A. Abou-Madawi, Mohamed A. Abdelaziz, Mohamed K. Elkazaz, A. Abdelmonem
{"title":"Multi-slice Computed Tomography Scan Assessment of Accuracy and Safety of Free-hand Pedicle Screw Fixation in Adolescent Idiopathic Scoliosis","authors":"A. Abou-Madawi, Mohamed A. Abdelaziz, Mohamed K. Elkazaz, A. Abdelmonem","doi":"10.57055/2314-8969.1263","DOIUrl":"https://doi.org/10.57055/2314-8969.1263","url":null,"abstract":"","PeriodicalId":11610,"journal":{"name":"Egyptian Spine Journal","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47773238","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Hossam Abdel Hameed El Sayyad, M. Zaghloul, M. Salama, M. Nagy
Background data: Tumors of the cauda equina represent an uncommon group of tumors with diverse pathologies and clinical manifestations. Surgery represents the mainstay of treatment for these tumors. Study design: A retrospective case series was conducted. Purpose: This study evaluates the clinical outcome and the extent of resection in a group of patients operated upon for resectioning tumors of the cauda equina in the absence of intraoperative neurophysiological monitoring. Patients and methods: This retrospective study was conducted on 25 adult patients operated upon for resection of primary cauda equina tumors in the absence of intraoperative neurophysiological monitoring. The modi fi ed McCormick scale was used for the evaluation of the functional outcome of the patients 12 months after surgery. The outcome was graded into four groups: excellent, good, fair, or poor. The extent of resection was assessed by MRI with contrast. Results: The mean duration of symptoms before diagnosis was 13.8 ± 8.2 months. Low back pain was the most common symptom (96%), with 44% of the patients having neurological de fi cits at presentation. There were 13 nerve sheath tumors (nine schwannomas and four neuro fi bromas) (52%) and eight (32%) ependymomas. Gross total resection was achieved in 80% and subtotal resection was achieved in 16%, whereas partial resection was achieved in 4% of the patients. Excellent, good, fair, and poor clinical outcomes were achieved in 68, 4, 20, and 8% of the patients, respectively. Conclusion: Cauda equina tumors are mostly benign with a favorable prognosis. High rates of gross total resection with favorable clinical outcomes could be achieved in most of these tumors, even in the absence of intraoperative neurophysiological monitoring (2022ESJ258).
{"title":"Surgical Resection of Tumors of the Cauda Equina in the Absence of Intraoperative Neurophysiological Monitoring: Experience with 25 Cases","authors":"Hossam Abdel Hameed El Sayyad, M. Zaghloul, M. Salama, M. Nagy","doi":"10.57055/2314-8969.1260","DOIUrl":"https://doi.org/10.57055/2314-8969.1260","url":null,"abstract":"Background data: Tumors of the cauda equina represent an uncommon group of tumors with diverse pathologies and clinical manifestations. Surgery represents the mainstay of treatment for these tumors. Study design: A retrospective case series was conducted. Purpose: This study evaluates the clinical outcome and the extent of resection in a group of patients operated upon for resectioning tumors of the cauda equina in the absence of intraoperative neurophysiological monitoring. Patients and methods: This retrospective study was conducted on 25 adult patients operated upon for resection of primary cauda equina tumors in the absence of intraoperative neurophysiological monitoring. The modi fi ed McCormick scale was used for the evaluation of the functional outcome of the patients 12 months after surgery. The outcome was graded into four groups: excellent, good, fair, or poor. The extent of resection was assessed by MRI with contrast. Results: The mean duration of symptoms before diagnosis was 13.8 ± 8.2 months. Low back pain was the most common symptom (96%), with 44% of the patients having neurological de fi cits at presentation. There were 13 nerve sheath tumors (nine schwannomas and four neuro fi bromas) (52%) and eight (32%) ependymomas. Gross total resection was achieved in 80% and subtotal resection was achieved in 16%, whereas partial resection was achieved in 4% of the patients. Excellent, good, fair, and poor clinical outcomes were achieved in 68, 4, 20, and 8% of the patients, respectively. Conclusion: Cauda equina tumors are mostly benign with a favorable prognosis. High rates of gross total resection with favorable clinical outcomes could be achieved in most of these tumors, even in the absence of intraoperative neurophysiological monitoring (2022ESJ258).","PeriodicalId":11610,"journal":{"name":"Egyptian Spine Journal","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47464603","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Background data: Posterior cervical laminectomy and lateral mass screw-rod fusion techniques were classically recommended in fl exible sagittal cervical alignment relying on indirect decompression via posterior cord shift. Purpose : This study aims to investigate the ef fi cacy of posterior cervical laminectomy with lateral mass screw-rod fi xation for treating multisegmental cervical spondylotic myelopathy (MCSM) with fl exible sagittal cervical alignment. Study design: This was a prospective clinical cohort study. Patients and methods: In total, 38 patients with clinically symptomatic MCSM with instability and/or fl exible kyphosis were admitted to our Zagazig University hospitals for posterior cervical laminectomy and lateral mass screw-rod fusion (long-segment instrumented fusion ≥ 3 segments) and completed the 24-month follow-up