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1.
Radiotherapy and Surgical Advances in the Treatment of Metastatic Spine Tumors: A Narrative Review.
Porras, JL, Pennington, Z, Hung, B, Hersh, A, Schilling, A, Goodwin, CR, Sciubba, DM
World neurosurgery. 2021;:147-154
Abstract
Spine tumors encompass a wide range of diseases with a commensurately broad spectrum of available treatments, ranging from radiation for spinal metastases to highly invasive en bloc resection for primary vertebral column malignancies. This high variability in treatment approaches stems both from variability in the goals of surgery (e.g., oncologic cure vs. symptom palliation) and from the significant advancements in surgical technologies that have been made over the past 2 decades. Among these advancements are improvements in surgical technique, namely minimally invasive approaches, increased availability of focused radiation modalities (e.g., proton therapy and linear accelerator devices), and new surgical technologies, such as carbon fiber-reinforced polyether ether ketone rods. In addition, several groups have described nonsurgical interventions, such as vertebroplasty and kyphoplasty for spinal instability secondary to pathologic fracture, and lesion ablation with spinal laser interstitial thermoablation, radiofrequency ablation, or cryoablation. We provide an overview of the latest technological advancements in spinal oncology and their potential usefulness for modern spinal oncologists.
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2.
Efficacy and complications of 125I seeds combined with percutaneous vertebroplasty for metastatic spinal tumors: A literature review.
Xie, LL, Chen, XD, Yang, CY, Yan, ZL, Zhu, J, Quan, KQ, Pu, D
Asian journal of surgery. 2020;(1):29-35
Abstract
To review the efficacy and complications of 125I seeds combined with percutaneous vertebroplasty for the treatment of metastatic spinal tumors. We searched PubMed/MEDLINE from its inception to November 2018 for articles on metastatic spinal tumors treated with 125I seeds combined with percutaneous vertebroplasty. A total of 273 articles were identified in PubMed/MEDLINE based on the search criteria. After deleting duplicate articles including two retrospective studies and three case control studies, five studies were included in this systematic review. In total, 161 patients aged from 49.2 to 62 years were included. The operative levels consisted of the thoracic vertebrae and lumbar vertebrae. Bone cement leakage occurred in 7 cases. None of the patients developed radiation myelopathy. Percutaneous vertebroplasty plus 125I seeds implantation is an effective palliative treatment and can alleviate back pain and enhance vertebral body strength in patients with end-stage spinal metastatic tumors. In future research, the effective dosage of 125I seeds implantation, the anchoring of seeds with safe distance, and the bone cement distribution in the vertebral body will be next research hotspot.
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3.
Novel Insights into the Pathogenesis of Spinal Sarcopenia and Related Therapeutic Approaches: A Narrative Review.
Kuo, YK, Lin, YC, Lee, CY, Chen, CY, Tani, J, Huang, TJ, Chang, H, Wu, MH
International journal of molecular sciences. 2020;(8)
Abstract
Spinal sarcopenia is a complex and multifactorial disorder associated with a loss of strength, increased frailty, and increased risks of fractures and falls. In addition, spinal sarcopenia has been associated with lumbar spine disorders and osteoporosis, which renders making decisions on treatment modalities difficult. Patients with spinal sarcopenia typically exhibit lower cumulative survival, a higher risk of in-hospital complications, prolonged hospital stays, higher postoperative costs, and higher rates of blood transfusion after thoracolumbar spine surgery. Several studies have focused on the relationships between spinal sarcopenia, appendicular muscle mass, and bone-related problems-such as osteoporotic fractures and low bone mineral density-and malnutrition and vitamin D deficiency. Although several techniques are available for measuring sarcopenia, each of them has its advantages and shortcomings. For treating spinal sarcopenia, nutrition, physical therapy, and medication have been proven to be effective; regenerative therapeutic options seem to be promising owing to their repair and regeneration potential. Therefore, in this narrative review, we summarize the characteristics, detection methodologies, and treatment options for spinal sarcopenia, as well as its role in spinal disorders.
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4.
Progresses in the imaging of calcium pyrophosphate crystal disease.
