1
|
Papanastassiou ID, Tolis K, Savvidou O, Fandridis E, Papagelopoulos P, Spyridonos S. Ganglion Cysts of the Proximal Tibiofibular Joint: Low Risk of Recurrence After Total Cyst Excision. Clin Orthop Relat Res 2021; 479:534-542. [PMID: 32773431 PMCID: PMC7899497 DOI: 10.1097/corr.0000000000001329] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2019] [Accepted: 05/08/2020] [Indexed: 01/31/2023]
Abstract
BACKGROUND Peroneal nerve neuropathy due to compression from tumors or tumor-like lesions such as ganglion cysts is rare. Few case series have been published and reported local recurrence rates are high, while secondary procedures are frequently employed. QUESTIONS/PURPOSES (1) What are the demographics of patients with ganglion cysts of the proximal tibiofibular joint, and what proportion of them present with intraneural cysts and peroneal nerve palsy? (2) What Musculoskeletal Tumor Society (MSTS) scores do patients with this condition achieve after decompression surgery with removal of the ganglion cyst, but no arthrodesis of the tibiofibular joint? (3) What proportion of patients experience local recurrence after surgery? METHODS Between 2009 to 2018, 30 patients (29 primary cases) were treated for chronic peroneal palsy or neuropathy due to ganglion cysts of the proximal tibiofibular joint at two tertiary orthopaedic medical centers with total resection of the cystic lesion. MRI with contrast and electromyography (EMG) were performed preoperatively in all patients. The minimum follow-up for this series was 1 year (median 48 months, range 13 to 120); 14% (4 of 29) were lost to follow-up before that time. The MSTS score was recorded preoperatively, at 6 weeks postoperatively, and at most-recent follow-up. RESULTS A total of 90% of the patients were male (26 of 29 patients) and the median age was 67 years (range 20 to 76). In all, 17% (5 of 29) were treated due to intraneural ganglia. Twenty-eight percent (8 of 29) presented with complete peroneal palsy (foot drop). The mean MSTS score improved from 67 ± 12% before surgery to 89 ± 12% at 6 weeks postoperative (p < 0.001) and to 92 ± 9% at final follow up (p = 0.003, comparison with 6 weeks postop). All patients improved their scores. A total of 8% (2 of 25 patients) experienced local recurrence after surgery. CONCLUSION Ganglion cysts of the proximal tibiofibular joint occurred more often as extraneural lesions in older male patients in this small series. Total excision was associated with improved functional outcome and low risk of neurologic damage and local recurrence, and we did not use any more complex reconstructive procedures. Tendon transfers may be performed simultaneously in older patients to stabilize the ankle joint, while younger patients may recover after decompression alone, although larger randomized studies are needed to confirm our preliminary observations. LEVEL OF EVIDENCE Level IV, therapeutic study.
Collapse
Affiliation(s)
- Ioannis D Papanastassiou
- I. D. Papanastassiou, Orthopedic Department, General Oncological Hospital Kifisias "Agioi Anargyroi," Athens, Greece
- I. D. Papanastassiou, O. Savvidou, P. Papagelopoulos, First Department of Orthopaedics, National and Kapodistrian University of Athens, "ATTIKON" University General Hospital, Athens, Greece
- K. Tolis, E. Fandridis, S. Spyridonos, Hand, Upper Limb and Microsurgery Department, "KAT" General Hospital, Athens, Greece
| | - Konstantinos Tolis
- I. D. Papanastassiou, Orthopedic Department, General Oncological Hospital Kifisias "Agioi Anargyroi," Athens, Greece
- I. D. Papanastassiou, O. Savvidou, P. Papagelopoulos, First Department of Orthopaedics, National and Kapodistrian University of Athens, "ATTIKON" University General Hospital, Athens, Greece
- K. Tolis, E. Fandridis, S. Spyridonos, Hand, Upper Limb and Microsurgery Department, "KAT" General Hospital, Athens, Greece
| | - Olga Savvidou