period between April 2014 and June 2018, and the last follow-up visit took place in October 2020. Patients were categorized into lordotic, straight, and kyphotic groups according to the shape of the cervical spine curve on a neutral lateral radiographic view. Results: A total of 266 lateral mass screws were inserted in 134 levels in 38 patients (three levels in 20 patients, four levels in 16 patients, and fi ve levels in two patients); all the patients had a good fusion, and the cervical spine was stable, based on the absence of hardware failure or subsidence. All 38 (100%) patients gained more lordosis with a variable degree according to the preoperative cervical sagittal alignment. The mean percentage of neck pain improvement according to the visual analog scale for the lordotic group was 69.1%, for the straight group was 43.8%, and for the kyphotic group was 15.8%. The mean percentage of neurological function improvement (Japanese Orthopedic Association score) for the lordotic group was 83.17%, for the straight group was 43%, and for the kyphotic group was 17%. The mean percentage of disability improvement (Neck Disability Index score) for the lordotic group was 47.66%, for the straight group was 24.5%, and for the kyphotic group was 16.66%. Conclusion: Decompressive cervical spine laminectomy with lateral mass screw stabilization is effective in treating MCSM with fl exible sagittal cervical alignment (2022ESJ259).
{"title":"Decompressive Cervical Laminectomy and Lateral Mass Screw-Rod Fusion for Multisegmental Cervical Spondylotic Myelopathy with Flexible Sagittal Cervical Alignment","authors":"Mohamed Hussein, Mohamed Abdelrazek, A. Eladawy","doi":"10.57055/2314-8969.1261","DOIUrl":"https://doi.org/10.57055/2314-8969.1261","url":null,"abstract":"Background data: Posterior cervical laminectomy and lateral mass screw-rod fusion techniques were classically recommended in fl exible sagittal cervical alignment relying on indirect decompression via posterior cord shift. Purpose : This study aims to investigate the ef fi cacy of posterior cervical laminectomy with lateral mass screw-rod fi xation for treating multisegmental cervical spondylotic myelopathy (MCSM) with fl exible sagittal cervical alignment. Study design: This was a prospective clinical cohort study. Patients and methods: In total, 38 patients with clinically symptomatic MCSM with instability and/or fl exible kyphosis were admitted to our Zagazig University hospitals for posterior cervical laminectomy and lateral mass screw-rod fusion (long-segment instrumented fusion ≥ 3 segments) and completed the 24-month follow-up period between April 2014 and June 2018, and the last follow-up visit took place in October 2020. Patients were categorized into lordotic, straight, and kyphotic groups according to the shape of the cervical spine curve on a neutral lateral radiographic view. Results: A total of 266 lateral mass screws were inserted in 134 levels in 38 patients (three levels in 20 patients, four levels in 16 patients, and fi ve levels in two patients); all the patients had a good fusion, and the cervical spine was stable, based on the absence of hardware failure or subsidence. All 38 (100%) patients gained more lordosis with a variable degree according to the preoperative cervical sagittal alignment. The mean percentage of neck pain improvement according to the visual analog scale for the lordotic group was 69.1%, for the straight group was 43.8%, and for the kyphotic group was 15.8%. The mean percentage of neurological function improvement (Japanese Orthopedic Association score) for the lordotic group was 83.17%, for the straight group was 43%, and for the kyphotic group was 17%. The mean percentage of disability improvement (Neck Disability Index score) for the lordotic group was 47.66%, for the straight group was 24.5%, and for the kyphotic group was 16.66%. Conclusion: Decompressive cervical spine laminectomy with lateral mass screw stabilization is effective in treating MCSM with fl exible sagittal cervical alignment (2022ESJ259).","PeriodicalId":11610,"journal":{"name":"Egyptian Spine Journal","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42080155","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Background data: Axillary nerve is one of the branches of the posterior cord of the brachial plexus that carries nerve fi bers from C5 and C6 roots and then travels to innervate the deltoid muscle and teres minor muscle; it maintains stability of the shoulder joint and provides sensation to the overlying skin. Many techniques are present to manage axillary nerve injuries according to the applied anatomy to provide more safety during exploration. It may be isolated or combined injury, and each type has its speci fi c protocol. Study design: This is a retrospective clinical case study. Patients and methods: Between January 2018 and December 2019, eight male patients with an average age of 32.2 years (range, 20 e 45 years) presented with complete loss of shoulder abduction. All of the patients underwent microsurgical axillary nerve neurotization using transfer of the part of the radial nerve of the medial head of the triceps and suturing it into the stump of the axillary nerve. The posterior approach in the prone position was used in all patients. The axillary nerve stumpwas proximalto the origin of the nerve to teres minormuscle.Thesurgical intervention was done forall eightpatients by the same team. Preoperative and follow-up clinical evaluation was done by assessing the motor power of all the patients, which was clinically evaluated using