1
|
Perna A, Franchini A, Gorgoglione FL, Barletta F, Moretti B, Piazzolla A, Bocchi MB, Velluto C, Tamburrelli F, Proietti L. Short-segment percutaneous fusion versus open posterior fusion with screw in the fractured vertebra for thoracolumbar junction burst vertebral fracture treatment. J Neurosci Rural Pract 2024; 15:34-41. [PMID: 38476412 PMCID: PMC10927060 DOI: 10.25259/jnrp_370_2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2023] [Accepted: 08/11/2023] [Indexed: 03/14/2024] Open
Abstract
Objectives The treatment options for thoracolumbar junction burst fractures remain a topic of controversy. Short-segment percutaneous fixation (SSPF) and short-segment open fixation including the fractured level (SSOFIFL) are both viable procedures for managing these fractures. At present, there is a lack of evidence in the literature demonstrating the absolute superiority of one treatment over the other. This study aimed to compare these two surgical strategies with a focus on radiological and clinical outcomes. Materials and Methods This retrospective case-control multicenter analysis involved patients with A3 and A4 vertebral fractures at the thoracolumbar junction (T11-L2) who underwent surgical treatment with either SSPF or SSOFIFL in the participating centers. Clinical outcomes were measured using the Oswestry Disability Index and visual analogue scale (VAS) both pre- and postoperatively. Radiological outcomes included kyphotic deformity (KD), anterior vertebral body height (AVBH), segmental kyphosis, and sagittal alignment parameters. Results A total of 156 patients were enrolled in the study, with 81 patients in Group A (SSPF) and 75 patients in Group B (SSOFIFL). Group B demonstrated better correction of KD (Group B: 3.4 ± 2.7° vs. Group A: 8.3 ± 3.2°, P = 0.003), AVBH, and sagittal alignment. A minor loss of correction was observed in Group B with respect to Group A (0.9 ± 1.7° vs 4.3° ± 2.1°, P = 0.043). Blood losses were lower in Group A (78 ± 15 min vs. 118 ± 23 min, P = 0.021) as well as during surgery (121.3 ± 34 mL vs. 210.2 ± 52 mL, P = 0.031), but the post-operative hemoglobin levels were comparable between the two groups. Conclusion SSOFIFL appears to show a major amount of KD correction and prevent loss of correction. This technique should be the preferred choice whenever possible. However, SSPF can be considered a valid alternative for damage control in polytrauma patients and fractures with low KD.
Collapse
Affiliation(s)
- Andrea Perna
- Department of Orthopedics and Traumatology, Fondazione Casa Sollievo della Sofferenza IRCCS, San Giovanni Rotondo, Italy
| | - Andrea Franchini
- Department of Basic Medical Science, Neuroscience and Sensory Organs, University of Bari “Aldo Moro,”Bari, Italy
| | - Franco Lucio Gorgoglione
- Department of Orthopedics and Traumatology, Fondazione Casa Sollievo della Sofferenza IRCCS, San Giovanni Rotondo, Italy
| | - Felice Barletta
- Department of Orthopedics and Traumatology, Fondazione Casa Sollievo della Sofferenza IRCCS, San Giovanni Rotondo, Italy
| | - Biagio Moretti
- Department of Basic Medical Science, Neuroscience and Sensory Organs, University of Bari “Aldo Moro,”Bari, Italy
| | - Andrea Piazzolla
- Department of Basic Medical Science, Neuroscience and Sensory Organs, University of Bari “Aldo Moro,”Bari, Italy
| | - Maria Beatrice Bocchi
- Department of Orthopedics and Traumatology, Fondazione Policlinico Universitario A. Gemelli, IRCCS - Università Cattolica del Sacro Cuore, Roma, Italy
| | - Calogero Velluto
- Department of Orthopedics and Traumatology, Fondazione Policlinico Universitario A. Gemelli, IRCCS - Università Cattolica del Sacro Cuore, Roma, Italy
| | - Francesco Tamburrelli
- Department of Orthopedics and Traumatology, Fondazione Policlinico Universitario A. Gemelli, IRCCS - Università Cattolica del Sacro Cuore, Roma, Italy
| | - Luca Proietti
- Department of Orthopedics and Traumatology, Fondazione Policlinico Universitario A. Gemelli, IRCCS - Università Cattolica del Sacro Cuore, Roma, Italy
| |
Collapse
|
2
|
Tundo A, Musetti L, Betrò S, Cambiali E, de Filippis R, Marazziti D, Mucci F, Proietti L, Dell’Osso L. Are anxious and mixed depression two sides of the same coin? Similarities and differences in patients with bipolar I, II and unipolar disorders. Eur Psychiatry 2023; 66:e75. [PMID: 37697671 PMCID: PMC10594275 DOI: 10.1192/j.eurpsy.2023.2445] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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] [Received: 12/27/2022] [Revised: 03/28/2023] [Accepted: 05/13/2023] [Indexed: 09/13/2023] Open
Abstract
BACKGROUND Diagnostic criteria are not always useful to discriminate major depression with anxious distress (ADS-D; Diagnostic and Statistical Manual for Mental Disorders, version-5 [DSM-5] criteria) from mixed depression (Koukopoulos' criteria; KMX-D). So, clinicians need alternative tools to improve their diagnostic ability and to choose the most appropriate treatment. The aim of the present study is to identify socio-demographic and clinical features that discriminate patients with ADS-D from those with KMX-D. METHODS Two hundred and forty-one consecutive outpatients with unipolar (51%) and bipolar (49%) disorder, fulfilling DSM-5 criteria for a current major depressive episode (MDE) and with a 21-item Hamilton Depression Rating Scale score ≥ 14, were recruited and treated in a prospective observational study. RESULTS Ten percent of patients met criteria for KMX-D, 22% ADS-D, and 37% for both. Irritable premorbid temperament, mixed depression polarity at onset, mixed depression recurrence, and a high number of mania symptoms at intake were typical features of patients with KMX-D. Depressive polarity at onset, a low number of mania symptoms at intake, and generalized anxiety disorder comorbidity were typical features of patients with ADS-D. Multinomial logistic regression confirmed that higher rate of irritable temperament and higher Young Mania Rating Scale total score differentiated patients with KMX-D from patients with pure MDE. CONCLUSION Our findings suggest some clinical features that could help differentiate between ADS-D and KMX-D in patients meeting both conditions and to select the appropriate treatment. However, the small sample size may have limited the power to detect differences between the groups. Further research is needed to confirm the results of present study.
Collapse
Affiliation(s)
| | - Laura Musetti
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | | | - Erika Cambiali
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | | | - Donatella Marazziti
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Federico Mucci
- Department of Biotechnology, Chemistry and Pharmacy, University of Siena, Siena, Italy
| | | | - Liliana Dell’Osso
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| |
Collapse
|
3
|
Perna A, Velluto C, Smakaj A, Tamburrelli F, Borruto MI, Santagada DA, Gorgoglione FL, Liuzza F, Proietti L. Positioning accuracy and facet joints violation after percutaneous pedicle screws placement with robot-assisted versus fluoroscopy-guided technique: Systematic review and meta-analysis. J Neurosci Rural Pract 2023; 14:406-412. [PMID: 37692811 PMCID: PMC10483214 DOI: 10.25259/jnrp_147_2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Accepted: 06/19/2023] [Indexed: 09/12/2023] Open
Abstract
Introduction Minimally invasive spine surgery became the gold standard for the treatment of many spinal diseases. Only a few comparative studies were performed regarding the superiority of robotic-assisted (RA) surgery over fluoroscopic guidance (FG) surgery during percutaneous pedicle screws placement. Therefore, the aim of the present study was to conduct a systematic literature review and meta-analysis to evaluate the accuracy and potential advantages of RA compared with FG. Material and Methods This study is a systematic literature review conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines. The review questions were formulated following the PICO scheme. Measured outcomes were presented using Forest plots. Heterogeneity among the included studies was assessed using the χ2 test, and the I2 statistic was utilized to estimate the proportion of total variation among the studies. A value exceeding 50% was considered indicative of substantial heterogeneity. Results Seven studies that met inclusion criteria were finally included in this meta-analysis. These seven studies include: 447 patients, 228 patients (931 screws) treated with robotic guide, and 219 patients (767 pedicle screws) using fluoroscopic guide, with a mean age of 55.2. The percentages of clinically acceptable screws were 94.3% in the robot-assisted group and 89% in the fluoroscopic guided group. The percentages of non-acceptable screws were 5.7% in the robot-assisted group and 11% in the fluoroscopic-guided group. Discussion Significant differences were observed between the two groups in terms of radiographic and clinical outcomes, with the robotic-assisted pedicle screw group exhibiting longer operative times. Robot technology serves as a valuable tool for assisting surgeons in challenging scenarios such as anatomical variants or patients with spinal deformities, ensuring accurate screw placement. Conclusion The accuracy of pedicle screw placement with robotic technology is higher than with FG. In fact, the robotic approach allows significantly lower complication rates, fewer cases of violation of the proximal articular facet, less intraoperative exposure to radiation, even if it requires longer surgical times than the FG technique.
Collapse
Affiliation(s)
- Andrea Perna
- Department of Geriatrics and Orthopaedics Sciences, IRCCS Fondazione Policlinico Universitario Agostino Gemelli, Roma, Italy
| | - Calogero Velluto
- Department of Geriatrics and Orthopaedics Sciences, IRCCS Fondazione Policlinico Universitario Agostino Gemelli, Roma, Italy
| | - Amarildo Smakaj
- Department of Geriatrics and Orthopaedics Sciences, IRCCS Fondazione Policlinico Universitario Agostino Gemelli, Roma, Italy
| | - Francesco Tamburrelli
- Department of Geriatrics and Orthopaedics Sciences, IRCCS Fondazione Policlinico Universitario Agostino Gemelli, Roma, Italy
| | - Maria Ilaria Borruto
- Department of Geriatrics and Orthopaedics Sciences, IRCCS Fondazione Policlinico Universitario Agostino Gemelli, Roma, Italy
| | - Domenico Alessandro Santagada
- Department of Geriatrics and Orthopaedics Sciences, IRCCS Fondazione Policlinico Universitario Agostino Gemelli, Roma, Italy
| | - Franco Lucio Gorgoglione
- Department of Orthopedics and Trauma Surgery, Fondazione Casa Sollievo Della Sofferenza IRCCS, San Giovanni Rotondo, Italy
| | - Francesco Liuzza
- Department of Geriatrics and Orthopaedics Sciences, IRCCS Fondazione Policlinico Universitario Agostino Gemelli, Roma, Italy
| | - Luca Proietti
- Department of Geriatrics and Orthopaedics Sciences, IRCCS Fondazione Policlinico Universitario Agostino Gemelli, Roma, Italy
| |
Collapse
|
4
|
Perna A, Proietti L. Editorial on: Musculoskeletal Rehabilitation: Current Challenges and New Perspectives. J Clin Med 2023; 12:3981. [PMID: 37373675 DOI: 10.3390/jcm12123981] [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: 05/11/2023] [Accepted: 06/08/2023] [Indexed: 06/29/2023] Open
Abstract
Musculoskeletal disorders are among the leading causes of disability and chronic pain worldwide, and their impact is expected to increase in the coming years [...].
Collapse
Affiliation(s)
- Andrea Perna
- Departments of Orthopedic and Traumatology, Fondazione Casa Sollievo della Sofferenza, San Giovanni Rotondo, 71013 Foggia, Italy
- Department of Orthopaedics and Traumatology, Fondazione Policlinico Universitario A. Gemelli IRCCS-Università Cattolica del Sacro Cuore, 00168 Rome, Italy
| | - Luca Proietti
- Department of Orthopaedics and Traumatology, Fondazione Policlinico Universitario A. Gemelli IRCCS-Università Cattolica del Sacro Cuore, 00168 Rome, Italy
| |
Collapse
|
5
|
Armocida D, Proietti L, Frati A. Letter to editor regarding: "Vertebral bone quality score independently predicts cage subsidence following transforaminal lumbar interbody fusion.". Spine J 2023:S1529-9430(23)00189-4. [PMID: 37149151 DOI: 10.1016/j.spinee.2023.04.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2023] [Revised: 04/20/2023] [Accepted: 04/21/2023] [Indexed: 05/08/2023]
Affiliation(s)
- Daniele Armocida
- Human Neurosciences Department Neurosurgery Division "Sapienza" University, Rome (RM), Italy; IRCCS "Neuromed" Pozzilli (IS), Italy.
| | - Luca Proietti
- Division of Spinal Surgery IRCCS Fondazione Policlinico Universitario Agostino Gemelli, Rome, Italy; Institute of Orthopaedic, Università Cattolica del Sacro Cuore, Rome, Italy
| | | |
Collapse
|
6
|
Armocida D, Perna A, Cofano F, Cimatti M, Arcidiacono UA, Marengo N, Ajello M, Garbossa D, Proietti L, Tamburrelli FC, Maiotti M, Santoro A, Frati A. Extreme Lateral Interbody Fusion (XLIF) with Lateral Modular Plate Fixation: Preliminary Report on Clinical and Radiological Outcomes. Acta Neurochir Suppl 2023; 135:431-437. [PMID: 38153505 DOI: 10.1007/978-3-031-36084-8_66] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/29/2023]
Abstract
The lateral transpsoas approach (extreme lateral interbody fusion, or XLIF) allows surgeons to use various lordotic cage sizes to help restore intervertebral disk height, correct sagittal alignment, and improve fusion rates. The use of standalone devices has consistently raised doubts due to the high risk of complications and inadequate functional recovery that a circumferential arthrodesis can support. The recent introduction of a novel XLIF cage with adapted lateral plate fixation (XLPF) may further enhance the structural rigidity, consolidating the cage and plate into a singular modular entity. Nine patients from our surgical centers underwent a procedure of 1-level XLIF with XLPF in selected cases. We observed that XLPF does not extend the intraoperative footprint and provides immediate rigidity to the anterior column without any additional risk of complications and with minimal increased time compared to the traditional cage implant procedure. Although it has been shown that the use of interbody fusion cages with supplemental posterior fixation improves stabilization in all directions, the technique of standalone lateral cages may also have a place in spine surgery in that the stability may be sufficient in selected cases, such as junctional syndrome and in some forms of degenerative scoliosis.
