Palliative dual iliac screw fixation for lumbosacral metastasis

2007 ◽  
Vol 7 (1) ◽  
pp. 99-102 ◽  
Author(s):  
Shunsuke Fujibayashi ◽  
Masashi Neo ◽  
Takashi Nakamura
Keyword(s):  
Screw Fixation ◽  
Spinal Metastases ◽  
Clinical Results ◽  
Spinal Fixation ◽  
Spinal Disease ◽  
Metastatic Lesions ◽  
Iliac Screw ◽  
Rod Breakage ◽  
Early Wound

✓ Spinal fixation for destructive metastatic lesions at the lumbosacral junction is challenging because of the large and unique load-bearing characteristics present. In particular, caudal fixation is difficult in cases of sacral destruction because of insufficient S-1 pedicle screw anchorage. The authors describe their surgical technique for secure iliac screw placement and the clinical results obtained in five patients with metastatic spinal disease. All patients in this study underwent palliative operations with dual iliac screw fixation between April 1999 and October 2002, and the clinical and radiological findings were assessed. In all five patients, spinal metastases extended into the sacrum. The metastases were from renal cell carcinomas in two patients, lung cancer in two, and a paraganglioma in one patient. Postoperative follow-up periods ranged from 3 months to 6 years (mean 28.4 months). Preoperatively, four patients could not walk due to severe pain or neurological compromise. Postoperatively, all patients reported a reduction in pain and regained the ability to walk. Complications included one case of early wound infection. In the patients with long survival after the operation, there was one case of iliac screw loosening and one case of rod breakage. The dual iliac screw fixation technique provided sufficient immediate stability for destructive lumbosacral metastasis.

scholarly journals The Role of a Navigational Radiofrequency Ablation Device and Concurrent Vertebral Augmentation for Treatment of Difficult-to-Reach Spinal Metastases

2021 ◽  
Vol 28 (5) ◽  
pp. 4004-4015
Author(s):  
Claudio Pusceddu ◽  
Davide De Francesco ◽  
Luca Melis ◽  
Nicola Ballicu ◽  
Alessandro Fancellu
Keyword(s):  
Radiofrequency Ablation ◽  
Pain Relief ◽  
Spinal Metastases ◽  
Local Tumor Control ◽  
Tumor Control ◽  
Vertebral Augmentation ◽  
Local Tumor ◽  
Metastatic Lesions ◽  
The Mean

Aims: The purpose of this study was to assess the effectiveness of a navigational radiofrequency ablation device with concurrent vertebral augmentation in the treatment of posterior vertebral body metastatic lesions, which are technically difficult to access. Primary outcomes of the study were evaluation of pain palliation and radiologic assessment of local tumor control. Materials and Methods: Thirty-five patients with 41 vertebral spinal metastases involving the posterior vertebral body underwent computed tomography-guided percutaneous targeted radiofrequency ablation, with a navigational radiofrequency ablation device, associated with vertebral augmentation. Twenty-one patients (60%) had 1 or 2 metastatic lesions (Group A) and fourteen (40%) patients had multiple (>2) vertebral lesions (Group B). Changes in pain severity were evaluated by visual analog scale (VAS). Metastatic lesions were evaluated in terms of radiological local control. Results: The procedure was technically successful in all the treated vertebrae. Among the symptomatic patients, the mean VAS score dropped from 5.7 (95% CI 4.9–6.5) before tRFA and to 0.9 (95% CI 0.4–1.3) after tRFA (p < 0.001). The mean decrease in VAS score between baseline and one week follow up was 4.8 (95% CI 4.2–5.4). VAS decrease over time between one week and one year following radiofrequency ablation was similar, suggesting that pain relief was immediate and durable. Neither patients with 1–2 vertebral metastases, nor those with multiple lesions, showed radiological signs of local progression or recurrence of the tumor in the index vertebrae during a median follow up of 19 months (4–46 months) and 10 months (4–37 months), respectively. Conclusion: Treatment of spinal metastases with a navigational radiofrequency ablation device and vertebral augmentation can be used to obtain local tumor control with immediate and durable pain relief, providing effective treatment in the multimodality management of difficult-to-reach spinal metastases.