the Motor Research Council scale. The mean follow-up period was 12 months. Results: A total of eight male patients who presented after a history of traumatic insults were included in the study. The average lapse between the traumatic insult and the surgical intervention was 5 months (range, 4 e 6 months). Shoulder abduction was grade 0 in all patients on the Motor Research Council scale. Five patients had complex de fi cits all over the upper limb among brachial plexus injuries, whereas three had isolated axillary nerve de fi cits. Overall, 62% of the patients ( fi ve patients) showed marked functional motor improvement, whereas three patients did not show any improvement. Mean time of the surgery was about 80 min. The mean amount of blood loss was 160 ml. The average period of recovery was 6 months, whereas the mean period of follow-up was 32 months. Conclusion: Harvesting the stump of the axillary nerve proximal to the takeoff of the branch of the teres minor muscle while suturing it with the radial nerve stump through the procedure of nerve transfer is the cardinal step for achieving functional motor recovery by gaining shoulder abduction (2021ESJ251).
{"title":"Neurotization of the Axillary Nerve: A Case Series and Review of the Literature","authors":"M. Elsebaey, A. Galhom","doi":"10.57055/2314-8969.1001","DOIUrl":"https://doi.org/10.57055/2314-8969.1001","url":null,"abstract":"Background data: Axillary nerve is one of the branches of the posterior cord of the brachial plexus that carries nerve fi bers from C5 and C6 roots and then travels to innervate the deltoid muscle and teres minor muscle; it maintains stability of the shoulder joint and provides sensation to the overlying skin. Many techniques are present to manage axillary nerve injuries according to the applied anatomy to provide more safety during exploration. It may be isolated or combined injury, and each type has its speci fi c protocol. Study design: This is a retrospective clinical case study. Patients and methods: Between January 2018 and December 2019, eight male patients with an average age of 32.2 years (range, 20 e 45 years) presented with complete loss of shoulder abduction. All of the patients underwent microsurgical axillary nerve neurotization using transfer of the part of the radial nerve of the medial head of the triceps and suturing it into the stump of the axillary nerve. The posterior approach in the prone position was used in all patients. The axillary nerve stumpwas proximalto the origin of the nerve to teres minormuscle.Thesurgical intervention was done forall eightpatients by the same team. Preoperative and follow-up clinical evaluation was done by assessing the motor power of all the patients, which was clinically evaluated using the Motor Research Council scale. The mean follow-up period was 12 months. Results: A total of eight male patients who presented after a history of traumatic insults were included in the study. The average lapse between the traumatic insult and the surgical intervention was 5 months (range, 4 e 6 months). Shoulder abduction was grade 0 in all patients on the Motor Research Council scale. Five patients had complex de fi cits all over the upper limb among brachial plexus injuries, whereas three had isolated axillary nerve de fi cits. Overall, 62% of the patients ( fi ve patients) showed marked functional motor improvement, whereas three patients did not show any improvement. Mean time of the surgery was about 80 min. The mean amount of blood loss was 160 ml. The average period of recovery was 6 months, whereas the mean period of follow-up was 32 months. Conclusion: Harvesting the stump of the axillary nerve proximal to the takeoff of the branch of the teres minor muscle while suturing it with the radial nerve stump through the procedure of nerve transfer is the cardinal step for achieving functional motor recovery by gaining shoulder abduction (2021ESJ251).","PeriodicalId":11610,"journal":{"name":"Egyptian Spine Journal","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49519944","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Ghazwan A. Hasan, Ahmed Alqatub, Yasameen Bani Weis, A. Al-Jasim, A. B. Ali, Mustafa Qatran
Recurrence of lumbar disc herniation has been reported in 5 e 11% of patients after conventional discectomy, and most of these patients are usually treated with repeated discectomy through the same initial approach. Tubular micro-discectomy is an increasingly popular surgery for lumbar disc prolapse and has replaced conventional open surgery in the last decade. However, it requires more experience and has a steep learning curve, especially in revision cases. We present the fi ndings of a tubular lumbar microdiscectomy performed after two conventional open laminectomies and discectomies, explaining the challenges and dif fi culties in such cases and leading the way for the use of minimally invasive spine surgeries after multiple open surgeries. A case report and literature review was performed. A middle-aged man who had undergone two open laminectomies and discectomies several years ago at L5 e S1 and fenestrated laminectomy at L4 e L5 presented with new radiculopathy over the S1 nerve root dermatome to which a new tubular microdiscectomy was performed. The patient ran a smooth postoperative course, and his symptoms improved. Tubular microdiscectomy achieves the goal of fi xation, is cost-effective, and goes with the patient preference. A successful tubular microdiscectomy is tough to accomplish after two spinal surgeries around and near the same involved spinal nerve.
