-
North American Spine Society Journal Mar 2024The treatment of spine metastases continues to pose a significant clinical challenge, requiring the integration of multiple therapeutic modalities to address the... (Review)
Review
Combination radiofrequency ablation and vertebral cement augmentation for spinal metastatic tumors: A systematic review and meta-analysis of safety and treatment outcomes.
BACKGROUND
The treatment of spine metastases continues to pose a significant clinical challenge, requiring the integration of multiple therapeutic modalities to address the multifactorial aspects of this disease process. Radiofrequency ablation (RFA) and vertebral cement augmentation (VCA) are 2 less invasive modalities compared to open surgery that have emerged as promising strategies, offering the potential for both pain relief and preservation of vertebral stability. The utility of these approaches, however, remains uncertain and subject to ongoing investigation.This systematic review and meta-analysis evaluates the available evidence and synthesize the results of studies that have investigated the combination of RFA and VCA for the treatment of spinal metastases, with the goal of providing a comprehensive and up-to-date assessment of the efficacy and safety of this therapeutic approach.
METHODS
A literature search was conducted using the electronic databases PubMed, Cochrane Central Register of Controlled Trials (CENTRAL), and Scopus from their inception to May 4th, 2022 in accordance with PRISMA guidelines. Studies were included if they met the following criteria: 1) spine metastases treated with RFA in combination with VCA, 2) available data on at least one outcome (i.e., pain palliation, complications, local tumor control), 3) prospective or retrospective studies with at least 10 patients, and 4) English language. Meta-analyses were conducted in R (R Foundation for Statistical Computing; Vienna, Austria), using the package.
RESULTS
In the 25 included studies, a total of 947 patients (females=53.9%) underwent RFA + VCA for spinal metastatic tumors. Out of 1,163 metastatic lesions, the majority were located in the lumbar region (585/1,163 [50.3%]) followed by thoracic (519/1,163 [44.6%]), sacrum (39/1,163 [3.4%]), and cervical (2/1,163 [0.2%]). 48/72 [66.7%] metastatic lesions expanded into the posterior elements. Preoperative pathologic vertebral fractures were identified in 115/176 [65.3%] patients. Between pre-procedure pain scores and postprocedure pain scores, average follow-up (FU) was 4.41±2.87 months. Pain scores improved significantly at a short-term FU (1-6 months), with a pooled mean difference (MD) from baseline of 4.82 (95% CI, 4.48-5.16). The overall local tumor progression (LTP) rate at short-term FU (1-6 months) was 5% (95% CI, 1%-8%), at mid-term FU (6-12 months) was 22% (95% CI, 0%-48%), and at long-term FU (>12 months) was 5% (95% CI, 0%-11%). The pooled incidence of total complications was 1% (95% CI, 0%-1%), the most frequent of which were transient radicular pain and asymptomatic cement extravasation.
CONCLUSIONS
The findings of this meta-analysis reveal that the implementation of RFA in conjunction with VCA for the treatment of spinal metastatic tumors resulted in a significant short-term reduction of pain, with minimal total complications. The LTP rate was additionally low. The clinical efficacy and safety of this technique are established, although further exploration of the long-term outcomes of RFA+VCA is warranted.
PubMed: 38510810
DOI: 10.1016/j.xnsj.2024.100317 -
Global Spine Journal Dec 2023A register-based retrospective series and a systematic review of literature.
STUDY DESIGN
A register-based retrospective series and a systematic review of literature.
OBJECTIVES
Tarlov cysts are meningeal cysts typically found in the sacral region. They have a dualistic nature ranging from an incidental finding to a symptomatic pathology. There are no established treatment protocols and predictors of operative outcome. Therefore, we aimed to study the outcome of surgical treatment for Tarlov cysts and to characterize patient-, and treatment-related factors predicting outcomes.
METHODS
A systematic review of previous literature was performed and a retrospective cohort of all patients operated on for Tarlov cysts at BLINDED between 1995 and 2020 was collected. Patient records were evaluated along with radiological images.
