120 results on '"Ghermandi R."'
Search Results
2. Management of symptomatic spine metastases: A multidisciplinary approach based flow-chart
- Author
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Pipola, V., Pasini, S., Ghermandi, R., Girolami, M., Falzetti, L., Pérez, S., Bas, T., and Gasbarrini, A.
- Published
- 2023
- Full Text
- View/download PDF
3. Surgical Planning in Cervical Spine Oncologic Patients
- Author
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Boriani, S., Ghermandi, R., Girolami, M., Gasbarrini, A., Boriani, Stefano, editor, Presutti, Livio, editor, Gasbarrini, Alessandro, editor, and Mattioli, Francesco, editor
- Published
- 2017
- Full Text
- View/download PDF
4. Posterior Approach to Cervical Spine
- Author
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Ghermandi, R., Girolami, M., Gasbarrini, A., Boriani, S., Boriani, Stefano, editor, Presutti, Livio, editor, Gasbarrini, Alessandro, editor, and Mattioli, Francesco, editor
- Published
- 2017
- Full Text
- View/download PDF
5. Exemplificative Cases in Cervical Spine
- Author
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Gasbarrini, A., Girolami, M., Ghermandi, R., Akman, Y. E., Boriani, S., Boriani, Stefano, editor, Presutti, Livio, editor, Gasbarrini, Alessandro, editor, and Mattioli, Francesco, editor
- Published
- 2017
- Full Text
- View/download PDF
6. Cervical Spine Instrumentation
- Author
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Girolami, M., Ghermandi, R., Gasbarrini, A., Akman, Y. E., Boriani, S., Boriani, Stefano, editor, Presutti, Livio, editor, Gasbarrini, Alessandro, editor, and Mattioli, Francesco, editor
- Published
- 2017
- Full Text
- View/download PDF
7. Anesthesiological Management and Patient Positioning
- Author
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Bacchin, M. R., Di Fiore, M., Akman, Y. E., Girolami, M., Ghermandi, R., Gasbarrini, A., Boriani, S., Boriani, Stefano, editor, Presutti, Livio, editor, Gasbarrini, Alessandro, editor, and Mattioli, Francesco, editor
- Published
- 2017
- Full Text
- View/download PDF
8. Anatomy of the Subaxial Cervical Spine
- Author
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Girolami, M., Ghermandi, R., Ghirelli, M., Gasbarrini, A., Boriani, S., Boriani, Stefano, editor, Presutti, Livio, editor, Gasbarrini, Alessandro, editor, and Mattioli, Francesco, editor
- Published
- 2017
- Full Text
- View/download PDF
9. AUTOLOGOUS MESENCHYMAL STEM CELLS IN THE TREATMENT OF SPINAL ANEURYSMAL BONE CYST
- Author
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Brodano, G.B., primary, Griffoni, C., additional, Facchini, G., additional, Carretta, E., additional, Salamanna, F., additional, Tedesco, G., additional, Evangelisti, G., additional, Terzi, S., additional, Ghermandi, R., additional, Bandiera, S., additional, Girolami, M., additional, Pipola, V., additional, Fini, M., additional, Gasbarrini, A., additional, and Leggi, L., additional
- Published
- 2023
- Full Text
- View/download PDF
10. Referred leg pain originating from the sacroiliac joint: 6-month outcomes from the prospective randomized controlled iMIA trial
- Author
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Dengler, Julius, Sturesson, Bengt, Kools, Djaya, Prestamburgo, Domenico, Cher, Daniel, van Eeckhoven, Eddie, Erk, Emanuel, Pflugmacher, Robert, Vajkoczy, Peter, Kools, D., Lesage, G., Martens, F., Keymeulen, H., Lecomte, Y., Dengler, J., Bayerl, S., Pflugmacher, R., Webler, M., Bornemann, R., Mues, A., Gasbarrini, A., Griffoni, C., Colangeli, S., Ghermandi, R., Prestamburgo, D., Valli, F., Gaetani, P., Silvani, V., Minelli, M., Vottorio, S., Adinolfi, D., Verlotta, M., Cattalani, A., Sturesson, B., Dahlberg, I., and and the iMIA study group
- Published
- 2016
- Full Text
- View/download PDF
11. Navigation-assisted surgery for tumors of the spine
- Author
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Bandiera, S., Ghermandi, R., Gasbarrini, A., Barbanti Bròdano, G., Colangeli, S., and Boriani, S.
- Published
- 2013
- Full Text
- View/download PDF
12. Le neoplasie del tratto lombare: trattamento chirurgico
- Author
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Bandiera, S., Gasbarrini, A., Barbanti Brodano, G., Terzi, S., Colangeli, S., Ghermandi, R., Babbi, L., Amendola, L., Griffoni, C., and Boriani, S.
- Published
- 2012
- Full Text
- View/download PDF
13. Diagnostic accuracy of positron emission tomography/computed tomography-driven biopsy for the diagnosis of lymphoma
- Author
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Broccoli, A., Nanni, C., Cappelli, A., Bacci, F., Gasbarrini, Antonio, Tabacchi, E., Piovani, C., Argnani, L., Ghermandi, R., Sabattini, E., Golfieri, R., Fanti, S., Zinzani, P. L., Gasbarrini A. (ORCID:0000-0002-7278-4823), Broccoli, A., Nanni, C., Cappelli, A., Bacci, F., Gasbarrini, Antonio, Tabacchi, E., Piovani, C., Argnani, L., Ghermandi, R., Sabattini, E., Golfieri, R., Fanti, S., Zinzani, P. L., and Gasbarrini A. (ORCID:0000-0002-7278-4823)
- Abstract
Introduction: Biopsy of affected tissue is required for lymphoma diagnosis and to plan treatment. Open incisional biopsy is traditionally the method of choice. Nevertheless, it requires hospitalization, availability of an operating room, and sometimes general anesthesia, and it is associated with several drawbacks. Fluorodeoxyglucose positron emission tomography/computed tomography (PET/CT) can be potentially used to drive biopsy to the most metabolically active area within a lymph node or extranodal masses. Methods: A study of diagnostic accuracy was conducted to assess the performance of a PET-driven needle biopsy in patients with suspect active lymphoma. Results: Overall, 99 procedures have been performed: three (3.0%) were interrupted because of pain but were successfully repeated in two cases. Median SUVmax of target lesions was 10.7. In 84/96 cases, the tissue was considered adequate to formulate a diagnosis (diagnostic yield of 87.5%) and to guide the following clinical decision. The target specimen was a lymph node in 60 cases and an extranodal site in 36. No serious adverse events occurred. The sensitivity of this procedure was 96%, with a specificity of 100%, a positive predictive value of 100%, and a negative predictive value of 75%. Conclusion: Patients can benefit from a minimally invasive procedure which allows a timely and accurate diagnosis of lymphoma at onset or relapse.
- Published
- 2020
14. The impact of SARS-CoV-2 pandemic on Oncologic and Degenerative Spine Surgery Department activity: the experience of Rizzoli Orthopaedic Institute under COVID-19 lockdown.
- Author
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GHERMANDI, R., PIPOLA, V., TERZI, S., TEDESCO, G., CAVALLARI, C., BANDIERA, S., BRÒDANO, G. BARBANTI, EVANGELISTI, G., GIROLAMI, M., and GASBARRINI, A.
- Abstract
OBJECTIVE: Experience of Department of Oncologic and Degenerative Spine Surgery of Rizzoli Orthopaedic Institute during SARS-CoV-2 pandemic lockdown. PATIENTS AND METHODS: Retrospective observational study of surgically treated patients from 09th March 2020 to 04th May 2020. Data collected: age, sex, type of disease, neurological status, days of hospitalization, complications and type of discharge. A comparison analysis with same period of the last year was performed in order to evaluate the impact of COVID-19 spreading on daily surgical activity. RESULTS: A total of 107 surgical procedures in 102 patients were performed from 09th March 2020 to 04th May 2020. Analysis showed a statistically significant difference in age, sex, ASIA class and type of treated disease compared to the same period of the last year (p=0.042, 0.006, 0.022 and 0.007, respectively). No statistically significant differences were observed in type of discharge, length of hospitalization and complications (p= 0.447, 0.261 and 0.127, respectively). 3 COVID-19 infections have been identified in hospitalized patients. 1 COVID-19 patient wad admitted from Emergency Department and was managed according to a dedicated path. CONCLUSIONS: Surgical activity was paradoxically increased during SARS-CoV-2 pandemic lockdown through the management of urgent and non-deferrable spinal disease with a low rate (3,9%) of COVID-19 infections. [ABSTRACT FROM AUTHOR]
- Published
- 2020
15. Is minimally-invasive spinal surgery a reliable treatment option in symptomatic spinal metastasis?
- Author
-
COLANGELI, S., CAPANNA, R., BANDIERA, S., GHERMANDI, R., GIROLAMI, M., PARCHI, P. D., PIPOLA, V., SACCHETTI, F., and GASBARRINI, A.
