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Radiotherapy and Oncology : Journal of... Apr 2020To interrogate inter-observer variability in gross tumour volume (GTV) and clinical target volume (CTV) delineation specific to the treatment of sacral metastases with...
BACKGROUND AND PURPOSE
To interrogate inter-observer variability in gross tumour volume (GTV) and clinical target volume (CTV) delineation specific to the treatment of sacral metastases with spinal stereotactic body radiation therapy (SBRT) and develop CTV consensus contouring recommendations.
MATERIALS AND METHODS
Nine specialists with spinal SBRT expertise representing 9 international centres independently contoured the GTV and CTV for 10 clinical cases of metastatic disease within the sacrum. Agreement between physicians was calculated with an expectation minimisation algorithm using simultaneous truth and performance level estimation (STAPLE) and with kappa statistics. Optimised confidence level consensus contours were obtained using a voxel-wise maximum likelihood approach and the STAPLE contours for GTV and CTV were based on an 80% confidence level.
RESULTS
Mean GTV STAPLE agreement sensitivity and specificity was 0.70 (range, 0.54-0.87) and 1.00, respectively, and 0.55 (range, 0.44-0.64) and 1.00 for the CTV, respectively. Mean GTV and CTV kappa agreement was 0.73 (range, 0.59-0.83) and 0.59 (range, 0.41-0.70), respectively. Optimised confidence level consensus contours were identified by STAPLE analysis. Consensus recommendations for the CTV include treating the entire segment containing the disease in addition to the immediate adjacent bony anatomic segment at risk of microscopic extension.
CONCLUSION
Consensus recommendations for CTV target delineation specific to sacral metastases treated with SBRT were established using expert contours. This is a critical first step to achieving standardisation of target delineation practice in the sacrum and will serve as a baseline for meaningful pattern of failure analyses going forward.
Topics: Consensus; Humans; Likelihood Functions; Magnetic Resonance Imaging; Observer Variation; Radiosurgery; Radiotherapy Planning, Computer-Assisted; Sacrum; Tumor Burden
PubMed: 31874346
DOI: 10.1016/j.radonc.2019.11.026 -
BMC Pregnancy and Childbirth Dec 2019It is believed that giving birth in an upright position is beneficial for both mother and the infant for several physiologic reasons. An upright positioning helps the... (Meta-Analysis)
Meta-Analysis
BACKGROUND
It is believed that giving birth in an upright position is beneficial for both mother and the infant for several physiologic reasons. An upright positioning helps the uterus to contract more strongly and efficiently, the baby gets in a better position and thus can pass through the pelvis faster. Upright and lateral positions enables flexibility in the pelvis and facilitates the extension of the outlet. Before implementing a change in birthing positions in our clinics we need to review evidences available and context valid related to duration of second stage of labor and birthing positions. Therefore this review aimed to examine the effect of maternal flexible sacrum birth position on duration of second stage of labor.
METHOD
The research searched articles using bibliographical Databases: Medline/PUBMED, SCOPUS, Google scholar and Google. All study designs were considered while investigating the impact of maternal flexible sacrum birthing positioning in relation duration of second stage of labor. Studies including laboring mothers with normal labor and delivery. A total of 1985 women were included in the reviewed studies. We included both qualitative and quantitative analysis.
RESULTS
We identified 1680 potential citations, of which 8 articles assessed the effect of maternal upright birth positioning on the reduction during the duration of second stage of labor. Two studies were excluded because of incomplete reports for meta analysis. The result suggested a reduction in duration of second stage of labor among women in a flexible sacrum birthing position, with a mean duration from 3.2-34.8. The pooled weighted mean difference with random effect model was 21.118(CI: 11.839-30.396) minutes, with the same significant heterogeneity between the studies (I = 96.8%, p < 000).
CONCLUSION
The second stage duration was reduced in cases of a flexible sacrum birthing position. Even though the reduction in duration varies across studies with considerable heterogeneity, laboring women should be encouraged to choose her comfortable birth position. Researchers who aim to compare different birthing positions should consider study designs which enable women to choose birthing position. PROSPERO REGISTRATION NUMBER: [CRD42019120618].
Topics: Female; Humans; Labor Stage, Second; Parturition; Patient Positioning; Posture; Pregnancy; Sacrum; Time Factors
PubMed: 31801479
DOI: 10.1186/s12884-019-2620-0 -
Neurosurgery Clinics of North America Jul 2019Most high-grade spondylolistheses are resultant from isthmic spondylolisthesis, as complete discontinuity of the pars is typically necessary to allow for this degree of... (Review)
Review
Most high-grade spondylolistheses are resultant from isthmic spondylolisthesis, as complete discontinuity of the pars is typically necessary to allow for this degree of anterior vertebral translation, although can occur less commonly in other scenarios. Higher-grade slips can affect the global sagittal balance of the patient and often result in altered gait patterns and compensatory posturing. Management usually entails surgical decompression and fusion with instrumentation. The addition of anterior column support carries many advantages, including greater surface area for fusion, dynamic compression load sharing at the lumbosacral junction, and a powerful adjunct for deformity correction.
