Comparison of Surgical Outcomes between Cortical Bone Trajectory and Conventional Pedicle Screw Trajectory for Lumbar Degenerative Spondylolisthesis (systematic review of literature)

Background Pedicle screw fixation the gold standard for lumbar spine stabilization. Pedicle screw has fixation offers multiple advantages, allowing superior correction of spinal deformities, and reduced rates of loss of non-union. Cortical Bone Trajectory (CBT) is a new technique in which screws follow a caudal-to-cephalad path in the sagittal plane and a medial-to-lateral directed path in the transverse plane. CBT is reducing operative and post-operative complications and has high fixation strength. Purpose To Compare the clinical outcomes between CBT and traditional trajectory (TT) in surgical management of degenerative spondylolisthesis. Materials and Methods A comprehensive electronic search in Pubmed, MEDLINE and Chocrane library databases, Google scholar and Research gate for articles that published between 2009 to 2020 using these keywords: Cortical bone trajectory, Cortical bone trajectory-pedicle screw, Pedicle screw. Results The majority of literature suggests that the CBT technique results in similar or decreased postoperative back and leg pain compared to TT. Regarding the disability ODI and the operative time showed no significant differences between the CBT and TT. Radiographic outcomes between both studies show no statistical difference in fusion rates and vertebral slippage. Intraoperative blood loss was significantly less with CBT compared to TT. Conclusion there is no widely accepted consensus regarding comparison of clinical outcomes and complications between the CBT and TT procedures. Generally, indications for CBT and TT are similar between most studies, especially for common pathologies resulting in spondylolisthesis.

Spine stabilization in patients with the thoracic and lumbar vertebrae fractures in reduced bone mineral density

Objective To compare the clinical effectiveness of various technical and tactical options for surgical treatment of patients with thoracic and lumbar vertebrae fractures with reduced bone mineral density.Material and Methods The study included 238 patients with the thoracic and lumbar vertebrae fractures with reduced bone mineral density (BMD). The patients were aged between 48 and 85 with T-score –1.5 to –3.5. The study did not include the patients with recurrent or multiple vertebral fractures, with absence of the clear date and fact of fracture in the case history, with neurological complications or polytrauma. The patients had fractures А1.2, А1.3, В1.2, В2.3 according to the classification of Magerl (1992). All patients underwent bisegmental transpedicular fixation (TPF). Group 1 included 68 patients who underwent non-cement augmented transpedicular screw fixation. Group 2 included 170 patients who underwent cement augmented transpedicular fixation. Both groups were divided into 2 subgroups. Subgroups 1.1 and 2.1 included patients operated in two stages. The first stage was TPF and the second stage was anterior corporodesis. Subgroups 1.2 и 2.2 included patients who underwent only TPF. Outcomes and complications were studied. The observation period lasted for not less than 2 years. Correlation analysis was performed between the technique of performing operations and surgical tactics in four subgroups and treatment outcomes.Conclusion 1. In the treatment of patients with fractures in the thoracic or lumbar spine with reduced BMD, isolated TPF with cemented screw implantation is clinically equivalent to two-stage surgical treatment - TPF with cementless or cemented implantation and anterior corprodesis of injured FPS. 2. In cementless TPF in patients with decreased BMD, anterior corprodesis of the injured VMS is necessary because its failure leads to the loss of anatomical relationship correction achieved during surgery, increase in local kyphosis, and functional maladaptation of patients.

Current Overview of Treatment for Metastatic Bone Disease

The number of patients with bone metastasis increases as medical management and surgery improve the overall survival of patients with cancer. Bone metastasis can cause skeletal complications, including bone pain, pathological fractures, spinal cord or nerve root compression, and hypercalcemia. Before initiation of treatment for bone metastasis, it is important to exclude primary bone malignancy, which would require a completely different therapeutic approach. It is essential to select surgical methods considering the patient’s prognosis, quality of life, postoperative function, and risk of postoperative complications. Therefore, bone metastasis treatment requires a multidisciplinary team approach, including radiologists, oncologists, and orthopedic surgeons. Recently, many novel palliative treatment options have emerged for bone metastases, such as stereotactic body radiation therapy, radiopharmaceuticals, vertebroplasty, minimally invasive spine stabilization with percutaneous pedicle screws, acetabuloplasty, embolization, thermal ablation techniques, electrochemotherapy, and high-intensity focused ultrasound. These techniques are beneficial for patients who may not benefit from surgery or radiotherapy.