- Abstract
OBJECTIVE: Up to 70% of patients with cancer are likely to develop spine metastasis. Radiation therapy is the standard of care for painful spinal metastases in absence of unstable or impending fractures. More frequently these patients require open palliative surgery for pain, vertebral collapse and neurological deficits. Minimally Invasive Spine Surgery (MISS) techniques using percutaneous pedicle screw fixation may be considered as an alternative to open surgery in selected cases. MISS techniques are thought to be associated with fewer tissues damages resulting in early pain relief, they also allow for early mobilization and optimization of function. PATIENTS AND METHODS: From 2011 to 2018, 52 patients affected by spinal metastasis were treated with MISS techniques in Rizzoli Orthopaedic Institute of Bologna and in Cisanello Hospital of Pisa, Italy. All patients underwent percutaneous pedicle screw fixations (PPSF) coupled with mini-decompressions in case it was required by spinal cord compressions. All patients were evaluated pre and post-operatively by Frenkel classification and VAS scores. RESULTS: Mean follow-up time was 19,4 months. Preoperatively, Frankel scores were E in 37 patients, D3 in 6 patients, D2 in 3 cases, D1 in 3 patients, B in one patient and C in two. The Frankel score improved in 10 patients, remained stable in 40 patients and worsened in two patients. Preoperatively, the mean VAS score in 29 patients treated with PPSF procedure with spinal decompression was 7, while postoperatively, it became 5. In 23 patients who underwent only PPSF procedure without spinal decompression mean VAS score was 5, postoperatively it became 3. CONCLUSIONS: In selected cases, MISS surgeries may be considered as a valid alternative to open surgery. Although the efficacy of PPSF has been well documented in trauma or degenerative spine surgery, there is not sufficient literature about MISS techniques in spinal metastasis and further studies are needed to elucidate the most appropriate patient in which this approach could represent the gold standard of treatment. [ABSTRACT FROM AUTHOR]
- Published
- 2020
16. Algoritmo terapeutico per il trattamento delle metastasi del sacro. Raccomandazioni del gruppo di studio SIOT sulle metastasi ossee
- Author
-
Capanna, R, Piccioli, A, Gasbarrini, A, Di Martino, A, Biagini, R, Denaro, V, Ghermandi, R, Girolami, M, Spinelli, Ms, Zoccali, C, and Rosa, Ma
- Subjects
metastasi del sacro ,algoritmo terapeutico ,metastasi ossee - Published
- 2016
17. Carbon ions therapy as single treatment in chordoma of the sacrum. Histologic and metabolic outcome studies.
- Author
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EVANGELISTI, G., FIORE, M. R., BANDIERA, S., BRODANO, G. BARBANTI, TERZI, S., GIROLAMI, M., PIPOLA, V., RIGHI, A., NANNI, C., FANTI, S., GHERMANDI, R., MOLINELLI, S., ORECCHIA, R., BORIANI, S., and GASBARRINI, A.
- Abstract
OBJECTIVE: Even though carbon ions treatment (CIRT) of sacral chordoma (SC) substantially reduces tumor mass, tumor remnants are observed in most patients. Differentiating tumor remnants from necrosis is challenging, expensive in terms of imaging and time-consuming. So far, there has not been a systematic histological and metabolic analysis of post-CIRT lesions. We designed a prospective study aiming to histologically a metabolically differentiate between viable tumor and foci of necrosis and of fibrosclerosis after CIRT and correlate these findings to clinical outcome in patients with SC. PATIENTS AND METHODS: Between January 2013 and December 2016 18 patients, 12 males and 6 females, with histological confirmation of sacral chordoma, underwent CIRT. The total dose was 70.4 GyE, with a daily fraction of 4.4 GyE, for 4 weeks. MRI was performed every three months after treatment. FDG PET-CT scan and CT-guided needle biopsy were performed 6-12 months after CIRT. The incidence of complications (intraoperative and postoperative), local control (LC), overall survival (OS) and progression-free survival (PFS), changes in neurological status, clinical outcomes and toxicity were considered. RESULTS: All histological analysis but 2 reported signs of necrosis and of fibrosclerosis after CIRT. One of these 2 patients turned into a dedifferentiated chordoma. Radiological partial response (PR) was observed in 10 patients (56.3%) and stable disease (SD) in 5 patients (28.3). Two patients (11%) had a local relapse. The overall survival rate was 100% at 24 months. FDG PET CT after CIRT showed uptake decreasing compared with the baseline exam in all but one patient. CONCLUSIONS: The histological presence of necrosis and of fibrosclerosis after CIRT at the histological analysis supports the previous clinical evidence on the efficacy of CIRT. Volumetric stability of the residual mass should be considered as a success of treatment. In cases of a volumetric increase of the mass, a CT needle biopsy should always be performed. In our series, during the follow-up, the FDG-PET was able to promptly detect an increased uptake in the case which later was histologically defined as dedifferentiated chordoma. [ABSTRACT FROM AUTHOR]
- Published
- 2019
- Full Text
- View/download PDF
18. Denosumab: non-surgical treatment option for selective arterial embolization resistant aneurysmal bone cyst of the spine and sacrum. Case report.
- Author
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GHERMANDI, R., TERZI, S., GASBARRINI, A., and BORIANI, S.
- Abstract
OBJECTIVE: Aneurysmal Bone Cyst (ABC) is a cystic lesion of bone, occurring in 70% of cases as a primary lesion. Even if the metaphyseal region of long bones is more frequently involved, vertebral localization is not rare: ABC represents 15% of all primary spine and sacral tumours. Selective arterial embolization (SAE) represents the first treatment option for vertebral ABC. However, in few cases, multiple SAEs are not possible. The aim of this work is to report two cases of vertebral ABC unresponsive to SAE positively treated with Denosumab. PATIENTS AND METHODS: Two patients affected by ABC of the lumbar spine were treated by SAE without any response. Thus, the patients were submitted to an off-label treatment with Denosumab, following the same protocol already used in case of Giant Cell Tumour (GCT): 120 mg once a week for 4 weeks consecutively, then once every 40 days. RESULTS: In both cases, patients resulted to be pain-free after 11-13 Denosumab administrations and CT scan showed almost complete ossification of the lesions. CONCLUSIONS: The two cases reported here are not conclusive but they may support the project of a prospective study to confirm the effectiveness of Denosumab in ABC treatment as an alternative to SAE. [ABSTRACT FROM AUTHOR]
- Published
- 2016
19. Spinal Infection Multidisciplinary Management Project (SIMP): From Diagnosis to Treatment Guideline
- Author
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Gasbarrini, A., primary, Boriani, L., additional, Nanni, C., additional, Zamparini, E., additional, Rorato, G., additional, Ghermandi, R., additional, Salvadori, C., additional, Allegri, V., additional, Bandiera, S., additional, Barbanti-Brodano, G., additional, Colangeli, S., additional, Corghi, A., additional, Terzi, S., additional, Babbi, L., additional, Amendola, L., additional, Cristini, F., additional, Marinacci, G., additional, Tumietto, F., additional, Ciminari, R., additional, Malaguti, M.C., additional, Rimondi, E., additional, Difiore, M., additional, Bacchin, R., additional, Facchini, F., additional, Frugiuele, J., additional, Morigi, A., additional, Albisinni, U, additional, Bonarelli, S, additional, Fanti, S., additional, Viale, P, additional, and Boriani, S., additional
- Published
- 2011
- Full Text
- View/download PDF
20. 282 THE TREATMENT OF SEVERE CHONDROPATIES OF THE KNEE WITH AUTOLOGOUS PLATELET RICH PLASMA INJECTIONS: PRELIMINARY RESULTS
- Author
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Giannini, S., primary, Vannini, F., additional, Timoncini, A., additional, Ghermandi, R., additional, and Rufflli, A., additional
- Published
- 2008
- Full Text
- View/download PDF
21. A post-market surveillance analysis of the safety of hydroxyapatite-derived products as bone graft extenders or substitutes for spine fusion.
- Author
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BRODANO, G. BARBANTI, GRIFFONI, C., ZANOTTI, B., GASBARRINI, A., BANDIERA, S., GHERMANDI, R., and BORIANI, S.