Topics: Decompression, Surgical; Humans; Lumbar Vertebrae; Sacrum; Spinal Fusion; Spondylolisthesis; Treatment Outcome
PubMed: 31078229
DOI: 10.1016/j.nec.2019.02.002 -
Injury Jul 2023Sacral fractures are complex injuries that follow a bimodal distribution, typically involving acute high energy trauma in young adults and low energy trauma in older... (Review)
Review
Sacral fractures are complex injuries that follow a bimodal distribution, typically involving acute high energy trauma in young adults and low energy trauma in older adults (> 65 years old). Nonunion is a rare but debilitating potential complication of undiagnosed or improperly managed sacral fractures. Various surgical techniques, including open reduction and internal fixation, sacroplasty, and percutaneous screw fixation, have been used to manage these fracture nonunions. In addition to reviewing the initial management of sacral fractures and the risk factors for fracture nonunion, this article describes techniques, specific cases and outcomes of these treatment strategies.
Topics: Young Adult; Humans; Aged; Bone Screws; Sacrum; Fracture Fixation, Internal; Fractures, Ununited; Treatment Outcome; Retrospective Studies
PubMed: 37179204
DOI: 10.1016/j.injury.2023.05.006 -
Spine Deformity Jul 2019Sacropelvic fixation is indicated in various clinical settings, most notably long spinal arthrodesis, reduction of high-grade spondylolisthesis, and complex sacral... (Review)
Review
Sacropelvic fixation is indicated in various clinical settings, most notably long spinal arthrodesis, reduction of high-grade spondylolisthesis, and complex sacral fractures. The sacropelvis is characterized by complex regional anatomy and poor bone quality. These factors make achieving solid fusion across the lumbosacral junction challenging. However, a better understanding of spinal biomechanics at that level has led to much higher fusion rates than those of the past. The newer fixation techniques are biomechanically superior to previous methods mainly because they achieve bony purchase anterior to the pivot point-first described by McCord et al. in 1994. Today, the two most widely used fixation techniques are iliac screws and S2-alar-iliac screws. Although these techniques are associated with very high rates of fusion, instrumentation-related pain and reoperation remain problematic. This review provides an overview of the regional anatomy and biomechanics at the lumbosacral junction, as well as a summary of fixation techniques with an emphasis on the most widely used techniques today. LEVEL OF EVIDENCE: IV.
Topics: Humans; Lumbar Vertebrae; Pelvic Bones; Postoperative Complications; Sacrum; Spinal Fractures; Spinal Fusion; Spondylolisthesis
PubMed: 31202365
DOI: 10.1016/j.jspd.2018.11.009 -
Neuroimaging Clinics of North America Nov 2019Sacral fractures result from high-impact trauma or in the form of insufficiency or pathologic fractures, resulting from osteoporosis, radiation therapy, or malignancy.... (Review)
Review
Sacral fractures result from high-impact trauma or in the form of insufficiency or pathologic fractures, resulting from osteoporosis, radiation therapy, or malignancy. In the emergency setting, the escalating use of computed tomography has substantially increased diagnosis of sacral fractures, which are frequently occult on radiographs. Radiologists should be familiar with and create reports using the most current fracture classification systems, because this improves communication with the treatment team and optimizes patient care. Sacroplasty is a safe, minimally invasive treatment option for many types of sacral fractures. It provides rapid and durable pain relief, with a low incidence of complications.
Topics: Humans; Magnetic Resonance Imaging; Sacrum; Spinal Fractures; Tomography, X-Ray Computed; Vertebroplasty
PubMed: 31677727
DOI: 10.1016/j.nic.2019.07.003 -
Injury Mar 2021Sacral fractures are often underdiagnosed but are relatively frequent in the setting of pelvic ring injury. Causes include traumatic insults and osteoporosis. Sacral... (Review)
Review
Sacral fractures are often underdiagnosed but are relatively frequent in the setting of pelvic ring injury. Causes include traumatic insults and osteoporosis. Sacral fractures have become more frequent owing to the growth of the elderly population worldwide as osteoporosis is an age-related disease. Misdiagnosed and neglected sacral fractures can result in chronic back pain, spine deformity, and instability. Unfortunately, the wide range of classification systems hinders adequate communication among clinicians. Therefore, a complete understanding of the pathology, and communication within the interdisciplinary team, are necessary to ensure adequate treatment and satisfactory clinical outcomes. The aim of this manuscript is to present the current knowledge available regarding classification systems, clinical assessment, decision-making factors, and current treatment options.
