Thoracic lateral extracavitary corpectomy for anterior column reconstruction with expandable and static titanium cages: Clinical outcomes and surgical considerations in a consecutive case series

2015 ◽  
Vol 129 ◽  
pp. 37-43 ◽  
Author(s):  
Christopher M. Holland ◽  
David I. Bass ◽  
Matthew F. Gary ◽  
Brian M. Howard ◽  
Daniel Refai
Keyword(s):  
Clinical Outcomes ◽  
Case Series ◽  
Anterior Column ◽  
Consecutive Case ◽  
Anterior Column Reconstruction ◽  
Titanium Cages

scholarly journals Postoperative Stereotactic Radiosurgery for Spinal Metastases: Clinical Outcomes, Failures, and Analysis of Local Control

Neurosurgery ◽  
2019 ◽  
Vol 66 (Supplement_1) ◽  
Author(s):  
Muhamed Hadzipasic ◽  
Laura Van Beaver ◽  
Caroline M Ayinon ◽  
Robert Koffie ◽  
Brian Winey ◽  
...  
Keyword(s):  
Stereotactic Radiosurgery ◽  
Clinical Outcomes ◽  
Local Control ◽  
Spinal Metastases ◽  
Anterior Column ◽  
Neurological Deficits ◽  
Surgical Approaches ◽  
Tumor Control ◽  
Complication Rates ◽  
Anterior Column Reconstruction

Abstract INTRODUCTION Stereotactic radiosurgery (SRS) is a viable treatment modality for patients with spinal metastases. SRS is increasingly being used in multimodal management. Results of postoperative SRS following separation surgery has been reported but clinical outcomes and local control for a more heterogenous surgical sample (ie, anterior approaches, anterior column reconstruction, revision surgery after previous SRS) are lacking in the literature. We present data on clinical outcomes and local tumor control at a major cancer center following contemporary surgical approaches for spine metastases. METHODS After IRB approval, retrospective review of patients between 2012 and 2017 was performed at a single institution. Demographics, tumor histology, survival/recurrence rates, clinical outcomes, and complications were analyzed. RESULTS Eighty-six consecutive patients treated with SRS after spine surgery were identified. Mean age was 64. Radiation dose was 18 Gy in 1 fraction using 6 MV photons with a 24 Gy boost. Follow-up was 3 to 84 mo, with average time between surgery (11.1% anterior, 88.9% posterior approach) and SRS 3 wk. Evaluation was every 3 mo after treatment with CT or MRI. 1- and 2-yr survival rates were 57% and 38%, respectively. Overall rate of local recurrence was 12.7%. Multivariate analysis revealed tumor location (thoracic) and histology (lung carcinoma, colon, or melanoma) as significant prognostic factors for local control and survival. The surgical/medical complication rates were 14.3% and 19.0%. The most common complication after SRS was acute pain flare. Rate of hardware failure was 6.3%. A total of 3 patients developed procedure-related neurological deficits, but there were no cases of radiation myelopathy. There were no differences in local control with anterior column reconstruction. CONCLUSION SRS is effective following all types of surgery for metastases, not just separation surgery. SRS should be considered in the postoperative management for spinal metastases given low complications and high local control rate (∼87%) irrespective of histology.

scholarly journals Biportal endoscopic posterior lumbar decompression and vertebroplasty for extremely elderly patients affected by lower lumbar delayed vertebral collapse with lumbosacral radiculopathy

2021 ◽  
Vol 16 (1) ◽  
Author(s):  
Min-Seok Kang ◽  
Dong-Hwa Heo ◽  
Hoon-Jae Chung ◽  
Ki-Han You ◽  
Hyong-Nyun Kim ◽  
...  
Keyword(s):  
Elderly Patients ◽  
Clinical Outcomes ◽  
Anterior Column ◽  
Vertebral Collapse ◽  
Lumbosacral Radiculopathy ◽  
Vas Score ◽  
Lower Lumbar ◽  
Anterior Column Reconstruction ◽  
Cleft Formation