Collapse
Affiliation(s)
- Daniele Armocida
- Neurosurgery Division, Human Neurosciences Department, "Sapienza" University, Rome (RM), Italy
| | - Andrea Perna
- Division of Spinal Surgery, IRCCS Fondazione Policlinico Universitario Agostino Gemelli, Rome, Italy
| | - Fabio Cofano
- Spine Surgery Unit-Humanitas Gradenigo, Torino, Italy
- Department of Neuroscience, "Rita Levi Montalcini," University of Torino, Torino, Italy
| | - Marco Cimatti
- Unit of Neurosurgery, Sant'Andrea Hospital, Rome, Italy
| | | | - Nicola Marengo
- Unit of Neurosurgery, AOU Città della Salute e della Scienza, Torino, Italy
| | - Marco Ajello
- Unit of Neurosurgery, AOU Città della Salute e della Scienza, Torino, Italy
| | - Diego Garbossa
- Department of Neuroscience, "Rita Levi Montalcini," University of Torino, Torino, Italy
- Unit of Neurosurgery, AOU Città della Salute e della Scienza, Torino, Italy
| | - Luca Proietti
- Division of Spinal Surgery, IRCCS Fondazione Policlinico Universitario Agostino Gemelli, Rome, Italy
- Institute of Orthopaedic, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Francesco Ciro Tamburrelli
- Division of Spinal Surgery, IRCCS Fondazione Policlinico Universitario Agostino Gemelli, Rome, Italy
- Institute of Orthopaedic, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Marco Maiotti
- Shoulder Unit Villa Stuart Clinic (Rome), Shoulder-Knee Unit PIO XI Clinic (Rome), Rome, Italy
| | - Antonio Santoro
- Neurosurgery Division, Human Neurosciences Department, "Sapienza" University, Rome (RM), Italy
| | - Alessandro Frati
- Neurosurgery Division, Human Neurosciences Department, "Sapienza" University, Rome (RM), Italy
- IRCCS "Neuromed", Pozzilli (IS), Italy
| |
Collapse
|
7
|
Candura D, Perna A, Calori S, Tamburrelli FC, Proietti L, Meluzio MC, Velluto C, Smakaj A, Santagada DA. Vertebral Candidiasis, the State of the Art: A Systematic Literature Review. Acta Neurochir Suppl 2023; 135:231-240. [PMID: 38153475 DOI: 10.1007/978-3-031-36084-8_36] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/29/2023]
Abstract
OBJECTIVE In recent years, Candida spondylodiscitis has represented an increasingly emerging disease in clinical practice. This condition requires long-term antibiotic therapy and sometimes surgical treatments. The main purpose of this study is to investigate the epidemiology, clinical and radiological aspects, treatment protocols, and outcomes of Candida-mediated vertebral osteomyelitis. METHODS A systematic review of the English literature was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines.The research was conducted on Medline, Cochrane library, PubMed, and Scopus using as search terms "vertebral"; "spinal"; "infection"; "spondylodiscitis"; "discitis"; "osteomyelitis"; "Candida"; and "Candidosis." A case of vertebral candidiasis that was surgically managed was also reported. RESULTS In total, 88 articles were included in our systematic review. Including the reported case, our analysis covered 113 cases of vertebral candidiasis. Candida albicans was isolated in 64 cases (56.1%), Candida tropicalis in 21 (18.4%), Candida glabrata in 14 (12.3%), and Candida parapsilosis in five (4.4%). The mean duration of the follow-up was 395 days. Finally, 87 (82%) patients completely recovered, ten (9.4%) died, and nine (8.5%) reported sequelae. CONCLUSION This systematic review summarized the state of the art on vertebral candidiasis, describing data on its clinical features, diagnostic criteria and current limitations, and treatment alternatives and their outcomes.
Collapse
Affiliation(s)
- Dario Candura
- Department of Aging, Neurological, Orthopedic, and Head-Neck Sciences, IRCCS A. Gemelli University Polyclinic Foundation, Rome, Italy
| | - Andrea Perna
- Department of Aging, Neurological, Orthopedic, and Head-Neck Sciences, IRCCS A. Gemelli University Polyclinic Foundation, Rome, Italy
- Department of Orthopedics and Traumatology, Fondazione Casa Sollievo Della Sofferenza, San Giovanni Rotondo, Rome, Italy
| | - Sara Calori
- Department of Aging, Neurological, Orthopedic, and Head-Neck Sciences, IRCCS A. Gemelli University Polyclinic Foundation, Rome, Italy
| | - Francesco Ciro Tamburrelli
- Department of Aging, Neurological, Orthopedic, and Head-Neck Sciences, IRCCS A. Gemelli University Polyclinic Foundation, Rome, Italy
- Department of Geriatrics and Orthopedics, Sacred Heart Catholic University, Rome, Italy
| | - Luca Proietti
- Department of Aging, Neurological, Orthopedic, and Head-Neck Sciences, IRCCS A. Gemelli University Polyclinic Foundation, Rome, Italy
- Department of Geriatrics and Orthopedics, Sacred Heart Catholic University, Rome, Italy
| | - Maria Concetta Meluzio
- Department of Aging, Neurological, Orthopedic, and Head-Neck Sciences, IRCCS A. Gemelli University Polyclinic Foundation, Rome, Italy
| | - Calogero Velluto
- Department of Aging, Neurological, Orthopedic, and Head-Neck Sciences, IRCCS A. Gemelli University Polyclinic Foundation, Rome, Italy
| | - Amarildo Smakaj
- Department of Aging, Neurological, Orthopedic, and Head-Neck Sciences, IRCCS A. Gemelli University Polyclinic Foundation, Rome, Italy
| | - Domenico Alessandro Santagada
- Department of Aging, Neurological, Orthopedic, and Head-Neck Sciences, IRCCS A. Gemelli University Polyclinic Foundation, Rome, Italy
| |
Collapse
|
8
|
Perna A, Velluto C, Smakaj A, Caredda M, Proietti L, Santagada DA, Candura D, Meluzio MC, Tamburrelli FC, Genitiempo M. Long-Term Clinical and Radiographic Outcomes After Bryan Cervical Disk Arthroplasty: A Systematic Literature Review. Acta Neurochir Suppl 2023; 135:321-329. [PMID: 38153488 DOI: 10.1007/978-3-031-36084-8_49] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/29/2023]
Abstract
Introductionː Cervical disk arthroplasty is a potential alternative procedure to anterior cervical decompression and fusion for the treatment of cervical disk disease. The aim of the study was to perform a systematic literature review on long-term clinical and radiological outcomes after Bryan cervical disk arthroplasty.Material and Methodsː A systematic literature review was performed according to PRISMA guidelines via PubMed and Embase, Scopus, and the Cochrane Library database by using the following keywords: "Bryan prosthesis"; "cervical disk arthroplasty"; "outcomes"; and "long-term follow-up." Eight articles with at least 10 years of follow-up were considered for eligibility.Resultsː In total, 481 patients were enrolled in the studies. Because of the occurrence of multiple treated levels, 588 arthroplasties were performed, divided as follows: 12 C3/4 cervical disk arthroplasties (2.01%), 63 C4/5 (10.71%), 325 C5/6 (55.27%), and 188 C6/7 (31.97%). The mean preoperative cervical lordosis was 13.6 ± 9.3°, whereas the last follow-up value was 12.8 ± 8.7°. In the last follow-up, the mean segmental range of motion was 8.2 ± 3.3°.Discussion: Recent studies have suggested that cervical disk arthroplasty should be safely performed in healthy young patients with disk degeneration who may need future revision surgery. The results suggest that this procedure preserves native cervical spinal biomechanics at long-term follow-up with acceptable adjacent segments disease and periprosthetic ossifications.Conclusionsː Cervical disk arthroplasty has good long-term device survival, motility, adjacent segment degeneration, and clinical outcomes. Therefore, it represents a valid alternative for the treatment of cervical spine degenerative pathologies, especially in young patients.
Collapse
Affiliation(s)
- Andrea Perna
- Department of Aging, Neurological, Orthopedics and Head-Neck Sciences, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
- Department of Geriatrics and Orthopedics, Università Cattolica del Sacro Cuore, Rome, Italy
- Department of Orthopedics, Fondazione Casa Sollievo Della Sofferenza IRCCS, San Giovanni Rotondo, Italy
| | - Calogero Velluto
- Department of Aging, Neurological, Orthopedics and Head-Neck Sciences, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Amarildo Smakaj
- Department of Aging, Neurological, Orthopedics and Head-Neck Sciences, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Matteo Caredda
- Department of Aging, Neurological, Orthopedics and Head-Neck Sciences, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Luca Proietti
- Department of Aging, Neurological, Orthopedics and Head-Neck Sciences, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
- Department of Geriatrics and Orthopedics, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Domenico Alessandro Santagada
- Department of Aging, Neurological, Orthopedics and Head-Neck Sciences, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Dario Candura
- Department of Aging, Neurological, Orthopedics and Head-Neck Sciences, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Maria Concetta Meluzio
- Department of Aging, Neurological, Orthopedics and Head-Neck Sciences, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Francesco Ciro Tamburrelli
- Department of Aging, Neurological, Orthopedics and Head-Neck Sciences, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
- Department of Geriatrics and Orthopedics, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Maurizio Genitiempo
- Department of Aging, Neurological, Orthopedics and Head-Neck Sciences, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| |
Collapse
|
9
|
Arcidiacono UA, Armocida D, Pesce A, Maiotti M, Proietti L, D’Andrea G, Santoro A, Frati A. Complex Regional Pain Syndrome after Spine Surgery: A Rare Complication in Mini-Invasive Lumbar Spine Surgery: An Updated Comprehensive Review. J Clin Med 2022; 11:jcm11247409. [PMID: 36556025 PMCID: PMC9781971 DOI: 10.3390/jcm11247409] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Revised: 12/02/2022] [Accepted: 12/08/2022] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Complex regional pain syndrome (CRPS) is a postoperative, misdiagnosed condition highlighted only by pain therapists after numerous failed attempts at pain control by the treating surgeon in the case of prolonged pain after surgery. It only occurs rarely after spine surgery, causing the neurosurgeon's inappropriate decision to resort to a second surgical treatment. METHODS We performed a systematic review of the literature reporting and analyzing all recognized and reported cases of CRPS in patients undergoing spinal surgery to identify the best diagnostic and therapeutic strategies for this unusual condition. We compare our experience with the cases reported through a review of the literature. RESULTS We retrieve 20 articles. Most of the papers are clinical cases showing the disorder's rarity after spine surgery. Most of the time, the syndrome followed uncomplicated lumbar spine surgery involving one segment. The most proposed therapy was chemical sympathectomy and spinal cord stimulation. CONCLUSION CRPS is a rare pathology and is rarer after spine surgery. However, it is quite an invalidating disorder. Early therapy and resolution, however, require a rapid diagnosis of the syndrome. In our opinion, since CRPS occurs relatively rarely following spinal surgery, it should not have a substantial impact on the indications for and timing of these operations. Therefore, it is essential to diagnose this rare occurrence and treat it promptly and appropriately.
Collapse
Affiliation(s)
| | - Daniele Armocida
- Human Neurosciences Department, Neurosurgery Division, “Sapienza” University, 00185 Rome, Italy
- IRCCS “Neuromed”, 86077 Pozzilli, Italy
- Correspondence: ; Tel.: +39-393-287-4496
| | - Alessandro Pesce
- Neurosurgery Unit, Santa Maria Goretti Hospital, Via Guido Reni 1, 04100 Latina, Italy
| | - Marco Maiotti
- Villa Stuart Hospital, Orthopedic Clinic, 00135 Roma, Italy
| | - Luca Proietti
- Division of Spinal Surgery, IRCCS Fondazione Policlinico Universitario Agostino Gemelli, Institute of Orthopaedics, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
| | | | - Antonio Santoro
- Human Neurosciences Department, Neurosurgery Division, “Sapienza” University, 00185 Rome, Italy
| | | |
Collapse
|
10
|
Meluzio MC, Smakaj A, Perna A, Velluto C, Grillo G, Proietti L, DE Martino I, Tamburrelli FC. Epidemiology, diagnosis and management of Baastrup's disease: a systematic review. J Neurosurg Sci 2022; 66:519-525. [PMID: 34342202 DOI: 10.23736/s0390-5616.21.05428-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
INTRODUCTION Baastrup's disease (BD) is a common cause of low back pain which is often underdiagnosed. It is characterized by adjacent interspinous processes contact and it can be associated with cystic lesions. The aim of this review was to evaluate the epidemiology, diagnosis, and treatment options of patients with BD. EVIDENCE ACQUISITION The present study is performed according to PRISMA statement. Medline via PubMed and Embase, Scopus, Cochrane Library database were searched using the keywords: "Baastrup," "kissing spines," "syndrome," "disease." A total of 35 papers met our inclusion criteria. Full texts were reviewed for demographic, clinical data and treatment. EVIDENCE SYNTHESIS 1308 patients were included in the studies. The mean age of the enrolled patients was 59.6 years. The M:F ratio was 1.3:1. Population-based studies demonstrated a decade on decade increase in the incidence. Standard and dynamic flexion-extension radiographs of the lumbar spine were performed in 213 (16.2%) of cases. MRI was performed in 735 patients (56.2%) whereas FDG PET/CT was used to demonstrate BD in 77 included cases (5.9%). CT scan was performed in 574 cases (43.9%). Twenty-six studies reported the treatment choice for a total of 277 patients. Anti-inflammatory drugs and physical therapy were chosen in 99 cases (35.7%). Percutaneous infiltrations and surgical decompression in 80 (28.9%) and 196 (70.7%) patients respectively. CONCLUSIONS Baastrup's disease is a common cause of low back pain. Proper diagnosis needs for imaging investigations and dynamic flexion-extension radiographs. Conservative and surgical therapies are available but there is a need for randomized clinical trials.
Collapse
Affiliation(s)
- Maria C Meluzio
- Department of Aging, Neurological, Orthopedic and Head-Neck Sciences, IRCCS A. Gemelli University Polyclinic Foundation, Rome, Italy
| | - Amarildo Smakaj
- Department of Aging, Neurological, Orthopedic and Head-Neck Sciences, IRCCS A. Gemelli University Polyclinic Foundation, Rome, Italy
| | - Andrea Perna
- Department of Aging, Neurological, Orthopedic and Head-Neck Sciences, IRCCS A. Gemelli University Polyclinic Foundation, Rome, Italy -
| | - Calogero Velluto
- Department of Aging, Neurological, Orthopedic and Head-Neck Sciences, IRCCS A. Gemelli University Polyclinic Foundation, Rome, Italy
| | - Giovanni Grillo
- Department of Aging, Neurological, Orthopedic and Head-Neck Sciences, IRCCS A. Gemelli University Polyclinic Foundation, Rome, Italy
| | - Luca Proietti
- Department of Aging, Neurological, Orthopedic and Head-Neck Sciences, IRCCS A. Gemelli University Polyclinic Foundation, Rome, Italy
- Department of Geriatrics and Orthopedics, Sacred Heart Catholic University, Rome, Italy
| | - Ivan DE Martino
- Department of Aging, Neurological, Orthopedic and Head-Neck Sciences, IRCCS A. Gemelli University Polyclinic Foundation, Rome, Italy
| | - Francesco C Tamburrelli
- Department of Aging, Neurological, Orthopedic and Head-Neck Sciences, IRCCS A. Gemelli University Polyclinic Foundation, Rome, Italy
- Department of Geriatrics and Orthopedics, Sacred Heart Catholic University, Rome, Italy
| |
Collapse
|
11
|
Ciolli G, Silva R, Giovannetti de Sanctis E, Proietti L, Mocini F, Corona K, Mazzoleni MG, Romanini E, Marescalchi M, Brancaccio V, Maccauro G, Cerciello S. Liner dissociation in total hip arthroplasty: a systematic review. Eur Rev Med Pharmacol Sci 2022; 26:138-150. [PMID: 36448866 DOI: 10.26355/eurrev_202211_30293] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
OBJECTIVE Liner dissociation (LD) is a rare catastrophic mechanical failure of total hip arthroplasty (THA). The study aims at reviewing the available literature regarding liner dissociations to point out their prevalence, describing any possible association and highlighting the surgical management at the time of revision. MATERIALS AND METHODS A systematic review of the literature was conducted from January 2002, until February 2022, according to the PRISMA guidelines. The main keywords were: "dissociation" AND "liner" OR "hip arthroplasty" OR "THA" and their MeSH terms in any possible combination. Cases of liner dissociation with all levels of evidence of any age published in indexed journals were included. The study quality of all included studies was evaluated using the MINORS criteria. The kappa (k) value was used to assess the consensus between reviewers in the selection of articles and methodological quality assessment. Finally, a sub-analysis was performed specifically concerning the elderly population. RESULTS Thirty-one manuscripts met the inclusion criteria of the systematic review (21 case reports and 10 case series). 124 LD in 123 patients, (53% females and 47% males) were evaluated. The overall prevalence of LD was 0.15%. The mean age at surgery was of 56.5 years (range 31-75 years). LD occurred in a primary surgery setting in 86% of the cases, at a mean time of presentation of 45.8 months after replacement surgery. 39.5% of the cups and 8.8% of the stems required revision. The mean follow-up after the revision was 18.4 months. Complications after revision occurred in 19.6% of cases, including 3 cases of re-dissociations. Re-revision was required in 13.6% of the revisions. The sub-analysis of the elderly population included 28 cases of LD identified in 10 manuscripts, with an average age of 73.5 years. CONCLUSIONS LD is a rare but catastrophic mechanical complication of modular THA that requires implant revision. The LD is not related to a specific prosthetic implant, liner material or design, acetabular positioning within the safe zone or age group.
