Vertebral Candidiasis, the State of the Art: A Systematic Literature Review.

OBJECTIVE: In recent years, Candida spondylodiscitis has represented an increasingly emerging disease in clinical practice. This condition requires long-term antibiotic therapy and sometimes surgical treatments. The main purpose of this study is to investigate the epidemiology, clinical and radiological aspects, treatment protocols, and outcomes of Candida-mediated vertebral osteomyelitis. METHODS: A systematic review of the English literature was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines.The research was conducted on Medline, Cochrane library, PubMed, and Scopus using as search terms "vertebral"; "spinal"; "infection"; "spondylodiscitis"; "discitis"; "osteomyelitis"; "Candida"; and "Candidosis." A case of vertebral candidiasis that was surgically managed was also reported. RESULTS: In total, 88 articles were included in our systematic review. Including the reported case, our analysis covered 113 cases of vertebral candidiasis. Candida albicans was isolated in 64 cases (56.1%), Candida tropicalis in 21 (18.4%), Candida glabrata in 14 (12.3%), and Candida parapsilosis in five (4.4%). The mean duration of the follow-up was 395 days. Finally, 87 (82%) patients completely recovered, ten (9.4%) died, and nine (8.5%) reported sequelae. CONCLUSION: This systematic review summarized the state of the art on vertebral candidiasis, describing data on its clinical features, diagnostic criteria and current limitations, and treatment alternatives and their outcomes.

Long-Term Clinical and Radiographic Outcomes After Bryan Cervical Disk Arthroplasty: A Systematic Literature Review.

Introductionː Cervical disk arthroplasty is a potential alternative procedure to anterior cervical decompression and fusion for the treatment of cervical disk disease. The aim of the study was to perform a systematic literature review on long-term clinical and radiological outcomes after Bryan cervical disk arthroplasty.Material and Methodsː A systematic literature review was performed according to PRISMA guidelines via PubMed and Embase, Scopus, and the Cochrane Library database by using the following keywords: "Bryan prosthesis"; "cervical disk arthroplasty"; "outcomes"; and "long-term follow-up." Eight articles with at least 10 years of follow-up were considered for eligibility.Resultsː In total, 481 patients were enrolled in the studies. Because of the occurrence of multiple treated levels, 588 arthroplasties were performed, divided as follows: 12 C3/4 cervical disk arthroplasties (2.01%), 63 C4/5 (10.71%), 325 C5/6 (55.27%), and 188 C6/7 (31.97%). The mean preoperative cervical lordosis was 13.6 ± 9.3°, whereas the last follow-up value was 12.8 ± 8.7°. In the last follow-up, the mean segmental range of motion was 8.2 ± 3.3°.Discussion: Recent studies have suggested that cervical disk arthroplasty should be safely performed in healthy young patients with disk degeneration who may need future revision surgery. The results suggest that this procedure preserves native cervical spinal biomechanics at long-term follow-up with acceptable adjacent segments disease and periprosthetic ossifications.Conclusionsː Cervical disk arthroplasty has good long-term device survival, motility, adjacent segment degeneration, and clinical outcomes. Therefore, it represents a valid alternative for the treatment of cervical spine degenerative pathologies, especially in young patients.

Positioning accuracy and facet joints violation after percutaneous pedicle screws placement with robot-assisted versus fluoroscopy-guided technique: Systematic review and meta-analysis.

Introduction: Minimally invasive spine surgery became the gold standard for the treatment of many spinal diseases. Only a few comparative studies were performed regarding the superiority of robotic-assisted (RA) surgery over fluoroscopic guidance (FG) surgery during percutaneous pedicle screws placement. Therefore, the aim of the present study was to conduct a systematic literature review and meta-analysis to evaluate the accuracy and potential advantages of RA compared with FG. Material and Methods: This study is a systematic literature review conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines. The review questions were formulated following the PICO scheme. Measured outcomes were presented using Forest plots. Heterogeneity among the included studies was assessed using the χ2 test, and the I2 statistic was utilized to estimate the proportion of total variation among the studies. A value exceeding 50% was considered indicative of substantial heterogeneity. Results: Seven studies that met inclusion criteria were finally included in this meta-analysis. These seven studies include: 447 patients, 228 patients (931 screws) treated with robotic guide, and 219 patients (767 pedicle screws) using fluoroscopic guide, with a mean age of 55.2. The percentages of clinically acceptable screws were 94.3% in the robot-assisted group and 89% in the fluoroscopic guided group. The percentages of non-acceptable screws were 5.7% in the robot-assisted group and 11% in the fluoroscopic-guided group. Discussion: Significant differences were observed between the two groups in terms of radiographic and clinical outcomes, with the robotic-assisted pedicle screw group exhibiting longer operative times. Robot technology serves as a valuable tool for assisting surgeons in challenging scenarios such as anatomical variants or patients with spinal deformities, ensuring accurate screw placement. Conclusion: The accuracy of pedicle screw placement with robotic technology is higher than with FG. In fact, the robotic approach allows significantly lower complication rates, fewer cases of violation of the proximal articular facet, less intraoperative exposure to radiation, even if it requires longer surgical times than the FG technique.

