Moderate sagittal plane deformity patients have similar radiographic and functional outcomes with either anterior or posterior surgery.

PURPOSE: This study aimed to compare the functional and radiographic outcomes of two surgical interventions for adult spinal deformity (ASD): anterior lumbar interbody fusion with anterior column realignment (ALIF-ACR) and posterior approach using Smith-Peterson osteotomy with transforaminal lumbar interbody fusion and pedicle screw fixation (TLIF-Schwab2). METHODS: A retrospective cohort study included 61 ASD patients treated surgically between 2019 and 2020 at a single tertiary orthopedic specialty hospital. Patients were divided into two groups: Group 1 (ALIF-ACR, 29 patients) and Group 2 (TLIF-Schwab2, 32 patients). Spinopelvic radiographic parameters and functional outcomes were evaluated at 3, 6, and 12 months postsurgery. RESULTS: Perioperative outcomes favored the ALIF-ACR group, with significantly smaller blood loss, shorter hospital stay, and operative time. Radiographic and functional outcomes were similar for both groups; however, the ALIF-ACR group did have a greater degree of correction in lumbar lordosis at 12 months. Complication profiles varied, with the ALIF-ACR group experiencing mostly hardware-related complications, while the TLIF-Schwab2 group faced dural tears, wound dehiscence, and proximal junctional kyphosis. Both groups had similar revision rates. CONCLUSION: Both ALIF-ACR and TLIF-Schwab2 achieved similar radiographic and functional outcomes in ASD patients with moderate sagittal plane deformity at 1-year follow-up. However, the safety profiles of the two techniques differed. Further research is required to optimize patient selection for each surgical approach, aiming to minimize perioperative complications and reoperation rates in this challenging patient population.

Cross-cultural adaptation, reliability, and validity of the Russian version of the Spine Oncology Study Group Outcomes Questionnaire (SOSGOQ2.0).

OBJECTIVE: The most validated health-related quality-of-life (HRQOL) questionnaire specific to the metastatic spine cancer population is the Spine Oncology Study Group Outcomes Questionnaire version 2 (SOSGOQ2.0). The purpose of this study was to translate and validate a Russian version of the SOSGOQ2.0. METHODS: The SOSGOQ2.0 was translated into Russian and cross-culturally adapted. In this study, 64 eligible patients completed the SOSGOQ2.0_RUS along with the EQ-5D 5 Level, SF-36 quality-of-life questionnaires, and visual analog scale for pain assessment scale (VAS). Internal consistency was measured using Cronbach's alpha, in which a score of 0.65 or higher is acceptable. Test-retest reliability was evaluated by examining the intraclass correlation coefficient (ICC). RESULTS: Included in this study were 64 Russian-speaking patients (median age 59 years) with metastatic spine disease. The most common primary tumors were breast, kidney, and prostate cancers. The overall Cronbach's alpha was 0.87, indicating high internal consistency. The overall ICC for the SOSGOQ2.0_RUS was 0.88 (95% CI 0.81-0.93), indicating high reliability and consistency of the measure. The physical function, pain, and mental health domains of the SF-36 moderately correlated with the same domains of the SOSGOQ2.0_RUS, with correlation coefficients ranging from 0.65 to 0.71. CONCLUSIONS: The SOSGOQ2.0_RUS is a reliable and valid questionnaire for assessing the HRQOL in patients with metastatic spinal tumors. The questionnaire showed high internal consistency, test-retest reliability, and good construct validity when compared with other established questionnaires.

Spinolaminar locking plates improve fixation strength compared to pedicle screws: a biomechanical analysis.