- Abstract
OBJECTIVE: Iliac crest bone graft (ICBG) is considered the gold standard for spine surgical procedures to achieve a successful fusion, because of its known osteoinductive and osteoconductive properties. Considering its autogenous origin, the use of ICBG has not been associated to an increase of intraoperative or postoperative complications directly related to the surgery. However, complications related to the harvesting procedure and to the donor site morbidity have been largely reported in the literature, favoring the development of a wide range of alternative products to be used as bone graft extenders or substitutes for spine fusion. The family of ceramic-based bone grafts has been widely used and studied during the last years for spine surgical procedures in order to reduce the need for iliac crest bone grafting and the consequent morbidity associated to the harvesting procedures. PATIENTS AND METHODS: We report here the results of a post-market surveillance analysis performed on four independent cohorts of patients (115 patients) to evaluate the safety of three different formulations of hydroxyapatite-derived products used as bone graft extenders/substitutes for lumbar arthrodesis. RESULTS: No intraoperative or post-operative complications related to the use of hydroxyapatite-derived products were detected, during medium and long follow up period (minimum 12 months-maximum 5 years). CONCLUSIONS: This post-market surveillance analysis evidenced the safety of ceramic products as bone graft extenders or substitutes for spine fusion. Moreover, the evidence of the safety of hydroxyapatite-derived products allows to perform clinical studies aimed at evaluating the fusion rates and the clinical outcomes of these materials as bone graft extenders/substitutes, in order to support their use as an alternative to ICBG for spine fusion. [ABSTRACT FROM AUTHOR]
- Published
- 2015
22. Spondylodiscitis in familial dysautonomia: a case report.
- Author
-
GHERMANDI, R., MESFIN, A., TERZI, S., COLANGELI, S., ZAMPARINI, E., and GASBARRINI, A.
- Abstract
Familial dysautomonia (FD, or Riley-Day syndrome) is a rare but fatal autosomal recessive peripheral neuropathy caused by a point mutation in I-κ-B kinase complex associated protein (IKBCAP) gene. The disease, that affects primarily people of Ashkenazi Jewish origin, prejudices the development of primary sensory neurons determining depletion of autonomic and sensory neurons. Musculoskeletal problems include: spinal deformities, foot deformities, fractures and arthopathies. In this article we review a case of a 34 years old male of non-Jewish origin affected by FD presenting L2-L3 kyphosis and inability to walk due to chronic L2-L3 spondylodiscitis not surgically treated 14 years before as acute disease. De novo spondylodiscitis affecting patients presenting FD and its subsequent management was not previously described in the literature. [ABSTRACT FROM AUTHOR]
- Published
- 2014
23. Myoepithelioma of the spine: first case in the literature.
- Author
-
GHERMANDI, R., PALA, E., GAMBAROTTI, M., COLANGELI, S., and BORIANI, S.
- Abstract
Myoepithelioma is a very rare tumour. This tumor type has been reported in the soft tissue, ear, sinonasal cavity, breast and lung. Although rare, myoepithelioma can occur in bone. We present the first case of myoepithelioma in the spine, documenting the clinical, radiographic and pathological features. [ABSTRACT FROM AUTHOR]
- Published
- 2014
24. Fluid-fluid levels detected on MRI and mimicking primary aneurismal bone cysts in a case of spinal bone metastasis.
- Author
-
COLANGELI, S., ROSSI, G., GHERMANDI, R., and RIMONDI, E.
- Abstract
INTRODUCTION: Spinal bone metastases may be lytic or sclerotic lesions. Sometimes aneurismal bone cyst (ABC)-like areas (also called "secondary ABC") can be found in giant-cell tumors, osteoblastomas and chondroblastomas but are rare in metastatic tumors. CASE REPORT: A retrospective study on 518 patients surgically treated for metastatic lesions of the spine from 1995 to 2012 was performed to evaluate the radiographic presentation. We propose a case report of a metastatic lesion associated with imaging features suggestive of aneurismal bone cyst. The patient was treated by intralesional surgery, after embolization of the lesion. CONCLUSIONS: Fluid-fluid levels detected on imaging can be found in bone metastases and may be similar to a primary aneurismal bone cyst. Embolization of metastastic tumor was useful to help the surgeon. [ABSTRACT FROM AUTHOR]
- Published
- 2014
25. Myoepithelioma of the spine: first case in the literature
- Author
-
Ghermandi, R., Pala, E., Gambarotti, M., Simone COLANGELI, Boriani, S., Ghermandi R, Pala E, Gambarotti M, Colangeli S, and Boriani S
- Subjects
Male ,Spinal Neoplasms ,Positron-Emission Tomography ,Humans ,Middle Aged ,respiratory system ,Tomography, X-Ray Computed ,Thoracic Vertebrae ,Spine ,Myoepithelioma ,respiratory tract diseases - Abstract
Myoepithelioma is a very rare tumour. This tumor type has been reported in the soft tissue, ear, sinonasal cavity, breast and lung. Although rare, myoepithelioma can occur in bone. We present the first case of myoepithelioma in the spine, documenting the clinical, radiographic and pathological features.
26. Augmentation technique with hamstring tendons in chronic partial lesions of the ACL: Clinical and arthrometric analysis
- Author
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Buda, R., Di Caprio, F., Ghermandi, R., Alberto Ruffilli, and Ferruzzi, A.
27. Augmentation technique with hamstring tendons in chronic partial lesions of the ACL: Clinical and arthrometric analysis
- Author
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Buda, R., Francesco Di Caprio, Ghermandi, R., Ruffilli, A., and Ferruzzi, A.
28. Is lumbar drainage of postoperative cerebrospinal fluid fistula after spine surgery effective?
- Author
-
Barbanti Bròdano, G., Serchi, E., Babbi, L., Terzi, S., Corghi, A., Gasbarrini, A., Stefano Bandiera, Griffoni, C., Colangeli, S., Ghermandi, R., and Boriani, S.
- Subjects
Male ,Postoperative Complications ,Treatment Outcome ,Fistula ,Cerebrospinal Fluid Rhinorrhea ,Drainage ,Humans ,Female ,Dura Mater ,Retrospective Studies - Abstract
This study is a retrospective consecutive case series analysis of 198 patients who underwent spine surgery between 2009 and 2010. The aim of this paper was to assess the efficacy and safeness of bed rest and lumbar drainage in treating postoperative CSF fistula. Postoperative cerebrospinal fluid (CSF) fistula is a well-known complication in spine surgery which lead to a significant change in length of hospitalization and possible postoperative complications. Management of CSF leaks has changed little over the past 20 years with no golden standard advocated from literature.Postoperative CSF fistulas were described in 16 of 198 patients (8%) who underwent spine surgery between 2009 and 2010. The choice of the therapeutic strategy was based on the clinical condition of the patients, taking into account the possibility to maintain the prone position continuously and the risk of morbidity due to prolonged bed rest. Six patients were treated conservatively (position prone for three weeks), ten patients were treated by positioning an external CSF lumbar drainage for ten days. The mean follow-up period was ten months.All patients healed their wound properly and no adverse events were recorded. Patients treated conservatively were cured in a mean period of 30 days, while patients treated with CSF drainage were cured in a mean period of 10 days.Lumbar drainage seems to be effective and safe both in preventing CSF fistula in cases of large dural tears and debilitated/irradiated patients and in treating CSF leaks.
29. Biomaterials as bone graft substitutes for spine surgery: From preclinical results to clinical study
- Author
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Barbanti Bròdano, G., Griffoni, C., Nataloni, A., Manfrini, M., Giavaresi, G., Bandiera, S., Alessandro Gasbarrini, Terzi, S., Ghermandi, R., Tedesco, G., Girolami, M., Tognon, M., and Fini, M.
- Subjects
Ambientale - Abstract
Vertebral fusion is performed in order to stabilize the spine in the presence of degenerative, traumatic or oncological pathologies that alter its stability. The autologous bone, harvested from the patient’s iliac crest or from the lamina during surgery, is still considered the “gold standard” for spine fusion due to its osteogenic, osteoinductive and osteoconductive properties. However, several biological and synthetic bone substitutes have been introduced as alternatives for regenerating bone tissue. We have studied in particular the use of ceramic biomaterials prepared from hydroxypatite (HA), starting from in vitro analysis, through an in vivo study on ovine animal model and a post-market surveillance analysis, to finally design and perform a clinical study, which is ongoing in our Department. In the first step, HA-derived biomaterials were tested in vitro in the presence of bone marrow-derived human mesenchymal stem cells (hMSCs) and evaluated for their ability to activate precursor cells. In the second step, the biomimetic bone graft substitute SintLife® putty (MgHA) was evaluated in vivo. A posterolateral fusion procedure was applied on 18 sheep, where a fusion level was treated with MgHA, while the other level was treated with autologous bone. Microtomography and histological/histomorphometric analysis were performed six months of after surgery. In the third step, we reported the results of a post-market surveillance study conducted on 4 independent cohorts of patients (total 115 patients), in which HA-derived biomaterials were used as bone graft substitutes or extenders. Finally, a clinical study has been designed and approved by the Ethics Committee of our Institute and is currently ongoing. This study aims to evaluate the efficacy of the ceramic biomaterial SintLife® putty for bone replacement in patients treated by posterolateral fusion for degenerative spine disorders. HA biomaterials were effective in promoting the in vitro growth of hMSCs and their osteogenic differentiation. In the animal model, SintLife® putty has been effective in generating neo-formed bone tissue with morphological and structural features similar to those of the pre-existing bone. The post-market surveillance analysis has not reported any intra-operative nor early or late post-operative adverse events. Seven patients are currently recruited for the clinical trial designed to evaluate Sintlife efficacy for spine fusion (FU range: 1-7 months). No adverse events have been recorded. The first CT analysis performed at 6 months FU showed a good spine fusion. The study is ongoing. Our results, obtained from in vitro, preclinical and clinical studies, suggest that biomaterials derived from hydroxyapatite could be a valid alternative to autologous bone graft for vertebral fusion. This would potentially avoid or reduce the need of autologous bone harvesting and therefore, the risk of drawback-related side effects.
