Functional and Surgical Outcomes of Corpectomy in Patients with Unstable Spinal Fractures.

BACKGROUND: Unstable fractures of the spine should be managed surgically. An anterior approach allows for precise decompression of the vertebral canal and reconstruction of the fractured vertebral body. The aim of the study was to evaluate the functional and surgical outcomes of anterior surgical approaches for vertebral body removal and prosthetic reconstruction. MATERIAL AND METHODS: The objectives of this paper were accomplished by reviewing the course of treatment and treatment outcomes of patients operated on at the Orthopaedic Oncology Department in Brzozw and the Department of Orthopaedics and Traumatology in District Hospital in Stalowa Wola in the years 2020-2021. In total, the treatment of 54 patients was analyzed. The study only included patients with traumatic and pathological fractures who underwent a single-level corpectomy. A total of 18 patients with fractures of the cervical spine, 15 of the thoracic spine and 21 of lumbar spine were treated. Before and after treatment, patients' neurological status was assessed according to the Frankel classification, performance was assessed with the Karnofsky score and pain intensity was analyzed with a VAS. The vertebral wedge angle (alpha), the ratio of the anterior height of the fractured vertebral body to the anterior height of the upper adjacent vertebral body (a/c), the ratio of the anterior height to the posterior height of the fractured vertebra (a/b) and the distance between the vertebral endplates adjacent to the fractured vertebra, measured between their anterior edges (A-B) were assessed. The most common general medical and surgical complications were also evaluated. RESULTS: After the surgery, significant pain relief measured using a VAS was noted (the median was 7 preoperatively and 4 postoperatively) and an improvement in performance according to the Karnofsky score was observed (the median was 50 preoperatively and 70 postoperatively). Out of the 14 patients with neurologic deficits 11 improved, while 5 regained the ability to walk. In four patients, the implant migrated into an adjacent vertebra and three patients suffered a fracture of the upper adjacent vertebra. The correction of the spine deteriorated in all 7 patients. There was no postoperative neurological deterioration of patients and no infectious complications. During the surgery, three patients suffered dura mater injury, which was identified intraoperatively and repaired. CONCLUSIONS: 1. Corpectomy followed by vertebral body replacement is an effective and safe method that enables the restoration of the shape of the vertebra, restoration of the physciological spinal curvature and direct neural decompression. 2. The treatment outcomes are good. Pain significantly decreases and performance improves in most patients. 3. Treatment complications are rare. The most often observed complication was migration of the implant into an adjacent vertebral endplate, fractures above the place of fixation and dura mater injury.

Analysis of Difficulties and Complications Following Implantation of Modular Prostheses in Patients with Lower Limb Bone Tumours.

BACKGROUND: The implantation of a modular prosthesis is the most popular method of reconstruction of bone defects in oncological patients. Along with clear-cut benefits associated with this procedure, there is also an increased risk of complications. Common complications include deep infections, aseptic loosening and mechanical implant damage. This study assessed the risk of complications following the implantation of a resection prosthesis in patients with lower limb bone tumours and to evaluate difficulties encountered during the treatment. MATERIAL AND METHODS: A total of 149 patients with lower limb tumours treated at the Department of Oncological Ortho-paedics in Brzozów had resection prostheses implanted in the years 2016 and 2017. We analysed this series and available literature reports with regard to complications of the procedure and those encountered during the treatment. RESULTS: The mean duration of the surgical procedure was 117±45 minutes. Intraoperative complications occurred in 18 cases. Gluteal muscle failure was seen in 34 (43%) of the 74 patients with proximal femoral tumours, and impaired knee extension was noted in 4 (67%) of the 6 patients following resection of the proximal tibia. There were two cases of dislocation following megaprosthetic reconstruction of the hip joint. Impaired wound healing was noted in 7 (5%) patients. Post-operative trophic lesions of the skin were seen in 2 (2%), and peripheral nerve damage in 2 (2%) patients (fibular nerve). Thromboembolic complications were noted in 3 (3%) patients. No aseptic complications, mechanical implant damage or deaths were recorded. CONCLUSIONS: 1. The most frequently encountered complication following the implantation of a modular prosthesis was muscle failure, which was associated with the extent of the procedure. 2. Aseptic loosening and mechanical implant damage were rare and occurred in the early postoperative period.