MENISCAL ALLOGRAFT TRANSPLANTATION COMBINED WITH ANTERIOR CRUCIATE LIGAMENT RECONSTRUCTION: A SYSTEMATIC REVIEW.

Introduction: To evaluate the clinical and functional outcomes of meniscal allograft transplantation (MAT) with anterior cruciate ligament reconstruction (ACLR) in a single surgical stage through a systematic review of the currently available evidence. Methods: A systematic search of the PubMed and Google Scholar databases, with no publication date limit, until December 2022 was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). Follow-up studies and case series published in English involving patients undergoing a combination of ACLR and MAT were included. The quality of these studies was assessed using the Methodological Index for Non-Randomized Studies (MINORS) checklist. A systematic review of the International Knee Documentation Committee (IKDC), Lysholm and Tegner activity scores was conducted. Results: Seven studies involving 154 patients were included. The mean follow-up was 5,3 years. The mean age at the time of the surgery was of 35.3 years. All studies used the Lysholm Knee score, IKDC score or Tegner activity score to measure clinical outcomes post-operatively and the mean improvements were 26.7, 24.7, and 1.8 respectively. The rate to return to sport was 75.5 %. No intra-operative complications were reported. The post-operative complication rate was 11.6%. Conclusions: MAT combined with ACLR procedure showed good clinical results up to an average of 5 years of follow-up. More studies need to be conducted that can better understand the long-term effects of this combined procedure.

Increased Frequency of Hand Hygiene and Other Infection Prevention Practices Correlates with Reduced Surgical Wound Infection Rates in Spinal Surgery during the COVID-19 Pandemic.

BACKGROUND: Due to the COVID-19 pandemic outbreak, many changes were done in the hospital practice, and new guidelines were issued in order to contain the infection spread. One of the most common measures is represented by a correct and frequent hand washing. Recently, an association between increased adherence to hand hygiene (HH) protocols and reduction in hospital infections was documented however no studies about the surgical wound infection rate were reported in the Literature. METHODS: The present study represents a multicentric retrospective epidemiological study. The HH compliance rate was recorded through direct observations by trained nurses, 24 h a day. The primary outcome was HH compliance rate. The association of HH with spinal surgical wound infections was the secondary outcome. RESULTS: We reported a compliance to HH practices during the pandemic period of 85.2% compared with 57% observed during 2019. Our analysis showed an overall surgical wound infection reduction of 66.6% during the hospital stay in the pandemic period. CONCLUSION: Hand hygiene has always been considered one of the most effective, reproducible and low-cost weapons to deal with hospital infections. The good health habits acquired during the COVID-19 pandemic should be maintained even after the virus is eradicated.

Early loss of angular kyphosis correction in patients with thoracolumbar vertebral burst (A3-A4) fractures who underwent percutaneous pedicle screws fixation.

PURPOSE: Percutaneous trans-pedicle screws represent a surgical option frequently performed in patients affected by thoracolumbar vertebral burst fractures (A3-A4). The aim of the study was to evaluate the early loss of kyphosis correction and its clinical correlations in a cohort of patients affected by burst spinal fracture treated with percutaneous trans-pedicle screws fixation. METHODS: The present investigation consists in a retrospective one center analysis. The primary outcome was the evaluation of the early loss of correction. Secondary outcomes were the bi-segmental kyphosis change, the clinical outcome and the correlation between clinical outcome and the loss of correction. RESULTS: Among 435 patients 97 were included in the study. A mean 3.3° of early loss of correction was observed between postoperative and 1 month follow-up evaluations. The mean anterior vertebral body height change was 3.8 mm. No statistical differences were found in clinical and functional outcomes between patients with >2° or <2° of kyphosis loss of correction. CONCLUSION: No statistical differences were found between 1 e 6 months postoperative kyphosis loss of correction. The amount of loss of correction seems not to influence clinical outcomes after percutaneous trans-pedicle screw fixation in patients with vertebral burst fractures.

Spontaneous Vertebral Aspergillosis, the State of Art: A Systematic Literature Review.