RESULTS
Ninety-seven consecutive patients were identified with follow-up data available for 96. Improvement of symptoms after surgery was observed in 76.0% of patients (excellent or good patient-reported outcome) and the complication rate was 17.5%. Sacral or lower back pain as a preoperative symptom was associated with improvement after surgery ( = .007), whereas previous lower back surgery was more common in patients who did not benefit from surgery ( = .034). No independent predictors of outcome were identified in a regression analysis.
CONCLUSIONS
This is the second-largest study on the treatment of Tarlov cysts ever published. Operative treatment in a selected patient population will likely produce improvement in the symptoms when balanced with the complication rate and profile of surgery. Preoperative lower back or sacral pain is a potential indicator for improvement after surgery.
PubMed: 38069780
DOI: 10.1177/21925682231221538 -
Spine Jan 2019Systematic review and meta-analysis. (Meta-Analysis)
Meta-Analysis
STUDY DESIGN
Systematic review and meta-analysis.
OBJECTIVE
This study aims to determine the differences in sagittal spinopelvic parameters between adolescent idiopathic scoliosis (AIS) Lenke types and non-scoliotic controls through a systematic review and meta-analysis of the available literature.
SUMMARY OF BACKGROUND DATA
AIS classification mainly focuses on frontal curve differences; however, the variations in the sagittal spinopelvic alignment in the current classification system is not fully established.
METHODS
Following preferred reporting items for systematic reviews and meta-analyses guidelines, searches were performed for sagittal spinal and pelvic parameters of Lenke types and non-scoliotic controls in PubMed, Scopus, EMBASE, and Cochrane databases. Selection criteria were: (1) age range 10 to 21 years; (2) Lenke types 1-6 (for AIS group) or non-scoliotic adolescents (for the control group); (3) preoperative data for T5-T12 thoracic kyphosis (TK), L1-S1 lumbar lordosis (LL), pelvic incidence (PI), sacral slope (SS), and sagittal vertical axis (SVA). (4) Written in English language. PI-LL mismatch was calculated from the weighted average of PI and LL. Publication bias between studies and within studies quality were assessed. A meta-regression compared each measured variable between groups. Thoracic (Lenke1 and 2) and thoracolumbar/lumbar (Lenke 5 and 6) scoliosis were combined and statistically compared with the control group.
RESULTS
Meta-analysis, including 81 AIS and 18 control studies, showed no significant differences in sagittal parameters between Lenke types and controls for LL, PI, PI-LL mismatch, SS, and SVA (P > 0.05). Publication bias was significant in Lenke 1 TK, Control LL, and Lenke 1, and 5 SVA. Stratification based on deformity region (thoracic vs. thoracolumbar/lumbar) showed no significant differences in sagittal spinopelvic parameters (P > 0.05).
CONCLUSION
No definitive difference was found between non-scoliotic adolescents and Lenke types in sagittal spinal and pelvic parameters. Future studies on developing a sagittal classification specific to AIS patients with a goal to improve surgical planning and outcome prediction are highly encouraged.
LEVEL OF EVIDENCE
4.
Topics: Adolescent; Case-Control Studies; Child; Humans; Kyphosis; Lordosis; Lumbar Vertebrae; Pelvic Bones; Sacrum; Scoliosis; Thoracic Vertebrae; Young Adult
PubMed: 29927859
DOI: 10.1097/BRS.0000000000002748 -
Clinical Spine Surgery May 2016Systematic review. (Comparative Study)
Comparative Study Review
STUDY DESIGN
Systematic review.
OBJECTIVE
To determine the fusion rate of an anterior lumbar interbody fusion (ALIF), transforaminal lumbar interbody fusion (TLIF), and axial arthrodesis at the lumbosacral junction in adult patients undergoing surgery for 1- and 2-level degenerative spine conditions.
SUMMARY OF BACKGROUND DATA
An L5/S1 interbody fusion is a commonly performed procedure for pathology such as spondylolisthesis with stenosis; however, it is unclear if 1 technique leads to superior fusion rates.
MATERIALS AND METHODS
A systematic search of MEDLINE was conducted for literature published between January 1, 1992 and August 17, 2014. All peer-reviewed articles related to the fusion rate of L5/S1 for an ALIF, TLIF, or axial interbody fusion were included.