据报道，在常规椎间盘切除术后，5 - 11%的患者会复发腰椎间盘突出症，这些患者中的大多数通常通过相同的初始入路进行重复椎间盘切除术。管状微椎间盘切除术是治疗腰椎间盘突出症的一种越来越流行的手术，在过去的十年中已经取代了传统的开放手术。然而，它需要更多的经验，有一个陡峭的学习曲线，特别是在修订的情况下。我们介绍了在两次传统开放椎板切除术和椎间盘切除术后进行管状腰椎微椎间盘切除术的结果，解释了在这种情况下的挑战和困难，并为多次开放手术后微创脊柱手术的应用开辟了道路。进行病例报告和文献复习。一名中年男子几年前在L5 e S1行了两次开放椎板切除术和椎间盘切除术，并在L4 e L5行了开窗椎板切除术，他出现了S1神经根皮节上的新神经根病，并对其进行了新的管状微椎间盘切除术。病人术后进展顺利，症状有所改善。管状微椎间盘切除术达到了固定的目的，具有成本效益，并且符合患者的偏好。在同一受累脊神经周围和附近进行两次脊柱手术后，成功的管状微椎间盘切除术是困难的。
{"title":"Tubular Microdiscectomy for Recurrent Disc Prolapse Following Two Rounds of Open Laminectomy and Discectomy: A Case Report and Literature Review","authors":"Ghazwan A. Hasan, Ahmed Alqatub, Yasameen Bani Weis, A. Al-Jasim, A. B. Ali, Mustafa Qatran","doi":"10.57055/2314-8969.1006","DOIUrl":"https://doi.org/10.57055/2314-8969.1006","url":null,"abstract":"Recurrence of lumbar disc herniation has been reported in 5 e 11% of patients after conventional discectomy, and most of these patients are usually treated with repeated discectomy through the same initial approach. Tubular micro-discectomy is an increasingly popular surgery for lumbar disc prolapse and has replaced conventional open surgery in the last decade. However, it requires more experience and has a steep learning curve, especially in revision cases. We present the fi ndings of a tubular lumbar microdiscectomy performed after two conventional open laminectomies and discectomies, explaining the challenges and dif fi culties in such cases and leading the way for the use of minimally invasive spine surgeries after multiple open surgeries. A case report and literature review was performed. A middle-aged man who had undergone two open laminectomies and discectomies several years ago at L5 e S1 and fenestrated laminectomy at L4 e L5 presented with new radiculopathy over the S1 nerve root dermatome to which a new tubular microdiscectomy was performed. The patient ran a smooth postoperative course, and his symptoms improved. Tubular microdiscectomy achieves the goal of fi xation, is cost-effective, and goes with the patient preference. A successful tubular microdiscectomy is tough to accomplish after two spinal surgeries around and near the same involved spinal nerve.","PeriodicalId":11610,"journal":{"name":"Egyptian Spine Journal","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44100561","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Background data: Since the initial idea by Kambin and Gellman in 1973 of percutaneous posterolateral lumbar disc decompression, the evolution of minimally invasive interventions in disc herniation has been widely growing. The advancements in optics and surgical instruments allowed surgeons to perform true minimally invasive procedures in a wide range of spine pathologies. In addition, transforaminal percutaneous endoscopic lumbar discectomy (TPELD) has been widely used in various degenerative spine pathologies, owing to the presence of high-speed drills, fl exible forceps, scissors, curettes, and probes to manage pathologies such as disc herniation or canal stenosis. Study design: A prospective clinical case study was performed. Purpose: The primary objective of this study was to assess the feasibility of migrated lumbar disc excision by TPELD, and the secondary objective was to report any technical dif fi culty or complications related to the technique. Patients and methods: Between January 2018 and January 2020, 20 patients who underwent TPELD for radiologically veri fi ed caudally migrated lumbar disc prolapse after the failure of conservative therapy were reported. Preoperative and postoperative clinical evaluations were performed for back pain and leg pain by the visual analog scale (VAS) score and for patients ’ disability by Oswestry Disability Index (ODI). The radiological evaluations preoperatively and post-operatively were done by lumbosacral MRI complemented by lumbosacral radiography anteroposterior and lateral views. The follow-up visits for the evaluation were immediately after surgery and 6 months and 1 year postoperatively. Results: A total of 20 cases were involved in this series from January 2018 to January 2020. Nine females and 11 males were included in the study. Postoperatively, the clinical assessment showed improvement in the VAS score of the back pain and leg pain as the mean VAS scores for back pain and leg pain immediately were 4.55 ± 1.70 and 2.4 ± 0.68, respectively. At the 6-month follow-up, the mean VAS scores for back pain, leg pain, and ODI were 2.15 ± 1.03, 1.35 ± 0.74, and 22.2 ± 6.59, respectively. Finally, after 12 months, the mean VAS scores for back pain, leg pain, and ODI were 1.25 ± 0.71, 0.8 ± 0.52, and 15.85 ± 9.22, respectively. Conclusion: Minimally invasive TPELD proves to be a valuable utility in managing migrated disc fragments in lumbar disc Prolapse (LDP). However, it is a technically demanding procedure, but with appropriate tools and introducing angles, it ef fi ciently removes migrated fragments with the preservation of anatomy. Consequently, the stability of the spine is not harmed (2021ESJ248).
