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Clinical Spine Surgery Apr 2024Systematic review and meta-analysis. (Meta-Analysis)
Meta-Analysis
STUDY DESIGN
Systematic review and meta-analysis.
OBJECTIVE
To report the ratio-of-differences between standing and sitting. To understand how sex and age influence these differences.
SUMMARY OF BACKGROUND DATA
Currently, spinal deformity surgery aims to realign the sagittal profile of the spine with-reference-to the standing posture resulting in overcorrection. New studies report significant disparities between standing and sitting spinal alignment.
METHODS
A comprehensive search and review of the published literature was performed on 4 platforms in accordance with the PRISMA 2009 checklist by 2 authors independently.
RESULTS
From 753 abstracts extracted from the databases, 38 papers involving 5423 patients were identified. sagittal vertical axis was more positive in sitting, with a pooled mean difference of 29.5 mm (95% CI: 17.9-41.0). Pelvic tilt (PT) was larger in sitting, with a pooled mean difference of 16.7 degrees (95% CI: 12.5-20.9), and a pooled odds ratio of 1.2(95% CI:1.1-1.3. P =0.001). Sacral Slope (SS) was smaller and lumbar lordosis (LL) was less lordotic in sitting, with a pooled mean difference of 15.0 degrees (95% CI: 11.918.1) and 21.1 degrees (95% CI:14.5-27.8), respectively, and a pooled odds ratio of 0.7 (95% CI: 0.6-0.8. P <0.001) and 0.7 (95% CI:0.6-0.7, P <0.001), respectively. Pelvic incidence and thoracic kyphosis was similar in sitting. Subgroup meta-analysis comparing odd ratio of standing to sitting showed: Among younger patients (age younger than 50), the PT and LL pooled odds-ratios were 1.4 and 0.7, respectively. Among older patients (age older than or equal to 50), the PT and LL pooled odds-ratios were 1.1 and 0.8, respectively. Among female patients, the SS pooled odds ratio was 0.6. Among male patients, the SS pooled odds ratio was 0.7.
CONCLUSION
When comparing sitting to standing, it gives a more positive sagittal vertical axis, a smaller SS and LL, and a larger PT. pelvic incidence and thoracic kyphosis remained similar. Younger and female patients have pronounced differences in SS, PT, and LL, suggesting the existence of age and sex variations, and its role to be considered when planning for spinal realignment surgeries. Clinical outcome studies are required to ascertain the impact of these findings.
Topics: Humans; Male; Female; Sitting Position; Lordosis; Kyphosis; Posture; Sacrum; Lumbar Vertebrae
PubMed: 37482640
DOI: 10.1097/BSD.0000000000001501 -
Journal of Orthopaedic Science :... May 2011Abdominosacral amputation is a potentially curative surgical approach for patients with recurrent rectal cancer. Previous reports have described differing extents of... (Review)
Review
BACKGROUND
Abdominosacral amputation is a potentially curative surgical approach for patients with recurrent rectal cancer. Previous reports have described differing extents of sacral resection. Most of these reports stated that high sacral involvement of the tumor is a contraindication for surgery; however, the basis for this is unclear.
METHODS
In this study, we reviewed the highest level of sacral amputation and the "contraindications" for this technique. Using a systematic literature survey, we analyzed the theoretical basis and the changes in surgical indications for recurrent rectal cancer.
RESULTS
We retrieved 33 articles from Medline and one study from the Cochrane Center Register of Controlled Trials. The highest level of resection was at the level of L5/S and S1 in one article, S1/2 and S2 in nine articles and S2/3 and S3 in 11 articles. Fifteen articles stated contraindications regarding sacral level, including tumor involvement of S1, the S1/2 junction, or the level above the S2/3 junction. Reasons stated for these contraindications included the risks associated with surgery, namely bladder dysfunction, anorectal dysfunction, genital dysfunction, walking disorder, and spinal fluid leak. In terms of the rationale for the contraindications, three articles referred to four previously published reviews or case series. None of these supporting publications were randomized controlled trials and they did not include any statistical evaluation.
CONCLUSION
The consensus for contraindications for sacral amputation was formed empirically, without strong supporting evidence. The balance between curability and dysfunction should be further evaluated scientifically.
