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World Neurosurgery Dec 2021Chordoma is a rare neoplasm of the neuraxis derived from remnants of the primitive notochord. The importance of wide margins and use of adjuvant therapy in spinal...
OBJECTIVE
Chordoma is a rare neoplasm of the neuraxis derived from remnants of the primitive notochord. The importance of wide margins and use of adjuvant therapy in spinal chordomas are still contentious points in the management of spinal chordomas. We conducted a systematic review of the surgical management of spinal chordomas alongside our 10-year institutional experience.
METHODS
A systematic search of the literature was performed in November 2020 using Embase and MEDLINE for articles regarding the surgical management of chordomas arising from the mobile spine and sacrum. We also searched for all adult patients who were surgically managed for spinal chordomas at our institute between 2010 and 2020. In both the systematic review and our institutional case series, data on adequacy of resection, use of adjuvant therapy, complications, recurrence (local or metastatic), and survival outcomes were collected.
RESULTS
We identified and analyzed 42 articles, yielding 1531 patients, from which the overall gross total or wide resection rate was 54.9%. Among the 8 cases in our institutional experience (4 sacral, 3 cervical, and 1 lumbar), we achieved gross total resection in 50% of initial operations. The recurrence rate was 25% in our gross total resection group and 50% where initial resection was subtotal. Of patients, 75% had no evidence of recurrence at most recent follow-up.
CONCLUSIONS
Albeit difficult at times because of the proximity to neurovascular tissue, achieving a wide resection followed by adjuvant therapy for spinal chordomas is of great importance. Multidisciplinary discussion is valuable to ensure the best outcome for the patient.
Topics: Adult; Aged; Chordoma; Combined Modality Therapy; Disease Management; Female; Humans; Male; Middle Aged; Radiotherapy, Adjuvant; Retrospective Studies; Spinal Neoplasms; Treatment Outcome
PubMed: 34506978
DOI: 10.1016/j.wneu.2021.09.001 -
Journal of Clinical Nursing Sep 2020To assess the effects of flexible sacrum positions on mode of delivery, duration of the second stage of labour, perineal trauma, postpartum haemorrhage, maternal pain,... (Meta-Analysis)
Meta-Analysis
AIMS AND OBJECTIVES
To assess the effects of flexible sacrum positions on mode of delivery, duration of the second stage of labour, perineal trauma, postpartum haemorrhage, maternal pain, abnormal foetal heart rate patterns and Apgar scores based on published literature.
BACKGROUND
Maternal positions served as a nonmedical intervention may facilitate optimal maternal and neonatal outcomes during labour. Flexible sacrum positions are conducive to expanding pelvic outlet. Whether flexible sacrum positions have positive effects on maternal and neonatal well-being is a controversial issue under heated discussion.
DESIGN
We performed a systematic review and meta-analysis based on PRISMA guidelines.
METHODS
Randomised controlled trials (RCTs) comparing any flexible sacrum position with non-flexible sacrum position in the second stage of labour were included. PubMed, EMBASE, Cochrane Library, CINAHL, CNKI (China National Knowledge Infrastructure), SinoMed and Wanfang databases were searched from inception to 11 March 2019 for published RCTs. Risk of bias was assessed by the Cochrane criteria, and random-effects meta-analyses were conducted by RevMan 5.3.
RESULTS
Sixteen studies (3,397 women) published in English were included. Flexible sacrum positions in the second stage of labour could reduce the incidence of operative delivery, instrumental vaginal delivery, caesarean section, episiotomy, severe perineal trauma, severe pain and shorten the duration of active pushing phase in the second stage of labour. However, flexible sacrum positions may increase the incidence of mild perineal trauma. There was no significant difference in the duration of the second stage of labour, maternal satisfaction and other outcomes.
CONCLUSIONS
Flexible sacrum positions are superior in promoting maternal well-being during childbirth. However, several results require careful interpretation. More rigorous original studies are needed to further explore their effects.
RELEVANCE TO CLINICAL PRACTICE
The results support the use of flexible sacrum positions. Flexible sacrum positions are recommended to apply flexibly or tailor to individual woman's labour progress.