Collapse
Affiliation(s)
- G Ciolli
- Orthopedics and Traumatology, Fondazione Policlinico Universitario A. Gemelli IRCCS - Sacred Heart Catholic University, Rome, Italy.
| | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
12
|
Santagada DA, Perna A, Tullo G, Proietti L, Vitiello R, Ferraro S, Giovannini S, Gasbarrini A, Franceschi F, Maccauro G, Tamburrelli FC, Covino M. Could serum procalcitonin play a role in an emergency setting for patients with pyogenic spondylodiscitis? Eur Rev Med Pharmacol Sci 2022; 26:66-77. [PMID: 36448858 DOI: 10.26355/eurrev_202211_30284] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
OBJECTIVE Spinal infections, represent quite rare but often severe conditions. However, due to symptoms' non-specificity and the lack of specific laboratory tests, diagnosis is often delayed with serious consequences for the patient's outcomes. The present investigation aimed at evaluating the role of procalcitonin (PCT) and other clinical features on the risk stratification and the clinical outcomes in spondylodiscitis patients treated in our Emergency Department. PATIENTS AND METHODS The present investigation represents a single-center retrospective study. Clinical records of consecutive patients admitted to our Emergency Department from 1 January 2015 to 31 March 2021 were evaluated and patients with spondylodiscitis diagnosis in this period were recruited. Our primary outcome was the degree of autonomy of patients following the acute event. Our secondary outcome was the resolution of the infection. RESULTS In the study period, a total of 345 patients were evaluated. Among these, 165 met the inclusion criteria, and constituted the study cohort. Concerning the primary outcome, we observed that the most significant predictive factors for being non-autonomous were elevated serum creatinine (> 1.05 mg/dl), Blood Urea Nitrogen (BUN) > 23 mg/dl, Lactate dehydrogenase > 228 U/L, PCT > 0.11 ng/mL. Patients with higher PCT (PCT > 0.11 ng/mL) and higher BUN (BUN > 23 mg/dl) had higher odds of infection persistence (the Odd Ratio, OR, were respectively 3.78 for PCT and 3.14 for BUN). CONCLUSIONS PCT assay may play a role in diagnosing spondylodiscitis in an emergency setting. A PCT value > 0.11 ng/mL should be considered as a red flag, a predictor of worse clinical outcomes and persistence of infection.
Collapse
Affiliation(s)
- D A Santagada
- Department of Orthopedics, Fondazione Policlinico Universitario "A. Gemelli" - IRCCS, Rome, Italy.
| | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
13
|
Candura D, Perna A, Velluto C, Proietti L, Mazzella GG, Borruto MI, Tamburrelli FC, Zirio G, Genitiempo M, Santagada DA. Conservative management of Anderson Type II odontoid fractures in octogenarians: is radiological union what we are searching for? Eur Rev Med Pharmacol Sci 2022; 26:33-42. [PMID: 36448854 DOI: 10.26355/eurrev_202211_30280] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
OBJECTIVE The C2 odontoid fractures represent one of the most common cervical spine injuries. Stabilization and immobility are required for a correct treatment. However, in some cases surgical treatment is recommended. There are still no guidelines for Type II odontoid fractures management. The present study aims at determining how non-union could impact on mortality, functional and clinical outcomes in octogenarian patients conservatively treated. MATERIALS AND METHODS The present investigation is a retrospective case series. All patients with diagnosis of Type II odontoid fractures, over 80 years and conservatively treated in our institution between January 2016 to April 2020 were potentially eligible for the study. The primary outcome was the bony fusion of the fracture after 3 months of conservative treatment. The secondary outcomes were clinical, functional outcomes and mortality. RESULTS Sixty-four patients were eligible for the study according to inclusion and exclusion criteria. Computer Tomography (CT) evaluation performed 3 months after trauma showed complete fracture healing in 31 patients (48.4%, Fused), while 33 patients (51.6%) were evaluated as non-fused. Among these, 6 months after the CT evaluation, 14 patients were classified as stable, while 19 were classified as unstable. There were no statistically significant changes in clinical and functional outcomes reported in our patient series between patients with complete radiological healing and patients who reported stable fibrous non-union. CONCLUSIONS In a selected group of elderly patients with a high risk for surgery, the conservative treatment of odontoid Type II fractures can be considered a viable management strategy. The achievement of a stable non-union allows for clinical and functional results comparable to complete fracture healing.
Collapse
Affiliation(s)
- D Candura
- Università Cattolica del Sacro Cuore, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy.
| | | | | | | | | | | | | | | | | | | |
Collapse
|
14
|
Proietti L, Aguglia A, Amerio A, Costanza A, Fesce F, Magnani L, Serafini G, Amore M. The efficacy of brief strategic therapy in treating obsessive-compulsive disorder: a case series. Acta Biomed 2022; 93:e2022271. [PMID: 36134720 PMCID: PMC10510989 DOI: 10.23750/abm.v93is1.13064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 03/29/2022] [Accepted: 05/17/2022] [Indexed: 01/27/2023]
Abstract
BACKGROUND AND AIM International guidelines indicate pharmacological therapy and cognitive-behavioral therapy (CBT) as gold standard treatments for obsessive-compulsive disorder (OCD). However, up to 40% patients do not fully respond to CBT, thus manifesting persistent symptomatology. Empirical research reported brief strategic therapy (BST) as a potential treatment for OCD. The aim of the present study is to evaluate the efficacy of BST in treating OCD and to identify the clinical characteristics associated to response. METHODS BST protocol was administered to patients with OCD. During a 24-weeks observational phase, the following scales have been administered at the baseline and every 4 weeks: Yale Brown Obsessive-Compulsive scale (Y-BOCS), Clinical Global Impression, Global Assessment of Functioning, Quality of Life Index, Medical Outcomes Study Short Form 12-item, Clinical Outcomes in Routine Evaluation-Outcome Measure, Generalized Anxiety Disorder Scale, Patient Health Questionnaire - 9 and Somatic Symptom Scale-8. RESULTS eight patients completed the treatment and a subgroup of five patients obtained clinical remission, defined as Y-BOCS total score < 25. The repeated measures ANOVA performed showed a significant decreased of the Y-BOCS total scores (p<.001). Comparisons between the two subgroups (remitters vs. non-remitters) highlighted some potential baseline characteristics associated with remission: i.e., higher mean level of anxiety, quality of life, physical health, and lower mean level of somatic symptoms and lower prevalence of personality disorders comorbidity. CONCLUSIONS BST could be a useful therapeutic strategy in treating OCD patients. Further studies with larger samples and with long-term follow-up are needed to assess the post-treatment maintenance of clinical effects.
Collapse
|
15
|
Taccardo G, Perna A, Santagada A, Passiatore M, Velluto C, Proietti L, Muscolino S, De Vitis R, D'Orio M. DOES AN EARLY POST-OPERATIVE PAIN RELIEVE INFLUENCE THE FUNCTIONAL OUTCOME OF PATIENTS WITH COLLES FRACTURES TREATED WITH EG-BLOCK SYSTEM? Georgian Med News 2022:11-16. [PMID: 36427833] [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] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
Distal Radius Fractures (DRFs) represent one of the most common elderly patient's fractures. Often DRFs required surgical treatment based on instability of the fragments and due to the high functional demand from patients. A general agreement on the best pharmacological treatment in the post-operative is still missing. The present study describes the clinical outcome in patients who underwent surgery for Colles fracture using ES fixation osteosynthesis. ; The present investigation represents a one center retrospective analysis. In this study, two different medical treatments were recognized, and groups consequently set (Group A: Ketoprofene 100 mg twice a day for 5 days, 59 patients; Group B: Tramadol 75 mg and Dexketoprofen 25 mg, 62 patients). Outcomes were the functionality of the affected wrist through AROM assessment and the evaluation of painkillers intake, pain itself and Quick-DASH.; 121 patients were included in the present study. The pharma blending of Tramadol 75 mg and Dexketoprofen 25 mg resulted effective for the rapid recovery of the treated wrist motion. In fact, in the group B motion was better compared to group A (p<0.05) for any movement examined (flexion, extension, pronation, supination) until the last follow-up (70 days).; Associations of different painkillers are common, even if a general agreement on the most effective combination is still missing. Tramadol and Dexketoprofen provide a good clinical result, less side effects and a better functional recovery of the wrist motion. This guarantees a fewer social cost and a best management of post-operative physiotherapy.
Collapse
Affiliation(s)
- G Taccardo
- 1Department of Orthopaedics, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - A Perna
- 1Department of Orthopaedics, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - A Santagada
- 1Department of Orthopaedics, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - M Passiatore
- 2Bone and Joint Surgery Department, ASST - Spedali Civili, Brescia, Italy
| | - C Velluto
- 1Department of Orthopaedics, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - L Proietti
- 1Department of Orthopaedics, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | | | - R De Vitis
- 1Department of Orthopaedics, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - M D'Orio
- 1Department of Orthopaedics, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| |
Collapse
|
16
|
Vagnani G, Proietti L, Gatti C. Does the founders’ involvement in R&D influence SMEs’ performance? Technology Analysis & Strategic Management 2022. [DOI: 10.1080/09537325.2022.2116573] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/15/2022]
Affiliation(s)
- Gianluca Vagnani
- Department of Management, Sapienza, University of Rome – Faculty of Economics, Rome, Italy
| | - Luca Proietti
- Department of Management, Sapienza, University of Rome – Faculty of Economics, Rome, Italy
| | - Corrado Gatti
- Department of Management, Sapienza, University of Rome – Faculty of Economics, Rome, Italy
| |
Collapse
|
17
|
di Vico G, Simonetta R, Correra G, Corona K, Proietti L, Morris BJ, Cerciello S. Popliteomeniscal fascicles tears with lateral meniscus instability: outcomes of arthroscopic surgical technique at mid-term follow-up. Arch Orthop Trauma Surg 2022; 143:2573-2579. [PMID: 35927338 DOI: 10.1007/s00402-022-04486-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2021] [Accepted: 05/16/2022] [Indexed: 11/02/2022]
Abstract
PURPOSE The popliteomeniscal fascicles (PMFs) are a crucial part of the posterolateral corner of the knee. They provide stability to the lateral meniscus and stabilize the joint during tibial internal rotation. The clinical diagnosis of a torn PMFs is difficult, and magnetic resonance imaging (MRI) may be inconclusive as well. The aim of the present study was to report the outcomes of a continuous series of patients affected by PMF lesions and treated with an arthroscopic repair. METHODS Seventeen patients (average age of 22 ± 3.6 years) with PMF lesions and lateral meniscus instability were prospectively enrolled. All patients were evaluated with clinical examination, International Knee Documentation Committee (IKDC), Lysholm and Tegner scores and 1.5 T MRI. All patients had the same arthroscopic procedure consisting of meniscal repair with an all-inside meniscal repair system (mean 2.2 ± 0.77 anchors) and followed with the same postoperative protocol. RESULTS All patients were available at a mean follow-up of 68 ± 24 months (range 49-84 months). Mean IKDC increased from 60.2 ± 13.5 to 83.1 ± 12, mean Lysholm score improved from 56.7 ± 8.2 to 89.8 ± 3.2, and mean Tegner score improved from 2.9 ± 1.3 to 6.5 ± 2. No intraoperative or postoperative complications were reported. MRI evaluation at 6-month follow-up showed successful healing of the menisco-popliteal fascicles in all cases. CONCLUSIONS The diagnosis and treatment of tears of the PMFs is still debated. Diagnostic confirmation of tearing of the PMFs is usually determined at the time of arthroscopy. Meniscal repair with an all-inside meniscal repair system appears to be an excellent treatment option, since it yields good functional results at mid-term follow-up, no local complications, and complete radiographic healing at 6-month follow-up MRI. Further studies are needed to confirm these promising early results. LEVEL OF EVIDENCE Case series, 4.
Collapse
Affiliation(s)
- G di Vico
- Department of Orthopaedics and Trauma Surgery, Clinica San Michele, Caserta, Maddaloni, Italy
| | - R Simonetta
- Cure Ortopediche Traumatologiche Messina, Messina, Italy
| | - G Correra
- Ospedale Cardarelli Napoli, Naples, Italy
| | - K Corona
- Department of Medicine and Health Sciences "Vincenzo Tiberio", University of Molise, Campobasso, Italy.
| | | | - B J Morris
- Baptist Health Medical Group Orthopedics and Sports Medicine, Lexington, USA
| | - S Cerciello
- Casa Di Cura Villa Betania, Rome, Italy.,Marrelli Hospital, Crotone, Italy.,Department of Orthopaedics, A. Gemelli University Hospital Foundation IRCCS, Catholic University, Rome, Italy
| |
Collapse
|
18
|
Perna A, Mancino F, Campana V, Satta P, Marcialis V, Glorioso D, Monterossi M, Proietti L, De Santis V. Is it time to resume elective knee arthroplasty surgery? A multidisciplinary experience in a Sardinian center during the SARS-CoV-2 pandemic. Orthop Rev (Pavia) 2022; 14:33768. [PMID: 35774931 PMCID: PMC9239359 DOI: 10.52965/001c.33768] [Citation(s) in RCA: 1] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2021] [Accepted: 10/24/2021] [Indexed: 09/19/2023] Open
Abstract
Background Starting in January 2020, the SARS-CoV-2 pandemic caused changes in the nation's health systems. The hospital's reorganization led to a near-total stop of non-urgent, elective surgeries across all specialties, including hip and knee arthroplasty. However, in May 2020, a gradual elective surgery restarting was possible. Considering the risk of COVID-19 infections, the European Knee Associates suggest the need to implement specific protocols for a safe return to orthopaedic elective surgery. Methods A retrospective analysis regarding all patients who underwent primary knee arthroplasty (TKA) between March 1st and October 1st, 2020 using an institutional database was performed. The study time was divided into 2 periods: Pandemic (from March 2020 to May 2020), Post Pandemic (from June 2020 to October 2020). A specific protocol was designed to safeguard the health of patients and healthcare workers during the SARS-CoV-2 pandemic. Results A total of 147 patients underwent total knee replacement surgery in the analyzed period. The mean surgical time was 77.6 (+/-18.9). The intraoperative mean blood loss was 54 (+/-28) ml. The mean hospital stay was 3-4 days. Among the treated patients no case of COVID-19 infection was observed. Conclusion The use of our protocol, developed ad hoc for the management of elective orthopedic patients, allowed the restart of elective orthopedic surgery in a safe and reproducible way with an average increase of 374% on surgical activity between the pandemic and post-pandemic periods without record cases of contagion among the treated patients.
