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Wang P, Zhang Y, Yang Z, Deng Q. Intraoperative pulling reduction and anterior cervical discectomy with fusion for cervical spine fracture and dislocation. Asian J Surg 2024; 47:1565-1566. [PMID: 38102008 DOI: 10.1016/j.asjsur.2023.12.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2023] [Accepted: 12/01/2023] [Indexed: 12/17/2023] Open
Affiliation(s)
- Peng Wang
- Department of Orthopaedics, Gansu Provincial Hospital of Traditional Chinese Medicine, Lanzhou, 730000, China
| | - Yanjun Zhang
- Department of Orthopaedics, Gansu Provincial Hospital of Traditional Chinese Medicine, Lanzhou, 730000, China
| | - Zhenyuan Yang
- Department of Orthopaedics, Gansu Provincial Hospital of Traditional Chinese Medicine, Lanzhou, 730000, China
| | - Qiang Deng
- Department of Orthopaedics, Gansu Provincial Hospital of Traditional Chinese Medicine, Lanzhou, 730000, China
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Chen Y, Li Z, Fan Y. A single-arm retrospective study regarding the clinical efficacy of unilateral biportal endoscopic decompression in the treatment of lumbar spinal stenosis. Asian J Surg 2024; 47:1216-1217. [PMID: 37985324 DOI: 10.1016/j.asjsur.2023.11.041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2023] [Accepted: 11/03/2023] [Indexed: 11/22/2023] Open
Affiliation(s)
- Youying Chen
- Department of Orthopaedics, Gansu Provincial Hospital of Traditional Chinese Medicine, Guazhou Street NO.418, Lanzhou City, Gansu Province, 730000, China
| | - Zhongfeng Li
- Department of Orthopaedics, Gansu Provincial Hospital of Traditional Chinese Medicine, Guazhou Street NO.418, Lanzhou City, Gansu Province, 730000, China
| | - Youfu Fan
- Department of Orthopaedics, Gansu Provincial Hospital of Traditional Chinese Medicine, Guazhou Street NO.418, Lanzhou City, Gansu Province, 730000, China.
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Feng Q, Xu S, Gong X, Wang T, He X, Liao D, Han F. An MRI-Based Radiomics Nomogram for Differentiation of Benign and Malignant Vertebral Compression Fracture. Acad Radiol 2024; 31:605-616. [PMID: 37586940 DOI: 10.1016/j.acra.2023.07.011] [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] [Subscribe] [Scholar Register] [Received: 01/20/2023] [Revised: 07/11/2023] [Accepted: 07/11/2023] [Indexed: 08/18/2023]
Abstract
RATIONALE AND OBJECTIVES This study aimed to develop and validate a magnetic resonance imaging (MRI)-based radiomics nomogram combining radiomics signatures and clinical factors to differentiate between benign and malignant vertebral compression fractures (VCFs). MATERIALS AND METHODS A total of 189 patients with benign VCFs (n = 112) or malignant VCFs (n = 77) were divided into training (n = 133) and validation (n = 56) cohorts. Radiomics features were extracted from MRI T1-weighted images and short-TI inversion recovery images to develop the radiomics signature, and the Rad score was constructed using least absolute shrinkage and selection operator regression. Demographic and MRI morphological characteristics were assessed to build a clinical factor model using multivariate logistic regression analysis. A radiomics nomogram was constructed based on the Rad score and independent clinical factors. Finally, the diagnostic performance of the radiomics nomogram, clinical model, and radiomics signature was validated using receiver operating characteristic and decision curve analysis (DCA). RESULTS Six features were used to build a combined radiomics model (combined-RS). Pedicle or posterior element involvement, paraspinal mass, and fluid sign were identified as the most important morphological factors for building the clinical factor model. The radiomics signature was superior to the clinical model in terms of the area under the curve (AUC), accuracy, and specificity. The radiomics nomogram integrating the combined-RS, pedicle or posterior element involvement, paraspinal mass, and fluid sign achieved favorable predictive efficacy, generating AUCs of 0.92 and 0.90 in the training and validation cohorts, respectively. The DCA indicated good clinical usefulness of the radiomics nomogram. CONCLUSION The MRI-based radiomics nomogram, combining the radiomics signature and clinical factors, showed favorable predictive efficacy for differentiating benign from malignant VCFs.
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Affiliation(s)
- Qianqian Feng
- Department of Radiology, Qionglai Medical Center Hospital, No. 172 Xinglin Road, Wenjun Street, Qionglai, Sichuan, 611530, People's Republic of China (Q.F., T.W.)
| | - Shan Xu
- Department of Radiology, Luzhou Traditional Chinese Medicine Hospital, No. 11 Jiangyang South Road, Luzhou, Sichuan, 646000, People's Republic of China (S.X.)
| | - Xiaoli Gong
- Department of Radiology, Jiangan County Traditional Chinese Medicine Hospital, No. 800 West Section of Raocheng Road, Yibin, Sichuan, 644200, People's Republic of China (X.G.)
| | - Teng Wang
- Department of Radiology, Qionglai Medical Center Hospital, No. 172 Xinglin Road, Wenjun Street, Qionglai, Sichuan, 611530, People's Republic of China (Q.F., T.W.)
| | - Xiaopeng He
- Department of Radiology, The Affiliated Hospital of Southwest Medical University, No.25 Taiping Street, Luzhou, Sichuan, 646000, People's Republic of China (X.H., D.L., F.H.).
| | - Dawei Liao
- Department of Radiology, The Affiliated Hospital of Southwest Medical University, No.25 Taiping Street, Luzhou, Sichuan, 646000, People's Republic of China (X.H., D.L., F.H.)
| | - Fugang Han
- Department of Radiology, The Affiliated Hospital of Southwest Medical University, No.25 Taiping Street, Luzhou, Sichuan, 646000, People's Republic of China (X.H., D.L., F.H.)
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Zhao Y, Han L, Li D, Wang Z. Solitary bone plasmacytoma of spine with involvement of inter vertebral disk: a case report and literature review. Skeletal Radiol 2024:10.1007/s00256-024-04566-x. [PMID: 38231261 DOI: 10.1007/s00256-024-04566-x] [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: 03/17/2023] [Revised: 12/29/2023] [Accepted: 01/04/2024] [Indexed: 01/18/2024]
Abstract
Primary malignant bone tumors of the spine are exceedingly rare, with solitary bone plasmacytoma (SBP) representing approximately 30% of all cases. Radiological assessments are crucial for localizing SBP and for ruling out a diagnosis of multiple myeloma (MM). Imaging features resembling a "mini-brain" appear to be distinctive for SBP. Vertebral lesions accompanied by adjacent disc space involvement typically suggest spinal infections, while the potential for SBP involvement is often overlooked. We present a case of a 61-year-old female with SBP who exhibited thoraco-lumbar spine destruction and adjacent disc space involvement. The patient sought treatment at our medical center due to lumbodorsal pain radiating bilaterally to the inguinal regions. Radiological findings revealed an osteolytic lesion involving the intervertebral disc, making it challenging to distinguish between tumor and inflammation. A biopsy of the vertebral lesion confirmed the diagnosis of SBP, which was further supported by laboratory results. Post-diagnosis, the patient underwent radiotherapy, receiving a total dose of 4000 Gy, which alleviated her symptoms. We also provide a comprehensive literature review on SBP with disc involvement to aid both clinical and radiological diagnoses.
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Affiliation(s)
- Yujun Zhao
- Department of Nuclear Medicine, The Affiliated Hospital of Qingdao University, Qingdao, 266061, Shandong, China
| | - Liang Han
- Department of Ultrasound, Qingdao Central Hospital, University of Health and Rehabilitation Sciences, Qingdao, 266042, Shandong, China
| | - DaCheng Li
- Department of Nuclear Medicine, The Affiliated Hospital of Qingdao University, Qingdao, 266061, Shandong, China
| | - Zhenguang Wang
- Department of Nuclear Medicine, The Affiliated Hospital of Qingdao University, Qingdao, 266061, Shandong, China.
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5
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Agosti E, Serioli S, Garg K, Pietrantoni A, Poliani PL, Fontanella MM. Treatment strategy for vertebral metastases from anal squamous cell carcinoma: a comprehensive literature review and case report. Int J Neurosci 2023; 133:1124-1128. [PMID: 35369848 DOI: 10.1080/00207454.2022.2052066] [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] [Subscribe] [Scholar Register] [Received: 02/02/2022] [Accepted: 02/21/2022] [Indexed: 10/18/2022]
Abstract
Purpose/aim of the study: Purpose/aim of the study:Central nervous system (CNS), skull, and vertebral metastases from anal squamous cell carcinoma (SCC) are an exceedingly rare entity. We report the first case of multiple vertebral metastases from a primary anal SCC with the aim of define a target therapeutic strategy.Case presentation: We present the case of a 68-year-old male admitted to our hospital for acute exacerbation chronic low back pain and left L2 radiculopathy. His medical history included the diagnosis of a human papilloma virus related, moderately differentiated anal SCC (cT3N0M0-stage IIB), treated with standard chemoradiotherapy regimen two years earlier. Spinal magnetic resonance imaging revealed an isolated solid lesion of the L2 vertebral body. After the surgical removal, histopathological examination confirmed the diagnosis of moderately differentiated SCC. At 1-month radiological follow-up, two new lesions at the level of T7 to T11 were identified. Additional chemotherapy and radiotherapy for metastatic localization of L2, T7, and T11 were administered. Two-year follow-up demonstrated a radiologically and clinically well-controlled disease. To supplement our case, a systematic literature review on the CNS, skull, and vertebral metastases and their treatments has been performed.Conclusion: Despite several proposed guidelines for the management of vertebral metastases, at present, a universally accepted treatment strategy for vertebral metastases from anal SCC has not been defined. Based on our clinical experience and literature review, in case of vertebral metastases from anal SCC, a prompt and aggressive, local and systemic, and multimodal treatment of the vertebral lesions may be paramount to improve the patient outcomes.
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Affiliation(s)
- Edoardo Agosti
- Department of Medical and Surgical Specialties, Division of Neurosurgery, Radiological Sciences and Public Health, University of Brescia, Brescia, Italy
| | - Simona Serioli
- Department of Medical and Surgical Specialties, Division of Neurosurgery, Radiological Sciences and Public Health, University of Brescia, Brescia, Italy
| | - Kanwaljeet Garg
- Department of Neurosurgery, All India Institute of Medical Sciences, New Delhi, India
| | - Alberto Pietrantoni
- Molecular and Translational Medicine Department, Pathology Unit, University of Brescia, Brescia, Italy
| | - Pietro Luigi Poliani
- Molecular and Translational Medicine Department, Pathology Unit, University of Brescia, Brescia, Italy
| | - Marco Maria Fontanella
- Department of Medical and Surgical Specialties, Division of Neurosurgery, Radiological Sciences and Public Health, University of Brescia, Brescia, Italy
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Li Z, Chen Y, Li Z, Deng Q. Posterior total resection of the vertebral column for severe kyphoscoliosis: A case report. Asian J Surg 2023; 46:5700-5701. [PMID: 37640647 DOI: 10.1016/j.asjsur.2023.08.088] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2023] [Accepted: 08/16/2023] [Indexed: 08/31/2023] Open
Affiliation(s)
- Zhongfeng Li
- Department of Orthopaedics, Gansu Provincial Hospital of Traditional Chinese Medicine, Lanzhou, 730000, China
| | - Youying Chen
- Department of Orthopaedics, Gansu Provincial Hospital of Traditional Chinese Medicine, Lanzhou, 730000, China
| | - Zhenhao Li
- Department of Orthopaedics, Gansu Provincial Hospital of Traditional Chinese Medicine, Lanzhou, 730000, China.
| | - Qiang Deng
- Department of Orthopaedics, Gansu Provincial Hospital of Traditional Chinese Medicine, Lanzhou, 730000, China
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Rejnmark L, Underbjerg L. Fracture Risk in Patients with Hypoparathyroidism. Curr Osteoporos Rep 2023; 21:632-636. [PMID: 37542005 DOI: 10.1007/s11914-023-00790-x] [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] [Accepted: 04/25/2023] [Indexed: 08/06/2023]
Abstract
PURPOSE OF REVIEW To summarize the recently published scientific evidence on fracture risk in hypoparathyroidism. RECENT FINDINGS Hypoparathyroidism is characterized by a low bone turnover and a high bone mineral density. Data on fracture risk are sparse and due to the rarity of the disease, available studies have only been able to include relatively few patients. Risk of non-vertebral fractures does not seem to be affected to any major degree, although epidemiological studies suggest a decreased risk of fractures at the humerus in postsurgical hypoparathyroidism, whereas an increased risk of fractures at the upper arm has been shown in non-surgical hypoparathyroidism. Several, but not all, studies have also pointed towards an increased risk of vertebral fractures, especially in non-surgical hypoparathyroidism. Fractures at the appendicular skeleton do not seem to be of specific concern in hypoparathyroidism, but emerging data suggest an increased risk of vertebral fractures, which needs to be clarified further in upcoming studies.
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Affiliation(s)
- Lars Rejnmark
- Department of Endocrinology and Internal Medicine, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, DK-8200 Aarhus N, Aarhus, Denmark.