Topics: Delivery, Obstetric; Female; Humans; Labor Stage, Second; Low Back Pain; Patient Positioning; Pregnancy; Pregnancy Outcome; Sacrum
PubMed: 32531856
DOI: 10.1111/jocn.15376 -
Journal of Vascular and Interventional... Nov 2019To evaluate the safety and efficacy of sacroplasty for the treatment of osteoporotic and malignant sacral fractures by performing a systematic review and meta-analysis... (Meta-Analysis)
Meta-Analysis
PURPOSE
To evaluate the safety and efficacy of sacroplasty for the treatment of osteoporotic and malignant sacral fractures by performing a systematic review and meta-analysis of existing literature.
MATERIALS AND METHODS
PubMed, Web of Science, and SCOPUS databases were searched from their inception until February 2018 for articles describing sacroplasty. Inclusion criteria were as follows: studies reporting > 5 patients, and pain assessment before and after the procedure recorded with visual analog scale (VAS). Demographic data, procedural details, technical success rates, VAS scores before and after the procedure, and procedural complications were recorded. A random-effects meta-analyses of the VAS pain score before the procedure, at 24-48 hours, at 6 months, and at 12 months were calculated.
RESULTS
Nineteen studies (18 case series and 1 cohort study) were identified consisting of 861 total patients (682 women and 167 men; mean age 73.89 ± 9.73 years). Patients underwent sacroplasty for the following indications: sacral insufficiency fractures secondary to osteoporosis (n = 664), malignancy (n = 167), and nonspecified sacral insufficiency fractures (n = 30). Technical and clinical successes were achieved in 98.9% (852/861) and 95.7% (623/651) of patients undergoing sacroplasty, respectively. The pooled major complication rate was 0.3%, with 3 patients requiring surgical decompression for cement leakage. Random-effects meta-analyses demonstrated statistically significant differences in the VAS pain level at preprocedure, 24-48 hours, 6 months, and 12 months, with cumulative pain scores of 8.32 ± 0.01, 3.55 ± 0.01, 1.48 ± 0.01, and 0.923 ± 0.01, respectively.
CONCLUSIONS
Sacroplasty appears safe and effective for pain relief in patients with osteoporotic or malignant sacral fractures, with statistically significant sustained improvement in VAS pain scores up to 12 months.
Topics: Aged; Aged, 80 and over; Back Pain; Bone Cements; Cementoplasty; Female; Fracture Healing; Humans; Male; Middle Aged; Osteoporotic Fractures; Risk Factors; Sacrum; Spinal Fractures; Spinal Neoplasms; Treatment Outcome
PubMed: 31587952
DOI: 10.1016/j.jvir.2019.06.013 -
Journal of Neurosurgery. Spine Jun 2022There is no consensus regarding the best surgical strategy at the lumbosacral junction (LSJ) in long constructs for adult spinal deformity (ASD). The use of interbody... (Review)
Review
OBJECTIVE
There is no consensus regarding the best surgical strategy at the lumbosacral junction (LSJ) in long constructs for adult spinal deformity (ASD). The use of interbody fusion (IF) has been advocated to increase fusion rates, with additional pelvic fixation (PF) typically recommended. The actual benefit of IF even when extending to the pelvis, however, has not been vigorously analyzed. The goal of this work was to better understand the role of IF, specifically with respect to arthrodesis, when extending long constructs to the ilium.
METHODS
A systematic review of the PubMed and Cochrane databases was performed to identify the relevant studies in English, addressing the management of LSJ in long constructs (defined as ≥ 5 levels) in ASD. The search terms used were as follows: "Lumbosacral Junction," "Long Constructs," "Long Fusion to the Sacrum," "Sacropelvic Fixation," "Interbody Fusion," and "Iliac Screw." The authors excluded technical notes, case reports, literature reviews, and cadaveric studies; pediatric populations; pathologies different from ASD; studies not using conventional techniques; and studies focused only on alignment of different levels.
RESULTS
The PRISMA protocol was used. The authors found 12 retrospective clinical studies with a total of 1216 patients who were sorted into 3 different categories: group 1, using PF or not (n = 6); group 2, using PF with or without IF (n = 5); and group 3, from 1 study comparing anterior lumbar interbody fusion versus transforaminal lumbar interbody fusion. Five studies in group 1 and 4 in group 2 had pseudarthrosis rate as primary outcome and were selected for a quantitative analysis. Forest plots were used to display the risk ratio, and funnel plots were used to look at the risk of publication bias. The summary risk ratios were 0.36 (0.23-0.57, p < 0.001) and 1.03 (0.54-1.96, p = 0.94) for the PF and IF, respectively; there is a protective effect of overall pseudarthrosis for using PF in long constructs for ASD surgeries, but not for using IF.
