Radiculopathy with motor deficit: a cross-sectional study of the impact of the surgeon's experience on the indication and timing of surgical treatment.

PURPOSE: The optimal management of patients with compressive radiculopathy with motor deficit (CRMD) is controversial. Our goal was to provide evidence on the impact of the spine surgeons' experience on surgical planning and timing. METHODS: Spine surgeons were invited to participate in a 5-item online survey. A literature review was carried out. RESULTS: Of the 94 spine surgeons who responded to the survey, 70% would operate early on a patient with acute CRMD, but only 48% would do so if the radicular pain had resolved. Surgeons with more than 15 years of experience chose more conservative options. Twenty published studies were selected in the literature review. CONCLUSION: The optimal management of patients with compressive radiculopathy associated with a non-progressive motor loss remains unknown. The results of our survey show that surgeons with extensive surgical experience take a more conservative and cautious approach.

Risk factors and prognosis of vertebral compressive fracture in pyogenic vertebral osteomyelitis.

OBJECTIVES: To analyse the clinical, microbiological and radiological characteristics, and to identify risk factors of vertebral compressive fracture (VF) in spontaneous pyogenic vertebral osteomyelitis (VO). METHODS: A retrospective clinical study and blinded radiological review of adult patients with VO. RESULTS: Eighty-eight patients were included: 57 (65%) had a definitive diagnosis of VO (positive microbiology), and 31 (35%) had a probable diagnosis of VO. Of these, 27 (30.7%) presented with VF at diagnosis of VO, and 4 afterwards (total 31, 35.2%). Patients with VF were considered to be at higher risk of osteopenia--they were older (74 vs 66 years, p = 0.013), and included high percentage of women (33 vs 41%, NS)--; and presented more dorsal involvement (56 vs 21%; p < 0.007). Causal microorganisms were similar between groups (VF, no VF). The time to diagnosis of VO was longer in the presence of VF (65 vs 23 days, p = 0.001), and also in cases with no isolated organisms. All patients received antibiotics, and just one patient required spinal stabilisation (VF). After 357 median days of follow-up, all patients were cured. Clinical improvement (residual pain, functional recovery) tended to be slower in patients with VF (log-rank 0.19 and 0.15, respectively), but clinical symptoms were similar in most patients at the last follow-up (VF, no VF). CONCLUSIONS: VF is a common complication in pyogenic VO that causes slower clinical recovery. Risk factors of VF are: osteopenia, a delayed diagnosis and dorsal involvement. Conservative management is probably appropriate for most cases, but spinal stabilisation should be considered in some specific cases.

Spinal cord compression of neoplastic origin: surgical experience using a common clinical language.

PURPOSE: To assess the value of a common clinical language in a multidisciplinary tumour board for spinal metastasis, using both the Rades score and the Spinal Instability Neoplastic Score (SINS) for multidisciplinary decision-making. METHODS: Retrospective study of 60 consecutive patients treated surgically for MSCC. The indication for surgery was done in a multidisciplinary board, basically according to SINS and RADES scores. Three prognostic groups were defined according to the Rades score: poor (Rades 1: 20-30 points), intermediate (Rades 2: 31-35), and good (Rades 3: 36-45). RESULTS: The 2-year overall survival (OS) rate was 50%, with median survival of 19 months. By Rades prognostic group (1, 2, 3), median OS was 6 months, 15 months, and not reached, respectively. OS rates at 6 months (Rades 1, 2, 3) were 51, 69, and 74.1%, respectively. Within the Rades 1 group, 6-month survival in patients with new-onset cancer was 68 vs. 40% in those with a known primary. The overall complication rate ≥ grade 3 was 23.3% (n = 14). In patients who underwent urgent surgery (< 48 h), the complication rate was 45.5% (5/11) versus 18.3% (9/49) in the planned surgeries. CONCLUSIONS: Our findings supports the utility of using a common language in multidisciplinary tumour board for spinal metastasis. The 2-year OS rate in this series was 50%, which is the highest OS reported to date in this population. In the poor prognosis subgroup (Rades 1), OS at 6 months was higher in patients with new-onset cancer versus those with a known primary (68 vs. 40%). These findings suggest that surgery should be the first treatment option in patients with MSCC as first symptom of cancer although a predicted poor prognosis.