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Timilsina K, Shrestha S, Bhatta OP, Paudel S, Lakhey RB, Pokharel RK. Atypical Aggressive Hemangioma of Thoracic Vertebrae Associated With Thoracic Myelopathy-A Case Report and Review of the Literature. Case Rep Orthop 2024; 2024:2307950. [PMID: 39165484 PMCID: PMC11335424 DOI: 10.1155/2024/2307950] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2024] [Revised: 07/05/2024] [Accepted: 08/02/2024] [Indexed: 08/22/2024] Open
Abstract
Aggressive thoracic hemangiomas are rare, benign tumors that extend into the spinal canal and cause neurological symptoms. Delayed diagnosis and treatment, due to a paucity of literature on optimal treatment strategies, can increase morbidity. This case report describes a 19-year-old male patient with aggressive thoracic hemangioma who presented with upper back pain and progressive weakness of the lower extremities. The patient underwent preoperative embolization and sclerotherapy, followed by decompression, posterior instrumentation, and stabilization. The final diagnosis was confirmed by biopsy, and there was a significant improvement in neurology after the surgical intervention. The diagnosis of rare lesions, such as aggressive hemangiomas, requires a high level of clinical suspicion and the assistance of imaging modalities in patients with features of compressive myelopathy. A combination of endovascular and surgical approaches can lead to optimal outcomes.
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Affiliation(s)
| | - Sandesh Shrestha
- Department of Orthopaedics and Trauma SurgeryTribhuvan University Teaching Hospital, Kathmandu, Nepal
| | | | - Sushil Paudel
- Department of Orthopaedics and Trauma SurgeryTribhuvan University Teaching Hospital, Kathmandu, Nepal
| | - Rajesh Bahadur Lakhey
- Department of Orthopaedics and Trauma SurgeryTribhuvan University Teaching Hospital, Kathmandu, Nepal
| | - Rohit Kumar Pokharel
- Department of Orthopaedics and Trauma SurgeryTribhuvan University Teaching Hospital, Kathmandu, Nepal
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Lofrese G, Cultrera F, Ricciardi L, Visani J, Tosatto L, Ruggiero M, Haznedari N, Menetti F. Preoperative elastoplasty of aggressive vertebral hemangiomas in elderly patients: a new strategy for reducing intraoperative bleeding and complications. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2024; 33:1921-1929. [PMID: 38491218 DOI: 10.1007/s00586-024-08201-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/26/2023] [Revised: 02/18/2024] [Accepted: 02/21/2024] [Indexed: 03/18/2024]
Abstract
PURPOSE Preoperative elastoplasty could be an alternative strategy for treating aggressive vertebral hemangiomas (VHs) in frail patients needing for spinal cord decompression, combining the advantages of embolization and vertebroplasty. METHODS Three elderly patients with spinal cord compression from thoracic aggressive VHs underwent XperCT-guided percutaneous injection of silicone (VK100), filling the whole affected vertebra, followed by a decompressive laminectomy. At 12-months follow-up no recurrences, vertebral collapse or segmental kyphosis were noted at the CT scans, with patients reporting an improvement of preoperative neurological deficits, VAS and Smiley-Webster pain scale (SWPS) parameters. RESULTS With its elastic modulus, non-exothermic hardening, and lower viscosity than PMMA, VK100 allowed a preoperative augmentation of the affected vertebral body, pedicles, and laminae without complications, with a controlled silicone delivery even in part of VH's epidural components thanks to XperCT-guidance. CONCLUSION When facing highly bony erosive VH encroaching the spinal canal, VK100 combines the advantages of embolization and vertebroplasty especially in elderly patients, permeating the whole VH's angioarchitecture, significantly reducing tumor.
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Affiliation(s)
- Giorgio Lofrese
- Neurosurgery Division, "M. Bufalini" Hospital, Viale Ghirotti 286, 47521, Cesena, Italy
| | - Francesco Cultrera
- Neurosurgery Division, "M. Bufalini" Hospital, Viale Ghirotti 286, 47521, Cesena, Italy
| | - Luca Ricciardi
- Neurosurgery Division, Sapienza University, Via di Grottarossa 1035, Rome, Italy.
