-
Infectious Diseases Now Mar 2021Surgery for genitourinary prolapse may be complicated, with postoperative infections. While promontofixation is recommended and widely used, the impact of postoperative... (Meta-Analysis)
Meta-Analysis
INTRODUCTION
Surgery for genitourinary prolapse may be complicated, with postoperative infections. While promontofixation is recommended and widely used, the impact of postoperative infections has received little study. We consequently decided to review the literature to identify risk factors for infection.
MATERIAL AND METHOD
We conducted a systematic review of the literature. PubMed, Medline and the Cochrane databases up until August 2019 were examined. The keywords were: "promontofixation", "colpopexy", "sacral colpopexy", "sacrocolpopexy". The primary outcome consisted in infectious complications. We also performed a meta-analysis using RevMan software.
RESULTS
Fifty-two among 1624 articles were selected. Infectious complications following promontofixation are infrequent. While few factors have been definitively associated with the occurrence of postoperative infections, associated procedures such as rectopexia or hysterectomy increase the risk of the latter. However, type of approach does not seem to affect the rate of occurrence of infectious complications.
CONCLUSION
This review of the literature underscores a lack of descriptive, statistical and therapeutic data on post-promontofixation infections, which are certainly underestimated. On the other hand, it helps to identify the association of certain factors with the occurrence of postoperative infections.
Topics: Female; Humans; Hysterectomy; Infections; Laparoscopy; Pelvic Organ Prolapse; Postoperative Complications; Risk Factors; Sacrum; Surgical Mesh; Uterine Prolapse; Vagina
PubMed: 33065251
DOI: 10.1016/j.medmal.2020.10.004 -
Journal of Bone Oncology Aug 2022Sacrectomy is indicated for the resection of life-threatening tumors in the sacrum area. Several studies have been conducted to investigate important aspects of... (Review)
Review
BACKGROUND
Sacrectomy is indicated for the resection of life-threatening tumors in the sacrum area. Several studies have been conducted to investigate important aspects of sacrectomy to help reduce the morbidity and mortality of patients who underwent the procedure. This aim of this systematic review was to highlight the prognoses of patients who underwent sacrectomy for the resection of primary bone tumors by analyzing information related to the intraoperative and perioperative periods of the procedure.
METHODOLOGY
Several databases were searched for relevant articles using the keywords "sacrectomy" and "survival" associated with the Boolean operators "or" and "and" ([SACRECTOMY OR SACRECTOM*] AND SURVIVAL).
RESULTS
A total of 13 articles were selected for data collection. The studies reported in the articles included a total of 384 patients, 140 of whom underwent partial sacrectomy, whereas 244 underwent total sacral resections. The results of the analysis indicated that the average volume of blood lost during a resection performed using the combined anterior and posterior approaches (average duration, 8.35 h) was 4571.94 mL. Regarding poor outcomes and adverse events in the included studies, 10 patients died in the early postoperative period, whereas four patients had hemorrhagic shock. The most prevalent complications reported were surgical wound infection and sphincter dysfunction.
CONCLUSION
The optimal surgical approach for sacrectomy depends on the location of the tumor. The anterior approach, preferably with laparoscopy, is currently widely used to reduce the amount of blood lost during the procedure. Although the most prevalent complications of sacrectomy have a high incidence rate, the procedure has a low mortality rate.
PubMed: 35924067
DOI: 10.1016/j.jbo.2022.100445 -
Clinical Neurology and Neurosurgery Mar 2021Pigmented villonodular synovitis (PVNS) is a lesion of uncertain etiology that involves the synovial membranes of joints or tendon sheaths, representing a diffuse and...
BACKGROUND AND OBJECTIVE
Pigmented villonodular synovitis (PVNS) is a lesion of uncertain etiology that involves the synovial membranes of joints or tendon sheaths, representing a diffuse and non-encapsulated form of the more common giant cell tumors of the synovium (GCTTS). PVNS was reclassified to denote a diffuse form of synovial giant cell tumor (TSGCT), while 'giant cell tumor of the tendon sheath (GCTTS)' was used for localized lesions. These pathologies rarely affect the axial skeleton. We provide an unprecedented and extensive systematic review of both lesions highlighting presentation, diagnostic considerations, treatment, prognosis, and outcomes, and we report a short case-series.
METHOD
We describe two-cases and conduct a systematic review in accordance with PRISMA guidelines.
RESULT
PVNS was identified in most of the cases reviewed (91.6 %), manifesting predominantly in the cervical spine (40 %). Patients commonly presented with neck pain (59 %), back pain (53 %), and lower back pain (81.2 %) for cervical, thoracic, and lumbar lesions, respectively. GTR occurred at rates of 94 %, 80 %, and 87.5 %. Recurrence was most common in the lumbar region (30.7 %). GCTTS cases (8%) manifested in the cervical and thoracic spine at the same frequency. We reported first case of GCTTS in the lumbosacral region. Both poses high rate of facet and epidural involvements.