OBJECTIVE: Vertebral aspergillosis is quite rare conditions, often misdiagnosed, that requires long-term antibiotic therapy, and sometimes, surgical treatments. The present investigations were aimed to investigate the epidemiology, clinical-radiological aspects, treatment protocols, and outcomes of Aspergillus-mediated vertebral osteomyelitis. METHODS: A systematic review of the pertinent English literature according to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines was performed. The research was conducted on Cochrane library, MEDLINE, PubMed, and Scopus using as search-terms "Aspergillus," "vertebral osteomyelitis," "spondylodiscitis," "spine infection." A case of vertebral aspergillosis conservatively managed was also reported. RESULTS: Eighty-nine articles were included in our systematic review. Including the reported case, our analysis covered 112 cases of vertebral aspergillosis. Aspergillus fumigatus was isolated in 68 cases (61.2%), Aspergillus flavus in 14 (12.6%), Aspergillus terreus in 4 (3.6%), Aspergillus nidulans in 2 (1.8%). Seventy-three patients (65.7%) completely recovered at the last follow-up evaluation; in 7 patients (6.3%) radiological signs of chronic infection were reported, whereas 32 patients (28.8%) died during the follow-up. CONCLUSION: This systematic review summarized the state of the art on vertebral aspergillosis, retrieving data on clinical features, diagnostic criteria and current limitations, treatment alternatives, and their outcomes.

Radiological evaluation of fusion patterns after lateral lumbar interbody fusion: institutional case series.

INTRODUCTION: There is no consensus on how to evaluate segmental fusion after lateral lumbar interbody fusion (LLIF). Bone bridges (BB) between two contiguous vertebra are reported as pathognomonic criteria for anterior fusion. However, to the best of our knowledge, there are no radiological investigations on zygapophyseal joints (ZJ) status after LLIF. The aim of this radiological study was to investigate the different fusion patterns after LLIF. MATERIALS AND METHODS: This is a retrospective single-centre radiological study. Patients who underwent LLIF and posterior percutaneous screw fixation for degenerative spondylolisthesis, on a single lumbar level, were considered for eligibility. Complete radiological data and a minimum follow-up of 1 year were the inclusion criteria. Intervertebral BB were investigated for evaluating anterior fusion and ZJ ankylotic degeneration was evaluated according Pathria et al., as a matter of proof of posterior fusion and segmental immobilization. RESULTS: Seventy-four patients were finally included in the present study. Twelve months after surgery, intervertebral BB were recognized in 58 segments (78.3%), whereas ZJ Pathria grade was I in 8 (10.8%) patients, II in 15 (20.3%) and III in 51 (68.9%) that were considered posteriorly fused. The overlapping rate between anteriorly and posteriorly fused segments was 72.4% (42 segments), whereas 10 (13.5%) did not achieve any fusion, anterior or posterior, and 6 (8.1%) were posteriorly fused only. CONCLUSIONS: Our results seem to suggest that anterior fusion is not sufficient to achieve segmental immobilization. Further properly designed investigations are needed to investigate eventual clinical-radiological correlations.

A rare case of tertiary syphilis spondylodiscitis of the upper cervical spine: Diagnostic and therapeutic complexity, review of literature.

Syphilis is a sexually transmitted disease caused by the spirochetes Treponema pallidum. Syphilitic spinal lesions present as erosive bone lesions often simulating spondylodiscitis or cancer. In this article we describe a rare case of cervical osteolytic lesion from tertiary syphilis. A 45-year-old male with axial neck pain, without fever presented with an isolated osteolytic lesion at C3. Tuberculous spondylitis was initially suspected. A new CT and contrast enhanced MRI of the cervical spine and of the neck showed an extention of the bone lesion at C3 with bilateral lymphadenomegaly. To confirm the diagnosis of tertiary syphilis, US-guided biopsy of the lymph nodes was performed. The patient was treated with i.m. benzylpenicillin 2.4 MIU and the follow-up showed clinical and radiological resolution of the condition. The aim of this case report is to raise awareness of tertiary syphilis in the differential diagnosis of lytic lesions of the spine among the spinal community.

Symptomatic vertebral hemangioma during pregnancy period: A case series and systematic literature review.

Vertebral Hemangioma (VH) is a benign tumor usually symptomless and discovered incidentally. Pregnancy, because of several hormonal and physiologic changes, is a recognized risk factor coinciding with the development of a rapid onset of neurological symptoms in patients affected by VH. In the Literature, sporadic cases of neurological symptoms have been described, which occurred during pregnancy, but only rarely the onset of symptoms was reported after pregnancy and childbirth. Usually surgical treatment is reserved for severe cases with rapid onset of neurological symptoms. However, the use of conservative treatments is still a topic of debate In the present study, we report a series of patients affected by VH become symptomatic during or after pregnancy along with a systematic review of the Literature.

Spinal surgery in COVID-19 pandemic era: One trauma hub center experience in central-southern Italy.