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark.
| | - Line Underbjerg
- Department of Endocrinology and Internal Medicine, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, DK-8200 Aarhus N, Aarhus, Denmark
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Lamb CD, Quinones A, Zhang JY, Paik G, Chaluts D, Carr M, Lonner BS, Margetis K. Evaluating Adult Idiopathic Scoliosis as an Independent Risk Factor for Critical Illness in SARS-CoV-2 Infection. World Neurosurg 2023; 177:S1878-8750(23)00810-0. [PMID: 37343676 PMCID: PMC10279461 DOI: 10.1016/j.wneu.2023.06.041] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2023] [Revised: 06/11/2023] [Accepted: 06/12/2023] [Indexed: 06/23/2023]
Abstract
BACKGROUND Thoracic spinal deformities may reduce chest wall compliance, leading to respiratory complications. The first SARS-CoV-2 (L-variant) strain caused critical respiratory illness, especially in vulnerable patients. This study investigates the association between scoliosis and SARS-CoV-2 (COVID-19) disease course severity. METHODS Clinical data of 129 patients treated between March 2020 to June 2021 who received a positive COVID-19 polymerase chain reaction result from Mount Sinai and had a scoliosis ICD-10 code (M41.0-M41.9) was retrospectively analyzed. Degree of coronal plane scoliosis on imaging was confirmed by 2 independent measurers and grouped into no scoliosis (Cobb angle <10°), mild (10°-24°), moderate (25°-39°), and severe (>40°) cohorts. Baseline characteristics were compared, and a multivariable logistic regression controlling for clinically significant comorbidities examined the significance of scoliosis as an independent risk factor for hospitalization, intensive care unit (ICU) admission, acute respiratory distress syndrome (ARDS), mechanical ventilation, and mortality. RESULTS The no (n = 42), mild (n = 14), moderate (n = 44), and severe scoliosis (n = 29) cohorts differed significantly only in age (P = 0.026). The percentage of patients hospitalized (P = 0.59), admitted to the ICU (P = 0.33), developing ARDS (P = 0.77), requiring mechanical ventilation (P = 1.0), or who expired (P = 0.77) did not significantly differ between cohorts. The scoliosis cohorts did not have a significantly higher likelihood of hospital admission (mild P = 0.19, moderate P = 0.67, severe P = 0.98), ICU admission (P = 0.97, P = 0.94, P = 0.22), ARDS (P = 0.87, P = 0.74, P = 0.94), mechanical ventilation (P = 0.73, P = 0.69, P = 0.70), or mortality (P = 0.74, P = 0.87, P = 0.66) than the no scoliosis cohort. CONCLUSIONS Scoliosis was not an independent risk factor for critical COVID-19 illness. No trends indicated any consistent effect of degree of scoliosis on increased adverse outcome likelihood.
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Affiliation(s)
- Colin D Lamb
- Department of Neurosurgery, Mount Sinai Hospital, New York, New York, USA.
| | - Addison Quinones
- Department of Neurosurgery, Mount Sinai Hospital, New York, New York, USA
| | - Jack Y Zhang
- Department of Neurosurgery, Mount Sinai Hospital, New York, New York, USA
| | - Gijong Paik
- Department of Neurosurgery, Mount Sinai Hospital, New York, New York, USA
| | - Danielle Chaluts
- Department of Neurosurgery, Mount Sinai Hospital, New York, New York, USA
| | - Matthew Carr
- Department of Neurosurgery, Mount Sinai Hospital, New York, New York, USA
| | - Baron S Lonner
- Department of Neurosurgery, Mount Sinai Hospital, New York, New York, USA
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Madhani SI, Oushy S, Savastano L. Revascularization of a Complex Case of Vertebrobasilar Insufficiency with Occipital Artery-Anterior Inferior Cerebellar Artery Bypass. World Neurosurg 2023; 173:3. [PMID: 36791882 DOI: 10.1016/j.wneu.2023.02.036] [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: 12/12/2022] [Revised: 02/06/2023] [Accepted: 02/07/2023] [Indexed: 02/15/2023]
Abstract
Atherosclerotic disease is the most common etiology in causing posterior circulation strokes and can be found within the intracranial vertebrobasilar system.1 Endovascular and surgical approaches to treat this disease have been defined with both advantages and disadvantages.2,3 We present a case of surgical revascularization of a complex case of vertebrobasilar insufficiency with occipital artery (OA)-anterior inferior cerebellar artery (AICA) bypass (Video 1). A 56-year-old gentleman presented with severe, disabling, and progressive symptoms of vertebrobasilar insufficiency refractory to maximal medical management. Symptom onset was 2 years prior after suffering a left lateral medullary stroke due to a left vertebral artery (VA) occlusion. Angiography showed left VA occlusion after the origin of the posterior inferior cerebellar artery (PICA) and a hypoplastic right VA mostly ending in a PICA with a small and critically stenosed branch to the basilar artery. An initial attempt to revascularize the chronic totally occluded left VA using a combination of anterograde and retrograde (via PComm) approaches was unsuccessful. The decision was made to proceed with an OA-AICA bypass. The end-to-side anastomosis was conducted in the right cerebellopontine cistern and was uncomplicated. Postoperative angiography demonstrated a patent bypass with brisk OA-to-AICA flow with retrograde filling of the basilar artery and its branches. No perioperative strokes. The patient remained free of recurrent symptoms of vertebrobasilar insufficiency at 6 months' follow-up.
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Affiliation(s)
- Sarosh Irfan Madhani
- Department of Neurologic Surgery, University of California San Francisco, California, USA
| | - Soliman Oushy
- Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Luis Savastano
- Department of Neurologic Surgery, University of California San Francisco, California, USA.
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McCormick ZL, Conger A, Smuck M, Lotz JC, Hirsch JA, Hickman C, Harper K, Burnham TR. Magnetic Resonance Imaging Characteristics Associated with Treatment Success from Basi vertebral Nerve Ablation: An Aggregated Cohort Study of Multicenter Prospective Clinical Trials Data. Pain Med 2022; 23:S34-S49. [PMID: 35856328 PMCID: PMC9297152 DOI: 10.1093/pm/pnac093] [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] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/16/2022] [Revised: 06/09/2022] [Accepted: 06/09/2022] [Indexed: 12/08/2022]
Abstract
Objective Investigate associations between endplate and motion segment magnetic resonance imaging (MRI) characteristics and treatment outcomes following basivertebral nerve radiofrequency ablation (BVN RFA) in patients with clinically suspected vertebral endplate pain (VEP). Design Aggregated cohort study of 296 participants treated with BVN RFA from three prospective clinical trials. Methods Baseline MRI characteristics were analyzed using stepwise logistic regression to identify factors associated with treatment success. Predictive models used three definitions of treatment success: (1) ≥50% low back pain (LBP) visual analog scale (VAS), (2) ≥15-point Oswestry Disability Index (ODI), and (3) ≥50% VAS or ≥15-point ODI improvements at 3-months post-BVN RFA. Results The presence of lumbar facet joint fluid (odds ratio [OR] 0.586) reduced the odds of BVN RFA treatment success in individuals with clinically suspected VEP. In patients with a less advanced degenerative disc disease (DDD) profile, a > 50% area of the endplate with bone marrow intensity changes (BMIC) was predictive of treatment success (OR 4.689). Both regressions areas under the curve (AUCs) were under 70%, indicating low predictive value. All other vertebral endplate, intervertebral disc, nerve roots facet joint, spinal segmental alignment, neuroforamina, lateral recesses, and central canal MRI characteristics were not associated with BVN RFA success. Conclusions In patients with vertebrogenic low back pain with Modic changes, the presence of degenerative findings of the anterior and posterior column was not associated with a clinically important impact on BVN RFA treatment success. None of the models demonstrated strong predictive value, indicating that the use of objective imaging biomarkers (Type 1 and/or 2 Modic changes) and a correlating presentation of pain remain the most useful patient selection factors for BVN RFA.
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Affiliation(s)
- Zachary L McCormick
- Department of Physical Medicine and Rehabilitation, University of Utah School of Medicine, Salt Lake City, Utah, USA
| | - Aaron Conger
- Department of Physical Medicine and Rehabilitation, University of Utah School of Medicine, Salt Lake City, Utah, USA
| | - Matthew Smuck
- Department of Orthopedics, Stanford University, Palo Alto, California, USA
| | - Jeffrey C Lotz
- Department of Orthopedics, University of California San Francisco, San Francisco, California, USA
| | - Joshua A Hirsch
- Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Colton Hickman
- Department of Physical Medicine and Rehabilitation, University of Utah School of Medicine, Salt Lake City, Utah, USA
| | | | - Taylor R Burnham
- Department of Physical Medicine and Rehabilitation, University of Utah School of Medicine, Salt Lake City, Utah, USA
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Talha KM, Baddour LM, Ishaq H, Ramesh R, Arshad V, Tariq W, Fischer KM, Berbari EF, Sohail MR, Palraj R. Native Vertebral Osteomyelitis in Patients with Staphylococcus aureus Bacteremia. Am J Med Sci 2021; 363:140-146. [PMID: 34407419 DOI: 10.1016/j.amjms.2021.06.018] [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] [Subscribe] [Scholar Register] [Received: 12/02/2020] [Revised: 05/19/2021] [Accepted: 06/23/2021] [Indexed: 11/25/2022]
Abstract
BACKGROUND The purpose of the study was to assess the epidemiology, risk factors and outcomes of native vertebral osteomyelitis (NVO) in patients with Staphylococcus aureus bacteremia (SAB). METHODS A retrospective institutional review was conducted at Mayo Clinic, Minnesota. Patients aged ≥ 18 years with SAB who developed NVO from January 1, 2006 to December 31, 2020 were included and 3-month follow-up data were abstracted. Data pertaining to patient demographics, risk factors and outcomes were recorded using REDCap. A 1:2 nested case-control analysis was performed, and controls were matched according to age, sex and year of SAB diagnosis. RESULTS A total of 103 patients had NVO. A majority (60.2%) of patients was male, with a median age of 62.0 years. Thirty-one (30.1%) cases were caused by methicillin-resistant S. aureus (MRSA). The lumbar spine was most commonly (57.6%) and the most commonly reported comorbid conditions included diabetes mellitus (36.9%) and coronary artery disease (27.2%). Mortality at three-month follow-up was 18.6%. Nested case-control analysis revealed that injection drug use (IDU) and tobacco consumption were significant risk factors associated with NVO, while chronic hemodialysis and chronic liver disease (CLD) were associated with a decreased risk of NVO. CONCLUSIONS Atherosclerotic vascular disease was prominent in our contemporary cohort with NVO in the setting of SAB. Diabetes mellitus, tobacco consumption, older age and male sex likely contributed to this profile. Because IDU was associated with NVO, an increased number of cases should be anticipated among patients with IDU given the ongoing opioid epidemic in the United States.
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Affiliation(s)
- Khawaja M Talha
- Division of Infectious Diseases, Department of Medicine, Mayo Clinic School of Medicine and Science, Rochester, Minnesota, USA.
| | - Larry M Baddour
- Division of Infectious Diseases, Department of Medicine, Mayo Clinic School of Medicine and Science, Rochester, Minnesota, USA; Department of Cardiovascular Disease, Mayo Clinic School of Medicine and Science, Rochester, Minnesota, USA.
| | - Hassan Ishaq
- Division of Infectious Diseases, Department of Medicine, Mayo Clinic School of Medicine and Science, Rochester, Minnesota, USA.
| | - Rommel Ramesh
- Division of Infectious Diseases, Department of Medicine, Mayo Clinic School of Medicine and Science, Rochester, Minnesota, USA.
| | - Verda Arshad
- Division of Infectious Diseases, Department of Medicine, Mayo Clinic School of Medicine and Science, Rochester, Minnesota, USA.
| | - Wajeeha Tariq
- Division of Infectious Diseases, Department of Medicine, Mayo Clinic School of Medicine and Science, Rochester, Minnesota, USA.
| | - Karen M Fischer
- Department of Biomedical Statistics and Informatics, Mayo Clinic School of Medicine and Science, Rochester, Minnesota, USA.
| | - Elie F Berbari
- Division of Infectious Diseases, Department of Medicine, Mayo Clinic School of Medicine and Science, Rochester, Minnesota, USA.
| | - M Rizwan Sohail
- Section of Infectious Diseases, Department of Medicine, Baylor College of Medicine, Houston, Texas, USA.
| | - Raj Palraj
- Division of Infectious Diseases, Department of Medicine, Mayo Clinic School of Medicine and Science, Rochester, Minnesota, USA.
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Razek AAKA, Taman S, Gamal W, El Ayouty M, Ali KM, Barakat TE. Diffusion tensor imaging of vertebral bone marrow in children with Gaucher's disease type I and III: Pre- and post-therapy. Clin Imaging 2021; 79:207-212. [PMID: 34116297 DOI: 10.1016/j.clinimag.2021.06.002] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2020] [Revised: 05/30/2021] [Accepted: 06/02/2021] [Indexed: 12/14/2022]
Abstract
PURPOSE To assess diffusion tensor imaging (DTI) of the vertebral bone marrow (BM) in children with Gaucher's disease (GD) types I and III before and after therapy. METHODS Prospective study was conducted upon 25 children with GD type I (n = 17) and III (n = 8) and 13 age and sex-matched controls underwent DTI of vertebral BM. Mean diffusivity (MD) and fractional anisotropy (FA) of vertebral BM was calculated and correlated with genotyping, chitotriosidase, hemoglobin (HB) and, platelet count. RESULTS There was a statistically significant difference in MD and FA of BM between patients and controls (P = 0.001 and 0.02). The area under the curve (AUC) of MD and FA used to differentiate untreated patients from controls was 0.902 and 0.68 with sensitivity, specificity, and, accuracy 92%, 84.6%, and, 89.5% respectively. There was a significant difference in MD and FA of BM between untreated and treated patients (P = 0.001 and 0.02). AUC of MD and FA used to differentiate untreated from treated patients was 0.93 and 0.649 with sensitivity, specificity, and accuracy of 92%, 80%, and 86% respectively. There was a significant difference in MD and FA (P = 0.03, 0.001 respectively) of BM in GD with homozygous L444P mutation (n = 9) and other mutations (n = 14). Chiotriptase, HB and platelet count of patients was correlated with MD (r = -0.36, 0.42, -0.41) and FA (r = -0.47, -0.37, -0.46) respectively. CONCLUSION DTI of vertebral BM can help in diagnosis and monitoring patients with GD after therapy and correlated with genotyping, and hematological biomarkers of GD.