30. Fluid-fluid levels detected on MRI and mimicking primary aneurismal bone cysts in a case of spinal bone metastasis
- Author
-
Simone COLANGELI, Rossi, G., Ghermandi, R., and Rimondi, E.
- Subjects
Bone Cysts, Aneurysmal ,Lung Neoplasms ,Spinal Neoplasms ,Humans ,Adenocarcinoma of Lung ,Female ,Adenocarcinoma ,Middle Aged ,Tomography, X-Ray Computed ,Embolization, Therapeutic ,Magnetic Resonance Imaging ,Body Fluids - Abstract
Spinal bone metastases may be lytic or sclerotic lesions. Sometimes aneurismal bone cyst (ABC)-like areas (also called "secondary ABC") can be found in giant-cell tumors, osteoblastomas and chondroblastomas but are rare in metastatic tumors.A retrospective study on 518 patients surgically treated for metastatic lesions of the spine from 1995 to 2012 was performed to evaluate the radiographic presentation. We propose a case report of a metastatic lesion associated with imaging features suggestive of aneurismal bone cyst. The patient was treated by intralesional surgery, after embolization of the lesion.Fluid-fluid levels detected on imaging can be found in bone metastases and may be similar to a primary aneurismal bone cyst. Embolization of metastastic tumor was useful to help the surgeon.
31. A post-market surveillance analysis of the safety of hydroxyapatite-derived products as bone graft extenders or substitutes for spine fusion
- Author
-
Brodano, G. B., Griffoni, C., Zanotti, B., Alessandro Gasbarrini, Bandiera, S., Ghermandi, R., and Boriani, S.
- Subjects
Adult ,Aged, 80 and over ,Male ,Bone Transplantation ,Lumbosacral Region ,Middle Aged ,Cohort Studies ,Ilium ,Durapatite ,Spinal Fusion ,Product Surveillance, Postmarketing ,Humans ,Female ,Aged - Abstract
Iliac crest bone graft (ICBG) is considered the gold standard for spine surgical procedures to achieve a successful fusion, because of its known osteoinductive and osteoconductive properties. Considering its autogenous origin, the use of ICBG has not been associated to an increase of intraoperative or postoperative complications directly related to the surgery. However, complications related to the harvesting procedure and to the donor site morbidity have been largely reported in the literature, favoring the development of a wide range of alternative products to be used as bone graft extenders or substitutes for spine fusion. The family of ceramic-based bone grafts has been widely used and studied during the last years for spine surgical procedures in order to reduce the need for iliac crest bone grafting and the consequent morbidity associated to the harvesting procedures.We report here the results of a post-market surveillance analysis performed on four independent cohorts of patients (115 patients) to evaluate the safety of three different formulations of hydroxyapatite-derived products used as bone graft extenders/substitutes for lumbar arthrodesis.No intraoperative or post-operative complications related to the use of hydroxyapatite-derived products were detected, during medium and long follow up period (minimum 12 months-maximum 5 years).This post-market surveillance analysis evidenced the safety of ceramic products as bone graft extenders or substitutes for spine fusion. Moreover, the evidence of the safety of hydroxyapatite-derived products allows to perform clinical studies aimed at evaluating the fusion rates and the clinical outcomes of these materials as bone graft extenders/substitutes, in order to support their use as an alternative to ICBG for spine fusion.
32. Spondylodiscitis in familial dysautonomia: a case report
- Author
-
Ghermandi, R., Mesfin, A., Terzi, S., Simone COLANGELI, Zamparini, E., and Gasbarrini, A.
- Subjects
Adult ,Male ,Radiography ,Discitis ,Lumbar Vertebrae ,Positron-Emission Tomography ,Dysautonomia, Familial ,Humans ,Kyphosis ,Magnetic Resonance Imaging - Abstract
Familial dysautomonia (FD, or Riley-Day syndrome) is a rare but fatal autosomal recessive peripheral neuropathy caused by a point mutation in I-κ-B kinase complex associated protein (IKBCAP) gene. The disease, that affects primarily people of Ashkenazi Jewish origin, prejudices the development of primary sensory neurons determining depletion of autonomic and sensory neurons. Musculoskeletal problems include: spinal deformities, foot deformities, fractures and arthopathies. In this article we review a case of a 34 years old male of non-Jewish origin affected by FD presenting L2-L3 kyphosis and inability to walk due to chronic L2-L3 spondylodiscitis not surgically treated 14 years before as acute disease. De novo spondylodiscitis affecting patients presenting FD and its subsequent management was not previously described in the literature.
33. Composite peek/carbon fiber pre-shaped rods and sublaminar bands for posterior stabilization of cervico-thoracic junction: A novel technique
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Gisberto Evangelisti, Giuseppe Tedesco, Alessandro Gasbarrini, Riccardo Ghermandi, Valerio Pipola, Marco Girolami, Stefano Boriani, Alessandro Ricci, Pipola V., Boriani S., Ghermandi R., Tedesco G., Evangelisti G., Girolami M., Ricci A., and Gasbarrini A.
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Adult ,Male ,Novel technique ,Polymers ,medicine.medical_treatment ,Sublaminar bands ,Neurosurgical Procedures ,Polyethylene Glycols ,Benzophenones ,03 medical and health sciences ,Fixation (surgical) ,0302 clinical medicine ,Carbon Fiber ,Cervical spine ,Physiology (medical) ,Peek ,Humans ,Medicine ,Cervico-thoracic stabilization ,Proton therapy ,Spinal Neoplasms ,Particle therapy ,business.industry ,En bloc resection ,General Medicine ,Ketones ,Middle Aged ,Spine ,Radiation therapy ,Treatment Outcome ,Sclerosing Epithelioid Fibrosarcoma ,Neurology ,030220 oncology & carcinogenesis ,Surgery ,Neurology (clinical) ,Implant ,Neoplasm Recurrence, Local ,business ,Nuclear medicine ,Carbon fiber reinforced peek rod ,030217 neurology & neurosurgery - Abstract
The combination of surgery plus radiotherapy is a valid treatment option when en bloc resection with wide margins is not feasible. The aim of this paper is to show a novel technique for fixation of cervico-thoracic junction with carbon fiber reinforced peek pre-shaped rods with sublaminar bands in order to guarantee cervical spine stability and particle therapy efficacy. A 42 years-old man with a Sclerosing Epithelioid Fibrosarcoma (SEF) arising from C7, involving the right latero-cervical region from C5 to the apex of the right lung, underwent an en bloc resection with a double approach (anterior plus posterior). Fixation of cervical spine was achieved with composite PEEK/carbon fiber rods connected to C4 and T2 laminae with sublaminar bands. After surgery, the patient received 9 cycles of chemotherapy (cisplatin, etoposide and adriamycin) and proton therapy. At 2 years follow-up, no local recurrence was detected with implant stability demonstrating no mechanical failure. The main issues related to this case were: planning en bloc resection able to achieve an Enneking appropriate margin; incorporate in the decision making process the functional loss related to the sacrifice of neurological structures infiltrated by the tumor; establish a therapeutic strategy that included, in addition to surgery, adjuvant chemotherapy and radiotherapy for improving local and systemic control; stabilize with implants that do not interfere with accelerated particle radiotherapy.
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- 2020
34. Spinal surgery complications: an unsolved problem—Is the World Health Organization Safety Surgical Checklist an useful tool to reduce them?
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Valerio Pipola, Giuseppe Tedesco, Riccardo Ghermandi, Cristiana Griffoni, Stefano Bandiera, Alessandro Gasbarrini, Asdrubal Falavigna, Silvia Terzi, Gisberto Evangelisti, Marco Girolami, Jarkko Halme, G. Barbanti-Brodano, Barbanti-Brodano G., Griffoni C., Halme J., Tedesco G., Terzi S., Bandiera S., Ghermandi R., Evangelisti G., Girolami M., Pipola V., Gasbarrini A., and Falavigna A.