- I. D. Papanastassiou, Orthopedic Department, General Oncological Hospital Kifisias "Agioi Anargyroi," Athens, Greece
- I. D. Papanastassiou, O. Savvidou, P. Papagelopoulos, First Department of Orthopaedics, National and Kapodistrian University of Athens, "ATTIKON" University General Hospital, Athens, Greece
- K. Tolis, E. Fandridis, S. Spyridonos, Hand, Upper Limb and Microsurgery Department, "KAT" General Hospital, Athens, Greece
| | - Emmanouil Fandridis
- I. D. Papanastassiou, Orthopedic Department, General Oncological Hospital Kifisias "Agioi Anargyroi," Athens, Greece
- I. D. Papanastassiou, O. Savvidou, P. Papagelopoulos, First Department of Orthopaedics, National and Kapodistrian University of Athens, "ATTIKON" University General Hospital, Athens, Greece
- K. Tolis, E. Fandridis, S. Spyridonos, Hand, Upper Limb and Microsurgery Department, "KAT" General Hospital, Athens, Greece
| | - Panayiotis Papagelopoulos
- I. D. Papanastassiou, Orthopedic Department, General Oncological Hospital Kifisias "Agioi Anargyroi," Athens, Greece
- I. D. Papanastassiou, O. Savvidou, P. Papagelopoulos, First Department of Orthopaedics, National and Kapodistrian University of Athens, "ATTIKON" University General Hospital, Athens, Greece
- K. Tolis, E. Fandridis, S. Spyridonos, Hand, Upper Limb and Microsurgery Department, "KAT" General Hospital, Athens, Greece
| | - Sarantis Spyridonos
- I. D. Papanastassiou, Orthopedic Department, General Oncological Hospital Kifisias "Agioi Anargyroi," Athens, Greece
- I. D. Papanastassiou, O. Savvidou, P. Papagelopoulos, First Department of Orthopaedics, National and Kapodistrian University of Athens, "ATTIKON" University General Hospital, Athens, Greece
- K. Tolis, E. Fandridis, S. Spyridonos, Hand, Upper Limb and Microsurgery Department, "KAT" General Hospital, Athens, Greece
| |
Collapse
|
2
|
Papanastassiou ID, Savvidou OD, Chloros GD, Megaloikonomos PD, Kontogeorgakos VA, Papagelopoulos PJ. Extensor Carpi Ulnaris Tenodesis Versus No Stabilization After Wide Resection of Distal Ulna Giant Cell Tumors. Hand (N Y) 2019; 14:242-248. [PMID: 29182026 PMCID: PMC6436123 DOI: 10.1177/1558944717743598] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND The necessity of stabilizing the residual ulnar stump after distal ulna tumor resection remains controversial. The authors retrospectively compared the outcome of patients who underwent wide resection of distal ulna giant cell tumors (GCTs) and reconstruction with tenodesis of the extensor carpi ulnaris (ECU) or without reconstruction. METHODS Between 2007 and 2015, 9 patients (6 females, 3 males; mean age, 36.8 years; range, 24-65 years) who underwent distal ulna resection for GCT of bone were retrospectively reviewed. The mean resection length was 8.1 cm. Five patients had no reconstruction, whereas 4 patients had stabilization of the ulnar stump using ECU tenodesis. With a mean follow-up of 3.6 years (2-9 years), the functional outcome using the quick Disability of Arm, Shoulder and Hand (DASH) score; Musculoskeletal Tumor Society score and grip strength; as well as the oncological outcome were evaluated. RESULTS Musculoskeletal Tumor Society functional scores were more than 24 in 7 patients and 20 to 24 in 2 patients (mean, 27.6 or 92%). Quick DASH scores ranged from 0 to 27.3 (mean, 11.1). In both groups, similar scores were observed ( P > .5). No patient had instability or pain related to the stump. There was no ulnar translation or subluxation of the radiocarpal joint. Grip strength in the operated hand, controlled for handedness, was 11% less than in the contralateral hand, although there was no difference between groups ( P > .4). All patients were disease-free at the latest follow-up. CONCLUSIONS The distal ulna may be widely resected with or without stabilization of the residual ulnar stump, yielding satisfactory local disease control and functional outcome.
