Session 16: Spine/Tumor
Fredag d. 27. oktober
13:00-14:30
Lokale: Stockholm/Copenhagen
Chairmen: Søren Morgen og Michael Bendtsen
Søren Schmidt Morgen, Lars Valentin Hansen, Robert Svardal-Stelmer, Martin Gehrchen, Benny Dahl
Spine Unit, Department of Orthopedic Surgery, Rigshospitalet, University of Copenhagen; Spine Unit, Department of Orthopedic Surgery, Rigshospitalet, University of Copenhagen; Spine Unit, Department of Orthopedic Surgery, Rigshospitalet, University of Copenhagen; Spine Unit, Department of Orthopedic Surgery, Rigshospitalet, University of Copenhagen; Spine Unit, Department of Orthopedic Surgery, Rigshospitalet, University of Copenhagen
Background: Minimally access spine surgery (MASS) is considered less morbid than open surgery (OS), but evidence from studies comparing MASS with OS in patients with metastatic spinal cord compression (MSCC) is limited. We examined the feasibility and efficacy of MASS versus OS in a randomized controlled study with 50 MSCC patients.
Purpose / Aim of Study: The objective of this study was to assess whether patients operated with MASS would experience a shorter operation time and less perioperative bleeding than patients treated with OS.
Materials and Methods: During 2012 to 2017 a total of 50 MSCC patients were included in a one-center, randomized controlled trial with 1-year follow up. Patients were randomized to either MASS or OS. Only patients with MSCC between T5 to L3 where included. Patients with Tokuhashi score ≤ 4, in need of sacral or iliosacral instrumentation. All patients were operated with posterior pedicle screw instrumentation two levels above and two levels below the metastatic level. In the MASS-group decompression was done through a localized incision at the metastatic level. A p-value < 0.05 was considered statistically significant.
Findings / Results: The mean age was 67 years (range 43- 89) and 40% were men. The mean operation time was longer for patients operated with MASS when compared to OS; 140 min vs. 118 min. However, this difference was not statistical significant (p = 0.09). The peri- operative blood loss in the MASS-group was significantly smaller than in the OS- group; 234 ml vs. 650 ml (p = 0.0037). There was no significant difference in the amount of revisions in the MASS versus the OS group; with two revisions in each group.
Conclusions: Surgical treatment of symptomatic MSCC with MASS technique results in significantly and clinically relevant less of blood loss to open surgery.
Spine Unit, Department of Orthopedic Surgery, Rigshospitalet, University of Copenhagen; Spine Unit, Department of Orthopedic Surgery, Rigshospitalet, University of Copenhagen; Spine Unit, Department of Orthopedic Surgery, Rigshospitalet, University of Copenhagen; Spine Unit, Department of Orthopedic Surgery, Rigshospitalet, University of Copenhagen; Spine Unit, Department of Orthopedic Surgery, Rigshospitalet, University of Copenhagen
Background: Minimally access spine surgery (MASS) is considered less morbid than open surgery (OS), but evidence from studies comparing MASS with OS in patients with metastatic spinal cord compression (MSCC) is limited. We examined the feasibility and efficacy of MASS versus OS in a randomized controlled study with 50 MSCC patients.
Purpose / Aim of Study: The objective of this study was to assess whether patients operated with MASS would experience a shorter operation time and less perioperative bleeding than patients treated with OS.
Materials and Methods: During 2012 to 2017 a total of 50 MSCC patients were included in a one-center, randomized controlled trial with 1-year follow up. Patients were randomized to either MASS or OS. Only patients with MSCC between T5 to L3 where included. Patients with Tokuhashi score ≤ 4, in need of sacral or iliosacral instrumentation. All patients were operated with posterior pedicle screw instrumentation two levels above and two levels below the metastatic level. In the MASS-group decompression was done through a localized incision at the metastatic level. A p-value < 0.05 was considered statistically significant.
Findings / Results: The mean age was 67 years (range 43- 89) and 40% were men. The mean operation time was longer for patients operated with MASS when compared to OS; 140 min vs. 118 min. However, this difference was not statistical significant (p = 0.09). The peri- operative blood loss in the MASS-group was significantly smaller than in the OS- group; 234 ml vs. 650 ml (p = 0.0037). There was no significant difference in the amount of revisions in the MASS versus the OS group; with two revisions in each group.
Conclusions: Surgical treatment of symptomatic MSCC with MASS technique results in significantly and clinically relevant less of blood loss to open surgery.
Andreas Kiilerich Andresen, Rune Paulsen, Frederik Busch, Alexander Isenberg-Jørgensen, Leah Carreon, Mikkel Østerheden Andersen
Center for Spine Surgery and Research, Middelfart Hospital; Center for Spine Surgery and Research, Middelfart Hospital; Center for Spine Surgery and Research, Middelfart Hospital; Center for Spine Surgery and Research, Middelfart Hospital; Department of Regional Health Research, University of Southern Denmark; Center for Spine Surgery and Research, Middelfart Hospital
Background: It is estimated that 10.000 patients seek medical care due to cervical radiculopathy every year in Denmark. Although the natural course is usually favorable, around 20 % undergo surgery for cervical degenerative disease every year in Denmark. We evaluated the results of anterior cervical decompression and fusion over a 4 year period from a single Danish center for spine surgery.