Low rates of complications after spinopelvic fixation with iliac screws in 260 adult patients with a minimum 2-year follow-up

2019 ◽  
Vol 30 (5) ◽  
pp. 635-643 ◽  
Author(s):  
James H. Nguyen ◽  
Thomas J. Buell ◽  
Tony R. Wang ◽  
Jeffrey P. Mullin ◽  
Marcus D. Mazur ◽  
...  
Keyword(s):  
Screw Fixation ◽  
Wound Dehiscence ◽  
Adult Patients ◽  
Complication Rates ◽  
Related Complication ◽  
Screw Head ◽  
Spinopelvic Fixation ◽  
Iliac Screws ◽  
Iliac Screw

OBJECTIVERecent literature describing complications associated with spinopelvic fixation with iliac screws in adult patients has been limited but has suggested high complication rates. The authors’ objective was to report their experience with iliac screw fixation in a large series of patients with a 2-year minimum follow-up.METHODSOf 327 adult patients undergoing spinopelvic fixation with iliac screws at the authors’ institution between 2010 and 2015, 260 met the study inclusion criteria (age ≥ 18 years, first-time iliac screw placement, and 2-year minimum follow-up). Patients with active spinal infection were excluded. All iliac screws were placed via a posterior midline approach using fluoroscopic guidance. Iliac screw heads were deeply recessed into the posterior superior iliac spine. Clinical and radiographic data were obtained and analyzed.RESULTSTwenty patients (7.7%) had iliac screw–related complication, which included fracture (12, 4.6%) and/or screw loosening (9, 3.5%). No patients had iliac screw head prominence that required revision surgery or resulted in pain, wound dehiscence, or poor cosmesis. Eleven patients (4.2%) had rod or connector fracture below S1. Overall, 23 patients (8.8%) had L5–S1 pseudarthrosis. Four patients (1.5%) had fracture of the S1 screw. Seven patients (2.7%) had wound dehiscence (unrelated to the iliac screw head) or infection. The rate of reoperation (excluding proximal junctional kyphosis) was 17.7%. On univariate analysis, an iliac screw–related complication rate was significantly associated with revision fusion (70.0% vs 41.2%, p = 0.013), a greater number of instrumented vertebrae (mean 12.6 vs 10.3, p = 0.014), and greater postoperative pelvic tilt (mean 27.7° vs 23.2°, p = 0.04). Lumbosacral junction–related complications were associated with a greater mean number of instrumented vertebrae (12.6 vs 10.3, p = 0.014). Reoperation was associated with a younger mean age at surgery (61.8 vs 65.8 years, p = 0.014), a greater mean number of instrumented vertebrae (12.2 vs 10.2, p = 0.001), and longer clinical and radiological mean follow-up duration (55.8 vs 44.5 months, p < 0.001; 55.8 vs 44.6 months, p < 0.001, respectively). On multivariate analysis, reoperation was associated with longer clinical follow-up (p < 0.001).CONCLUSIONSPrevious studies on iliac screw fixation have reported very high rates of complications and reoperation (as high as 53.6%). In this large, single-center series of adult patients, iliac screws were an effective method of spinopelvic fixation that had high rates of lumbosacral fusion and far lower complication rates than previously reported. Collectively, these findings argue that iliac screw fixation should remain a favored technique for spinopelvic fixation.

Instrumented surgical treatment for metastatic spinal tumors: is fusion necessary?

2020 ◽  
Vol 32 (3) ◽  
pp. 456-464 ◽  
Author(s):  
Se-Jun Park ◽  
Keun-Ho Lee ◽  
Chong-Suh Lee ◽  
Joon Young Jung ◽  
Jin Ho Park ◽  
...  
Keyword(s):  
Scale Score ◽  
Eastern Cooperative Oncology Group ◽  
Spinal Metastases ◽  
Visual Analog Scale Score ◽  
Spinal Tumors ◽  
Complication Rates ◽  
Pull Out ◽  
Rod Breakage ◽  
Cage Migration

OBJECTIVEThe goal of this study was to evaluate the radiographic and clinical results of instrumentation surgery without fusion for metastases to the spine.METHODSBetween 2010 and 2017, patients with spinal tumors who underwent instrumentation without fusion surgery were consecutively evaluated. Preoperative and postoperative clinical data were evaluated. Data were inclusive for last follow-up and just prior to death if the patient died. Instrumentation-related complications included screw migration, screw or rod breakage, cage migration, and screw loosening.RESULTSExcluding patients who died within 6 months, a total of 136 patients (140 operations) were recruited. The average follow-up duration was 16.5 months (median 12.4 months). The pain visual analog scale score decreased from 6.4 to 2.5 (p < 0.001) and the Eastern Cooperative Oncology Group scale score improved (p < 0.001). There were only 3 cases (2.1%) of symptomatic instrumentation-related complications that resulted in revisions. There were 6 cases of nonsymptomatic complications. The most common complication was screw migration or pull-out (5 cases). There were 3 cases of screw or rod breakage and 1 case of cage migration. Two-thirds of the cases of instrumentation-related complications occurred after 6 months, with a mean postoperative period of 1 year.CONCLUSIONSThe current study reported successful outcomes with very low complication rates after nonfusion surgery for patients with spinal metastases, even among those who survived for more than 6 months. More than half of the instrumentation-related complications were asymptomatic and did not require revision. The results suggest that nonfusion surgery might be sufficient for a majority of patients with spinal metastases.