| | - Jacopo Visani
- Neurosurgery Division, "M. Bufalini" Hospital, Viale Ghirotti 286, 47521, Cesena, Italy
| | - Luigino Tosatto
- Neurosurgery Division, "M. Bufalini" Hospital, Viale Ghirotti 286, 47521, Cesena, Italy
| | - Maria Ruggiero
- Neuroradiology Division, "M. Bufalini" Hospital, Viale Ghirotti 286, 47521, Cesena, Italy
| | - Nicolò Haznedari
- Neuroradiology Division, "M. Bufalini" Hospital, Viale Ghirotti 286, 47521, Cesena, Italy
| | - Federico Menetti
- Neuroradiology Division, "M. Bufalini" Hospital, Viale Ghirotti 286, 47521, Cesena, Italy
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Mousavi SR, Akbari S, Rasekhi A, Kazeminezhad A, Motlagh MAS, Taherpour S. A less aggressive approach to the treatment of aggressive vertebral hemangioma of the thoracic spine: A case report and literature review. Int J Surg Case Rep 2023; 105:108027. [PMID: 36965444 PMCID: PMC10073888 DOI: 10.1016/j.ijscr.2023.108027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2022] [Revised: 02/07/2023] [Accepted: 03/21/2023] [Indexed: 03/27/2023] Open
Abstract
BACKGROUND Different treatments are available for aggressive vertebral hemangioma [AVH], but a consensus is yet to be reached about the best therapeutic approach. PURPOSE To explore the possibility that selecting a less aggressive therapeutic approach for AVH decreases the intraoperative and postoperative complications while providing similar clinical, radiographic, and disease-free survival results to more aggressive therapeutic methods. STUDY We report the case of an AVH of the thoracic spine at the T5 level, treated via perioperative selective arterial embolization plus surgical decompression via laminectomy and reconstruction with polymethylmethacrylate (PMMA) vertebroplasty. PATIENT The patient was a 17-year-old male referred to our center with the chief complaint of low back pain from two months earlier, without any response to analgesics, and with neurologic manifestations as paraparesis (one month) and progressive sphincter problems (one week). Upon imaging, the impression was an aggressive spinal tumor with cord compression. OUTCOME MEASURES After the operation, the patient's pain immediately improved, and his neurologic manifestations progressively improved. RESULTS The patient started walking with help about three weeks after the operation. Roughly six months later, he achieved a complete neurological recovery. At present, about two years following the operation, he has a normal life without any neurological problems. CONCLUSION Based on our experience with AVH, the selection of less aggressive therapeutic approaches such as perioperative diagnostic angiography and selective embolization decrease the intraoperative and postoperative complications like intraoperative bleeding and neurological injury, while achieving similar clinical, radiographic, and disease-free survival outcomes to more aggressive therapeutic methods.
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Affiliation(s)
- Seyed Reza Mousavi
- Department of Neurosurgery, Shiraz University of medical science, Shiraz, Iran; Shiraz Neuroscience Research Center, Shiraz University of medical science, Shiraz, Iran
| | - Somayeh Akbari
- Histomorphometry and Stereology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Alireza Rasekhi
- Department of Radiology, Shiraz University of medical science, Shiraz, Iran
| | - Ali Kazeminezhad
- Department of Neurosurgery, Peymanieh Hospital, Trauma Research Center, Jahrom University, Iran
| | | | - Sanaz Taherpour
- Department of Neurosurgery, Shiraz University of medical science, Shiraz, Iran.
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Fusini F, Rava A, Zanchini F, Pola E, Nasto LA, Cipolloni V, Gargiulo G, Coniglio A, Massè A, Massimo G. Is vertebral stenting kyphoplasty a good choice in the treatment of osteoporotic vertebral fracture? A series of 47 patients (v2). Orthop Rev (Pavia) 2022; 14:56174. [PMID: 36589512 PMCID: PMC9797016 DOI: 10.52965/001c.56174] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/05/2022] Open
Abstract
Background The incidence of vertebral fragility fracture is increasing over last three decades with an essential impact on quality of life. Some devices were proposed to improve conventional kyphoplasty in the last five years, known as vertebral stenting kyphoplasty (VSK). Materials and Methods All osteoporotic vertebral fractures (OVF) treated with VSK, single-level fracture without neurological impairment, and with more than 24 months of follow-up were included in the study. We recorded fracture types according to DGOU classification, fracture level, regional kyphosis angle (RKA), Oswestry disability index (ODI), and complications. Results Forty-seven consecutive patients were included. RKA significantly improved from pre to postoperative values (p<0.000001) and to follow-up values (p<0.00001). A significant difference was found between preoperative RKA of (OF2+OF3) and OF4 (p<0.00001), confirmed immediately after surgery (p= 0.005425) and at last follow up (p= 0.000947). A significant difference was found in correction of RKA between (OF2+OF3) and OF4 at injury time and after treatment (p<0.00001), and it was confirmed at the last follow-up (p=0.000026). ODI showed a significant difference between (OF2+OF3) and OF4 type of fractures (p=0.038216). We recorded five complications: 2 cases of leakage without neurological impairment, two progressions of kyphosis, and one implant migration. Conclusions VSK is an excellent and reliable option in the treatment of OVF, with good clinical results and preservation of obtained RKA at the time of treatment. However, in case of vertebral collapse with the involvement of both vertebral plates, surgeons must be aware of possible implant failure or migration. Level of Evidence 4.
