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Study Design: A multicenter retrospective study of patients who underwent unilateral and bilateral balloon kyphoplasty.Objective: The aim of this study was to compare the radiographic and clinical results of unilateral and bilateral balloon kyphoplasty to treat osteoporotic vertebral compression fractures.Summary Of Background Data: Percutaneous kyphoplasty has long been used as a successful method in the treatment of osteoporotic vertebral compression fractures. Although the bilateral approach is considered to be the mainstay application of percutaneous kyphoplasty, the unilateral approach has also been shown to be sufficient and even more effective in some cases.Methods: A total of 87 patients who underwent percutaneous kyphoplasty due to osteoporotic vertebral compression fractures between 2009 and 2016 were retrospectively evaluated and divided into two groups as patients who underwent unilateral or bilateral percutaneous kyphoplasty. Unilateral percutaneous kyphoplasty was performed in 36 and bilateral percutaneous kyphoplasty in 51 patients. The groups were compared in terms of clinical outcomes, radiological findings, and complications. Clinical outcomes were evaluated using Visual Analogue Scale and Oswestry Disability Index and the radiological findings were evaluated by comparing the preoperative and postoperative day 1 and year 1 values of anterior, middle, and posterior vertebral heights and kyphosis angle.Results: Clinical improvement occurred in both groups but no significant difference was observed. In radiological workup, no significant difference was found between the groups in terms of improvements in vertebral heights and kyphosis angle. Operative time and the amount of cement used for the surgery were significantly lower in the patients that underwent unilateral kyphoplasty.Conclusion: Unilateral percutaneous kyphoplasty is as effective as bilateral percutaneous kyphoplasty both radiologically and clinically. Operative time and the amount of cement used for the surgery are significantly lower in unilateral kyphoplasty, which may play a role in decreasing complication rates.Level Of Evidence: 3. [ABSTRACT FROM AUTHOR]

Study Design: A retrospective multicenter study.Objective: To identify the incidence of anterior arch fracture (AAF) of the atlas following C1 (first cervical vertebra) laminectomy without fusion, and its risk factors.Summary Of Background Data: C1 laminectomy without fusion is a widely accepted surgical procedure performed to decompress the spinal cord that is compromised at the C1/C2 level, but without instability. Several case series have reported spontaneous AAF following this procedure. However, the incidence of post-laminectomy AAF and its risk factors have not been studied.Methods: This retrospective study included patients who underwent C1 laminectomy without fusion in any of the four participating institutions between April 2002 and March 2016. The incidence of AAF following C1 laminectomy was determined, and the included patients were grouped into those who developed AAF (AAF group) and those who did not (non-AAF group). Patient demographics and radiographic parameters including subaxial cervical balance on x-ray (C2-7 sagittal vertical axis, C2-7 lordosis, C2-7 coronal cobb angle, and T1-slope), and morphology of the atlas on computed tomography (CT) scan were compared with the AAF and non-AAF groups.Results: Seventy patients who underwent C1 laminectomy without fusion were included in the study. The incidence of AAF was 14.2% (10/70). Multivariate analysis revealed that a large inferior facet angle (IFA, defined as the coronal inclination angle of the C1/2 facet as measured on CT) and the presence of subaxial ankylosis (bony ankylosis below C2 on CT) were independent risk factors for AAF. There were no significant differences in the subaxial cervical balance as measured on x-ray between the AAF and non-AAF groups (P > 0.05).Conclusion: The incidence of AAF after C1 laminectomy without fusion is not uncommon. Preoperative assessment using CT may identify patients at high risk of AAF.Level Of Evidence: 4. [ABSTRACT FROM AUTHOR]

