Efficacy and safety of halo-gravity traction in the treatment of spinal deformities: A systematic review of the literature

OBJECTIVE

To determine, through a systematic review, the effects of halo gravity traction in spinal deformity.

METHODS

Prospective studies or case series of patients with scoliosis or kyphosis treated with cranial halo gravity traction (HGT) were included. Radiological outcomes were measured in the sagittal and/or coronal planes. Pulmonary function was also assessed. Perioperative complications were also collected.

RESULTS

Thirteen studies were included. Congenital etiology was the most frequent etiology observed. Most studies provided clinically relevant curve correction values in the sagittal and coronal planes. Pulmonary values improved significantly after the use of HGT. Finally, there were a pool of 83 complications in 356 patients (23.3%). The most frequent complications were screw infection (38 cases).

CONCLUSIONS

Preoperative HGT appears to be a safe and effective intervention for deformity that allows correction prior to surgery. However, there is a lack of homogeneity in the published studies.

Efficacy and safety of halo-gravity traction in the treatment of spinal deformities: A systematic review of the literature

OBJECTIVE

To determine, through a systematic review, the effects of halo-gravity traction (HGT) in spinal deformity.

METHODS

Prospective studies or case series of patients with scoliosis or kyphosis treated with cranial HGT were included. Radiological outcomes were measured in the sagittal and/or coronal planes. Pulmonary function was also assessed. Perioperative complications were also collected.

RESULTS

Thirteen studies were included. Congenital etiology was the most frequent etiology observed. Most studies provided clinically relevant curve correction values in the sagittal and coronal planes. Pulmonary values improved significantly after the use of HGT. Finally, there were a pool of 83 complications in 356 patients (23.3%). The most frequent complications were screw infection (38 cases).

CONCLUSIONS

Preoperative HGT appears to be a safe and effective intervention for deformity that allows correction prior to surgery. However, there is a lack of homogeneity in the published studies.

Management of symptomatic spine metastases: A multidisciplinary approach based flow-chart

We described an algorithm for the management of spinal metastases in which the importance of single parameters varies depending on when they are contemplated. Each patient follows his own «personal» sequential process which does not necessarily consider all the parameters each time as some may be irrelevant for the purpose of choosing the type of treatment for that single individual. For instance, a patient in general poor condition with a high ASA score is usually not a candidate for surgery, regardless of the primary tumor nature or the number of metastases. For this patient, the most important element would be the sensitivity of the tumor to adjuvant treatment. Similarly, a patient with acute and progressive spinal cord injury would undergo surgical decompression and stabilization without considering a more strenuous intervention.

Management of symptomatic spine metastases: A multidisciplinary approach based flow-chart

We described an algorithm for the management of spinal metastases in which the importance of single parameters varies depending on when they are contemplated. Each patient follows his own "personal" sequential process which does not necessarily consider all the parameters each time as some may be irrelevant for the purpose of choosing the type of treatment for that single individual. For instance, a patient in general poor condition with a high "ASA" score is usually not a candidate for surgery, regardless of the primary tumor nature or the number of metastases. For this patient, the most important element would be the sensitivity of the tumor to adjuvant treatment. Similarly, a patient with acute and progressive spinal cord injury would undergo surgical decompression and stabilization without considering a more strenuous intervention.

Efficacy and safety of ethanol injections in 18 cases of vertebral hemangioma: a mean follow-up of 2 years

STUDY DESIGN

The clinical records and radiographs of 18 patients with vertebral hemangiomas treated with ethanol vertebroplasty were reviewed to evaluate the usefulness of this method.

OBJECTIVES

To assess, after a mean 2-year follow-up, the complication rate, results, and patient satisfaction with ethanol injection into vertebral hemangioma.

SUMMARY OF BACKGROUND DATA

There is controversy about the safety of ethanol injections in the treatment of vertebral hemangiomas.

METHODS

Twenty-four patients with vertebral hemangiomas were prepared for ethanol vertebroplasty. Eighteen patients were treated with ethanol vertebroplasty (average age, 49 years; range, 18-77 years) with a mean follow-up of 2 years (range, 1-4 years). The rest of the patients were not treated with ethanol vertebroplasty because in a pretreatment test injection the contrast medium was not retained by the hemangioma.

RESULTS

Intralesional injections of alcohol did not cause clinical complications in any of the cases.

CONCLUSIONS

This study shows that intralesional alcohol injections can be considered a safe technique for vertebral hemangiomas. However, a careful technique is required.

Psammomatous melanotic schwannoma localized in the mediastinum: diagnosis by fine-needle aspiration cytology

The cytological characteristics are presented in a case of psammomatous melanotic schwannoma localized in the mediastinum, diagnosed by fine-needle aspiration cytology (FNAC), with later histological confirmation. This lesion affected a 38-year-old male, with a tumor measuring 5 cm in diameter located in the posterior mediastinum in contact with the spinal cord, with erosion of the adjacent vertebra (T5), that caused constant pain localized in the right scapular region with an evolution of several weeks. The cytological characteristics of psammomatous melanotic schwannoma are discussed, along with the histological and immunohistochemical features of this infrequent neural tumor, which aid in establishing a differential diagnosis. The importance of a correct histological diagnosis of this tumor is of particular clinical relevance after having been identified as one of the possible components of Carney's complex. This possibility demands a meticulous patient exploration in search of any other components that make up this complex, given the aggressive character of some of them. These lesions could, if not detected early enough, produce fatal consequences for the patient, fundamentally in those patients with cardiac myxomas. In this case, following an exhaustive clinical examination there was no pathology associated with this complex. It is therefore considered to be an isolated psammomatous melanotic schwannoma, and not a part of Carney's complex.

Effect of nitrous oxide and propofol on amino acid metabolism in neoplasic patients

In a randomized controlled clinical trial, 14 patients requiring resection of tumors were divided in two groups: one group was anesthetized with nitrous oxide [67% N2O-33% O2 (vol/vol)] and the other with propofol. Two other groups of subjects were studied: a group of patients that was undergoing orthopedic procedures and was anesthetized with nitrous oxide [67% N2O-33% O2 (vol/vol)] and a control group (fasted for 10 hrs and no anesthesia). In patients requiring resection of tumors, the blood L-methionine concentration was significantly lower and the blood amino acid pattern was significantly affected after the administration of nitrous oxide (120-310 mins) compared with values after the induction of anesthesia and before surgery. The administration of propofol (120-240 mins) did not produce any of these changes. No patients required blood transfusion during surgery, and the patients had not previously been treated with cancer chemotherapeutic agents. The administration of nitrous oxide (60-150 mins) to patients undergoing orthopedic procedures did not affect blood L-methionine. It is concluded that the administration of nitrous oxide to cancer-bearing patients, but not to those undergoing orthopedic surgery, produced major changes in amino acid metabolism; therefore, consideration should be given to the avoidance of exposure of cancer patients to nitrous oxide.

A lumbar chordoma treated with a wide resection

Chordomas are rare skeletal tumors arising from the embryonic remains of the notochord [18, 30]. These tumors tend to appear in midline regions, particularly at the upper and lower extremities of the spinal column. We report the case of a 74-year-old woman with radicular compression associated with an L3 chordoma that was treated with a wide resection.