Collapse
Affiliation(s)
- Andrea Perna
- Department of Geriatrics, Neurosciences and Orthopaedics, Fondazione Policlinico Universitario Agostino Gemelli IRCCS
| | - Fabio Mancino
- Department of Geriatrics, Neurosciences and Orthopaedics, Fondazione Policlinico Universitario Agostino Gemelli IRCCS
| | | | - Paolo Satta
- Department of Orthopaedics, Mater Olbia Hospital
| | | | - Davide Glorioso
- Department of Geriatrics, Neurosciences and Orthopaedics, Fondazione Policlinico Universitario Agostino Gemelli IRCCS
| | - Martina Monterossi
- Department of Anaesthesiology, Intensive Care Medicine and Toxicology, Fondazione Policlinico Universitario Agostino Gemelli IRCCS
| | - Luca Proietti
- Department of Geriatrics, Neurosciences and Orthopaedics, Fondazione Policlinico Universitario Agostino Gemelli IRCCS
| | - Vincenzo De Santis
- Department of Orthopaedics and Traumatology, Università Cattolica del Sacro Cuore
| |
Collapse
|
19
|
Perna A, Smakaj A, Vitiello R, Velluto C, Proietti L, Tamburrelli FC, Maccauro G. Posterior Percutaneous Pedicle Screws Fixation Versus Open Surgical Instrumented Fusion for Thoraco-Lumbar Spinal Metastases Palliative Management: A Systematic Review and Meta-analysis. Front Oncol 2022; 12:884928. [PMID: 35444954 PMCID: PMC9013833 DOI: 10.3389/fonc.2022.884928] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2022] [Accepted: 03/14/2022] [Indexed: 02/02/2023] Open
Abstract
Background Surgical palliative treatment of spinal metastases (SM) could influence the quality of life (QoL) in cancer patients, since the spine represents the most common site of secondary bony localization. Traditional open posterior instrumented fusion (OPIF) and Percutaneous pedicle screw fixation (PPSF) became the main surgical treatment alternatives for SM, but in Literature there is no evidence that describes the absolute superiority of one treatment over the other. Materials and Methods This is a systematic review and meta-analysis of comparative studies on PPSF versus OPIF in patients with SM, conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. The outcomes of interest were: complications, blood loss, infections, mortality, pain and also the Quality of Life (QoL). Results There were a total of 8 studies with 448 patients included in the meta-analyses. Postoperative complications were more frequent in OPIF (odds ratio of 0.48. 95% CI, 0.27 to 0.83; p= 0.01), PPFS was associated with blood loss (odds ratio -585.70. 95% IC, -848.28 to -323.13.69; p< 0.0001) and a mean hospital stay (odds ratio -3.77. 95% IC, -5.92 to -1.61; p= 0.0006) decrease. The rate of infections was minor in PPFS (odds ratio of 0.31. 95% CI, 0.12 to 0.81; p= 0.02) whereas the occurrence of reinterventions (0.76. 95% CI, 0.25 to 2.27; p= 0.62) and the mortality rate was similar in both groups (odds ratio of 0.79. 95% CI, 0.40 to 1.58; p= 0.51). Finally, we also evaluated pre and post-operative VAS and the meta-analysis suggested that both techniques have a similar effect on pain. Discussion and Conclusion The PPSF treatment is related with less complications, a lower rate of infections, a reduction in intraoperative blood loss and a shorter hospital stay compared to the OPIF treatment. However, further randomized clinical trials could confirm the results of this meta-analysis and provide a superior quality of scientific evidence.
Collapse
Affiliation(s)
- Andrea Perna
- Department of Geriatrics and Orthopaedic Sciences, Università Cattolica del Sacro Cuore, Rome, Italy
- Department of Aging, Neurological, Orthopaedic and Head-Neck Sciences, Fondazione Policlinico Universitario Agostino Gemelli Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Rome, Italy
- *Correspondence: Andrea Perna,
| | - Amarildo Smakaj
- Department of Geriatrics and Orthopaedic Sciences, Università Cattolica del Sacro Cuore, Rome, Italy
- Department of Aging, Neurological, Orthopaedic and Head-Neck Sciences, Fondazione Policlinico Universitario Agostino Gemelli Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Rome, Italy
| | - Raffaele Vitiello
- Department of Geriatrics and Orthopaedic Sciences, Università Cattolica del Sacro Cuore, Rome, Italy
- Department of Aging, Neurological, Orthopaedic and Head-Neck Sciences, Fondazione Policlinico Universitario Agostino Gemelli Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Rome, Italy
| | - Calogero Velluto
- Department of Geriatrics and Orthopaedic Sciences, Università Cattolica del Sacro Cuore, Rome, Italy
- Department of Aging, Neurological, Orthopaedic and Head-Neck Sciences, Fondazione Policlinico Universitario Agostino Gemelli Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Rome, Italy
| | - Luca Proietti
- Department of Geriatrics and Orthopaedic Sciences, Università Cattolica del Sacro Cuore, Rome, Italy
- Department of Aging, Neurological, Orthopaedic and Head-Neck Sciences, Fondazione Policlinico Universitario Agostino Gemelli Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Rome, Italy
| | - Francesco Ciro Tamburrelli
- Department of Geriatrics and Orthopaedic Sciences, Università Cattolica del Sacro Cuore, Rome, Italy
- Department of Aging, Neurological, Orthopaedic and Head-Neck Sciences, Fondazione Policlinico Universitario Agostino Gemelli Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Rome, Italy
| | - Giulio Maccauro
- Department of Geriatrics and Orthopaedic Sciences, Università Cattolica del Sacro Cuore, Rome, Italy
- Department of Aging, Neurological, Orthopaedic and Head-Neck Sciences, Fondazione Policlinico Universitario Agostino Gemelli Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Rome, Italy
| |
Collapse
|
20
|
Bongiorno T, Foglio L, Proietti L, Vasconi M, Moretti V, Lopez A, Carminati D, Galafat A, Vizcaíno A, Fernández FA, Alarcón F, Parati K. Hydrolyzed microalgae from biorefinery as a potential functional ingredient in Siberian sturgeon (A. baerii Brandt) aquafeed. ALGAL RES 2022. [DOI: 10.1016/j.algal.2021.102592] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
|
21
|
Perna A, Proietti L, Smakaj A, Velluto C, Meluzio MC, Rovere G, Florio D, Zirio G, Tamburrelli FC. The role of femoral obliquity angle and T1 pelvic angle in predicting quality of life after spinal surgery in adult spinal deformities. BMC Musculoskelet Disord 2021; 22:999. [PMID: 34847906 PMCID: PMC8630841 DOI: 10.1186/s12891-021-04823-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2021] [Accepted: 10/27/2021] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Adult spinal deformities (ASD) represent a growing clinical condition related to chronic pain, disability and reduction in quality of life (QoL). A strong correlation among spinal alignment, spinopelvic parameters and QoL after spinal fusion surgery in ASD patients was thoroughly investigated over the last decade, However, only few studies focused on the relationship between lumbo-pelvic-femoral parameters - such as Femoral Obliquity Angle (FOA), T1 Pelvic Angle (TPA) and QoL. METHODS Radiological and clinical data from 43 patients surgically treated with thoracolumbar posterior spinal fusion for ASD between 2015 and 2018 were retrospectively analyzed. The primary outcomes were the correlation between preoperative spino-pelvic-femoral parameters and postoperative clinical, functional outcomes and QoL. Secondary outcomes were: changes in sagittal radiographic parameters spino-pelvic-femoral, clinical and functional outcomes and the rate of complications after surgery. RESULTS Using Spearman's rank correlation coefficients, spinopelvic femoral parameters (FOA, TPA, pre and post-operative) are directly statistically correlated to the quality of life (ODI, SRS-22, pre and post-operative; > 0,6 strong correlation, p < 0.05). Stratifying the patients according pre preoperative FOA value (High FOA ≥ 10 and Normal/Low FOA < 10), those belonging to the first group showed worse clinical (VAS: 5.2 +/- 1.4 vs 2.9 +/- 0.8) and functional outcomes (ODI: 35.6+/- 6.8 vs 23.2 +/- 6.5) after 2 years of follow-up and a greater number of mechanical complications (57.9% vs 8.3% p < 0.0021). CONCLUSION Based on our results, preoperative FOA and TPA could be important prognostic parameters for predicting disability and quality of life after spinal surgery in ASD patients and early indicators of possible spinal sagittal malalignment. FOA and TPA, like other and better known spinopelvic parameters, should always be considered when planning corrective surgery in ASD patients.
Collapse
Affiliation(s)
- Andrea Perna
- Fondazione Policlinico Universitario Agostino Gemelli - IRCCS, Largo A. Gemelli, 8, 00168, Rome, Italy
- Istituto di Ortopedia e Traumatologia, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Luca Proietti
- Fondazione Policlinico Universitario Agostino Gemelli - IRCCS, Largo A. Gemelli, 8, 00168, Rome, Italy
- Istituto di Ortopedia e Traumatologia, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Amarildo Smakaj
- Fondazione Policlinico Universitario Agostino Gemelli - IRCCS, Largo A. Gemelli, 8, 00168, Rome, Italy.
- Istituto di Ortopedia e Traumatologia, Università Cattolica del Sacro Cuore, Rome, Italy.
| | - Calogero Velluto
- Fondazione Policlinico Universitario Agostino Gemelli - IRCCS, Largo A. Gemelli, 8, 00168, Rome, Italy
- Istituto di Ortopedia e Traumatologia, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Maria Concetta Meluzio
- Fondazione Policlinico Universitario Agostino Gemelli - IRCCS, Largo A. Gemelli, 8, 00168, Rome, Italy
- Istituto di Ortopedia e Traumatologia, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Giuseppe Rovere
- Fondazione Policlinico Universitario Agostino Gemelli - IRCCS, Largo A. Gemelli, 8, 00168, Rome, Italy
- Istituto di Ortopedia e Traumatologia, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Daniela Florio
- Istituto di Ortopedia e Traumatologia, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Gianfranco Zirio
- Fondazione Policlinico Universitario Agostino Gemelli - IRCCS, Largo A. Gemelli, 8, 00168, Rome, Italy
- Istituto di Ortopedia e Traumatologia, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Francesco Ciro Tamburrelli
- Fondazione Policlinico Universitario Agostino Gemelli - IRCCS, Largo A. Gemelli, 8, 00168, Rome, Italy
- Istituto di Ortopedia e Traumatologia, Università Cattolica del Sacro Cuore, Rome, Italy
| |
Collapse
|
22
|
Armocida D, Pesce A, Cimatti M, Proietti L, Santoro A, Frati A. Minimally Invasive Transforaminal Lumbar Interbody Fusion Using Expandable Cages: Increased Risk of Late Postoperative Subsidence Without a Real Improvement of Perioperative Outcomes: A Clinical Monocentric Study. World Neurosurg 2021; 156:e57-e63. [PMID: 34492389 DOI: 10.1016/j.wneu.2021.08.127] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2021] [Revised: 08/26/2021] [Accepted: 08/27/2021] [Indexed: 01/12/2023]
Abstract
BACKGROUND Minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF) is one of several approaches to lumbar interbody fusion that has proven to be a safe and effective treatment for symptomatic lumbar degenerative disease The clinical outcomes of MIS-TLIF are generally favorable, but there is still controversy regarding its ability to restore sagittal alignment. For this reason, expandable transforaminal lumbar interbody fusion cages have been developed and designed to improve ability to restore disc height and segmental lordosis. The use of expandable cages in transforaminal lumbar interbody fusion has increased drastically; however, it is not clear how effective cage expansion is in regard to disc space lordosis, distraction, and long-term outcome. METHODS We reviewed a cohort of patients with symptomatic lumbar degenerative disc pathology who underwent MIS-TLIF at our institution. We compared clinical and radiographic outcomes of expandable versus nonexpandable cage use in MIS-TLIF focusing on mean changes in segmental lordosis, disc height, and postoperative complications. The results were compared with other studies reported in the international literature. RESULTS Mean change in segmental lordosis was not significantly different between the 2 groups. A significantly higher rate of postoperative subsidence was demonstrated in the expandable cage group. CONCLUSION This study established that expandable cage use in single-level transforaminal lumbar interbody fusion did not reduce the rate of postoperative complications, but rather significantly increased a patient's risk of postoperative subsidence. Expandable cages do not presently demonstrate improved clinical outcomes or improved sagittal alignment compared with static cages.
Collapse
Affiliation(s)
- Daniele Armocida
- Human Neurosciences Department, Sapienza University, Rome, Italy.
| | | | - Marco Cimatti
- Human Neurosciences Department, Sapienza University, Rome, Italy
| | - Luca Proietti
- Division of Spinal Surgery, IRCCS Fondazione Policlinico Universitario Agostino Gemelli, Rome, Italy; Institute of Orthopaedics, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Antonio Santoro
- Human Neurosciences Department, Sapienza University, Rome, Italy
| | - Alessandro Frati
- Human Neurosciences Department, Sapienza University, Rome, Italy; IRCCS Neuromed, Pozzilli, Italy
| |
Collapse
|
23
|
Ricciardi L, Scerrati A, Bonis PD, Miscusi M, Trungu S, Visocchi M, Papacci F, Raco A, Proietti L, Pompucci A, Olivi A, Montano N. Long-term Radiologic and Clinical Outcomes after Three-level Contiguous Anterior Cervical Diskectomy and Fusion without Plating: A Multicentric Retrospective Study. J Neurol Surg A Cent Eur Neurosurg 2021; 82:556-561. [PMID: 34010980 DOI: 10.1055/s-0041-1726112] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
BACKGROUND Anterior cervical diskectomy and fusion (ACDF) has been providing good surgical, clinical, and radiologic outcomes in patients suffering from cervical degenerative disk disease (DDD). However, the role of anterior plating is still debated, especially in three-level procedures. This study aimed to investigate long-term clinical and radiologic outcomes and complications after three-level contiguous ACDF without plating for cervical DDD. METHODS Two institutional databases were retrieved (January 2009-December 2014) for patients treated with three-level contiguous ACDF without plating. Minimum follow-up (FU) was 5 years. Demographical data, smoking status, implant types, Neck Disability Index (NDI), visual analog scale (VAS) for neck pain, complications, fusion rate, adjacent segment degeneration (ASD), cervical lordosis (CL), and residual segmental mobility were evaluated. RESULTS We enrolled 21 patients. Tantalum and carbon fiber cages were implanted, respectively, in 13 and 8 patients. The mean FU length was 5.76 ± 0.87 years. Mean NDI score was 78.29 ± 9.98% preoperatively and 8.29 ± 1.67% at last FU (p < 0.01), whereas mean VAS score decreased from 7.43 ± 1.14 preoperatively to 0.95 ± 0.95 at last FU (p < 0.01). Complications were one postoperative hematoma, one superficial wound infection, and five cases of postoperative dysphagia (recovered within 3 days). The fusion rate was 90% and ASD was reported in three (14%) cases. The mean CL was 6.33 ± 2.70 degrees preoperatively, 8.19 ± 1.97 degrees 3 months after surgery (p = 0.02), and 7.62 ± 1.96 degrees at latest FU. There was no residual mobility on every operated segment at last FU. The smoking status was an independent risk factor for nonfusion in this case series (p = 0.02). CONCLUSIONS Three-level contiguous ACDF without plating seems to be an effective treatment for cervical DDD. Properly designed comparative clinical trials are needed to further investigate this topic.