Andrés, M, Sivera, F, Pascual, E
Current opinion in rheumatology. 2020;(2):140-145
Abstract
PURPOSE OF REVIEW Calcium pyrophosphate crystal disease (CPPD) may be considered a neglected disorder, common in clinics and wards, but not receiving enough attention since the time it was recognized as a disease entity. This review aims to highlight the advances occurred in recent years in terms of imaging of CPPD, and their potential aid in diagnosing CPPD. RECENT FINDINGS The main advances in CPPD imaging have occurred with ultrasound and computed tomography. Ultrasound has been shown as more sensitive than conventional radiography in detecting chondrocalcinosis. OMERACT definitions of ultrasound signs of CPPD have been provided; validations process is still ongoing. Computed tomography has been used to assess CPPD at the spine. Some studies suggest that dual-energy scans could accurately detect chondrocalcinosis and discriminate from other calcified structures. SUMMARY Ultrasound and computed tomography may have a role in CPPD detection, though the specifics are still unclear. It remains necessary to have studies comparing them with synovial fluid analysis for crystals in a clinical scenario.
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5.
The Use of Tranexamic Acid to Reduce Surgical Blood Loss: A Review Basic Science, Subspecialty Studies, and The Evolution of Use in Spine Deformity Surgery.
Slattery, C, Kark, J, Wagner, T, Verma, K
Clinical spine surgery. 2019;(2):46-50
Abstract
Significant blood loss is often seen in orthopedic surgeries, especially complex spinal procedures that constitute long surgical times, large incisions, and rich blood supplies. Tranexamic acid (TXA), a synthetic analog of the amino acid lysine, has proven to be a cost-effective method in decreasing transfusion rates and avoiding complications associated with low blood volume. Recent data on TXA's use in spine surgery suggest that TXA remains both efficacious and safe, although the ideal dosing and timing of administration is still a point of disagreement. The purpose of this study is to review the literature for the use of TXA in spine surgery to better understand its safety profile and ideal dosage. This narrative review on TXA was conducted on prospective orthopedic studies that used TXA in spine deformity surgery. TXA in adult and pediatric spine surgery has decreased intraoperative and postoperative blood loss, decreasing the need for blood transfusions. The most common dose in the literature is a 10 mg/kg loading dose, followed by 1 mg/kg per hour. Although the proper dosing of TXA for spine surgery remains debatable, studies have proven that TXA is effective at reducing blood loss without increasing the risk of thrombotic events.
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6.
Dual-Energy CT in Evaluation of the Acute Abdomen.
Murray, N, Darras, KE, Walstra, FE, Mohammed, MF, McLaughlin, PD, Nicolaou, S
Radiographics : a review publication of the Radiological Society of North America, Inc. 2019;(1):264-286
Abstract
Evaluation of the nontraumatic acute abdomen with multidetector CT has long been accepted and validated as the reference standard in the acute setting. Dual-energy CT has emerged as a promising tool, with multiple clinical applications in abdominal imaging already demonstrated. With its ability to allow characterization of materials on the basis of their differential attenuation when imaged at two different energy levels, dual-energy CT can help identify the composition of internal body constituents. Therefore, it is possible to selectively identify iodine to assess the enhancement pattern of an organ, including the identification of hyperenhancement in cases of inflammatory processes, or ischemic changes secondary to vascular compromise. Quantification of iodine uptake with contrast material-enhanced dual-energy CT is also possible, and this quantification has been suggested to be useful in differentiating inflammatory from neoplastic conditions. Dual-energy CT can help determine the composition of gallstones and urolithiasis and can be used to accurately differentiate uric acid urinary calculi from non-uric acid urinary calculi. Moreover, dual-energy CT is capable of substantially reducing artifacts caused by metallic prostheses, to improve the imaging evaluation of abdominopelvic organs. The possibility of creating virtual nonenhanced images in the evaluation of acute aortic syndrome, gastrointestinal hemorrhage and ischemia, or pancreatic pathologic conditions substantially reduces the radiation dose delivered to the patient, by eliminating a true nonenhanced acquisition. Finally, by increasing the iodine conspicuity, contrast-enhanced dual-energy CT can render an area of free active extravasation or endoleak more visible, compared with conventional single-energy CT. This article reviews the basics of dual-energy CT and highlights its main clinical applications in evaluation of the nontraumatic acute abdomen. ©RSNA, 2019.
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7.
Perioperative Nutritional Optimization in Spine Surgery.
Qureshi, R, Rasool, M, Puvanesarajah, V, Hassanzadeh, H
Clinical spine surgery. 2018;(3):103-107
Abstract
Nutritional optimization in patients undergoing spine surgery is important as improved surgical outcomes and decreased rates of complications have been noted in optimized patients. With the increasingly high numbers of elderly patient and patients with metabolic comorbidities undergoing spine procedures, perioperative nutritional status should be enhanced for the best possible surgical outcomes. Methods of optimization include preoperative screening with Nutritional Risk Score or other scoring systems, looking for changes in body mass index, detecting sarcopenia, and screening for metabolic abnormalities. Assessment of blood glucose, electrolytes, cholesterol, vitamin levels, visceral proteins, and lean body mass must be done preoperatively and close monitoring should be continued postoperatively. Albumin helps to determine the health status of patients before surgery and prealbumin as a predictor of surgical outcomes is being investigated. Malnourished patients should be given balanced diets replenishing key nutrient deficits, glucose should be maintained with sliding scale insulin or continuous infusions and immunonutrition may be implemented. Postoperatively, patients should initiate a diet as soon as possible to decrease overall length of stay and complication rates, facilitating return to normal activities.