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medicine.medical_specialty ,World Health Organization ,Patient safety ,Spine surgery ,Postoperative Complications ,Degenerative disease ,medicine ,Humans ,Orthopedics and Sports Medicine ,Surgical checklist ,Retrospective Studies ,Clinical outcome ,business.industry ,General surgery ,Incidence (epidemiology) ,Middle Aged ,medicine.disease ,Checklist ,Radiological weapon ,Surgery ,Patient Safety ,Neurosurgery ,business ,Complication - Abstract
Purpose To investigate whether the World Health Organization Safety Surgical Checklist (SSC) is an effective tool to reduce complications in spinal surgery. Methods We retrospectively evaluated the clinical and radiological charts prospectively collected from patients who underwent a spinal surgery procedure from January 2010 to December 2012. The aim of this study was to compare the incidence of complications between two periods, from January to December 2010 (without checklist) and from January 2011 and December 2012 (with checklist), in order to assess the checklist’s effectiveness. Results The sample size was 917 patients with an average of 30-month follow-up. The mean age was 52.88 years. The majority of procedures were performed for oncological diseases (54.4%) and degenerative diseases (39.8%). In total, 159 complications were detected (17.3%). The overall incidence of complications for trauma, infectious pathology, oncology, and degenerative disease was 22.2%, 19.2%, 18.4%, and 15.3%, respectively. No correlation was observed between the type of pathology and the complication incidence. We observed a reduction in the overall incidence of complications following the introduction of the SSC: In 2010 without checklist, the incidence of complications was 24.2%, while in 2011 and 2012, following the checklist introduction, the incidence of complications was 16.7% and 11.7%, respectively (mean 14.2%). Conclusions The SSC seems to be an effective tool to reduce complications in spinal surgery. We propose to extend the use of checklist system also to the preoperative and postoperative phases in order to further reduce the incidence of complications. Graphic abstract These slides can be retrieved under Electronic Supplementary Material.
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- 2019
35. Diagnostic accuracy of positron emission tomography/computed tomography-driven biopsy for the diagnosis of lymphoma
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Pier Luigi Zinzani, Cristina Nanni, Alberta Cappelli, Carlo Piovani, Alessandro Gasbarrini, Riccardo Ghermandi, Elena Tabacchi, Francesco Bacci, Alessandro Broccoli, Rita Golfieri, Elena Sabattini, Lisa Argnani, Stefano Fanti, Broccoli A., Nanni C., Cappelli A., Bacci F., Gasbarrini A., Tabacchi E., Piovani C., Argnani L., Ghermandi R., Sabattini E., Golfieri R., Fanti S., and Zinzani P.L.
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medicine.medical_specialty ,Positron emission tomography ,Lymphoma ,Biopsy ,Settore MED/12 - GASTROENTEROLOGIA ,Diagnostic accuracy ,Computed tomography ,030218 nuclear medicine & medical imaging ,Driven biopsy ,03 medical and health sciences ,0302 clinical medicine ,Fluorodeoxyglucose F18 ,Positron Emission Tomography Computed Tomography ,Diagnosis ,medicine ,Humans ,Radiology, Nuclear Medicine and imaging ,Adverse effect ,Lymph node ,Retrospective Studies ,medicine.diagnostic_test ,business.industry ,Settore MED/09 - MEDICINA INTERNA ,General Medicine ,medicine.disease ,medicine.anatomical_structure ,Neoplasm Recurrence ,Local ,030220 oncology & carcinogenesis ,Positron-Emission Tomography ,Orthopedic surgery ,Original Article ,Radiology ,Neoplasm Recurrence, Local ,Radiopharmaceuticals ,business ,Diagnosi - Abstract
Introduction Biopsy of affected tissue is required for lymphoma diagnosis and to plan treatment. Open incisional biopsy is traditionally the method of choice. Nevertheless, it requires hospitalization, availability of an operating room, and sometimes general anesthesia, and it is associated with several drawbacks. Fluorodeoxyglucose positron emission tomography/computed tomography (PET/CT) can be potentially used to drive biopsy to the most metabolically active area within a lymph node or extranodal masses. Methods A study of diagnostic accuracy was conducted to assess the performance of a PET-driven needle biopsy in patients with suspect active lymphoma. Results Overall, 99 procedures have been performed: three (3.0%) were interrupted because of pain but were successfully repeated in two cases. Median SUVmax of target lesions was 10.7. In 84/96 cases, the tissue was considered adequate to formulate a diagnosis (diagnostic yield of 87.5%) and to guide the following clinical decision. The target specimen was a lymph node in 60 cases and an extranodal site in 36. No serious adverse events occurred. The sensitivity of this procedure was 96%, with a specificity of 100%, a positive predictive value of 100%, and a negative predictive value of 75%. Conclusion Patients can benefit from a minimally invasive procedure which allows a timely and accurate diagnosis of lymphoma at onset or relapse.
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- 2020
36. Carbon Ions Therapy as Single Treatment in Chordoma of the Sacrum. Histologic and Metabolic Outcome Studies
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G, Evangelisti, M R, Fiore, S, Bandiera, G, Barbanti Brodano, S, Terzi, M, Girolami, V, Pipola, A, Righi, C, Nanni, S, Fanti, R, Ghermandi, S, Molinelli, R, Orecchia, S, Boriani, A, Gasbarrini, and Evangelisti G, Fiore MR, Bandiera S, Barbanti Brodano G, Terzi S, Girolami M, Pipola V, Righi A, Nanni C, Fanti S, Ghermandi R, Molinelli S, Orecchia R, Boriani S, Gasbarrini A.
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Adult ,Aged, 80 and over ,Male ,Sacrum ,Heavy Ion Radiotherapy ,Middle Aged ,Magnetic Resonance Imaging ,Carbon ,Progression-Free Survival ,Survival Rate ,Erythema ,Positron Emission Tomography Computed Tomography ,Chordoma ,Humans ,Female ,Paresthesia ,Aged - Abstract
Objective: Even though carbon ions treatment (CIRT) of sacral chordoma (SC) substantially reduces tumor mass, tumor remnants are observed in most patients. Differentiating tumor remnants from necrosis is challenging, expensive in terms of imaging and time-consuming. So far, there has not been a systematic histological and metabolic analysis of post-CIRT lesions. We designed a prospective study aiming to histologically a metabolically differentiate between viable tumor and foci of necrosis and of fibrosclerosis after CIRT and correlate these findings to clinical outcome in patients with SC. Patients and methods: Between January 2013 and December 2016 18 patients, 12 males and 6 females, with histological confirmation of sacral chordoma, underwent CIRT. The total dose was 70.4 GyE, with a daily fraction of 4.4 GyE, for 4 weeks. MRI was performed every three months after treatment. FDG PET-CT scan and CT-guided needle biopsy were performed 6-12 months after CIRT. The incidence of complications (intraoperative and postoperative), local control (LC), overall survival (OS) and progression-free survival (PFS), changes in neurological status, clinical outcomes and toxicity were considered. Results: All histological analysis but 2 reported signs of necrosis and of fibrosclerosis after CIRT. One of these 2 patients turned into a dedifferentiated chordoma. Radiological partial response (PR) was observed in 10 patients (56.3%) and stable disease (SD) in 5 patients (28.3). Two patients (11%) had a local relapse. The overall survival rate was 100% at 24 months. FDG PET CT after CIRT showed uptake decreasing compared with the baseline exam in all but one patient. Conclusions: The histological presence of necrosis and of fibrosclerosis after CIRT at the histological analysis supports the previous clinical evidence on the efficacy of CIRT. Volumetric stability of the residual mass should be considered as a success of treatment. In cases of a volumetric increase of the mass, a CT needle biopsy should always be performed. In our series, during the follow-up, the FDG-PET was able to promptly detect an increased uptake in the case which later was histologically defined as dedifferentiated chordoma.
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- 2019
37. Secondary chondrosarcoma of the lumbar spine in hereditary multiple exostoses
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Emanuela Castiello, Addisu Mesfin, Stefano Boriani, Riccardo Ghermandi, Davide Donati, Mesfin A, Ghermandi R, Castiello E, Donati DM, and Boriani S
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medicine.medical_specialty ,Lumbar Vertebrae ,Spinal Neoplasms ,LUMBAR SPINE ,business.industry ,exostose ,Hereditary multiple exostoses ,Chondrosarcoma ,Bone Neoplasms ,medicine.disease ,Neoplasms, Multiple Primary ,Young Adult ,medicine ,Humans ,Surgery ,Orthopedics and Sports Medicine ,Lumbar spine ,Female ,Neurology (clinical) ,Radiology ,Secondary Chondrosarcoma ,business ,Exostoses, Multiple Hereditary - Abstract
We report a case of a 19-year-old woman with hereditary multiple exostoses, confirmed via EXT2 gene mutation, who presented to our clinic with a 4-month history of low back pain.
