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Daniel M. Sciubba - One of the best experts on this subject based on the ideXlab platform.
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Predicting survival for metastatic Spine Disease: a comparison of nine scoring systems
The spine journal : official journal of the North American Spine Society, 2018Co-Authors: A. Karim Ahmed, C. Rory Goodwin, Amir S. Heravi, Rachel C. Kim, Nancy Abu-bonsrah, Eric W. Sankey, Daniel Kerekes, Rafael De La Garza Ramos, Joseph H. Schwab, Daniel M. SciubbaAbstract:Abstract Background Context Despite advances in spinal oncology, research in patient-based prognostic calculators for metastatic Spine Disease is lacking. Much of the literature in this area investigates the general predictive accuracy of scoring systems in heterogeneous populations, with few studies considering the accuracy of scoring systems based on patient specifics such as type of primary tumor. Purpose The aim of the present study was to compare the ability of widespread scoring systems to estimate both overall survival at various time points and tumor-specific survival for patients undergoing surgical treatment for metastatic Spine Disease in order to provide surgeons with information to determine the most appropriate scoring system for a specific patient and timeline. Study Design This is a retrospective study. Patient Sample Patients who underwent surgical resection for metastatic Spine Disease at a single institution were included. Outcome Measures Areas under the receiver operating characteristic curves were generated from comparison of actual survival of patients and survival as predicted by application of prevalent scoring systems. Methods A preoperative score for all 176 patients was retrospectively calculated utilizing the Skeletal Oncology Research Group (SORG) Classic Scoring Algorithm, SORG Nomogram, original Tokuhashi, revised Tokuhashi, Tomita, original Bauer, modified Bauer, Katagiri, and van der Linden scoring systems. Univariate and multivariate Cox proportional hazard models were constructed to assess the association of patient variables with survival. Receiver operating characteristic analysis modeling was utilized to quantify the accuracy of each test at different end points and for different primary tumor subgroups. No funds were received in support of this work. The authors have no conflicts of interest to disclose. Results Among all patients surgically treated for metastatic Spine Disease, the SORG Nomogram demonstrated the highest accuracy at predicting 30-day (area under the curve [AUC] 0.81) and 90-day (AUC 0.70) survival after surgery. The original Tokuhashi was the most accurate at predicting 365-day survival (AUC 0.78). Multivariate analysis demonstrated multiple preoperative factors strongly associated with survival after surgery for spinal metastasis. The accuracy of each scoring system in determining survival probability relative to primary tumor etiology and time elapsed since surgery was assessed. Conclusions Among the nine scoring systems assessed, the present study determined the most accurate scoring system for short-term (30-day), intermediate (90-day), and long-term (365-day) survival, relative to primary tumor etiology. The findings of the present study may be utilized by surgeons in a personalized effort to select the most appropriate scoring system for a given patient.
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emerging and established clinical histopathological and molecular parametric prognostic factors for metastatic Spine Disease secondary to lung cancer helping surgeons make decisions
Journal of Clinical Neuroscience, 2016Co-Authors: Nuno Batista, Laurence D. Rhines, Daniel M. Sciubba, Ziya L. Gokaslan, Ilya Laufer, Arjun Sahgal, Michael G. Fehlings, Jin Tee, Michael H Weber, Shreyaskumar PatelAbstract:Abstract Metastatic lung cancer to the Spine occurs at high rates with patients usually given poor prognoses. Recent studies have observed that patients with certain genetic and molecular aberrations have better responses to adjuvant therapy. As such, current metastatic Spine Disease treatment algorithms grading all lung primaries’ prognosis as poor may lead to inadequate treatment of spinal metastases. The aims of this study are to determine current survival patterns in metastatic Spine Disease secondary to lung cancer and identify relevant parameters that influence the prognostication of these patients. A systematic review in accordance with PRISMA guidelines was conducted for literature published between January 1, 1996 and September 31, 2015. The 27 studies identified were Level IV retrospective studies with an overall ‘low’ level of evidence. The overall median survival of patients with Spine involved metastatic lung cancer was poor, ranging from 3.6 to 9 months. Median survival of patients with non-small cell lung cancer being treated with epidermal growth factor receptor (EGFR) inhibitors were observed to be better, with survival of up to 18 months. This review reports a subset of lung cancer patients with oncogenic molecular mutations that appear to confer a better overall survival. In these patients, individualized assessment rather than strict adherence to current metastatic scoring algorithms when determining management may be preferred.