The aim of the study is to analyze and report the results of the surgical activity in a spinal unit of a trauma hub in central Italy during COVID-19 pandemic. Surgical activity was compared between COVID 19 pandemic and the same period of time in 2019 at our institution. A 50% reduction of surgical procedures during the last three months was observed compared with the same period of time in 2019. The compliance with the containment rules for the spread of the infection, were sufficient to allow safe surgical activity for the medical teams and patients.

Single-level Bryan cervical disc arthroplasty: evaluation of radiological and clinical outcomes after 18 years of follow-up.

PURPOSE: Many studies reported mid-term clinical and radiological outcomes after cervical disc arthroplasty. Only a few studies analysed the long-term results. The aim of the study was to evaluate the clinical and radiological outcomes in patients treated with single-level Bryan cervical disc arthroplasty after 18 years of follow-up. METHODS: This study was a retrospective analysis of institutional databases concerning patients treated with Bryan cervical disc arthroplasty. SF36 PCS, NDI and VAS were used to evaluate clinical and functional outcomes. Standard, flexion-extension X-ray and MRI were used to evaluate the radiological results. RESULTS: Fifty-seven patients treated with single-level Bryan cervical disc arthroplasty completed the 18-year follow-up. At the final follow-up, a residual movement was observed in 32 patients (56%). The treated level range of motion decreased from 10.1° pre-operatively to 6.1° at the last follow-up (p = 0.0021). The range of motion of the adjacent segments and of the cervical spine had no significant change. Disc degeneration of the adjacent segment after 18-year follow-up was observed in 77.1% of treated patients. CONCLUSION: The clinical and radiographic outcomes 18 years after surgery are acceptable. The treated level range of motion reduction and the adjacent segment degeneration seems not to affect the clinical results after 18 years of follow-up.

Early Outcomes and Perioperative Complications of the Arthroscopic Latarjet Procedure: Systematic Review and Meta-analysis.

BACKGROUND: The arthroscopic Latarjet-Bristow procedure is emerging as a reliable alternative to the open procedure. The reduced soft tissue damage with potential advantages of early pain control and functional recovery is attractive. However, the operation is technically more demanding, and there are concerns regarding the potential for increased recurrence and complication rates. PURPOSE: To evaluate the available literature focusing on the reported functional outcomes and complications of the arthroscopic Latarjet procedure and compare them with the open procedure. STUDY DESIGN: Systematic review and meta-analysis. METHODS: A comprehensive systematic review was performed with the keywords "arthroscopy," "arthroscopic," "Latarjet," and "Bristow," with no limit regarding the year of publication. The review was limited to the English-language articles, and each article was evaluated with a modified MINORS (methodological index for nonrandomized studies) scoring system. RESULTS: Fourteen studies met the inclusion criteria and were included in the review. Overall, 813 patients met inclusion criteria, with a mean follow-up of 24.5 months. The mean Walch-Duplay and Rowe scores were 89.6 and 90.2, respectively. The overall complication rate was 16.5%; intraoperative conversion to open surgery, 2%; recurrence, 2.5%; and revision surgery, 5.6%. When only comparative studies were considered, the overall complication rates were 23.7% (arthroscopically) and 15.3% (open). The recurrence and revision surgery rates were 6.5% and 5.7% in the study group, while the corresponding values in the control group were 4% and 2.9%. The mean MINORS score was 14.5 (11.6 for noncomparative studies and 19 for comparative studies). CONCLUSION: The arthroscopic Latarjet-Bristow procedure is reliable. Outcomes are satisfactory, with less pain and faster recovery in the first postoperative week. However, the procedure is technically demanding, and higher rates of complications and reoperations should be expected. Finally, the arthroscopic operation is much more expensive in terms of implanted materials than the open procedure.

Intraspinal extradural benign fibrous histiocytoma of the lumbar spine in a pediatric patient. Case report and literature review.

INTRODUCTION: Benign fibrous histiocytoma (BFH) is a rare skeletal tumor. Spinal localizations have been previously described in 17 cases, and this is the first report of BFH occurring at the lumbar spine in a pediatric patient. CASE REPORT: A 13-year-old male complained lower limb motor and sensory impairment with severe claudication and urination disorders. A huge intraspinal, extradural mass at L4-L5 level, clearly evident on a preoperative MRI, caused dislocation and severe compression of the cauda equina nerve roots. After a biopsy, confirming BFH, a tumor resection and L4-S1 vertebral arthrodesis was carried out. At 1 year follow-up, no recurrence was detached on postoperative MRI, with complete neurological recovery. DISCUSSION AND CONCLUSION: Review of the literature is discussed. Histological examination is mandatory for a correct diagnosis and plan of treatment. None of the pediatric patients treated for BFH have ever shown local relapse.