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Affiliation(s)
| | - Saher Taman
- Department of Diagnostic Radiology, Mansoura Faculty of Medicine, Mansoura, Egypt
| | - Walaa Gamal
- Gastroenterology and Hepatology Unit, Department of Pediatrics, Mansoura Faculty of Medicine, Mansoura, Egypt
| | - Mostafa El Ayouty
- Gastroenterology and Hepatology Unit, Department of Pediatrics, Mansoura Faculty of Medicine, Mansoura, Egypt
| | - Khadiga M Ali
- Department of Pathology, Mansoura Faculty of Medicine, Mansoura, Egypt
| | - Tarik Elsayed Barakat
- Gastroenterology and Hepatology Unit, Department of Pediatrics, Mansoura Faculty of Medicine, Mansoura, Egypt
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Sun Q, Tian FM, Liu F, Fang JK, Hu YP, Lian QQ, Zhou Z, Zhang L. Denosumab alleviates inter vertebral disc degeneration adjacent to lumbar fusion by inhibiting endplate osteochondral remodeling and vertebral osteoporosis in ovariectomized rats. Arthritis Res Ther 2021; 23:152. [PMID: 34049577 PMCID: PMC8161944 DOI: 10.1186/s13075-021-02525-8] [Citation(s) in RCA: 8] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2020] [Accepted: 05/05/2021] [Indexed: 01/22/2023] Open
Abstract
Background Although adjacent segmental intervertebral disc degeneration (ASDD) is one of the most common complications after lumbar fusion, its exact mechanism remains unclear. As an antibody to RANKL, denosumab (Dmab) effectively reduces bone resorption and stimulates bone formation, which can increase bone mineral density (BMD) and improve osteoporosis. However, it has not been confirmed whether Dmab has a reversing or retarding effect on ASDD. Methods Three-month-old female Sprague-Dawley rats that underwent L4–L5 posterolateral lumbar fusion (PLF) with spinous-process wire fixation 4 weeks after bilateral ovariectomy (OVX) surgery were given Dmab 4 weeks after PLF surgery (OVX+PLF+Dmab group). In addition, the following control groups were defined: Sham, OVX, PLF, and OVX+PLF (n=12 each). Next, manual palpation and X-ray were used to evaluate the state of lumbar fusion. The bone microstructure in the lumbar vertebra and endplate as well as the disc height index (DHI) of L5/6 was evaluated by microcomputed tomography (μCT). The characteristic alterations of ASDD were identified via Safranin-O green staining. Osteoclasts were detected using tartrate-resistant acid phosphatase (TRAP) staining, and the biomechanical properties of vertebrae were evaluated. Aggrecan (Agg), metalloproteinase-13 (MMP-13), and a disintegrin and metalloproteinase with thrombospondin motifs 4 (ADAMTS-4) expression in the intervertebral disc were detected by immunohistochemistry and real-time polymerase chain reaction (RT-PCR) analysis. In addition, the expression of CD24 and Sox-9 was assessed by immunohistochemistry. Results Manual palpation showed clear evidence of the fused segment’s immobility. Compared to the OVX+PLF group, more new bone formation was observed by X-ray examination in the OVX+PLF+Dmab group. Dmab significantly alleviated ASDD by retaining disc height index (DHI), decreasing endplate porosity, and increasing vertebral biomechanical properties and BMD. TRAP staining results showed a significantly decreased number of active osteoclasts after Dmab treatment, especially in subchondral bone and cartilaginous endplates. Moreover, the protein and mRNA expression results in discs (IVDs) showed that Dmab not only inhibited matrix degradation by decreasing MMP-13 and ADAMTS-4 but also promoted matrix synthesis by increasing Agg. Dmab maintained the number of notochord cells by increasing CD24 but reducing Sox-9. Conclusions These results suggest that Dmab may be a novel therapeutic target for ASDD treatment.
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Affiliation(s)
- Qi Sun
- Department of Orthopedic Surgery, Hebei Medical University, Shijiazhuang, People's Republic of China
| | - Fa-Ming Tian
- Medical Research Center, North China University of Science and Technology, Tangshan, People's Republic of China
| | - Fang Liu
- Medical Research Center, North China University of Science and Technology, Tangshan, People's Republic of China
| | - Jia-Kang Fang
- Medical Research Center, North China University of Science and Technology, Tangshan, People's Republic of China
| | - Yun-Peng Hu
- Medical Research Center, North China University of Science and Technology, Tangshan, People's Republic of China
| | - Qiang-Qiang Lian
- Medical Research Center, North China University of Science and Technology, Tangshan, People's Republic of China
| | - Zhuang Zhou
- Department of Bone and Soft Tissue Oncology, The Third Hospital of Hebei Medical University, Shijiazhuang, People's Republic of China
| | - Liu Zhang
- Department of Orthopedic Surgery, Hebei Medical University, 361 Zhongshan ERoad, Hebei, 050000, Shijiazhuang, People's Republic of China.
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Garg K, Dash A, Aggarwal A, Duetzmann S. Vertebral Pneumatocyst-A Systematic Review. World Neurosurg 2021; 151:77-86. [PMID: 33933696 DOI: 10.1016/j.wneu.2021.04.092] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2021] [Revised: 04/18/2021] [Accepted: 04/19/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND Intraosseous pneumatocyst refers to gas-filled cystic lesions inside bone. Whereas ilium and sacrum are the commonest locations for pneumatocysts, vertebral pneumatocysts are rare. Various theories have been proposed to explain the etiopathogenesis of vertebral pneumatocysts and the most widely accepted theory is the extension of air from intervertebral disc or joint spaces into the pneumatocyst cavity. The aim of this systematic review was to study all the cases of vertebral pneumatocyst reported in the literature to understand this rare disease and its clinical importance. METHODS A comprehensive search of the PubMed, Embase, and Scopus databases was performed to retrieve case reports and case series describing the cases of pneumatocyst. RESULTS A total of 61 cases of incidentally reported vertebral pneumatocyst were included in the systematic review. The mean age of the patients was 57.82 ± 10.2 years (range, 31-89 years). The mean size of the pneumatocysts was 8.67 ± 4.18 mm (range, 2-20 mm). CONCLUSIONS The prevalence of pneumatocyst increased with increasing age, with most of the reported patients belonging to the 50-70 years age-group. Most of these patients have large pneumatocysts with degenerative changes in spine. Another less common subset of young patients with small pneumatocysts without associated degenerative changes has also been described. Pneumatocysts were most common in the cervical spine, with C5 being the most commonly affected vertebra. Most of the pneumatocysts remain stable in size on follow-up, although 3 cases of enlarging pneumatocyst have also been reported. An enlarging pneumatocyst should be closely followed up, although its benign nature has been reported in the literature.
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Affiliation(s)
- Kanwaljeet Garg
- Department of Neurosurgery, All India Institute of Medical Sciences, New Delhi, India.
| | - Atmaranjan Dash
- Department of Neurosurgery, All India Institute of Medical Sciences, New Delhi, India
| | - Ankita Aggarwal
- Department of Radiodiagnosis, VMMC and Safdarjung Hospital, New Delhi, India
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15
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Krafft PR, Noureldine MHA, Jallo GI, Shah SA, Alikhani P. Percutaneous lumbar pedicle fixation in young children with flexion-distraction injury-case report and operative technique. Childs Nerv Syst 2021; 37:1363-8. [PMID: 32740674 DOI: 10.1007/s00381-020-04845-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Accepted: 07/28/2020] [Indexed: 10/23/2022]
Abstract
Thoracolumbar fractures in children are relatively uncommon and should be regarded as a separate entity from those in adults. While percutaneous pedicle fixation has emerged as an effective alternative to open fixation in adults with unstable thoracolumbar fractures, this technique is rarely applied in children. We report a 6-year-old girl with an L3 chance fracture, which was treated via short-segment percutaneous pedicle fixation. We also discussed the technical challenges and caveats of this surgical technique in young children. While potentially more challenging, percutaneous pedicle fixation is feasible in young children with thoracolumbar fractures. Specific differences between the developing and mature spine in regard to anatomical and biomechanical characteristics, including ligamentous laxity and intrinsic elasticity, should be taken into consideration. Future studies are needed to compare outcomes of minimally invasive spinal techniques to open surgery in children.
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16
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Iida S, Kobayashi F, Kawano R, Saita K, Ogihara S. Thoracic spine hemangioma causing rapidly progressive myelopathy and mimicking a malignant tumor: A case report. Radiol Case Rep 2021; 16:938-41. [PMID: 33659033 DOI: 10.1016/j.radcr.2021.01.060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2021] [Revised: 01/29/2021] [Accepted: 01/31/2021] [Indexed: 11/23/2022] Open
Abstract
Vertebral hemangiomas are common benign tumors that are mostly asymptomatic and are discovered incidentally. Only 0.9–1.2% of all vertebral hemangiomas, termed aggressive vertebral hemangiomas, expand to cause pain and neural compression. We present an extremely rare case of a 49-year-old woman who had an aggressive vertebral hemangioma of the thoracic spine that caused rapidly progressive myelopathy with remarkable irregular extraosseous bone proliferation, which mimicked a malignant vertebral tumor. In this case, despite the lesion's hostile appearance during imaging, the pathological diagnosis was benign and symptom-based surgical treatment with posterior decompression and stabilization provided good clinical outcomes during the postoperative 18 months follow-up period. In this case, despite the use of standard imaging modalities (radiograph, CT, and MRI), making a preoperative imaging diagnosis of an aggressive vertebral hemangioma was difficult, and although aggressive vertebral hemangiomas with atypical radiological features are rare, they should be considered as a differential diagnosis.
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17
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Patel S, Ansari D, Patil SN, Burch TG, Chaker AN, Rosinski CL, Chaudhry NS, Mehta AI. High-Grade Spinal Hemangioma: A National Cancer Database Analysis. World Neurosurg 2021; 148:e527-e535. [PMID: 33460817 DOI: 10.1016/j.wneu.2021.01.020] [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: 10/23/2020] [Revised: 01/06/2021] [Accepted: 01/06/2021] [Indexed: 10/22/2022]
Abstract
BACKGROUND Spinal hemangiomas are common primary tumors of the vertebrae. Although these tumors are most frequently benign and asymptomatic, they can rarely exhibit aggressive growth and invasion into neighboring structures. Treatment for these aggressive variants is controversial, often involving surgery, chemotherapy, and/or radiotherapy. This study sought to investigate current trends affecting overall survival (OS) using the National Cancer Database (NCDB) and to formulate treatment recommendations. METHODS The National Cancer Database was queried for spinal hemangiomas between 2004 and 2016. A Cox proportional hazards model was used to perform multivariate regression analysis of survival. Survival curves for comparative visualization of demographic and treatment factors were generated using a semiparametric Cox approach. RESULTS A cohort of 102 patients with histologically confirmed spinal hemangiomas was identified in the database. Mean OS was 1.94 years. Administered treatments included partial surgical resection (n = 17), radical resection (n = 14), chemotherapy (n = 34), and radiotherapy (n = 56). Multivariate analysis revealed associations between decreased OS and advanced age (>65 years) and presence of metastasis. Cox survival analysis further revealed improved OS in patients who received surgical treatment and higher radiation dose. CONCLUSIONS This retrospective analysis finding that treatment with surgical resection and/or radiotherapy is associated with increased OS constitutes the largest cohort of patients with aggressive vertebral hemangiomas to date. Given that the mean OS of the study cohort was 1.94 years, our findings suggest that the optimal treatment regimen to maximize survival should consist of early surgical resection with adjuvant high-dose radiotherapy.
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Affiliation(s)
- Saavan Patel
- Department of Neurosurgery, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Darius Ansari
- Department of Neurosurgery, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Shashank N Patil
- Department of Neurosurgery, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Taylor G Burch
- Department of Neurosurgery, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Anisse N Chaker
- Department of Neurosurgery, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Clayton L Rosinski
- Department of Neurosurgery, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Nauman S Chaudhry
- Department of Neurosurgery, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Ankit I Mehta
- Department of Neurosurgery, University of Illinois at Chicago, Chicago, Illinois, USA.
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Murumkar V, Jabeen S, Peer S, Ramalingaiah AH, Saini J. Ruptured vertebrobasilar junction aneurysm unmasking subclavian steal syndrome. Surg Neurol Int 2020; 11:419. [PMID: 33365182 PMCID: PMC7749953 DOI: 10.25259/sni_561_2020] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2020] [Accepted: 11/17/2020] [Indexed: 11/04/2022] Open
Abstract
Background Subclavian steal occurs due to stenosis or occlusion of the subclavian artery or innominate artery proximal to the origin of the vertebral artery. Often asymptomatic, the condition may be unmasked due to symptoms of vertebrobasilar insufficiency triggered by strenuous physical exercise involving the affected upper limb. The association of vertebrobasilar junction (VBJ) aneurysms with subclavian steal syndrome has been rarely reported. Hereby, we present a case of VBJ aneurysm associated with subclavian steal treated successfully with endovascular coiling. Case Description A 65-year-old female presented in the emergency department with acute severe headache and vomiting with no focal neurological deficits. Non-contrast computed tomography of the brain showed modified Fischer Grade 3 subarachnoid hemorrhage. Subsequent digital subtraction angiogram (DSA) showed VBJ aneurysm directed inferiorly with the left subclavian artery occlusion. There was retrograde filling of the left vertebral artery on right vertebral injection, confirming the diagnosis of subclavian steal. Balloon assisted coiling of the VBJ aneurysm was performed while gaining access through the stenotic left vertebral artery ostium which provided a more favorable hemodynamic stability to the coil mass. Conclusion Subclavian steal exerting undue hemodynamic stress on vertebrobasilar circulation can be an etiological factor for the development of the flow-related aneurysms. Access to the VBJ aneurysms may be feasible through the stenosed vertebral artery if angioplasty is performed before the coiling of the aneurysm.