3D-Printed Titanium Custom-Made Prostheses in Reconstruction after Pelvic Tumor Resection: Indications and Results in a Series of 14 Patients at 42 Months of Average Follow-Up

Wide resection is currently considered the mainstay treatment for primary bone tumors. When the tumor is located in anatomically complex segments, 3D-Printed Titanium Custom-Made Prostheses (3DPTCMP) are possible reconstructive solutions. The aim of the present paper is to analyze indications, results and complications of a series of 14 patients who underwent pelvis reconstruction with 3DPTCMP after tumor removal from January 2015 to December 2019. Chondrosarcoma was the main histology; indications were tumors located in the acetabular area without enough residual bone to support a cup with an iliac stem, and tumors located near the sacrum-iliac joint. The margins were wide in 12 cases, and marginal and intralesional in one case each. In three cases, resection also included the sacrum-iliac joint, so a spine stabilization was performed and linked to the pelvic prosthesis; The average MSTS score was 46.3%; the 5-year local recurrence-free survival was 85.7%. Wound dehiscences were the main complication, resolved with multiple debridements; nevertheless, prosthesis removal was necessary in one case. Currently, the 3DPTCMP is an effective resource for reconstruction after resection of tumors located in the pelvis. Further studies are necessary to value long-term results; more strategies are necessary to try to reduce the infection rate and improve osteointegration.

Safety and Efficacy of All-In-One Percutaneous Pedicle Screw System

Study Design: Retrospective study of the prospectively collected outcomes data. Objective: The indications for PPS placement during minimally invasive spine stabilization (MISt) procedures have increased in recent years. To the best of our knowledge, no studies have documented the outcomes of PPS insertion using the all-in-one PPS system. This study compared the conventional methods and the use of all-in-one percutaneous pedicle screw (PPS) system with respect to the speed and accuracy of PPS placement. We also determined the advantages associated with the use of the all-in-one PPS system. Methods: We evaluated 54 patients who underwent PPS insertion using the conventional method and the all-in-one PPS system during MISt procedures. We also assessed the number of implanted PPSs, the time taken to implant PPSs, and the accuracy of PPS placement based on postoperative computed tomography images. Results: A total of 254 PPSs were inserted (126 using the conventional method and 128 using the all-in-one PPS system). The PPS insertion time with the all-in-one PPS system (mean, 25.3 ± 9.1 s) was significantly shorter than that using the conventional method (mean, 63.1 ± 13.0 s; P < 0.01). With respect to the accuracy of PPS insertion, ≥ 2 mm pedicle breach was noted in one case each in both groups. Conclusions: PPS placement using the all-in-one PPS system is as safe as conventional methods and has the potential to save the surgical time of MISt procedures.

Hybrid therapy versus Total En Bloc Spondyectomy in the treatment of Solitary Radioresistant Spinal Metastases：A propensity score-matched analysis

Background Both hybrid therapy (HT) and total en bloc spondylectomy (TES)can lead to good results for solitary radioresistant metastatic spinal tumors with high-grade epidural spinal cord compression (ESCC). However, there is still a lack of comparative studies on the treatment efficacy of these two methods. Methods We retrospectively reviewed patients with the above-mentioned tumors between January 2012 and May 2019. A total of 157 patients underwent surgery, among whom 64 received HT, and 93 were treated with TES. Propensity score matching allowed the generation of best-matched pairs for the 2 categories (1:1 ratio). Local control rates and survival rates were estimated using the Kaplan–Meier method. Results All patients received a minimum of 2-year follow-up. The longest follow-up time was 88 months. The survival rates and local progression-free survival rates after HT were comparable with TES at 1 year (84.6% vs. 83.1%; 90.2% vs. 90%), 2 year (60.8% vs. 64.3%; 64.1% vs. 62.1%), and 5 year (18.8% vs. 24.1%; 24.4% vs. 28.4%). There were no significant differences in pain control, improvement of neurological status, spine stabilization restoration, and improvement in quality of life between groups. However, HT showed more advantages in shortening operative time and reducing intraoperative blood loss than TES. Conclusion Our results suggest that HT can obtain satisfactory results comparable to TES for solitary radioresistant metastatic spinal tumors with high-grade ESCC. In addition, compared with TES, HT has the advantages of shortening operative time and reducing perioperative complications. For solitary radioresistant metastatic spinal tumors with a high degree of ESCC, HT may be a promising treatment in the future.