Purpose / Aim of Study: The purpose of this study is to present how the clinical outcome data correlates to postoperative satisfaction, and how many of our patients have improved clinically relevant at the 1 year follow up.
Materials and Methods: This study is a retrospective study based on prospectively collected data from 252 consecutive patients treated with anterior cervical decompression and fusion over 1- 3 levels. Data in the DaneSpine registry was collected pre- and postoperatively, and at 1 year after surgery. The outcome measures were Neck Disability Index (NDI), European Quality of Life 5D (EQ-5D), visual analogue score (VAS) and Short Form-36 Physical Component Summary (PCS).
Findings / Results: Of 252 cases enrolled 201 (79%) had follow-up data available at a minimum 1-year post-operatively. The mean preoperative NDI was 40.20 and improved to 23.48. Mean EQ-5D was 0.50 and improved to 0.70, and mean VAS arm was 59.68 improved to 27.31. All improvements were statistically significant. 72% were back to work 1 year after surgery. 61.5% were satisfied one year after surgery, and only 6 % were dissatisfied. Postoperative satisfaction was statistically correlated to achieving MCID on all parameters except EQ-5D.
Conclusions: Patients who undergo anterior cervical discectomy and fusion can expect improvement in their pain and disability, with 73% of patients reporting a positive change in health status after surgery.
Center for Spine Surgery and Research, Middelfart Hospital; Center for Spine Surgery and Research, Middelfart Hospital; Center for Spine Surgery and Research, Middelfart Hospital; Center for Spine Surgery and Research, Middelfart Hospital; Department of Regional Health Research, University of Southern Denmark; Center for Spine Surgery and Research, Middelfart Hospital
Background: It is estimated that 10.000 patients seek medical care due to cervical radiculopathy every year in Denmark. Although the natural course is usually favorable, around 20 % undergo surgery for cervical degenerative disease every year in Denmark. We evaluated the results of anterior cervical decompression and fusion over a 4 year period from a single Danish center for spine surgery.
Purpose / Aim of Study: The purpose of this study is to present how the clinical outcome data correlates to postoperative satisfaction, and how many of our patients have improved clinically relevant at the 1 year follow up.
Materials and Methods: This study is a retrospective study based on prospectively collected data from 252 consecutive patients treated with anterior cervical decompression and fusion over 1- 3 levels. Data in the DaneSpine registry was collected pre- and postoperatively, and at 1 year after surgery. The outcome measures were Neck Disability Index (NDI), European Quality of Life 5D (EQ-5D), visual analogue score (VAS) and Short Form-36 Physical Component Summary (PCS).
Findings / Results: Of 252 cases enrolled 201 (79%) had follow-up data available at a minimum 1-year post-operatively. The mean preoperative NDI was 40.20 and improved to 23.48. Mean EQ-5D was 0.50 and improved to 0.70, and mean VAS arm was 59.68 improved to 27.31. All improvements were statistically significant. 72% were back to work 1 year after surgery. 61.5% were satisfied one year after surgery, and only 6 % were dissatisfied. Postoperative satisfaction was statistically correlated to achieving MCID on all parameters except EQ-5D.
Conclusions: Patients who undergo anterior cervical discectomy and fusion can expect improvement in their pain and disability, with 73% of patients reporting a positive change in health status after surgery.
Søren Ohrt-Nissen, Blaine Fritz, Jonas Walbom, Kasper Kragh, Thomas Bjarnsholt, Benny Dahl , Claus Manniche
Department of Orthopaedic Surgery, Spine Unit, Rigshospitalet; Department of Immunology and Microbiology, University of Copenhagen, Faculty of Health Sciences; Department of Orthopaedic Surgery, Spine Unit, Rigshospitalet; Department of Immunology and Microbiology, University of Copenhagen, Faculty of Health Sciences; Department of Clinical Microbiology, Rigshospitalet; Spine surgery, Texas children's hospital; Spine Centre of Southern Denmark, Institute of Regional Health Service, University of Southern Denmark
Background: A relationship has been suggested between lumbar intervertebral disc herniation (LDH) and chronic bacterial infection frequently involving P. acnes, which is known to cause chronic infection through the formation of biofilm.
Purpose / Aim of Study: To assess whether a disc infection involving biofilm formation is present in patients with LDH.
Materials and Methods: Patients with LDH undergoing primary discectomy were prospectively included. Patients operated for spinal fractures or deformities were included as controls. Bacterial 16S rDNA was purified and amplified by real-time polymerase chain reaction (PCR). Sanger sequencing was performed on PCR positive samples. Formalin- fixed paraffin embedded tissue sections were stained using fluorescence in situ hybridization with peptide nucleic acid probes (one P. acnes specific probe and one universal bacterial probe). To visualize bacterial aggregates, tissue sections were examined for the first 50 included patients by confocal laser scanning microscopy (CLSM).