{"title":"Transforaminal Percutaneous Endoscopic Lumbar Discectomy (TPELD) in Caudal Migrated Lumbar Disc Herniations: A Case Series and Literature Review","authors":"M. Abdelfattah, Mohamed K. Elkazaz, A. Khedr","doi":"10.57055/2314-8969.1005","DOIUrl":"https://doi.org/10.57055/2314-8969.1005","url":null,"abstract":"Background data: Since the initial idea by Kambin and Gellman in 1973 of percutaneous posterolateral lumbar disc decompression, the evolution of minimally invasive interventions in disc herniation has been widely growing. The advancements in optics and surgical instruments allowed surgeons to perform true minimally invasive procedures in a wide range of spine pathologies. In addition, transforaminal percutaneous endoscopic lumbar discectomy (TPELD) has been widely used in various degenerative spine pathologies, owing to the presence of high-speed drills, fl exible forceps, scissors, curettes, and probes to manage pathologies such as disc herniation or canal stenosis. Study design: A prospective clinical case study was performed. Purpose: The primary objective of this study was to assess the feasibility of migrated lumbar disc excision by TPELD, and the secondary objective was to report any technical dif fi culty or complications related to the technique. Patients and methods: Between January 2018 and January 2020, 20 patients who underwent TPELD for radiologically veri fi ed caudally migrated lumbar disc prolapse after the failure of conservative therapy were reported. Preoperative and postoperative clinical evaluations were performed for back pain and leg pain by the visual analog scale (VAS) score and for patients ’ disability by Oswestry Disability Index (ODI). The radiological evaluations preoperatively and post-operatively were done by lumbosacral MRI complemented by lumbosacral radiography anteroposterior and lateral views. The follow-up visits for the evaluation were immediately after surgery and 6 months and 1 year postoperatively. Results: A total of 20 cases were involved in this series from January 2018 to January 2020. Nine females and 11 males were included in the study. Postoperatively, the clinical assessment showed improvement in the VAS score of the back pain and leg pain as the mean VAS scores for back pain and leg pain immediately were 4.55 ± 1.70 and 2.4 ± 0.68, respectively. At the 6-month follow-up, the mean VAS scores for back pain, leg pain, and ODI were 2.15 ± 1.03, 1.35 ± 0.74, and 22.2 ± 6.59, respectively. Finally, after 12 months, the mean VAS scores for back pain, leg pain, and ODI were 1.25 ± 0.71, 0.8 ± 0.52, and 15.85 ± 9.22, respectively. Conclusion: Minimally invasive TPELD proves to be a valuable utility in managing migrated disc fragments in lumbar disc Prolapse (LDP). However, it is a technically demanding procedure, but with appropriate tools and introducing angles, it ef fi ciently removes migrated fragments with the preservation of anatomy. Consequently, the stability of the spine is not harmed (2021ESJ248).","PeriodicalId":11610,"journal":{"name":"Egyptian Spine Journal","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43495486","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Background data: Approximately 60% of osseous metastases are in the spine, and 10% of patients with spinal metastases are expected to develop spinal cord compression. In our opinion, there is a need for a recent review of the management of spinal metastases and the role of oncological spine surgeons due to recent advances in the diagnosis and management of spinal metastases. Purpose: This study aims to review the available data about the current concepts regarding decision making and treatment options for spinal metastasis. Study design: A narrative literature review was performed. Patients and methods: The authors reviewed the English literature published over the past two decades for recent and relevant data about decision making and treatment options in cases of spinal metastases. A PubMed search was con-ducted, and the most relevant articles according to the study aim and spine surgeon ' s practice were extracted. Results: The classi fi cation-based approaches described by Tokuhashi and colleagues and Tomita and colleagues are well-established methods to estimate life expectancy in patients with spinal metastasis; however, they do not consider newer radiotherapy technologies and chemotherapies to treat these metastases. Recent advances in molecular genetics might explain why survival might be different in patients having the same tumor histopathology and metastases. Survival