Robotic-assisted percutaneous iliac screw fixation for destructive lumbosacral metastatic lesions: an early single-institution experience

2021 ◽  
Author(s):  
Christine Park ◽  
Clifford Crutcher ◽  
Vikram A. Mehta ◽  
Timothy Y. Wang ◽  
Khoi D. Than ◽  
...  
Keyword(s):  
Screw Fixation ◽  
Single Institution ◽  
Robotic Assisted ◽  
Metastatic Lesions ◽  
Iliac Screw

scholarly journals Unilateral versus bilateral iliac screws for spinopelvic fixation: are two screws better than one?

2014 ◽  
Vol 36 (5) ◽  
pp. E10 ◽  
Author(s):  
Rajiv Saigal ◽  
Darryl Lau ◽  
Rishi Wadhwa ◽  
Hai Le ◽  
Morsi Khashan ◽  
...  
Keyword(s):  
Postoperative Infection ◽  
Screw Fixation ◽  
Insufficiency Fractures ◽  
Single Institution ◽  
Spinopelvic Fixation ◽  
Iliac Screws ◽  
Iliac Screw ◽  
Sacral Insufficiency Fractures ◽  
The Mean

Object Long-segment spinal instrumentation ending at the sacrum places substantial biomechanical stress on sacral screws. Iliac (pelvic) screws relieve some of this stress by supplementing the caudal fixation. It remains an open question whether there is any clinically significant difference in sacropelvic fixation with bilateral versus unilateral iliac screws. The primary purpose of this study was to compare clinical and radiographic complications in the use of bilateral versus unilateral iliac screw fixation. Methods The authors retrospectively reviewed 102 consecutive spinal fixation cases that extended to the pelvis at a single institution (University of California, San Francisco) in the period from 2005 to 2012 performed by the senior authors. Charts were reviewed for the following complications: reoperation, L5–S1 pseudarthrosis, sacral insufficiency fracture, hardware prominence, iliac screw loosening, and infection. The t-test, Pearson chi-square test, and Fisher exact test were used to determine statistical significance. Results The mean follow-up was 31 months. Thirty cases were excluded: 12 for inadequate follow-up, 15 for lack of L5–S1 interbody fusion, and 3 for preoperative osteomyelitis. The mean age among the 72 remaining cases was 62 years (range 39–79 years). Forty-six patients underwent unilateral and 26 bilateral iliac screw fixation. Forty-one percent (n = 19) of the unilateral cases and 50% (n = 13) of the bilateral cases were treated with reoperation (p = 0.48). In addition, 13% (n = 6) of the unilateral and 19% (n = 5) of the bilateral cases developed L5–S1 pseudarthrosis (p = 0.51). There were no sacral insufficiency fractures. Thirteen percent (n = 6) of the unilateral and 7.7% (n = 2) of the bilateral cases developed postoperative infection (p = 0.70). Conclusions In a retrospective single-institution study, single versus dual pelvic screws led to comparable rates of reoperation, iliac screw removal, postoperative infection, pseudarthrosis, and sacral insufficiency fractures. For spinopelvic fixation, placing bilateral (vs unilateral) pelvic screws produced no added clinical benefit in most cases.

Posterior atlantoaxial facet screw fixation

1993 ◽  
Vol 79 (2) ◽  
pp. 234-237 ◽  
Author(s):  
Paul Marcotte ◽  
Curtis A. Dickman ◽  
Volker K. H. Sonntag ◽  
Dean G. Karahalios ◽  
Janine Drabier
Keyword(s):  
Screw Fixation ◽  
Metastatic Tumor ◽  
Atlantoaxial Instability ◽  
Os Odontoideum ◽  
Rigid Fixation ◽  
Spinal Fixation ◽  
Strut Graft ◽  
Content Type ◽  
Fine Print

✓ Eighteen patients with atlantoaxial instability were treated with posterior atlantoaxial facet screws to obtain immediate rigid fixation of C1–2. Of these 18 patients, instability occurred due to trauma in nine, rheumatoid arthritis in six, neoplasms in two, and os odontoideum in one. Four patients presented with nonunion after failed C1–2 wire and graft procedures. In all cases in this series the screw fixations were augmented with an interspinous C1–2 strut graft which was wired in place to provide three-point stabilization and to facilitate bone fusion. In every case fixation was satisfactory, and C1–2 alignment and stability were restored without complications due to instrumentation. One patient died 3 months postoperatively from metastatic tumor; the spinal fixation was intact. All 17 surviving patients have developed osseous unions (mean follow-up period 12 months, range 6 to 16 months). Posterior atlantoaxial facet screw fixation provides immediate multidirectional rigid fixation of C1–2 that is mechanically superior to wiring or clamp fixation. This technique maximizes success without the need for a supplemental rigid external orthosis, and is particularly useful for pseudoarthrosis.