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When Less Is More: The indications for MIS Techniques and Separation Surgery in Metastatic Spine Disease.
Spine, 2016Co-Authors: Scott L Zuckerman, Meic H. Schmidt, Ilya Laufer, Arjun Sahgal, Yoshiya J Yamada, Dean Chou, John H Shin, Naresh Kumar, Daniel M. SciubbaAbstract:Systematic review. The aim of this study was to review the techniques, indications, and outcomes of minimally invasive surgery (MIS) and separation surgery with subsequent radiosurgery in the treatment of patients with metastatic Spine Disease. The utilization of MIS techniques in patients with Spine metastases is a growing area within spinal oncology. Separation surgery represents a novel paradigm where radiosurgery provides long-term control after tumor is surgically separated from the neural elements. PubMed, Embase, and CINAHL databases were systematically queried for literature reporting MIS techniques or separation surgery in patients with metastatic Spine Disease. PRISMA guidelines were followed. Of the initial 983 articles found, 29 met inclusion criteria. Twenty-five articles discussed MIS techniques and were grouped according to the primary objective: percutaneous stabilization (8), tubular retractors (4), mini-open approach (8), and thoracoscopy/endoscopy (5). The remaining 4 studies reported separation surgery. Indications were similar across all studies and included patients with instability, refractory pain, or neurologic compromise. Intraoperative variables, outcomes, and complications were similar in MIS studies compared to traditional approaches, and some MIS studies showed a statistically significant improvement in outcomes. Studies of mini-open techniques had the strongest evidence for superiority. Low-quality evidence currently exists for MIS techniques and separation surgery in the treatment of metastatic Spine Disease. Given the early promising results, the next iteration of research should include higher-quality studies with sufficient power, and will be able to provide higher-level evidence on the outcomes of MIS approaches and separation surgery. N/A.
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When Less Is More: The indications for MIS Techniques and Separation Surgery in Metastatic Spine Disease.
Spine, 2016Co-Authors: Scott L Zuckerman, Meic H. Schmidt, Yoshiya Yamada, Ilya Laufer, Arjun Sahgal, Dean Chou, John H Shin, Naresh Kumar, Daniel M. SciubbaAbstract:STUDY DESIGN Systematic review. OBJECTIVE The aim of this study was to review the techniques, indications, and outcomes of minimally invasive surgery (MIS) and separation surgery with subsequent radiosurgery in the treatment of patients with metastatic Spine Disease. SUMMARY OF BACKGROUND DATA The utilization of MIS techniques in patients with Spine metastases is a growing area within spinal oncology. Separation surgery represents a novel paradigm where radiosurgery provides long-term control after tumor is surgically separated from the neural elements. METHODS PubMed, Embase, and CINAHL databases were systematically queried for literature reporting MIS techniques or separation surgery in patients with metastatic Spine Disease. PRISMA guidelines were followed. RESULTS Of the initial 983 articles found, 29 met inclusion criteria. Twenty-five articles discussed MIS techniques and were grouped according to the primary objective: percutaneous stabilization (8), tubular retractors (4), mini-open approach (8), and thoracoscopy/endoscopy (5). The remaining 4 studies reported separation surgery. Indications were similar across all studies and included patients with instability, refractory pain, or neurologic compromise. Intraoperative variables, outcomes, and complications were similar in MIS studies compared to traditional approaches, and some MIS studies showed a statistically significant improvement in outcomes. Studies of mini-open techniques had the strongest evidence for superiority. CONCLUSIONS Low-quality evidence currently exists for MIS techniques and separation surgery in the treatment of metastatic Spine Disease. Given the early promising results, the next iteration of research should include higher-quality studies with sufficient power, and will be able to provide higher-level evidence on the outcomes of MIS approaches and separation surgery. LEVEL OF EVIDENCE N/A.
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Management of Metastatic Spine Disease
2014Co-Authors: Daniel M. Sciubba, Alp YurterAbstract:The incidence of primary cancer increases with each passing year, and patients are living longer as a result of improved therapies and interdisciplinary management. Consequently, long-term complications such as debilitating spinal metastases are becoming more prevalent. In this review, the mechanism of metastasis, clinical presentation, and imaging modalities are briefly summarized. Then, various surgical options, radiotherapies, vertebral augmentation procedures, and systemic therapies are described, including recent, clinically-relevant statistics. Currently, the treatment of spinal metastases is palliative and ideally involves a multidisciplinary approach across various specialties. The number of available treatments continues to grow, resulting in paradigm shifts. Only by determining the niche of each therapy can physicians provide the optimal regimen for patients with metastatic Spine Disease.
