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Study Design: Burst fractures not associated with any neurological deficits are frequent but not therapeutic agreement on their management is available to date. This case-control study was conducted to try to help guide therapeutic decision in the treatment of such fractures.Materials and Methods: This case-control study includes consecutive retrospective evaluation of 25 case-patients treated by posterior short-segment fixation associated with kyphoplasty (SFK) in the treatment of A3 thoracolumbar unstable fractures, as compared to a control-group composed of 82 patients treated by long-segment (LF) pedicle screws.Results: SFK patients bled significantly less than the LF patients (p=0.04). Assessment of deformation progression, vertebral height restoration and reduction of the regional kyphotic angle in the SFK and LF groups revealed no statistically significant superiority of one approach on another. In contrast, the height of endplates was significantly increased in the SFK group (p=0.006). The patients' pain levels were significantly improved in the SFK group (p=0.002). However, patients from the SFK group stood earlier postoperatively (1.7 vs 3.7days, p=0.001).Conclusion: We believe that SFK in vertebral fractures is as efficient as LF for bone consolidation and spine stabilization. In addition, SFK patients may use fewer analgesics. [ABSTRACT FROM AUTHOR]

Study Design: Fifty-one patients with spinal multiple myeloma (MM) metastases were operated and followed between January 2004 and July 2014.Objective: The aim of this study was to consider the efficiency of surgical prognosis scores in the management of spinal metastases myelomas.Summary Of Background Data: The spine is the most common site of bone metastases in MM. Surgery in spine metastases MM is a matter of debate and its impact on the increase of a patient's survival time is not clear. Several surgical survival scores have been developed to determine the best treatment in these patients.Methods: We studied 51 patients operated for spinal MM metastases between January 2004 and July 2014. We determined the Tokuhashi and Tomita survival scores and compared them with documented patient survivals. The two scores were also compared with the International Staging System (ISS).Results: Median survival (MS) was 108 months [standard deviation (SD) 62] for ISS I, 132.2 (SD 40) for ISS II, and 45.5 months (SD 16.3) for ISS III (P = 0.09). According to Tokuhashi survival score, 21 patients (41.2%) will survive <6 months, 6 (11.8%) 6 to 12 months, and 24 (47%) >12 months. According to Tomita et al., 50 patients (98%) will survive >49.9 months and 1 patient (2%) <15 months. Regardless of the ISS grade prognosis, Tokuhashi survival score, and to a lesser extent Tomita score, underestimated the actual survival very significantly [P < 0.0001, Log Rank (Mantel-Cox)].Conclusion: We suggest that spine surgical prognosis scores are not accurate and are not able to predict the survival of patients with spine myeloma metastases. Spine surgeons have to be guided not by the initial ISS stage but rather by spinal instability and neurological status.Level Of Evidence: N/A. [ABSTRACT FROM AUTHOR]

This document, published in the Neurosurgical Review, provides a detailed description of the surgical technique known as "unilateral biportal endoscopy" (UBE) for the treatment of spinal disorders. The UBE technique involves the use of two small incisions to access the epidural and foraminal areas of the spine, allowing for a magnified view and precise surgical maneuvers. The document outlines the step-by-step process of the surgery, including the use of various instruments and techniques for exposure, laminectomy, flavectomy, hemostasis, and closure. The authors emphasize the benefits of the UBE technique, such as reduced muscle injury, shorter hospital stays, and improved patient recovery. They also provide specific indications and technical variations for different types of spinal hernias and cysts. Overall, this document serves as a comprehensive guide for spine surgeons interested in learning and implementing the UBE technique. [Extracted from the article]