Collapse
Affiliation(s)
- Luca Ricciardi
- UO di Neurochirurgia, Pia Fondazione di Culto e Religione Cardinal G. Panico, Tricase, Italy
| | - Alba Scerrati
- UOC di Neurochirurgia, Azienda Ospedaliera Sant'Anna, Dipartimento di Morfologia, Chirurgia e Medicina Sperimentale, Università di Ferrara, Ferrara, Italy
| | - Pasquale De Bonis
- UOC di Neurochirurgia, Azienda Ospedaliera Sant'Anna, Dipartimento di Morfologia, Chirurgia e Medicina Sperimentale, Università di Ferrara, Ferrara, Italy
| | - Massimo Miscusi
- UOC di Neurochirurgia, Azienda Ospedaliera Sant'Andrea, Sapienza, Roma, Italy
| | - Sokol Trungu
- UO di Neurochirurgia, Pia Fondazione di Culto e Religione Cardinal G. Panico, Tricase, Italy.,UOC di Neurochirurgia, Azienda Ospedaliera Sant'Andrea, Sapienza, Roma, Italy
| | - Massimiliano Visocchi
- UOC di Neurochirurgia, Fondazione Policlinico Universitario A. Gemelli IRCCS, UCSC, Roma, Italy
| | - Fabio Papacci
- UOC di Neurochirurgia, Fondazione Policlinico Universitario A. Gemelli IRCCS, UCSC, Roma, Italy
| | - Antonino Raco
- UOC di Neurochirurgia, Azienda Ospedaliera Sant'Andrea, Sapienza, Roma, Italy
| | - Luca Proietti
- UOC di Chirurgia Vertebrale, Fondazione Policlinico Universitario A. Gemelli IRCCS, UCSC, Roma, Italy
| | - Angelo Pompucci
- UOC di Neurochirurgia, Ospedale Santa Maria Goretti, Latina, Italy
| | - Alessandro Olivi
- UOC di Neurochirurgia, Fondazione Policlinico Universitario A. Gemelli IRCCS, UCSC, Roma, Italy
| | - Nicola Montano
- UOC di Neurochirurgia, Fondazione Policlinico Universitario A. Gemelli IRCCS, UCSC, Roma, Italy
| |
Collapse
|
24
|
Perna A, Passiatore M, Massaro A, Terrinoni A, Bianchi L, Cilli V, D’Orio M, Proietti L, Taccardo G, De Vitis R. Skin manifestations in COVID-19 patients, state of the art. A systematic review. Int J Dermatol 2021; 60:547-553. [PMID: 33533036 PMCID: PMC8014166 DOI: 10.1111/ijd.15414] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Revised: 12/10/2020] [Accepted: 12/15/2020] [Indexed: 01/08/2023]
Abstract
INTRODUCTION Since COVID-19 has become a pandemic, extensive literature has been produced. The commonest symptoms of COVID-19 disease are fever, cough, anosmia, and lymphocytopenia. However, other apparently less common clinical symptoms have been described, including skin lesions. We conducted a systematic review to evaluate skin involvement in COVID-19. METHODS The authors performed a systematic review of literature, in accordance with the Preferred Reporting Items for Systematic and Meta-Analysis (PRISMA). The search was reiterated until May 06, 2020. RESULTS Overall, 1593 patients (M/F ratio: 1 : 9) with suspect of COVID-19 were examined. The mean age was 37.8 (range 0-91) years. Among the analyzed patients, 84 (5.3%) were pediatrics (<18 years). Chilblains are very common among skin lesions and represent almost half of all skin lesions reported (46%); in 75% of patients with cutaneous manifestation, the latter presented before other typical clinical manifestation of COVID-19. Vasculitis or thrombosis was identified in almost 70% of patients who suffered from skin manifestations. CONCLUSION The present study highlights the importance of skin involvement in COVID-19. Limbs should be examined to eventually foresee the onset of further typical symptoms. Chilblains can be considered typical features. Studies with higher scientific evidence are required.
Collapse
Affiliation(s)
- Andrea Perna
- Istituto di Clinica OrtopedicaFondazione Policlinico Universitario A. Gemelli IRCCSRomaItalia
| | - Marco Passiatore
- Istituto di Clinica OrtopedicaFondazione Policlinico Universitario A. Gemelli IRCCSRomaItalia
| | - Antonio Massaro
- Unità Operativa di DermatologiaDipartimento di Medicina dei SistemiUniversità di Roma Tor VergataRomaItalia
| | | | - Luca Bianchi
- Unità Operativa di DermatologiaDipartimento di Medicina dei SistemiUniversità di Roma Tor VergataRomaItalia
| | - Vitale Cilli
- Chirurgie de la MainCHIREC site DeltaBruxellesBelgique
| | - Marco D’Orio
- Istituto di Clinica OrtopedicaFondazione Policlinico Universitario A. Gemelli IRCCSRomaItalia
| | - Luca Proietti
- Istituto di Clinica OrtopedicaFondazione Policlinico Universitario A. Gemelli IRCCSRomaItalia,Università Cattolica del Sacro CuoreRomaItalia
| | - Giuseppe Taccardo
- Istituto di Clinica OrtopedicaFondazione Policlinico Universitario A. Gemelli IRCCSRomaItalia,Università Cattolica del Sacro CuoreRomaItalia
| | - Rocco De Vitis
- Istituto di Clinica OrtopedicaFondazione Policlinico Universitario A. Gemelli IRCCSRomaItalia,Università Cattolica del Sacro CuoreRomaItalia
| |
Collapse
|
25
|
Tundo A, Musetti L, Del Grande C, de Filippis R, Proietti L, Cambiali E, Franceschini C, Dell'Osso L. Is short-term antidepressant treatment effective and safe in bipolar depression? Results from an observational multicenter study. Hum Psychopharmacol 2021; 36:e2773. [PMID: 33351233 DOI: 10.1002/hup.2773] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2020] [Revised: 09/27/2020] [Accepted: 12/01/2020] [Indexed: 12/30/2022]
Abstract
OBJECTIVES To investigate the short-term effectiveness and the short-term and long-term safety of acute antidepressant (AD) treatment of bipolar depression in a naturalistic setting. METHODS Patients with bipolar (n = 86) or unipolar (n = 111) depression were consecutively recruited and treated with AD (combined with mood stabilizer [MS] and/or second-generation antipsychotics in bipolar depression). Exclusion criteria were mixed depression, high mood instability, previous predominantly mixed depression (both bipolar and unipolar depression), rapid cycling course and previous switch AD-emerging (bipolar depression). RESULTS After 12 weeks of treatment, no difference was found in remission, response and improvement rates between bipolar and unipolar depression. Concerning short-term safety, switching and suicidality did not differ significantly between the two groups, and no suicide attempt was observed. Concerning long-term safety, patients with bipolar depression had a significant reduction of depressive and total recurrences during the year of follow-up, compared to the year before entering the study, without significant changes in (hypo)mania and mixed depression recurrences, and suicide rates. CONCLUSIONS Acute AD treatment of bipolar depression is effective in the short-term and safe in the short- and long-term, when administered in combination with MSs and/or second-generation antipsychotics, with a low risk of switch, mixed depression and cycle acceleration.
Collapse
Affiliation(s)
| | - Laura Musetti
- Department of Clinical and Experimental Medicine, Section of Psychiatry, University of Pisa, Pisa, Italy
| | - Claudia Del Grande
- Department of Clinical and Experimental Medicine, Section of Psychiatry, University of Pisa, Pisa, Italy
| | | | | | - Erika Cambiali
- Department of Clinical and Experimental Medicine, Section of Psychiatry, University of Pisa, Pisa, Italy
| | - Caterina Franceschini
- Department of Clinical and Experimental Medicine, Section of Psychiatry, University of Pisa, Pisa, Italy
| | - Liliana Dell'Osso
- Department of Clinical and Experimental Medicine, Section of Psychiatry, University of Pisa, Pisa, Italy
| |
Collapse
|
26
|
Fumo C, Armocida D, Perna A, Pesce A, Ricci E, Tamburrelli FC, Frati A, Santoro A, Proietti L. Surgical Decision-Making in Spinal Instability in Facioscapulohumeral Muscular Dystrophy Related with a Spinal Muscle Atrophy. J Neurosci Rural Pract 2021; 12:445-446. [PMID: 33927541 PMCID: PMC8064827 DOI: 10.1055/s-0041-1722816] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Affiliation(s)
- Caterina Fumo
- Division of Spinal Surgery, IRCCS Fondazione Policlinico Universitario Agostino Gemelli, Rome, Italy
| | - Daniele Armocida
- Neurosurgery Division, Human Neurosciences Department, "Sapienza" University, Italy
| | - Andrea Perna
- Division of Spinal Surgery, IRCCS Fondazione Policlinico Universitario Agostino Gemelli, Rome, Italy
| | | | - Enzo Ricci
- Division of Neurology, IRCCS Fondazione Policlinico Universitario Agostino Gemelli, Rome, Italy.,Institute of Neurology, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Francesco Ciro Tamburrelli
- Division of Spinal Surgery, IRCCS Fondazione Policlinico Universitario Agostino Gemelli, Rome, Italy.,Institute of Orthopaedic, Università Cattolica del Sacro Cuore, Rome, Italy
| | | | - Antonio Santoro
- Neurosurgery Division, Human Neurosciences Department, "Sapienza" University, Italy
| | - Luca Proietti
- Division of Spinal Surgery, IRCCS Fondazione Policlinico Universitario Agostino Gemelli, Rome, Italy.,Institute of Orthopaedic, Università Cattolica del Sacro Cuore, Rome, Italy
| |
Collapse
|
27
|
Perna A, Santagada DA, Bocchi MB, Zirio G, Proietti L, Tamburrelli FC, Genitiempo M. Early loss of angular kyphosis correction in patients with thoracolumbar vertebral burst (A3-A4) fractures who underwent percutaneous pedicle screws fixation. J Orthop 2021; 24:77-81. [PMID: 33679031 DOI: 10.1016/j.jor.2021.02.029] [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] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2020] [Revised: 12/28/2020] [Accepted: 02/14/2021] [Indexed: 11/16/2022] Open
Abstract
Purpose Percutaneous trans-pedicle screws represent a surgical option frequently performed in patients affected by thoracolumbar vertebral burst fractures (A3-A4). The aim of the study was to evaluate the early loss of kyphosis correction and its clinical correlations in a cohort of patients affected by burst spinal fracture treated with percutaneous trans-pedicle screws fixation. Methods The present investigation consists in a retrospective one center analysis. The primary outcome was the evaluation of the early loss of correction. Secondary outcomes were the bi-segmental kyphosis change, the clinical outcome and the correlation between clinical outcome and the loss of correction. Results Among 435 patients 97 were included in the study. A mean 3.3° of early loss of correction was observed between postoperative and 1 month follow-up evaluations. The mean anterior vertebral body height change was 3.8 mm. No statistical differences were found in clinical and functional outcomes between patients with >2° or <2° of kyphosis loss of correction. Conclusion No statistical differences were found between 1 e 6 months postoperative kyphosis loss of correction. The amount of loss of correction seems not to influence clinical outcomes after percutaneous trans-pedicle screw fixation in patients with vertebral burst fractures.
Collapse
Affiliation(s)
- Andrea Perna
- Istituto di Clinica Ortopedica, Fondazione Policlinico Universitario A. Gemelli, Catholic University, Rome, Italy
| | | | - Maria Beatrice Bocchi
- Istituto di Clinica Ortopedica, Fondazione Policlinico Universitario A. Gemelli, Catholic University, Rome, Italy
| | - Gianfranco Zirio
- Istituto di Clinica Ortopedica, Fondazione Policlinico Universitario A. Gemelli, Catholic University, Rome, Italy
| | - Luca Proietti
- Istituto di Clinica Ortopedica, Fondazione Policlinico Universitario A. Gemelli, Catholic University, Rome, Italy.,Istituto di Clinica Ortopedica, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Francesco Ciro Tamburrelli
- Istituto di Clinica Ortopedica, Fondazione Policlinico Universitario A. Gemelli, Catholic University, Rome, Italy.,Istituto di Clinica Ortopedica, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Maurizio Genitiempo
- Istituto di Clinica Ortopedica, Fondazione Policlinico Universitario A. Gemelli, Catholic University, Rome, Italy
| |
Collapse
|
28
|
Perna A, Ricciardi L, Fantoni M, Taccari F, Torelli R, Santagada DA, Fumo C, Tamburrelli FC, Proietti L. Spontaneous Vertebral Aspergillosis, the State of Art: A Systematic Literature Review. Neurospine 2020; 18:23-33. [PMID: 33211946 PMCID: PMC8021829 DOI: 10.14245/ns.2040338.169] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Accepted: 07/23/2020] [Indexed: 01/07/2023] Open
Abstract
Objective Vertebral aspergillosis is quite rare conditions, often misdiagnosed, that requires long-term antibiotic therapy, and sometimes, surgical treatments. The present investigations were aimed to investigate the epidemiology, clinical-radiological aspects, treatment protocols, and outcomes of Aspergillus-mediated vertebral osteomyelitis.
Methods A systematic review of the pertinent English literature according to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines was performed. The research was conducted on Cochrane library, MEDLINE, PubMed, and Scopus using as search-terms “Aspergillus,” “vertebral osteomyelitis,” “spondylodiscitis,” “spine infection.” A case of vertebral aspergillosis conservatively managed was also reported.
Results Eighty-nine articles were included in our systematic review. Including the reported case, our analysis covered 112 cases of vertebral aspergillosis. Aspergillus fumigatus was isolated in 68 cases (61.2%), Aspergillus flavus in 14 (12.6%), Aspergillus terreus in 4 (3.6%), Aspergillus nidulans in 2 (1.8%). Seventy-three patients (65.7%) completely recovered at the last follow-up evaluation; in 7 patients (6.3%) radiological signs of chronic infection were reported, whereas 32 patients (28.8%) died during the follow-up.
Conclusion This systematic review summarized the state of the art on vertebral aspergillosis, retrieving data on clinical features, diagnostic criteria and current limitations, treatment alternatives, and their outcomes.
Collapse
Affiliation(s)
- Andrea Perna
- UOC Chirurgia Vertebrale, Fondazione Policlinico Universitario Agostino Gemelli - IRCCS, Rome, Italy
| | - Luca Ricciardi
- UO di Neurochirurgia, Pia fondazione di Culto e Religione Cardinal G. Panico, Tricase, Italy.,UOC di Neurochirurgia, Azienda Ospedaliera Sant'Andrea, Dipartimento NESMOS, Facoltà di Medicina e Psicologia, Sapienza, Rome, Italy
| | - Massimo Fantoni
- Dipartimento di Scienze di Laboratorio e Infettivologiche, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Rome, Italy.,Dipartimento di Sicurezza e Bioetica, Università Cattolica S. Cuore, Rome, Italy
| | - Francesco Taccari
- Dipartimento di Sicurezza e Bioetica, Università Cattolica S. Cuore, Rome, Italy
| | - Riccardo Torelli
- Dipartimento di Scienze di Laboratorio e Infettivologiche, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Rome, Italy
| | - Domenico Alessandro Santagada
- UOC Chirurgia Vertebrale, Fondazione Policlinico Universitario Agostino Gemelli - IRCCS, Rome, Italy.,Istituto di clinica ortopedica, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Caterina Fumo
- UOC Chirurgia Vertebrale, Fondazione Policlinico Universitario Agostino Gemelli - IRCCS, Rome, Italy
| | - Francesco Ciro Tamburrelli
- UOC Chirurgia Vertebrale, Fondazione Policlinico Universitario Agostino Gemelli - IRCCS, Rome, Italy.,Istituto di clinica ortopedica, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Luca Proietti
- UOC Chirurgia Vertebrale, Fondazione Policlinico Universitario Agostino Gemelli - IRCCS, Rome, Italy.,Istituto di clinica ortopedica, Università Cattolica del Sacro Cuore, Rome, Italy
| |
Collapse
|
29
|
Aguglia A, Amerio A, Proietti L, Costanza A, Serafini G, Amore M. Oral mucositis induced by risperidone: rare side effect of a frequently prescribed medication. Gen Psychiatr 2020; 33:e100228. [PMID: 32875274 PMCID: PMC7430323 DOI: 10.1136/gpsych-2020-100228] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [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] [Received: 03/26/2020] [Revised: 05/31/2020] [Accepted: 07/02/2020] [Indexed: 11/05/2022] Open
Abstract
Risperidone is a safe second-generation antipsychotic which is rarely associated with the emergence of a few adverse effects, such as oral lesions and stomatitis. We report the case of a 77-year-old woman affected by a neurocognitive disorder with psychotic features and treated with risperidone 2 mg/day. After 1 week, she showed a burning mouth syndrome with oral lesions and risperidone was discontinued. Antipsychotic-induced oral ulcerations may be caused by the reduction of saliva protection with minor adverse effects related to oral movement disorders or impairment of the bacterial flora of saliva.