Peter Vajkoczy - One of the best experts on this subject based on the ideXlab platform.
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impact of sacropelvic fixation on the development of postoperative sacroiliac joint pain following multilevel stabilization for degenerative Spine Disease
Clinical Neurology and Neurosurgery, 2016Co-Authors: Tobias Finger, Simon Bayerl, Marcus Czabanka, Johannes Woitzik, M Bertog, Peter VajkoczyAbstract:Abstract Objective We hypothesised, that the inclusion of the ilium for multilevel lumbosacral fusions reduces the incidence of postoperative sacroiliac joint (SIJ) pain. The primary objective of this study was to compare the frequency of postoperative SIJ pain in patients undergoing multilevel stabilization with and without sacropelvic fixation for multilevel degenerative Spine Disease. In addition, we aimed at identifying factors that may predict the worsening or new onset of postoperative SIJ pain. Methods A total of 63 patients with multisegmental fusion surgery with a minimum follow up of 12 months were evaluated. 34 patients received sacral fixation (SF group) and 29 patients received an additional sacropelvic fixation device (SPF group). Primary outcome parameters were changes in SIJ pain between the groups and the influence of pelvic parameters, the patients age, the patients body mass index (BMI) and the length of the stabilization on the SIJ pain. Results Between the two surgical groups there were no differences concerning age (p = 0.3), BMI (p = 0.56), length of follow up (p = 0.96), length of the construct (p = 0.56). In total 31.7% of the patients had a worsening/new onset of SIJ pain after surgery. An additional fixation of the SIJ with iliac screws or iliosacral plate did not have an influence on the SIJ pain (p = 0.67). Likewise, pelvic parameters were not predictive for the outcome of the SIJ pain. Only an increased preoperative BMI correlated with a higher chance of a new onset of SIJ pain (p = 0.037). Conclusion In our retrospective study there was no influence of a sacropelvic fixation techniques on the SIJ pain in patients with multilevel degenerative Spine Disease after multilevel stabilization surgeries. The patients’ BMI is the only preoperative factor that correlated with a higher incidence to develop postoperative SIJ pain, independently of the implantation of a sacropelvic fixation device.
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sacropelvic fixation versus fusion to the sacrum for spondylodesis in multilevel degenerative Spine Disease
European Spine Journal, 2014Co-Authors: Tobias Finger, Simon Bayerl, Julia Onken, Marcus Czabanka, Johannes Woitzik, Peter VajkoczyAbstract:Retrospective study. For successful multilevel correction and stabilization of degenerative spinal deformities, a rigid basal construct to the sacrum is indispensable. The primary objective of this study was to compare the results of two different sacropelvic fixation techniques to conventional stabilization to the sacrum in patients with multilevel degenerative Spine Disease. A total of 69 patients with multisegmental fusion surgery (mean number of stabilized functional spinal units: 7.0 ± 3.3) with a minimum of 1-year follow-up were included. 32 patients received fixation to the sacrum (S1), 23 patients received S1 and iliac screw fixation (iliac) and 14 patients were treated with iliosacral plate fixation (plate). Primary outcome parameters were radiographic outcome concerning fusion in the segment L5–S1, rate of screw loosening, back and buttock pain reduction [numeric rating scale for pain evaluation: 0 indicating no pain, 10 indicating the worst pain], overall extent of disability after surgery (Oswestry Disability Index) and the number of complications. The three groups did not differ in body mass index, ASA score, the number of stabilized functional spinal units, duration of surgery, the number of previous Spine surgeries, or postoperative complication rate. The incidence of L5–S1 pseudarthrosis after 1 year in the S1, iliac, and plate groups was 19, 0, and 29 %, respectively (p < 0.05 iliac vs. plate). The incidence of screw loosening after 1 year in the S1, iliac, and plate groups was 22, 4, and 43 %, respectively (p < 0.05 iliac vs. plate). Average Oswestry scores after 1 year in the S1, iliac, and plate groups were 40 ± 18, 42 ± 20, and 58 ± 18, respectively (p < 0.05 both S1 and iliac vs. plate). The surgical treatment of multilevel degenerative Spine Disease carries a significant risk for pseudarthrosis and screw loosening, mandating a rigid sacropelvic fixation. The use of an iliosacral plate resulted in an inferior surgical and clinical outcome when compared to iliac screws.