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- 2013
38. Spinal infection multidisciplinary management project (SIMP): from diagnosis to treatment guideline
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F. Facchini, Giovanni Barbanti-Brodano, Fabio Tumietto, R. Bacchin, Cristina Nanni, Luca Boriani, Eugenio Rimondi, Pierluigi Viale, Ugo Albisinni, S Bonarelli, Stefano Fanti, Stefano Bandiera, Simone Colangeli, Alessandro Gasbarrini, Eleonora Zamparini, Rosanna Ciminari, Riccardo Ghermandi, L. Babbi, Alessandro Corghi, Vincenzo Allegri, A. Morigi, M. Difiore, Francesco Cristini, Maria Cristina Malaguti, Stefano Boriani, J. Frugiuele, Giada Rorato, G. Marinacci, Luca Amendola, Silvia Terzi, Caterina Salvadori, Gasbarrini A, Boriani L, Nanni C, Zamparini E, Rorato G, Ghermandi R, Salvadori C, Allegri V, Bandiera S, Barbanti-Brodano G, Colangeli S, Corghi A, Terzi S, Babbi L, Amendola L, Cristini F, Marinacci G, Tumietto F, Ciminari R, Malaguti MC, Rimondi E, Difiore M, Bacchin R, Facchini F, Frugiuele J, Morigi A, Albisinni U, Bonarelli S, Fanti S, Viale P, and Boriani S
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Spondylodiscitis ,Adult ,Male ,medicine.medical_specialty ,Discitis ,Immunology ,Guidelines as Topic ,Young Adult ,Multidisciplinary approach ,Fluorodeoxyglucose F18 ,Antibiotic therapy ,Immunology and Allergy ,Medicine ,Vertebral osteomyelitis ,Humans ,Medical physics ,Prospective Studies ,Prospective cohort study ,Aged ,Pharmacology ,Aged, 80 and over ,business.industry ,Osteomyelitis ,Extremely Helpful ,Guideline ,Middle Aged ,medicine.disease ,Bone Diseases, Infectious ,Magnetic Resonance Imaging ,Spine ,Surgery ,Anti-Bacterial Agents ,Positron-Emission Tomography ,Female ,Spinal Diseases ,spondylodiscitis ,Radiopharmaceuticals ,business ,Tomography, X-Ray Computed - Abstract
Spine infections require a multidisciplinary approach to be treated and solved. A guide line to drive physicians in the deep complexity of such a disease is extremely helpful. SIMP suggests a flow-chart built up on clear concepts such as right and well managed antibiotic therapy, sound stability of the spine, correct and smart use of the standard and functional imaging techniques, such as f18 FDG PET/CT. In 16 months a total of 41 patients have been treated for spondylodiscitis, discitis and vertebral osteomyelitis by our team of physicians and 25 patients have been enrolled in a prospective study whose target is the assessment of the SIMP flow-chart and of every single aspect that characterize it.
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- 2011
39. Combined arthroscopic treatment of tibial plateau and intercondylar eminence avulsion fractures
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Roberto Buda, Alberto Ferruzzi, Antonio Timoncini, Riccardo Ghermandi, Sandro Giannini, Francesco Di Caprio, Alessandro Parma, Di Caprio F., Buda R., Ghermandi R., Ferruzzi A., Timoncini A., Parma A., and Giannini S.
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Knee arthritis ,Adult ,Male ,musculoskeletal diseases ,medicine.medical_specialty ,Knee Joint ,medicine.medical_treatment ,Avulsion ,Arthroscopy ,medicine ,Tibial plateau fracture ,Internal fixation ,Humans ,Orthopedics and Sports Medicine ,medicine.diagnostic_test ,business.industry ,Avulsion fracture ,General Medicine ,medicine.disease ,musculoskeletal system ,Surgery ,Tibial Fractures ,Knee pain ,Treatment Outcome ,avulsion fracture ,Orthopedic surgery ,fracture fixation ,Female ,medicine.symptom ,business - Abstract
Fractures of the tibial plateau represent 1% of all fractures and 8% of fractures in the elderly population1. These fractures represent a surgical challenge because of the variety of fracture patterns and the associated soft-tissue injuries. If not adequately treated, these fractures often cause persistent knee pain, arthritis, and angular deformity. In one study, posttraumatic knee arthritis following a tibial plateau fracture was reported, after a seven-year follow-up, in 74% of patients with an associated meniscal tear and in 34% of patients with intact menisci2. Intercondylar eminence avulsion fractures are relatively uncommon. First described by Poncet in 1875, this injury usually has been considered to be the childhood equivalent of anterior cruciate ligament rupture in adults3. As an isolated injury, these fractures are most frequent in pediatric patients between the ages of eight and fourteen years4-9. These lesions also can occur in adults in association with another periarticular injury or a tibial plateau fracture3,5. In our experience, 19.4% of tibial plateau fractures have been associated with an intercondylar eminence fracture whereas 84.3% of tibial spine fractures in adults have been associated with a tibial plateau fracture (unpublished data). Associated tibial plateau and intercondylar eminence avulsion fractures are complex articular lesions that vary widely from one patient to another, and therefore treatment requires personalized solutions. When determining the best treatment, anatomic joint reconstruction with minimally invasive techniques should be considered. Arthroscopic reduction and internal fixation have demonstrated various advantages over open reduction and internal fixation in terms of surgical morbidity, time of hospital stay, recovery, and complications such as infection and loss of knee motion10-12. The high prevalence of associated intra-articular lesions justifies the use of arthroscopy to evaluate and treat all of …
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- 2010
40. Therapeutic strategies for mobile spine chordoma: en bloc Versus intralesional surgery with adjuvant charged-particle therapy.
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De Robertis M, Ghermandi R, Pipola V, Griffoni C, Cianchetti M, Rotondi M, Asunis E, Tosini G, Cini C, Morenghi E, Noli LE, Alcherigi C, Monetta A, Tedesco G, Terzi S, Girolami M, Bròdano GB, Fiore MR, Bandiera S, and Gasbarrini A
- Abstract
Purpose: The aim of this retrospective study is to analyze the impact of en bloc resection with negative margins versus intralesional resection plus adjuvant hadron-therapy (HT) on local control (LC) and overall survival (OS) in patients with mobile spine chordomas. Mechanical complications incidence as well as risk factors, and outcome differences are investigated as secondary endpoints., Methods: 33 patients in a period from January 2013 to December 2021 were enrolled for the final analysis. The inclusion criteria were: lesions located in the mobile spine (C1-L5), age ≥ 15 years, minimum follow-up of 2 years, en bloc or intralesional surgical resection, virgin or recurrent chordomas, with only one previous surgical treatment., Results: No difference was found in terms of LC between the two groups. The presence of pathologic fracture at pre-operative imaging and the presence of macroscopic residual tumor after surgery, independently from its entity, seemed to be associated with an increased risk of LR. No difference was found between planned en bloc and planned intralesional surgery in terms of mechanical complications occurrence. Eight patients (24.24%) had mechanical complications during the follow up period: male sex, presence of pathologic fracture at baseline, a combined surgical approach, the use of carbon fiber-only hardware appeared to be associated with an increased risk of mechanical complications after the primary surgery., Conclusions: En bloc resection, whenever possible, is always to be preferred for its widely recognized potential in LC and OS improvement. However, technology advances in high-dose conformal charged-particle therapy have allowed improvement of local control rates as an adjuvant therapy of intralesional surgery for mobile spine chordoma, with acceptable acute and chronic toxicity., (© 2024. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)
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- 2024
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41. Prolonged operative time significantly impacts on the incidence of complications in spinal surgery.
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Monetta A, Griffoni C, Falzetti L, Evangelisti G, Noli LE, Tedesco G, Cavallari C, Bandiera S, Terzi S, Ghermandi R, Girolami M, Pipola V, Gasbarrini A, and Brodano GB
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- Humans, Middle Aged, Male, Female, Aged, Retrospective Studies, Incidence, Adult, Spine surgery, Risk Factors, Intraoperative Complications epidemiology, Intraoperative Complications etiology, Orthopedic Procedures adverse effects, Orthopedic Procedures methods, Operative Time, Postoperative Complications epidemiology, Postoperative Complications etiology, Spinal Diseases surgery
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Background: In spinal surgery adverse events (AE) and surgical complications (SC) significantly affect patient's outcome and quality of life. The duration of surgery has been investigated in different surgical field as risk factor for complications. The aim of this study is to analyze the correlation between operative time and adverse events in spinal surgery., Methods: We retrospectively analyzed data collected prospectively in a cohort of 336 patients surgically treated for spinal diseases of oncological and degenerative origin in a single center, between January 2017 to January 2018. Demographics and clinical data were collected. Adverse events were classified using Spinal Adverse Events Severity System version 2 (SAVES-V2) capture system. Focusing on degenerative patients, bivariate analysis and univariate logistic regression were used to determine the association between operative time and complications., Results: A total of 105/336 patients experienced an AE related to surgery, respectively 38% in the oncological group and 28% in the degenerative group. The average age at surgery was 60.3 years (SD 17.1) and the mean operative time was 164.8 ± 138 min. A total of 206 adverse events (30 intraoperative, 135 early postoperative and 41 late postoperative AEs) were recorded. Early post-operative complications accounted for the most recorded AEs (55.5% in the oncological group and 73.2% in the degenerative group). Univariate logistic regression analyses confirmed that operative time correlated with increased risk of intra-operative (p-value = 0.0008), early post-operative (p-value < 0.001) and late post-operative (p-value < 0.001) adverse events., Conclusions: This study highlights the strong correlation between the occurrence of adverse events in spinal surgery and prolonged operative time and suggests that efforts should be made to minimize the duration of surgical procedures while prioritizing patient's safety, without compromising the technical achievement of the procedure., (© 2024. The Author(s).)