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Affiliation(s)
- Federico Fusini
- Department of Orthopaedic and TraumatologyRegina Montis Regalis Hospital, ASL CN1, Strada S. Rocchetto 99, 12084, Mondovì (CN), Italy
| | - Alessandro Rava
- Department of Orthopaedic and Traumatology, Spine Surgery Unit, Spine Surgery Unit, Orthopaedic and Trauma CentreCittà della Salute e della Scienza di Torino, via Zuretti 29, 10131 Turin, Italy
| | - Fabio Zanchini
- Clinical OrthopaedicsUniversity of Campania “Luigi Vanvitelli”, via L. de Crecchio 4, 80138, Naples, Italy
| | - Enrico Pola
- Clinical OrthopaedicsUniversity of Campania “Luigi Vanvitelli”, via L. de Crecchio 4, 80138, Naples, Italy
| | - Luigi Aurelio Nasto
- Clinical OrthopaedicsUniversity of Campania “Luigi Vanvitelli”, via L. de Crecchio 4, 80138, Naples, Italy
| | - Valerio Cipolloni
- Spine Division, Department of Orthopaedics and TraumatologyA. Gemelli IRCCS University Hospital, Catholic University of Rome, Largo Francesco Vito 1, 00168, Rome, Italy
| | - Giosuè Gargiulo
- Department of Orthopaedic and Traumatology, Spine Surgery Unit, Spine Surgery Unit, Orthopaedic and Trauma CentreCittà della Salute e della Scienza di Torino, via Zuretti 29, 10131 Turin, Italy
| | - Angela Coniglio
- Department of Orthopaedic and Traumatology, Spine Surgery Unit, Spine Surgery Unit, Orthopaedic and Trauma CentreCittà della Salute e della Scienza di Torino, via Zuretti 29, 10131 Turin, Italy
| | - Alessandro Massè
- Department of Orthopaedic and TraumatologyOrthopaedic and Trauma Centre, Città della Salute e della Scienza di Torino, University of Turin, via Zuretti 29, 10131 Turin, Italy
| | - Girardo Massimo
- Department of Orthopaedic and Traumatology, Spine Surgery Unit, Spine Surgery Unit, Orthopaedic and Trauma CentreCittà della Salute e della Scienza di Torino, via Zuretti 29, 10131 Turin, Italy
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Miszczyk M, Napieralska A, Woźniak G, Kraszkiewicz M, Gola M, Kalemba M, Głowacki G, Tomasik B, Kocot-Kępska M, Miszczyk L. Conventionally fractionated radiotherapy versus CyberKnife hypofractionated radiotherapy for painful vertebral haemangiomas - A randomized clinical trial. Radiother Oncol 2022; 176:46-52. [PMID: 36184997 DOI: 10.1016/j.radonc.2022.09.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Revised: 09/09/2022] [Accepted: 09/11/2022] [Indexed: 12/14/2022]
Abstract
BACKGROUND AND PURPOSE The outcomes of conventional radiotherapy for painful vertebral haemangiomas have been improved through dose escalation at the expense of overall treatment time. We hypothesized that with the aid of precise hypofractionated radiotherapy, it is possible to safely deliver a similar biological equivalent dose over a significantly shorter course of treatment with a comparable efficacy and safety. MATERIALS AND METHODS In this prospective, single-institution unblinded randomized clinical trial (NCT02332408) patients with painful vertebral haemangiomas were allocated one-to-one either to 25 Gy delivered in five fractions (CK) or conventionally fractionated radiotherapy up to 36 Gy (conv.). The main endpoint was pain relief at two years, measured on a subjective and numerical scale (NRS). RESULTS The trial was finished yielding 74 evaluable patients, including 38 in the CK arm. Adverse events were infrequent and the treatment was well tolerated. The overall treatment time was significantly shorter in the CK arm (median of 13 days vs 25 days). At two years, more than half of the patients reported improvement (46; 62.2 %) , in 21 cases the pain symptoms were stable (28.4 %), and in seven cases worse (9.5 %). There were significantly more patients reporting improvement in the CK arm (73.7 % vs 50 %; p = 0.036). The median decrease in NRS was 4 (IQR 1-5) or 59 % (IQR 20-86 %), and the difference between arms was not statistically significant. CONCLUSION Five fractions hypofractionated radiotherapy for painful vertebral haemangiomas up to a total dose of 25 Gy is a safe treatment modality, significantly shorter compared to conventional fractionation, and possibly more effective.
