Stand-alone anterior lumbar interbody fusion for degenerative disc disease of the lumbar spine: results with a 2-year follow-up.

STUDY DESIGN: Retrospective chart review. OBJECTIVE: To report outcomes of a consecutive series of patients diagnosed with degenerative disc disease (DDD) between L4 and S1, treated with stand-alone anterior lumbar interbody fusion (ALIF, either 1 or 2 levels) and use of recombinant human bone morphogenetic protein 2 for bony fusion with instrumented fixation. SUMMARY OF BACKGROUND DATA: Degeneration of the lumbar spine is described as lumbar spondylosis, or DDD. To treat DDD, surgical interventions include: ALIF, circumferential fusion (360° fusion), posterior spinal fusion, and total disc replacement. Currently, there has been paucity in the literature on the evaluation of ALIFs. METHODS: Researchers reviewed a consecutive series of patients with DDD who had undergone a 1-level or 2-level ALIF between 2005 and 2010, with the use of recombinant human bone morphogenetic protein 2. Patients' clinical and functional outcomes were documented. Radiographs were analyzed for disc height, mean optical density, and integrated optical density. Operative time, length of hospital stay, and estimated blood loss were also reported. RESULTS: Patients' 2-year Oswestry Disability Index and visual analogue scale presurgery scores significantly improved (P ≤ 0.0001). Patients' 2-year postoperative disc height was significantly greater than the preoperative disc height at the fused level (P ≤ 0.0001); there was no significant difference at the level adjacent to fusion. Majority of patients (107 of 115, 93.0%) satisfied fusion criteria based on mean optical density. Intraoperative time, estimated blood loss, and hospital stay was significantly fewer with 1-level and 2-level ALIFs than 360° fusions and total disc replacement. CONCLUSION: Stand-alone ALIF used to treat DDD can produce comparative clinical and functional outcomes. ALIFs showed significant decreases in blood loss, operative time, and hospital stay. Furthermore, at 2 years' time, mean optical density suggests high rate of bony fusion, and no significant loss of disc height was noted at the adjacent level. LEVEL OF EVIDENCE: 4.

Expression of Vascular Endothelial Growth Factor correlates with the advance of clinical osteosarcoma.

PURPOSE: Osteosarcoma is the most common primary malignancy in orthopaedic surgery. Studies suggest that expression of VEGF and high vascularity within osteosarcoma may correlate with poor prognosis. The purpose of this study was to determine whether there was a correlation of VEGF expression with clinical tumour stage and metastasis. METHODS: This retrospective case series examined 54 cases of osteosarcoma patients who were treated during a ten-year period. Relevant clinical information included age, gender, tumour location, stage, adjuvant therapy, morbidity, mortality, and tumour subtypes. The clinical information was analysed for correlation of VEGF expression and tumour prognosis. Tumour sections were examined by routine H&E and by immunohistochemistry for VEGF, CD31, and the oncogenes c-myc and c-fos. RESULTS: There was a significantly positive correlation between VEGF expression and tumour stages among these cases (p < 0.01). The data also suggested a higher cancer recurrence and more frequent cases of remote metastasis in the high-VEGF group compared to the low-VEGF group. VEGF expression also positively associated with c-fos and c-myc expressions in the primary tumour sections. CONCLUSION: The results of this study highlight the role of VEGF in angiogenesis and tumour burden. Data also suggest the influence of VEGF may associate with the elevations of c-fos and c-myc expression. The development of novel therapies to target the VEGF pathway in osteosarcoma may lead to improved survival.

Thromboembolic events in patients with cervical carcinoma: Incidence and effect on survival.

OBJECTIVES: The purpose of this study was to determine whether thromboembolic events (TE) in cervical cancer patients are associated with survival by comparing the survival of patients with and without thromboembolic events over a seven year period. METHODS: Utilizing a retrospective chart review we identified patients with any diagnosis of a TE, associated risk factors for TE development and overall survival. We also collected clinico-pathological data including stage, histology, height, weight, smoking history, radiation and chemotherapy treatment data and the temporal relationship of the development of TE to the time of cancer diagnosis. Data sources included the University of Iowa Hospitals and Clinics (UIHC) Tumor Registry and the UIHC Gynecologic Oncology Tumor Data Base as well as a search of UIHC medical record data bases using ICD-9 codes to initially identify all patients diagnosed with cervical carcinoma. RESULTS: In this study, the incidence of TE in cervical cancer patients was 11.7%. There was a clear and significant difference in survival between patients with and without TE. We identified an association between TE and stage, chemotherapy, brachytherapy, and radiation therapy. CONCLUSIONS: The major findings of our study are a significant incidence of thromboembolism in patients with cervical cancer, and a significant decrease in survival in patients who experience thromboembolism at presentation or during treatment. Deaths in these patients were overwhelmingly related to progressive cancer rather than the TE itself, suggesting that this adverse prognostic event may be related to aggressive tumor biology.