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Affiliation(s)
- Vivek Murumkar
- Department of Neuroimaging and Interventional Radiology, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| | - Shumyla Jabeen
- Department of Neuroimaging and Interventional Radiology, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| | - Sameer Peer
- Department of Neuroimaging and Interventional Radiology, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| | | | - Jitender Saini
- Department of Neuroimaging and Interventional Radiology, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
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Kacprzynski G, Bucher J. Delayed vertebral artery dissection after mild trauma in a motor vehicle collision. Am J Emerg Med 2021; 45:678.e1-2. [PMID: 33298350 DOI: 10.1016/j.ajem.2020.11.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2020] [Revised: 11/09/2020] [Accepted: 11/14/2020] [Indexed: 11/21/2022] Open
Abstract
Vertebral artery dissection can be insidious and is a leading cause of stroke in young patients, second only behind cardioembolic events [1]. We present the case of a 42-year-old patient who presented to the emergency department with diaphoresis and a complaint of neck pain one month after a low speed motor vehicle collision. The patient was transferred to a stroke center where cerebral angiography showed severe vertebral artery stenosis with likelihood of dissection after a noncontrast CT was negative for hemorrhage. She was definitively treated with antiplatelet therapy and discharged to rehab. By reviewing the most recent literature, we better define this illness. Most commonly, patients with arterial dissection present with head or neck pain, stroke, and Horner syndrome. It is now thought that vertebral artery dissection is a multifactorial disease process where certain intrinsic factors are present in the setting of an exacerbating extrinsic factor such as a low speed car accident, direct trauma, heavy lifting, or a rotational sports injury. And while our patient was treated with antiplatelet therapy and intravascular intervention, vertebral artery dissection is rare and further research is required to better guide treatment as there is no definitive data showing superiority of either anticoagulation or antiplatelet pharmaceutics.
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20
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Song L, Han S, Zhang W, Jiang L. 18F-fluorodeoxyglucose positron emission tomography/computed tomography in the evaluation of spinal giant cell tumors. Skeletal Radiol 2020; 49:1737-1745. [PMID: 32444915 DOI: 10.1007/s00256-020-03468-y] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2020] [Revised: 04/29/2020] [Accepted: 05/10/2020] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To investigate the value of 18F-fluorodeoxyglucose (18F-FDG) positron emission tomography/computed tomography (PET/CT) in the evaluation of spinal giant cell tumors (GCTs). MATERIALS AND METHODS The PET/CT and clinical data of 16 patients with spinal GCTs were reviewed. The maximal standardized uptake value (SUVmax), longest diameter, and CT features of spinal GCTs were analyzed. The value of PET/CT and MRI in displaying the recurrent lesions was compared. PET Response Criteria in Solid Tumors were adopted to evaluate the response to radiotherapy. RESULTS Data from 7 males and 9 females (median age 32.5 years) were analyzed. Eight patients had primary GCTs with a median SUVmax of 11.91 and a median length of 4.42 cm. Eight patients had relapsed GCTs with a median SUVmax of 10.34 and a median length of 6.23 cm. There was no statistical difference between the SUVmax of primary and relapsed GCTs. The SUVmax did not correlate with length. In 8 relapsed patients, 4 lesions invaded the vertebral canal, but 2 of which were not displayed on MRI. Metal prostheses showed extremely low signal intensity on MRI, even in the 3 cases with increased intra-prosthetic 18F-FDG concentration. Five relapsed patients with subsequent radiotherapy had a repeat PET/CT. A complete, partial, and stable metabolic response was observed in 1, 3, and 1 patient, respectively. CONCLUSIONS Both the primary and recurrent spinal GCTs avidly accumulate 18F-FDG. For recurrent GCTs, PET/CT may provide incremental value in the assessment of the vertebral canal and intra-prosthetic involvement and the response to radiotherapy.
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Affiliation(s)
- Le Song
- Department of Nuclear Medicine, Peking University Third Hospital, Beijing, 100191, People's Republic of China
| | - Songbo Han
- Department of Radiology, Peking University Third Hospital, Beijing, 100191, People's Republic of China
| | - Weifang Zhang
- Department of Nuclear Medicine, Peking University Third Hospital, Beijing, 100191, People's Republic of China.
| | - Liang Jiang
- Department of Orthopedics, Peking University Third Hospital, Beijing, 100191, People's Republic of China.
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Kwon YE, Choi HY, Oh HJ, Ahn SY, Ryu DR, Kwon YJ. Vertebral fracture is associated with myocardial infarction in incident hemodialysis patients: a Korean nationwide population-based study. Osteoporos Int 2020; 31:1965-1973. [PMID: 32394062 DOI: 10.1007/s00198-020-05423-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [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: 11/21/2019] [Accepted: 04/14/2020] [Indexed: 10/24/2022]
Abstract
UNLABELLED Chronic kidney disease (CKD)-mineral and bone disorder suggests that fragile bone and vascular disorder might be connected closely in CKD patients. In this study, fracture event was significantly associated with myocardial infarction (MI) in end-stage renal disease patients on hemodialysis (HD), especially for vertebral fractures. INTRODUCTION CKD-mineral and bone disorder is characterized by biochemical abnormalities, bone disorders, and vascular calcification. We aimed to verify the association between fracture and MI in CKD patients. METHODS Records for incident CKD stage 3 to 5 patients and patients who initiated HD between July 2014 and June 2018 were retrieved from the Korean Health Insurance Review & Assessment Service Database. Fractures were defined using diagnostic codes and were classified into vertebral, femoral, and other site fractures. MI was defined using a combination of MI diagnostic codes and related procedure codes. Multiple logistic regressions and 1:1 propensity score matching analysis were conducted. RESULTS A total of 38,935 patients (HD, 11,379; pre-dialysis CKD, 27,556) were included in this study. A total of 5,057 (13.0%) patients experienced fracture, and 1,431 (3.7%) patients had MI. Multiple logistic regression analysis showed that fracture was significantly associated with MI in the HD group (odds ratio (OR) 1.34, P = 0.024), but not in the pre-dialysis CKD group (OR 1.04, P = 0.701). After propensity score matching for age, gender, and diabetes mellitus between patients with and without fracture, fracture still significantly correlated with MI in HD patients (OR 1.47, P = 0.034) but not in patients with pre-dialysis CKD (OR 1.04, P = 0.751). Subgroup analysis by fracture site found that vertebral fracture was associated with MI in HD patients (OR 2.11, P = 0.024), but femoral or other site fractures were not. CONCLUSION In HD patients, fracture was significantly associated with MI, especially for vertebral fractures patients.
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Affiliation(s)
- Y E Kwon
- Department of Internal Medicine, Hanyang University College of Medicine, Myongji Hospital, Goyang-si, South Korea
| | - H Y Choi
- The Korean Society of Nephrology, Seoul, South Korea
| | - H J Oh
- Ewha Institute of Convergence Medicine and Research Institute for Human Health Information, Ewha Womans University, Seoul, South Korea
| | - S Y Ahn
- Department of Internal Medicine, Korea University College of Medicine, Seoul, South Korea
| | - D-R Ryu
- Department of Internal Medicine, Ewha Womans University College of Medicine, Seoul, South Korea.
| | - Y J Kwon
- Department of Internal Medicine, Korea University College of Medicine, Seoul, South Korea.
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Aljuboori Z, Ding D, Andaluz N. Occipital Artery to Anterior Inferior Cerebellar Artery (AICA) Bypass for Treatment of a Ruptured Proximal AICA-Posterior Inferior Cerebellar Artery Mycotic Aneurysm. World Neurosurg 2020; 142:176-178. [PMID: 32585380 DOI: 10.1016/j.wneu.2020.06.090] [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: 05/02/2020] [Accepted: 06/10/2020] [Indexed: 10/24/2022]
Abstract
BACKGROUND Intracranial mycotic aneurysms are uncommon. They can occur due to extravascular extension or intravascular seeding of the vessel wall. They often result in subarachnoid hemorrhage with poor prognosis. We present a rare case of subarachnoid hemorrhage due to vertebral artery dissection with aproximal anterior inferior cerebellar artery (AICA)-posterior inferior cerebellar artery common trunk mycotic aneurysm after an episode of bacterial meningitis. CASE DESCRIPTION A 66-year-old male with history of 2 episodes of culture-negative bacterial meningitis presented with a Hunt and Hess grade II, Fisher grade III subarachnoid hemorrhage. Catheter angiography showed a right-sided intracranial vertebral artery (VA) dissection and a fusiform AICA-posterior inferior cerebellar artery trunk aneurysm. The patient underwent an endovascular occlusion of the VA dissecting aneurysm followed by an occipital artery to AICA bypass with trapping of the aneurysm. The patient developed a left-sided numbness and weakness after the coiling procedure due to anteromedian medullary stroke (occlusion of the right anterior spinal artery). The patient's magnetic resonance imaging 3 weeks before the aneurysm rupture and during the second episode of meningitis showed new enhancement of both vertebral arteries with a mild reduction in the right VA caliber. At 6 weeks' follow-up the patient was off the ventilator but had a modified Rankin Scale score of 5. CONCLUSIONS Bacterial meningitis can lead to inflammatory injury of the intracranial vessels with resultant aneurysm formation. New enhancement of the vessel wall indicates that patients are at risk of developing mycotic aneurysms; therefore close observation with repeated vascular imaging is necessary.
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Affiliation(s)
- Zaid Aljuboori
- Department of Neurosurgery, University of Louisville, Louisville, Kentucky, USA.
| | - Dale Ding
- Department of Neurosurgery, University of Louisville, Louisville, Kentucky, USA
| | - Norberto Andaluz
- Department of Neurosurgery, University of Louisville, Louisville, Kentucky, USA
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Song L, Han S, Jiang L, Zhang W. F18-fluorodeoxyglucose positron emission tomography/computed tomography in the evaluation of vertebral vascular tumors. Clin Imaging 2020; 65:24-32. [PMID: 32353715 DOI: 10.1016/j.clinimag.2020.03.019] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2019] [Revised: 03/20/2020] [Accepted: 03/30/2020] [Indexed: 12/15/2022]
Abstract
PURPOSE F-FDG PET/CT in vertebral vascular tumors. MATERIALS AND METHODS We retrospectively collected PET/CT and clinical data of patients with vertebral vascular tumors and analyzed the location, number, and bone destruction and FDG uptake features of the lesion. We measured SUVmax and maximum diameter and analyzed the correlations between SUVmax and the pathological results, size, and CT features. RESULTS Twenty-one pathology-proven vertebral vascular tumors were included: 2 angiosarcomas (SUVmax, 11.6 and 32.3), 1 epithelioid hemangioendothelioma (SUVmax, 5.7), 1 epithelioid hemangioma (SUVmax, 8.5), and 17 aggressive hemangiomas. Twelve cases of typical hemangiomas were included as controls. The SUVmax and diameter of the aggressive hemangiomas were higher than those of the typical hemangiomas. The mean SUVmax of aggressive hemangiomas with cortical destruction was higher than that of those without cortical destruction (t = -2.566, P = 0.022). Radioactive distribution in aggressive hemangiomas was homogeneous and heterogeneous in nine and eight cases, respectively. In six aggressive hemangiomas, the FDG uptake of residual and marginal sclerosing bone was higher than that of the osteolytic destruction area and/or paravertebral soft tissue. Six aggressive hemangiomas involved the spinal canal, without clear visualization on PET/CT. CONCLUSION F-FDG PET/CT shows limitations in evaluating the spinal canal involvement of aggressive hemangioma.
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Affiliation(s)
- Le Song
- Department of Nuclear Medicine, Peking University Third Hospital, 100191 Beijing, PR China
| | - Songbo Han
- Department of Radiology, Peking University Third Hospital, 100191 Beijing, PR China
| | - Liang Jiang
- Department of Orthopedics, Peking University Third Hospital, 100191 Beijing, PR China
| | - Weifang Zhang
- Department of Nuclear Medicine, Peking University Third Hospital, 100191 Beijing, PR China.
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Ehresman J, Pennington Z, Schilling A, Lubelski D, Ahmed AK, Cottrill E, Khan M, Sciubba DM. Novel MRI-based score for assessment of bone density in operative spine patients. Spine J 2020; 20:556-562. [PMID: 31683066 DOI: 10.1016/j.spinee.2019.10.018] [Citation(s) in RCA: 68] [Impact Index Per Article: 17.0] [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: 09/04/2019] [Revised: 10/16/2019] [Accepted: 10/28/2019] [Indexed: 02/03/2023]
Abstract
BACKGROUND Good bone quality is key in avoiding a multitude of afflictions, including osteoporotic fragility fractures and poor outcomes after spine surgery. In patients undergoing instrumented spine fusion, bone quality often dictates screw pullout strength, insertional torque, and vertebral body loading properties. While dual-energy X-ray absorptiometry (DEXA) screening is the current method of assessing bone mineral density, the majority of patients do not have DEXA measurements available before undergoing surgical instrumentation. PURPOSE To create a simple magnetic resonance imaging (MRI)-based score to evaluate bone quality and evaluate the degree to which it correlates with conventional DEXA scores. STUDY DESIGN/SETTING Retrospective cohort. PATIENT SAMPLE Patients ≥18 years of age undergoing spine surgery for degenerative conditions between 2013 and 2018. OUTCOME MEASURES Correlation of the vertebral bone quality (VBQ) score with DEXA T-scores, and association between VBQ score and presence of osteopenia/osteoporosis. METHODS Using noncontrast T1-weighted MRIs of the lumbar spine, the novel VBQ score was calculated for each patient. DEXA T-scores of the femoral neck and total hip were obtained and were compared with patient VBQ scores using linear regression and Pearson's correlation. RESULTS Among 68 patients included in this study, 37 were found to have osteopenia/osteoporosis (T-score < -1.0) based on DEXA. A greater VBQ score was significantly associated with the presence of osteopenia/osteoporosis with a predictive accuracy of 81%. VBQ scores correlated moderately with femoral neck T-scores, the lowest overall T-scores of each patient, and correlated fairly with total hip T-scores. CONCLUSIONS This is the first study to correlate the novel VBQ score obtained from MRIs with DEXA T-score. We found this score to be a significant predictor of healthy versus osteopenic/osteoporotic bone with an accuracy of 81%, and found that VBQ score was moderately correlated with femoral neck and overall lowest T-score.