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- 2024
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42. Conventional Spinal Chordomas: Investigation of SMARCB1/INI1 Protein Expression, Genetic Alterations in SMARCB1 Gene, and Clinicopathological Features in 89 Patients.
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Maioli M, Cocchi S, Gambarotti M, Benini S, Magagnoli G, Gamberi G, Griffoni C, Gasbarrini A, Ghermandi R, Noli LE, Alcherigi C, Ferrari C, Bianchi G, Asioli S, Pignotti E, and Righi A
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The partial loss of SMARCB1/INI1 expression has recently been reported in skull base conventional chordomas, with possible therapeutic implications. We retrospectively analyzed 89 patients with conventional spinal chordomas to investigate the differences in the immunohistochemical expression of SMARCB1/INI1 and the underlying genetic alterations in the SMARCB1 gene. Moreover, we assessed the correlation of clinicopathological features (age, gender, tumor size, tumor location, surgical margins, Ki67 labelling index, SMARCB1/INI1 pattern, previous surgery, previous treatment, type of surgery, and the Charlson Comorbidity Index) with patient survival. Our cohort included 51 males and 38 females, with a median age at diagnosis of 61 years. The median tumor size at presentation was 5.9 cm. The 5-year overall survival (OS) and 5-year disease-free survival (DFS) rates were 90.8% and 54.9%, respectively. Partial SMARCB1/INI1 loss was identified in 37 (41.6%) patients with conventional spinal chordomas (27 mosaic and 10 clonal). The most frequent genetic alteration detected was the monoallelic deletion of a portion of the long arm of chromosome 22, which includes the SMARCB1 gene. Partial loss of SMARCB1/INI1 was correlated with cervical-thoracic-lumbar tumor location ( p = 0.033) and inadequate surgical margins ( p = 0.007), possibly due to the high degree of tumor invasiveness in this site. Among all the considered clinicopathological features related to patient survival, only tumor location in the sacrococcygeal region and adequate surgical margins positively impacted DFS. In conclusion, partial SMARCB1/INI1 loss, mostly due to 22q deletion, was detected in a significant number of patients with conventional spinal chordomas and was correlated with mobile spine location and inadequate surgical margins., Competing Interests: The authors declare no conflicts of interest.
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- 2024
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43. Denosumab Re-Challenge and Long-Term Efficacy for Aneurysmal Bone Cyst of the Spine: Enhanced Treatment Algorithm.
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Evangelisti G, Altorfer FCS, Falzetti L, Palmerini E, Griffoni C, Ghermandi R, Boriani S, Monetta A, Cesari M, Ibrahim T, and Gasbarrini A
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Background/Objective: Surgical treatment of aneurysmal bone cysts (ABCs) can be challenging, especially in the spine. Non-surgical treatments such as with denosumab have shown promising results in different osteolytic pathologies. This retrospective observational study aimed to evaluate the long-term clinical and radiologic response of patients with ABCs of the mobile spine treated with denosumab and propose an updated treatment algorithm. Methods: Six patients with relapsed and symptomatic ABCs of the mobile spine were treated with denosumab (120 mg subcutaneously on days 1, 8, 15, 29, and every 4 weeks thereafter) between 2012 and 2023. Disease assessments were conducted using CT and MRI at 3, 6, 9, and 12 months post-treatment. Clinical data, including pain levels, symptoms, and adverse events, were documented from patients' charts. Results: Patients underwent an initial phase of treatment with denosumab, receiving a mean of 22 administrations (range 13-42) over a median follow-up period of 41 months (range 15-98 months). Clinical improvement was observed in all patients after 4 weeks of treatment, and all patients demonstrated a radiological response after 12-24 weeks on denosumab. Three patients were progression-free after discontinuing denosumab following 13, 15, and 42 administrations, respectively. At the last follow-up, after 38, 43, and 98 months, these patients remained stable without relapse of the disease. Three patients had a relapse of disease after denosumab; two of them underwent denosumab re-challenge, while one patient received one mesenchymal stem cells (MSCs) injection. All patients showed clinical and radiological improvement and were resulted to be disease-free at the last follow-up. Conclusions: This study demonstrates the long-term efficacy and safety of denosumab in treating ABCs of the mobile spine, as well as the potential of re-challenge in managing recurrence. A treatment algorithm is proposed, positioning denosumab as a viable therapeutic option after other local treatments. Careful patient selection, monitoring, and further research are necessary to optimize denosumab use for ABCs.
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- 2024
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44. Epithelioid Hemangioma of the Spine: A Case Series and Treatment Flow Chart-Experience from a Single Centre.
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Asunis E, Cini C, De Robertis M, Griffoni C, Bandiera S, Righi A, Ghermandi R, Pipola V, Girolami M, Tedesco G, Gambarotti M, and Gasbarrini A
- Abstract
Epithelioid hemangioma is recognized by the World Health Organization as a distinct benign neoplasm; however, it is characterized by locally aggressive and rarely metastasizing behavior. Epithelioid vascular tumors are rare bony vascular lesions with varying degrees of malignant potential that remain controversial because of their rarity, unusual morphological features, and unpredictable biological behavior. The application of new molecular tools, such as massive parallel sequencing technologies, have provided new diagnostic markers and an opportunity to further refine the classification of bone vascular neoplasms. Very few cases of EH of the spine have been reported in the literature; therefore, it is difficult to make evidence-based therapeutic decisions for these patients. We report herein our experience with eleven patients suffering from EH of the spine. The study population included three males and eight females treated in our center from 2016 to the present; the average age was 44.8 years (range 14-75 years). The surgical, clinical, and radiographic data were retrospectively analyzed. The mean follow-up was 34.8 months. All patients presented lytic vertebral body lesions, six of them with pathological fracture. The majority of patients (80%) presented myelo-radicular compression. All patients were surgically treated, and preoperative embolization was performed in all cases. In light of the literature review and the clinical experience of our center, we can consider EH a locally aggressive tumor that requires surgical treatment in case of symptoms. Here, we propose a treatment algorithm that could be useful in the management of patients with this rare disease.
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- 2024
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45. Factors associated with increased length of stay and risk of complications in 336 patients submitted to spine surgery. The role of a validated capture system (SAVES v2) as a first-line tool to properly face the problem.
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Falzetti L, Griffoni C, Carretta E, Pezzi A, Monetta A, Cavallari C, Ghermandi R, Tedesco G, Terzi S, Bandiera S, Evangelisti G, Girolami M, Pipola V, Tosini G, Noli LE, Gasbarrini A, and Barbanti Brodano G
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- Humans, Prospective Studies, Retrospective Studies, Length of Stay, Postoperative Complications epidemiology, Postoperative Complications etiology, Spine surgery
- Abstract
Purpose: In this study, we analyzed the use of a validated capture system (Spinal Adverse Events Severity system, SAVES V2) as a first non-technical skill to properly face the relevant problem of surgical complications (SCs) and adverse events (AEs) in spinal surgery., Methods: We retrospectively collected AEs occurring in a tertiary referral center for spine surgery from January 2017 to January 2018 and classified them according to SAVES V2 system. We compared this collection of AEs with a prospective collection performed without any classification system. Univariate and multivariate logistic regression models were used to determined odds ratio (ORs) for selected potential risk factors of AEs and prolonged length of stay., Results: Overall a higher number of AEs was retrospectively recorded using SAVES system compared to the prospective recording without the use of any capture system (97/336 vs 210/336, p < 0.001). The length of stay (LOS) increased in the group of complicated patients for all the procedures examined. In the non-oncological group, LOS was significantly higher for complicated patients compared to uncomplicated patients (F = 44.11, p = 0.0000). Similar results have been obtained in the oncological group of patients. In the multivariate regression model surgical time and postoperative AEs emerged as risk factors for prolonged LOS, while only the presence of previous surgeries was confirmed as risk factor for AEs., Conclusion: Considering that the rate of AEs and SCs in spinal surgery is still high despite the improvement of technical skills, we suggest the use of SAVES V2 capture system as a first-line tool to face the problem., (© 2024. The Author(s).)