Topics: Aged; Humans; Neck Injuries; Osteoporosis; Pelvic Bones; Sacrum; Spinal Fractures
PubMed: 33187674
DOI: 10.1016/j.injury.2020.11.015 -
International Urogynecology Journal Sep 2021The objective was to develop an instructional video that utilizes fluoroscopic images and anatomical landmarks to increase the surgeon's ability to troubleshoot optimal...
INTRODUCTION AND HYPOTHESIS
The objective was to develop an instructional video that utilizes fluoroscopic images and anatomical landmarks to increase the surgeon's ability to troubleshoot optimal placement of the foramen needle and lead during a stage I sacral neuromodulation (SNM) procedure.
METHODS
Eight different examples of suboptimal foramen needle placement with subsequent corrections during a SNM procedure were performed and recorded on a fresh female cadaver.
RESULTS
Fluoroscopic images were obtained during the procedure, and illustrations of the posterior aspect of the sacrum highlighting the S3 foramina and nerve are shown for anatomical comparison.
CONCLUSIONS
This video demonstrates how to efficiently identify and correct suboptimal foramen needle placement in order to obtain optimal lead placement during an SNM procedure. Understanding the relationship between the bony landmarks on fluoroscopy and the S3 nerve and foramen are important in order to understand how to correct a suboptimal foramen needle and thus achieve optimal lead placement.
Topics: Cadaver; Electric Stimulation Therapy; Female; Humans; Sacrum
PubMed: 33416966
DOI: 10.1007/s00192-020-04614-9 -
JBJS Reviews Aug 2021Spinopelvic dissociation is a complex and variable injury pattern that requires an integrated, multidisciplinary team including orthopaedic trauma and spine surgeons.
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Spinopelvic dissociation is a complex and variable injury pattern that requires an integrated, multidisciplinary team including orthopaedic trauma and spine surgeons.
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Protocols and efficient channels of communication should be in place at tertiary Level-I trauma centers to ensure appropriate and timely treatment of patients with spinopelvic dissociation.
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Patients with spinopelvic dissociation may present with acute neurological deficits and impending cauda equina syndrome, necessitating urgent, coordinated care.
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Lumbopelvic fixation with sacroiliac screws yields a stable, multiplanar construct that connects the spine to the pelvis and allows for early mobilization.
Topics: Fracture Fixation, Internal; Humans; Pelvis; Sacrum
PubMed: 34766943
DOI: 10.2106/JBJS.RVW.20.00196 -
World Neurosurgery Nov 2023Sacral masses can be removed using anterior, posterior, or combined approaches. Achieving total sacrectomy through a posterior-only approach results in a shorter... (Review)
Review
BACKGROUND
Sacral masses can be removed using anterior, posterior, or combined approaches. Achieving total sacrectomy through a posterior-only approach results in a shorter procedure time, minimal tissue damage, and a reduced risk of complications. In this study, we aimed to share our experience with performing total sacrectomy using a posterior-only approach in 26 patients and to assess their clinical outcomes at our center.
MATERIALS AND METHODS
This retrospective study examines the clinical progression, surgical response, and outcomes of 26 patients with various sacral mass pathologies. We accessed patient information from our hospital records.
RESULTS
The study included 14 men (54%) and 12 women (46%), with an average age of 49.8 years. Most cases had a normal body mass index, while 6 were overweight. Sacrectomy was performed at a high level in 12 patients and at a middle level in 14 patients. In addition to pain, motor deficits were observed in 9 patients, and sphincter dysfunction was found in 5. Preoperative embolization was conducted for 11 patients. The most prevalent lesions were chordoma (8 patients), malignant peripheral nerve sheath tumor (4 patients), giant cell tumor (3 patients), and solitary plasmacytoma (3 patients). Only 1 patient experienced a temporary partial motor deficit after surgery. There were no instances of cerebrospinal fluid leakage. Five patients experienced local recurrence, and 1 had distant metastasis.
CONCLUSIONS
Performing sacrectomy for large or giant sacral tumors through a posterior approach is both feasible and safe, resulting in reduced morbidity and no significant change in overall survival.
Topics: Male; Humans; Female; Middle Aged; Retrospective Studies; Spinal Neoplasms; Sacrum; Chordoma; Pain
PubMed: 37625639
DOI: 10.1016/j.wneu.2023.08.078