Complications of spine surgery for metastasis.

The spinal column represents the third most common site for metastases after the lungs and the liver, and the most common site for metastatic bone disease. With life-extending advances in the systemic treatment of cancer patients, the surgical procedures performed for spinal metastases will increase, and their related complications will increase unavoidably. Furthermore, considering the high complication rates reported in the spinal literature regarding spine surgery overall, it becomes clear that a better understanding of complications that the cancer patients with spinal metastases may experience is necessary. This article aims to summarize and critically examine the current evidence for complications after spine surgery for metastatic spinal disease, in both the perioperative and postoperative period. This paper would be useful for the treating physicians of these patients in their clinical practice.

Treatment of kyphotic deformities in adults: our experience.

PURPOSE: Many degenerative phenomena frequently result into kyphotic lumbar and thoracic deformities or cause their progression combined with deformities on the frontal plane of the spine. In these patients, the progression of the sagittal imbalance may lead to a series of disabling functional and painful consequences. The analysis of the spinopelvic parameters biases the choice of the correction surgical strategy aimed at restoring a good tri-dimensional and sagittal balance of the spine. MATERIALS AND METHODS: Sample included 62 patients treated in our Operation Unit that were enrolled for evaluation; they were affected with prevailing sagittal deformities. RESULTS: Clinical results were evaluated through the administration of SF-36, Oswestry Disability Index (ODI), Roland Morris (RM), and visual analogical scale (VAS). CONCLUSIONS: In our experience, patients with sagittal imbalance and short fusion areas show a higher risk of correction loss; the arthrodesis area must include the thoracolumbar junction, and it is often necessary to include the whole thoracic spine in the arthrodesis area. This is to avoid any loss of correction, implants mobilization, and proximal hyperkyphosis.

Lumbar Stabilization with DSS-HPS® System: Radiological Outcomes and Correlation with Adjacent Segment Degeneration.

Arthrodesis has always been considered the main treatment of degenerative lumbar disease. Adjacent segment degeneration is one of the major topics related to fusion surgery. Non-fusion surgery may prevent this because of the protective effect of persisting segmental motion. The aims of the study were (1) to describe the radiological outcomes in the adjacent vertebral segment after lumbar stabilization with DSS-HPS® system and (2) to verify the hypothesis that this system prevents the degeneration of the adjacent segment. This is a retrospective monocentric analysis of twenty-seven patients affected by degenerative lumbar disease underwent spinal hybrid stabilization with the DSS-HPS® system between January 2016 and January 2019. All patients completed 1-year radiological follow-up. Preoperative X-rays and magnetic resonance images, as well as postoperative radiographs at 1, 6 and 12 months, were evaluated by one single observer. Pre- and post-operative anterior and posterior disc height at the dynamic (DL) and adjacent level (AL) were measured; segmental angle (SA) of the dynamized level were measured. There was a statistically significant decrease of both anterior (p = 0.0003 for the DL, p = 0.036 for the AL) and posterior disc height (p = 0.00000 for the DL, p = 0.00032 for the AL); there were a statistically significant variations of the segmental angle (p = 0.00000). Eleven cases (40.7%) of radiological progression of disc degeneration were found. The DSS-HPS® system does not seem to reduce progression of lumbar disc degeneration in a radiologic evaluation, both in the dynamized and adjacent level.

Comparison of single-level L4-L5 versus L5-S1 lumbar disc replacement: results and prognostic factors.

The aim of our prospective non-randomized clinical study was to analyze operative data, short-term results, safety, efficacy, complications, and prognostic factors for single-level total lumbar disc replacement (TLDR), and to compare results between different levels (L4-L5 vs. L5-S1). Thirty-six patients with single-level L4-L5 or L5-S1 TLDR, with 1-year minimum follow-up (FU), had complete clinical [SF36, visual analog scale (VAS), Oswestry Disability Index (ODI)] and radiological data, and were included in our study. Mean FU was 38.67 +/- 17.34 months. Replaced level was L4-L5 in 12 (33.3%) cases, and L5-S1 in 24 cases (66.7%). Mean age at diagnosis was 41.17 +/- 7.14 years. 24 (66.7%) were females and 12 (33.3%) were males. Statistical analyses were assessed using t tests or Mann-Whitney test for continuous variables and Chi-square test or Fisher's exact test analyses for categorical variables. Univariate linear regression and binary logistic regression analyses were utilized to evaluate the relationship between surgical outcomes and covariates (gender, age, etiology, treated level, pre-operative SF36, ODI, and VAS). Mean operative time was 147.03 +/- 30.03 min. Mean hospital stay was 9.69 +/- 5.39 days, and mean return to ambulation was 4.31 +/- 1.17 days. At 1-year FU, patients revealed a statistical significant improvement in VAS pain (P = 0.000), ODI lumbar function (P = 0.000), and SF36 general health status (P = 0.000). Single-level TLDR is a good alternative to fusion for chronic discogenic low back pain refractory to conservative measures. Our study confirmed satisfactory clinical results for monosegmental L4-L5 and L5-S1 disc prosthesis, with no difference between the two different levels for SF36 (P = 0.217), ODI (P = 0.527), and VAS (P = 0.269). However, replacement of the L4-L5 disc is affected by an increased risk of complication (P = 0.000). There were no prognostic factors for intraoperative blood loss or return to ambulation. Age (P = 0.034) was the only prognostic factor for operative time. Hospital stay was affected by level (P = 0.036) and pre-op VAS (P = 0.006), while complications were affected by the level (P = 0.000) and pre-op ODI (P = 0.049). Complete pre-operative assessment (in particular VAS and ODI questionnaires) is important because more debilitating patients will have more hospital stay and higher complications or complaints. Patients had to be informed that complications, possibly severe, are particularly frequent (80.6%).

Transoral kyphoplasty for tumors in C2.

BACKGROUND CONTEXT: The management of tumors of the C2 body remains controversial. In cancer patients, major procedures may be contraindicated, and nonoperative treatment could fail. PURPOSE: To describe a new surgical technique, the transoral kyphoplasty, that we performed in 3 cases of tumors in C2 after nonoperative treatment failure. STUDY DESIGN: Case series of three patients. PATIENT SAMPLE: Three patients from the senior author's practice. OUTCOME MEASURES: To reduce pain and avoid both C2 collapse and prolonged immobilization, transoral kyphoplasties were performed. METHODS: From February 2004 to January 2006, three cases of tumors in C2 did not show healing after nonoperative treatments. RESULTS: No complications and/or complaints were related to the procedure. There were no C2-related symptoms or neurological problems. The first patient died 8 months after surgery. The second and the third are alive with follow-ups of 2 years and 6 months, respectively. In all cases, cervical motion was restored, and patients are pain free, with no findings regarding pathologic mobility/instability on X-ray and computed tomography scan. CONCLUSIONS: Transoral kyphoplasty proved to be safe, quick, and effective in reducing pain and avoiding vertebral collapse in patients with tumors in C2 not responding to nonoperative treatment.