Transforaminal epidural steroid injections in cervical spinal disease with moderate to severe disability: Comparative study in patients with or without surgery.
Medicine (Baltimore). 2020 Feb;99(7):e19266
Authors: Hong JY, Park JS, Suh SW, Yang JH, Park SY, Kim BT
Despite many clinical trials on cervical epidural steroid injections, the indications for and long-standing outcomes of this treatment remain controversial. We evaluated the outcomes and indications for transforaminal cervical epidural steroid injection (TCESI) in patients with moderate to severe disability.We prospectively gathered data from patients with 1 or 2-level cervical degenerative disease (herniated disc, foraminal stenosis) with moderate to severe disability (3.5 < initial visual analog scale < 6.5, 15 < Neck Disability Index < 35) and greater than 12 weeks of pain, despite conservative treatment. Patients with persistent disability and those who desired surgical intervention underwent decompression surgery. The clinical and demographic characteristics were compared between groups.Of the 309 patients who underwent TCESI, 221 (72%) did not receive surgical treatment during the 1-year follow-up period. The remaining 88 patients (28%) underwent surgery at a mean of 4.1 months after initial TCESI. Patients who underwent injection alone showed a significant decrease in disability and pain that persisted until the 1-year follow-up visit (P < .05). In patients who underwent surgery, the mean disability and pain scores after injection did not decrease for several months, although the scores significantly decreased up to 1 year after surgery (P < .05).The TCESI significantly decreased pain and disability in the moderate to severe disability group up to 1 year after injection. We recommend cervical TCESI as an initial treatment with moderate to severe disability patients.
PMID: 32049868 [PubMed - indexed for MEDLINE]
Two surgical strategies for treating multilevel cervical spondylotic myelopathy combined with kyphotic deformity.
Medicine (Baltimore). 2020 Feb;99(7):e19215
Authors: Yeh KT, Chen IH, Lee RP, Yu TC, Peng CH, Liu KL, Wang JH, Wu WT
This study compared the surgical outcomes of two surgical methods for treating multilevel cervical spondylotic myelopathy (MCSM) combined with cervical kyphotic deformity (CKD): (1) the ELTA method consisted of expansive open-door laminoplasty (EOLP) followed by three-segment anterior cervical discectomy fusion (ACDF), and (2) the LAPI method consisted of long-segment ACDF followed by long-level posterior instrumented fusion (PIF). Surgical treatment of CKD combined with MCSM remains challenging. Surgical considerations should include adequate spinal cord decompression and restoration of satisfactory cervical sagittal alignment (CSA). In certain situations, a solid PIF structure is vital to prevent failure.We included 105 patients who underwent the aforementioned surgical methods for MCSM combined with CKD from January 2013 to December 2017. The minimum follow-up period was 1 year. Comparative analysis was performed to compare the two surgical strategies' preoperative and postoperative functional outcomes, including a visual analog scale for neck pain, neck disability index, the Japanese Orthopedic Association cervical myelopathy score, and the Nurick score, as well as the CSA radiographic outcomes, including C2-7 Cobb angle, C2-7 sagittal vertical axis, and C7 slope. The risk factors related to reduced improvement in functional status were analyzed.A total of 63 patients underwent ELTA and 42 patients underwent LAPI. Improvements in functional outcomes were considerable in both groups. The mean C2-7 Cobb angle was restored from 7.4° ± 2.1° kyphosis to 8.8° ± 4.7° lordosis in the ELTA group and from 15.3° ± 4.2° kyphosis to 15.8° ± 8.1° lordosis in the LAPI group. The maximal correction angle was 22.6° in the ELTA group and 42.6° in the LAPI group.Although changes in CSA seemed to be significantly correlated with improvements of functional status, the ELTA and LAPI methods were both effective for treating MCSM combined with CKD, when appropriately selected. The ELTA method was indicated for MCSM patients who had a low degree of CKD, whereas the LAPI method was indicated for MCSM patients who had poor function scores and a high degree of CKD.
PMID: 32049859 [PubMed - indexed for MEDLINE]
Drainage after posterior single-level instrumented lumbar fusion: Natural pressure vs negative pressure.