Collapse
|
3
|
Papanastassiou ID, Piskopakis A, Gerochristou MA, Chloros GD, Savvidou OD, Issaiades D, Papagelopoulos PJ. Dedifferentiation of an atypical lipomatous tumor of the thigh - a 6 year follow-up study. J Musculoskelet Neuronal Interact 2019; 19:123-126. [PMID: 30839311 PMCID: PMC6454253] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Affiliation(s)
- Ioannis D. Papanastassiou
- General Oncological Hospital Kifisias “Agioi Anargyroi”, Athens, Greece,Corresponding author: Ioannis Dimitri Papanastassiou, MD, PhD, General Oncological Hospital Kifisias “Agioi Anargyroi”, Kalyftaki, Athens, Greece E-mail:
| | | | | | | | - Olga D. Savvidou
- First Department of Orthopaedics, National and Kapodistrian University of Athens, School of Medicine, ATTIKON University Hospital
| | | | - Panayiotis J. Papagelopoulos
- First Department of Orthopaedics, National and Kapodistrian University of Athens, School of Medicine, ATTIKON University Hospital
| |
Collapse
|
4
|
Athanasopoulos KG, Papanastassiou ID, Drinis I, Groumas N, Gerochristou MA, Petropoulou K. A patient with Guillain-Barré syndrome and late recovery after 1 year. J Musculoskelet Neuronal Interact 2019; 19:226-228. [PMID: 31186394 PMCID: PMC6587086] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Affiliation(s)
| | - Ioannis D. Papanastassiou
- General Oncological Hospital Kifisias “Agioi Anargyroi”, Athens, Greece,Corresponding author: Ioannis Dimitri Papanastassiou, MD, PhD, General Oncological Hospital Kifisias “Agioi Anargyroi”, Kalyftaki, Athens, Greece E-mail:
| | - Ioannis Drinis
- Second Department of Physical & Rehabilitation Medicine-National Rehabilitation Centre, Athens, Greece
| | - Nicholas Groumas
- First Department of Physical & Rehabilitation Medicine-National Rehabilitation Centre, Athens, Greece
| | | | - Konstantina Petropoulou
- Second Department of Physical & Rehabilitation Medicine-National Rehabilitation Centre, Athens, Greece
| |
Collapse
|
5
|
Papanastassiou ID, Vrionis FD. Is early vertebroplasty/kyphoplasty justified in multiple myeloma given the rapid vertebral fracture progression? Spine J 2016; 16:833-4. [PMID: 27480021 DOI: 10.1016/j.spinee.2015.12.083] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2015] [Revised: 12/08/2015] [Accepted: 12/21/2015] [Indexed: 02/03/2023]
Abstract
Xiao R, Miller JA, Margetis K, et al. Radiographic progression of vertebral fractures in patients with multiple myeloma. Spine J 2016:16:822-32 (in this issue).
Collapse
Affiliation(s)
- Ioannis D Papanastassiou
- H. Lee Moffitt Cancer Center, Department of Neurosurgery, 12902 Magnolia Drive, Tampa, FL 33612, USA; General Oncological Hospital Kifisias "Agioi Anargyroi", Department of Orthopedics, Kalyftaki, Athens 14564, Greece
| | - Frank D Vrionis
- General Oncological Hospital Kifisias "Agioi Anargyroi", Department of Orthopedics, Kalyftaki, Athens 14564, Greece.
| |
Collapse
|
6
|
Papanastassiou ID, Filis AK, Gerochristou MA, Vrionis FD. Controversial issues in kyphoplasty and vertebroplasty in malignant vertebral fractures. Cancer Control 2015; 21:151-7. [PMID: 24667402 DOI: 10.1177/107327481402100208] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Kyphoplasty (KP) and vertebroplasty (VP) have been successfully employed in the treatment of pathological vertebral fractures. METHODS A critical review of the medical literature was performed and controversial issues were analyzed. RESULTS Evidence supports KP as the treatment of choice to control fracture pain and the possible restoration of sagittal balance, provided that no overt instability or myelopathy is present, the fracture is painful and other pain generators have been excluded, and positive radiological findings are present. Unilateral procedures yield similar results to bilateral ones and should be pursued whenever feasible. Biopsy should be routinely performed and 3 to 4 levels may be augmented in a single operation. Higher cement filling appears to yield better results. Radiotherapy is complementary with KP and VP but must be individualized. CONCLUSIONS In cases of painful cancer fractures, if overt instability or myelopathy is not present, unilateral KP should be pursued, whenever feasible, followed by radiotherapy. The technological advances in hardware and biomaterials, as well as combining KP with other modalities, will help ensure a safe and more effective procedure. Address.