Collapse
Affiliation(s)
- Andrea Aguglia
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DiNOGMI), Section of Psychiatry, University of Genoa, Genoa, Italy.,IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Andrea Amerio
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DiNOGMI), Section of Psychiatry, University of Genoa, Genoa, Italy.,IRCCS Ospedale Policlinico San Martino, Genoa, Italy.,Mood Disorders Program, Tufts Medical Center, Boston, MA, USA
| | - Luca Proietti
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DiNOGMI), Section of Psychiatry, University of Genoa, Genoa, Italy.,IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Alessandra Costanza
- Department of Psychiatry, Faculty of Medicine, University of Geneva (UNIGE), Geneva, Switzerland.,Department of Psychiatry, ASO Santi Antonio e Biagio e Cesare Arrigo Hospital, Alessandria, Italy
| | - Gianluca Serafini
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DiNOGMI), Section of Psychiatry, University of Genoa, Genoa, Italy.,IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Mario Amore
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DiNOGMI), Section of Psychiatry, University of Genoa, Genoa, Italy.,IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| |
Collapse
|
30
|
Smimmo A, Perna A, Fantoni M, De Marco D, Velluto C, Proietti L, Sali M, Tamburrelli FC. Non tuberculous mycobacteria related spondylodiscitis: a case report and systematic literature review. Infez Med 2020; 28:425-435. [PMID: 32920580] [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] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
PURPOSE Mycobacterium xenopi and Non Tuberculous Mycobacteria (NTM) are rare causes of spondylodiscitis (SD). The aim of this study was to highlight the relevance of considering these pathogens in differential diagnosis of slow growing SD, obtaining the correct diagnosis and evaluating the key points of management and therapy approach. METHODS A case of surgically treated Mycobacterium xenopi SD is reported. A systematic review according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines was performed. The research was conducted on MEDLINE, PubMed and Scopus using as search-terms "vertebral", "spinal", "infection", "spondylodiscitis", "discitis", "osteomyelitis", "atypical", "nontuberculous", "mycobacterium". RESULTS After the screening of 444 titles and abstracts, 113 papers were considered eligible for the full-text analysis. Seventy-seven studies that met inclusion criteria were finally included in the review. Overall, including our report, 91 patients affected by NTM SD were analyzed in this systematic review Conclusion: This review highlights the rarity of spinal infections due to NTM and the difficulty of their management. A tailored approach with prolonged antibiotic therapy, eventually associated with surgery in selected cases were suggested for the treatment of NTM infections.
Collapse
Affiliation(s)
- Alessandro Smimmo
- UOC Chirurgia Vertebrale, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Andrea Perna
- UOC Chirurgia Vertebrale, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Massimo Fantoni
- Dipartimento di Scienze di Laboratorio e Infettivologiche, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy; Dipartimento di Sicurezza e Bioetica, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Davide De Marco
- UOC Chirurgia Vertebrale, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Calogero Velluto
- UOC Chirurgia Vertebrale, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Luca Proietti
- UOC Chirurgia Vertebrale, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, ItalyA. Gemelli IRCCS, Rome, Italy; Istituto di Clinica Ortopedica, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Michela Sali
- Dipartimento di Scienze di Laboratorio e Infettivologiche, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy; Dipartimento di Scienze Biotecnologiche di Base, Cliniche Intensivologiche e Perioperatorie - Sezione di Microbiologia, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Francesco Ciro Tamburrelli
- UOC Chirurgia Vertebrale, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy; Istituto di Clinica Ortopedica, Università Cattolica del Sacro Cuore, Rome, Italy
| |
Collapse
|
31
|
Proietti L, Perna A, Ricciardi L, Fumo C, Santagada DA, Giannelli I, Tamburrelli FC, Leone A. Radiological evaluation of fusion patterns after lateral lumbar interbody fusion: institutional case series. Radiol Med 2020; 126:250-257. [PMID: 32654029 DOI: 10.1007/s11547-020-01252-5] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2019] [Accepted: 07/02/2020] [Indexed: 01/04/2023]
Abstract
INTRODUCTION There is no consensus on how to evaluate segmental fusion after lateral lumbar interbody fusion (LLIF). Bone bridges (BB) between two contiguous vertebra are reported as pathognomonic criteria for anterior fusion. However, to the best of our knowledge, there are no radiological investigations on zygapophyseal joints (ZJ) status after LLIF. The aim of this radiological study was to investigate the different fusion patterns after LLIF. MATERIALS AND METHODS This is a retrospective single-centre radiological study. Patients who underwent LLIF and posterior percutaneous screw fixation for degenerative spondylolisthesis, on a single lumbar level, were considered for eligibility. Complete radiological data and a minimum follow-up of 1 year were the inclusion criteria. Intervertebral BB were investigated for evaluating anterior fusion and ZJ ankylotic degeneration was evaluated according Pathria et al., as a matter of proof of posterior fusion and segmental immobilization. RESULTS Seventy-four patients were finally included in the present study. Twelve months after surgery, intervertebral BB were recognized in 58 segments (78.3%), whereas ZJ Pathria grade was I in 8 (10.8%) patients, II in 15 (20.3%) and III in 51 (68.9%) that were considered posteriorly fused. The overlapping rate between anteriorly and posteriorly fused segments was 72.4% (42 segments), whereas 10 (13.5%) did not achieve any fusion, anterior or posterior, and 6 (8.1%) were posteriorly fused only. CONCLUSIONS Our results seem to suggest that anterior fusion is not sufficient to achieve segmental immobilization. Further properly designed investigations are needed to investigate eventual clinical-radiological correlations.
Collapse
Affiliation(s)
- Luca Proietti
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
- Istituto di Ortopedia e Traumatologia, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Andrea Perna
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
- Istituto di Ortopedia e Traumatologia, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Luca Ricciardi
- UO di Neurochirurgia, Pia Fondazione di Culto e Religione Cardinal G. Panico, Via Pio X, 4, 73039, Tricase, LE, Italy.
- UO di Neurochirurgia, Azienda Ospedaliera Sant'Andrea, Facoltà di Medicina e Psicologia, Sapienza, Rome, Italy.
| | - Caterina Fumo
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
- Istituto di Ortopedia e Traumatologia, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Domenico Alessandro Santagada
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
- Istituto di Ortopedia e Traumatologia, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Ilaria Giannelli
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
- Istituto di Ortopedia e Traumatologia, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Francesco Ciro Tamburrelli
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
- Istituto di Ortopedia e Traumatologia, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Antonio Leone
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
- Dipartimento di Scienze Radiologiche, Università Cattolica del Sacro Cuore, Rome, Italy
| |
Collapse
|
32
|
Santagada DA, Perna A, Meluzio MC, Ciolli G, Proietti L, Tamburrelli FC. Symptomatic vertebral hemangioma during pregnancy period: A case series and systematic literature review. Orthop Rev (Pavia) 2020; 12:8685. [PMID: 32913613 PMCID: PMC7459382 DOI: 10.4081/or.2020.8685] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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] [Received: 06/15/2020] [Accepted: 06/17/2020] [Indexed: 12/11/2022] Open
Abstract
Vertebral Hemangioma (VH) is a benign tumor usually symptomless and discovered incidentally. Pregnancy, because of several hormonal and physiologic changes, is a recognized risk factor coinciding with the development of a rapid onset of neurological symptoms in patients affected by VH. In the Literature, sporadic cases of neurological symptoms have been described, which occurred during pregnancy, but only rarely the onset of symptoms was reported after pregnancy and childbirth. Usually surgical treatment is reserved for severe cases with rapid onset of neurological symptoms. However, the use of conservative treatments is still a topic of debate In the present study, we report a series of patients affected by VH become symptomatic during or after pregnancy along with a systematic review of the Literature.
Collapse
Affiliation(s)
- Domenico Alessandro Santagada
- Istituto di Clinica Ortopedica, UOC di Chirurgia Vertebrale, Fondazione Policlinico Universitario "A.Gemelli" IRCCS, Rome; Università Cattolica Del Sacro Cuore, Rome, Italy
| | - Andrea Perna
- Istituto di Clinica Ortopedica, UOC di Chirurgia Vertebrale, Fondazione Policlinico Universitario "A.Gemelli" IRCCS, Rome; Università Cattolica Del Sacro Cuore, Rome, Italy
| | - Maria Concetta Meluzio
- Istituto di Clinica Ortopedica, UOC di Chirurgia Vertebrale, Fondazione Policlinico Universitario "A.Gemelli" IRCCS, Rome; Università Cattolica Del Sacro Cuore, Rome, Italy
| | - Gianluca Ciolli
- Istituto di Clinica Ortopedica, UOC di Chirurgia Vertebrale, Fondazione Policlinico Universitario "A.Gemelli" IRCCS, Rome; Università Cattolica Del Sacro Cuore, Rome, Italy
| | - Luca Proietti
- Istituto di Clinica Ortopedica, UOC di Chirurgia Vertebrale, Fondazione Policlinico Universitario "A.Gemelli" IRCCS, Rome; Università Cattolica Del Sacro Cuore, Rome, Italy
| | - Francesco Ciro Tamburrelli
- Istituto di Clinica Ortopedica, UOC di Chirurgia Vertebrale, Fondazione Policlinico Universitario "A.Gemelli" IRCCS, Rome; Università Cattolica Del Sacro Cuore, Rome, Italy
| |
Collapse
|
33
|
Vergani E, Bruno C, Silvestrini A, Meucci E, Proietti L, Perna A, Tamburrelli FC, Mancini A. Oxidative stress and anabolic hormones in back pain: Current concept and preliminary analysis in male cohort. Orthop Rev (Pavia) 2020; 12:8686. [PMID: 32913614 PMCID: PMC7459380 DOI: 10.4081/or.2020.8686] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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] [Received: 06/15/2020] [Accepted: 06/17/2020] [Indexed: 01/22/2023] Open
Abstract
Back Pain (BP) is a common medical problem; anabolic hormones, through the modulation of oxidative stress (OS), could influence fracture risk. We evaluated the prevalence of anabolic hormonal deficiencies and their relationship with OS in males with BP, associated or not to nontraumatic fractures. 49 males with BP, from 36 to 80 years, were divided in two groups according to radiological evidence of nontraumatic fractures; group A (n=25): non-fractured; group B (n=24): fractured. A different prevalence of hormonal deficits was observed: 24% of hypotestosteronemia in A, 0% in B; 16% of GHD in A, 29% in B; Total Antioxidant Capacity (TAC) showed a trend toward higher levels in B. In A, despite lower TAC, a significant inverse correlation was present between TAC and IGF-1. A greater prevalence of GHD in patients with vertebral fractures was seen and, in a subgroup, OS could mediate the deleterious effects of hyposecretory GH state.
Collapse
Affiliation(s)
- Edoardo Vergani
- Dipartimento di Medicina e Chirurgia Traslazionale, Università Cattolica del Sacro Cuore, Rome.,Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome
| | - Carmine Bruno
- Dipartimento di Medicina e Chirurgia Traslazionale, Università Cattolica del Sacro Cuore, Rome.,Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome
| | - Andrea Silvestrini
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome.,Dipartimento di Scienze Biotecnologiche di base, cliniche intensivologiche e peri-operatorie, Università Cattolica del Sacro Cuore, Rome
| | - Elisabetta Meucci
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome.,Dipartimento di Scienze Biotecnologiche di base, cliniche intensivologiche e peri-operatorie, Università Cattolica del Sacro Cuore, Rome
| | - Luca Proietti
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome.,Dipartimento di Scienze geriatriche e ortopediche, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Andrea Perna
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome.,Dipartimento di Scienze geriatriche e ortopediche, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Francesco Ciro Tamburrelli
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome.,Dipartimento di Scienze geriatriche e ortopediche, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Antonio Mancini
- Dipartimento di Medicina e Chirurgia Traslazionale, Università Cattolica del Sacro Cuore, Rome.,Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome
| |
Collapse
|
34
|
Mancino F, Cacciola G, Di Matteo V, Perna A, Proietti L, Greenberg A, Ma M, Sculco PK, Maccauro G, De Martino I. Surgical implications of the hip-spine relationship in total hip arthroplasty. Orthop Rev (Pavia) 2020; 12:8656. [PMID: 32913592 PMCID: PMC7459374 DOI: 10.4081/or.2020.8656] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [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] [Received: 06/10/2020] [Accepted: 06/17/2020] [Indexed: 12/28/2022] Open
Abstract
Total hip arthroplasty (THA) is considered the most successful orthopedic surgical procedure of the last century with excellent survivorship up to 20-years. However, instability remains a major issue representing the most common reason for revision after THA. Hip-spine relationship has gained progressive interest between arthroplasty surgeons and its understanding is crucial in order to identify high-risk patients for postoperative dislocation. Spinal deformity and abnormal spinopelvic mobility have been associated with increased risk for instability, dislocation and revision THA. Preoperative workup begins with standing anteroposterior pelvis x-ray and lateral spinopelvic radiographs in the standing and sitting position. Hip-spine stiffness needs to be addressed before THA in consideration of adapting the preoperative planning to the patient's characteristics. Acetabular component should be implanted with different anteversion and inclination angles according to the pattern of hip-spine motion in order to reduce the risk of impingement and consequent dislocation. Different algorithmic approaches have been proposed in case of concomitant hip-spine disease and in case of altered sagittal balance and pelvic mobility. The aim of this review is to investigate and clarify the hip-spine relationships and evaluate the impact on modern total hip arthroplasty.
Collapse
Affiliation(s)
- Fabio Mancino
- Division of Orthopaedics and Traumatology, Department of Aging, Neurological, Orthopaedic and Head- Neck Studies, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy.,Università Cattolica del Sacro Cuore, Rome, Italy
| | - Giorgio Cacciola
- GIOMI Istituto Ortopedico del Mezzogiorno d'Italia Franco Scalabrino, Ganzirri, Messina, Italy
| | - Vincenzo Di Matteo
- Division of Orthopaedics and Traumatology, Department of Aging, Neurological, Orthopaedic and Head- Neck Studies, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy.,Università Cattolica del Sacro Cuore, Rome, Italy
| | - Andrea Perna
- Division of Orthopaedics and Traumatology, Department of Aging, Neurological, Orthopaedic and Head- Neck Studies, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy.,Università Cattolica del Sacro Cuore, Rome, Italy
| | - Luca Proietti
- Division of Orthopaedics and Traumatology, Department of Aging, Neurological, Orthopaedic and Head- Neck Studies, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy.,Università Cattolica del Sacro Cuore, Rome, Italy
| | - Alexander Greenberg
- Stavros Niarchos Foundation Complex Joint Reconstruction Center, Hospital for Special Surgery, New York, NY, USA
| | - Malahias Ma
- Stavros Niarchos Foundation Complex Joint Reconstruction Center, Hospital for Special Surgery, New York, NY, USA
| | - Peter K Sculco
- Stavros Niarchos Foundation Complex Joint Reconstruction Center, Hospital for Special Surgery, New York, NY, USA
| | - Giulio Maccauro
- Division of Orthopaedics and Traumatology, Department of Aging, Neurological, Orthopaedic and Head- Neck Studies, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy.,Università Cattolica del Sacro Cuore, Rome, Italy
| | - Ivan De Martino
- Division of Orthopaedics and Traumatology, Department of Aging, Neurological, Orthopaedic and Head- Neck Studies, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| |
Collapse
|
35
|
Armocida D, Brunetto GMF, Proietti L, Palmieri M, Pesce A, Santoro A, Balsamo G, Di Nardo G, Frati A. Transoral Endoscopic Approach to Repair Early Pharyngeal Perforations After Anterior Cervical Spine Surgery without Failure of Instrumentation: Our Experience and Review of Literature. World Neurosurg 2020; 141:219-225. [PMID: 32562902 DOI: 10.1016/j.wneu.2020.06.080] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2020] [Revised: 06/08/2020] [Accepted: 06/09/2020] [Indexed: 11/26/2022]
Abstract
BACKGROUND Pharyngoesophageal injury during anterior cervical spine surgery is a rare and potentially life-threatening complication; generally it is the result of intraoperative manipulation or hardware erosion and sometimes may be due to weakness of the pharyngoesophageal wall from pre-existing pathologic conditions, such as diabetes, gastritis, or obesity. CASE DESCRIPTION We describe the management strategies in patients with an early postoperative hypopharyngeal perforation that occurred after anterior cervical spine surgery without failure of instrumentation, and we present a case treated endoscopically at our institution. CONCLUSIONS Appropriate treatment for pharyngoesophageal perforations is controversial and not investigated in detail. There is a lack of prospective studies comparing initial conservative versus surgical approaches to treatment. In addition, endoscopic management is growing as a therapeutic option, but no consensus concerning the indications for an endoscopic approach in the treatment of pharyngoesophageal injury in anterior cervical spine surgery is currently reached. A common theme proposed in the literature is that early recognition and aggressive investigation and treatment are essential to ensure a good outcome. A customized interdisciplinary surgical approach is essential for successful treatment. Use of the transoral endoscopic approach is a useful noninvasive method to treat this rare but potentially devastating complication.