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sacropelvic fixation versus fusion to the sacrum for spondylodesis in multilevel degenerative Spine Disease
European Spine Journal, 2014Co-Authors: Tobias Finger, Simon Bayerl, Julia Onken, Marcus Czabanka, Johannes Woitzik, Peter VajkoczyAbstract:STUDY DESIGN: Retrospective study. OBJECTIVE: For successful multilevel correction and stabilization of degenerative spinal deformities, a rigid basal construct to the sacrum is indispensable. The primary objective of this study was to compare the results of two different sacropelvic fixation techniques to conventional stabilization to the sacrum in patients with multilevel degenerative Spine Disease. METHODS: A total of 69 patients with multisegmental fusion surgery (mean number of stabilized functional spinal units: 7.0 ± 3.3) with a minimum of 1-year follow-up were included. 32 patients received fixation to the sacrum (S1), 23 patients received S1 and iliac screw fixation (iliac) and 14 patients were treated with iliosacral plate fixation (plate). Primary outcome parameters were radiographic outcome concerning fusion in the segment L5-S1, rate of screw loosening, back and buttock pain reduction [numeric rating scale for pain evaluation: 0 indicating no pain, 10 indicating the worst pain], overall extent of disability after surgery (Oswestry Disability Index) and the number of complications. RESULTS: The three groups did not differ in body mass index, ASA score, the number of stabilized functional spinal units, duration of surgery, the number of previous Spine surgeries, or postoperative complication rate. The incidence of L5-S1 pseudarthrosis after 1 year in the S1, iliac, and plate groups was 19, 0, and 29 %, respectively (p < 0.05 iliac vs. plate). The incidence of screw loosening after 1 year in the S1, iliac, and plate groups was 22, 4, and 43 %, respectively (p < 0.05 iliac vs. plate). Average Oswestry scores after 1 year in the S1, iliac, and plate groups were 40 ± 18, 42 ± 20, and 58 ± 18, respectively (p < 0.05 both S1 and iliac vs. plate). CONCLUSION: The surgical treatment of multilevel degenerative Spine Disease carries a significant risk for pseudarthrosis and screw loosening, mandating a rigid sacropelvic fixation. The use of an iliosacral plate resulted in an inferior surgical and clinical outcome when compared to iliac screws.
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Sacropelvic fixation versus fusion to the sacrum for spondylodesis in multilevel degenerative Spine Disease.
European spine journal : official publication of the European Spine Society the European Spinal Deformity Society and the European Section of the Cerv, 2014Co-Authors: Tobias Finger, Simon Bayerl, Julia Onken, Marcus Czabanka, Johannes Woitzik, Peter VajkoczyAbstract:Retrospective study. For successful multilevel correction and stabilization of degenerative spinal deformities, a rigid basal construct to the sacrum is indispensable. The primary objective of this study was to compare the results of two different sacropelvic fixation techniques to conventional stabilization to the sacrum in patients with multilevel degenerative Spine Disease. A total of 69 patients with multisegmental fusion surgery (mean number of stabilized functional spinal units: 7.0 ± 3.3) with a minimum of 1-year follow-up were included. 32 patients received fixation to the sacrum (S1), 23 patients received S1 and iliac screw fixation (iliac) and 14 patients were treated with iliosacral plate fixation (plate). Primary outcome parameters were radiographic outcome concerning fusion in the segment L5–S1, rate of screw loosening, back and buttock pain reduction [numeric rating scale for pain evaluation: 0 indicating no pain, 10 indicating the worst pain], overall extent of disability after surgery (Oswestry Disability Index) and the number of complications. The three groups did not differ in body mass index, ASA score, the number of stabilized functional spinal units, duration of surgery, the number of previous Spine surgeries, or postoperative complication rate. The incidence of L5–S1 pseudarthrosis after 1 year in the S1, iliac, and plate groups was 19, 0, and 29 %, respectively (p
Adam N. Wallace - One of the best experts on this subject based on the ideXlab platform.
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Evaluation of the Metastatic Spine Disease Multidisciplinary Working Group Algorithms as Part of a Multidisciplinary Spine Tumor Conference
Global spine journal, 2019Co-Authors: Soumon Rudra, Adam N. Wallace, Mary K. Lauman, Hayley Stowe, Lauren E. Henke, Michael C. Roach, Jiayi Huang, Christina Tsien, Jeffrey D. Bradley, Paul SantiagoAbstract:Study Design:Retrospective cohort study.Objective:The Metastatic Spine Disease Multidisciplinary Working Group Algorithms are evidence and expert opinion–based strategies for utilizing radiation th...