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Affiliation(s)
- Marcin Miszczyk
- III(rd) Radiotherapy and Chemotherapy Department, M. Sklodowska-Curie National Research Institute of Oncology, Gliwice Branch, Gliwice, Poland.
| | - Aleksandra Napieralska
- Radiotherapy Department, M. Sklodowska-Curie National Research Institute of Oncology, Gliwice Branch, Gliwice, Poland
| | - Grzegorz Woźniak
- Radiotherapy Department, M. Sklodowska-Curie National Research Institute of Oncology, Gliwice Branch, Gliwice, Poland
| | - Małgorzata Kraszkiewicz
- Radiotherapy Department, M. Sklodowska-Curie National Research Institute of Oncology, Gliwice Branch, Gliwice, Poland
| | - Michał Gola
- Radiology and Diagnostic Imaging Department, M. Sklodowska-Curie National Research Institute of Oncology, Gliwice Branch, Gliwice, Poland
| | - Michał Kalemba
- Department of Nuclear Medicine and Endocrine Oncology, M. Sklodowska-Curie National Research Institute of Oncology, Gliwice Branch, Gliwice, Poland
| | - Grzegorz Głowacki
- Radiotherapy Department, M. Sklodowska-Curie National Research Institute of Oncology, Gliwice Branch, Gliwice, Poland
| | - Bartłomiej Tomasik
- Department of Oncology and Radiotherapy, Faculty of Medicine, Medical University of Gdańsk, Poland
| | - Magdalena Kocot-Kępska
- Department of Pain Research and Treatment, Jagiellonian University Medical College, Krakow, Poland
| | - Leszek Miszczyk
- III(rd) Radiotherapy and Chemotherapy Department, M. Sklodowska-Curie National Research Institute of Oncology, Gliwice Branch, Gliwice, Poland
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Xu D, Kong M, Zhu K, Han X, Zhang W, Zeng X, Zhou C, Ma X. Clinical evaluation of preoperative embolization, vertebroplasty, and decompression in the treatment of aggressive vertebral hemangiomas. J Orthop Surg (Hong Kong) 2021; 29:2309499021993997. [PMID: 33641539 DOI: 10.1177/2309499021993997] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
OBJECTIVE To evaluate the efficacy and safety of preoperative embolization and vertebroplasty in the treatment of aggressive hemangioma. METHODS A retrospective clinical review of patients diagnosed with aggressive vertebral hemangiomas was conducted. All the patients were assigned to three groups according to the treatment strategies: patients in Group A underwent embolization and decompression with internal fixation, patients in Group B underwent vertebroplasty and decompression with internal fixation, patients in Group C received all three treatments. Clinical indexes were compared within three groups. RESULTS There were 16 patients received embolization and decompression (Group A), 19 patients underwent decompression with vertebroplasty (Group B) and 16 patients in Group C. The operative duration of patients in group A (198.33 ± 38.43 min) were less than another two groups (p = 0.001). The intraoperative blood loss of patients in group C was 713.33 ± 165.13 mL, which was significantly less than group A and group B (p = 0.045). Patients in group C exhibited the lowest volume of drainage on POD 1 (178.33 ± 66.76 mL), which showed significant difference compared with group A (368.33 ± 191.15 mL, p = 0.01). There was no significant difference of preoperative and postoperative VAS and JOA score among three groups, as well as drainage on POD 2, total volume and hospital duration. CONCLUSION Both embolization and vertebroplasty are efficient and safe measures to reduce blood loss in the surgical treatment of aggressive vertebral hemangiomas, combination of all three methods is also competent.
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Affiliation(s)
- Derong Xu
- Department of Spine Surgery, 235960The Affiliated Hospital of Qingdao University, Qingdao, Shandong Province, China.,Derong Xu and Meng Kong are co-first authors
| | - Meng Kong
- Department of Spine Surgery, 235960The Affiliated Hospital of Qingdao University, Qingdao, Shandong Province, China.,Derong Xu and Meng Kong are co-first authors
| | - Kai Zhu
- Department of Spine Surgery, 235960The Affiliated Hospital of Qingdao University, Qingdao, Shandong Province, China
| | - Xing Han
- Department of Spine Surgery, 235960The Affiliated Hospital of Qingdao University, Qingdao, Shandong Province, China
| | - Wenwei Zhang
- Department of Spine Surgery, 235960The Affiliated Hospital of Qingdao University, Qingdao, Shandong Province, China
| | - Xiangxu Zeng
- Department of Spine Surgery, 235960The Affiliated Hospital of Qingdao University, Qingdao, Shandong Province, China
| | - Chuanli Zhou
- Department of Spine Surgery, 235960The Affiliated Hospital of Qingdao University, Qingdao, Shandong Province, China
| | - Xuexiao Ma
- Department of Spine Surgery, 235960The Affiliated Hospital of Qingdao University, Qingdao, Shandong Province, China
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Marton N, Ramos-Oliver I, Cajal AG, de Albert M, Dominguez Oronoz R. Transarticular epithelioid hemangioma of the ankle-a case of a rare vascular neoplasm. Skeletal Radiol 2021; 50:1263-1270. [PMID: 33420574 DOI: 10.1007/s00256-020-03687-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2020] [Revised: 11/24/2020] [Accepted: 11/29/2020] [Indexed: 02/02/2023]
Abstract
Epithelioid hemangioma of the bone is a rare kind of vascular neoplasm posing a diagnostic challenge because of its ability to mimic malignant tumors. We report a case of a fast-growing, talofibular joint-involving epithelioid hemangioma, which was suspectedly initiated by vascular damage due to trauma and arthroscopy. The ankle mass appeared as a lytic lesion on the CT images and as a T1 hypo-, T2 mildly hyperintense, lobulated structure on the MRI scans. The contrast enhancement pattern was typical to vascular neoplasms. Histologically the lesion consisted of well-formed vessels lined with epithelioid cells with a slightly atypical nuclear morphology, inflammation with a significant number of eosinophils, and low mitotic rate. Immunohistochemistry analysis showed the presence of vascular markers but no rearrangements characteristic of soft tissue sarcomas were registered by the next-generation sequencing. The surgical treatment was curative. The report presents current imaging methods and summarizes the imaging findings of transarticular spreading tumors. The paper also highlights that for the differential diagnosis of vascular tumors showing signs of aggressivity, the pathological analysis is inevitable. Correct diagnosis of the epithelioid hemangioma is essential, as the treatment of more malignant entities is substantially different. An added value of the report is that to the best of our knowledge, a transarticular spreading epithelioid hemangioma of the ankle has never been described before.