Topics: Amputation, Surgical; Bone Neoplasms; Contraindications; Decision Making; Humans; Neoplasm Recurrence, Local; Rectal Neoplasms; Risk Factors; Sacrum
PubMed: 21451973
DOI: 10.1007/s00776-011-0050-6 -
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 -
The Journal of Spinal Cord Medicine Nov 2020Chordomas are rare primary tumors of bone characterized by local aggressiveness and poor prognosis. The surgical exeresis plays a critical role for their management....
Chordomas are rare primary tumors of bone characterized by local aggressiveness and poor prognosis. The surgical exeresis plays a critical role for their management. The aim was to provide an overview of the surgical management of chordomas of the mobile spine and sacrum, describing the most common surgical approaches, the role of surgical margins, the difficulties of en block resection, the outcomes of surgery, the recurrence rate and the use of associated therapies. We performed a systematic search using the keywords "chordoma" in combination with "surgery", "spine", "sacrum" and "radiotherapy". Fifty-eight studies, describing 1359 patients with diagnosis of chordoma were retrieved. 17 studies were performed on subjects with cervical chordomas and 49 focused on patients with sacrococcygeal chordomas. The remaining studies included patients with chordomas in cranial region and/or mobile spine and/or sacroccygeal region. The recurrence rate ranged from 25% to 60% for cervical chordomas, and from 18% to 89% for sacrococcygeal chordomas. Despite the remarkable advances in the local management of chordoma performed in the last decades, the current results of surgery alone are still unsatisfactory. The radical en bloc excision of tumour is technically demanding, particularly in the cervical spine. Although radical surgery must still be considered the gold standard for the management of chordomas, a multidisciplinary approach is required to improve the local control of the disease in patients who undergo both radical and non-radical surgery. Adjuvant radiation therapy increases the continuous disease-free survival and the local recurrence-free survival. Systematic review; level III.
Topics: Chordoma; Humans; Retrospective Studies; Sacrum; Spinal Cord Injuries; Spinal Neoplasms; Treatment Outcome
PubMed: 30048230
DOI: 10.1080/10790268.2018.1483593 -
Spine Jul 2010Cross-sectional study and systematic review of the literature. (Review)
Review
STUDY DESIGN
Cross-sectional study and systematic review of the literature.
OBJECTIVE
Describe the natural history of spinopelvic alignment parameters and their behavior in patients with degenerative spinal deformity.
SUMMARY OF BACKGROUND DATA
Normal stance and gait requires congruence between the spine-sacrum and pelvis-lower extremities. This is determined by the pelvic incidence (PI), and 2 positional parameters, the pelvic tilt, and sacral slope (SS). The PI also affects lumbar lordosis (LL), a positional parameter. The final goal is to position the body's axis of gravity to minimize muscle activity and energy consumption.
METHODS
Two study cohorts were recruited: 32 healthy teenagers (Risser IV-V) and 54 adult patients with symptomatic spinal deformity. Standing radiographs were used to measure spinopelvic alignment and positional parameters (SS, PI, sacral-femoral distance [SFD], C7-plumbline [C7P], LL, and thoracic kyphosis). Data from comparable groups of asymptomatic individuals were obtained from the literature.
RESULTS
PI increases linearly with age (r2 = 0.8646) and is paralleled by increasing SFD (r2 = 0.8531) but not by SS. Patients with symptomatic deformity have higher SFD (42 +/- 13.6 mm vs. 63.6 +/- 21.6 mm; P < 0.001) and lower SS (42 degrees +/- 9.6 degrees vs. 30.7 degrees +/- 13.6 degrees; P < 0.001) but unchanged PI. The C7P also presents a linear increase throughout life (r2 = 0.8931), and is significantly increased in patients with symptomatic deformity (40 +/- 37 mm vs. 70.3 +/- 59.5 mm; P < 0.001).
CONCLUSION
First, Gradual increase in PI is described throughout the lifespan that is paralleled by an increase in SFD, and is not by an increase in the SS. This represents a morphologic change of the pelvis. Second, Patients with symptomatic deformity of the spine present an increased C7P, thoracic hypokyphosis, reduced LL, and signs of pelvic retroversion (decreased LL and SS; increased SFD).