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The metastatic Spine Disease multidisciplinary working group algorithms
The oncologist, 2015Co-Authors: Adam N. Wallace, Clifford G. Robinson, Jeffrey J Meyer, Nam D. Tranf, Afshin Gangi, Matthew R. Callstrom, Samuel T. Chao, Brian A. Van Tine, Jonathan M. Morris, Brian M. BruelAbstract:The Metastatic Spine Disease Multidisciplinary Working Group consists of medical and radiation oncologists, surgeons, and interventional radiologists from multiple comprehensive cancer centers who have developed evidence- and expert opinion-based algorithms for managing metastatic Spine Disease. The purpose of these algorithms is to facilitate interdisciplinary referrals by providing physicians with straightforward recommendations regarding the use of available treatment options, including emerging modalities such as stereotactic body radiation therapy and percutaneous tumor ablation. This consensus document details the evidence supporting the Working Group algorithms and includes illustrative cases to demonstrate how the algorithms may be applied.
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Use of Imaging in the Management of Metastatic Spine Disease With Percutaneous Ablation and Vertebral Augmentation.
AJR. American journal of roentgenology, 2015Co-Authors: Adam N. Wallace, Taylor J. Greenwood, Jack W. JenningsAbstract:OBJECTIVE. The purpose of this article is to describe the role of imaging in the management of metastatic Spine Disease with percutaneous ablation and vertebral augmentation. Topics include the imaging diagnosis of spinal metastases, imaging factors related to patient selection and procedural planning, intraprocedural imaging guidance, and posttreatment imaging assessment. CONCLUSION. Radiologists should be familiar with pertinent imaging findings related to the percutaneous management of metastatic Spine Disease.
Meic H. Schmidt - One of the best experts on this subject based on the ideXlab platform.
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When Less Is More: The indications for MIS Techniques and Separation Surgery in Metastatic Spine Disease.
Spine, 2016Co-Authors: Scott L Zuckerman, Meic H. Schmidt, Ilya Laufer, Arjun Sahgal, Yoshiya J Yamada, Dean Chou, John H Shin, Naresh Kumar, Daniel M. SciubbaAbstract:Systematic review. The aim of this study was to review the techniques, indications, and outcomes of minimally invasive surgery (MIS) and separation surgery with subsequent radiosurgery in the treatment of patients with metastatic Spine Disease. The utilization of MIS techniques in patients with Spine metastases is a growing area within spinal oncology. Separation surgery represents a novel paradigm where radiosurgery provides long-term control after tumor is surgically separated from the neural elements. PubMed, Embase, and CINAHL databases were systematically queried for literature reporting MIS techniques or separation surgery in patients with metastatic Spine Disease. PRISMA guidelines were followed. Of the initial 983 articles found, 29 met inclusion criteria. Twenty-five articles discussed MIS techniques and were grouped according to the primary objective: percutaneous stabilization (8), tubular retractors (4), mini-open approach (8), and thoracoscopy/endoscopy (5). The remaining 4 studies reported separation surgery. Indications were similar across all studies and included patients with instability, refractory pain, or neurologic compromise. Intraoperative variables, outcomes, and complications were similar in MIS studies compared to traditional approaches, and some MIS studies showed a statistically significant improvement in outcomes. Studies of mini-open techniques had the strongest evidence for superiority. Low-quality evidence currently exists for MIS techniques and separation surgery in the treatment of metastatic Spine Disease. Given the early promising results, the next iteration of research should include higher-quality studies with sufficient power, and will be able to provide higher-level evidence on the outcomes of MIS approaches and separation surgery. N/A.
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When Less Is More: The indications for MIS Techniques and Separation Surgery in Metastatic Spine Disease.