Study Design: Biomechanical investigation using cadaver spines.Objective: The aim of the present study was to assess the magnitude of the deflation effect after balloon kyphoplasty (BKP) or use of minimally invasive vertebral body stent (MIVBS) in in vitro biomechanical condition.Summary Of Background Data: BKP is a well-established minimally invasive treatment option for osteoporotic vertebral compression fractures. However, this technique can lead to a secondary height loss-known as the "deflation effect"-causing intrasegmental kyphosis and an overall alignment failure.Methods: The study was conducted on 24 human cadaveric vertebral bodies (T12-L5). After creating a compression fracture model, the fractured vertebral bodies were reduced by BKP (n = 12) or by MIVBS (n = 12) and then augmented with polymethyl methacrylate bone cement. Each step of the procedure was performed under fluoroscopic guidance and the results were analyzed quantitatively. Finally, the strength and stiffness of augmented vertebral bodies were measured by biomechanical tests.Results: Complete initial reduction of the fractured vertebral body height was achieved by both systems. Secondary loss of reduction after balloon deflation was significantly greater in the BKP group (2.36 ± 0.63 mm vs. 0.34 ± 0.43 mm in the MIVBS group; P < 0.05). Height gain was significantly higher in the MIVBS group (77.68% ± 11.46% vs. 34.87% ± 13.16% in the BKP group; P < 0.05). Increase in the kyphotic angle gain (relative to the preoperative kyphotic angle) was significantly more in the MIVBS group (95.60% ± 6.12% vs. 77.0% ± 4.94% in the BKP group; P < 0.05). Failure load was significantly higher in the MIVBS group (189% ± 16% vs. 146% ± 14%; P < 0.05). However, stiffness was not significantly different between the two groups.Conclusion: The deflation effect after BKP can be significantly decreased with the use of the MIVBS technique.Level Of Evidence: N/A. [ABSTRACT FROM AUTHOR]

Cancer metastasis is a key event in tumor progression associated not only with mortality but also significant morbidity. Metastatic disease can promote end-organ dysfunction and even failure through mass effect compression of various vital organs including the spinal cord. In such cases, prompt medical attention is needed to restore neurological function, relieve pain, and prevent permanent damage. The three therapeutic approaches to managing metastatic spinal cord compression include corticosteroids, surgery, and radiation therapy. Although each may improve patients' symptoms, their combination has yielded the best outcome. In cancer patients with clinical suspicion of spinal cord compression, dexamethasone should be initiated followed by surgical decompression, when possible, and radiation. The latter becomes the preferred treatment in patients with inoperable disease. [ABSTRACT FROM AUTHOR]

Study Design. Review article. Objective. The article mainly reviewed the development and current situation of percutaneous kyphoplasty (PKP) in China, aiming to introduce native efforts and progress for PKP procedure on the exploring road. Summary of Background Data. Since PKP was first reported in China in 2002, Chinese orthopedic researchers have performed lots of clinical applications and studies on the treatment of osteoporotic vertebral compression fracture, spinal metastatic tumor, hemangioma, myeloma, vertebral nonunion, and so on. Methods. We reviewed the papers on PKP published by native researchers in English and Chinese via Pubmed, EMBASE, the Scopus database, and a series of Chinese databases including Wanfang Data, China National Knowledge Infrastructure (CNKI), and the China Science and Technology Journal Database. The large sample capacity researches, convictive systematic analysis, and overviews were mainly elected as convictive evidence to describe the overall situation of clinical outcomes, complications, and the various technical aspects used to improve conventional surgical management and clinical applications of PKP in China. Results. Until October 2015, 211 articles in English and 2352 studies in Chinese about PKP were reported by 1443 Chinese institutions from 22 provinces around China. More than 50976 patients reported through published articles have received the treatment of PKP. With the technique gradually improved, including puncture, bone cement infusion, vertebral expander instruments, diagnosis, and treatment of special type of vertebral fractures, PKP is performed with the better efficacy and less complication. Conclusion. With the progression of minimally invasive spinal surgery around the world, PKP in China has been performed with a trend towards a rapid, safe, and effective treatment. Digital, real-time and artificial intelligence are the directions of future development of PKP. [ABSTRACT FROM AUTHOR]

The article discusses the signs and symptoms of spinal cord compression (SCC), and the diagnosis, treatment, and nursing care for patients with SCC. Topics covered include the anatomy and pathophysiology of the human spinal cord, the development of SCC, and the different types of pain associated with SCC. It also discusses the assessments and diagnostic studies that must be performed to diagnose SCC, the therapies used in treating SCC, and the important role of nurses in managing SCC.

Background: Metastatic spinal cord compression is a disastrous consequence of non-small-cell lung cancer (NSCLC). There have been few studies of the outcomes or prognostic factors in patients with metastatic spinal cord compression from NSCLC treated with surgery and adjuvant therapies. Methods: From 2002 to 2013, 116 patients with metastatic spinal cord compression from NSCLC treated with surgery and adjuvant therapies were enrolled in this retrospective analysis. Kaplan-Meier methods and Cox regression analysis were used to estimate overall survival and identify prognostic factors for survival. Results: Multivariate analysis suggested that the Eastern Cooperative Oncology Group performance status (ECOG-PS), preoperative and postoperative Frankel scores, postoperative adjuvant radiation therapy, and target therapy were independent prognostic factors. Ninety patients died at a median of twelve months (range, three to forty-sevenmonths) postoperatively, and twenty-six patients were still alive at the time of final follow-up (at a median of fifteen months [range, five to fifty-four months]). Conclusions: The complete disappearance of deficits in spinal cord function after surgery was the most robust predictor of survival. Adjuvant radiation therapy and target therapy were also associated with a better prognosis. [ABSTRACT FROM AUTHOR]