CONCLUSION
Spinal PVNS and GCTTS are rare. These lesions manifest most commonly as PVNS within the cervical spine. Both types have a high rate of facet and epidural involvement, while PVNS has the highest rate of recurrence within the lumbar spine. The clinical and radiological features of these lesions make them difficult to differentiate from others with similar histogenesis, necessitating tissue diagnosis. Proper management via GTR resolves the lesion, with low rates of recurrence.
Topics: Adult; Back Pain; Female; Gait Disorders, Neurologic; Giant Cell Tumor of Tendon Sheath; Humans; Hypesthesia; Low Back Pain; Lumbar Vertebrae; Magnetic Resonance Imaging; Muscle Weakness; Neck Pain; Neurosurgical Procedures; Sacrum; Spinal Fusion; Spinal Neoplasms; Synovitis, Pigmented Villonodular; Thoracic Vertebrae; Young Adult
PubMed: 33596487
DOI: 10.1016/j.clineuro.2021.106489 -
Neurourology and Urodynamics Jun 2021The aim of this systematic review is to provide an updated report on the efficacy and complications of sacral neuromodulation (SNM) and percutaneous tibial nerve... (Review)
Review
AIM
The aim of this systematic review is to provide an updated report on the efficacy and complications of sacral neuromodulation (SNM) and percutaneous tibial nerve stimulation (PTNS) in the treatment of chronic nonobstructive urinary retention (CNOUR), with a focus on the contemporary technique of SNM utilizing the percutaneous placement of tined leads.
METHODS
This systematic review was conducted with the use of PRISMA guidelines and registered with PROSPERO (CRD42020208052). A systematic literature search was conducted in Embase, PubMed, and Cochrane databases. Inclusion criteria include English language and human participants. Exclusion criteria include SNM studies involving less than 10 CNOUR patients, studies containing data obtained using open, surgical implantation of nontined leads, and studies that only reported the test phase success rate with no long-term efficacy data. The risk of bias assessment was conducted using the National Institutes of Health study quality assessment tool.
RESULTS
A total of 16 papers studies were included (11 SNM and 5 PTNS) in this review. The success rate for SNM ranges between 42.5% and 100% (median = 79.2%) for the test stimulation phase and 65.5%-100% (median = 89.1%) in the long term. Most SNM studies reported revision and explantation rates of lesser than 20%. The success rate was much lower for PTNS, in the 50%-60% range and complications were minimal.
CONCLUSION
SNM using the contemporary percutaneous tined lead implantation technique appears to be an effective treatment for CNOUR and is durable in the long term. Compared to SNM, PTNS appears less efficacious with less evidence supporting its use in CNOUR. Further prospective studies are required to define the role of PTNS in the treatment of CNOUR.
Topics: Electric Stimulation Therapy; Humans; Lumbosacral Plexus; Sacrococcygeal Region; Sacrum; Tibial Nerve; Treatment Outcome; Urinary Retention
PubMed: 33973670
DOI: 10.1002/nau.24694 -
Spine Deformity Nov 2022To review and compare biomechanical properties between S2 alar-iliac (S2AI) screws and traditional iliac screws for spinopelvic fixation. (Review)
Review
PURPOSE
To review and compare biomechanical properties between S2 alar-iliac (S2AI) screws and traditional iliac screws for spinopelvic fixation.
METHODS
A systematic review was performed according to PRISMA guidelines. All clinical, cadaveric, and finite-element model (FEM) studies that compared the biomechanical properties between S2AI screws and traditional iliac screws were included. Study methodological quality for cadaveric studies were analyzed using the Quality Appraisal for Cadaveric Studies (QUACS) scale.
RESULTS
Eight studies (4 cadaveric, 4 FEM) analyzing 58 S2AI screws and 48 traditional iliac screws were included. According to QUACS, the overall methodological quality was "moderate to good" for all four cadaveric studies. All four cadaveric studies found no difference in biomechanical stiffness, screw toggle, rod strain, and/or load-to-failure between the S2AI screws and traditional iliac screws for spinopelvic fixation. All four FEM studies found that S2AI screws were associated with lower implant stresses compared to traditional iliac screws.
CONCLUSIONS
There is moderate biomechanical evidence to suggest that there is no significant difference in stability and stiffness between S2AI screws and traditional iliac screws for spinopelvic fixation. However, there is some evidence to support that the placement of S2AI screws may have lower implant stresses on the overall lumbosacral instrumentation compared to traditional iliac screws.