Spine, 2016Co-Authors: Scott L Zuckerman, Meic H. Schmidt, Yoshiya Yamada, Ilya Laufer, Arjun Sahgal, Dean Chou, John H Shin, Naresh Kumar, Daniel M. SciubbaAbstract:STUDY DESIGN Systematic review. OBJECTIVE The aim of this study was to review the techniques, indications, and outcomes of minimally invasive surgery (MIS) and separation surgery with subsequent radiosurgery in the treatment of patients with metastatic Spine Disease. SUMMARY OF BACKGROUND DATA The utilization of MIS techniques in patients with Spine metastases is a growing area within spinal oncology. Separation surgery represents a novel paradigm where radiosurgery provides long-term control after tumor is surgically separated from the neural elements. METHODS PubMed, Embase, and CINAHL databases were systematically queried for literature reporting MIS techniques or separation surgery in patients with metastatic Spine Disease. PRISMA guidelines were followed. RESULTS Of the initial 983 articles found, 29 met inclusion criteria. Twenty-five articles discussed MIS techniques and were grouped according to the primary objective: percutaneous stabilization (8), tubular retractors (4), mini-open approach (8), and thoracoscopy/endoscopy (5). The remaining 4 studies reported separation surgery. Indications were similar across all studies and included patients with instability, refractory pain, or neurologic compromise. Intraoperative variables, outcomes, and complications were similar in MIS studies compared to traditional approaches, and some MIS studies showed a statistically significant improvement in outcomes. Studies of mini-open techniques had the strongest evidence for superiority. CONCLUSIONS Low-quality evidence currently exists for MIS techniques and separation surgery in the treatment of metastatic Spine Disease. Given the early promising results, the next iteration of research should include higher-quality studies with sufficient power, and will be able to provide higher-level evidence on the outcomes of MIS approaches and separation surgery. LEVEL OF EVIDENCE N/A.
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Thoracoscopic transdiaphragmatic approach for ventral decompression and reconstruction of metastatic Spine Disease.
Neurosurgical focus, 2012Co-Authors: Meic H. SchmidtAbstract:The management of metastatic Spine Disease is complex, but usually involves radiation therapy and/or surgical treatment. Surgery followed by radiation has a significant role in select patients presenting with metastatic spinal cord compression. Ventral decompression can be achieved through several surgical approaches including posterior, posterolateral, and anterior surgical approaches. Although open thoracotomy is the most common approach for ventral decompression, it is associated with significant spinal access morbidity. This video illustrates a thoracoscopic transdiaphragmatic approach for symptomatic L-1 metastatic spinal cord compression. This approach allows for a minimal incision in the diaphragm to expose the thoracolumbar junction and allows for corpectomy, spinal canal decompression, vertebral body replacement, and spinal stabilization via four small incisions along the chest wall. The step-by-step technique illustrates operative nuances and surgical pearls to safely perform this approach in a ...
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timing of surgery and radiotherapy in the management of metastatic Spine Disease a systematic review
International Journal of Oncology, 2010Co-Authors: Eyal Itshayek, Ziya L. Gokaslan, Meic H. Schmidt, Peter C Gerszten, Josh Yamada, Mark H Bilsky, Christopher I Shaffrey, David W Polly, Peter Paul Varga, Charles G. FisherAbstract:The last decade has witnessed a dramatic change in management of metastatic Spine Disease, with an increased role for surgery and emerging use of stereotactic radiotherapy, often in combination. Patients may be treated with radiotherapy followed by surgery, or have surgery and then adjuvant radiotherapy. In both cases, the surgeon and oncologist need to select the optimal timing for surgery and radiotherapy to minimize wound complications while obtaining maximum oncolytic effects. The purpose of this review was to determine the optimal timing of surgery and radiotherapy in patients surgically treated for spinal metastases. A systematic review utilizing Medline, Embase, Paper First, Web of Science, Google Scholar, and the Cochrane Database of Systematic Reviews was performed. References were screened to further identify relevant studies and basic science literature reviewed. A total of 46 reports discussing the timing of surgery after radiotherapy, describing experience in 5836 patients, were identified. Only one retrospective study addressed the research question and suggested that surgery within seven days of radiation increases the rate of postoperative wound complications. Timing of adjuvant radiotherapy following surgery was addressed in 51 reports describing 7090 patients. None of the studies specifically answered the research question. The time interval between radiotherapy and surgery was reported as 5-21 days in nine studies. Based on this systematic review together with the understanding of general principles of wound healing and effects of radiation on wound healing, the optimal radiotherapy-surgery/surgery-radiotherapy time interval should be at least one week to minimize wound complications.