Collapse
|
7
|
Pazionis TJC, Papanastassiou ID, Maybody M, Healey JH. Embolization of hypervascular bone metastases reduces intraoperative blood loss: a case-control study. Clin Orthop Relat Res 2014; 472:3179-87. [PMID: 24964883 PMCID: PMC4160496 DOI: 10.1007/s11999-014-3734-3] [Citation(s) in RCA: 57] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2013] [Accepted: 06/02/2014] [Indexed: 01/31/2023]
Abstract
BACKGROUND Small case series suggest that preoperative transcatheter arterial embolization minimizes bleeding and facilitates surgery for hypervascular metastatic bone tumors. However, control groups would make our confidence in clinical recommendations stronger, but small patient numbers make prospective trials difficult to conduct on this topic. QUESTIONS/PURPOSES In this case-control study, we asked whether (1) patients who undergo embolization have less estimated blood loss and/or shorter operative time than patients who do not have embolization; (2) larger tumor size, greater initial tumor vascularity, and longer interval from embolization to surgery are associated with greater estimated blood loss and packed red blood cell transfusion volume; and (3) embolization does not affect renal function in patients with normal preoperative renal function. METHODS We retrospectively reviewed records of patients with hypervascular bone metastases treated at our institution between 1998 and 2008. Twenty-seven patients with renal cell carcinoma and 12 with thyroid carcinoma who underwent embolization before 41 surgical procedures were matched to 41 patients who did not have embolization with respect to age, diagnosis, tumor size and potential vascularity, and procedure type; matching was performed without knowledge of outcomes. In univariate and multivariate analyses, age, tumor size, use of embolization, surgery type and risk, embolization-to-surgery interval, and degree of devascularization were evaluated for correlations with estimated blood loss, packed red blood cell transfusion volume, operative time, and postembolization renal function. RESULTS Overall, patients who had embolization had less mean estimated blood loss (0.90 versus 1.77 L; p = 0.002), packed red blood cell transfusion volume (2.15 versus 3.56 U; p = 0.020), and operative time (3.13 versus 3.91 hours; p < 0.001). Larger tumor size correlated with greater estimated blood loss (r = 0.451; p = 0.003), packed red blood cell transfusion volume (r = 0.50; p = 0.002), and operative time (r = 0.595; p < 0.001). Neither the interval for embolization to surgery nor the degree of devascularization correlated with estimated blood loss or transfusion volume. In open rodding with intralesional curettage, transcatheter arterial embolization was associated with reduced estimated blood loss, transfusion volume, and operative time. Packed red blood cell transfusion volume was not reduced by embolization in intramedullary nailing procedures with the patient numbers available. Among patients with normal preoperative renal function who had embolization, creatinine levels remained normal. Mild transient, reversible renal function change occurred in one patient with preoperatively abnormal renal function. CONCLUSIONS This study suggests that preoperative embolization probably reduces estimated blood loss, particularly for large tumors and during open femoral procedures.
Collapse
Affiliation(s)
- Theresa J. C. Pazionis
- Orthopaedic Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY 10065 USA ,Department of Orthopaedic Surgery, McMaster University, Hamilton, ON Canada
| | - Ioannis D. Papanastassiou
- Orthopaedic Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY 10065 USA ,Department of Orthopedics, General Oncological Hospital Kifisias, “Agioi Anargyroi”, Athens, Greece
| | - Majid Maybody
- Interventional Radiology Service, Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY USA
| | - John H. Healey
- Orthopaedic Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY 10065 USA
| |
Collapse
|
8
|
Papanastassiou ID, Gerochristou M, Aghayev K, Vrionis FD. Defining the indications, types and biomaterials of corpectomy cages in the thoracolumbar spine. Expert Rev Med Devices 2014; 10:269-79. [DOI: 10.1586/erd.12.79] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
|
9
|
Papanastassiou ID, Karypidis D, Kokkalis ZT, Gerochristou MA, Demertzis N. Double approach operation for large extracompartmental proximal thigh tumors. J Surg Oncol 2013; 107:673-9. [PMID: 23280402 DOI: 10.1002/jso.23296] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2012] [Accepted: 10/27/2012] [Indexed: 11/09/2022]
Abstract
Resection of large femoral triangle tumors that invade the bone (or vice versa) still remains a challenge. A lateral-only approach would hinder dissection of the mass, away from the femoral vessels, while an iliofemoral-only type of approach would make bone resection and megaprosthetic reconstruction very arduous. The authors describe a two-stage, one-position operation via a double surgical approach: the first stage is comprised by an iliofemoral approach and dissection of the femoral vessels, followed by proximal femoral resection and reconstruction stage. One illustrative case is presented along with the authors overall experience. We believe that this operation facilitates wide tumor resection in a safe and step-wise manner, as not to add to the morbidity of the procedure.