INTRODUCTION: Pedicle screw loosening is a significant complication of posterior spinal fixation, particularly among osteoporotic patients and in deformity constructs. In orthopedic trauma surgery, locking plates and screws have revolutionized the fixation of osteoporotic fractures. We have combined the traumatology principle of fixed-angle locking plate fixation with the spine principles of segmental instrumentation. METHODS: A novel spinolaminar locking plate was designed based on morphometric studies of human thoracolumbar vertebrae. The plates were fixed to cadaveric human lumbar spines and connected to form 1-level L1-L2 or L4-L5 constructs and compared to similar pedicle screw constructs. Pure moment testing was performed to assess range of motion before and after 30,000 cycles of cyclic fatigue. Post-fatigue fixture pullout strength was assessed by applying a continuous axial tensile force oriented to the principal axis of the pedicle until pullout was observed. RESULTS: Spinolaminar plate fixation resulted in superior pullout strength compared to pedicle screws (1,065 ± 400N vs. 714 ± 284N, p = 0.028). Spinolaminar plates performed equivalently to pedicle screws in range of motion reduction during flexion/extension and axial rotation. Pedicle screws outperformed the spinolaminar plates in lateral bending. Finally, no spinolaminar constructs failed during cyclic fatigue testing, whereas one pedicle screw construct did. CONCLUSIONS: The spinolaminar locking plate maintained adequate fixation post-fatigue, particularly in flexion/extension and axial rotation compared to pedicle screws. Moreover, spinolaminar plates were superior to pedicle screw fixation with respect to cyclic fatiguing and pullout strength. The spinolaminar plates offer a viable option for posterior lumbar instrumentation in the adult spine.

Conditional survival after surgery for metastatic tumors of the spine: does prognosis change over time?

PURPOSE: Conditional survival (CS) provides a dynamic prediction of patient survival by incorporating the time an individual has already survived given their disease specific characteristics. The objective of the current study was to estimate CS among patients after surgery for spinal cord compression or spinal instability, as well as stratify CS according to relevant patient- and disease-related characteristics. METHODS: The clinical outcomes of 361 patients undergoing surgical management of metastatic spinal tumors were retrospectively analyzed. Stratification of this cohort according to disease and surgery-specific characteristics allowed for univariate and multivariate statistical analyses of our study population. Observed overall and conditional survival estimates were calculated by the Kaplan-Meier method. RESULTS: 12-month conditional survival in patients undergoing surgical management of metastatic spine tumors increased from 57% at baseline to 70% at 24 months following spine surgery. Overall survival (OS) was influenced by CCI grade, Katagiri tumor type, presence of lung metastasis, type of spine surgery, presence of postoperative systemic therapy and ambulatory status at follow-up. Analyses of OS and CS by prognostic strata were similar with exception of stratification by surgery type. Differences in survival between strata tend to converge over time. Unfavorable factors for OS appear to be less relevant after a period of 24 months following spine surgery. CONCLUSION: Patients after surgery for metastatic tumors of the spine can expect a positive trend in conditional survival as survivorship increases. Even patients with a more severe disease can be encouraged with gains in conditional survival over time. LEVEL OF EVIDENCE: Level IV (retrospective cohort study).

Reliability and Validity of Adapted Russian Version of Hospital for Special Surgery Lumbar Spine Surgery Expectations Survey.

Background: Patients' expectations are an important determinant in their decision to undergo lumbar spinal surgery-particularly their expectations of recovery after surgery. The Hospital for Special Surgery Lumbar Spine Surgery Expectations Survey (HSS-LSSES) is one tool used to assess this; however, the original version was only available in English. Objective: We sought to evaluate the reliability and validity of a translated and adapted Russian-language version of the HSS-LSSES. Methods: This was a prospective study of 91 patients with degenerative disc disease who underwent lumbar spine surgery with instrumented fixation at a single institution in Saint Petersburg, Russia. Patients were recruited between December 2019 and February 2021 and asked about their expectations of surgery with a translated and adapted Russian version of the HSS-LSSES. To analyze construct validity, participants also completed disease-specific and general quality-of-life scales (Oswestry Disability Index, European Quality of Life-5 Dimensions, and 36-item Short-Form Health Survey). Intraclass correlation coefficients (ICCs; 2-way random effects model, absolute agreement) were used to determine test-retest reliability of the total score of the Russian HSS-LSSES. Internal consistency was evaluated through the estimation of Cronbach's alpha between the test and retest response of the questionnaire. Results: The test-retest stability of the Russian HSS-LSSES evaluated through the estimation of ICC was found to have good stability. The instrument was shown to have high internal consistency. Conclusion: This study demonstrates that a translated and adapted Russian version of HSS-LSSES had good internal consistency, reliability, construct validity, and no floor and ceiling effects. Therefore, we recommend its use as a tool for evaluating Russian-speaking patients' expectations before lumbar spine surgery.