RESULTS
In total, 42 articles and 1507 patients were included in this systematic review. A difference in overall fusion rates was identified, with a rate of 99.2% (range, 96.4%-99.8%) for a TLIF, 97.2% (range, 91.0%-99.2%) for an ALIF, and 90.5% (range, 79.0%-97.0%) for an axial interbody fusion (P=0.005). In a paired analysis directly comparing fusion techniques, only the difference between a TLIF and an axial interbody fusion was significant. However, when only cases in which bilateral pedicle screws supported the interbody fusion, no statistical difference (P>0.05) between the 3 techniques was identified.
CONCLUSIONS
The current literature available to guide the treatment of L5/S1 pathology is poor, but the available data suggest that a high fusion rate can be expected with the use of an ALIF, TLIF, or axial interbody fusion. Any technique-dependent benefit in fusion rate can be eliminated with common surgical modifications such as the use of bilateral pedicle screws.
Topics: Arthrodesis; Humans; Lumbar Vertebrae; Sacrum; Spinal Diseases; Spinal Fusion
PubMed: 26841206
DOI: 10.1097/BSD.0000000000000356 -
Spine Sep 2021Systematic review and meta-analysis. (Meta-Analysis)
Meta-Analysis
The Comparison of Spinopelvic Parameters, Complications, and Clinical Outcomes After Spinal Fusion to S1 with or without Additional Sacropelvic Fixation for Adult Spinal Deformity: A Systematic Review and Meta-analysis.
STUDY DESIGN
Systematic review and meta-analysis.
OBJECTIVE
The purpose of the study was to compare the outcomes and after spinal fusion with or without iliac screw (IS) insertion for patients with adult spinal deformity (ASD).
SUMMARY OF BACKGROUND DATA
The number of patients undergoing multilevel spinal stabilization for the treatment of ASD is growing. However, the selection of spinopelvic fixation for ASD patients with long fusion is controversial.
METHODS
A comprehensive literature search was performed without time restriction according to the guidelines from the Cochrane Collaboration in May 2020 using PubMed, EMBASE, and the Cochrane Library. The comparison of the two types of fixation was evaluated by spinopelvic parameters, incidence rate of complications, rate of revision, and clinical outcomes at the last follow-up.
RESULTS
The literature search identified 422 records, of which eight studies were included for meta-analysis with a total of 439 patients. All the included studies provided level III evidence. There was no significant difference in the sagittal vertical axis, pelvic incidence, the proximal junctional kyphosis rates, the pseudarthrosis rates, the revision rates, and the clinical outcomes at the last follow-up between those who receive sacrum fixation and sacropelvic fixation. Nevertheless, greater lumbar lordosis (LL) (weighted mean difference [WMD], 4.15; 95% confidence interval [CI] 2.46-5.84, P < 0.01), greater sacral slope (SS) (WMD, 2.32; 95% CI 1.21-3.43, P < 0.01), and lower rate of the distal instrumentation instability (odds ratio, 0.25; 95% CI 0.10-0.61, P = 0.002) were observed in IS group between the comparison.
CONCLUSION
The clinical outcomes in the IS group were similar to those in the non-IS group, but the application of the IS significantly restored LL, prevented decompensation, and reduced the occurrence of the distal instrumentation instability. Therefore, the IS may be a good choice for the operative treatment of ASD patients with sagittal malalignment and other risks of lumbosacral fracture, metal breakage, and screw pullout.Level of Evidence: 3.
Topics: Adult; Humans; Kyphosis; Lordosis; Lumbar Vertebrae; Retrospective Studies; Spinal Fusion
PubMed: 34384096
DOI: 10.1097/BRS.0000000000004003 -
Journal of Plastic, Reconstructive &... Feb 2020Following the excision of sacral tumors, plastic surgeons are often faced with a large soft tissue defect that necessitates flap coverage to promote wound healing and... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Following the excision of sacral tumors, plastic surgeons are often faced with a large soft tissue defect that necessitates flap coverage to promote wound healing and obliterate the resulting dead space. We aimed to evaluate the outcomes and complications following soft tissue reconstruction of sacrectomy defects.