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Affiliation(s)
- Nikolett Marton
- Department of Radiology, Jahn Ferenc Hospital, 1 Koves ut, Budapest, H-1204, Hungary. .,Experimental Rheumatology Research Group, Semmelweis University, Budapest, Hungary.
| | | | | | - Matías de Albert
- Department of Radiology, Vall d'Hebron Hospital, Barcelona, Spain
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Fusini F, Colò G, Risitano S, Massè A, Rossi L, Coniglio A, Girardo M. Back to the future in traumatic fracture shapes of lumbar spine: An analysis of risk of kyphosis after conservative treatment. JOURNAL OF CRANIOVERTEBRAL JUNCTION AND SPINE 2021; 12:38-43. [PMID: 33850380 PMCID: PMC8035588 DOI: 10.4103/jcvjs.jcvjs_189_20] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2020] [Accepted: 11/13/2020] [Indexed: 01/20/2023] Open
Abstract
Introduction: Nonosteoporotic burst vertebral fracture could commonly be treated with conservative or surgical approach. Currently, decision-making process is based on thoracolumbar (TL) AO spine severity injury score. However, some factors could affect posttraumatic kyphosis (PTK) and could be taken into account. The aim of the present study is to identify if axial and sagittal fracture shape and initial kyphosis are the risk factors for PTK. Materials and Methods: All consecutive patients treated between 2016 and 2017 for TL vertebral fracture with conservative treatment were retrospectively evaluated in the study. Only type A3 and A4 vertebral fractures were included in the study. Patients suffering from osteoporosis or other metabolic bone disease, aged above 60 years old were excluded from the study. Initial and 6 months X-ray from injury were analyze to evaluate local kyphosis and region of injury while initial assessment was performed with computed tomography to better identify fracture type and in some cases magnetic resonance imaging to exclude posterior ligament complex injury. Axial and sagittal view of the vertebral plate was analyzed and classified in three shapes according to fragment comminution and dislocation. Statistical analysis was performed trough STATA13 software. Student's t-test was used to evaluate the differences between initial and follow up kyphosis; odds ratio (OR) was used to evaluate the role of initial kyphosis, vertebral sagittal and axial fracture shape as a risk factor for PTK. Kruskal–Wallis test was used to assess the differences among vertebral shape fractures and final kyphosis. Fisher's exact test was used to assess the differences between fracture patterns and final kyphosis. Results: An initial kyphosis >10° (OR 36.75 P = 0.015), shape c vertebral plate (OR 147 P = 0.0015), and sagittal shape 3 (OR 32.25 P = 0.0025) are strongly related with PTK. Kruskal–Wallis test revealed a statistically significant difference among axial fracture shape (P < 0.0001) and sagittal fracture shape (P = 0.004) and also for initial kyphosis >10° (P < 0.0001). Fisher's exact test showed a significant difference for final kyphosis among pattern c3 and other patterns of fracture (P = 0.0001). Conclusions: A burst type lumbar vertebral fracture affecting a patient with initial local kyphosis >10° and comminution and displacement of vertebral plate and vertebral body is at high risk to develop a local kyphosis >20° in the follow-up if treated conservatively.