Collapse
Affiliation(s)
- Daniele Armocida
- Neurosurgery Division, Human Neurosciences Department, Sapienza University of Rome, Rome, Italy.
| | | | - Luca Proietti
- Institute of Orthopaedics, Università Cattolica del Sacro Cuore, Rome, Italy; NESMOS Department, Faculty of Medicine and Psychology, Sant'Andrea Hospital, Sapienza University of Rome, Rome, Italy
| | - Mauro Palmieri
- Neurosurgery Division, Human Neurosciences Department, Sapienza University of Rome, Rome, Italy
| | - Alessandro Pesce
- Neurosurgery Division, Human Neurosciences Department, Sapienza University of Rome, Rome, Italy; IRCCS Neuromed, Pozzilli, Italy
| | - Antonio Santoro
- Neurosurgery Division, Human Neurosciences Department, Sapienza University of Rome, Rome, Italy
| | - Giorgio Balsamo
- Department of Otorhinolaryngology, Sant'Eugenio Hospital, Rome, Italy
| | - Giovanni Di Nardo
- NESMOS Department, Faculty of Medicine and Psychology, Sant'Andrea Hospital, Sapienza University of Rome, Rome, Italy
| | | |
Collapse
|
36
|
Genitiempo M, Perna A, Santagada DA, Meluzio MC, Proietti L, Bocchi MB, Logroscino CA, Tamburrelli FC. Single-level Bryan cervical disc arthroplasty: evaluation of radiological and clinical outcomes after 18 years of follow-up. Eur Spine J 2020; 29:2823-2830. [PMID: 32529522 DOI: 10.1007/s00586-020-06486-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Accepted: 05/30/2020] [Indexed: 12/30/2022]
Abstract
PURPOSE Many studies reported mid-term clinical and radiological outcomes after cervical disc arthroplasty. Only a few studies analysed the long-term results. The aim of the study was to evaluate the clinical and radiological outcomes in patients treated with single-level Bryan cervical disc arthroplasty after 18 years of follow-up. METHODS This study was a retrospective analysis of institutional databases concerning patients treated with Bryan cervical disc arthroplasty. SF36 PCS, NDI and VAS were used to evaluate clinical and functional outcomes. Standard, flexion-extension X-ray and MRI were used to evaluate the radiological results. RESULTS Fifty-seven patients treated with single-level Bryan cervical disc arthroplasty completed the 18-year follow-up. At the final follow-up, a residual movement was observed in 32 patients (56%). The treated level range of motion decreased from 10.1° pre-operatively to 6.1° at the last follow-up (p = 0.0021). The range of motion of the adjacent segments and of the cervical spine had no significant change. Disc degeneration of the adjacent segment after 18-year follow-up was observed in 77.1% of treated patients. CONCLUSION The clinical and radiographic outcomes 18 years after surgery are acceptable. The treated level range of motion reduction and the adjacent segment degeneration seems not to affect the clinical results after 18 years of follow-up.
Collapse
Affiliation(s)
- Maurizio Genitiempo
- Istituto di Clinica Ortopedica, Fondazione Policlinico Universitario A. Gemelli IRCCS, Catholic University, Largo A. Gemalli, 8, 00168, Rome, Italy
| | - Andrea Perna
- Istituto di Clinica Ortopedica, Fondazione Policlinico Universitario A. Gemelli IRCCS, Catholic University, Largo A. Gemalli, 8, 00168, Rome, Italy.
| | - Domenico Alessandro Santagada
- Istituto di Clinica Ortopedica, Fondazione Policlinico Universitario A. Gemelli IRCCS, Catholic University, Largo A. Gemalli, 8, 00168, Rome, Italy
| | - Maria Concetta Meluzio
- Istituto di Clinica Ortopedica, Fondazione Policlinico Universitario A. Gemelli IRCCS, Catholic University, Largo A. Gemalli, 8, 00168, Rome, Italy
| | - Luca Proietti
- Istituto di Clinica Ortopedica, Fondazione Policlinico Universitario A. Gemelli IRCCS, Catholic University, Largo A. Gemalli, 8, 00168, Rome, Italy.,Istituto di Clinica Ortopedica, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Maria Beatrice Bocchi
- Istituto di Clinica Ortopedica, Fondazione Policlinico Universitario A. Gemelli IRCCS, Catholic University, Largo A. Gemalli, 8, 00168, Rome, Italy
| | - Carlo Ambrogio Logroscino
- Istituto di Clinica Ortopedica, Fondazione Policlinico Universitario A. Gemelli IRCCS, Catholic University, Largo A. Gemalli, 8, 00168, Rome, Italy.,Istituto di Clinica Ortopedica, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Francesco Ciro Tamburrelli
- Istituto di Clinica Ortopedica, Fondazione Policlinico Universitario A. Gemelli IRCCS, Catholic University, Largo A. Gemalli, 8, 00168, Rome, Italy.,Istituto di Clinica Ortopedica, Università Cattolica del Sacro Cuore, Rome, Italy
| |
Collapse
|
37
|
Tamburrelli FC, Perna A, Proietti L. Letter to the editor concerning "Prone single-position extreme lateral interbody fusion (Pro-XLIF): preliminary results" by Lamartina C and Berjano P (Eur Spine J; 2020: https://doi.org/10.1007/s00586-020-06303-z). Eur Spine J 2020; 29:1771-1772. [PMID: 32418047 DOI: 10.1007/s00586-020-06456-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/13/2020] [Revised: 03/13/2020] [Accepted: 05/07/2020] [Indexed: 11/29/2022]
Affiliation(s)
- Francesco Ciro Tamburrelli
- UOC Chirurgia Vertebrale, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Rome, Italy.,Istituto di Clinica Ortopedica, Università Cattolica del Sacro Cuore, Largo A. Gemelli 8, 00168, Rome, Italy
| | - Andrea Perna
- UOC Chirurgia Vertebrale, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Rome, Italy. .,Istituto di Clinica Ortopedica, Università Cattolica del Sacro Cuore, Largo A. Gemelli 8, 00168, Rome, Italy.
| | - Luca Proietti
- UOC Chirurgia Vertebrale, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Rome, Italy.,Istituto di Clinica Ortopedica, Università Cattolica del Sacro Cuore, Largo A. Gemelli 8, 00168, Rome, Italy
| |
Collapse
|
38
|
De Vitis R, Passiatore M, Perna A, Proietti L, Taccardo G. COVID-19 contagion and contamination through hands of trauma patients: what risks and what precautions? J Hosp Infect 2020; 105:354-355. [PMID: 32259547 PMCID: PMC7129819 DOI: 10.1016/j.jhin.2020.03.037] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2020] [Accepted: 03/30/2020] [Indexed: 12/16/2022]
Affiliation(s)
- R De Vitis
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, Istituto di Clinica Ortopedica, Roma, Italy
| | - M Passiatore
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Istituto di Clinica Ortopedica, Roma, Italy.
| | - A Perna
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Istituto di Clinica Ortopedica, Roma, Italy
| | - L Proietti
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, Istituto di Clinica Ortopedica, Roma, Italy
| | - G Taccardo
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, Istituto di Clinica Ortopedica, Roma, Italy
| |
Collapse
|
39
|
Perna A, Ricciardi L, Sturiale CL, Fantoni M, Tamburrelli FC, Bonfiglio N, Proietti L. Skipped vertebral spontaneous spondylodiscitis caused by Granulicatella adiacens: Case report and a systematic literature review. J Clin Orthop Trauma 2020; 11:937-941. [PMID: 32879584 PMCID: PMC7452249 DOI: 10.1016/j.jcot.2019.07.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2019] [Revised: 06/23/2019] [Accepted: 07/11/2019] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Granulicatella adiacens is a nutritional variant of streptococcus (NVS), which has been rarely reported as an etiologic agent in spondylodiscitis (SD). MATERIAL AND METHODS We report a case of a 51-year-old male with from chronic low-back pain associated with right sciatica and ipsilateral monoparesis. Spinal MRI showed radiological signs on L1-L2 and L5-S1 discs consistent with SD. We also performed a systematic review of the pertinent literature in order to retrieve all the key information regarding microbiological and clinical features. RESULTS Including our patients, seven cases with a mean age 56 ± 10.2 years were reported in English literature. Six patients were conservatively managed with antibiotic therapy (66%), whereas three with surgery in combination with antibiotics (33%). An endocarditis was associated in three cases, and a pacemaker infection in one. All patients received targeted antibiotic therapy resulting in a quick improvement of clinical symptoms with favorable outcome. Our case is the only with a skip spontaneous SD, which needed a surgical decompression due to the associated neurological symptoms. CONCLUSIONS This incidence of SD sustained by Granulicatella adiances could be underestimated due to their particular microbiological conditions requested for their cultures. However, this infection should be suspected in cases of culture-negative SD, especially when associated with endocarditis.
Collapse
Affiliation(s)
- Andrea Perna
- Fondazione Policlinico Universitario Agostino Gemelli – IRCCS, Rome, Italy
- Istituto di ortopedia e traumatologia, unità di chirurgia vertebrale, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Luca Ricciardi
- Fondazione Policlinico Universitario Agostino Gemelli – IRCCS, Rome, Italy
- Istituto di Neurochirurgia, Università Cattolica del Sacro Cuore, Rome, Italy
- Corresponding author. Department of Neurosurgery, Fondazione Policlinico Universitario Agostino Gemelli – IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy, Largo A. Gemelli 1, 00168, Rome, Italy.
| | | | - Massimo Fantoni
- Fondazione Policlinico Universitario Agostino Gemelli – IRCCS, Rome, Italy
- Istituto di Malattie infettive, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Francesco Ciro Tamburrelli
- Fondazione Policlinico Universitario Agostino Gemelli – IRCCS, Rome, Italy
- Istituto di ortopedia e traumatologia, unità di chirurgia vertebrale, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Nadia Bonfiglio
- Fondazione Policlinico Universitario Agostino Gemelli – IRCCS, Rome, Italy
- Istituto di ortopedia e traumatologia, unità di chirurgia vertebrale, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Luca Proietti
- Fondazione Policlinico Universitario Agostino Gemelli – IRCCS, Rome, Italy
- Istituto di ortopedia e traumatologia, unità di chirurgia vertebrale, Università Cattolica del Sacro Cuore, Rome, Italy
| |
Collapse
|
40
|
Tamburrelli FC, Perna A, Proietti L, Zirio G, Santagada DA, Genitiempo M. The Feasibility of Long-Segment Fluoroscopy-guided Percutaneous Thoracic Spine Pedicle Screw Fixation, and the Outcome at Two-year Follow-up. Malays Orthop J 2019; 13:39-44. [PMID: 31890109 PMCID: PMC6915314 DOI: 10.5704/moj.1911.007] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/05/2022] Open
Abstract
Introduction: Posterior percutaneous instrumentation may represent a challenge when multiple levels need to be instrumentated, especially when including the upper thoracic spine. The aim of the present study was to evaluate the technical feasibility and the long-term outcome of such long constructs in different surgical conditions. Materials and Methods: This investigation was a retrospective cohort study which included patients who underwent thoraco-lumbar percutaneous fixations. We collected clinical, surgical and radiological data, with a minimum follow-up of 24 months. Health-related quality-of-life, residual pain, instrumentation placement, and complications were studied. Results: A total of 18 procedures were enrolled, in which 182 screws were implanted, (170 positioned in thoracic and 12 in lumbar pedicles, respectively). No surgical complications or hardware failure occurred in our series, 6 out of 182 (3,2%) screws had a partial pedicle breach, without neurological impairment or need for surgical revision. Conclusion: According to our results, a fully posterior percutaneous approach for long thoraco-lumbar spine instrumentation can be considered safe and reproducible, although an adequate training is strictly required.
Collapse
Affiliation(s)
- F C Tamburrelli
- UOC Vertebral Surgery, IRCCS Fondazione Policlinico Universitario Agostino Gemelli, Rome, Italy.,Institute of Orthopedic Clinic, Università Cattolica del Sacro Cuore, Rome, Italy
| | - A Perna
- UOC Vertebral Surgery, IRCCS Fondazione Policlinico Universitario Agostino Gemelli, Rome, Italy
| | - L Proietti
- UOC Vertebral Surgery, IRCCS Fondazione Policlinico Universitario Agostino Gemelli, Rome, Italy.,Institute of Orthopedic Clinic, Università Cattolica del Sacro Cuore, Rome, Italy
| | - G Zirio
- UOC Vertebral Surgery, IRCCS Fondazione Policlinico Universitario Agostino Gemelli, Rome, Italy
| | - D A Santagada
- UOC Vertebral Surgery, IRCCS Fondazione Policlinico Universitario Agostino Gemelli, Rome, Italy
| | - M Genitiempo
- UOC Vertebral Surgery, IRCCS Fondazione Policlinico Universitario Agostino Gemelli, Rome, Italy
| |
Collapse
|
41
|
Proietti L, Scaramuzzo L, Sessa S, Schirò GR, Logroscino CA. Response to the letter by Sen Yang, Weimin Jiang. Orthop Traumatol Surg Res 2019; 105:1217. [PMID: 31345738 DOI: 10.1016/j.otsr.2019.07.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Affiliation(s)
- Luca Proietti
- Fondazione Policlinico Universitario "Agostino Gemelli" I.R.C.C.S., Rome, Italy; Division of Spinal Surgery, Catholic University of Sacred Heart, Rome, Italy.
| | - Laura Scaramuzzo
- I.R.C.C.S. Orthopedic Institute Galeazzi, Spine Surgery Division 1, Milan, Italy
| | - Sergio Sessa
- Orthopedic Institure "Bambin Gesù" Palidoro, Rome, Italy
| | | | - Carlo Ambrogio Logroscino
- Fondazione Policlinico Universitario "Agostino Gemelli" I.R.C.C.S., Rome, Italy; Division of Spinal Surgery, Catholic University of Sacred Heart, Rome, Italy
| |
Collapse
|
42
|
Gigante A, Gasperini M, Iacolare A, Molfino A, Proietti L, Margiotta D, Navarini L, Afeltra A, Rosato E, Muscaritoli M. MON-PO498: Phase Angle as a Marker of Microvascular Damage in Systemic Sclerosis. Clin Nutr 2019. [DOI: 10.1016/s0261-5614(19)32331-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
|
43
|
Gigante A, Gasperini M, Iacolare A, Molfino A, Proietti L, Rosato E, Muscaritoli M. GM01: Comparison of ESPEN 2015 and GLIM Criteria for Assessing Malnutrition in Systemic Sclerosis. Clin Nutr 2019. [DOI: 10.1016/s0261-5614(19)32124-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
|
44
|
Proietti L, Ricciardi L, Noia G, Barone G, Valenzi E, Perna A, Giannelli I, Scaramuzzo L, Visocchi M, Papacci F, Tamburrelli FC. Extensive Spinal Epidural Abscesses Resolved with Minimally Invasive Surgery: Two Case Reports and Review of the Recent Literature. Acta Neurochir Suppl 2019; 125:345-353. [PMID: 30610344 DOI: 10.1007/978-3-319-62515-7_50] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
PURPOSE An extensive spinal epidural abscess is a rare condition and causes significant morbidity and mortality. Few authors have described this uncommon entity, which requires early diagnosis and optimal treatment to avoid devastating complications. The purpose of this study was to evaluate a minimally invasive technique for treatment of an extensive spinal epidural abscess by describing two cases. Furthermore, we conducted a review of the recent literature on the management of this rare condition. METHODS We report two cases of spinal abscesses extending to the whole epidural space, successfully treated by use of a minimally invasive technique consisting of multilevel laminotomy and catheter irrigation to decompress and drain the epidural space. RESULTS This technique is able to decompress the spinal cord, isolate the pathogen and evacuate the abscess. No complications, late spine deformity or dura penetration were observed in our patients. CONCLUSION Urgent surgical decompression, in combination with long-term antibiotic treatment, is generally considered the treatment of choice for an extensive spinal epidural abscess. A minimally invasive technique can be very useful as a surgical option.