METHODS
Applying the Preferred Reporting Items for Systematic Review and Meta-Analyses (PRISMA), a comprehensive search of several databases was performed from 1950 to 2019 for articles reporting outcomes of soft tissue flap reconstruction after sacrectomy. Demographics, surgical characteristics, and complication rates were abstracted and analyzed.
RESULTS
A total of 544 articles were identified in the initial search, out of which 26 met our inclusion criteria. Gluteal-based flap was the most commonly used (50%), followed by the vertical rectus abdominis myocutaneous (VRAM) flap (38%) and free latissimus dorsi (5%). Patients who underwent high sacrectomy had significantly higher local complications than those who underwent low sacrectomy [OR: 2.57(1.12,5.92); p = 0.03]. Patients who received preoperative radiation had a significantly higher complication rate than those who did not [OR: 2.91(1.25,6.79); p = 0.01]. The pooled local complication rate was 37% in the gluteal-based flap group and 50% in the VRAM flap group. Total flap loss was identified in 1 gluteal and 2 VRAM flaps.
CONCLUSION
Gluteal-based and VRAM flaps are the two most common options for soft tissue reconstruction after sacrectomy. Both flaps demonstrate a high complication rate after this morbid procedure; however, total flap loss seems to be a rare occurrence. Most patients can achieve good functional outcome following reconstruction.
Topics: Humans; Plastic Surgery Procedures; Sacrococcygeal Region; Sacrum; Surgical Flaps
PubMed: 31757686
DOI: 10.1016/j.bjps.2019.09.049 -
Journal of Neurointerventional Surgery Jan 2019Thoracolumbar and sacral spinal epidural arteriovenous fistulas (SEDAVFs) are an increasingly recognized form of spinal vascular malformation. The purpose of this study... (Meta-Analysis)
Meta-Analysis
BACKGROUND AND PURPOSE
Thoracolumbar and sacral spinal epidural arteriovenous fistulas (SEDAVFs) are an increasingly recognized form of spinal vascular malformation. The purpose of this study was to perform a systematic review of the demographics, clinical presentation and treatment results of thoracolumbar SEDAVFs.
MATERIALS AND METHODS
Pubmed, Scopus and Web of Science databases were searched from January 2000 to January 2018 for articles on treatment of SEDAVFs. Pooled data of individual patients were analyzed for demographic and clinical features of SEDAVFs as well as treatment outcomes.
RESULTS
There were 125 patients from 11 studies included. Mean age was 63.5 years. There was a male sex predilection (69.6%). Sensory symptoms including pain or numbness were the most frequently presenting symptoms. Fistula location was the lumbosacral spine in 79.2% and the thoracic spine in 20.8%. Involvement of intradural venous drainage was more common than extradural venous drainage only (89.6% vs 10.4%). Of the 123 treated patients, endovascular therapy was performed in 67.5% of patients, microsurgery in 23.6%, and combined treatment in 8.9%. The overall complete obliteration rate was 83.5% and did not differ between groups. Clinical symptoms improved in 70.7% of patients, were stable in 25%, and worsened in 1.7% with no difference between treatment modalities.
CONCLUSIONS
Thoracic and lumbosacral SEDAVFs often present with symptoms secondary to congestive myelopathy or compressive symptoms. Both endovascular and microsurgical treatments were associated with high obliteration rates and good clinical outcomes.
Topics: Aged; Arteriovenous Fistula; Embolization, Therapeutic; Epidural Space; Female; Humans; Lumbosacral Region; Male; Microsurgery; Middle Aged; Sacrum; Spinal Diseases; Thoracic Arteries; Treatment Outcome
PubMed: 30166334
DOI: 10.1136/neurintsurg-2018-014203 -
International Urogynecology Journal Jan 2017Neovaginal prolapse (NP) is a rare event as few cases have been reported in the literature. Its management is complex and depends on the initial pathology, the... (Review)
Review
INTRODUCTION AND HYPOTHESIS
Neovaginal prolapse (NP) is a rare event as few cases have been reported in the literature. Its management is complex and depends on the initial pathology, the vaginoplasty technique and the patient's history. We present a review the literature on this rare event.