Collapse
Affiliation(s)
- Ioannis D Papanastassiou
- Department of Orthopedics, General Oncological Hospital Kifisias Agioi Anargyroi, Athens, Greece.
| | | | | | | | | |
Collapse
|
10
|
Papanastassiou ID, Aghayev K, Berenson JR, Schmidt MH, Vrionis FD. Is Vertebral Augmentation the Right Choice for Cancer Patients With Painful Vertebral Compression Fractures? J Natl Compr Canc Netw 2012; 10:715-9. [DOI: 10.6004/jnccn.2012.0074] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
|
11
|
Papanastassiou ID, Aghayev K, Saleh E, Gerochristou M, Vrionis FD. The actual management of tumor and vertebral compression fractures. J Neurosurg Sci 2012; 56:77-85. [PMID: 22617170] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
Tumor related fractures of the spine frequently dictate surgical management. The most critical factors influencing the need and type of surgery are degree of epidural cord compression, radiosensitivity of the tumor, presence of spinal instability and patient medical status/ estimated survivorship. There is a wide spectrum of therapeutic options: major en bloc resections in primary or oligometastatic disease; decompression and fusion in non-radiosensitive tumors with cord compression followed by adjuvant radiation therapy (RT); kyphoplasty/ vertebroplasty for stable compression fractures or minimally invasive corpectomy for more unstable fractures and RT- only for radiosensitive tumors not causing overt instability. Radiation therapy has always been essential component of the treatment algorithm although it has been displaced from principal treatment modality in the last 2 decades. However, the advent of more targeted and efficient forms of RT (radiosurgery) may be a new treatment paradigm for more radioresistant tumors and may obviate the need for major operations.
Collapse
|
12
|
Papanastassiou ID, Phillips FM, Van Meirhaeghe J, Berenson JR, Andersson GBJ, Chung G, Small BJ, Aghayev K, Vrionis FD. Comparing effects of kyphoplasty, vertebroplasty, and non-surgical management in a systematic review of randomized and non-randomized controlled studies. Eur Spine J 2012; 21:1826-43. [PMID: 22543412 DOI: 10.1007/s00586-012-2314-z] [Citation(s) in RCA: 139] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/20/2011] [Revised: 11/16/2011] [Accepted: 04/09/2012] [Indexed: 12/20/2022]
Abstract
PURPOSE To determine if differences in safety or efficacy exist between balloon kyphoplasty (BKP), vertebroplasty (VP) and non-surgical management (NSM) for the treatment of osteoporotic vertebral compression fractures (VCFs). METHODS As of February 1, 2011, a PubMed search (key words: kyphoplasty, vertebroplasty) resulted in 1,587 articles out of which 27 met basic selection criteria (prospective multiple-arm studies with cohorts of ≥ 20 patients). This systematic review adheres to preferred reporting items for systematic reviews and meta-analyses (PRISMA) guidelines. RESULTS Pain reduction in both BKP (-5.07/10 points, P < 0.01) and VP (-4.55/10, P < 0.01) was superior to that for NSM (-2.17/10), while no difference was found between BKP/VP (P = 0.35). Subsequent fractures occurred more frequently in the NSM group (22 %) compared with VP (11 %, P = 0.04) and BKP (11 %, P = 0.01). BKP resulted in greater kyphosis reduction than VP (4.8º vs. 1.7°, P < 0.01). Quality of life (QOL) improvement showed superiority of BKP over VP (P = 0.04), along with a trend for disability improvement (P = 0.08). Cement extravasation was less frequent in the BKP (P = 0.01). Surgical intervention within the first 7 weeks yielded greater pain reduction than VCFs treated later. CONCLUSIONS BKP/VP provided greater pain relief and fewer subsequent fractures than NSM in osteoporotic VCFs. BKP is marginally favored over VP in disability improvement, and significantly favored in QOL improvement. BKP had a lower risk of cement extravasation and resulted in greater kyphosis correction. Despite this analysis being restricted to Level I and II studies, significant heterogeneity suggests that the current literature is delivering inconsistent messages and further trials are needed to delineate confounding variables.
