliefs in high-risk groups.

PMID: 25726859 [PubMed – indexed for MEDLINE]

Percutaneous lumbar laser disc decompression: an update of current evidence.

By London Spine

Percutaneous lumbar laser disc decompression: an update of current evidence.

Pain Physician. 2013 Apr;16(2 Suppl):SE229-60

Authors: Singh V, Manchikanti L, Calodney AK, Staats PS, Falco FJ, Caraway DL, Hirsch JA, Cohen SP

Abstract
BACKGROUND: Since the descriptions by Mixter and Barr of surgical treatment for rupture of the intervertebral disc in 1934, open surgical procedures have become a common practice. Disc herniations are often classified as being contained or non-contained. The results of open surgical discectomy for contained disc herniation have been poor. Consequently, several  less invasive techniques have been developed including percutaneous lumbar laser disc decompression.
STUDY DESIGN:   A systematic review of the literature of percutaneous lumbar laser disc decompression.
OBJECTIVE:   The objective of this systematic review is to evaluate and update the clinical effectiveness of percutaneous lumbar laser discectomy in managing radicular pain secondary to contained disc herniation.
METHODS: The available literature on lumbar laser disc decompression in managing chronic low back and lower extremity pain was reviewed. Quality assessment and clinical relevance of randomized trials were graded according to the Cochrane Musculoskeletal Review Group criteria for interventional techniques, and observational studies according to the Newcastle-Ottawa Scale criteria.The level of evidence was classified as good, fair, and limited or poor based on the quality of evidence developed by the U.S. Preventive Services Task Force (USPSTF). Data sources included relevant literature identified through searches of PubMed and EMBASE from 1966 to September 2012, and manual searches of the bibliographies of known primary and review articles.
OUTCOME MEASURES:   Pain relief was the primary outcome measure. Other outcome measures were functional improvement, improvement of psychological status, opioid intake, and return-to-work. Short-term effectiveness was defined as effectiveness lasting one year or less, whereas, long-term effectiveness was defined as benefit persisting for greater than one year.
RESULTS: Based on USPSTF criteria, the indicated level of evidence for percutaneous lumbar laser disc decompression is limited for short- and long-term relief.
LIMITATIONS:   Although laser discectomy has been utilized for many years, there is a paucity of randomized clinical trials.
CONCLUSION:   This systematic review shows limited evidence for percutaneous lumbar laser disc decompression.

PMID: 23615885 [PubMed – in process]

Influence of an eccentric load added at the back of the head on head-neck posture.

By London Spine
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Influence of an eccentric load added at the back of the head on head-neck posture.

Gait Posture. 2013 Sep;38(4):951-5

Authors: Pavan EE, Frigo CA, Pedotti A

Abstract
A biomechanical study of the head-neck complex in seated subjects was conducted to verify whether a slight load, applied at the back of the head, could beneficially affect the head-neck posture, one of the factors of postural neck pain. An eccentric load of 0.5 kg was applied to the subjects’ head by means of a special cap. A group of asymptomatic subjects (n=10, 28.9±12.1 yrs), and a group of subjects that had experienced mild, occasional neck pain (n=10, 39.6±18.4 yrs) were compared. They were analyzed while maintaining a still posture that was periodically perturbed to avoid habituation. A 3D motion analyzer and reflective markers placed over the head, the neck and the trunk, were used to compute head inclination and translation and head/neck flexion angle in different conditions: before, during and after having had the load applied for 15 min. Although the moment induced by the load was extensor, a forward-oriented movement of the head was observed in both groups. However, the forward displacement, in relation to the initial position, was smaller in the mild neck pain group than in the asymptomatic group (5.7±4.7 mm vs. 8.9±5.5 mm, P<0.05 and 2.6±5.9 mm vs. 11.0±9.0 mm after 15 min, P<0.05). After removing the load, the mild neck pain subjects assumed a retracted position (-3.8±2.7 mm) while the asymptomatic subjects stayed protracted (+3.5±5.1 mm, P<0.01). These unexpected findings suggest that a slight load added to the head can influence the postural control mechanisms and, in symptomatic subjects, lead to a new strategy aimed at a reduction of the neck extensor muscle contraction.

PMID: 23711986 [PubMed – indexed for MEDLINE]