Efficacy of Local Control Strategies for Ewing Sarcoma After Neoadjuvant Chemotherapy: A Network Meta-analysis.

OBJECTIVE: This network meta-analysis aimed at comparing the efficacy of local control strategies after neoadjuvant chemotherapy in patients with Ewing sarcoma. DESIGN: Network meta-analysis was used to synthesize direct and indirect evidence in a network of trials that compare multiple interventions and has the potential to rank the competing treatments according to the studied outcome. SETTING: There are three treatment options for local Ewing's sarcoma after neoadjuvant chemotherapy, namely surgery, radiotherapy and surgery plus radiotherapy (SR). PARTICIPANTS: Records of 2540 patients from 11 studies were analyzed. MAIN OUTCOME MEASURES: Potentially relevant studies were retrieved from PubMed and Embase, and screened according to inclusion and exclusion criteria. Hazard ratios and the associated 95% confidence intervals were used to describe the efficacy of different interventions on 5-year local recurrence rate and 5-year event-free survival rate. Surface under the cumulative ranking curve (SUCRA) was calculated for ranking probabilities of different treatment. RESULTS: Compared with radiotherapy, surgery had better efficacy [local recurrence, OR (95% CI) 0.48 (0.33 - 0.87)] and SR had a similar effect as surgery [local recurrence, OR (95% CI) 0.50 (0.29 - 0.82)]. There were no statistically significant differences between three different local control strategies in 5-year local recurrence rate. SUCRA values suggested that surgery was better than SR for 5-year local recurrence rate (0.79 vs 0.70) and 5-year event free survival rate (0.67 vs 0.50), respectively. CONCLUSIONS: Both surgery and SR were superior to radiotherapy in reducing 5-yer local recurrence of patients with Ewing sarcoma after neoadjuvant chemotherapy. Surgery had higher efficacy than SR on improving the prognosis of patients.

Endoscopic rhizotomy for chronic lumbar zygapophysial joint pain.

BACKGROUND: Chronic lumbar zygapophysial joint pain is a common cause of chronic low back pain. Percutaneous radiofrequency ablation (RFA) is one of the effective management options; however, the results from the traditional RFA need to be improved in certain cases. The aim of this study is to investigate the effect of percutaneous radiofrequency ablation under endoscopic guidance (ERFA) for chronic low back pain secondary to facet joint arthritis. METHODS: This is a prospective study enrolled 60 patients. The cases were randomized into two groups: 30 patients in the control group underwent traditional percutaneous radiofrequency ablation, others underwent ERFA. The lumbar visual analog scale (VAS), MacNab score, and postoperative complications were used to evaluate the outcomes. All outcome assessments were performed at postoperative 1 day, 1 month, 3 months, 6 months, and 12 months. RESULTS: There was no difference between the two groups in preoperative VAS (P > 0.05). VAS scores, except the postoperative first day, in all other postoperative time points were significantly lower than preoperative values each in both groups (P < 0.05). There was no significant difference between the two groups in VAS at 1 day, 1 month, and 3 months after surgery (P > 0.05). However, the EFRA demonstrated significant benefits at the time points of 3 months and 6 months (P > 0.05). The MacNab scores of 1-year follow-up in the ERFA group were higher than that in the control group (P < 0.05). The incidence of complications in the ERFA group was significantly less than that in the control group (P < 0.05). CONCLUSIONS: ERFA may achieve more accurate and definite denervation on the nerves, which leads to longer lasting pain relief.

Cervical posterior longitudinal ligament ossification : Microscopy-assisted anterior corpectomy and fusion.

OBJECTIVE: To explore the clinical efficacy and safety of microscopy-assisted anterior corpectomy and fusion for cervical ossification of the posterior longitudinal ligament (OPLL). METHODS: A retrospective review of 32 cervical OPLL patients who underwent microscopy-assisted anterior corpectomy and fusion from June 2012 to March 2017 was carried out. Patients were evaluated with outcome metrics: Japanese Orthopaedic Association (JOA) scores (17 points method), visual analog scale (VAS), and radiographic parameters of the lordotic angle. The complications during treatment and follow-up were recorded. RESULTS: This study included 32 patients (15 males and 17 females) with a mean age of 58.3 ± 2.9 years (range 42-68 years). The average duration of follow-up was 19.0 ± 3.5 months (range 11-46 months). The scores of postoperative VAS significantly decreased (P < 0.05). The average JOA score at 12 months postoperation significantly improved (p < 0.05). The lordotic angle increased after surgery (P < 0.05). There was no titanium mesh subsidence, no pseudarthrosis or hardware failure at 1­year follow-up. COMPLICATIONS: One cerebrospinal fluid leakage in the surgery was managed using a gelatine sponge and the patient recovered after 1 week: One patient developed laryngeal nerve injury symptom of hoarseness and recovered spontaneously in 2 weeks without intervention and 1 patient suffered slight postoperative infection. There was no worsening of neurological function. CONCLUSION: Microscopy-assisted anterior cervical anterior surgery appears to be a safe and effective treatment option for selected cases of cervical posterior longitudinal ligament ossification.