Hardware Failure in Spinal Tumor Surgery: A Hallmark of Longer Survival?

OBJECTIVE: Instrumentation failure in spine tumor surgery is a common reason for revision operation. Increases in patient survival demand a better understanding of the hardware longevity. The study objective was to investigate risk factors for instrumentation failure requiring revision surgery in patients with spinal tumors. METHODS: A retrospective cohort from a single tertiary care specialty hospital from January 2005 to January 2021, for patients with spinal primary or metastatic tumors who underwent surgical intervention with instrumentation. Demographic and treatment data were collected and analyzed. Kaplan-Meier analysis was performed for overall survival, and separate univariate and multivariate regression analysis was performed. RESULTS: Three hundred fifty-one patients underwent surgical intervention for spinal tumor, of which 23 experienced instrumentation failure requiring revision surgery (6.6%). Multivariate regression analysis identified pelvic fixation (odds ratio [OR], 10.9), spinal metastasis invasiveness index (OR, 1.11), and survival of greater than 5 years (OR, 3.6) as significant risk factors for hardware failure. One- and 5-year survival rates were 57% and 8%, respectively. CONCLUSION: Instrumentation failure after spinal tumor surgery is a common reason for revision surgery. Our study suggests that the use of pelvic fixation, invasiveness of the surgery, and survival greater than 5 years are independent risk factors for instrumentation failure.

Whole-Spine Magnetic Resonance Imaging: A Review of Suggested Indications.

¼: The spinal column has a propensity for lesions to manifest in a multifocal manner, and identification of the lesions can be difficult. ¼: When used to image the spine, magnetic resonance imaging (MRI) most accurately identifies the presence and location of lesions, guiding the treatment plan and preventing potentially devastating complications that are known to be associated with unidentified lesions. ¼: Certain conditions clearly warrant evaluation with whole-spine MRI, whereas the use of whole-spine MRI with other conditions is more controversial. ¼: We suggest whole-spine MRI when evaluating and treating any spinal infection, lumbar stenosis with upper motor neuron signs, ankylosing disorders of the spine with concern for fracture, congenital scoliosis undergoing surgical correction, and metastatic spinal tumors. ¼: Use of whole-spine MRI in patients with idiopathic scoliosis and acute spinal trauma remains controversial.

Metastasectomy and Targeted Therapy for Patients With Spinal Metastases of Renal Cell Carcinoma.

BACKGROUND: Renal cell carcinoma (RCC) is an aggressive malignant disease that frequently metastasizes to the spine. The main purpose of our study is to evaluate the influence of surgery as well as targeted therapy on the survival of patients with RCC metastases of the spine. METHODS: Retrospective cohort study. We identified 100 patients with spinal RCC metastases who were retrospectively reviewed for preoperative conditions, treatment, and survival. Metastasectomy was performed in 39 cases, and 61 patients underwent decompression procedures with stabilization. Only 26 patients had adjuvant targeted therapy (7 with metastasectomy, 19 with palliative decompression). Pain, neurological status, survival time (from operation to death or last follow up), and local progression-free survival were evaluated. RESULTS: Neurological function recovery and reported significant pain relief were observed. There was no significant difference in overall survival for the patients with metastasectomy and palliative decompression (P = .750). Metastasectomy provided better local control of disease compared with decompression (P = .043). There was a statistically significant difference in overall survival for the patients who received targeted therapy (P = .012). CONCLUSIONS: Metastasectomy is effective for local control of tumors. Targeted therapy can potentially prolong overall survival for patients with spinal RCC metastases. LEVEL OF EVIDENCE: 3. CLINICAL RELEVANCE: Our findings suggest that spinal metastasectomy is useful for local control of tumor growth but not for live expectancy. Effective systemic therapy is key role in stopping of disease progression.