Collapse
Affiliation(s)
- Luca Proietti
- Spine Surgery Division, Agostino Gemelli Hospital, Catholic University of the Sacred Heart of Rome, Rome, Italy
| | - Luca Ricciardi
- Institute of Neurological Surgery, Catholic University of the Sacred Heart of Rome, Agostino Gemelli Hospital, Rome, Italy
| | - Giovanni Noia
- Spine Surgery Division, Agostino Gemelli Hospital, Catholic University of the Sacred Heart of Rome, Rome, Italy.
| | - Giuseppe Barone
- Division of Orthopaedics and Traumatology, Santa Maria della Misericordia Hospital, University of Perugia, Perugia, Italy
| | - Eugenio Valenzi
- Spine Surgery Division, Agostino Gemelli Hospital, Catholic University of the Sacred Heart of Rome, Rome, Italy
| | - Andrea Perna
- Spine Surgery Division, Agostino Gemelli Hospital, Catholic University of the Sacred Heart of Rome, Rome, Italy
| | - Ilaria Giannelli
- Spine Surgery Division, Agostino Gemelli Hospital, Catholic University of the Sacred Heart of Rome, Rome, Italy
| | - Laura Scaramuzzo
- Spine Surgery Division 1, IRCCS Galeazzi Orthopaedic Institute, Milan, Italy
| | - Massimiliano Visocchi
- Institute of Neurological Surgery, Catholic University of the Sacred Heart of Rome, Agostino Gemelli Hospital, Rome, Italy
| | - Fabio Papacci
- Institute of Neurological Surgery, Catholic University of the Sacred Heart of Rome, Agostino Gemelli Hospital, Rome, Italy
| | - Francesco Ciro Tamburrelli
- Spine Surgery Division, Agostino Gemelli Hospital, Catholic University of the Sacred Heart of Rome, Rome, Italy
| |
Collapse
|
45
|
Proietti L, Perna A, Schirò GR, Noia G, Fumo C, Tamburrelli FC. Residual mobility after removal of instrumentation in patient, with type a2-a3 vertebral fractures, treated with percutaneous pedicle screw fixation. J BIOL REG HOMEOS AG 2019; 33:133-139. XIX Congresso Nazionale S.I.C.O.O.P. Societa' Italiana Chirurghi Ortopedici Dell'ospedalita' Privata Accreditata. [PMID: 31172730 DOI: pmid/31172730] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Percutaneous techniques for treatment of thoraco-lumbar fractures type A2 and A3 are widely used. These techniques are considered temporary fixations and instrumentation must be removed with fracture healing. The aim of the study is to analyze clinical results, motility of treated segments and any loss of correction after the removal of instrumentation. We evaluated 36 patients who underwent surgery for removal of the instrumentation. Standard and dynamics x-ray before surgery and at 1 and 12 months after surgery were obtained. Radiographic evaluation was performed by comparing loss of correction after removal of the instrumentation, residual mobility of fractured vertebra, upper and lower level with values defined by Dvorak. For clinical assessment were used SF-12, Oswestry Disability Index (ODI) and Visual Analog Scale (VAS), administered before surgery and at 1 and 12 months after the removal. We analyzed a total of 108 levels in 36 patients. After removal of the instrumentation a normal range of motion was restored in the proximal and distal segment of the fracture, while at level of fractured segment we noticed a decrease in motility. Clinically, patients had a significant decrease in VAS and ODI at 1 month after removal. Our study shows that percutaneous fixation for treatment of thoraco-lumbar fractures type A2 and A3, allows to preserve motility of the treated segments after the removal of the instrumentation until 12 months. The removal of instrumentation is associated with good clinical results without of loss of correction in treated segment.
Collapse
Affiliation(s)
- L Proietti
- Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy.,Division of Spinal Surgery, Catholic University of Sacred Heart, Rome, Italy
| | - A Perna
- Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy.,Division of Spinal Surgery, Catholic University of Sacred Heart, Rome, Italy
| | - G R Schirò
- Orthopaedic Department, Niguarda Hospital, Milan, Italy
| | - G Noia
- Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy.,Division of Spinal Surgery, Catholic University of Sacred Heart, Rome, Italy
| | - C Fumo
- Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy.,Division of Spinal Surgery, Catholic University of Sacred Heart, Rome, Italy
| | - F C Tamburrelli
- Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy.,Division of Spinal Surgery, Catholic University of Sacred Heart, Rome, Italy
| |
Collapse
|
46
|
Tundo A, Musetti L, de Filippis R, Grande CD, Falaschi V, Proietti L, Dell'Osso L. Is there a relationship between depression with anxious distress DSM-5 specifier and bipolarity? A multicenter cohort study on patients with unipolar, bipolar I and II disorders. J Affect Disord 2019; 245:819-826. [PMID: 30699865 DOI: 10.1016/j.jad.2018.11.024] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2018] [Revised: 10/02/2018] [Accepted: 11/03/2018] [Indexed: 11/24/2022]
Abstract
BACKGROUND To estimate the prevalence of DSM-5 anxious distress specifier (ADS) in depressed patients with major depressive disorder (MDD) or bipolar I or II disorder (BD), and to compare socio-demographic and clinical characteristics, and response to naturalistic short-term treatment between ADS and non-ADS group. METHODS 241 outpatients with a major depressive episode (MDE) were consecutively recruited. Outcome were remission (HDRS21 total score < 7), response (≥50% reduction of baseline HDRS21) and improvement (CGI-i score ≤ 2) after 12 weeks of treatment sustained for 4 weeks. RESULTS ADS was more frequent in BD than in MDD (respectively, 66.9% and 51.2%, χ2 = 6.1, p = 0.013). Compared with those non-ADS, patients with ADS had more severe depressive (respectively, HDRS21 total score 20.0 ± 4.4 and 18.6 ± 3.9, t-test = 2.67, p = 0.008) and mania symptoms (respectively, Y-MRS total score 2.2 ± 2.9 and 1.3 ± 2.3, M-W-test = 2.86; p = 0.004) at intake, a higher rate of BD family history (respectively, 35.2% and 22.2%, Χ2-test 10.4, p = 0.004) and more previous hypomanic episodes (respectively, (median (range) 0 (0-20) and 0 (0-15), MW-test = 2.39 p = 0.017). In the MDD group, patients with ADS had higher scores on hyperthymic temperament and mania symptoms (Y-MRS total score (median (range) 2.2 (0-26) and 0 (0-11), respectively, M-W test 2.071, p = 0.038). ADS and no-ADS patients did not significantly differ on outcome measures. LIMITATIONS The observational nature of the study and the absence of blinding in outcome assessment. CONCLUSIONS ADS is the most common DSM-5 specifier for MDE, is more frequent in BD and need a personalized treatment with moderate use of antidepressants, mostly tricyclic.
Collapse
Affiliation(s)
| | - Laura Musetti
- Department of Clinical and Experimental Medicine, Section of Psychiatry, University of Pisa, Via Roma 67, Pisa 56100, Italy.
| | | | - Claudia Del Grande
- Department of Clinical and Experimental Medicine, Section of Psychiatry, University of Pisa, Via Roma 67, Pisa 56100, Italy
| | - Valentina Falaschi
- Department of Clinical and Experimental Medicine, Section of Psychiatry, University of Pisa, Via Roma 67, Pisa 56100, Italy
| | | | - Liliana Dell'Osso
- Department of Clinical and Experimental Medicine, Section of Psychiatry, University of Pisa, Via Roma 67, Pisa 56100, Italy
| |
Collapse
|
47
|
Vagnani G, Gatti C, Proietti L. A conceptual framework of the adoption of innovations in organizations: a meta-analytical review of the literature. J Manag Gov 2019. [DOI: 10.1007/s10997-019-09452-6] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
|
48
|
Ricciardi L, Sturiale CL, Pucci R, Reale G, Stifano V, Izzo A, Perna A, Proietti L, Forcato S, Rivera Perla KM, El Boustany S, Olivi A, Polli FM. Patient-Oriented Aesthetic Outcome After Lumbar Spine Surgery: A 1-Year Follow-Up Prospective Observational Study Comparing Minimally Invasive and Standard Open Procedures. World Neurosurg 2018; 122:e1041-e1046. [PMID: 30415051 DOI: 10.1016/j.wneu.2018.10.208] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2018] [Revised: 10/09/2018] [Accepted: 10/11/2018] [Indexed: 10/27/2022]
Abstract
BACKGROUND Despite recent treatment developments, back pain and related disabilities still represent a challenge for practitioners. Among the available surgical techniques, many different features and outcomes have been investigated; however, aesthetic result was missing among them. The present investigation was designed to prospectively compare patient-oriented aesthetic results after minimally invasive surgery (MIS) and standard open surgery (SOS) for the lumbar spine. METHODS This was a prospective observational study with 1-year follow-up. Patients who underwent SOS were assigned to group 1 and MIS to group 2. Patient-oriented aesthetic result evaluation was collected using a dedicated visual aesthetic analogue scale. The Vancouver Scar Scale was used to exclude objective underlying influencing factors. The Oswestry Disability Index and a 10-point itemized visual analogue scale for back pain were administered to assess the clinical and functional status. Follow-up data were collected before discharge at 1, 6, and 12 months. Statistical analysis was conducted, and P < 0.05 was considered as significant. RESULTS We enrolled 74 patients, 44 in group 1 and 30 in group 2. The 2 groups were homogeneous for demographic and clinical data. No clinical or functional differences were measured at the end of follow-up. Visual aesthetic analogue scale reported greater mean values in group 1 at every follow-up time. CONCLUSIONS Patients seem to prefer the aesthetic result from a single midline incision after SOS compared with MIS. The use of specific techniques could be considered if there is scientific evidence reporting greater aesthetic outcome, having similar clinical and functional ones.
Collapse
Affiliation(s)
- Luca Ricciardi
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy; Department of Neurosurgery, Mayo Clinic, Jacksonville, Florida, USA; Istituto di Neurochirurgia, Università Cattolica del Sacro Cuore, Rome, Italy.
| | | | - Resi Pucci
- Dipartimento di Scienze Odontostomatologiche e Maxillo Facciali, "Sapienza" Università di Roma, Rome, Italy
| | - Gabriele Reale
- Dipartimento di Scienze Odontostomatologiche e Maxillo Facciali, "Sapienza" Università di Roma, Rome, Italy
| | - Vito Stifano
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy; Istituto di Neurochirurgia, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Alessandro Izzo
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy; Department of Neurosurgery, Mayo Clinic, Jacksonville, Florida, USA; Istituto di Neurochirurgia, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Andrea Perna
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy; Istituto di Ortopedia, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Luca Proietti
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy; Istituto di Ortopedia, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Stefano Forcato
- Unità operativa di neurochirurgia, Pia Fondazione Panico, Ospedale di Tricase (LE), Italy
| | | | | | - Alessandro Olivi
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy; Istituto di Neurochirurgia, Università Cattolica del Sacro Cuore, Rome, Italy
| | | |
Collapse
|
49
|
Perna A, Ricciardi L, Barone G, Tamburrelli FC, Proietti L, Pola E. Medical management of acute non-specific low back pain: comparison of different medical treatments, one center's retrospective analysis. J BIOL REG HOMEOS AG 2018; 32:121-129. [PMID: 30644292] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Within the developed countries, low back pain and related ailments represent one of the most relevant conditions, affecting both health and socio-economic systems. Non-specific acute low back pain (nsALBP) could represent either an isolated event or the presenting symptom of an underlying condition. Its management is usually medical and radiological investigations should be avoided. However, a general agreement on the best pharmacological treatment is still missing. In the present study, we retrospectively collected patients' data from the institutional database. Two different medical treatments were recognized and groups consequently set. Outcomes were the clinical status, measured using the visual analogue scale (VAS) score for back pain, the use rate of rescue drugs, side effects related to medical treatment, compliance to the treatment, and global satisfaction. The pharma blending of Tramadol 75 mg and Dexketoprofen 25 mg (available blended in a single tablet), resulted effective in the nsALBP management, with less side effects and rescue-drug use along with a higher compliance. Furthermore, patient satisfaction in this treatment group was significatively higher. Many different medical treatments have been investigated and reported in nsALBP management during the last decades. Associations of different drugs are the most common protocols, even though there is no general agreement. Tramadol and Dexketoprofen provide a good clinical result, fewer side effects and a long-lasting and more effective painkiller action, reducing the use of rescue drugs. Moreover, our results suggest that a single tab may provide a higher compliance rate.
Collapse
Affiliation(s)
- A Perna
- Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
- Division of Spinal Surgery, Catholic University of Sacred Heart, Rome, Italy
| | - L Ricciardi
- Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
- Departments of Neurosurgery Catholic University of Sacred Heart, Rome, Italy
- Department of Neurosurgery, Mayo Clinic, Jacksonville, FL, United States
| | - G Barone
- Spinal Division I, IRCCS Orthopedic Institute Galeazzi, Milan, Italy
| | - F C Tamburrelli
- Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
- Division of Spinal Surgery, Catholic University of Sacred Heart, Rome, Italy
| | - L Proietti
- Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
- Division of Spinal Surgery, Catholic University of Sacred Heart, Rome, Italy
| | - E Pola
- Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
- Division of Spinal Surgery, Catholic University of Sacred Heart, Rome, Italy
| |
Collapse
|
50
|
Tamburrelli FC, Meluzio MC, Masci G, Perna A, Burrofato A, Proietti L. Etiopathogenesis of Traumatic Spinal Epidural Hematoma. Neurospine 2018; 15:101-107. [PMID: 29656630 PMCID: PMC5944636 DOI: 10.14245/ns.1834938.469] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2017] [Revised: 02/07/2018] [Accepted: 02/13/2018] [Indexed: 12/22/2022] Open
Abstract
Spinal epidural hematoma (SEH) is a rare cause of nerve root or cord compression; its pathogenesis is not always clearly recognizable. The aim of this paper was to investigate possible etiopathological factors in a consecutive series of patients affected by traumatic SEH treated at our institution. Seven patients with neurologic impairment due to traumatic SEH were retrospectively analyzed after diagnosis and surgical treatment. Thoracic localization was found in 5 cases, and lumbar and cervical localization were found in 1 patient each. One patient was affected by ankylosing spondylitis and one by diffuse idiopathic skeletal hyperostosis. SEH was associated with spine fractures in 6 cases. Only 2 cases of traumatic SEH resulted from high-energy trauma. All patients underwent surgical decompression within 24 hours after admittance to the hospital. Three patients recovered completely, 3 remained paraplegic, and 1 remained monoplegic. Several concomitant conditions are suggested to be predisposing factors for the development of SEH, although its inherent mechanism is still unknown. Two patients in the present series were affected by rheumatologic disorders, confirming the elevated incidence of hematomas in such patients compared to the normal population. Three very unusual cases of SEH occurred in senile patients affected by osteoporotic fractures. Early diagnosis and urgent decompression of the hematoma remain mandatory.
Collapse
Affiliation(s)
| | - Maria Concetta Meluzio
- Division of Spinal Surgery, Department of Orthopedics, Catholic University of Sacred Heart, Rome, Italy
| | - Giulia Masci
- Division of Spinal Surgery, Department of Orthopedics, Catholic University of Sacred Heart, Rome, Italy
| | - Andrea Perna
- Division of Spinal Surgery, Department of Orthopedics, Catholic University of Sacred Heart, Rome, Italy
| | - Aaron Burrofato
- Division of Spinal Surgery, Department of Orthopedics, Catholic University of Sacred Heart, Rome, Italy
| | - Luca Proietti
- Division of Spinal Surgery, Department of Orthopedics, Catholic University of Sacred Heart, Rome, Italy
| |
Collapse
|