Topics: Humans; Sacrum; Spinal Fusion; Biomechanical Phenomena; Bone Screws; Cadaver
PubMed: 35763199
DOI: 10.1007/s43390-022-00528-2 -
Colorectal Disease : the Official... Mar 2024Sacral neuromodulation (SNM) is a minimally invasive treatment option for functional constipation. Evidence regarding its effectiveness is contradictory, driven by... (Review)
Review
AIM
Sacral neuromodulation (SNM) is a minimally invasive treatment option for functional constipation. Evidence regarding its effectiveness is contradictory, driven by heterogeneous study populations and designs. The aim of this study was to assess the effectiveness, safety and cost-effectiveness of SNM in children and adults with refractory idiopathic slow-transit constipation (STC).
METHOD
OVID Medline, OVID Embase, Cochrane Library, the KSR Evidence Database, the NHS Economic Evaluation Database and the International HTA Database were searched up to 25 May 2023. For effectiveness outcomes, randomized controlled trials (RCTs) were selected. For safety outcomes, all study designs were selected. For cost-effectiveness outcomes, trial- and model-based economic evaluations were selected for review. Study selection, risk of bias and quality assessment, and data extraction were independently performed by two reviewers. For the intervention 'sacral neuromodulation' effectiveness outcomes included defaecation frequency and constipation severity. Safety and cost-effectiveness outcomes were, respectively, adverse events and incremental cost-effectiveness ratios.
RESULTS
Of 1390 records reviewed, 67 studies were selected for full-text screening. For effectiveness, one cross-over and one parallel-group RCT was included, showing contradictory results. Eleven studies on safety were included (four RCTs, three prospective cohort studies and four retrospective cohort studies). Overall infection rates varied between 0% and 22%, whereas reoperation rates varied between 0% and 29%. One trial-based economic evaluation was included, which concluded that SNM was not cost-effective compared with personalized conservative treatment at a time horizon of 6 months. The review findings are limited by the small number of available studies and the heterogeneity in terms of study populations, definitions of refractory idiopathic STC and study designs.
CONCLUSION
Evidence for the (cost-)effectiveness of SNM in children and adults with refractory idiopathic STC is inconclusive. Reoperation rates of up to 29% were reported.
Topics: Adult; Child; Humans; Cost-Benefit Analysis; Constipation; Sacrum; Research Design; Electric Stimulation Therapy
PubMed: 38247282
DOI: 10.1111/codi.16876 -
Archivos Espanoles de Urologia Sep 2021Sacral electrical stimulation has been used for more than a century as an alternative therapy for adult urinary syndromes. In the literature, several studies have...
OBJECTIVES
Sacral electrical stimulation has been used for more than a century as an alternative therapy for adult urinary syndromes. In the literature, several studies have validated the efficacy of this technique based on clinical and urodynamic criteria. Nevertheless, few studies have shown beneficial results in children with overactive bladder.
MATERIAL AND METHODS
We performed a systematic review of studies assessing the impact of sacral electroestimulation treatment on overactive bladder in children. The search identified 389 potentially eligible items. Of them, 14 studies published between 2001and 2019 met the study criteria and were selected for systematic review. RESULTS: All of papers included in this review individually demonstrated a high efficiency rate with good shortterm results, as well as safety in its use due to its minimalrate of adverse effects. However, the comparison of the results obtained in all of them was not possible because the high variety and heterogeneity in the different studies. The main limitation is that there is still no standard protocol for the application of this therapy in the pediatric population.
CONCLUSION
This review revealed the promising benefits of sacral electroneuromodulation in pediatric patients with overactive bladder. However, more studies with strictly meet pediatric overactive bladder diagnosis and management criteria should be done to protocolize and clarify the effectiveness of this therapeutic approach.
Topics: Adult; Child; Electric Stimulation Therapy; Humans; Pediatrics; Sacrum; Treatment Outcome; Urinary Bladder, Overactive
PubMed: 34472439
DOI: No ID Found -
Spine Deformity May 2023Studies on sagittal alignment parameters have solely focused on patients with preexisting spinal deformity. Limited data in the literature have analyzed pelvic incidence... (Review)
Review
PURPOSE
Studies on sagittal alignment parameters have solely focused on patients with preexisting spinal deformity. Limited data in the literature have analyzed pelvic incidence (PI) values in an asymptomatic patient population. The purpose of this study was to: (1) systematically review the literature to analyze normative PI values in asymptomatic patients; and (2) provide a more definitive geometric measurement guide for determining surgical interventions.
METHODS
A systematic review of retrospective studies was performed by searching PubMed to identify studies that analyzed PI measurements in asymptomatic subjects. The following search phrases were used: (pelvic incidence, pelvic tilt, sacral slope, sagittal alignment, radiograph, asymptomatic, normative values, and adults) using Boolean operators AND, OR and NOT. Patients with pathology involving the osseous pelvic anatomy (including fracture, infection, tumor, previous surgery, and lumbosacral fusion) that would prevent measurement of the selected parameters were not included. Pelvic incidence (PI) values were analyzed.