Renal cell carcinoma metastasis of the spine: bleeding control methods / Metástase de carcinoma de células renais da coluna vertebral: métodos de controle de sangramento / Metástasis espinal de carcinoma de células renales: métodos de control de sangrado

ABSTRACT Objective: This report compares various methods of bleeding control, and their influence on outcome and survival after decompression procedures for spinal metastasis of renal cell carcinoma (MRCC). Methods: A retrospective study. All patients underwent palliative decompression procedures. We compared 3 groups of patients stratified by methods of bleeding control. The first group (EMB) included 22 patients who underwent preoperative embolization of a tumor. The second group (HEM) consisted of 20 patients, treated surgically using intraoperative local hemostatic agents. In the third group (COMBI) 15 patients were treated with a combination of methods. Results: The average intraoperative blood loss for the EMB group was slightly less than the average for the HEM and COMBI groups, but without significant differences. The postoperative drainage loss in the HEM and COMBI groups was significantly less than in EMB group. The complication rate (infections, hematomas, neurological deficit) was practically equal in all groups. No statistically significant differences in local tumor recurrence and overall survival were found between groups. Conclusions: The overall results did not show that usage of different bleeding control methods can affect early or long-term outcomes. Level of Evidence III; retrospective study.

RESUMO Objetivo: Este artigo compara vários métodos de controle de sangramento, sua influência no resultado e sobrevida após procedimentos de descompressão para metástases espinhais de carcinoma de células renais (MRCC). Métodos: Estudo retrospectivo. Todos os pacientes foram submetidos a procedimentos de descompressão paliativa. Comparamos três grupos de pacientes estratificados por métodos de controle de sangramento. O primeiro grupo (EMB) incluiu 22 pacientes submetidos à embolização pré-operatória de um tumor. O segundo grupo (HEM) consistiu em 20 pacientes tratados cirurgicamente usando agentes hemostáticos locais intra operatórios. No terceiro grupo (COMBI), 15 pacientes foram tratados com uma combinação de métodos. Resultados: A perda de sangue intra-operatória média para o grupo EMB foi ligeiramente inferior à média nos grupos HEM e COMBI ,sem diferenças significativas. A perda de drenagem pós-operatória nos grupos HEM e COMBI foi significativamente menor do que no grupo EMB. A taxa de complicações (infecções, hematomas, déficit neurológico) foi quase igual em todos os grupos. Não houve diferença estatisticamente significativa na recorrência local do tumor e a sobrevida global foi encontrada entre os grupos. Conclusões: Os resultados globais não mostraram que o uso de diferentes métodos de controle de sangramento pode afetar os resultados precoce e de longo prazo. Nível de Evidência III; Estudo retrospectivo.

RESUMEN Objetivo: Este estudio compara varios métodos de control de sangrado, su influencia en el resultado y la supervivencia después de los procedimientos de descompresión de metástasis espinal de carcinoma de células renales (CCR). Métodos: Estudio retrospectivo en el que todos los pacientes fueron sometidos a procedimientos de descompresión paliativa. Comparamos 3 grupos de pacientes estratificados por métodos de control de sangrado. El primer grupo (EMB) incluyó a 22 pacientes sometidos a embolización preoperatoria de un tumor. El segundo grupo (HEM) consistió en 20 pacientes, tratados quirúrgicamente con agentes hemostáticos locales intraoperatorios. En el tercer grupo (COMBI) 15 pacientes fueron tratados con una combinación de métodos. Resultados: La pérdida de sangre intraoperatoria promedio en el grupo EMB fue ligeramente menor que el promedio en los grupos HEM y COMBI, pero sin diferencias significativas. La pérdida por drenaje posoperatorio en los grupos HEM y COMBI fue significativamente menor que en el grupo EMB. La tasa de complicaciones (infecciones, hematomas, déficit neurológico) fue prácticamente igual en todos los grupos. No se encontraron diferencias estadísticamente significativas en la recurrencia local del tumor y la supervivencia general entre los grupos. Conclusiones: Los resultados generales no mostraron que el uso de diferentes métodos de control de sangrado pueda afectar los resultados a corto o largo plazo. Nivel de Evidencia III; Estudio retrospectivo.