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minimally invasive thoracoscopic approach for anterior decompression and stabilization of metastatic Spine Disease
Neurosurgical Focus, 2008Co-Authors: Meic H. SchmidtAbstract:Object The choices available in the management of metastatic Spine Disease are complex, and the role of surgical therapy is increasing. Recent studies have indicated that patients treated with direct surgical decompression and stabilization before radiation have better functional outcomes than those treated with radiation alone. The most common anterior surgical approach for direct spinal cord decompression and stabilization in the thoracic Spine is open thoracotomy; however, thoracotomy for spinal access is associated with morbidity that can be avoided with minimally invasive techniques like thoracoscopy. Methods A minimally invasive thoracoscopic approach was used for the surgical treatment of thoracic and thoracolumbar metastatic spinal cord compression. This technique allows ventral decompression via corpectomy, inter-body reconstruction with expandable cages, and stabilization with an anterolateral plating system designed specifically for minimally invasive implantation. This technique was performed ...
Tobias Finger - One of the best experts on this subject based on the ideXlab platform.
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impact of sacropelvic fixation on the development of postoperative sacroiliac joint pain following multilevel stabilization for degenerative Spine Disease
Clinical Neurology and Neurosurgery, 2016Co-Authors: Tobias Finger, Simon Bayerl, Marcus Czabanka, Johannes Woitzik, M Bertog, Peter VajkoczyAbstract:Abstract Objective We hypothesised, that the inclusion of the ilium for multilevel lumbosacral fusions reduces the incidence of postoperative sacroiliac joint (SIJ) pain. The primary objective of this study was to compare the frequency of postoperative SIJ pain in patients undergoing multilevel stabilization with and without sacropelvic fixation for multilevel degenerative Spine Disease. In addition, we aimed at identifying factors that may predict the worsening or new onset of postoperative SIJ pain. Methods A total of 63 patients with multisegmental fusion surgery with a minimum follow up of 12 months were evaluated. 34 patients received sacral fixation (SF group) and 29 patients received an additional sacropelvic fixation device (SPF group). Primary outcome parameters were changes in SIJ pain between the groups and the influence of pelvic parameters, the patients age, the patients body mass index (BMI) and the length of the stabilization on the SIJ pain. Results Between the two surgical groups there were no differences concerning age (p = 0.3), BMI (p = 0.56), length of follow up (p = 0.96), length of the construct (p = 0.56). In total 31.7% of the patients had a worsening/new onset of SIJ pain after surgery. An additional fixation of the SIJ with iliac screws or iliosacral plate did not have an influence on the SIJ pain (p = 0.67). Likewise, pelvic parameters were not predictive for the outcome of the SIJ pain. Only an increased preoperative BMI correlated with a higher chance of a new onset of SIJ pain (p = 0.037). Conclusion In our retrospective study there was no influence of a sacropelvic fixation techniques on the SIJ pain in patients with multilevel degenerative Spine Disease after multilevel stabilization surgeries. The patients’ BMI is the only preoperative factor that correlated with a higher incidence to develop postoperative SIJ pain, independently of the implantation of a sacropelvic fixation device.
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sacropelvic fixation versus fusion to the sacrum for spondylodesis in multilevel degenerative Spine Disease
European Spine Journal, 2014Co-Authors: Tobias Finger, Simon Bayerl, Julia Onken, Marcus Czabanka, Johannes Woitzik, Peter VajkoczyAbstract:Retrospective study. For successful multilevel correction and stabilization of degenerative spinal deformities, a rigid basal construct to the sacrum is indispensable. The primary objective of this study was to compare the results of two different sacropelvic fixation techniques to conventional stabilization to the sacrum in patients with multilevel degenerative Spine Disease. A total of 69 patients with multisegmental fusion surgery (mean number of stabilized functional spinal units: 7.0 ± 3.3) with a minimum of 1-year follow-up were included. 32 patients received fixation to the sacrum (S1), 23 patients received S1 and iliac screw fixation (iliac) and 14 patients were treated with iliosacral plate fixation (plate). Primary outcome parameters were radiographic outcome concerning fusion in the segment L5–S1, rate of screw loosening, back and buttock pain reduction [numeric rating scale for pain evaluation: 0 indicating no pain, 10 indicating the worst pain], overall extent of disability after surgery (Oswestry Disability Index) and the number of complications. The three groups did not differ in body mass index, ASA score, the number of stabilized functional spinal units, duration of surgery, the number of previous Spine surgeries, or postoperative complication rate. The incidence of L5–S1 pseudarthrosis after 1 year in the S1, iliac, and plate groups was 19, 0, and 29 %, respectively (p < 0.05 iliac vs. plate). The incidence of screw loosening after 1 year in the S1, iliac, and plate groups was 22, 4, and 43 %, respectively (p < 0.05 iliac vs. plate). Average Oswestry scores after 1 year in the S1, iliac, and plate groups were 40 ± 18, 42 ± 20, and 58 ± 18, respectively (p < 0.05 both S1 and iliac vs. plate). The surgical treatment of multilevel degenerative Spine Disease carries a significant risk for pseudarthrosis and screw loosening, mandating a rigid sacropelvic fixation. The use of an iliosacral plate resulted in an inferior surgical and clinical outcome when compared to iliac screws.