Abstract Background Lower lumbar osteoporotic vertebral compression fracture in extremely elderly patients can often lead to lumbosacral radiculopathy (LSR) due to delayed vertebral collapse (DVC). Surgical intervention requires posterior instrumented lumbar fusion as well as vertebral augmentation or anterior column reconstruction depending on the cleft formation and intravertebral instability. However, it is necessary to decide on surgery in consideration of the patient’s frail status, surgical invasiveness, and rehabilitation. In the lower lumbar DVC without intravertebral instability, biportal endoscopic posterior lumbar decompression and vertebroplasty (BEPLD + VP) can be simultaneously attempted. This study aimed to assess the clinical outcomes of BEPLD + VP for the treatment of DVC-related LSR. Methods This retrospective case series enrolled 18 consecutive extremely elderly (aged ≥ 75-year-old) patients (6 men and 12 women) who had lower lumbar (at or below L3) DVC-related LSR. Patients who require anterior column reconstruction, such as cleft formation accompanied by intravertebral instability and patients who have not been followed for more than 6 months, were excluded from this study. All patients underwent BEPLD + VP under epidural anesthesia. Clinical results were evaluated by the visual analog scale (VAS) score and the modified Japanese Orthopedic Association (mJOA) scores. Results Most of the patients had DVC affecting level L4, with the deformation being a flat type or concave type rather than a wedge type. The VAS score (back and leg) significantly decreased from 7.78 ± 1.17 and 6.89 ± 1.13 preoperatively to 2.94 ± 0.64 and 2.67 ± 1.08 within 2 postoperative days (p < 0.001). The mJOA score significantly improved from 4.72 ± 1.27 preoperatively to 8.17 ± 1.15 in the final follow-up (p < 0.001). The mean recovery rate (RR) in the last follow-up was 56.07% ± 9.98. Incidental durotomy was reported in two patients and epidural hematomas in another two patients; however, all patients improved with conservative treatment, and no re-operation was required. Conclusions BELPD + VP was a type of salvage therapy that reduces surgical morbidity, requires major spine surgery under general anesthesia and provides good clinical outcomes in extremely elderly patients with DVC-related LSR.

scholarly journals Biportal endoscopic posterior lumbar decompression and vertebroplasty for extremely elderly patients affected by lower lumbar delayed vertebral collapse with lumbosacral radiculopathy

2021 ◽  
Author(s):  
Min-Seok Kang ◽  
Dong-Hwa Heo ◽  
Hoon-Jae Chung ◽  
Ki-Han You ◽  
Hyong-Nyun Kim ◽  
...  
Keyword(s):  
Elderly Patients ◽  
Clinical Outcomes ◽  
Clinical Results ◽  
Anterior Column ◽  
Vertebral Collapse ◽  
Lumbosacral Radiculopathy ◽  
Lower Lumbar ◽  
Anterior Column Reconstruction ◽  
Cleft Formation