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Affiliation(s)
- Jeff Ehresman
- Department of Neurosurgery, Johns Hopkins School of Medicine, 600 N. Wolfe St., Meyer 5-185A, Baltimore, MD 21287, USA
| | - Zach Pennington
- Department of Neurosurgery, Johns Hopkins School of Medicine, 600 N. Wolfe St., Meyer 5-185A, Baltimore, MD 21287, USA
| | - Andrew Schilling
- Department of Neurosurgery, Johns Hopkins School of Medicine, 600 N. Wolfe St., Meyer 5-185A, Baltimore, MD 21287, USA
| | - Daniel Lubelski
- Department of Neurosurgery, Johns Hopkins School of Medicine, 600 N. Wolfe St., Meyer 5-185A, Baltimore, MD 21287, USA
| | - A Karim Ahmed
- Department of Neurosurgery, Johns Hopkins School of Medicine, 600 N. Wolfe St., Meyer 5-185A, Baltimore, MD 21287, USA
| | - Ethan Cottrill
- Department of Neurosurgery, Johns Hopkins School of Medicine, 600 N. Wolfe St., Meyer 5-185A, Baltimore, MD 21287, USA
| | - Majid Khan
- Department of Radiology, Johns Hopkins School of Medicine, Baltimore, MD 21287, USA
| | - Daniel M Sciubba
- Department of Neurosurgery, Johns Hopkins School of Medicine, 600 N. Wolfe St., Meyer 5-185A, Baltimore, MD 21287, USA.
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Hardcastle N, Kron T, Cook O, Lehmann J, Mitchell PLR, Siva S. Credentialing of vertebral stereotactic ablative body radiotherapy in a multi-centre trial. Phys Med 2020; 72:16-21. [PMID: 32193090 DOI: 10.1016/j.ejmp.2020.03.004] [Citation(s) in RCA: 2] [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: 12/07/2019] [Revised: 02/11/2020] [Accepted: 03/02/2020] [Indexed: 12/23/2022] Open
Abstract
PURPOSE/OBJECTIVE Stereotactic ablative body radiotherapy (SABR) in multi-centre trials requires rigorous quality assurance to ensure safe and consistent treatment for all trial participants. We report results of vertebral SABR dosimetry credentialing for the ALTG/TROG NIVORAD trial. MATERIAL/METHODS Centres with a previous SABR site visit performed axial film measurement of the benchmarking vertebral plan in a local phantom and submitted radiochromic film images for analysis. Remaining centres had on-site review of SABR processes and axial film measurement of the vertebral benchmarking plan. Films were analysed for dosimetric and positional accuracy: gamma analysis (>90% passing 2%/2mm/10% threshold) and ≤ 1 mm positional accuracy at target-cord interface was required. RESULTS 19 centres were credentialed; 11 had on-site measurement. Delivery devices included linear accelerator, TomoTherapy and CyberKnife systems. Five centres did not achieve 90% gamma passing rate. Of these, three were out of tolerance (OOT) in low (<5Gy) dose regions and > 80% passing rate and deemed acceptable. Two were OOT over the full dose range: one elected not to remeasure; the other also had positional discrepancy greater than 1 mm and repeat measurement with a new plan was in tolerance. The original OOT was attributed to inappropriate MLC constraints. All centres delivered planned target-cord dose gradient within 1 mm. CONCLUSION Credentialing measurements for vertebral SABR in a multi-centre trial showed although the majority of centres delivered accurate vertebral SABR, there is high value in independent audit measurements. One centre with inappropriate MLC settings was detected, which may have resulted in delivery of clinically unacceptable vertebral SABR plans.
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Affiliation(s)
- Nicholas Hardcastle
- Physical Sciences, Peter MacCallum Cancer Centre, VIC, Australia; Centre for Medical Radiation Physics, University of Wollongong, NSW, Australia.
| | - Tomas Kron
- Physical Sciences, Peter MacCallum Cancer Centre, VIC, Australia; Centre for Medical Radiation Physics, University of Wollongong, NSW, Australia; Sir Peter MacCallum Cancer Centre, University of Melbourne, VIC, Australia
| | - Olivia Cook
- Trans Tasman Radiation Oncology Group, NSW, Australia
| | - Joerg Lehmann
- Trans Tasman Radiation Oncology Group, NSW, Australia; School of Mathematical and Physical Sciences, The University of Newcastle, NSW, Australia; Department of Radiation Oncology, Calvary Mater Newcastle, NSW, Australia; Institute of Medical Physics, The University of Sydney, NSW, Australia
| | - Paul L R Mitchell
- Department of Medical Oncology, Olivia Newton John Cancer Centre, Austin Health, VIC, Australia
| | - Shankar Siva
- Radiation Oncology, Peter MacCallum Cancer Centre, VIC, Australia; Sir Peter MacCallum Cancer Centre, University of Melbourne, VIC, Australia
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Sofoluke N, Shimony N, Goren O. Endovascular Treatment of Traumatic Transection of the Vertebral Artery Caused by Penetrating Injury to the Oropharynx in a Pediatric Patient. World Neurosurg 2020; 137:389-392. [PMID: 32084620 DOI: 10.1016/j.wneu.2020.02.063] [Citation(s) in RCA: 2] [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] [Subscribe] [Scholar Register] [Received: 12/17/2019] [Revised: 02/08/2020] [Accepted: 02/10/2020] [Indexed: 11/29/2022]
Abstract
BACKGROUND Pediatric isolated penetrating traumatic vertebral artery injuries require urgent multidisciplinary management as they may lead to potentially fatal posterior circulation ischemia. CASE DESCRIPTION We present a 19-month-old patient with an isolated penetrating vertebral artery injuries at the V2 segment of the right vertebral artery and report our strategy for her endovascular treatment which involved simultaneous coil embolization and foreign body removal. CONCLUSION Endovascular treatment can be considered first line treatment of oral penetrating injuries to the vertebral artery, where the penetrating object has an anterior to posterior trajectory.
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Affiliation(s)
- Nelson Sofoluke
- Department of Neurosurgery, Geisinger Medical Center, Danville, Pennsylvania, USA.
| | - Nir Shimony
- Department of Neurosurgery, Geisinger Medical Center, Danville, Pennsylvania, USA
| | - Oded Goren
- Department of Neurosurgery, Geisinger Medical Center, Danville, Pennsylvania, USA
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Muratore M, Allasia S, Viglierchio P, Abbate M, Aleotti S, Masse A, Bistolfi A. Surgical treatment of traumatic thoracolumbar fractures: a retrospective review of 101 cases. Musculoskelet Surg 2020; 105:49-59. [PMID: 32026381 DOI: 10.1007/s12306-020-00644-0] [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: 06/11/2019] [Accepted: 02/02/2020] [Indexed: 11/30/2022]
Abstract
PURPOSE To evaluate the outcomes of vertebral stabilisation after acute traumatic thoracolumbar fractures, correlating the outcome with patient clinical data, type and location of fracture, presence of neurological damage, timing of surgical intervention and number of instrumented levels. The results have been evaluated also through the AO classification and AOSIS score. METHODS Retrospective analysis of 101 patients with traumatic thoracolumbar injuries from T3 to L5 operated 2011-2016 by posterior or antero-posterior fixation. The demographic data, trauma dynamics, number and type of fractures, associated lesions, timing of surgery, hospital stay, AOSIS score, RKA, SF-36 and ODI scores, pre- and post-operative neurological condition (ASIA grade), possible complications and re-interventions were evaluated for each patient. RESULTS Fractures mainly involved the region between T11 and L2. The probability of medullary involvement increases with the increase in severity of the main fracture type with no relation with the vertebral region. Type B and C fractures were common in the thoracic region and rare in the thoracolumbar junction. ODI and SF-36 scores were significantly better in patients with a lower AOSIS score, specifically in lesions classified as type A, amyelic and with no comorbidity. No difference was found in the clinical scores between thoracic, thoracolumbar and lumbar fractures, nor between male and female patients. None of the 10 patients with ASIA A lesion at presentation achieved any degree of recovery: 50% of them had a thoracic lesion. Re-intervention rate was 15%. Hospital stay was significantly higher in patients with type C fractures, and complication rate was on average 14% (7% in type A fractures, 16% in B and 25% in C). CONCLUSIONS This study confirmed the validity of the posterior approach in the surgical treatment of thoracolumbar fractures. Outcomes and complication risks are related to fracture severity. Surgical treatment can be recommended even with an AOSIS score of two or three. The combined antero-posterior approach could be useful in cases with LSC > 8, especially in the thoracolumbar region. The degree of neurological recovery depends on fracture type, location, ASIA score and presence of comorbidities. Early intervention in myelic patients allows for a better prognosis. Level of evidence III retrospective case series.
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Affiliation(s)
- M Muratore
- Department of Orthopaedics, Traumatology and Rehabilitation, Orthopaedic and Trauma Centre, CTO, Hospital Città della Salute e della Scienza, Via Zuretti 29, 10126, Turin, Italy
| | - S Allasia
- School of Orthopaedics and Traumatology, University of the Studies of Turin, Via Zuretti 29, 10126, Turin, Italy
| | - P Viglierchio
- Department of Orthopaedics, Traumatology and Rehabilitation, Orthopaedic and Trauma Centre, CTO, Hospital Città della Salute e della Scienza, Via Zuretti 29, 10126, Turin, Italy
| | - M Abbate
- Department of Orthopaedics, Traumatology and Rehabilitation, Orthopaedic and Trauma Centre, CTO, Hospital Città della Salute e della Scienza, Via Zuretti 29, 10126, Turin, Italy
| | - S Aleotti
- Department of Orthopaedics, Traumatology and Rehabilitation, Orthopaedic and Trauma Centre, CTO, Hospital Città della Salute e della Scienza, Via Zuretti 29, 10126, Turin, Italy
| | - A Masse
- Department of Orthopaedics, Traumatology and Rehabilitation, Orthopaedic and Trauma Centre, CTO, Hospital Città della Salute e della Scienza, Via Zuretti 29, 10126, Turin, Italy.,School of Orthopaedics and Traumatology, University of the Studies of Turin, Via Zuretti 29, 10126, Turin, Italy
| | - A Bistolfi
- Department of Orthopaedics, Traumatology and Rehabilitation, Orthopaedic and Trauma Centre, CTO, Hospital Città della Salute e della Scienza, Via Zuretti 29, 10126, Turin, Italy.
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Yang J, Zhong N, Hu J, Yang X, Xiao J. The first total vertebral involvement of benign fibrous histiocytoma: A case report and literature review. J Bone Oncol 2020; 20:100274. [PMID: 31908914 PMCID: PMC6940612 DOI: 10.1016/j.jbo.2019.100274] [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] [Subscribe] [Scholar Register] [Received: 10/11/2019] [Revised: 12/18/2019] [Accepted: 12/19/2019] [Indexed: 10/28/2022] Open
Abstract
BACKGROUND Benign fibrous histiocytoma (BFH) is a rare bone tumor, extremely seldom in the spine. METHODS We present a 52-year-old patient diagnosed with a BFH in the thoracic spine treated with total en bloc spondylectomy. A review of the published literature was also conducted. RESULTS Non-ossifying fibroma (NOF) and BFH are named as one tumor called NOF/BFH. A total of 20 spinal BFHs have been previously reported, mainly involving the posterior elements. We present a BFH with total vertebral involvement. Curettage and excision are the main treatment options with limited recurrence. CONCLUSIONS This is the first total vertebral BFH up to now. Spinal BFH occupies rather low aggressiveness. With rather limited recurrence and malignant degeneration, surgical interventions seem enough for its management.
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Affiliation(s)
| | | | | | - Xinghai Yang
- Department of Orthopedic Oncology, Changzheng Hospital, Second Military Medical University, Fengyang Rd 415#, Huangpu District, Shanghai, China
| | - Jianru Xiao
- Department of Orthopedic Oncology, Changzheng Hospital, Second Military Medical University, Fengyang Rd 415#, Huangpu District, Shanghai, China
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Aoun F, Malek E, Kazan D, Albisinni S, Peltier A, Bollens R, Roumeguère T. Management of chronic testicular pain due to thoracolumbar junction syndrome: A pilot study. Prog Urol 2020; 30:114-118. [PMID: 31980366 DOI: 10.1016/j.purol.2019.12.002] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2019] [Revised: 12/05/2019] [Accepted: 12/14/2019] [Indexed: 10/25/2022]
Abstract
INTRODUCTION Thoracolumbar dysfunction (TLD) had been evoked as a possible etiology of chronic testicular pain. Our study investigated the efficacy of osteopathic diagnosis and treatment of TLD in men with chronic testicular pain. METHODS Patients suffering from testicular pain were examined for thoracolumbar dysfunction and enrolled in a prospective trial if they have both conditions. Following standardized examination, all patients were prescribed 1 to 3 osteopathic treatment sessions, usually at weekly interval. Treatment success was evaluated using the Visual Analog scale and durability was assessed by regular follow-up. Patient satisfaction was also assessed. Comparison of pain improvement was done using Wilcoxon matched-pairs signed-ranks test. Logistic regression was used to assess for risk factors of success. A P<0.001 was used for significance. RESULT Out of 62 patients enrolled, 41 patients (median age 32 years, IQR 24-37) were suffering from chronic testicular pain and TLD. 37 of the 41 participants completed the treatment and follow-up according to the plan. Patients underwent a median of 2 osteopathic treatment sessions (range 1-3). Overall, pain disappeared completely in 25 patients (67.5%) and improvement was noted in 7 patients (18.9%). After initial improvement, two patients experienced relapse at their last visit (5.4%). Five patients (13.5%) had no improvement of their symptoms after osteopathic treatment. Statistically, improvement was significant with a P<0.001 and on logistic regression, site of pain and duration of pain were the sole predictors of failure. CONCLUSION TLD is a pathology that should be considered in the differential diagnosis in patients with chronic testicular pain and osteopathic manipulation of the spine appears to be an effective treatment option.