Background: Multiple myeloma (MM) is th e most common primary malignant tum or of the spine and bone. Spinal metastases are part of the evolution and progression of the MM disease. Therefore, this study aims at investigating prognostic factors associated with overall survival (OS) in patients with symptomatic spine MM metastases. Methods: Consecutive spine surgery procedures were performed in th e largest series reported to date and comprising 51 patients with osteolytic vertebral compression fractures resulting from MM, diagnosed by e ither bone marrow or tum or biopsy. Results: The mean age of patients was 61.1 years and mean follow-up was 31.9 months. Through univariate analyses, ISS stage (p < 0.0001), preoperative spine instability (SINS score) (p < 0.03), posterior osteosynthesis fixation (p < 0.002), preoperative adjuvant therapy (p < 0.02), postoperative adjuvant tre a tm en t (p < 0.001), bone marrow tran sp lan t (p < 0.03) and newly MM diagnosed (p < 0.03) emerged as powerful predictors of survival. Cox multivariate proportional hazard model indicated that only ISS Stage and stabilization surgery such as osteosynthesis were two in d ependent predictive factors for OS [hazard ratio (HR): 0.268, 95% confidence interval (Cl) 0.0 7 -0 .5 3 6 ; p < 0.006 for the former and HR: 0.184, 95% confidence interval (Cl) 0 .0 3 -0 .8 9 ; p < 0.04 for th e latter]. Conclusion: Stabilization surgery combined to ISS staging should be considered as an imp o rtan t prognostic survival factor for patients with symptomatic MM spine metastases. [ABSTRACT FROM AUTHOR]

Background: Multiple myeloma (MM) is the most common primary malignant tumor of the spine and bone. Spinal metastases are part of the evolution and progression of the MM disease. Therefore, this study aims at investigating prognostic factors associated with overall survival (OS) in patients with symptomatic spine MM metastases. Methods: Consecutive spine surgery procedures were performed in the largest series reported to date and comprising 51 patients with osteolytic vertebral compression fractures resulting from MM, diagnosed by either bone marrow or tumor biopsy. Results: The mean age of patients was 61.1 years and mean follow-up was 31.9 months. Through univariate analyses, ISS stage (p < 0.0001), preoperative spine instability (SINS score) (p < 0.03), posterior osteosynthesis fixation (p < 0.002), preoperative adjuvant therapy (p < 0.02), postoperative adjuvant treatment (p < 0.001), bone marrow transplant (p < 0.03) and newly MM diagnosed (p < 0.03) emerged as powerful predictors of survival. Cox multivariate proportional hazard model indicated that only ISS Stage and stabilization surgery such as osteosynthesis were two independent predictive factors for OS [hazard ratio (HR): 0.268, 95% confidence interval (CI) 0.07e0.536; p < 0.006 for the former and HR: 0.184, 95% confidence interval (CI) 0.03e0.89; p < 0.04 for the latter]. Conclusion: Stabilization surgery combined to ISS staging should be considered as an important prognostic survival factor for patients with symptomatic MM spine metastases. [ABSTRACT FROM AUTHOR]

Mini: The incidence of spinal metastasis (SpM) is increasing, and life expectancy for patients with malignancy is also rising. The "elderly" represent a population with steady growth in SpM proportion. Bracing is associated with lower survival. We believe that surgery should be considered, regardless of the patient's age. [ABSTRACT FROM AUTHOR]

Objective A three-dimensional reconstruction technique using the CustomBone (CB) prosthesis allows custom-made cranioplasty (CP) possessing osseointegration properties owing to its porous hydroxyapatite (HA) composition. This reconstruction technique has replaced less expensive techniques such as subcutaneously preserved autologous bone (SP). Our primary objective was to evaluate complications between CB and SP CP techniques. A secondary objective was to assess cosmetic results and osseointegration of CPs. Methods This single-center study comprised patients undergoing delayed CB or SP CP after craniectomy between 2007 and 2014. A prospective interview was conducted to collect all data, including 2-year follow-up clinical and radiologic data. Cosmetic results were assessed by a qualitative score, and osseointegration was assessed by measuring relative fusion at the CP margins. Results Of 100 patients undergoing CB or SP CP between 2007 and 2014, 92 (CB, n = 44; SP, n = 48) participated in the prospective interview. No significant difference in complication rates was observed between the 2 groups. The main complication specific to the CB group was fracture of the prosthesis observed in 20.8% patients. A higher rate of good cosmetic results was observed in the CB group (92.5% vs. 74.3%, P = 0.031). In the CB group, 51% of patients demonstrated no signs of bone fusion of the CP. Conclusions Although the CB prosthesis is associated with cosmetic advantages, the porous hydroxyapatite composition makes it fragile in the short-term and long-term, and effective osseointegration remains uncertain. [ABSTRACT FROM AUTHOR]