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Affiliation(s)
- Federico Fusini
- Department of Orthopaedic and Traumatology, Regina Montis Regalis Hospital, Cuneo, Italy
| | - Gabriele Colò
- Department of Orthopaedics and Traumatology, Regional Center for Joint Arthroplasty, Alessandria, Italy
| | - Salvatore Risitano
- Department of Orthopaedic and Traumatology, Maggiore Hospital of Chieri, Turin, Italy
| | - Alessandro Massè
- Department of Orthopaedic and Traumatology, Orthopaedic and Traumatology Hospital, AOU Città della Salute e della Scienza di Torino, Torino, Italy
| | - Laura Rossi
- Division of Orthopedic Oncologic Surgery, Orthopaedic and Traumatology Center, AOU Città della Salute e della Scienza di Torino, Turin, Italy
| | - Angela Coniglio
- Department of Orthopaedic and Traumatology, Spine Surgery Unit, Orthopaedic and Traumatology Hospital, AOU Città della Salute e della Scienza di Torino, Torino, Italy
| | - Massimo Girardo
- Department of Orthopaedic and Traumatology, Spine Surgery Unit, Orthopaedic and Traumatology Hospital, AOU Città della Salute e della Scienza di Torino, Torino, Italy
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Coniglio A, Rava A, Fusini F, Colò G, Massè A, Girardo M. Effectiveness and reliability of cannulated fenestrated screws augmented with polymethylmethacrylate cement in the surgical treatment of osteoporotic vertebral fractures. JOURNAL OF CRANIOVERTEBRAL JUNCTION AND SPINE 2021; 12:33-37. [PMID: 33850379 PMCID: PMC8035586 DOI: 10.4103/jcvjs.jcvjs_188_20] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2020] [Accepted: 11/04/2020] [Indexed: 12/11/2022] Open
Abstract
Background Implants' stability, especially in osteoporosis patients, is a challenging matter. Nowadays, the adoption of cannulated fenestrated screws augmented with polymethylmethacrylate cement (PMMA CSF) is described by some authors. This single-center, retrospective observational study aims to evaluate the long-term effectiveness, reliability, and mechanical performances of this type of screws in osteoporotic fractures. Materials and Methods All the patients surgically treated from January 2009 to December 2019 with PMMA CSF were evaluated and submitted to the inclusion and exclusion criteria. Clinical and radiological evaluations were performed at pre- and post-surgery time and at the follow-up (FU). Loss of correction in the sagittal plane (bisegmental Cobb angle), kyphosis angle of the fracture (fractured vertebral angle), loosening of pedicle screws (screw's apex vertebral body's anterior cortex mean gap called SAAC gap and screw's apex vertebral body's superior endplate mean gap called SASE gap), visual analog scale, and Oswestry disability index scores were evaluated. Results One hundred and sixty-three patients (58 males and 105 females) aged over 65 years affected by vertebral osteoporotic fractures were included in the study. At FU, we do not found significant differences in radiological items in respect to the postoperative period. Only one case of loosening and 18 cases of cement leaking (without neurological impairments) were found. Clinical scores improvement was significant in the interval between preoperative and FU. Conclusions PMMA CSF seems to can guarantee good efficacy and effectiveness in the surgical treatment of vertebral fractures in osteoporosis.
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Affiliation(s)
- Angela Coniglio
- Department of Orthopaedic and Traumatology, Orthopaedic and Trauma Centre, Spine Surgery Unit, Città della Salute e della Scienza di Torino, Turin, Italy
| | - Alessandro Rava
- Department of Orthopaedic and Traumatology, Orthopaedic and Trauma Centre, Città della Salute e della Scienza di Torino, University of Turin, Turin, Italy
| | - Federico Fusini
- Department of Orthopaedic and Traumatology, Regina Montis Regalis Hospital, Mondovì, Italy
| | - Gabriele Colò
- Department of Orthopaedics and Traumatology, Regional Center for Joint Arthroplasty, Alessandria, Italy
| | - Alessandro Massè
- Department of Orthopaedic and Traumatology, Orthopaedic and Trauma Centre, Città della Salute e della Scienza di Torino, University of Turin, Turin, Italy
| | - Massimo Girardo
- Department of Orthopaedic and Traumatology, Orthopaedic and Trauma Centre, Spine Surgery Unit, Città della Salute e della Scienza di Torino, Turin, Italy
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Cinnella P, Amico S, Rava A, Cravino M, Gargiulo G, Girardo M. Surgical treatment of scoliosis in neurofibromatosis type I: A retrospective study on posterior-only correction with third-generation instrumentation. JOURNAL OF CRANIOVERTEBRAL JUNCTION AND SPINE 2020; 11:104-110. [PMID: 32904980 PMCID: PMC7462135 DOI: 10.4103/jcvjs.jcvjs_50_20] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2020] [Accepted: 05/02/2020] [Indexed: 01/05/2023] Open