Collapse
Affiliation(s)
- Ioannis D Papanastassiou
- H. Lee Moffitt Cancer Center and Research Institute, NeuroOncology Program and Department of Neurosurgery and Orthopaedics, University of South Florida College of Medicine, 12902 Magnolia Drive, Tampa, FL, 33647, USA.
| | | | | | | | | | | | | | | | | |
Collapse
|
13
|
Kokkalis ZT, Efstathopoulos DG, Papanastassiou ID, Sarlikiotis T, Papagelopoulos PJ. Ulnar nerve injuries in guyon canal: A report of 32 cases. Microsurgery 2012; 32:296-302. [DOI: 10.1002/micr.21951] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2011] [Accepted: 11/18/2011] [Indexed: 11/09/2022]
|
14
|
Papanastassiou ID, Jain S, Baaj AA, Eleraky M, Papagelopoulos PJ, Vrionis FD. Vertebrectomy and expandable cage placement via a one-stage, one-position anterolateral retroperitoneal approach in L5 tumors. J Surg Oncol 2011; 104:552-8. [PMID: 21520091 DOI: 10.1002/jso.21910] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2010] [Accepted: 02/24/2011] [Indexed: 11/11/2022]
Abstract
Spinal reconstruction of the L5 vertebrae after tumor resection remains a challenge. Complex resection followed by circumferential fixation in the same setting, or in staged fashion, is often employed. The added operative time associated with this method potentially increases morbidity and mortality in an inherently high-risk procedure and anatomy in the lumbosacral area makes reconstruction more challenging. The authors describe a technique involving L5 vertebrectomy, placement of an expandable cage, and anterolateral L4-S1 screw fixation via a one-stage, one-position, anterolateral retroperitoneal approach. Two illustrative cases are presented along with the authors overall experience in L5 tumor operations. We believe that this is a feasible reconstructive option after tumor resection in lower lumbar metastatic spine disease. The approach may be also utilized in combined anteroposterior (two-stage) procedures in primary malignant tumors or oligometastatic disease.
Collapse
|
15
|
Papanastassiou ID, Mavrogenis A, Kokkalis ZT, Nikolopoulos K, Skourtas K, Papagelopoulos PJ. Fixation of Femoral Neck Fractures Using Divergent Versus Parallel Cannulated Screws. J Long Term Eff Med Implants 2011; 21:63-9. [DOI: 10.1615/jlongtermeffmedimplants.v21.i1.50] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
|
16
|
Papanastassiou ID, Eleraky M, Vrionis FD. Contralateral femoral nerve compression: An unrecognized complication after extreme lateral interbody fusion (XLIF). J Clin Neurosci 2011; 18:149-51. [DOI: 10.1016/j.jocn.2010.07.109] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2010] [Accepted: 07/16/2010] [Indexed: 10/18/2022]
|
17
|
Papanastassiou ID, Baaj AA, Dakwar E, Eleraky M, Vrionis FD. Failure of cervical arthroplasty in a patient with adjacent segment disease associated with Klippel-Feil syndrome. Indian J Orthop 2011; 45:174-7. [PMID: 21430874 PMCID: PMC3051126 DOI: 10.4103/0019-5413.77139] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Cervical arthroplasty may be justified in patients with Klippel-Feil syndrome (KFS) in order to preserve cervical motion. The aim of this paper is to report an arthroplasty failure in a patient with KFS. A 36-year-old woman with KFS underwent two-level arthroplasty for adjacent segment disc degeneration. Anterior migration of the cranial prosthesis was encountered 5 months postoperatively and was successfully revised with anterior cervical fusion. Cervical arthroplasty in an extensively stiff and fused neck is challenging and may lead to catastrophic failure. Although motion preservation is desirable in KFS, the special biomechanical features may hinder arthroplasty. Fusion or hybrid constructs may represent more reasonable options, especially when multiple fused segments are present.