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Affiliation(s)
- F Aoun
- Urology department, Institut Jules Bordet, Université Libre de Bruxelles, Brussels, Belgium; Urology department, Hôtel Dieu de France, Université Saint-Joseph, Lebanon.
| | - E Malek
- Osteopathic Medicine department, Levant Hospital, Lebanon
| | - D Kazan
- Urology department, Hôtel Dieu de France, Université Saint-Joseph, Lebanon
| | - S Albisinni
- Urology department, Cliniques Universitaires de Bruxelles, hôpital Erasme, Université Libre de Bruxelles, Brussels, Belgium
| | - A Peltier
- Urology department, Institut Jules Bordet, Université Libre de Bruxelles, Brussels, Belgium
| | - R Bollens
- Urology department, Centre Hospitalier de Wallonie picarde, Belgium
| | - T Roumeguère
- Urology department, Cliniques Universitaires de Bruxelles, hôpital Erasme, Université Libre de Bruxelles, Brussels, Belgium
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Toal M, McLoughlin C, Pierce N, Moss J, English S, Lindsay JR. Detection of vertebral fracture in an acute hospital setting: an intervention to reduce future fracture risk through fracture liaison service intervention? Arch Osteoporos 2020; 15:160. [PMID: 33040188 PMCID: PMC7547950 DOI: 10.1007/s11657-020-00832-2] [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: 04/17/2020] [Accepted: 09/30/2020] [Indexed: 02/03/2023]
Abstract
UNLABELLED We introduced a standardised reporting system in the radiology department to highlight vertebral fractures and to signpost fracture prevention services. Our quality improvement project achieved improved fracture reporting, access to the FLS service, bone density assessment and anti-fracture treatment. PURPOSE Identification of vertebral fragility fractures (VF) provides an opportunity to identify individuals at high risk who might benefit from secondary fracture prevention. We sought to standardise VF reporting and to signpost fracture prevention services. Our aim was to improve rates of VF detection and access to our fracture liaison service (FLS). METHODS We introduced a standardised reporting tool within the radiology department to flag VFs with signposting for referral for bone densitometry (DXA) and osteoporosis assessment in line with Royal Osteoporosis Society guidelines. We monitored uptake of VF reporting during a quality improvement phase and case identification within the FLS service. RESULTS Recruitment of individuals with VF to the FLS service increased from a baseline of 63 cases in 2017 (6%) to 95 (8%) in 2018 and 157 (8%) in 2019 and to 102 (12%) in the first 6 months of 2020 (p = 0.001). One hundred fifty-three patients with VFs were identified during the QI period (56 males; 97 females). Use of the terminology 'fracture' increased to 100% (mean age 70 years; SD 13) in computed tomography (n = 110), plain X-ray (n = 37) or magnetic resonance imaging (n = 6) reports within the cohort. Signposting to DXA and osteoporosis assessment was included in all reports (100%). DXA was arranged for 103/153; 12 failed to attend. Diagnostic categories were osteoporosis (31%), osteopenia (36%) or normal bone density (33%). A new prescription for bone protection therapy was issued in 63/153. Twelve of the series died during follow-up. CONCLUSIONS Standardisation of radiology reporting systems facilitates reporting of prevalent vertebral fractures and supports secondary fracture prevention strategies.
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Affiliation(s)
- Michael Toal
- Mater Infirmorum Hospital, Belfast Health & Social Care Trust, Belfast, Northern Ireland
| | - Connor McLoughlin
- Mater Infirmorum Hospital, Belfast Health & Social Care Trust, Belfast, Northern Ireland
| | - Nicole Pierce
- Mater Infirmorum Hospital, Belfast Health & Social Care Trust, Belfast, Northern Ireland
| | - Julie Moss
- Royal Victoria Hospital, Belfast Health & Social Care Trust, Belfast, Northern Ireland
| | - Sarah English
- Musgrave Park Hospital, Belfast Health & Social Care Trust, Belfast, Northern Ireland
| | - John R Lindsay
- Mater Infirmorum Hospital, Belfast Health & Social Care Trust, Belfast, Northern Ireland ,Musgrave Park Hospital, Belfast Health & Social Care Trust, Belfast, Northern Ireland
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Abstract
Introduction The spine surgeon has knowledge and skills that allow him to make decisions when performing a surgical procedure, based on the evidence and ethical values and expectations of the patient. Any surgical procedure will be preceded by a diagnosis based on four fundamental pillars: traumatic, degenerative, vertebral destruction syndrome and deformities. Once the lesion is categorized, the surgeon will use his knowledge to identify instability or neurological compromise. When performing a surgical procedure, it should be kept in mind in the transoperative the four key objectives that will count, to achieve a satisfactory management: decompress, implement, merge and correct the sagittal balance. Objective To analyze the fundamental criteria in decision making, for conservative or surgical management in the spine. Results The assessment scales and the most frequent and best practices in relation to spine surgery will be analyzed, as well as the applications that will be applied and evaluated in each particular case, which will strengthen the diagnostic impression and the value forecast. Conclusion Implementing the culture of using patient outcome measurements as an assessment tool helps the spine surgeon to decide on a treatment plan that can be adapted to the patient's preferences and needs. We must base our clinical objective on the stability and the neurological commitment of the patient, there being four diagnostic possibilities; which will be corrected for four fundamental objectives.
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Affiliation(s)
- José M A Jiménez-Ávila
- Clínica de Columna, Centro Médico Nacional de Occidente, Instituto Mexicano del Seguro Social. Guadalajara, Jalisco, México
| | | | - Arelhi C González-Cisneros
- Escuela de Medicina del Instituto Tecnológico y de Estudios Superiores de Monterrey, Campus Guadalajara. Guadalajara, Jalisco, México
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Alqahtani FF, Messina F, Offiah AC. Are semi-automated software program designed for adults accurate for the identification of vertebral fractures in children? Eur Radiol 2019; 29:6780-6789. [PMID: 31119416 PMCID: PMC6828619 DOI: 10.1007/s00330-019-06250-4] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [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: 03/25/2019] [Revised: 04/12/2019] [Accepted: 04/24/2019] [Indexed: 11/05/2022]
Abstract
Objectives To assess whether diagnostic accuracy of morphometric vertebral fracture (VF) diagnosis in children can be improved using AVERT™ (a 33-point semi-automated program developed for VF diagnosis in adults) compared with SpineAnalyzer™ (a 6-point program), which has previously been shown to be of insufficient accuracy. Materials and methods Lateral spine radiographs (XR) and dual-energy X-ray absorptiometry (DXA) scans of 50 children and young people were analysed by two observers using two different programs (AVERT™ and SpineAnalyzer™). Diagnostic accuracy (sensitivity, specificity, false-negative (FN) and false-positive rates (FP)) was calculated by comparing with a previously established consensus arrived at by three experienced paediatric musculoskeletal radiologists, using a simplified algorithm-based qualitative scoring system. Observer agreement was calculated using Cohen’s kappa. Results For XR, overall sensitivity, specificity, FP and FN rates using AVERT™ were 36%, 95%, 5% and 64% respectively and 26%, 98%, 2% and 75% respectively, using SpineAnalyzer™. For DXA, overall sensitivity, specificity, FP and FN rates using AVERT™ were 41%, 91%, 9% and 59% respectively and 31%, 96%, 4% and 69% respectively, using SpineAnalyzer. Reliability (kappa) ranged from 0.34 to 0.37 (95%CI, 0.26–0.46) for AVERT™ and from 0.26 to 0.31 (95%CI, 0.16–0.44) for SpineAnalyzer™. Inter- and intra-observer agreement ranged from 0.41 to 0.47 for AVERT™ and from 0.50 to 0.79 for SpineAnalyzer™. Conclusion AVERT™ has slightly higher accuracy but lower observer reliability for the representation of vertebral morphometry in children when compared with SpineAnalyzer™. However, neither software program is satisfactorily reliable for VF diagnosis in children. Key Points • SpineAnalyzer™ and AVERT™ have low diagnostic accuracy and observer agreement when compared to three paediatric radiologists’ readings for the diagnosis of vertebral fractures (VF) in children. • Neither AVERT™ nor SpineAnalyzer™ is satisfactorily reliable for VF diagnosis in children. • Development of specific paediatric software and normative values (incorporating age-related physiological variation in children) is required.
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Affiliation(s)
- Fawaz F Alqahtani
- Academic Unit of Child Health, Department of Oncology and Metabolism, University of Sheffield, Medical School, University of Sheffield, Street Building, Western Bank, Sheffield, S10 2TH, UK. .,Department of Radiological Sciences, College of Applied Medical Sciences, Najran University, Najran, Kingdom of Saudi Arabia.
| | - Fabrizio Messina
- School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - Amaka C Offiah
- Academic Unit of Child Health, Department of Oncology and Metabolism, University of Sheffield, Medical School, University of Sheffield, Street Building, Western Bank, Sheffield, S10 2TH, UK.,Radiology Department, Sheffield Children's NHS Foundation Trust, Sheffield, UK
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Morgonsköld D, Warkander V, Savvides P, Wihlborg A, Bouzereau M, Möller H, Gerdhem P. Inter- and intra-rater reliability of vertebral fracture classifications in the Swedish fracture register. World J Orthop 2019; 10:14-22. [PMID: 30705837 PMCID: PMC6354108 DOI: 10.5312/wjo.v10.i1.14] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2018] [Revised: 12/03/2018] [Accepted: 12/24/2018] [Indexed: 02/06/2023] Open
Abstract
AIM To investigate the inter- and intra-rater reliability of the vertebral fracture classifications used in the Swedish fracture register.
METHODS Radiological images of consecutive patients with cervical spine fractures (n = 50) were classified by 5 raters with different experience levels at two occasions. An identical process was performed with thoracolumbar fractures (n = 50). Cohen’s kappa was used to calculate the inter- and intra-rater reliability.
RESULTS The mean kappa coefficient for inter-rater reliability ranged between 0.54 and 0.79 for the cervical fracture classifications, between 0.51 and 0.72 for the thoracolumbar classifications (overall and for different sub classifications), and between 0.65 and 0.77 for the presence or absence of signs of ankylosing disorder in the fracture area. The mean kappa coefficient for intra-rater reliability ranged between 0.58 and 0.80 for the cervical fracture classifications, between 0.46 and 0.68 for the thoracolumbar fracture classifications (overall and for different sub classifications) and between 0.79 and 0.81 for the presence or absence of signs of ankylosing disorder in the fracture area.
CONCLUSION The classifications used in the Swedish fracture register for vertebral fractures have an acceptable inter- and intra-rater reliability with a moderate strength of agreement.
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Affiliation(s)
- David Morgonsköld
- Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm SE-14186, Sweden
| | | | - Panayiotis Savvides
- Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm SE-14186, Sweden
- Department of Orthopaedics, Karolinska University Hospital, Stockholm SE-14186, Sweden
| | - Axel Wihlborg
- Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm SE-14186, Sweden
- Department of Orthopaedics, Karolinska University Hospital, Stockholm SE-14186, Sweden
| | - Mathilde Bouzereau
- Department of Emergency Medicine, Karolinska University Hospital, Stockholm SE-14186, Sweden
| | - Hans Möller
- Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm SE-14186, Sweden
- Department of Orthopaedics, Karolinska University Hospital, Stockholm SE-14186, Sweden
| | - Paul Gerdhem
- Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm SE-14186, Sweden
- Department of Orthopaedics, Karolinska University Hospital, Stockholm SE-14186, Sweden
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Demetrious JS. Spontaneous cervical artery dissection: a fluoroquinolone induced connective tissue disorder? Chiropr Man Therap 2018; 26:22. [PMID: 30002812 PMCID: PMC6036697 DOI: 10.1186/s12998-018-0193-z] [Citation(s) in RCA: 4] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2018] [Accepted: 05/01/2018] [Indexed: 11/12/2022] Open
Abstract
Background Spontaneous cervical artery dissections more often manifest in young people and have been associated with catastrophic consequences. Some indeterminate risk factors have been identified, making the diagnosis of developing dissections quite difficult. Fluoroquinolone antibiotics have been recognized for their degradative effects on connective tissue. Recent studies have implicated fluoroquinolones in the genesis of aortic artery aneurysms. It is the purpose of this paper to provide reasoning for a testable hypothesis of whether fluoroquinolones constitute a risk factor associated with cervical artery dissections. Methods A PubMed search was conducted to investigate whether cervical artery dissection has been associated with fluoroquinolone use. An assessment of risk factors was made of hereditary connective tissue disorders, infection, and seasonal predisposition related to cervical artery dissection. These factors were considered in conjunction with reports of connective tissue toxicity associated with fluoroquinolone medications. Results It appears that no reported cases of cervical artery dissection have previously been correlated with fluoroquinolone use. Heritable connective tissue disorders, infection, seasonal predisposition and condition latencies are associated with fluoroquinolone medications. Several recent articles have implicated fluoroquinolones with aortic dissections and aneurysm. Conclusion A causal relationship of fluoroquinolone antibiotics to cervical artery dissection is plausible. The suppositions developed in this paper are insufficient to suggest that fluoroquinolones currently represent an established risk factor in the development of cervical artery dissections. Fluoroquinolones may indeed be a novel and previously unrecognized cause of cervical artery dissections.
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Sun J, Kong Q, Yang Y, Shi J, Hou Y, Xu X, Wang Y, Yang H, Guo Y, Shi G, Wang Y, Zhang P. Nonfusion Intracorporeal Enhancement System for the Treatment of Osteoporotic Vertebral Compression Fractures-Preliminary Clinical Result of a Novel Technique. World Neurosurg 2018; 117:e387-95. [PMID: 29913290 DOI: 10.1016/j.wneu.2018.06.039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2018] [Revised: 06/05/2018] [Accepted: 06/06/2018] [Indexed: 11/23/2022]
Abstract
OBJECTIVE This study sought to determine whether implantation of a newly designed nonfusion intracorporeal enhancement (NICE) system is an effective and safe way to treat osteoporotic vertebral compression fracture (OVCF). METHODS Thirteen patients with OVCF (10 women, 3 men; mean age 69 years, T11-L4) were included. From June 2014 to June 2016, all patients were treated with the NICE system. The clinical and radiologic results were evaluated preoperatively, postoperatively, and at 24 months follow-up based on the visual analog scale and the Oswestry Disability Index, radiography, magnetic resonance imaging, and computed tomography (height of fractured body and kyphosis Cobb angle). RESULTS There was a significant improvement in pain intensity (visual analog scale score decreased from 8.3 preoperatively to 2.2 postoperatively, and decreased to 1.5 twenty-four months postoperatively). Also, a significant reduction was observed in that the mean Oswestry Disability Index decreased from 71.9% preoperatively to 17.6% after 24 months. The mean Cobb angle had a significant improvement, which decreased from 6.6° preoperatively to 1.3° postoperatively and then decreased to 1.2° after 24 months. Height of fractured body improved significantly from 66.4% to 86.5% and slightly decreased to 82.4% after 24 months. No specific complications were identified to be associated with this technique. CONCLUSIONS With a low complication rate, the clinical midterm results are satisfactory. The treatment of symptomatic OVCF with the NICE system is a safe and effective procedure.