is related to genes in tumors, and this is proven for melanoma, breast cancer, and non-small-cell lung cancer. Neurologic, oncologic, mechanical, and systemic framework was recently developed and provided a comprehensive assessment of metastatic spinal tumors, including four pillars: neurologic, oncologic, mechanical, and systemic assessment. In this framework, the role of oncological spine surgeons is limited to separation surgery or restoring spinal stability, whereas the rest of the management depends mainly on radiotherapy. Targeted therapeutics are recent drugs that have the potential to improve markedly the outcomes in cases of spinal metastases. Several targeted therapies have been approved for metastatic renal cell carcinoma. Conclusion: Prognosis in cases of spinal metastases seems to be more in fl uenced by genetic subtyping. The role of spinal oncological surgery is fading away. Surgery is limited to separation surgery and surgeries for restoration of spinal stability. The future of spinal metastases management lies in the recent advances in techniques of radiotherapy and targeted therapeutics (2021ESJ254).
{"title":"Recent Trends in the Management of Spinal Metastasis: A Narrative Review of the Literature","authors":"Mohamed Abdel-wanis, D. Khan","doi":"10.57055/2314-8969.1000","DOIUrl":"https://doi.org/10.57055/2314-8969.1000","url":null,"abstract":"Background data: Approximately 60% of osseous metastases are in the spine, and 10% of patients with spinal metastases are expected to develop spinal cord compression. In our opinion, there is a need for a recent review of the management of spinal metastases and the role of oncological spine surgeons due to recent advances in the diagnosis and management of spinal metastases. Purpose: This study aims to review the available data about the current concepts regarding decision making and treatment options for spinal metastasis. Study design: A narrative literature review was performed. Patients and methods: The authors reviewed the English literature published over the past two decades for recent and relevant data about decision making and treatment options in cases of spinal metastases. A PubMed search was con-ducted, and the most relevant articles according to the study aim and spine surgeon ' s practice were extracted. Results: The classi fi cation-based approaches described by Tokuhashi and colleagues and Tomita and colleagues are well-established methods to estimate life expectancy in patients with spinal metastasis; however, they do not consider newer radiotherapy technologies and chemotherapies to treat these metastases. Recent advances in molecular genetics might explain why survival might be different in patients having the same tumor histopathology and metastases. Survival is related to genes in tumors, and this is proven for melanoma, breast cancer, and non-small-cell lung cancer. Neurologic, oncologic, mechanical, and systemic framework was recently developed and provided a comprehensive assessment of metastatic spinal tumors, including four pillars: neurologic, oncologic, mechanical, and systemic assessment. In this framework, the role of oncological spine surgeons is limited to separation surgery or restoring spinal stability, whereas the rest of the management depends mainly on radiotherapy. Targeted therapeutics are recent drugs that have the potential to improve markedly the outcomes in cases of spinal metastases. Several targeted therapies have been approved for metastatic renal cell carcinoma. Conclusion: Prognosis in cases of spinal metastases seems to be more in fl uenced by genetic subtyping. The role of spinal oncological surgery is fading away. Surgery is limited to separation surgery and surgeries for restoration of spinal stability. The future of spinal metastases management lies in the recent advances in techniques of radiotherapy and targeted therapeutics (2021ESJ254).","PeriodicalId":11610,"journal":{"name":"Egyptian Spine Journal","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44484036","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Background data: Anterior cervical discectomy and fusion (ACDF) is a well-known operative technique for treating cervical disc diseases causing myelopathy and/or radiculopathy. Postoperative immobilization with a rigid cervical brace is widely followed after ACDF using a standalone cage and soft braces frequently. Some authors have recommended using postoperative cervical braces, whereas others do not, and among surgeons who agree with postoperative collar usage, the type of cervical orthoses and the duration of use are also issues of debate. Purpose: This study aims to compare between results of ACDF by using the Philadelphia collar and soft collar postoperatively. Study design: A prospective study was