ABSTRACT
BACKGROUND: Smoking is a known predictor of negative outcomes in spinal surgery. However, its effect on the functional outcomes and revision rates after ADR is not well-documented. This study is a retrospective analysis of prospectively collected data at a major tertiary center. The objective was to elucidate the impact of smoking on functional outcomes in cervical artificial disc replacement (ADR). METHODS: Patients who underwent cervical ADR for myelopathy or radiculopathy from 2004 to 2015 with a minimum of 2 years of follow-up were included in the study. Patient function was assessed using Short Form-36 (SF-36), American Association of Orthopaedic Surgery (AAOS) cervical spine, and Japanese Orthopaedic Association (JOA) scoring systems preoperatively and at 2 years postoperatively. Incidence of further surgery on affected and adjacent segments was analyzed as well. RESULTS: A total of 137 patients were included in the study, consisting of 117 nonsmokers and 20 smokers. There were 60 patients who presented with myelopathy and 77 with radiculopathy. The mean age of smokers was 42.6 years, compared with 46.4 years in the nonsmoker group (P < .01). Statistical improvement was noted in postoperative range of motion, as well as AAOS, SF-36, and JOA scores in both groups, with no difference between groups at 2 years of follow-up. A total of 84.2% of nonsmokers and 87.5% of smokers reported as surgery having met their expectations. A total of 5 of 117 nonsmokers (5.1%) and 4 of 20 smokers (20%) needed revision surgery (P = .018). Three of the 4 smokers who required surgery for adjacent or multisegment disease, whereas only 2 of the nonsmokers needed an operation for adjacent segment disease. CONCLUSIONS: Our analysis indicates that there is no difference in functional outcome or patient satisfaction between smokers and nonsmokers. Smokers have a higher chance of revision surgery after an artificial disc replacement compared with nonsmokers at 2 years. LEVEL OF EVIDENCE: 3.
ABSTRACT
STUDY DESIGN: A case report. OBJECTIVE: The aim of this study was to highlight that rapid progression or recurrence of giant cell tumor of the bone (GCTB) can still occur with cessation of Denosumab in the management of unresectable GCTB even in cases with prior demonstration of excellent response to treatment and stable disease over a protracted length of surveillance despite dose reduction. The close proximity of unresectable GCTB to vital structures makes it prudent that we monitor these patients closely given its locally aggressive nature. SUMMARY OF BACKGROUND DATA: Cervical spine GCTB is extremely rare. Unresectable GCTB has historically been a challenge to treat due to the lack of prospective, randomized clinical trials to guide treatment. Radiotherapy has fallen out of favor due to the risk of malignant transformation, especially as most GCTB patients are young.In recent years, improved understanding of the receptor activator of nuclear factor-κB ligand (RANKL) in the pathophysiology of GCTB has led to the use of Denosumab in patients with recurrent/unresectable/metastatic GCTB and in patients whom surgical resection carries a high morbidity. To date, the optimal dosage and duration of therapy in the treatment of GCTB is unknown. METHODS: We report a case of cervical spine GCTB in a 53-year-old male with positive surgical margins managed with Denosumab. RESULTS: This is the first reported case of a cervical spine GCTB managed with Denosumab showing excellent response to treatment, recurrence of disease post cessation of Denosumab despite earlier satisfactory disease control and stabilization achieved even with dose reduction, and again an excellent response with recommencement of the drug. CONCLUSION: Denosumab is an excellent option in patients with unresectable GCTB or when surgery will result in excessive morbidity. However, further studies are required to determine optimal dosing, treatment duration, side effect profile, and whether Denosumab is truly able to achieve partial or complete disease remission in the long run. LEVEL OF EVIDENCE: 4.