METHODS
We describe the case of a 72-year-old woman who presented with NP 1 year after pelvic exenteration and radiotherapy for recurrent cervical carcinoma associated with vaginal reconstruction by shaped-tube omentoplasty. She had undergone two previous surgical procedures (posterior sacrospinous ligament suspension and partial colpocleisis), but NP recurred each time within a few months. We performed an anterior approach to the sacrospinous ligament and inserted a mesh under the anterior wall of the neovagina, with the two mesh arms driven through the sacrospinous ligament in a tension-free manner (Uphold Lite® system). The MEDLINE, Cochrane Library, ClinicalTrials and OpenGrey databases were systematically searched for literature on the management of NP following bowel vaginoplasty, mechanical dilatation, graciloplasty, omentoplasty, rectus abdominis myocutaneous flap and the Davydov procedure.
RESULTS
The postoperative course in the patient whose case is described was uneventful and after 1 year of follow-up, the anatomical results and patient satisfaction were good. The systematic search of the databases revealed several studies on the treatment of NP using abdominal and vaginal approaches, and these are reviewed.
CONCLUSIONS
Overall, sacrocolpopexy would appear to be a good option for the treatment of prolapse after bowel vaginoplasty, but too few cases have been reported to establish this technique as the standard management of NP.
Topics: Aged; Carcinoma; Female; Humans; Neoplasm Recurrence, Local; Pelvic Exenteration; Postoperative Complications; Plastic Surgery Procedures; Sacrum; Surgical Mesh; Treatment Outcome; Uterine Cervical Neoplasms; Uterine Prolapse; Vagina
PubMed: 27038991
DOI: 10.1007/s00192-016-3009-5 -
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 -
Critical Care Medicine Nov 2018To systematically assess the incidence and prevalence of pressure injuries in adult ICU patients and the most frequently occurring pressure injury sites. (Meta-Analysis)
Meta-Analysis
OBJECTIVES
To systematically assess the incidence and prevalence of pressure injuries in adult ICU patients and the most frequently occurring pressure injury sites.
DATA SOURCES
MEDLINE, Embase, the Cochrane Library, and Cumulative Index to Nursing and Allied Health Literature.
STUDY SELECTION
Observational studies reporting incidence rates, cumulative incidence, and prevalence of pressure injuries.
DATA EXTRACTION
Two reviewers independently screened studies, extracted data, and assessed the risk of bias. Meta-analyses of pooled weighted estimates were calculated using random effect models with 95% CIs reported due to high heterogeneity. Sensitivity analyses included studies that used skin inspection to identify a pressure injury, studies at low risk of bias, studies that excluded stage 1 and each stage of pressure injury.
DATA SYNTHESIS
Twenty-two studies, 10 reporting cumulative incidence of pressure injury irrespective of stage, one reporting incidence rate (198/1,000 hospital-days), and 12 reporting prevalence were included. The 95% CI of cumulative incidence and prevalence were 10.0-25.9% and 16.9-23.8%. In studies that used skin inspection to identify pressure injuries, the 95% CI of cumulative incidence was 9.4-27.5%; all prevalence studies used skin inspection therefore the results were unchanged. In studies assessed as low risk of bias, the 95% CI of cumulative incidence and prevalence were 6.6-36.8% and 12.2-24.5%. Excluding stage 1, the 95% CI of cumulative incidence and prevalence were 0.0-23.8% and 12.4-15.5%. Five studies totalling 406 patients reported usable data on location; 95% CI of frequencies of PIs were as follows: sacrum 26.9-48.0%, buttocks 4.1-46.4%, heel 18.5-38.9%, hips 10.9-15.7%, ears 4.3-19.7%, and shoulders 0.0-40.2%.
CONCLUSIONS
Although well-designed studies are needed to ensure the scope of the problem of pressure injuries is better understood, it is clear prevention strategies are also required.
Topics: Adult; Critical Care; Hospitalization; Humans; Incidence; Pressure Ulcer; Prevalence; Wound Healing
PubMed: 30095501
DOI: 10.1097/CCM.0000000000003366