Topics: Adolescent; Adult; Cohort Studies; Cross-Sectional Studies; Diagnosis, Differential; Female; Humans; Kyphosis; Lower Extremity; Male; Pelvis; Postural Balance; Radiography; Retrospective Studies; Spinal Curvatures; Spine
PubMed: 20581754
DOI: 10.1097/BRS.0b013e3181d35ca9 -
Neurosurgery Sep 2008To review and define principles and features of treatment for adult degenerative scoliosis, the most common cause of adult spinal deformities. (Review)
Review
OBJECTIVE
To review and define principles and features of treatment for adult degenerative scoliosis, the most common cause of adult spinal deformities.
STUDY DESIGN
We conducted a comprehensive review of the literature and our clinical experience.
METHODS
A systematic review of Medline was conducted, including journal articles published in March 2007 and before. We searched for articles related to adult spinal deformities (scoliosis) and treatments.
CONCLUSION
Degenerative scoliosis is a complex disorder. The primary surgical aims are to decompress the neural elements, normalize both sagittal balance and coronal and rotational deformity, fixate to the sacrum/ilium when appropriate, and optimize conditions for osteogenesis and fusion.
Topics: Adult; Age Factors; Humans; Radiography; Scoliosis; Spinal Fusion
PubMed: 18812938
DOI: 10.1227/01.NEU.0000325485.49323.B2 -
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 -
International Urogynecology Journal Jan 2016Pelvic organ prolapse is showing an increasing prevalence (3 - 50%). The gold standard treatment of apical prolapse is sacrocolpopexy which can be performed via minimal... (Comparative Study)
Comparative Study Meta-Analysis Review
INTRODUCTION
Pelvic organ prolapse is showing an increasing prevalence (3 - 50%). The gold standard treatment of apical prolapse is sacrocolpopexy which can be performed via minimal access (laparoscopy or robotics) or open approaches. The aim of this review was to appraise the effectiveness of minimal access surgery versus the open approach in the treatment of apical prolapse.
METHODS
Keywords were searched in: CINAHL, MEDLINE, CENTRAL, Cochrane MDSG Trials Register, Cochrane Library, Current Controlled Trials, ClinicalTrials.gov, WHO International Trials Registry Platform search portal, LILACS, and Google Scholar databases. Data up to 31 April 2014 were considered. Randomized and nonrandomized controlled trials evaluating all women who underwent minimally invasive sacropexy (MISC) and open sacropexy (OSC) were included. A data extraction tool was used for data collection. MISC was compared with OSC using narrative analysis and meta-analysis (RevMan) where appropriate.
RESULTS
MISC and OSC were compared in 12 studies involving 4,757 participants. MISC and OSC were equally effective in terms of point-C POP-Q measurements and recurrence rate. MISC was associated with a lower transfusion rate (odds ratio 0.41, 95% CI 0.20 - 0.83), shorter length of hospital stay (mean difference -1.57 days, 95% CI -1.91 - -1.23 days), and less blood loss (mean difference -113.27 mL, 95% CI -163.67 - -62.87 mL) but a longer operating time (mean difference 87.47, 95% CI 58.60 - 116.34, p < 0.0001).
CONCLUSIONS
MISC showed similar anatomic results to OSC with a lower transfusion rate, shorter length of hospital stay and less blood loss. The rate of other complications was similar between the approaches. Cautious interpretation of results is advised due to risk of bias caused by the inclusion of nonrandomized studies.
Topics: Controlled Clinical Trials as Topic; Female; Gynecologic Surgical Procedures; Humans; Laparoscopy; Sacrum; Uterine Prolapse; Vagina
PubMed: 26249236
DOI: 10.1007/s00192-015-2765-y -
Orthopaedic Surgery May 2017Giant cell tumor of the bone (GCTB) is a locally aggressive tumor with a certain distant metastatic rate. For sacral GCT (SGCT) and pelvic GCT (PGCT), surgery has its... (Review)
Review
Giant cell tumor of the bone (GCTB) is a locally aggressive tumor with a certain distant metastatic rate. For sacral GCT (SGCT) and pelvic GCT (PGCT), surgery has its limitations, especially for unresectable or recurrent tumors. Selective arterial embolization (SAE) is reported to be an option for treatment in several cases, but there are few systematic reviews on the effects of SAE on SGCT and/or PGCT. Medline and Embase databases were searched for eligible English articles. Inclusion and exclusion criteria were conducted before searching. All the clinical factors were measured by SPSS software, with P-values ≤0.05 considered statistically significant. A total of 9 articles were retrieved, including 44 patients receiving SAE ranging from 1 to 10 times. During the mean follow-up period of 85.8 months, the radiographic response rate was 81.8%, with a local control and overall survival rate of 75% and 81.8%, respectively. No bowel, bladder, or sexual dysfunction was observed. Three patients developed distant metastases and finally died. Patients with primary tumors tended to have better prognosis than those with recurrence (P = 0.039). The favorable outcomes of SAE suggest that it may be an alternative treatment for SGCT and PGCT patients for whom surgery is not appropriate.