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- 2024
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46. Electrochemotherapy in Aggressive Hemangioma of the Spine: A Case Series and Narrative Literature Review.
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Tedesco G, Noli LE, Griffoni C, Ghermandi R, Facchini G, Peta G, Papalexis N, Asunis E, Pasini S, and Gasbarrini A
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(1) Background: this case series and literature review aims to evaluate the efficacy and safety of electrochemotherapy in the management of aggressive spinal hemangiomas, presenting two distinct cases. (2) Methods: we present two cases of spinal aggressive hemangioma which were refractory to conventional treatments and underwent electrochemotherapy. Case 1 involves a 50-year-old female who presented with an aggressive spinal hemangioma of L1, who previously underwent various treatments including surgery, radio-chemotherapy, and arterial embolization. Case 2 describes a 16-year-old female with a T12 vertebral hemangioma, previously treated with surgery and stabilization, who faced limitations in treatment options due to her young age and the location of the hemangioma. (3) Results: in Case 1, electrochemotherapy with bleomycin was administered following the failure of previous treatments and resulted in the reduction of the lesion size and improvement in clinical symptoms. In Case 2, electrochemotherapy was chosen due to the risks associated with other treatments and was completed without any adverse events. Both cases demonstrated the potential of electrochemotherapy as a viable treatment option for spinal hemangiomas, especially in complex or recurrent cases. (4) Conclusions: electrochemotherapy with bleomycin is a promising treatment for aggressive spinal hemangiomas when conventional therapies are not feasible or have failed. Further research is needed to establish definitive protocols and long-term outcomes of electrochemotherapy in spinal hemangioma management.
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- 2024
- Full Text
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47. Safety and efficacy of autologous bone marrow clot as a multifunctional bioscaffold for instrumental posterior lumbar fusion: a 1-year follow-up pilot study.
- Author
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Salamanna F, Tedesco G, Sartori M, Griffoni C, Spinnato P, Romeo P, Ghermandi R, Fini M, Giavaresi G, Gasbarrini A, and Barbanti Brodano G
- Subjects
- Humans, Follow-Up Studies, Pilot Projects, Prospective Studies, Bone Marrow, Quality of Life
- Abstract
Background: Bone marrow aspirate (BMA), when combined with graft substitutes, has long been introduced as a promising alternative to iliac crest bone graft in spinal fusion. However, the use of BMA is limited by the absence of a standardized procedure, a structural texture, and the potential for diffusion away from the implant site. Recently, the potential use of a new formulation of BMA, named BMA clot, has been preclinically described. In this report, we present the results of a prospective pilot clinical study aimed at evaluating the safety and efficacy of autologous vertebral BMA (vBMA) clot as a three-dimensional and multifunctional bioscaffold in instrumented posterior lumbar fusion., Methods: Ten consecutive patients with an indication of multilevel (≤5) posterior spinal fusion due to lumbar spine degenerative diseases were included in the study and treated with vBMA. Clinical outcomes were assessed using the Visual Analog Scale (VAS), Oswestry Disability Index (ODI), and EuroQoL-5L (EQ-5L) preoperatively and at 3 months and 12 months after spinal fusion. Bone fusion quality was evaluated at the 12-month follow-up using the Brantigan classification on radiography (XR) imaging. Bone density was measured on computed tomography (CT) scans at 6 and 12 months of follow-up visits at the intervertebral arches and intervertebral joint areas and expressed in Hounsfield unit (HU)., Results: The results indicate a successful posterolateral fusion rate of approximately 100% (considering levels with C, D, and E grades according to the Brantigan classification) at the 12-month follow-up, along with an increase in bone density from 6 to 12 months of follow-up. An improvement in the quality of life and health status following surgery, as assessed by clinical scores (ODI, VAS, and EQ-5L), was also observed as early as 3 months postsurgery. No adverse events related to the vBMA clot were reported., Conclusion: This prospective pilot study demonstrates the effectiveness and safety profile of vBMA clot as an advanced bioscaffold capable of achieving posterior lumbar fusion in the treatment of degenerative spine diseases. This lays the groundwork for a larger randomized clinical study., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2024 Salamanna, Tedesco, Sartori, Griffoni, Spinnato, Romeo, Ghermandi, Fini, Giavaresi, Gasbarrini and Barbanti Brodano.)
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- 2024
- Full Text
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48. Minimally invasive treatment of pedicle stress fracture in a young athlete: A case report.
- Author
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Ghermandi R, Falzetti L, Haddad D, Pipola V, and Gasbarrini A
- Abstract
Introduction: Pedicle stress fractures are an uncommon type of non-union often associated with contralateral neural arch interruption in young, active patients. Patients present with long-lasting low back pain, and the diagnosis is usually delayed. Treatment is generally conservative. Few cases treated surgically are described in the literature, with a high degree of treatment heterogeneity and no consensus on optimal treatment., Presentation of Case: A 24-year-old male, following a sports-related trauma, developed persistent lower back pain. Imaging revealed a right L3 pedicle stress fracture with left lamina and pars interarticularis interruption. A minimally invasive percutaneous approach targeting the pedicle fracture was chosen. The procedure aimed to alleviate pain and promote non-union healing, without addressing the contralateral defect. The patient quickly recovered, achieving significant pain relief, and starting a tailored physical therapy program. At the 4-month follow-up, the pedicle fracture healed with callus formation. The patient returned to sports practice., Discussion: Pedicle stress fractures may result from biomechanical force redistribution. Diagnosis is challenging, necessitating advanced imaging, including bone scintigraphy, MRI, and CT scans. Conservative management with rest, restriction with a brace, and focused rehabilitation usually achieves good results. When conservative management fails, surgery should be considered. Surgical options include direct repair, bone grafting, and screw fixation of the pedicle and contralateral pars defect., Conclusion: Minimally invasive surgery can achieve good clinical and functional results while avoiding blood loss and soft tissue trauma. Treating only the stress fracture is sufficient to promote bone healing, in contrast to more complex procedures., Competing Interests: Conflict of interest statement The authors declare that they have no competing interests., (Copyright © 2023 The Authors. Published by Elsevier Ltd.. All rights reserved.)
- Published
- 2023
- Full Text
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49. Carbon Fiber-Reinforced PolyEtherEtherKetone (CFR-PEEK) Instrumentation in Degenerative Disease of Lumbar Spine: A Pilot Study.
- Author
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Ghermandi R, Tosini G, Lorenzi A, Griffoni C, La Barbera L, Girolami M, Pipola V, Barbanti Brodano G, Bandiera S, Terzi S, Tedesco G, Evangelisti G, Monetta A, Noli LE, Falzetti L, and Gasbarrini A
- Abstract
CFR-PEEK is gaining popularity in spinal oncological applications due to its reduction of imaging artifacts and radiation scattering compared with titanium, which allows for better oncological follow-up and efficacy of radiotherapy. We evaluated the use of these materials for the treatment of lumbar degenerative diseases (DDs) and considered the biomechanical potential of the carbon fiber in relation to its modulus of elasticity being similar to that of bone. Twenty-eight patients with DDs were treated using CRF-PEEK instrumentation. The clinical and radiographic outcomes were collected at a 12-month FU. Spinal fusion was evaluated in the CT scans using Brantigan scores, while the clinical outcomes were evaluated using VAS, SF-12, and EQ-5D scores. Out of the patients evaluated at the 12-month FU, 89% showed complete or almost certain fusion (Brantigan score D and E) and presented a significant improvement in all clinical parameters; the patients also presented VAS scores ranging from 6.81 ± 2.01 to 0.85 ± 1.32, EQ-5D scores ranging from 53.4 ± 19.3 to 85.0 ± 13.7, SF-12 physical component scores (PCSs) ranging from 29.35 ± 7.04 to 51.36 ± 9.75, and SF-12 mental component scores (MCSs) ranging from 39.89 ± 11.70 to 53.24 ± 9.24. No mechanical complications related to the implant were detected, and the patients reported a better tolerance of the instrumentation compared with titanium. No other series of patients affected by DD that was stabilized using carbon fiber implants have been reported in the literature. The results of this pilot study indicate the efficacy and safety of these implants and support their use also for spinal degenerative diseases.
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- 2023
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50. Imaging of Atlantoaxial Calcium Pyrophosphate Deposition Disease With Unusual Onset as Drop Attack.
- Author
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D'Agostino V, Vanzi B, Ghermandi R, and Spinnato P
- Subjects
- Humans, Tomography, X-Ray Computed methods, Syncope, Chondrocalcinosis diagnostic imaging, Atlanto-Axial Joint diagnostic imaging
- Published
- 2023
- Full Text
- View/download PDF
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