Abstract
Background: Scoliosis is the most common orthopedic complication of neurofibromatosis type I. Scoliosis can be occurred with two patterns: dystrophic or idiopathic-like. In adolescence, in consideration of bone dystrophy, osteopenia, and often associated hyperkyphosis, most of the authors recommend an anterior-posterior approach. According to other authors, modern instrumentations could be sufficient to sustain a solid posterior arthrodesis. Materials and Methods: Ten patients were diagnosed with scoliosis in neurofibromatosis type I aged between 8 and 25 years, Cobb angle of the thoracic curve >45°, and minimum follow-up (FU) of 1 year and treated with posterior-only approach with third-generation high-density instrumentations. Radiographic measurements were performed on the coronal and sagittal planes. Nonparametric tests (Friedman test and Wilcoxon test) were applied to evaluate the reducibility of the preoperative curve (T0), the postoperative surgical correction (T1), and its maintenance on FU. Results: Statistics showed results compared to those evaluated in the literature with a combined approach regarding surgical correction and its maintenance on FU. On T1, a median correction of 53.5% of the scoliotic curve and of 33.7% of the thoracic hyperkyphosis was observed. On FU, the correction was maintained. A global improvement in balance was appreciated. The curves, despite rigid, showed a relative reducibility to bending tests and traction. No significant complications occurred. Conclusions: The posterior-only approach produces a satisfactory correction of the dystrophic neurofibromatosis scoliosis if associated with the use of high-density third-generation instrumentations. We are confident in recommending posterior-only approach in dystrophic neurofibromatosis scoliosis with coronal curves till 110° and coexisting thoracic kyphosis till 80°
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Affiliation(s)
- Pasquale Cinnella
- Spine Surgery Unit, Orthopaedic and Trauma Centre, Città della Salute e della Scienza di Torino, University of Turin, Italy
| | - Silvia Amico
- Department of Clinical and Molecular Sciences, School of Medicine, Università Politecnica delle Marche, Ancona, Italy
| | - Alessandro Rava
- Department of Orthopaedic and Traumatology, Orthopaedic and Trauma Centre, Città della Salute e della Scienza di Torino, University of Turin, Turin, Italy
| | - Mattia Cravino
- Department of Pediatric Orthopaedic, Regina Margherita Pediatric Hospital, Turin, Italy
| | - Giosuè Gargiulo
- Spine Surgery Unit, Orthopaedic and Trauma Centre, Città della Salute e della Scienza di Torino, University of Turin, Italy
| | - Massimo Girardo
- Spine Surgery Unit, Orthopaedic and Trauma Centre, Città della Salute e della Scienza di Torino, University of Turin, Italy
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Long-Term Outcomes of Excision Surgery for Aggressive Vertebral Hemangiomas. World Neurosurg 2020; 142:e474-e480. [PMID: 32688038 DOI: 10.1016/j.wneu.2020.07.077] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Accepted: 07/12/2020] [Indexed: 12/31/2022]
Abstract
OBJECTIVE We describe the clinical outcomes in patients with aggressive vertebral hemangiomas (AVHs) after total tumor excision and discuss the treatment options for AVHs. METHODS A retrospective data review of 15 patients (6 men, 9 women) with AVHs who underwent total excision between 1996 and 2018 was performed. RESULTS In total, 13 thoracic and 2 lumbar lesions were involved with 8 type A-D tumors and 7 type B-D tumors based on the Weinstein-Boriani-Biagini classification. All tumors showed low or low-iso signal intensity by T1-weighted magnetic resonance imaging. All patients received a combination of preoperative transarterial embolization and total tumor excision including the tumor margins. Eleven patients underwent total tumor excision as the initial surgery (total en bloc spondylectomy = 10 patients, piecemeal total tumor excision = 1 patient), and 4 underwent it as either a revision procedure 2 weeks after ineffective laminectomy or in the long-term follow-up (4-14 years) as a piecemeal total tumor excision. Intraoperative blood loss ranged from 150 to 3400 mL (mean, 1314 mL). None of the cases had a recurrence during the mean follow-up period of 128.4 ± 88.6 months. CONCLUSIONS Low signal intensity on T1-weighted magnetic resonance imaging was observed in all the patients with AVHs. The long-term clinical results of the preoperative transarterial embolization and total tumor excision were satisfactory. The effect of decompressive incomplete tumor excision is temporary for AVHs, and repeated tumor excision may be necessary because of tumor recurrence in the long term. Reliable total tumor excision during the initial surgery is desirable.