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sacropelvic fixation versus fusion to the sacrum for spondylodesis in multilevel degenerative Spine Disease
European Spine Journal, 2014Co-Authors: Tobias Finger, Simon Bayerl, Julia Onken, Marcus Czabanka, Johannes Woitzik, Peter VajkoczyAbstract:STUDY DESIGN: Retrospective study. OBJECTIVE: For successful multilevel correction and stabilization of degenerative spinal deformities, a rigid basal construct to the sacrum is indispensable. The primary objective of this study was to compare the results of two different sacropelvic fixation techniques to conventional stabilization to the sacrum in patients with multilevel degenerative Spine Disease. METHODS: A total of 69 patients with multisegmental fusion surgery (mean number of stabilized functional spinal units: 7.0 ± 3.3) with a minimum of 1-year follow-up were included. 32 patients received fixation to the sacrum (S1), 23 patients received S1 and iliac screw fixation (iliac) and 14 patients were treated with iliosacral plate fixation (plate). Primary outcome parameters were radiographic outcome concerning fusion in the segment L5-S1, rate of screw loosening, back and buttock pain reduction [numeric rating scale for pain evaluation: 0 indicating no pain, 10 indicating the worst pain], overall extent of disability after surgery (Oswestry Disability Index) and the number of complications. RESULTS: The three groups did not differ in body mass index, ASA score, the number of stabilized functional spinal units, duration of surgery, the number of previous Spine surgeries, or postoperative complication rate. The incidence of L5-S1 pseudarthrosis after 1 year in the S1, iliac, and plate groups was 19, 0, and 29 %, respectively (p < 0.05 iliac vs. plate). The incidence of screw loosening after 1 year in the S1, iliac, and plate groups was 22, 4, and 43 %, respectively (p < 0.05 iliac vs. plate). Average Oswestry scores after 1 year in the S1, iliac, and plate groups were 40 ± 18, 42 ± 20, and 58 ± 18, respectively (p < 0.05 both S1 and iliac vs. plate). CONCLUSION: The surgical treatment of multilevel degenerative Spine Disease carries a significant risk for pseudarthrosis and screw loosening, mandating a rigid sacropelvic fixation. The use of an iliosacral plate resulted in an inferior surgical and clinical outcome when compared to iliac screws.
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Sacropelvic fixation versus fusion to the sacrum for spondylodesis in multilevel degenerative Spine Disease.
European spine journal : official publication of the European Spine Society the European Spinal Deformity Society and the European Section of the Cerv, 2014Co-Authors: Tobias Finger, Simon Bayerl, Julia Onken, Marcus Czabanka, Johannes Woitzik, Peter VajkoczyAbstract:Retrospective study. For successful multilevel correction and stabilization of degenerative spinal deformities, a rigid basal construct to the sacrum is indispensable. The primary objective of this study was to compare the results of two different sacropelvic fixation techniques to conventional stabilization to the sacrum in patients with multilevel degenerative Spine Disease. A total of 69 patients with multisegmental fusion surgery (mean number of stabilized functional spinal units: 7.0 ± 3.3) with a minimum of 1-year follow-up were included. 32 patients received fixation to the sacrum (S1), 23 patients received S1 and iliac screw fixation (iliac) and 14 patients were treated with iliosacral plate fixation (plate). Primary outcome parameters were radiographic outcome concerning fusion in the segment L5–S1, rate of screw loosening, back and buttock pain reduction [numeric rating scale for pain evaluation: 0 indicating no pain, 10 indicating the worst pain], overall extent of disability after surgery (Oswestry Disability Index) and the number of complications. The three groups did not differ in body mass index, ASA score, the number of stabilized functional spinal units, duration of surgery, the number of previous Spine surgeries, or postoperative complication rate. The incidence of L5–S1 pseudarthrosis after 1 year in the S1, iliac, and plate groups was 19, 0, and 29 %, respectively (p