Background: Paraplegia or death secondary to upper cervical spine instability and spinal cord compression are known consequences of Morquio syndrome. Decompression and fusion of the upper cervical spine are indicated to treat spinal cord compression. The purpose of this study was to report the intermediate to long-term results of upper cervical spine fusion in children with Morquio syndrome. Methods: Twenty patients (nine female and eleven male) with Morquio syndrome who underwent upper cervical spine fusion at a mean age of sixty-three months were retrospectively analyzed with use of hospital records. Radiographic and clinical results were reported. Results: The average follow-up period was eight years and ten months. Fusion was achieved in all patients except one; this patient underwent a revision with transarticular C1-C2 screw fixation. Seven patients developed symptomatic instability below the fusion mass that required extension of fusion to lower levels at a mean of ninety-one months after the initial operation. Two patients required decompression and fusion of a site other than the upper cervical spine. Asymptomatic cervicothoracic and thoracolumbar kyphosis was prevalent among our patients. All patients were neurologically stable at the time of the latest follow-up visit. Conclusions: Upper cervical spine fusion provides reliable fusion and a stable neural outcome in patients with Morquio syndrome. However, distal junctional instability is a major problem at long-term follow-up. Kyphotic deformity of the cervicothoracic and thoracolumbar junction may be present in a large number of patients with Morquio syndrome and evaluation for spinal stenosis at these levels should also be considered. [ABSTRACT FROM AUTHOR]

The article focuses on a study which examined the fate of posterior osteophytes following anterior cervical discectomy and fusion (ACDF) using computed tomography. Information on the advantage of the ACDF method is provided. Results of the study showed that posterior osteophytes decreased in 23% of patients and increased in 16%. No significant changes were observed in the mean anteroposterior diameter of each intervertebral foramen of fused segments postoperatively.

The article reviews treatment options for patients who present with metastatic spinal cord compression. A potentially debilitating and common complication of cancer is metastatic epidural spinal cord compression (MESCC), with an incidence of 2.5 to 14 percent of all cancer patients. External beam radiotherapy, a component in metastatic spinal cord compression, is used wither as primary treatment modality or as an adjuvant treatment after operation.

The article presents a study that investigates whether diffusion tensor imaging (DTI) is better that standard magnetic resonance imaging (MRI) in detecting myelophathic changes from spinal cord compression. The study also checks the correlation with actual clinical signs. Subjects were 52 patients with spondylotic cervical spinal cord compression and 13 people in the controlled group. The results of the study show MRI-DTI are better than MRI test alone.

The article discusses the prognosis and treatment for malignant epidural spinal cord compression (MESCC) in patients with prostate cancer. MSCC is a metastatic cancer complication divided into intradural and extradural, that could lead to progressive pain, paralysis and sensory loss. Using tumor histology as an overall survival (OS) predictor, surgery and radiation should be considered for good prognosis patients while a single fraction of 8 Gy can be effective in poor prognosis patients.

The following is a summary of the recommendations in the AAOS' clinical practice guideline, The Treatment of Symptomatic Osteoporotic Spinal Compression fractures. This summary does not contain rationales that explain how and why these recommendations were developed nor does it contain the evidence supporting these recommendations. All readers of this summary are strongly urged to consult the full guideline and evidence report for this information. We are confident that those who read the full guideline and evidence report will see that the recommendations were developed using systematic evidence-based processes designed to combat bias, enhance transparency, and promote reproducibility This summary of recommendations is not intended to stand alone. Treatment decisions should be made in light of all circumstances presented by the patient. Treatments and procedures applicable to the individual patient rely on mutual communication between patient, physician, and other healthcare practitioners. [ABSTRACT FROM AUTHOR]

The article describes the case of a patient diagnosed with multiple myeloma ten months earlier who has been going for her monthly treatment at an outpatient chemotherapy clinic. She complained of having backache for two days and was sent for an emergency magnetic resonance imaging of the spine for diagnosis of malignant spinal cord compression (MSCC). It discusses spinal cord lesions, external beam radiation (EBRT), and neurologic function.