conducted. Patients and methods: This study included 60 patients with ACDF: 28 used Philadelphia collar (group I) and 32 used soft collar (group II). Cases with single-level ACDF to four levels were included, and revision and deformity cases were excluded. For 1 year, both groups were followed up regarding fusion rate, subsidence, cage migration, neck disability index (NDI), and visual analog scale of the neck and arm pain. Results: Neck and arm pains using visual analog scale scores preoperatively and 3, 6, and 12 months postoperatively also showed no signi fi cant difference between both groups. Subsidence was noticed among two (7.1%) patients in group I and one (3.1%) patient in group II. No signi fi cant differences in fusion rates were found between both groups. After a 12-month follow-up in more than two-level procedures, the NDI score among group II was signi fi cantly lower ( P ¼ 0.045). Linear regression analysis revealed that preoperative NDI, age, BMI, and operation level were the predictors of postoperative NDI, excluding the presence of diabetes mellitus and brace type. Conclusion: Cervical brace after ACDF by either Philadelphia or soft collar does not affect the fusion rate, cage subsidence, or outcomes of the neck and arm pain (2021ESJ255).
{"title":"Comparative Study Between the Results of Anterior Cervical Discectomy and Fusion Using Philadelphia or Soft Collar Postoperatively","authors":"M. Nafady","doi":"10.57055/2314-8969.1003","DOIUrl":"https://doi.org/10.57055/2314-8969.1003","url":null,"abstract":"Background data: Anterior cervical discectomy and fusion (ACDF) is a well-known operative technique for treating cervical disc diseases causing myelopathy and/or radiculopathy. Postoperative immobilization with a rigid cervical brace is widely followed after ACDF using a standalone cage and soft braces frequently. Some authors have recommended using postoperative cervical braces, whereas others do not, and among surgeons who agree with postoperative collar usage, the type of cervical orthoses and the duration of use are also issues of debate. Purpose: This study aims to compare between results of ACDF by using the Philadelphia collar and soft collar postoperatively. Study design: A prospective study was conducted. Patients and methods: This study included 60 patients with ACDF: 28 used Philadelphia collar (group I) and 32 used soft collar (group II). Cases with single-level ACDF to four levels were included, and revision and deformity cases were excluded. For 1 year, both groups were followed up regarding fusion rate, subsidence, cage migration, neck disability index (NDI), and visual analog scale of the neck and arm pain. Results: Neck and arm pains using visual analog scale scores preoperatively and 3, 6, and 12 months postoperatively also showed no signi fi cant difference between both groups. Subsidence was noticed among two (7.1%) patients in group I and one (3.1%) patient in group II. No signi fi cant differences in fusion rates were found between both groups. After a 12-month follow-up in more than two-level procedures, the NDI score among group II was signi fi cantly lower ( P ¼ 0.045). Linear regression analysis revealed that preoperative NDI, age, BMI, and operation level were the predictors of postoperative NDI, excluding the presence of diabetes mellitus and brace type. Conclusion: Cervical brace after ACDF by either Philadelphia or soft collar does not affect the fusion rate, cage subsidence, or outcomes of the neck and arm pain (2021ESJ255).","PeriodicalId":11610,"journal":{"name":"Egyptian Spine Journal","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43044447","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Hazem M. Alkosha, H. Elsobky, Basem I. Awad, A. Zidan, A. Hady, Amin Sabry
{"title":"Subtotal Sacrectomy followed by Maximally Tolerated 3D Conformal Radiation for High-Level Chordomas with Neural Integrity: Technique and Outcome","authors":"Hazem M. Alkosha, H. Elsobky, Basem I. Awad, A. Zidan, A. Hady, Amin Sabry","doi":"10.57055/2314-8969.1004","DOIUrl":"https://doi.org/10.57055/2314-8969.1004","url":null,"abstract":"","PeriodicalId":11610,"journal":{"name":"Egyptian Spine Journal","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48498801","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Background data: The rationale behind lumbar fusion surgery is to eliminate pathologic segmental motion and its accompanying symptoms, especially low back pain. Posterolateral fusion (PLF) using pedicle screw fi xation has been one of the most popular procedures among the posterior lumbar reconstruction techniques. Lumbar interbody fusion is a recognized surgical technique in treating chronic low back pain in segmental instability. Purpose: The purpose of this study was to compare the clinical and radiological