Comparison of surgical interventions for degenerative deformities and instability of the spine among elderly patients / A comparação de intervenções cirúrgicas para pacientes idosos com deformações degenerativas e instabilidade da coluna vertebral / Comparación de intervenciones quirúrgicas para pacientes ancianos con deformaciones degenerativas e inestabilidad de la columna vertebral

ABSTRACT Objective: To evaluate the surgical results among elderly patients with degenerative deformities and instability of the spine. Methods: A retrospective study of 437 patients (337 women, 100 men) with a mean age 60. The mean follow-up time was five years. The inclusion criteria were diseases and complications following spinal trauma associated with deformities, degenerative processes, acute pain syndrome, and spinal stenosis with neurological deficit. Four study groups (A, B, C and D) were created and defined by type of surgical intervention. Group A patients (the reference group) - decompression of neural structures on both sides without fixation. Group B - decompression and transpedicular fixation performed without correction of the deformity. Group C - patients operated up to the lower-thoracic region with transpedicular screws, correction of the deformity and decompression of spinal stenosis. Group D - transpedicular fixation up to higher-thoracic region; correction of the deformity and decompression of neurological structures. The mean follow-up time was five years. Results: Group D patients achieved the best outcome. The results observed were good in 57.2% of cases (60 patients); satisfactory in 40% of cases (42 patients); and unsatisfactory in 2.8% of cases (three patients). The worst findings were observed in Group A: satisfactory in 13.4% of cases (15 patients); and, unsatisfactory in 86.6% of cases (97 patients). No good results were observed in this group. Conclusion: The results suggest that performing full deformity correction with transpedicular fixation up to the higher-thoracic region gives the best outcomes for elderly patients, and helps to prevent long-term complications. Evidence level III; Retrospective Comparative Study.

RESUMO Objetivo: Avaliar os resultados da operação em idosos com deformações degenerativas e instabilidade da coluna vertebral. Método: Estudo retrospectivo de 437 pacientes (337 mulheres, 100 homens) com idade média de 60 anos. A duração média da observação foi de cinco anos. Os critérios de inclusão foram doenças e complicações após uma deformidade, processos degenerativos, síndrome da dor aguda e estenose espinhal com déficit neurológico. Quatro grupos de estudo (A, B, C e D) foram criados por tipo de intervenção cirúrgica. Grupo A (grupo de referência): descompressão das estruturas neuronais de ambos os lados sem fixação. Grupo B: descompressão e fixação transpedicular realizadas sem correção. Os pacientes do grupo C foram submetidos à cirurgia para região torácica inferior com parafusos transpediculares, correção e descompressão. Grupo D com fixação transpedicular na região torácica alta; correção total; descompressão de estruturas neurológicas. A duração média da observação foi de cinco anos. Resultados: no grupo D, melhores resultados foram observados. Bons resultados em 57,2% dos casos (60 pacientes); satisfatório em 40% dos casos (42 pacientes); e insatisfatório em 2,8% (3 pacientes). Os piores resultados foram obtidos no Grupo A. Resultados satisfatórios em 13,4% dos casos (15 pacientes); e insatisfatório em 86,6% dos casos (97 pacientes). Conclusão: Os resultados sugerem que a realização de uma correção completa da deformidade com fixação transpedicular na região torácica alta leva a melhores desfechos para pacientes idosos e ajuda a evitar complicações em longo prazo. Nível de evidência III; Estudo Retrospecitvo Comparativo.