RESULTS
A total of 29 studies met inclusion criteria, including 3629 asymptomatic subjects who underwent standing lateral radiographs (mean age, 41.1 years; range, 24-69 years) for the purposes of analyzing pelvic incidence values. Overall, the mean PI value was 50.0° (range, 24-69) which is consistent with reported values in the literature.
CONCLUSION
Wide anatomical variability and broad clinical interpretation of PI normative values do little to guide surgical planning for successful outcomes. However, this systematic review has presented PI-stratified normative values in a large sample of asymptomatic subjects which can serve as a grounded geometric reference for spine surgeons when considering surgical intervention approaches.
Topics: Adult; Humans; Retrospective Studies; Sacrum; Posture; Standing Position; Radiography
PubMed: 36735158
DOI: 10.1007/s43390-023-00649-2 -
European Spine Journal : Official... Nov 2021The aim of our study is to analyse mid- to long-term severe adult spinal deformity (ASD) surgery outcomes by comparing three-column osteotomies (3CO) and multiple... (Review)
Review
Adult spinal deformity surgery: posterior three-column osteotomies vs anterior lordotic cages with posterior fusion. Complications, clinical and radiological results. A systematic review of the literature.
PURPOSE
The aim of our study is to analyse mid- to long-term severe adult spinal deformity (ASD) surgery outcomes by comparing three-column osteotomies (3CO) and multiple anterior interbody fusion cages (AC).
MATERIALS AND METHODS
The PRISMA flowchart was used to systematically review the literature. Only articles with a minimum 24-month follow-up were examined, and 11 articles were included. The following radiological parameters were observed: pelvic incidence (PI), pelvic tilt (PT), lumbar lordosis (LL), sagittal vertical axis (SVA), Cobb angle and T1-sacrum plumbline. Clinical outcome was assessed using the visual analogue scale (VAS) and Oswestry disability index (ODI) scores. The main complications were analysed, and the two groups were compared.
RESULTS
Except for age, the two populations were homogeneous. Both techniques had the same number of posterior instrumented levels (7.4 ± 1.7). The AC group had a mean 3 ± 1.4 interbody fusions per patient. In the PSO group, all patients had 1 3CO and 89.8% of the osteotomies were performed at L2 or L3 vertebrae. No difference was observed between the two groups in terms of clinical outcomes. Both techniques were effective in sagittal parameters restoration with a final PI-LL mismatch = 4.4°. The PSO group had a statistically higher rate of intraoperative blood loss (p = 0.036), major complications, pseudoarthrosis and dural tears (p < 0.001).
CONCLUSION
Both PSO and multiple AC are effective in treating ASD. Multiple AC seems more suitable when treating older patients because of a lower intraoperative blood loss, lower rate of major complications and fewer number of revision surgeries.
Topics: Adult; Humans; Lordosis; Lumbar Vertebrae; Osteotomy; Retrospective Studies; Spinal Fusion; Treatment Outcome
PubMed: 34415448
DOI: 10.1007/s00586-021-06925-x -
Expert Review of Medical Devices Mar 2023While 3D printing of bone models for preoperative planning or customized surgical templating has been successfully implemented, the use of patient-specific additively...
INTRODUCTION
While 3D printing of bone models for preoperative planning or customized surgical templating has been successfully implemented, the use of patient-specific additively manufactured (AM) implants is a newer application not yet well established. To fully evaluate the advantages and shortcomings of such implants, their follow-up results need to be evaluated.
AREA COVERED
This systematic review provides a survey of the reported follow-ups on AM implants used for oncologic reconstruction, total hip arthroplasty both primary and revision, acetabular fracture, and sacrum defects.
EXPERT OPINION
The review shows that Titanium alloy (Ti4AL6V) is the most common type of material system used due to its excellent biomechanical properties. Electron beam melting (EBM) is the predominant AM process for manufacturing implants. In almost all cases, porosity at the contact surface is implemented through the design of lattice or porous structures to enhance osseointegration. The follow-up evaluations show promising results, with only a small number of patients suffering from aseptic loosening, wear, or malalignment. The longest reported follow-up length was 120 months for acetabular cages and 96 months for acetabular cups. The AM implants have proven to serve as an excellent option to restore premorbid skeletal anatomy of the pelvis.
Topics: Humans; Acetabulum; Follow-Up Studies; Osseointegration; Porosity; Prosthesis Design; Pelvic Bones; Patient-Specific Modeling; Sacrum; Biomechanical Phenomena; Prostheses and Implants
PubMed: 36860182
DOI: 10.1080/17434440.2023.2183839