Flow cytometric evaluation of the safety of intraoperative salvaged blood filtered with leucocyte depletion filter in spine tumour surgery.

BACKGROUND: Intraoperative cell salvage (IOCS) has not been widely adopted in oncological surgery due to the hypothetical concern of reinfusion of malignant cells. We evaluated the feasibility of IOCS in combination with leucocyte depletion filter (LDF) in metastatic spine tumour surgery (MSTS). METHODS: Patients with known primary epithelial tumour, operated for metastatic spinal disease, were recruited. Blood samples were collected at five different stages during surgery: 2 stages from patient vein during induction and at the time of maximum tumour manipulation, 3 stages from the operative blood prior to IOCS processing, after IOCS processing, and after IOCS-LDF processing. Of the samples taken at each stage, 5 ml were analyzed for tumour cells using flow cytometry. RESULTS: Of 12 patients recruited, only 11 could be finally analyzed. Flow cytometry analysis of their samples showed that 8 of 11 patients had tumour cells in the unfiltered salvaged blood. In filtered salvaged blood, the tumour cell count was zero in the majority of samples (8/11 patients), whereas three patients' samples had a few tumour cells. The mean difference between the tumour cell quantity in the samples from the patient vein and filtered salvaged blood was significant. CONCLUSIONS: IOCS-LDF was shown to be effective in removing tumour cells from the blood salvaged during MSTS. If there were any tumour cells found, the quantity was significantly less than that in the patient's circulation. The results of this study reiterates the conclusions of our previous published work where we showed that IOCS-LDF treated blood in MSTS is safe for transfusion.

The Subaxial Cervical Spine Injury Classification System: an external agreement validation study.

BACKGROUND CONTEXT: In 2007, the Subaxial Cervical Spine Injury Classification (SLIC) system was introduced demonstrating moderate reliability in an internal validation study. PURPOSE: To assess the agreement on the SLIC system using clinical data from a spinal trauma population and whether the SLIC treatment algorithm outcome improved agreement on treatment decisions among surgeons. STUDY DESIGN: An external classification validation study. PATIENT SAMPLE: Twelve spinal surgeons (five consultants and seven fellows) assessed 51 randomly selected cases. OUTCOME MEASURES: Raw agreement, Fleiss kappa, and intraclass correlation coefficient statistics were used for reliability analysis. Majority rules and latent class modeling were used for accuracy analysis. METHODS: Fifty-one randomly selected cases with significant injuries of the cervical spine from a prospective consecutive series of trauma patients were assessed using the SLIC system. Neurologic details, plain radiographs, and computed tomography scans were available for all cases as well as magnetic resonance imaging in 21 cases (41%). No funds were received in support of this study. The authors have no conflict of interest in the subject of this article. RESULTS: The inter-rater agreement on the most severely affected level of injury was strong (κ=0.76). The agreement on the morphologic injury characteristics was poor (κ=0.29) and agreement on the integrity of the discoligamentous complex was average (κ=0.46). The inter-rater agreement on the treatment verdict after the total SLIC injury severity score was slightly lower than the surgeons' agreement on personal treatment preference (κ=0.55 vs. κ=0.63). Latent class analysis was not converging and did not present accurate estimations of the true classification categories. Based on these findings, no second survey for testing intrarater agreement was performed. CONCLUSIONS: We found poor agreement on the morphologic injury characteristics of the SLIC system, and its treatment algorithm showed no improved agreement on treatment decisions among surgeons. The authors discuss that the reproducibility of the SLIC system is likely to improve when unambiguous true morphologic injury characteristics are being implemented.

Femoral canal obliteration secondary to prolonged alendronate use: a case report.

Insufficiency fractures secondary to prolonged alendronate use is due to inhibition of osteoclastic activity and suppressed bone turnover. Complications of fracture fixation include non-union, mal-union, and difficulty in intramedullary nail insertion. We report a technical challenge in intramedullary nailing of an obliterated femoral canal in a patient on long-term bisphosphonate treatment. The fracture site was explored. The medullary canal was re-created by drilling. Patience and caution during drilling and reaming are necessary to avoid iatrogenic fractures.

Clinical outcome following treatment of stable and unstable intertrochanteric fractures with dynamic hip screw.

INTRODUCTION: Intertrochanteric (IT) fractures are associated with significant morbidity and mortality in the elderly population. We aim to compare the clinical outcome of unstable with stable IT fractures after treatment with dynamic hip screw (DHS). MATERIALS AND METHODS: Patients with IT fractures treated with DHS at National University Hospital between 2003 and 2005 were included in the study. Patients were divided into 2 groups: stable and unstable IT fractures. Clinical outcome parameters include perioperative complications, functional outcomes, and incidence of morbidity and mortality. RESULTS: One hundred and thirty-six patients were analysed. Mean age was 77 years. There were 61 stable and 78 unstable fractures. Average length of follow-up was 30 months. The rates of local complications were not significantly different between the 2 groups. The incidence of malunion and excessive impaction were significantly higher in the unstable group. The ambulatory status at one year post-surgery was not significantly different between the 2 groups. In terms of general postoperative complications and one year mortality rate, there was no significant difference between the 2 groups. The need for blood transfusion was significantly higher in the unstable group. CONCLUSION: In summary, DHS fixation provides comparable postoperative outcomes in unstable IT fractures with relatively low rates of complications. Although it was associated with a higher incidence of malunion and excessive impaction in the unstable fracture group, there was no difference in functional status at one-year compared to the stable group.

Vascularization and morphological changes of the endplate after axial compression and distraction of the intervertebral disc.

STUDY DESIGN: An in vivo study of the rabbit's endplate and intervertebral disc (IVD). OBJECTIVE: To assess the histologic features and vascularization of the endplate after axial compression and distraction, along with the degeneration and regeneration status of IVD. SUMMARY OF BACKGROUND DATA: Current studies mainly focus on the changes in the IVD in response to degeneration and regeneration. However, the basic science regarding degenerative changes of the vertebral endplate and its actions on the IVD is lacking. The endplate is responsible for nutrient flow to the IVD through diffusion. It has been postulated that changes in the endplate may be responsible for the degeneration of the IVD. METHODS: Twenty New Zealand white rabbits were equally divided into 4 groups as follows; group A, 28 days of compression only; group B, 28 days of disc compression followed by 28 days of unloading; group C, 28 days of disc compression followed by 28 days of distraction; and group D, sham operated animals with apparatus placement only. At the end of the study, all the animals in the 4 groups were killed and the lumbar segments harvested for analysis of their disc height, vascularity, and histologic examination. RESULTS: Compression decreased the disc height and the rabbits showed signs of disc degeneration. Ossified endplates with decreased cells and extracellular matrix, and decreased vascular channel volume were observed. Cellular and morphologic regeneration were observed on unloading and distraction of the compressed discs, although the cartilaginous endplates were partially ossified. The volume of vascular channels increased significantly after distraction. Fluorescent vascular tracer showed the presence of active blood flow in the vascular channels near the cartilaginous endplates. CONCLUSION: Compression resulted in degeneration of the cartilaginous endplate and decrease in the osseous endplate vascular channel volume, both of which led to the degeneration of the IVD. Unloading and distraction allowed the regeneration of the extracellular matrix in both the endplate and the recovery of vascular channels.