RESUMEN Objetivo: Evaluar los resultados quirúrgicos en pacientes ancianos con deformaciones degenerativas e inestabilidad de la columna vertebral. Métodos: Estudio retrospectivo de 437 pacientes (337 mujeres, 100 hombres) con edad promedio de 60 años. La duración media de la observación fue de 5 años. Los criterios para la inclusión fueron enfermedades y complicaciones posteriores a traumatismo espinal asociado con deformidades, procesos degenerativos, síndrome de dolor agudo y estenosis espinal con déficit neurológico. Se crearon cuatro grupos de estudio (A, B, C y D) por tipo de intervención quirúrgica. Grupo A (el grupo de referencia): descompresión de las estructuras neuronales en ambos lados sin fijación. Grupo B: descompresión y fijación transpedicular realizadas sin corrección de la deformidad. Los pacientes del grupo C habían sido operados hasta la región torácica inferior con tornillos transpediculares, corrección de la deformidad y descompresión de la estenosis espinal. Grupo D con fijación transpedicular hasta la región torácica superior, corrección de la deformidad y descompresión de estructuras neurológicas. La duración media de la observación fue cinco años. Resultados: En grupo D se observaron mejores resultados. Los resultados observados fueron buenos en 57,2% de los casos (60 pacientes); satisfactorios en 40% de los casos (42 pacientes) e insatisfactorios en 2,8% (tres pacientes). Los peores resultados se obtuvieron en el Grupo A. Resultados satisfactorios en 13,4% de los casos (15 pacientes) e insatisfactorios en 86,6% de los casos (97 pacientes). No se observaron buenos resultados en este grupo. Conclusión: Los resultados sugieren que realizar una corrección de deformidad completa con fijación transpedicular hasta zona torácica superior lleva a mejores resultados para pacientes de edad avanzada y ayuda a evitar complicaciones a largo plazo. Nivel de evidencia III; Estudio Retrospectivo Comparativo.

Preoperative embolization and local hemostatic agents in palliative decompression surgery for spinal metastases of renal cell carcinoma.

BACKGROUND: Intraoperative hemorrhage can sometimes be massive in patients with spinal metastasis of renal cell carcinoma (MRCC). Preoperative embolization and local hemostatic agents are routinely use in spinal tumor surgery, but there have been no comparisons between these methods. This report compares the efficiency of various methods of bleeding control and their influence on outcome and survival after decompression procedures for MRCC. MATERIALS AND METHODS: This was a retrospective case-control study of 54 patients with hypervascular extraosseous MRCC. All patients underwent palliative decompression procedures. We compared two groups of patients stratified by methods of bleeding control. The first group (EMB) included 32 patients who underwent preoperative embolization of a tumor. The second group (HEM) consisted of 22 patients, treated surgically using intraoperative local hemostatic agents. The parameters under evaluation were blood loss volume, drainage loss, possible complications, time of hospital stay and survival. RESULTS: The median intraoperative blood loss for EMB group [1275 (95% CI 1175-1500) mL] was slightly less than the median in HEM group [1400 (95% CI 1050-1725) mL] without significant differences (p = 0.681). The postoperative drainage loss in HEM group [250 (95% CI 140-325) mL] was significantly less than that in EMB group [500 (95% CI 425-550) mL] (p = 0.013). The complication rate (infections, hematomas, neurological deficit) was nearly equal in all groups. No statistically significant difference in overall survival was found between groups: EMB-26 months (1 year-93.3%, 3 years-26.7%) and HEM-24 months (1 year-95.2%, 3 years-16.3%) (p = 0.360). CONCLUSION: Our results suggest that not all patients with MRCC require preoperative embolization, because usage of modern hemostatic agents can be an alternative bleeding control method.

Spinal deformity in elderly patients: comparison of two distal termination sites of lumbar curve fusion.

PURPOSE: This report compares the clinical, radiographic, and functional outcomes of fusion from thoracolumbar region terminating at L5 or at sacrum and pelvis in elderly patients with spinal deformity. METHODS: Ninety-four elderly patients who underwent spinal deformity surgery at our institution were evaluated. Patients were divided into two groups. The group L included 43 patients who underwent fusion of lumbar curve from thoracolumbar region to L5. The group P consisted of 51 patients who were treated using fusion from lower thoracic region to S1 extending to the pelvis. Radiographic outcomes, health-related to the quality of life (HRQOL) parameters, and complications with a 3-year minimum follow-up were analyzed and compared between two groups. RESULTS: In the group L, the ideal sagittal balance was not achieved. The group P showed a better restoration of global spinal alignments compared with the group L. The HRQOL scores (VAS, ODI, SRS-24) of the patients after 3 years are slightly higher in the group P, but we did not get significant difference between groups. The total number of complications was higher in the group P. CONCLUSIONS: The research showed that fusion of lumbar curve extending to the pelvis provided good sagittal balance, global spinal alignments, and likely HRQOL parameters after 3-year follow-up. But, eventually, we obtained higher number of complications.