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Lalikian K, Parsiani R, Won R, Chang E, Turner RB. Ceftaroline for the treatment of osteomyelitis caused by methicillin-resistant Staphylococcus aureus: a case series. J Chemother 2018; 30:124-128. [PMID: 28697650 DOI: 10.1080/1120009x.2017.1351729] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [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] [Indexed: 10/19/2022]
Abstract
Despite limited clinical data, ceftaroline is commonly used for treatment of complicated, invasive infections caused by methicillin-resistant Staphylococcus aureus (MRSA). A retrospective chart review was conducted of adult patients receiving ceftaroline for MRSA osteomyelitis admitted between April 2011 and March 2016 at a five-hospital system. Twelve patients met the inclusion criteria. All patients received prior antimicrobial therapy with a median time to switch to ceftaroline of 45.5 days. Five of the 12 patients (41.7%) met criteria for ceftaroline failure. Patients with vertebral osteomyelitis (58%) had a longer length of stay, longer ceftaroline treatment, but similar success rates to those with non-vertebral osteomyelitis (57% vs. 60%). Ceftaroline is a viable alternative for a challenging patient population that has failed or are unable to receive other therapies.
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Affiliation(s)
- Karineh Lalikian
- a School of Pharmacy , Pacific University , Hillsboro , OR , USA
| | - Rita Parsiani
- a School of Pharmacy , Pacific University , Hillsboro , OR , USA
| | | | | | - R Brigg Turner
- a School of Pharmacy , Pacific University , Hillsboro , OR , USA
- b Legacy Health , Portland , OR , USA
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Naylor AR, Ricco JB, de Borst GJ, Debus S, de Haro J, Halliday A, Hamilton G, Kakisis J, Kakkos S, Lepidi S, Markus HS, McCabe DJ, Roy J, Sillesen H, van den Berg JC, Vermassen F, Kolh P, Chakfe N, Hinchliffe RJ, Koncar I, Lindholt JS, Vega de Ceniga M, Verzini F, Archie J, Bellmunt S, Chaudhuri A, Koelemay M, Lindahl AK, Padberg F, Venermo M. Editor's Choice - Management of Atherosclerotic Carotid and Vertebral Artery Disease: 2017 Clinical Practice Guidelines of the European Society for Vascular Surgery (ESVS). Eur J Vasc Endovasc Surg 2018; 55:3-81. [PMID: 28851594 DOI: 10.1016/j.ejvs.2017.06.021] [Citation(s) in RCA: 785] [Impact Index Per Article: 130.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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Daou B, Hammer C, Mouchtouris N, Starke RM, Koduri S, Yang S, Jabbour P, Rosenwasser R, Tjoumakaris S. Anticoagulation vs Antiplatelet Treatment in Patients with Carotid and Vertebral Artery Dissection: A Study of 370 Patients and Literature Review. Neurosurgery 2017; 80:368-379. [PMID: 28362967 DOI: 10.1093/neuros/nyw086] [Citation(s) in RCA: 44] [Impact Index Per Article: 6.3] [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: 05/14/2015] [Accepted: 10/24/2016] [Indexed: 12/22/2022] Open
Abstract
Background Dissection of the carotid and vertebral arteries is an important cause of stroke in young patients. Objective The objective of this study is to compare antithrombotic treatments in patients with carotid and vertebral dissections. Methods Three hundred seventy patients with carotid and vertebral artery dissections were included. Univariate and multivariate analyses were conducted to analyze the association between treatment and new or recurrent events and clinical outcome. Results Mean follow-up was 24.3 months. In patients with spontaneous dissection, 55% received antiplatelets, 29.4% anticoagulation, and 12.6% combined treatment. New or recurrent ischemic and hemorrhagic events occurred in 9.6% of patients on antiplatelets, 10.4% on anticoagulation, and 13.3% on combined treatment. For traumatic dissection, 58.3% received antiplatelets, 26.9% anticoagulation, and 10.2% combined treatment. New or recurrent ischemic and hemorrhagic events occurred in 6.9% on antiplatelets, 11.1% on anticoagulation, and 20% on combined treatment. In patients with intracranial dissection, 63.1% were started on antiplatelets, 19.7% on anticoagulation, and 14.5% on combined treatment. Ischemic and hemorrhagic events occurred in 8.5% on antiplatelet treatment, 15.4% on anticoagulation, and 18.2% on combined treatment. In patients with extracranial dissection, 54.4% were on antiplatelets, 28.9% on anticoagulation, and 11.2% on combined treatment. Ischemic and hemorrhagic events occurred in 10.1% on antiplatelet treatment, 9.3% on anticoagulation, and 13.8% on combined treatment. The association between antithrombotic treatment and ischemic/hemorrhagic events and clinical outcome was not significant for all subtypes of dissection. Conclusion The rate of new or recurrent events is similar with antiplatelet and anticoagulation treatment in treating intracranial and extracranial carotid and vertebral artery dissection.
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Affiliation(s)
- Badih Daou
- Department of Neurosurgery, Thomas Jefferson University and Jefferson Hospital for Neuroscience, Philadelphia, PA, USA
| | - Christine Hammer
- Department of Emergency Surgery, John Radcliffe Hospital, Oxford University Hospitals, NHS Foundation Trust, Oxford, UK
| | - Nikolaos Mouchtouris
- Department of Neurosurgery, Thomas Jefferson University and Jefferson Hospital for Neuroscience, Philadelphia, PA, USA
| | - Robert M Starke
- Department of Neurological Surgery, Miller School of Medicine, University of Miami, Miami, Florida, USA
| | - Sravanthi Koduri
- Drexel University College of Medicine, Philadelphia, Pennsylvania, USA
| | - Steven Yang
- The Robotics Institute, Carnegie Mellon University, Pittsburgh, PA, USA
| | - Pascal Jabbour
- Department of Neurosurgery, Thomas Jefferson University and Jefferson Hospital for Neuroscience, Philadelphia, PA, USA
| | - Robert Rosenwasser
- Department of Neurosurgery, Thomas Jefferson University and Jefferson Hospital for Neuroscience, Philadelphia, PA, USA
| | - Stavropoula Tjoumakaris
- Department of Neurosurgery, Thomas Jefferson University and Jefferson Hospital for Neuroscience, Philadelphia, PA, USA
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Abstract
Due to dramatic improvements in life expectancy we are seeing a rapidly growing population of older people. Increasing frailty and susceptibility to fragility fractures are becoming pressing issues for both the individuals that suffer them as well as society, through pressures on health and social care budgets. The success of fracture liaison services, co-ordinated programmes enhancing the management of the fracture, osteoporosis, frailty and falls risk, is undisputed. To achieve optimal outcomes, however, it is important to have a standardisation of design, scope and structure of the service. Experience has taught us that by delegating responsibility for the holistic care of the patient to a trained and adequately resourced professional/team (fracture prevention practitioner) with clear standards against which benchmarking occurs, is the optimal model of delivery. Future challenges include how best to measure the success of services in imparting a reduction in fractures at a local population level as well as how to detect those patients with unmet need who do not uniformly present to health care services, such as those with vertebral fractures. The implementation of fracture liaison services however, is a clear demonstration of how collaboration between health care, social care and charity organisations, among others, has materially improved the health and well-being of the population.
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Affiliation(s)
- Kate E Shipman
- Department of Clinical Chemistry, Western Sussex NHS Trust, Chichester, UK.
| | | | | | - Tim Jones
- National Osteoporosis Society, Bath, UK
| | - Neil J Gittoes
- Centre for Endocrinology, Diabetes and Metabolism, Birmingham Health Partners & Department of Endocrinology, 3rd Floor Heritage Building, Queen Elizabeth Hospital, Birmingham, UK
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Abstract
Cervical artery dissections (CeAD) include both internal carotid and vertebral artery dissections. They are rare but important causes of stroke, especially in younger patients. CeAD should be considered in patients with strokelike symptoms, a new-onset headache and/or neck pain, and/or other risk factors. Early imaging with computed tomography (CT) or magnetic resonance imaging (MRI) is key to making the diagnosis. Treatment may vary depending on the extent of the dissection, timing of the dissection, and other comorbidities. The overall prognosis is good, but does depend on the initial severity of symptoms.
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Affiliation(s)
- Jennifer J Robertson
- Department of Emergency Medicine, Emory University School of Medicine, 1648 Pierce Drive Northeast, Atlanta, GA 30307, USA
| | - Alex Koyfman
- Department of Emergency Medicine, University of Texas-Southwestern, Parkland Hospital, 5323 Harry Hines Boulevard, Dallas, TX 75390, USA.
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Namazi MH, Khaheshi I, Momenizadeh A, Dousti A, Naderian M. Successful Angioplasty of Left Vertebral Artery and Right Subclavian Artery Via Retrograde Approach. J Clin Diagn Res 2017; 11:OD05-OD06. [PMID: 28384916 DOI: 10.7860/jcdr/2017/22254.9257] [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: 06/22/2016] [Accepted: 10/25/2016] [Indexed: 11/24/2022]
Abstract
We describe a 77-year-old male who had right upper limb ischemic symptoms and history of unsuccessful right subclavian artery angioplasty. According to ultrasound findings, upper limb angiography was performed which confirmed stenosis of the left vertebral and right subclavian arteries. Percutaneous angioplasty and stenting of left vertebral and right subclavian arteries were performed in two separate sessions. Retrograde approach was scheduled for right subclavian artery angioplasty which is challenging due to potential risks to adjacent vertebral artery. This case reports underscores that percutaneous approaches may be preferential given their confirmed long-term efficacy and lower morbidity.
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Affiliation(s)
- Mohammad Hasan Namazi
- Cardiovascular Research Center, Modarres hospital, Shahid Beheshti University of Medical Sciences , Tehran, Iran
| | - Isa Khaheshi
- Department of Cardiology, Cardiovascular Research Center, Modarres hospital, Shahid Beheshti University of Medical Sciences , Tehran, Iran
| | - Amir Momenizadeh
- Department of Cardiology, Cardiovascular Research Center, Modarres hospital, Shahid Beheshti University of Medical Sciences , Tehran, Iran
| | - Amir Dousti
- Department of Cardiology, Cardiovascular Research Center, Modarres hospital, Shahid Beheshti University of Medical Sciences , Tehran, Iran
| | - Mohammadreza Naderian
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences , Tehran, Iran; Students' Scientific Research Center (SSRC), Tehran University of Medical Sciences, Tehran, Iran
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Garg B, Dixit V, Batra S, Malhotra R, Sharan A. Non-surgical management of acute osteoporotic vertebral compression fracture: A review. J Clin Orthop Trauma 2017; 8:131-138. [PMID: 28720988 PMCID: PMC5498748 DOI: 10.1016/j.jcot.2017.02.001] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [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: 12/18/2016] [Revised: 01/20/2017] [Accepted: 02/02/2017] [Indexed: 02/08/2023] Open
Abstract
Osteoporosis is a major public health problem. Last decade has seen rise in osteoporotic vertebral fractures. Pragmatic management of osteoporotic VCF is challenging to the surgeons. In clinical settings, the situation becomes more complex when it comes to managing painful osteoporotic vertebral compression fractures (VCFs) due to various co-morbid factors that may limit aggressive interventions. Patients with Osteoporotic vertebral fractures are often characterized by general/relative immobility and physical frailty. Osteoporotic VCF not only affects the quality of life (e.g. pain) but also decreases the lifespan of the individual. The present review critically evaluates the currently prevailing non-surgical management modalities (conservative) offered in acute symptomatic osteoporotic VCFs that occur either within (0-5 days) of any incident event or present with the onset of symptoms such as pain.
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Affiliation(s)
- Bhavuk Garg
- Department of Orthopaedics, All India Institute of Medical Sciences, New Delhi, India
| | - Vivek Dixit
- Department of Orthopaedics, All India Institute of Medical Sciences, New Delhi, India
| | - Sahil Batra
- Department of Orthopaedics, All India Institute of Medical Sciences, New Delhi, India
| | - Rajesh Malhotra
- Department of Orthopaedics, All India Institute of Medical Sciences, New Delhi, India
| | - Alok Sharan
- WESTMED Spine Centre, New York, NY, United States
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Abstract
UNLABELLED Height measurements are currently used to guide imaging decisions that assist in osteoporosis care, but their clinical reliability is largely unknown. We found both clinical height measurements and electronic health record height data to be unreliable. Improvement in height measurement is needed to improve osteoporosis care. INTRODUCTION The aim of this study is to assess the accuracy and reliability of clinical height measurement in a university healthcare clinical setting. METHODS Electronic health record (EHR) review, direct measurement of clinical stadiometer accuracy, and observation of staff height measurement technique at outpatient facilities of the University of Wisconsin Hospital and Clinics. We examined 32 clinical stadiometers for reliability and observed 34 clinic staff perform height measurements at 12 outpatient primary care and specialty clinics. An EHR search identified 4711 men and women age 43 to 89 with no known metabolic bone disease who had more than one height measurement over 3 months. The short study period and exclusion were selected to evaluate change in recorded height not due to pathologic processes. RESULTS Mean EHR recorded height change (first to last measurement) was -0.02 cm (SD 1.88 cm). Eighteen percent of patients had height measurement differences noted in the EHR of ≥2 cm over 3 months. The technical error of measurement (TEM) was 1.77 cm with a relative TEM of 1.04 %. None of the staff observed performing height measurements followed all recommended height measurement guidelines. Fifty percent of clinic staff reported they on occasion enter patient reported height into the EHR rather than performing a measurement. When performing direct measurements on stadiometers, the mean difference from a gold standard length was 0.24 cm (SD 0.80). Nine percent of stadiometers examined had an error of >1.5 cm. CONCLUSIONS Clinical height measurements and EHR recorded height results are unreliable. Improvement in this measure is needed as an adjunct to improve osteoporosis care.