Abstract Background: Lower lumbar osteoporotic vertebral compression fracture in extremely elderly patients can often lead to lumbosacral radiculopathy (LSR) due to delayed vertebral collapse (DVC). Surgical intervention requires posterior instrumented lumbar fusion as well as vertebral augmentation or anterior column reconstruction depending on the cleft formation and intravertebral instability. However, it is necessary to decide surgery in consideration of the patient’s frail status, surgical invasiveness, and rehabilitation. In the lower lumbar DVC without intravertebral instability, biportal endoscopic posterior lumbar decompression and vertebroplasty (BEPLD+VP) can be simultaneously attempted. In particular, in high-risk elderly patients, BEPLD+VP can be performed under regional anesthesia, can reduce the need for spinal fusion, and can provide good clinical results such as rapid functional recovery. This study aimed to assess clinical outcomes of BEPLD+VP for the treatment of DVC-related LSR. Methods: This retrospective case series enrolled 18 consecutive extremely elderly (aged ≥ 75-year-old) patients (6 men and 12 women) who had lower lumbar (at or below L3) DVC-related LSR. Patients who require anterior column reconstruction, such as cleft formation accompanied by intravertebral instability, and patients who have not been followed for more than 6 months were excluded from this study. All patients underwent BEPLD+VP under epidural anesthesia. Clinical results were evaluated by the visual analog scale (VAS) score and the modified Japanese Orthopedic Association (mJOA) scores. Results: Most of the patients had DVC affecting level L4, with the deformation being flat type or concave type rather than wedge type. The VAS score decreased from 8.1 preoperatively to 3.1 postoperatively (p<0.001). The mJOA score significantly improved from 4.72 ± 1.27 preoperatively to 8.17 ± 1.15 in the final follow-up (p<0.001). The mean RR in the last follow-up was 56.07% ± 9.98. Incidental durotomy was reported in two patients and epidural hematomas in another two patients; however, all patients improved with conservative treatment and no re-operation was required.Conclusions: BELPD+VP was a type of salvage therapy that reduces surgical morbidity, requires major spine surgery under general anesthesia, and provides good clinical outcomes in extremely elderly patients with DVC-related LSR.

Punch Grafting for the Management of Hard-to-Heal Diabetic Foot Ulcers: A Prospective Case Series

2021 ◽  
pp. 153473462110310
Author(s):  
Marta García-Madrid ◽  
Irene Sanz-Corbalán ◽  
Aroa Tardáguila-García ◽  
Raúl J. Molines-Barroso ◽  
Mateo López-Moral ◽  
...  
Keyword(s):  
Wound Healing ◽  
Clinical Outcomes ◽  
Diabetic Foot ◽  
Donor Site ◽  
Case Series ◽  
Foot Ulcers ◽  
Diabetic Foot Ulcers ◽  
Wound Debridement ◽  
Prospective Case Series

Punch grafting is an alternative treatment to enhance wound healing which has been associated with promising clinical outcomes in various leg and foot wound types. We aimed to evaluate the clinical outcomes of punch grafting as a treatment for hard-to-heal diabetic foot ulcers (DFUs). Six patients with chronic neuropathic or neuroischemic DFUs with more than 6 months of evolution not responding to conventional treatment were included in a prospective case series between May 2017 and December 2020. All patients were previously debrided using an ultrasound-assisted wound debridement and then, grafted with 4 to 6 mm punch from the donor site that was in all cases the anterolateral aspect of the thigh. All patients were followed up weekly until wound healing. Four (66.7%) DFUs were located in the heel, 1 (16.7%) in the dorsal aspect of the foot and 1 (16.7%) in the Achilles tendon. The median evolution time was 172 (interquartile range [IQR], 25th-75th; 44-276) weeks with a median area of 5.9 (IQR; 1.87-37.12) cm2 before grafting. Complete epithelization was achieved in 3 (50%) patients at 12 weeks follow-up period with a mean time of 5.67 ± 2.88 weeks. Two of the remaining patients achieved wound healing at 32 and 24 weeks, respectively, and 1 patient showed punch graft unsuccessful in adhering. The median time of wound healing of all patients included in the study was 9.00 (IQR; 4.00-28.00) weeks. The wound area reduction (WAR) at 4 weeks was 38.66% and WAR at 12 weeks was 88.56%. No adverse effects related to the ulcer were registered through the follow-up period. Autologous punch graft is an easy procedure that promotes healing, achieving wound closure in chronic DFUs representing an alternative of treatment for hard-to-heal DFUs in which conservative treatment has been unsuccessful.

Outcomes and Prognostic Factors for a Consecutive Case Series of 115 Patients with Somatic Leiomyosarcoma

2012 ◽  
Vol 94 (8) ◽  
pp. 736-744 ◽  
Author(s):  
John A Abraham ◽  
Michael J Weaver ◽  
Jason L Hornick ◽  
David Zurakowski ◽  
John E Ready
Keyword(s):  
Prognostic Factors ◽  
Case Series ◽  
Consecutive Case
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