Risk factors for adjacent segment disease development after lumbar fusion.

STUDY DESIGN: Retrospective cohort study. PURPOSE: To identify factors which may be important in the occurrence of symptomatic adjacent segment disease (ASD) after lumbar fusion. OVERVIEW OF LITERATURE: Many reports have been published about the risk factors for ASD after lumbar fusion. Despite on the great numbers of risk factors identified for ASD development, study results have been inconsistent and there is controversy regarding which are the most important. METHODS: This study evaluated 120 patients who underwent 360° fusion lumbar surgery from 2007 to 2012. We separated the population into two groups: the first group included 60 patients with long lumbar fusion (three or more levels) and the second group included 60 patients with short lumbar fusion (less than three levels). RESULTS: In the first group, symptomatic ASD was found in 19 cases during the one year follow-up. There were 14 cases with sagittal imbalance and 5 cases at the incipient stage of disc degeneration according to the preoperative magnetic resonance imaging. At the three year follow-up, symptomatic ASD was diagnosed in 31 cases, of which 17 patients had postoperative sagittal balance disturbance. In the second group, 10 patients had ASD at the one year follow-up. Among these cases, preoperative disc degenerative changes were identified in 8 patients. Sagittal imbalance was found only in 2 cases with symptomatic ASD at the one year follow-up. At the three year follow-up, the number of patients with symptomatic ASD increased to 14. Among them, 13 patients had initial preoperative adjacent disc degenerative changes. CONCLUSIONS: Patients with postoperative sagittal imbalance have a statistically significant increased risk of developing symptomatic ASD due to an overloading the adjacent segments and limited compensatory capacities due to the large number of fixed mobile segments. In the case of a short fixation, preoperative degenerative changes are more important factors in the development of ASD.

Preoperative embolization versus local hemostatic agents in surgery of hypervascular spinal tumors.

BACKGROUND: Currently, there is no consensus about how to reduce the intraoperative risk of hemorrhage in spinal decompression surgery of hypervascular spinal tumors, such as aggressive hemangioma, multiple myeloma, plasmacytoma, metastasis of renal cell carcinoma. METHODS: A retrospective study of 110 patients, operated in our institute was held in the period between 2003 and 2013. There were 69 male and 41 female patients with extradural hypervascular spinal tumor. The study included 61 patients with metastasis of renal cell carcinoma, 27 with multiple myeloma, 15 with plasmacytoma and 7 with aggressive hemangioma. The first group included 57 patients who underwent preoperative tumor embolization. The second group consisted of 53 patients, which were treated surgically using intraoperative local hemostatic agents. We performed 2 types of treatment options: palliative decompression and total spondylectomy. The first group was divided into two subgroups: 30 patients with palliative decompression (1PD) and 27 with total spondylectomy (1TS). In the second group there were: 28 patients with palliative decompression (2PD) and 25 with total spondylectomy (2TS). The parameters under evaluation were the blood loss volume, drainage loss, operation time, hemoglobin level, possible complications and time of hospital stay. RESULTS: The average intraoperative blood loss for all embolized patients was slightly less than in subgroups with local hemostatic agents. No significant difference in blood loss volume was found between groups 1PD and 2PD (p > 0.05). In groups 1TS and 2TS, we did get significant difference (p < 0.05). Statistically significant difference in the average drainage loss was found between two methods of hemostasis in both subgroups (p < 0.05). The operation time was not significantly different between groups. Postoperative hemoglobin level reduce is almost equal in both groups of patients. Postoperative complications were also nearly equal in the groups. The average hospital stay was significantly less (p < 0.05) in groups with 2PD and 2TS. CONCLUSIONS: The research proves that for patients with hypervascular spinal tumors, who underwent palliative decompression, there is no significant difference between two methods of reducing blood loss. Therefore, we do not see reasons to use expensive and risky procedure of embolization for such patients. While for patients with total spondylectomy preoperative embolization is efficient to reduce intraoperative bleeding.