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8.
Perioperative Management of Blood Loss in Spine Surgery.
Qureshi, R, Puvanesarajah, V, Jain, A, Hassanzadeh, H
Clinical spine surgery. 2017;(9):383-388
Abstract
Spine procedures are associated with high rates of blood loss which can result in a greater need for transfusions. Repeated exposure to blood products is associated with risks and adverse reactions such as transfusion-related acute lung injury, fluid shifting, and infections. With the higher number of spine procedures and the increasing open surgery times associated with difficult procedures, excessive blood loss has become more prevalent. Perioperative methods have been established to combat the excessive blood loss and decrease the need for blood products. Preoperatively, anemia and coagulopathy screening is standard at least 4 weeks before elective procedures. Erythropoietin, iron loading or transfusions are used to decrease preoperative anemia, a predisposing factor for blood loss. Autologous predonation of blood has been shown to be ineffective and decreases preoperative hemoglobin levels. Intraoperatively, antifibrinolytics such as tranexamic acid and aminocaproic acid are used to decrease blood loss. In addition, fibrinogen concentrates, thromboelastometry, acute normovolemic hemodilution, controlled hypotension, and temperature regulation are some of the techniques used to decrease blood loss and the need for transfusions. Postoperatively, fibrin sealants, shed blood salvage, and erythropoietin or intravenous iron are used in management of blood loss, especially in instances when the patient refuses blood products.
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9.
Patient-Reported Outcome (PRO) questionnaires for people with pain in any spine region. A systematic review.
Leahy, E, Davidson, M, Benjamin, D, Wajswelner, H
Manual therapy. 2016;:22-30
Abstract
BACKGROUND/OBJECTIVE This systematic review investigates the measurement properties of Patient-Reported Outcome (PRO) questionnaires which evaluate disability associated with pain in any area of the spine. METHOD PRO questionnaires for people with pain in any spinal region were identified from existing systematic reviews and recent studies. Databases were searched for studies which evaluated the measurement properties of the included questionnaires to August 2015. Data synthesis used a levels of evidence approach which considered study methodological quality. RESULTS The Extended Aberdeen Back Pain Scale (EA), Functional Rating Index (FRI) and Spine Functional Index (SFI) were identified as eligible for this review. The FRI was evaluated in 15 studies, with positive results for internal consistency, structural validity, hypothesis testing and responsiveness, negative results for measurement error and conflicting results for reliability. The SFI was evaluated in 3 studies with positive results for internal consistency, reliability, content validity, and structural validity. Conflicting results were found for hypothesis testing. The EA was evaluated in 3 studies which found negative results for internal consistency and structural validity. CONCLUSIONS The FRI is provisionally recommended for the assessment of disability in people with multi-area spinal pain. This conclusion is based on studies of mainly fair methodological quality.
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10.
Enhanced recovery after surgery (ERAS) and its applicability for major spine surgery.
Wainwright, TW, Immins, T, Middleton, RG
Best practice & research. Clinical anaesthesiology. 2016;(1):91-102
Abstract
This article examines the relevance of applying the Enhanced Recovery after Surgery (ERAS) approach to patients undergoing major spinal surgery. The history of ERAS, details of the components of the approach and the underlying rationale are explained. Evidence on outcomes achieved by using the ERAS approach in other orthopaedic and complex surgical procedures is then outlined. Data on major spinal surgery rates and current practice are reviewed; the rationale for using ERAS in major spinal surgery is discussed, and potential challenges to its adoption are acknowledged. A thorough literature search is then undertaken to examine the use of ERAS pathways in major spinal surgery, and the results are presented. The article then reviews the evidence to support the application of individual ERAS components such as patient education, multimodal pain management, surgical approach, blood loss, nutrition and physiotherapy in major spinal surgery, and discusses the need for further robust research to be undertaken. The article concludes that given the rising costs of surgery and levels of patient dissatisfaction, an ERAS pathway that focuses on optimising clinical procedures by adopting evidence-based practice and improving logistics should enable major spinal surgery patients to recover more quickly with lower rates of morbidity and improved longer-term outcomes.