Collapse
Affiliation(s)
- Ioannis D Papanastassiou
- H. Lee Moffitt Cancer Center and Research Institute, Neurooncology Program, University of South Florida College of Medicine, 12902 Magnolia Drive, Tampa, Florida, 33612, USA,Address for correspondence: Dr. Ioannis Papanastassiou, H. Lee Moffitt Cancer Center and Research Institute, University of South Florida College of Medicine, 12902 Magnolia Drive, Tampa, Fl, 33647, USA. E-mail:
| | - Ali A Baaj
- H. Lee Moffitt Cancer Center and Research Institute, Neurooncology Program, University of South Florida College of Medicine, 12902 Magnolia Drive, Tampa, Florida, 33612, USA
| | - Elias Dakwar
- H. Lee Moffitt Cancer Center and Research Institute, Neurooncology Program, University of South Florida College of Medicine, 12902 Magnolia Drive, Tampa, Florida, 33612, USA
| | - Mohammad Eleraky
- H. Lee Moffitt Cancer Center and Research Institute, Neurooncology Program, University of South Florida College of Medicine, 12902 Magnolia Drive, Tampa, Florida, 33612, USA
| | - Frank D Vrionis
- H. Lee Moffitt Cancer Center and Research Institute, Neurooncology Program, University of South Florida College of Medicine, 12902 Magnolia Drive, Tampa, Florida, 33612, USA
| |
Collapse
|
18
|
Eleraky MA, Setzer M, Papanastassiou ID, Baaj AA, Tran ND, Katsares KM, Vrionis FD. Role of motor-evoked potential monitoring in conjunction with temporary clipping of spinal nerve roots in posterior thoracic spine tumor surgery. Spine J 2010; 10:396-403. [PMID: 20421074 DOI: 10.1016/j.spinee.2010.02.015] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2009] [Revised: 01/19/2010] [Accepted: 02/14/2010] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT The vascular supply of the thoracic spinal cord depends on the thoracolumbar segmental arteries. Because of the small size and ventral course of these arteries in relation to the dorsal root ganglion and ventral root, they cannot be reliably identified during surgery by anatomic or morphologic criteria. Sacrificing them will most likely result in paraplegia. PURPOSE The goal of this study was to evaluate a novel method of intraoperative testing of a nerve root's contribution to the blood supply of the thoracic spinal cord. STUDY DESIGN/SETTING This is a clinical retrospective study of 49 patients diagnosed with thoracic spine tumors. Temporary nerve root clipping combined with motor-evoked potential (MEP) and somatosensory-evoked potential (SSEP) monitoring was performed; additionally, postoperative clinical evaluation was done and reported in all cases. METHODS All cases were monitored by SSEP and MEPs. The nerve root to be sacrificed was temporarily clipped using standard aneurysm clips, and SSEP/MEP were assessed before and after clipping. Four nerve roots were sacrificed in four cases, three nerve roots in eight cases, and two nerve roots in 22 cases. Nerve roots were sacrificed bilaterally in 12 cases. RESULTS Most patients (47/49) had no changes in MEP/SSEP and had no neurological deficit postoperatively. One case of a spinal sarcoma demonstrated changes in MEP after temporary clipping of the left T11 nerve root. The nerve was not sacrificed, and the patient was neurologically intact after surgery. In another case of a sarcoma, MEPs changed in the lower limbs after ligation of left T9 nerve root. It was felt that it was a global event because of anesthesia. Postoperatively, the patient had complete paraplegia but recovered almost completely after 6 months. CONCLUSIONS Temporary nerve root clipping combined with MEP and SSEP monitoring may enhance the impact of neuromonitoring in the intraoperative management of patients with thoracic spine tumors and favorably influence neurological outcome.
Collapse
Affiliation(s)
- Mohammed A Eleraky
- H. Lee Moffitt Cancer Center & Research Institute, NeuroOncology Program, University of South Florida College of Medicine, Tampa, FL 33612, USA
| | | | | | | | | | | | | |
Collapse
|