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Affiliation(s)
- A L Mikula
- University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - S J Hetzel
- Department of Biostatistics and Medical Informatics, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - N Binkley
- Department of Medicine - Geriatrics, University of Wisconsin, Madison, WI, USA
| | - P A Anderson
- Department of Orthopedics and Rehabilitation, University of Wisconsin School of Medicine and Public Health, UWMF Centennial Building, 1685 Highland Ave, 6th Floor, Madison, WI, 53705, USA.
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Abstract
Dissection refers to a tear in the wall of an artery, with the two main types being intracranial or extracranial. Dissections tend to occur most commonly in the young, sometimes secondary to trauma involving the neck. To confirm a dissection, some type of vessel imaging is necessary, including magnetic resonance angiography (MRA), computed tomography angiography (CTA), or angiography. The most common presentation of a dissection (especially extracranial) is pain, usually head and neck pain along with a Horner's syndrome. Patients may also present with ischemic symptoms, including transient ischemic attack (TIA) or stroke, which may also be a complication of a dissection. Although headache is a common presentation, there is little research into phenotype or long-term outcomes. There are a number of case reports detailing the phenotypes of headaches that may be present in dissection, including a migraine-like or hemicrania-like headache. Dissections are usually treated with some type of anti-platelet or anti-coagulation, although there are only a few randomized controlled trials. In a new acute headache, dissection is an important diagnosis to keep in mind.
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Affiliation(s)
- Huma U Sheikh
- Department of Neurology, Icahn School of Medicine at Mt Sinai, Beth Israel-Mt Sinai Hospital, New York, NY, 10003, USA.
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Ramirez GA, Della-Torre E, Campochiaro C, Bozzolo E, Berti A, Praderio L, Dagna L, Sabbadini MG. Juxta- vertebral lesions in granulomatosis with polyangiitis. Semin Arthritis Rheum 2016; 46:356-360. [PMID: 27586405 DOI: 10.1016/j.semarthrit.2016.07.009] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [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: 03/03/2016] [Revised: 05/29/2016] [Accepted: 07/15/2016] [Indexed: 01/20/2023]
Abstract
OBJECTIVES To describe the clinical, pathological, serological, and radiological characteristics of juxta-vertebral masses occurring in patients with granulomatosis with polyangiitis (GPA). METHODS We analyzed the clinical records of patients with juxta-vertebral lesions from our GPA study cohort and reviewed the English literature for other cases of GPA with juxta-vertebral localization. RESULTS Out of 74 patients in our GPA study cohort, six (8%) had juxta-vertebral lesions. We found 10 cases of juxta-vertebral GPA described in the English literature. Overall, juxta-vertebral lesions were detected at GPA onset in 11/16 (69%) patients, and preferentially occurred on the right side of the spine (12/15 patients, 80%). Fifteen patients (94%) with juxta-vertebral lesions had systemic GPA. Juxta-vertebral lesions were associated with back pain at GPA onset in 8/16 (50%) patients. In all of them juxta-vertebral lesions resolved or improved after treatment. CONCLUSIONS Preference for the right-anterior side of the spine, increased 18FDG uptake on PET scan, low or absent invasiveness of the surrounding tissues, and occurrence in the context of systemic disease were the main features of juxta-vertebral GPA. Symptomatic lesions showed a better response to immunosuppressive therapies.
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Affiliation(s)
- Giuseppe A Ramirez
- Vita-Salute San Raffaele University, Milan, Italy; Unit of Internal Medicine and Clinical Immunology, IRCCS-San Raffaele Scientific Institute, Ospedale San Raffaele, via Olgettina 60, 20132 Milan, Italy.
| | - Emanuel Della-Torre
- Vita-Salute San Raffaele University, Milan, Italy; Unit of Internal Medicine and Clinical Immunology, IRCCS-San Raffaele Scientific Institute, Ospedale San Raffaele, via Olgettina 60, 20132 Milan, Italy
| | - Corrado Campochiaro
- Vita-Salute San Raffaele University, Milan, Italy; Unit of Internal Medicine and Clinical Immunology, IRCCS-San Raffaele Scientific Institute, Ospedale San Raffaele, via Olgettina 60, 20132 Milan, Italy
| | - Enrica Bozzolo
- Unit of Internal Medicine and Clinical Immunology, IRCCS-San Raffaele Scientific Institute, Ospedale San Raffaele, via Olgettina 60, 20132 Milan, Italy
| | - Alvise Berti
- Vita-Salute San Raffaele University, Milan, Italy; Unit of Internal Medicine and Clinical Immunology, IRCCS-San Raffaele Scientific Institute, Ospedale San Raffaele, via Olgettina 60, 20132 Milan, Italy
| | - Luisa Praderio
- Unit of Internal Medicine and Clinical Immunology, IRCCS-San Raffaele Scientific Institute, Ospedale San Raffaele, via Olgettina 60, 20132 Milan, Italy
| | - Lorenzo Dagna
- Vita-Salute San Raffaele University, Milan, Italy; Unit of Internal Medicine and Clinical Immunology, IRCCS-San Raffaele Scientific Institute, Ospedale San Raffaele, via Olgettina 60, 20132 Milan, Italy
| | - Maria Grazia Sabbadini
- Vita-Salute San Raffaele University, Milan, Italy; Unit of Internal Medicine and Clinical Immunology, IRCCS-San Raffaele Scientific Institute, Ospedale San Raffaele, via Olgettina 60, 20132 Milan, Italy
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Abstract
Imaging manifestations of hematological diseases and their potential complications are broad, and there may be significant overlap in features of various disease processes. Knowledge of appropriate choice of imaging test, pertinent imaging patterns, and pathophysiology of disease can help the reader increase specificity in the diagnosis and treatment of the patient. Most importantly, we encourage readers of this review to engage their radiologists during the diagnostic, treatment, and management phases of care delivery.
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Tyner HL, Virk A, Nassr A, Razonable R. Mycoplasma hominis vertebral spine infection: Case report and a review of infections of bone and joints. J Infect Chemother 2016; 22:755-8. [PMID: 27234356 DOI: 10.1016/j.jiac.2016.04.008] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2016] [Revised: 04/04/2016] [Accepted: 04/25/2016] [Indexed: 11/23/2022]
Abstract
BACKGROUND Mycoplasma hominis (M. hominis) is a common commensal that colonizes the human urogenital tract, wherein it is also known to cause genito-urinary infections. It has rarely been reported to cause spinal infections. CASE DESCRIPTION We describe the case of a 53-year old diabetic woman who developed spontaneous, culture-negative L3-4 osteomyelitis that progressed clinically and radiographically despite debridement, stabilization, and empiric broad-spectrum antimicrobial therapy. After her third debridement procedure, cultures of the multiple intraoperative specimens yielded M. hominis. LITERATURE REVIEW A PubMed search identified a total of 4 reports of M. hominis causing spinal osteomyelitis and 22 other cases involving bones and joints. CLINICAL RELEVANCE M. hominis is a rare cause of bone and joint infections. Because of low clinical suspicion for this pathogen, combined with its fastidious nature and the difficult growth characteristics of this organism, M. hominis infections may be unrecognized and untreated, resulting in high morbidity. In addition to bacterial culture, molecular tests are available to detect M. hominis in clinical samples. This case report and review of the literature suggest that, in some cases of purulent culture-negative osteomyelitis, especially if not responding to standard empiric antibacterial therapy, M. hominis should be considered as a potential pathogen.
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Kendler DL, Bauer DC, Davison KS, Dian L, Hanley DA, Harris ST, McClung MR, Miller PD, Schousboe JT, Yuen CK, Lewiecki EM. Vertebral Fractures: Clinical Importance and Management. Am J Med 2016; 129:221.e1-10. [PMID: 26524708 DOI: 10.1016/j.amjmed.2015.09.020] [Citation(s) in RCA: 163] [Impact Index Per Article: 20.4] [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: 03/29/2015] [Revised: 09/17/2015] [Accepted: 09/21/2015] [Indexed: 11/19/2022]
Abstract
Vertebral fractures are common and can result in acute and chronic pain, decreases in quality of life, and diminished lifespan. The identification of vertebral fractures is important because they are robust predictors of future fractures. The majority of vertebral fractures do not come to clinical attention. Numerous modalities exist for visualizing suspected vertebral fracture. Although differing definitions of vertebral fracture may present challenges in comparing data between different investigations, at least 1 in 5 men and women aged >50 years have one or more vertebral fractures. There is clinical guidance to target spine imaging to individuals with a high probability of vertebral fracture. Radiology reports of vertebral fracture need to clearly state that the patient has a "fracture," with further pertinent details such as the number, recency, and severity of vertebral fracture, each of which is associated with risk of future fractures. Patients with vertebral fracture should be considered for antifracture therapy. Physical and pharmacologic modalities of pain control and exercises or physiotherapy to maintain spinal movement and strength are important components in the care of vertebral fracture patients.
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Affiliation(s)
- D L Kendler
- Department of Medicine, University of British Columbia, Vancouver, Canada.
| | - D C Bauer
- Departments of Medicine and Epidemiology and Biostatistics, University of California, San Francisco
| | | | - L Dian
- Department of Medicine, University of British Columbia, Vancouver, Canada
| | - D A Hanley
- Departments of Medicine, Oncology, and Community Health Sciences, Cumming School of Medicine, University of Calgary, AB, Canada
| | - S T Harris
- Departments of Medicine and Epidemiology and Biostatistics, University of California, San Francisco
| | | | - P D Miller
- Colorado Center for Bone Research, Lakewood
| | - J T Schousboe
- Park Nicollet Health Services, Park Nicollet Osteoporosis Center, Minneapolis, Minn; Division of Health Policy and Management, University of Minnesota, Minneapolis
| | - C K Yuen
- Prohealth Clinical Research, University of British Columbia, Vancouver, Canada
| | - E M Lewiecki
- New Mexico Clinical Research and Osteoporosis Center, Albuquerque
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Abstract
BACKGROUND High grade metastatic spinal tumors are most common and are invasive. These patients can succumb to disease progression if not treated timely. Although considered as invasive and morbid, total enbloc spondylectomy (TES) in selected cases has better survival rates. The authors describe the results of TES for high grade metastatic spinal tumors. MATERIALS AND METHODS Five patients (four females and one male) underwent TES for solitary metastatic vertebral lesion between November 2012 and January 2014. These patients presented to us with spinal instability, unrelenting severe spinal pain and/or with severe progressive radiculopathy. Average age was 46.2 years (range 39-62 years). After complete investigations, computed tomography scan, magnetic resonance imaging scan and positron emission tomography (PET) scan, it was confirmed that these patients had high grade solitary vertebral metastatic tumor. RESULTS Average duration of followup was 18 months (range 16-20 months). The average preoperative visual analog scale score of 9.4 (range 9-10) improved to 2 (range 1-4) at last followup. Average blood loss was 1440 mL (range 1000-2000 mL). Average duration of surgery was 198 min (range 180-240 min). Significant pain relief was noticed in each patient in the immediate postoperative period and during followups. These patients attained complete functional activities of daily living with in a month. The imaging showed implants in situ, no recurrence of tumor, and no activity on PET scan at the final followup. CONCLUSION The present series shows favorable short term results of TES for solitary, metastatic, high grade vertebral body tumors by a team approach.
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Affiliation(s)
- Sanganagouda S Patil
- Department of Spine Surgery, Wockhardt Hospital and Medical Research Centre, Mumbai, Maharashtra, India,Address for correspondence: Dr. Sanganagouda S Patil, Department of Spine Surgery, Wockhardt Hospital and Medical Research Centre, Agripada, Dr. Anand Rao Nair Road, Mumbai Central, Mumbai - 400 008, Maharashtra, India. E-mail:
| | - Abhay M Nene
- Department of Spine Surgery, Wockhardt Hospital and Medical Research Centre, Mumbai, Maharashtra, India
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Goodwin CR, Liang L, Abu-Bonsrah N, Hdeib A, Elder BD, Kosztowski T, Bettegowda C, Laterra J, Burger P, Sciubba DM. Extraneural Glioblastoma Multiforme Vertebral Metastasis. World Neurosurg 2016; 89:578-582.e3. [PMID: 26704201 DOI: 10.1016/j.wneu.2015.11.061] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2015] [Revised: 11/15/2015] [Accepted: 11/19/2015] [Indexed: 01/10/2023]
Abstract
Glioblastoma multiforme (GBM) is the most common malignant central nervous system tumor; however, extraneural metastasis is uncommon. Of those that metastasize extraneurally, metastases to the vertebral bodies represent a significant proportion. We present a review of 28 cases from the published literature of GBM metastasis to the vertebra. The mean age at presentation was 38.4 years with an average overall survival of 26 months. Patients were either asymptomatic with metastasis discovered at autopsy or presented with varying degrees of pain, weakness of the extremities, or other neurologic deficits. Of the cases that included the time to spinal metastasis, the average time was 26.4 months with a reported survival of 10 months after diagnosis of vertebral metastasis. A significant number of patients had no treatments for their spinal metastasis, although the intracranial lesions were treated extensively with surgery and/or adjuvant therapy. With increasing incremental gains in the survival of patients with GBM, clinicians will encounter patients with extracranial metastasis. As such, this review presents timely information concerning the presentation and outcomes of patients with vertebral metastasis.
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