CONCLUSIONS
The long-held contention that L5/S1 IF is always advantageous in long-construct deformity surgery is not supported by the current literature. Based on the findings from this systematic review and meta-analysis, PF with or without additional L5/S1 interbody grafting demonstrates similar overall construct pseudarthrosis rates. The added risk and costs associated with IF, therefore, should be more closely considered on a case-by-case basis.
PubMed: 34920436
DOI: 10.3171/2021.9.SPINE21883 -
International Urogynecology Journal Dec 2017The treatment of post-hysterectomy vaginal vault prolapse (VVP) has been investigated in several randomized clinical trials (RCTs), but a systematic review of the topic... (Meta-Analysis)
Meta-Analysis Review
INTRODUCTION AND HYPOTHESIS
The treatment of post-hysterectomy vaginal vault prolapse (VVP) has been investigated in several randomized clinical trials (RCTs), but a systematic review of the topic is still lacking. The aim of this study is to compare the effectiveness of treatments for VVP.
METHODS
We performed a systematic review and meta-analysis of the literature on the treatment of VVP found in PubMed and Embase. Reference lists of identified relevant articles were checked for additional articles. A network plot was constructed to illustrate the geometry of the network of the treatments included. Only RCTs reporting on the treatment of VVP were eligible, conditional on a minimum of 30 participants with VVP and a follow-up of at least 6 months.
RESULTS
Nine RCTs reporting 846 women (ranging from 95 to 168 women) met the inclusion criteria. All surgical techniques were associated with good subjective results, and without differences between the compared technique, with the exception of the comparison of vaginal mesh (VM) vs laparoscopic sacrocolpopexy (LSC). LSC is associated with a higher satisfaction rate. The anatomical results of the sacrocolpopexy (laparoscopic, robotic [RSC]. and abdominal [ASC]) are the best (62-91%), followed by the VM. However, the ranges of the anatomical outcome of VM were wide (43-97%). The poorest results are described for the sacrospinal fixation (SSF; 35-81%), which also correlates with the higher reoperation rate for pelvic organ prolapse (POP; 5-9%). The highest percentage of complications were reported after ASC (2-19%), VM (6-29%), and RSC (54%). Mesh exposure was seen most often after VM (8-21%). The rate of reoperations carried out because of complications, recurrence prolapse, and incontinence of VM was 13-22%. Overall, sacrocolpopexy reported the best results at follow-up, with an outlier of one trial reporting the highest reoperation rate for POP (11%). The results of the RSC are too small to make any conclusion, but LSC seems to be preferable to ASC.
CONCLUSIONS
A comparison of techniques was difficult because of heterogeneity; therefore, a network meta-analysis was not possible. All techniques have proved to be effective. The reported differences between the techniques were negligible. Therefore, a standard treatment for VVP could not be given according to this review.
Topics: Female; Gynecologic Surgical Procedures; Humans; Hysterectomy; Laparoscopy; Pelvic Organ Prolapse; Postoperative Complications; Sacrum; Surgical Mesh; Treatment Outcome; Vagina
PubMed: 29038834
DOI: 10.1007/s00192-017-3493-2 -
Archives of Orthopaedic and Trauma... Sep 2013Percutaneous iliosacral screw placement following pelvic trauma is associated with high rates of revisions, screw malpositioning, the risk of neurological damage and... (Meta-Analysis)
Meta-Analysis Review
Malposition and revision rates of different imaging modalities for percutaneous iliosacral screw fixation following pelvic fractures: a systematic review and meta-analysis.
INTRODUCTION
Percutaneous iliosacral screw placement following pelvic trauma is associated with high rates of revisions, screw malpositioning, the risk of neurological damage and inefficient stability. The correct entry point and the small target corridor may be difficult to visualize using only an image intensifier. Therefore, 2D and 3D image-based navigation and reconstruction techniques could be helpful tools. The aim of this systematic review and meta-analysis was to evaluate the best available evidence regarding the rate of malpositioning and revisions using different techniques for screw implantation, i.e., conventional, 2D and 3D image-based navigation and reconstruction techniques, CT navigation.