Assessment of Physical Performance and Early Treatment Outcomes after Implantation of Modular Prostheses of Femoral and Tibial Shaft.

BACKGROUND: Tumours of bone diaphyses often require resection followed by bone reconstruction. The use of modular pro-sthe-ses permits early limb loading and rapid improvement in physical performance. The aim of this study was to evaluate the func-tioning of patients and early treatment outcomes after the implantation of modular prostheses. The analysis covered the correlation between the extent of resection, physical performance and the number of perioperative complications. MATERIAL AND METHODS: 10 patients (5 women and 5 men) with diaphyseal tumours who had modular prostheses implanted were treated at the Orthopaedic Oncology Department in Brzozów between 2014 and 2018. The mean age of the patients was 51.1 years (range: 26-63 years). Functional outcomes were assessed using the MSTS and the Karnofsky scoring system. A VAS was used to evaluate pain intensity. the extent of resection was also analysed, considering bone length and tumour weight. RESULTS: The mean tumour weight was 374g (150-700g). The length of the implants varied from 10 to 25 cm. The mean dura-tion of hospitalisation was 16 days (14-19 days). At 3 months following the surgery, the intensity of pain had decreased from a mean of 6.8 points to 4.2 points (a decrease of 26% from the pre-operative baseline). The MSTS showed improvement of functional performance from a mean of 10.8 points (36%) to 22.9 points (76%). The Karnofsky scores demonstrated an increase in physical performance from 47 to 67 points (20 points on average). Superficial infection of the wound developed in 1 patient. CONCLUSIONS: 1. The treatment of diaphyseal tumours with modular prostheses produces good functional outcomes. 2. The extent of the resection and the size of the implant have an effect on the post-operative physical performance of the patients. 3. Pre-operative evaluation of the weight of the tumour may be helpful in predicting the patient's post-operative functional status. 4. Phy-sical perfor-mance is better after the resection of femoral vs tibial tumours.

Surgical Treatment Outcomes in Metastatic Tumours Located at the Craniocervical Junction.

BACKGROUND: Cancer metastases to the upper section of the cervical spine are found in a low percentage of patients. Their conservative treatment consists in radio- and chemotherapy as well as immobilisation in an orthopaedic collar. Surgery is the treatment of choice in patients with lesions causing spinal instability or compressing neural structures. The aim of this study was to assess the outcomes of surgical treatment conducted in patients with metastases located in the upper section of the cervical spine. MATERIAL AND METHODS: The study analysed the medical records of 20 patients who underwent surgical treatment at the Department of Oncological Orthopaedics in Brzozów in 2015-2016. The majority of the patients were female (75%). The mean age of the male patients was 58 years and that of the female patients was 68 years. The most common complaints were pain (90%) and neurological deficits (50%; mainly Frankel Grade C). The most common primary tumour was breast cancer (35%). 58% of the patients had slow-growing tumours according to the Tomita system. Surgical procedures lasted a mean of 117 minutes and involved fixation of a mean of 7.5 levels. The treatment reduced the patients' VAS score for pain by 3.89 points, improved function (Karnofsky scale) by 18 points and produced neurological improvement in 66% of the patients. The overall 2.5-year survival rate was 35%. The mean hospital stay lasted 14.5 days. One patient died on the 8th post-operative day due to cardiovascular complications. There was one case of delayed wound healing due to a haema-toma. No mechanical damage to the implants, infections, or cerebrospinal fluid leaks were found. CONCLUSIONS: 1. Metastases located in the upper cervical spine are rare and cause significant technical difficulties. 2. Fixation with lateral mass screws and plates fixed with screws to the occipital bone is a safe and effective method. 3. Surgical treatment allows for restoring spinal stability, reducing pain, and improving the patients' quality of life.

Assessment of Post-operative Physical Performance in Patients after Resection Arthroplasty of the Proximal Femur.

