European spine journal : official publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society
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To make a literature review on spinal stenosis recurrence after a first surgery and edit rules to avoid this complication. ⋯ After this literature review and analysis of post-operative stenosis, it seems important to provide some advice to avoid revision surgeries more or less induced by the surgery. It looks interesting when performing simple decompression without fusion in the lumbar spine to analyse the risk of instability induced by the decompression and facet resection but also by a global balance analysis. Regarding pre-operative stenosis in a previously operated area, different causes may be evocated, like screw or cage malpositionning but also insufficient decompression which is a common cause. Intraoperatively, the use of neuromonitoring and intraoperative CT scan with navigation are useful tool in complex cases to avoid persisting stenosis. Pre-op analysis and planning are key parameters to decrease post-op problems. These slides can be retrieved under Electronic Supplementary Material.
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Review Meta Analysis
Clinical effectiveness of Enneking appropriate versus Enneking inappropriate procedure in patients with primary osteosarcoma of the spine: a systematic review with meta-analysis.
Primary osteosarcoma of the spine is a rare osseous tumour. En bloc resection, in contrast to intralesional resection, is the only procedure able to provide Enneking appropriate (EA) margins, which has improved local control and survival of patients with primary osteosarcoma of the spine. The objective of this study is to compare the risk of local recurrence, metastases development and survival in patients with primary osteosarcoma of the spine submitted to Enneking appropriate (EA) and Enneking inappropriate (EI) procedures. ⋯ EA procedure increases the ratio of remission and survival after 24 months of follow-up. Multidisciplinary oncologic groups should weigh the morbidity of an en bloc resection, knowing that in the first year the probability of survival is the same for EA and EI procedures. These slides can be retrieved under Electronic Supplementary Material.
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Review Meta Analysis
Clinical effectiveness of Enneking appropriate versus Enneking inappropriate procedure in patients with primary osteosarcoma of the spine: a systematic review with meta-analysis.
Primary osteosarcoma of the spine is a rare osseous tumour. En bloc resection, in contrast to intralesional resection, is the only procedure able to provide Enneking appropriate (EA) margins, which has improved local control and survival of patients with primary osteosarcoma of the spine. The objective of this study is to compare the risk of local recurrence, metastases development and survival in patients with primary osteosarcoma of the spine submitted to Enneking appropriate (EA) and Enneking inappropriate (EI) procedures. ⋯ EA procedure increases the ratio of remission and survival after 24 months of follow-up. Multidisciplinary oncologic groups should weigh the morbidity of an en bloc resection, knowing that in the first year the probability of survival is the same for EA and EI procedures. These slides can be retrieved under Electronic Supplementary Material.
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As adult spinal deformity surgery is performed more and more, the spine surgeon is faced with the challenge to treat pseudoarthrosis. The presentation may vary, from asymptomatic patients, who should be observed in most of the cases, to patients with acute episode of broken rods, and or chronic pain with often trunk imbalance. In some instances, patients will present with neurologic symptoms. ⋯ Despite the extent of these surgeries and the potential for immediate postoperative complications, the outcome is in most cases satisfactory if these goals are achieved. In this review, the authors explore different scenarios for pseudoarthrosis in the adult spine deformity patient and the preferred treatment method to obtain the best outcome for every individual patient. These slides can be retrieved under Electronic Supplementary Material.
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Dynamic stabilization of the spine has been performed since the 1990s with the double purpose of restoring spinal segmental stability and allowing residual movement at the operated level. When we take into account the different motion-preserving devices and the spinal areas where they are applied, we can identify three categories of spinal implants: anterior cervical, anterior lumbar, and posterior lumbar. However, as in all prosthetic procedures performed in orthopedic surgery, the life span of a joint replacement device is a central topic of discussion, and this is true also for spinal dynamic devices, being revision surgery a complex procedure in specific cases. ⋯ Surgical revision of spinal dynamic implants could be a demanding surgery especially in anterior approaches. Anterior cervical revision remains globally safe, but careful preoperative evaluation of vessels and ureter are suggested to avoid intraoperative complications in the lumbar spine. In posterior revision, a proper sagittal alignment of the spine should be restored. These slides can be retrieved under Electronic Supplementary Material.