METHODS
A systematic review and meta-analysis were performed using the data available on Ovid Medline. 430 studies published between 1/1948 and 2/2011 were identified by two independent investigators. Inclusion criteria were percutaneous iliosacral screw fixation after traumatic pelvic fractures with included revision rate or positioning of the screw, language of the article English or German. Exclusion criteria were osteoporotic fracture, tumor, reviews, epidemiological studies, biomechanical/cadaveric studies, studies about operative technique. For statistical analysis the random effect model was used.
RESULTS
A total of 51 studies fulfilled the inclusion requirements describing 2,353 percutaneous screw implantations following pelvic trauma in 1,731 patients. The estimated rate of malposition was 0.1 % for 262 screws using CT navigation. This rate was significantly lower (p < 0.0001) than for the conventional technique with malposition rate of 2.6 % (total 1,832 screws). Using 2D and 3D image-based navigation and reconstruction techniques, the malposition rate was 1.3 % (total 445 screws). No significance was observed between the conventional and the 2D and 3D image-based navigation and reconstruction techniques. The rates of revision were not statistically significant with 2.7 % (1,832 implantations) in the conventional group, 1.3 % (445 implantations) in the group of 2D and 3D image-based navigation and reconstruction techniques and 0.8 % (262 implantations) using the CT navigation.
CONCLUSIONS
CT navigation has the lowest rate of screw malposition, but on the other hand it could not be used for all type of fractures where surgical procedures (reduction maneuvers, additional osteosynthetic procedures) are necessary. The 2D and 3D image-based navigation and reconstruction techniques provide encouraging results with slightly lower rate of complications compared to the conventional technique and are additional tools to enhance the precision and decrease the rate of revision.
Topics: Bone Malalignment; Bone Screws; Diagnostic Imaging; Fractures, Bone; Humans; Ilium; Image Processing, Computer-Assisted; Internal Fixators; Pelvic Bones; Postoperative Complications; Reoperation; Sacrum
PubMed: 23748798
DOI: 10.1007/s00402-013-1788-4 -
Complementary Therapies in Medicine Dec 1999The objective of this research was to review critically the scientific basis of craniosacral therapy as a therapeutic intervention. (Review)
Review
OBJECTIVES
The objective of this research was to review critically the scientific basis of craniosacral therapy as a therapeutic intervention.
DESIGN
A systematic search for and critical appraisal of research on craniosacral therapy was conducted. Medline, Embase, Healthstar, Mantis, Allied and Alternative Medicine, Scisearch and Biosis were searched from their start date to February 1999.
MAIN OUTCOME MEASURES
A three-dimensional evaluative framework with related appraisal criteria: (A) craniosacral interventions and health outcomes; (B) validity of craniosacral assessment; and (C) pathophysiology of the craniosacral system.
RESULTS
The available research on craniosacral treatment effectiveness constitutes low-grade evidence conducted using inadequate research protocols. One study reported negative side effects in outpatients with traumatic brain injury. Low inter-rater reliability ratings were found.
CONCLUSIONS
This systematic review and critical appraisal found insufficient evidence to support craniosacral therapy. Research methods that could conclusively evaluate effectiveness have not been applied to date.
Topics: Adult; Cerebrospinal Fluid; Child, Preschool; Complementary Therapies; Cranial Sutures; Humans; Physical Therapy Modalities; Sacrum; Treatment Outcome
PubMed: 10709302
DOI: 10.1016/s0965-2299(99)80002-8 -
Folia Morphologica 2021The aim of this study is to present the level of aortic bifurcation in a sample of Greek origin (case series) and to perform an up-to-date systematic review in the...
BACKGROUND
The aim of this study is to present the level of aortic bifurcation in a sample of Greek origin (case series) and to perform an up-to-date systematic review in the existing literature.
MATERIALS AND METHODS
Seventy-six formalin-fixed adult cadavers were dissected and studied in order to research the level of aortic bifurcation. Additionally, PubMed and Google Scholar databases were searched for eligible articles concerning the level of aortic bifurcation for the period up to February 2020.
RESULTS
The mean level of aortic bifurcation according to our case series was the lower third of the L4 vertebral body (21/76, 27.6%). The level of aortic bifurcation ranged between the lower third of the L3 vertebral body and the lower third of the L5 body. No statistically significant correlation was found between the two sexes. The systematic review of the literature revealed 31 articles which were considered eligible and a total number of 3537 specimens were retracted. According to the recorded findings the most common mean level of aortic bifurcation was the body of L4 vertebra (1495/3537 cases, 42.2%), while the range of aortic bifurcation was described to occur from upper third of L3 vertebrae to the upper third of the S1 vertebrae in the 52.8% of the cases (1866/3537).