outcomes of stabilizing the lumbar spine using transforaminal lumbar interbody fusion (TLIF) versus PLF for lumbar segmental instability. Study design: A prospective, nonrandomized clinical controlled trial was performed. Patients and methods: A total of 40 patients with segmental lumbar instability were divided into two groups (TLIF and PLF groups), with 20 patients each. Top-loaded pedicle screw construct was used with both groups. The mean age of the patients was 48.35 years in the TLIF group and 45.3 years in the PLF group. Sex distribution was six males and 14 females in the TLIF group and seven males and 13 females in the PLF group. Mechanical low back pain was the chief complaint in all patients.Sciaticawasacomplaintin12(60%)patientsofthe TLIFgroupand13(65%)patientsofthe PLFgroup. Patientswere evaluated preoperatively and postoperatively by visual analog scale (VAS), Oswestry disability index, and radiographs. Results: The average operative time was 214.5 min in the TLIF group and 192.5 min in the PLF group. The mean estimated blood loss was 278 ml in the TLIF group and 259 ml in the PLF group. The average length of hospital stay was 3.85 days in the TLIF group and 3.8 days in the PLF group. Patients progressively improved regarding VAS and Oswestry disability index in both groups, with no statistically signi fi cant difference, except for VAS for back pain, where the TLIF group gave better results. However, the TLIF group gave better results in patients with postlaminectomy instability than the PLF group. Solid fusion occurred in 17 (85%) patients of the TLIF group and 16 (80%) patients of the PLF group, with no statistical difference. Conclusion: Both TLIF and PLF are effective and safe options for treating segmental lumbar instability. However, interbody fusion yields superior results in patients with postlaminectomy instability (2021ESJ253).
{"title":"Transforaminal Lumbar Interbody Fusion versus Posterolateral Fusion for Surgical Treatment of Segmental Lumbar Spinal Instability","authors":"A. Eladawy, Essam M. Youssef, Mohamed Abdeen","doi":"10.57055/2314-8969.1002","DOIUrl":"https://doi.org/10.57055/2314-8969.1002","url":null,"abstract":"Background data: The rationale behind lumbar fusion surgery is to eliminate pathologic segmental motion and its accompanying symptoms, especially low back pain. Posterolateral fusion (PLF) using pedicle screw fi xation has been one of the most popular procedures among the posterior lumbar reconstruction techniques. Lumbar interbody fusion is a recognized surgical technique in treating chronic low back pain in segmental instability. Purpose: The purpose of this study was to compare the clinical and radiological outcomes of stabilizing the lumbar spine using transforaminal lumbar interbody fusion (TLIF) versus PLF for lumbar segmental instability. Study design: A prospective, nonrandomized clinical controlled trial was performed. Patients and methods: A total of 40 patients with segmental lumbar instability were divided into two groups (TLIF and PLF groups), with 20 patients each. Top-loaded pedicle screw construct was used with both groups. The mean age of the patients was 48.35 years in the TLIF group and 45.3 years in the PLF group. Sex distribution was six males and 14 females in the TLIF group and seven males and 13 females in the PLF group. Mechanical low back pain was the chief complaint in all patients.Sciaticawasacomplaintin12(60%)patientsofthe TLIFgroupand13(65%)patientsofthe PLFgroup. Patientswere evaluated preoperatively and postoperatively by visual analog scale (VAS), Oswestry disability index, and radiographs. Results: The average operative time was 214.5 min in the TLIF group and 192.5 min in the PLF group. The mean estimated blood loss was 278 ml in the TLIF group and 259 ml in the PLF group. The average length of hospital stay was 3.85 days in the TLIF group and 3.8 days in the PLF group. Patients progressively improved regarding VAS and Oswestry disability index in both groups, with no statistically signi fi cant difference, except for VAS for back pain, where the TLIF group gave better results. However, the TLIF group gave better results in patients with postlaminectomy instability than the PLF group. Solid fusion occurred in 17 (85%) patients of the TLIF group and 16 (80%) patients of the PLF group, with no statistical difference. Conclusion: Both TLIF and PLF are effective and safe options for treating segmental lumbar instability. However, interbody fusion yields superior results in patients with postlaminectomy instability (2021ESJ253).","PeriodicalId":11610,"journal":{"name":"Egyptian Spine Journal","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48690848","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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