BACKGROUND: Resection arthroplasty is increasingly used in the treatment of proximal femur metastates. How-ever, a coherent, unified rehabilitation protocol of such patients is yet to be developed. The aim of this study was to present the early treatment outcomes of modular endoprosthetic replacement. MATERIAL AND METHODS: A total of 42 resections of proximal femur tumour, followed by modular endoprosthetic replacement, were performed at the Orthopaedic Oncology Department in Brzozów between 2012 and 2015. The mean age of the patients was 63 ± 11 years, with females accounting for 54% of the group. All the patients were rehabilitated in accordance with the protocol developed by Shehadeh et al. Pain intensity was measured using the VAS scale, while the HHS, MSTS and an original scale designed by the authors were used to assess overall physical performance and gait efficiency. RESULTS: Thirty GMRS and 12 MUTARS endoprostheses were implanted. The implants were fixed with bone cement in 36 (85%) cases and cementless in 8 (15%). Mean pain severity assessed at 6 weeks after the surgery with the VAS scale was 3.8. Mean gait efficiency and physical performance assessed with the HHS and MSTS scores were 75 and 20 points, respectively. Two patients experienced complications. A total of 39 patients were evaluated post-operatively at 6 weeks after the surgery, of whom 37 (95%) patients could walk efficiently using crutches or with physical assistance of others. CONCLUSION: Modular arthroplasty performed in patients after metastatic tumour resection allows for early rehabi-li-ta-tion and ambulation which significantly improves their quality of life.

Neurological Complications after Surgical Treatment of Metastatic Tumours of the Spine.

[b]Background.[/b] Postoperative impairment of neurological function is a rare but serious complication of surgical treatment of metastatic tumours located in the spine. This paper presents an analysis of the causes, symptoms and methods of treatment of spinal cord function impairment in the postoperative period.[b]Materials and methods. [/b]The study retrospectively analysed the treatment of 525 patients diagnosed with compression of neural structures and neurological deficits in the course of metastatic disease who were operated on in 2012-2015. The baseline degree of spinal cord damage was assessed with the Frankel scale. Surgical treatment methods were selected based on the results obtained with the Tomita system as well as the Tokuhashi and Bauer scores.[b]Results. [/b]A total of 8 (1.5%) cases of impaired neurological function were identified in the postoperative period. The spinal cord damage had no discernible cause in 6 cases. Symptoms of neurological function impairment occurred with a delay in 6 patients. In 2 cases, the symptoms were observed immediately after the end of the surgery. One patient demonstrated improved neurological status after revision surgery.[b]Conclusions.[/b] 1. Surgical decompression of the spinal cord in the course of neoplastic disease is rarely complicated by neurological function impairment. 2. Neurological complications occurred mainly after treatment of tumours located in the thoracic section of the spine. 3. Prognostic scores used for qualifying patients for appropriate surgical treatment focus mainly on patient survival and do not account for potential complications.

Inveterate (42-year-old) Hip Dislocation Treated with Arthroplasty. A Case Study.

Dislocation of the hip usually results from a high-energy injury sustained during a road accident. Inveterate dislocations persisting for many months or years are extremely rare. Selection of an appropriate treatment method is not easy and is always associated with the risk of serious complications. The present authors hope that a description of the course of diagnostic work-up and treatment of a patient in whom a hip dislocation persisted for 42 years will prove interesting and helpful for orthopaedists who may encounter such a case in their practice. The patient sustained a dislocation of the right hip in 1974. He did not agree to undergo reduction immediately after the injury. Initially, he experienced extremely severe pain and difficulty walking, but gradually learned to walk without crutches and even took up a job. The limb was considerably shortened with only minimal movement in the hip joint. The pelvic geometry was altered and spinal scoliosis developed. In the last several years, the patient experienced a significant increase in pain and a decrease in function that prevented him from walking unassisted. Following a thorough physical examination, and based on computed tomography images, the patient was qualified for hip arthroplasty. An analysis of the available literature prompted the present authors to use a cemented implant and not to use bone grafts. Early treatment outcomes are good.