Single staged en-bloc sacrectomy in giant cell tumor of sacrum using pre-operative embolization: A case report.

BACKGROUND: Giant cell tumor (GCT) is a benign tumor with progressive and destructive characteristics involving metaphysis, with extension to the epiphyseal tissue, en-bloc resection surgery is the main choice for surgical treatment. IMPORTANCE: Our case report will discuss en bloc resection with pre-operative embolization for treating GCT in the sacrum to reduce the incidence of intraoperative bleeding. CASE PRESENTATION: A 33-year-old woman complained of low back pain radiating to the left leg that had been present for one year. Lumbosacral X-ray examination revealed a destructive osteolytic lesion involving the sacrum I-III and left iliac bones surrounded by soft tissue mass. The surgery on the patient 24 h later included installing posterior pedicle screw instrumentation on the 3rd and 4th lumbar, iliac screw, and using bone cement. After that, we performed a curettage on the mass and filled it with a bone graft. DISCUSSION: Non-surgical GCT management is effective but has a high local recurrence rate when used alongside curettage. Intralesional resection and en bloc resection are the most common surgical treatments. GCT with pathological fractures requires more invasive procedures, such as en-bloc resection, but excision can be performed to minimize surgical complications. Arterial embolization is a curative therapy for GCT sacral tumors. CONCLUSION: En-bloc resection with pre-operative arterial embolization for treating GCT can reduce the incidence of intraoperative bleeding.

Study epidemiology of risk fracture in osteoporosis based on frax score, and osta score, with risk of fall using Ontario score in elderly Indonesia.

Background: Osteoporosis is characterized by a low bone mass of bone tissue. If osteoporosis is not treated properly, it will increase the high risk of fracture. The common causes of fracture on osteoporosis condition due to falls. This study aims to find the correlation between the risk of osteoporosis with fall risk (ONTARIO) based on osteoporosis fracture risk (FRAX). Methods: This study is an analytic study with a cross-sectional method. We collected the sample using random cluster sampling in the six primary health care in Malang on different times service since August-September 2021. Total patient 139, however only 132 patients were included in this study. After collecting data is complete, we analyze using Chi-square tests. Results: The mean age of participants was 63.9 ± 7.14. with the age group was dominated by the range of 60-64. It was found that the result of the FRAX SCORE had a low-risk category for major fracture osteoporosis and risk hip fracture. In contrast, from the OSTA score in this study, more than 68 participants (50.8%) were found medium and high-risk scores. Then, in ONTARIO score of the risk fall assessment, and high score in 57 participants (43.2%). If compared between OSTA and ONTARIO, there was a significant relationship between OSTA score and ONTARIO score (p < 0.000) with high-risk OSTA have a significant relationship with a high risk of falling and vice versa. Conclusion: In this study, there was a relationship between the risk of high osteoporosis and the risk of falling.

Surgical Site Infection Management following Spinal Instrumentation Surgery: Implant Removal vs. Implant Retention: an Updated Systematical Review.

Background: The number of lumbar spine surgery increased in recent years. Spinal instrumentation surgery was an integral component in the treatment of spinal pathologies, which can cause surgical site infection (SSI). Surgical site infections (SSIs) are the leading cause of mortality and morbidity after spinal instrumentation surgery. The management of SSI was implant retention and removal is still unclear. Objective: The objective of this literature is to systematically review the implant removal and retention method for SSI management after spinal instrumentation surgery. Methods: We searched in PubMed and ScienceDirect for cohort and randomized control trial studies in English, published between 2002 and 2022, which had data on patients with spinal instrumentation surgery. The underlying disease, comorbidities, common bacteria, type of infection, the onset of infection, implant removal, and retention percentage and recommendation were analyzed. Bias analysis using Newcastle-Ottawa Quality Assessment. Results: We included 15 studies with a total sample were 2.584 with an average of age 15 to 66 years old. The most common organism detected were S. Aureus, MRSA, and S. Epidermis. The most common surgical procedure indications were degenerative followed by scoliosis. Implant removal and retention rate were 0-100% and 0-90,32% respectively. Implant removal is more frequently used in patients after spinal instrumentation surgery than the implant retention method. Conclusion: Implant retention can be performed in case of SSI is < 3 months after surgery. Implant removal is recommended if the incidence of SSI is > 3 months. Empirical antibiotics therapy is necessary to reduce the possibility of implant removal after debridement. Further studies on the effect of implant removal and retention in patients on infection recurrence, pain, and quality of life of patients are needed.

Functional outcome and fusion rates of translaminar screw fixation of the lumbar and lumbosacral spine: A case series.

INTRODUCTION: Pedicle screw fixation has been the gold standard because this technique allows solid arthrodesis and provides a degree of stiffness that immediately diminishes mechanical back pain. Although the translaminar screw technique is considered inferior to the pedicle screw technique due to the thought that it is minimally invasive, studies proved that both fixation systems had significantly greater stiffness and reduced range of motion compared with the normal vertebrae. The purpose of this study is to determine the fusion rate, the clinical outcome of translaminar screw fixation of the lumbar and lumbosacral for the long term. CASE PRESENTATION: We evaluate six patients with a degenerative lumbar disorder and performed posterior lumbar fixation and fusion with the translaminar screw. The translaminar screw was performed monosegmentally (3 patients), across two segments (1 patient), and across three segments (2 patients). We then evaluate Oswestry Disability Index (ODI) score one week, three months, and one year postoperatively. DISCUSSION: When lumbosacral spine fusion procedures are performed without supplemental internal fixation, a 10% pseudoarthrosis rate can be expected for single-level fusions, and the percentage can reach 30% if more than two levels are fused. Compared to the pedicle screw technique, the translaminar technique provides a limited profile and less bony invasion that will minimize the risk of failure. CONCLUSION: Translaminar screw offers immediate postoperative stability, seen in postoperatively, patients experienced better quality of life than preoperatively. It also represents a useful and inexpensive technique for short segment fusion of the non-traumatic lumbar and lumbosacral spine.

Multiple osteochondromas of the cervical spine, a potential cause of radiculopathy in the elderly: A case report and review of literature.

INTRODUCTION: Osteochondroma is the most prevalent type of bone tumour, often arising in the long bones. Most are found in the third decade of life, and rarely in the axial skeleton of elderly patients. This case report aims to highlight the possibility of this differential diagnosis in an elderly patient with symptoms of radiculopathy, aside from degenerative cause. PRESENTATION OF CASE: A 76-years-old woman presented to the authors' hospital with complaints of pain and numbness of the left suboccipital and preauricular region. There was hypoesthesia of left C2 and C3 dermatome without any signs of myelopathy. CT-scan and MRI showed an expansile bone lesion from the posterior arch of C1 and lamina of C2. The patient underwent laminectomy of C1 and hemilaminectomy of C2. Postoperative histopathologic examination showed the features of osteochondroma. Radiologic follow-up after nine months showed no sign of recurrence. After eighteen months, the patient was ambulatory with complaints of fingers numbness and moderate neck pain. DISCUSSION: Osteochondroma usually arises in long bone metaphysis. This lesion normally ceases to grow with growth plate closure, but other findings suggest it may continue to grow beyond skeletal maturity. About 29.5% of all osteochondroma of the spine would cause radiculopathy, and 27% would cause myelopathy. The cervical spine osteochondroma is usually treated by en bloc resection through posterior approach. CONCLUSION: Osteochondroma of the cervical spine in the elderly is rare. However, this diagnosis could be considered as a possible cause of radiculopathy in this age group aside from other degenerative causes.