Spinal Fixation after Anterior Decompression for Symptomatic Spinal Metastasis

Neurosurgery ◽  
1988 ◽  
Vol 22 (2) ◽  
pp. 324-327 ◽  
Author(s):  
Richard G. Perrin ◽  
Robert J. McBroom
Keyword(s):  
Steel Plate ◽  
Screw Fixation ◽  
Spinal Metastasis ◽  
Spinal Column ◽  
Spinal Metastases ◽  
Rotational Stability ◽  
Spinal Fixation ◽  
Anterior Decompression ◽  
Surgical Strategies ◽  
Spinal Stabilization

Abstract Surgical strategies for the treatment of symptomatic spinal metastases must take into account both decompression of the spinal cord and stabilization of the spinal column. A method is described for securing spinal stabilization in patients who have undergone surgical decompression for symptomatic spinal metastases by an anterior approach. The fixation device used is a tailor-made prosthesis consisting of a U-shaped stainless steel plate permitting screw fixation to secure axial and rotational stability with an interposed methyl methacrylate strut to provide axial strength and support. The device has been used successfully in 51 patients who have undergone anterior decompression procedures for symptomatic spinal metastases. (Neurosurgery 22:324-327, 1988)

Klinische Langzeitergebnisse der perkutanen transluminalen Angioplastie bei Patienten mit peripherer arterieller Verschlusskrankheit

VASA ◽  
2002 ◽  
Vol 31 (1) ◽  
pp. 36-42 ◽  
Author(s):  
. Bucek ◽  
Hudak ◽  
Schnürer ◽  
Ahmadi ◽  
Wolfram ◽  
...  
Keyword(s):  
Success Rate ◽  
Clinical Stage ◽  
Ankle Brachial Index ◽  
Clinical Situation ◽  
Clinical Results ◽  
Transluminal Angioplasty ◽  
Term Outcome ◽  
Long Term Outcome

Background: We investigated the long-term clinical results of percutaneous transluminal angioplasty (PTA) in patients with peripheral arterial occlusive disease (PAOD) and the influence of different parameters on the primary success rate, the rate of complications and the long-term outcome. Patients and methods: We reviewed clinical and hemodynamic follow-up data of 166 consecutive patients treated with PTA in 1987 in our department. Results: PTA improved the clinical situation in 79.4% of patients with iliac lesions and in 88.3% of patients with femoro-popliteal lesions. The clinical stage and ankle brachial index (ABI) post-interventional could be improved significantly (each P < 0,001), the same results were observed at the end of follow-up (each P < 0,001). Major complications occurred in 11 patients (6.6%). The rate of primary clinical long-term success for suprainguinal lesions was 55% and 38% after 5 and 10 years (femoro-popliteal 44% and 33%), respectively, the corresponding data for secondary clinical long-term success were 63% and 56% (60% and 55%). Older age (P = 0,017) and lower ABI pre-interventional (P = 0,019) significantly deteriorated primary clinical long-term success for suprainguinal lesions, while no factor could be identified influencing the outcome of femoro-popliteal lesions significantly. Conclusion: Besides an acceptable success rate with a low rate of severe complications, our results demonstrate favourable long-term clinical results of PTA in patients with PAOD.

PRIMARY MELANOMA OF THE GALLBLADDER MANIFESTED BY ACUTE CHOLECYSTITIS. DESCRIPTION OF A SINGLE CASE

2018 ◽  
Vol 64 (2) ◽  
pp. 253-255
Author(s):  
Oleg Kit ◽  
Yevgeniy Kolesnikov ◽  
Roman Myagkov ◽  
Leonid Kharin ◽  
Yevgeniya Nepomnyashchaya
Keyword(s):  
Acute Cholecystitis ◽  
Mucous Membrane ◽  
Cutaneous Melanoma ◽  
Multidisciplinary Approach ◽  
Single Case ◽  
Primary Melanoma ◽  
Metastatic Lesions ◽  
Long Term Follow Up

Most of melanomas of the gallbladder are metastatic lesions of cutaneous melanoma. Primary melanomas of the gallbladder are described as single, polypoid, intraluminal masses emanating from the mucous membrane. The most important characteristic is the absence of melanoma damage to the skin. If it is not possible to localize primary melanoma a multidisciplinary approach to diagnostic search comes to the fore. Predicting for primary melanoma of the gallbladder is a difficult task due to the small number of cases and the absence of long-term follow-up for this category of patients.

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