Medicine (Baltimore). 2020 Feb;99(7):e19154
Authors: Chen T, Chang H, Liu K, Shi M, Song C, Meng X
Recent findings have shown a trend toward recommending against the routine use of drains in spinal surgery because it carries the risk for potential complications. However, most surgeons still use closed suction drainage to prevent hematoma formation. This study is to compare the clinical outcomes between natural pressure drainage and negative pressure drainage after posterior lumbar interbody fusion.Consecutive 132 patients who underwent spinal fusion in the Third Hospital of Hebei Medical University and met the inclusion criteria were reviewed from January 2018 to January 2019 and divided into negative pressure drainage group and natural pressure drainage group according to different pressure drainage. There were 64 patients who had a negative pressure drainage placed and 68 patients who had a natural pressure drainage placed. Demographics, intraoperative blood loss, operative room time, drainage volume at the 1st postoperative day, total volume of postoperative drainage, the total drainage days, postoperative temperature, and postoperative complications (wound infection, symptomatic hematoma) were compared between the 2 groups.The median drainage volume at the 1st postoperative day in negative pressure group was 204.89 ± 95.19 mL, while in natural pressure group, it was 141.00 ± 52.19 mL (P = .000). The median total volume of postoperative drainage in negative pressure group was 378.06 ± 117.98 mL, while in natural pressure group, it was 249.32 ± 70.74 mL (P = .000). The median total drainage days between natural pressure group and negative pressure group were obviously different (2.93 ± 0.55 vs 3.51 ± 0.71 days, P = .000). There was no difference in patient characteristics, operative data, postoperative temperature, and complications.Natural pressure drainage significantly reduced postoperative drainage volume and indwelling time, but did not increase postoperative complications. Therefore, it may offer an alternative to negative pressure drainage and is as safe and effective as negative pressure drainage.
PMID: 32049842 [PubMed - indexed for MEDLINE]
Pharmacokinetic Analysis of [18F]FAZA Dynamic PET Imaging Acquisitions for Highlighting Sacrum Tumor Profiles.
Clin Nucl Med. 2020 Jan;45(1):e36-e38
Authors: Provost C, Mammar H, Belly-Poinsignon A, Madar O, Champion L
A patient enrolled in a clinical trial (NCT02802969) with suspicion of chordoma underwent an [F]FAZA PET/CT, a radiolabeled nitroimidazole analog of hypoxia PET imaging. The patient's images showed a different tumor profile compared to those observed in other hypoxic or nonhypoxic chordoma patients. The motivation for using [F]FAZA pharmacokinetic imaging was to compare this profile with histologically confirmed cases of chordoma. Through visual imaging and quantification of blood and tumor time-activity curves, we excluded the hypothesis that it was a chordoma, diagnosing a paraganglioma.
PMID: 31693621 [PubMed - indexed for MEDLINE]
FDG PET/CT of Cervical Gout With Spinal Cord Compression.
Clin Nucl Med. 2020 Jan;45(1):e29-e31
Authors: Emsen B, Fitoussi A, Chalaye J, Adam C, Itti E
We report FDG PET/CT images of a 63-year-old woman referred for characterization of osteolytic lesions of the cervical spine. This patient with chronic renal failure had a history of follicular thyroid carcinoma with undifferentiated cells, treated by a total thyroidectomy, completed by radioactive iodine in 2017. Because of cancer history, a FDG PET/CT was performed and showed multiple moderately hypermetabolic osteolytic lesions of the spine from C3 to T1, with joint erosion on CT. A laminectomy was performed for cervical spinal cord decompression and revealed a gouty tophus.
PMID: 31652157 [PubMed - indexed for MEDLINE]
Skin Ultrasound Measurement as a Potential Marker of Bone Quality: A Prospective Pilot Study of Patients undergoing Lumbar Spinal Fusion.
J Orthop Res. 2019 12;37(12):2508-2515
Authors: Salzmann SN, Okano I, Rentenberger C, Winter F, Miller CO, Schadler P, Sax OC, Miller TT, Shue J, Boskey AL, Sama AA, Cammisa FP, Girardi FP, Hughes AP
Bone mineral density (BMD) is not the sole predictor of fracture development. Qualitative markers including bone collagen maturity contribute to bone fragility. Bone and related type I collagen containing connective tissues degenerate in parallel fashion. With aging, changes in skin collagen content and quality have been observed that can be detected on ultrasound (US) as a decrease in dermal thickness and an increase in reticular layer echogenicity. We hypothesized that US dermal thickness and echogenicity correlate with bone collagen maturity. Data of 43 prospectively enrolled patients (mean age 61 years, 24 females), who underwent instrumented, posterior lumbar fusion was analyzed. Besides preoperative quantitative computed tomography (QCT) and skin US measurements, intraoperative bone biopsies were obtained and analyzed with Fourier-transform infrared spectroscopy. Among men, there was no correlation between US measurements and collagen maturity. Among women, dermal layer thickness correlated negatively with collagen maturity in trabecular bone of the iliac crest (r = -0.51, p = 0.01) and vertebra (r = -0.59, p = 0.01) as well as in cortical bone of the iliac crest (r = -0.50, p = 0.02) and vertebra (r = -0.50, p = 0.04). In addition, echogenicity correlated positively with collagen maturity in trabecular vertebral bone (r = 0.59, p = 0.01). In both genders, US measurements showed no correlation with QCT BMD. In summary, ultrasound skin parameters are associated with bone quality factors such as collagen maturity, rather than bone quantity (BMD). Ultrasound of the skin may thereby be an easy and accessible take off point for diagnosis of bone collagen maturity and connective tissue degeneration in the future. © 2019 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 37:2508-2515, 2019.
PMID: 31403220 [PubMed - indexed for MEDLINE]