Value and role of surgical margins in transoral laser microsurgery of the larynx, literature review and clinical considerations.

PURPOSE: There is no agreement on the most appropriate post-operative pathway for the management of positive margins after laser cordectomy for early stage glottic tumours (T1-2N0M0). This literature review and meta-analysis aim to evaluate the post-operative treatment with the best oncological results among follow-up, radiotherapy (RT) and surgical second look. The parameters utilized were incidence of recurrence, overall (OS), disease-specific (DSS) and disease-free (DFS) survival and larynx preservation (LP). METHODS: The articles were found through a string typed into PubMed from 2007 to 2022. The studies with detailed oncological results were selected according to inclusion criteria, and then the meta-analysis was carried out. RESULTS: Sixteen studies met the inclusion criteria for 2808 patients. The positive margin was found in 748 patients (26.6%), of which 416 were referred to follow-up, 89 to RT and 242 to a surgical second look. A false positive margin was found in 58/104 patients (56%). The recurrence rate in patients with positive margins was significantly higher (p = 0.003). In OS, DSS, DFS and LP, the odds ratio (OR) value was always greater than 1, assessing the role of the positive margin as a risk factor. CONCLUSIONS: Prospective studies will be necessary to establish the role of positive margin as a prognostic factor. A surgical second look in case of positive margin seems to be the best option for the patient in terms of lower risk of recurrence and better oncological results. Better collaboration between surgeon and pathologist would be desirable to limit the real and false positive margins.

Functional assessment of the lumbar spine through the optoelectronic ZooMS system. Clinical application.

AIM: The radiographic method remains the main imaging technique for the physiological, anatomical and possibly pathological analysis of the spine thanks to its ease of use, precision and reliability. Despite this, the technique is inadequate for functional and dynamic studies. This paper aims to apply a dedicated noninvasive methodology based on optoelectronic techniques for the functional evaluation of the lumbar spine. METHODS: A reference data set for typical movements (i.e. flexion/extension, lateral bending, axial rotation) of the lumbar spine has been developed. Twenty healthy subjects have been recruited (10 males and 10 females) to create the databases of healthy subjects; one subject who suffers from lumbar spine diseases has been analyzed and his mobility has been compared to healthy subjects. RESULTS: Two databases have been created: in the former, the entire movement is normalized in time with respect to its duration; in the latter, all movements are classified in characteristic phases and each single phase is normalized to a defined duration. These databases include both the global movement of the lumbar tract of the spine and the movement of the single functional units (2 vertebrae, the intervertebral disk and the intervening surrounding soft tissues). Moreover, these databases are divided into male and female databases according to the natural differences in range of motion and pattern of movement. A clinical application for pathologic subjects is shown demonstrating the applicability and usability of this protocol. CONCLUSION: This method allows to assess both the quality and the quantity of lumbar spine movement (both global and metameric level) of the subject and to distinguish the patient from the healthy subject.

Evaluation of head-to-trunk control in whiplash patients using digital CranioCorpoGraphy during a stepping test.

We used digital-CranioCorpoGraphy (dCCG) to document whiplash effects on head-on-trunk stabilization while subjects walked on the spot (Fukuda test). Twenty-five healthy subjects were compared with 33 whiplash patients. Whiplash patients were classified as chronic (more than 6 months after injury) and recent (less than 6 months after injury). Clear differences between healthy subjects and patients were seen and three different strategies were detected. Pattern A appeared similar to normals but quantitative analysis showed significant differences with paradoxical head over-stabilization (collar-effect); pattern B decreased head stability; pattern C decreased head stabilization with reduced displacements of the body. Due to the complexity of the data analyzed for each marker, a coefficient of performance (CP) was calculated to simplify the cut-off between normal and pathological tests. CP clearly identified an abnormal stepping pattern. Our findings indicate that firstly dCCG identified a specific vestibular task in whiplash patients, secondly whiplash did not always provoke vestibular involvement and thirdly dCCG could be a tool to discriminate patients with and without vestibular involvement after whiplash.

ZooMS: a non invasive analysis of global and metameric movement of the lumbar spine.

AIM: The assessment of spine mobility is an important parameter to define its functionality. In the last decades a lot of research has been carried out mainly through radiographic investigations; non invasive methods demonstrated not to be sufficiently accurate, not to allow free movement, not to provide metameric assessment and suitable for everyday clinical practice. The aim of this study is the development of a new experimental non invasive protocol, called Zoom on mobility of the spine (ZooMS) to assess the mobility of lumbar spine, from the 11th thoracic to the sacrum bone and the pelvis, with the possibility of identifying the metameric contribution of each rotation around all the axes correlated to the global movement. METHODS: We developed a dedicated non invasive methodology based on optoelectronic techniques for 3D target recording to be applied to the functional evaluation of the mobility of the lumbar spine in young healthy males. Ten subjects participated in the method validation, performing free rotations (flexion/extension, lateral bending and axial rotation) from standing to the maximum excursion and back. RESULTS: The comparison of the range of motion (RoM) with those presented in literature was satisfactory, although some differences were shown (above all in axial rotation, which however gives the minor contribution to the mobility of the lumbar spine). The validation of the protocol was successful in terms of intraoperator, interoperator and circadian remarking, the 3 factors eventually affecting its repeatability. CONCLUSION: The RoM of the whole lumbar spine and of each functional unit, together with the pattern of movement may so represent an innovative and important aspect in clinical applications.