Safety and efficacy of cement augmentation with fenestrated pedicle screws for tumor-related spinal instability

OBJECTIVE Achieving rigid spinal fixation can be challenging in patients with cancer-related instability, as factors such as osteopenia, radiation, and immunosuppression adversely affect bone quality. Augmenting pedicle screws with cement is a strategy to overcome construct failure. This study aimed to assess the safety and efficacy of cement augmentation with fenestrated pedicle screws in patients undergoing posterior, open thoracolumbar surgery for spinal metastases. METHODS A retrospective review was performed for patients who underwent surgery for cancer-related spine instability from 2016 to 2019 at the Massachusetts General Hospital. Patient demographics, surgical details, radiographic characteristics, patterns of cement extravasation, complications, and prospectively collected Patient-Reported Outcomes Measurement Information System Pain Interference and Pain Intensity scores were analyzed using descriptive statistics. Logistic regression was performed to determine factors associated with cement extravasation. RESULTS Sixty-nine patients underwent open posterior surgery with a total of 502 cement-augmented screws (mean 7.8 screws per construct). The median follow-up period for those who survived past 90 days was 25.3 months (IQR 10.8–34.6 months). Thirteen patients (18.8%) either died within 90 days or were lost to follow-up. Postoperative CT was performed to assess the instrumentation and patterns of cement extravasation. There was no screw loosening, pullout, or failure. The rate of cement extravasation was 28.9% (145/502), most commonly through the segmental veins (77/145, 53.1%). Screws breaching the lateral border of the pedicle but with fenestrations within the vertebral body were associated with a higher risk of leakage through the segmental veins compared with screws without any breach (OR 8.77, 95% CI 2.84–29.79; p < 0.001). Cement extravasation did not cause symptoms except in 1 patient who developed a symptomatic thoracic radiculopathy requiring decompression. There was 1 case of asymptomatic pulmonary cement embolism. Patients experienced significant pain improvement at the 3-month follow-up, with decreases in Pain Interference (mean change 15.8, 95% CI 14.5–17.1; p < 0.001) and Pain Intensity (mean change 28.5, 95% CI 26.7–30.4; p < 0.001). CONCLUSIONS Cement augmentation through fenestrated pedicle screws is a safe and effective option for spine stabilization in the cancer population. The risk of clinically significant adverse events from cement extravasation is very low.

Impact of trauma workshop on knowledge, attitude and practice conducted on undergraduate MBBS students

In India the organized trauma care services are restricted only to tertiary care centres and golden hour trauma care is often delayed. We decided to create awareness among the MBBS students by teaching basic trauma management skills since they are the first responders to a trauma victim brought to any hospital setup. This would help improve primary trauma care. Aim: To assess the improvement in knowledge, attitude and practice after primary trauma care workshop in MBBS students Methods and Material: A one day primary trauma care workshop was conducted in our institute for two consecutive years during the annual academic undergraduate conference 2018 and 2019 respectively. The MBBS students enrolled were given a questionnaire to solve before and after the workshop. They received a lecture on triage and hands-on practice on Primary survey, log roll & cervical spine stabilization, Airway management, Intravenous fluids & shock management and Basic life support. Statistical analysis: The pre and post workshop questionnaires were statistically analyzed by paired t-test using software version SPSS 20.0 and a P value of < 0.05 was considered statistically significant. Results: Pre workshop 9.9% and 10.5% of the students had above average total score in 2018 and 2019 respectively which increased to 67.6% and 78.5% post workshop. The mean Knowledge, Attitude and Practice scores also improved individually. Conclusion: We should include such workshops in the undergraduate curriculum, it would improve primary trauma care and will reduce trauma related morbidity and mortality

Exploring new roles for actin upon LTP induction in dendritic spines

Dendritic spines, small protrusions of the dendrites, enlarge upon LTP induction, linking morphological and functional properties. Although the role of actin in spine enlargement has been well studied, little is known about its relationship with mechanical membrane properties, such as membrane tension, which is involved in many cell processes, like exocytosis. Here, we use a 3D model of the dendritic spine to investigate how polymerization of actin filaments can effectively elevate the membrane tension to trigger exocytosis in a domain close to the tip of the spine. Moreover, we show that the same pool of actin promotes full membrane fusion after exocytosis and spine stabilization.