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Rava A, Dema E, Palmisani M, Palmisani R, Cervellati S, Girardo M. Sublaminar fixation versus hooks and pedicle screws in scoliosis surgery for Marfan syndrome. JOURNAL OF CRANIOVERTEBRAL JUNCTION AND SPINE 2020; 11:26-30. [PMID: 32549709 PMCID: PMC7274359 DOI: 10.4103/jcvjs.jcvjs_12_20] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2020] [Accepted: 03/02/2020] [Indexed: 01/18/2023] Open
Abstract
Background: In patients with Marfan syndrome (MFS), surgical correction of spinal deformities with hooks and/or pedicle screws involves a higher rate of complications than in patients with adolescent idiopathic scoliosis. Therefore, sublaminar instrumentation is often a last resort option. This study wants to assess the ability of sublaminar fixation to achieve three-dimensional scoliosis correction and spine stabilization compared with hook and/or pedicle screw systems. Methods: Twenty-one MFS patients who underwent posterior spinal fusion at a highly specialized medical center in 1995–2017 were divided into two different groups retrospectively evaluated at a minimum follow-up of 2 years. Group 1 (8 patients) was composed by hooks and screws instrumentation, while Group 2 (13 patients) was composed by hook or pedicle screw system associated to sublaminar wires/bands. Radiological (correction and long-term stability) and general endpoints (mean blood loss, surgery time, and complications) were compared between the groups. Results: The degree of correction compared with the preoperative status was satisfactory with both approaches, although the difference between them was not significant. No significant differences were found for general endpoints between groups. Conclusion: Our data suggest that scoliosis correction with sublaminar fixation is not inferior to treatment with hooks and/or pedicle screws. Level of Evidence: III.
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Affiliation(s)
- Alessandro Rava
- Department of Orthopaedic and Traumatology, Orthopaedic and Trauma Centre, Cittá della Salute e della Scienza, University of Turin, Turin, Italy
| | - Eugenio Dema
- Scoliosis and Spinal Surgery Centre, Hesperia Hospital, Modena, Italy
| | - Matteo Palmisani
- Scoliosis and Spinal Surgery Centre, Hesperia Hospital, Modena, Italy
| | - Rosa Palmisani
- Department of Clinical and Molecular Sciences, School of Medicine, Universitá Politecnica delle Marche, Ancona, Italy
| | | | - Massimo Girardo
- Department of Orthopaedic and Traumatology, Spine Surgery Unit, Orthopaedic and Trauma Centre, Cittá della Salute e della Scienza, Turin, Italy
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Cinnella P, Rava A, Mahagna AA, Fusini F, Masse A, Girardo M. Over 70° thoracic idiopathic scoliosis: Results with screws or hybrid constructs. JOURNAL OF CRANIOVERTEBRAL JUNCTION AND SPINE 2019; 10:108-113. [PMID: 31404131 PMCID: PMC6652256 DOI: 10.4103/jcvjs.jcvjs_39_19] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Adolescent idiopathic scoliosis is the most common type of scoliosis. High degrees curve can be treated with the anterior, posterior, or combined anterior-posterior approach. Contrarily to the anterior approach, the posterior one is widely used nowadays for its good correction outcomes and relatively low-complication rate. MATERIALS AND METHODS We evaluated retrospectively 27 patients, treated with posterior approach. Patients were divided into two groups, namely pedicle screws group (PSG) and hybrid group (pedicle screws + sublaminar bands). Radiographic measurements, including thoracic and lumbar Cobb° measurements of primary and secondary curves, coronal balance and sagittal balance, kyphosis and lordosis, curve flexibility, first and last vertebra included in the arthrodesis, and implant density were evaluated. Clinical patients' satisfaction was also evaluated with Scoliosis Research Society (SRS) 24 questionnaire. RESULTS Considering both groups, on preoperative X-rays, the average primary scoliotic curve angle was 83.56° ± 10.96° (range 70°-112°), whereas the global flexibility was 64° ± 7.63 (range 46°-72°). The curves were classified following the Lenke classification: 17 Type 1, 2 Type 2, and 8 Type 3. The primary curve resulted to be well corrected in both groups. In T0, the groups were homogeneous, but in T1 and follow-up, PSG stated a better mean value. No other significative differences can be found between groups for all other items (P > 0.05). Clinical results of SRS 24 were excellent in both groups. CONCLUSIONS The posterior approach proved to be an excellent technique for obtaining good clinical and radiographic results if the surgeon adopts the third-generation high-density implants. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Pasquale Cinnella
- Spine Surgery Unit, Orthopaedic and Trauma Centre, Città della Salute e della Scienza di Torino, University of Turin, Turin, Italy
| | - Alessandro Rava
- Department of Orthopaedic and Traumatology, Orthopaedic and Trauma Centre, Città della Salute e della Scienza di Torino, University of Turin, Turin, Italy
| | - Antonio Abed Mahagna
- Department of Orthopaedic and Traumatology, IRCCS Foundation, S. Matteo Hospital Institute, University of Pavia, Pavia, Italy
| | - Federico Fusini
- Department of Orthopaedic and Traumatology, Orthopaedic and Trauma Centre, Città della Salute e della Scienza di Torino, University of Turin, Turin, Italy
| | - Alessandro Masse
- Department of Orthopaedic and Traumatology, Orthopaedic and Trauma Centre, Città della Salute e della Scienza di Torino, University of Turin, Turin, Italy
| | - Massimo Girardo
- Spine Surgery Unit, Orthopaedic and Trauma Centre, Città della Salute e della Scienza di Torino, University of Turin, Turin, Italy
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