CONCLUSIONS
The mean level of AA corresponds to the body of L4 and presents a great range (form L3U to S1U). Knowledge of the mean level of aortic bifurcation and its probable ranges is of great significance for interventional radiologists and especially vascular surgeons that deal with aneurism proximal to the aortic bifurcation.
Topics: Adult; Aorta, Abdominal; Cadaver; Greece; Humans; Lumbar Vertebrae; Sacrum
PubMed: 32488853
DOI: 10.5603/FM.a2020.0064 -
ANZ Journal of Surgery Apr 2016Sacral neuromodulation (SNM) has emerged as a treatment option for faecal incontinence (FI). However, its objective effect on symptoms and anorectal function is... (Review)
Review
BACKGROUND
Sacral neuromodulation (SNM) has emerged as a treatment option for faecal incontinence (FI). However, its objective effect on symptoms and anorectal function is inconsistently described. This study aimed to systematically review the impact of SNM on clinical symptoms and gastrointestinal physiology in patients with FI, including factors that may predict treatment outcome.
METHODS
An electronic search of MEDLINE (1946-2014)/EMBASE database was performed in accordance with PRISMA guidelines. Articles that reported the relevant outcome measures following SNM were included. Clinical outcomes evaluated included: frequency of FI episodes, FI severity score and success rates. Its impact on anorectal and gastrointestinal physiology was also evaluated.
RESULTS
Of 554 citations identified, data were extracted from 81 eligible studies. Meta-analysis of the data was precluded due to lack of a comparison group in most studies. After permanent SNM, 'perfect' continence was noted in 13-88% of patients. Most studies reported a reduction in weekly FI episodes (median difference of the mean -7.0 (range: -24.8 to -2.7)) and Wexner scores (median difference of the mean -9 (-14.9 to -6)). A trend towards improved resting and squeeze anal pressures and a reduction in rectal sensory volumes were noted. Studies failed to identify any consistent impact on other physiological parameters or clinicophysiological factors associated with success.
CONCLUSION
SNM improves clinical symptoms and reduces number of incontinence episodes and severity scores in patients with FI, in part by improving anorectal physiological function. However, intervention studies with standardized outcome measures and physiological techniques are required to robustly assess the physiological impact of SNM.
Topics: Anal Canal; Electric Stimulation Therapy; Fecal Incontinence; Female; Humans; Male; Quality of Life; Sacrum; Treatment Outcome
PubMed: 26245170
DOI: 10.1111/ans.13257 -
European Spine Journal : Official... Dec 2020A systematic review and meta-analysis. (Meta-Analysis)
Meta-Analysis Review
STUDY DESIGN
A systematic review and meta-analysis.
OBJECTIVE
The purpose of this study was to evaluate the clinical outcome and safety of sacroplasty for patients with secondary metastatic lesions to the sacrum.
METHODS
Several databases, including the Cochrane library, PubMed and EMBASE, were systematically searched to identify potentially eligible articles in English language. All the above databases were searched until December 2019. The search strategy was based on the combination of the following keywords: sacroplasty AND secondary tumours OR metastasis OR metastases. The reference list of the selected literature was also reviewed and a standard PRISMA template utilised.
RESULTS
From a total of 102 articles initially identified, a final seven studies were identified as meeting the inclusion criteria. A total of 107 patients from these studies were included. The follow-up ranged from immediate post-operatively to 30.5 months. The mean preoperative VAS was 8.38 (range 6.9-9.3), which improved significantly to 3.01 (range 1.12-4.7) post-operatively (p < 0.001). The most frequent complication reported was cement leakage, which occurred in 26 patients (25.4%), but without any neurological or other adverse sequelae.
CONCLUSIONS
Sacroplasty in the management of secondary sacral tumours is a safe procedure that can achieve a significant reduction in pain, as quantified by VAS scores, and low complication rate.
Topics: Bone Cements; Humans; Sacrococcygeal Region; Sacrum; Spinal Fractures; Treatment Outcome
PubMed: 32772170
DOI: 10.1007/s00586-020-06562-w