Topics: Adolescent; Adult; Aged; Bone Neoplasms; Embolization, Therapeutic; Female; Giant Cell Tumor of Bone; Humans; Male; Middle Aged; Pelvic Bones; Pelvic Neoplasms; Sacrum; Spinal Neoplasms; Treatment Outcome; Young Adult
PubMed: 28644557
DOI: 10.1111/os.12336 -
European Radiology Jun 2024To assess the efficacy and safety of sulfur hexafluoride microbubbles on ultrasound-guided high-intensity focused ultrasound (HIFU) ablation of uterine fibroids. (Meta-Analysis)
Meta-Analysis Review
OBJECTIVES
To assess the efficacy and safety of sulfur hexafluoride microbubbles on ultrasound-guided high-intensity focused ultrasound (HIFU) ablation of uterine fibroids.
METHODS
Studies that compared HIFU-microbubble combination with HIFU-only in patients with uterine fibroids were searched from inception to April 2022. The standardized mean difference (SMD) or relative risk (RR) with 95% confidence interval (CI) for different outcome parameters was calculated.
RESULTS
Seven studies were included, with a total of 901 patients (519 in the combination group and 382 in the HIFU-only group). The energy consumption for treating 1 cm of the lesion in the combination group was less than that in the HIFU-only group [SMD = - 2.19, 95%CI (- 3.81, - 0.57), p = 0.008]. The use of microbubbles was associated with shortening the duration of the treatment and sonication [SMD = - 2.60, 95%CI (- 4.09, - 1.10), p = 0.0007; SMD = - 2.11, 95%CI (- 3.30, - 0.92), p = 0.0005]. The rates of significant greyscale changes during HIFU were greater in the combination group, as well as the increase of non-perfused volume ratio [RR = 1.26, 95%CI (1.04, 1.54), p = 0.02; SMD = 0.32, 95%CI (0.03, 0.61), p = 0.03]. The average sonication durations to reach significant greyscale changes and for ablating 1 cm of the fibroid lesion were shorter in the combination group [SMD = - 1.24, 95%CI (- 2.02, - 0.45), p = 0.002; SMD = - 0.22, 95%CI (- 0.42, - 0.02), p = 0.03]. The two groups had similar post-HIFU adverse effects, while the combination group had fewer intraprocedural adverse events like abdominal pain, sacrum pain, and leg pain.
CONCLUSIONS
Sulfur hexafluoride microbubbles can be safely used to enhance and accelerate the ablation effects of HIFU in the treatment of uterine fibroids.
CLINICAL RELEVANCE STATEMENT
The combination of HIFU with sulfur hexafluoride microbubbles offers a promising non-invasive treatment option for patients with uterine fibroids.
KEY POINTS
• Sulfur hexafluoride microbubbles combined with ultrasound-guided high-intensity focused ultrasound (USgHIFU) has potential advantages in the treatment of uterine fibroids. • Sulfur hexafluoride microbubbles not only enhance the effects of USgHIFU treatment for uterine fibroids but also shorten its duration. • Sulfur hexafluoride microbubbles do not increase the incidence of USgHIFU-related adverse events in the treatment of uterine fibroids.
Topics: Leiomyoma; Microbubbles; Female; Humans; High-Intensity Focused Ultrasound Ablation; Uterine Neoplasms; Sulfur Hexafluoride; Treatment Outcome
PubMed: 37950765
DOI: 10.1007/s00330-023-10407-7