Findings / Results: A total of 51 LDH patients and 14 controls were included. Bacterial DNA was detected by PCR in 16/51 samples in the LDH group and 7/14 controls (p=0.215). Sequencing identified bacteria in 9/16 and 6/7 PCR positive samples in the LDH and control groups, respectively. CLSM demonstrated tissue-embedded bacterial aggregates with host inflammatory cells in 7/44 LDH patients and no controls. Only one sample positive for aggregates by CLSM was positive for bacterial 16S rDNA by PCR.
Conclusions: CLSM demonstrated bacterial aggregates and inflammatory cells in 16% of LDH patients, suggesting chronic bacterial infection. Discordance between molecular and microscopic analyses highlights the importance of a dual-approach diagnostic strategy to discriminate infection versus contamination.
Department of Orthopaedic Surgery, Spine Unit, Rigshospitalet; Department of Immunology and Microbiology, University of Copenhagen, Faculty of Health Sciences; Department of Orthopaedic Surgery, Spine Unit, Rigshospitalet; Department of Immunology and Microbiology, University of Copenhagen, Faculty of Health Sciences; Department of Clinical Microbiology, Rigshospitalet; Spine surgery, Texas children's hospital; Spine Centre of Southern Denmark, Institute of Regional Health Service, University of Southern Denmark
Background: A relationship has been suggested between lumbar intervertebral disc herniation (LDH) and chronic bacterial infection frequently involving P. acnes, which is known to cause chronic infection through the formation of biofilm.
Purpose / Aim of Study: To assess whether a disc infection involving biofilm formation is present in patients with LDH.
Materials and Methods: Patients with LDH undergoing primary discectomy were prospectively included. Patients operated for spinal fractures or deformities were included as controls. Bacterial 16S rDNA was purified and amplified by real-time polymerase chain reaction (PCR). Sanger sequencing was performed on PCR positive samples. Formalin- fixed paraffin embedded tissue sections were stained using fluorescence in situ hybridization with peptide nucleic acid probes (one P. acnes specific probe and one universal bacterial probe). To visualize bacterial aggregates, tissue sections were examined for the first 50 included patients by confocal laser scanning microscopy (CLSM).
Findings / Results: A total of 51 LDH patients and 14 controls were included. Bacterial DNA was detected by PCR in 16/51 samples in the LDH group and 7/14 controls (p=0.215). Sequencing identified bacteria in 9/16 and 6/7 PCR positive samples in the LDH and control groups, respectively. CLSM demonstrated tissue-embedded bacterial aggregates with host inflammatory cells in 7/44 LDH patients and no controls. Only one sample positive for aggregates by CLSM was positive for bacterial 16S rDNA by PCR.
Conclusions: CLSM demonstrated bacterial aggregates and inflammatory cells in 16% of LDH patients, suggesting chronic bacterial infection. Discordance between molecular and microscopic analyses highlights the importance of a dual-approach diagnostic strategy to discriminate infection versus contamination.
Ane Simony MD PhD, Carsten Ernst MD, Stig Mindedahl Jespersen MD, PhD
Sector for Spine Surgery & Research, Middelfart Hospital; Sector for Spine Surgery & Research, Middelfart Hospital; Rygsektionen, Odense Universitets Hospital
Background: Coccydynia caused by falling or giving birth is mostly reported in females in the age 30-60 years. Many treatment modalities have been suggested including special pillows, steroid injections, special physiotherapy and pain medication.
Purpose / Aim of Study: The purpose of this study is to report the outcome, 1 year after surgery with partial or complete removal of the coccyx.
Materials and Methods: Patients with a duration of symptoms more than 12-18 months after trauma, no effect of conservative treatment and reported pain VAS > 3 in sitting position, are referred to treatment. Surgery with full or partially removal of the coccyx bone is suggested. Al patients are treated with 2-3 diagnostic steroid injections prior to surgery, to ensure the coccyx is inducing the pain. All patients are recorded in the Danespine database, and the statistics are performed with Stata version 1.2
Findings / Results: 138 consecutive patients were evaluated 3 and 12 months after surgery. 3 months after surgery, 40 % of the patients are pain free in sitting position, 47 % of the patients are experiencing some degree of discomfort in sitting position but are improved and 13 % of the patients are still experiencing pain while sitting. 99 patients are satisfied, 1 year after the surgery. 22 patients have hoped to have a bigger improvement and 17 patients are not satisfied. 32 patients developed infections after surgery and received antibiotics, 5 reoperations was performed, 3 due to infections and 2 due to rupture of the skin after return to normal daily living 3 months after surgery.
Conclusions: Patients with severe symptoms and pain duration of more than 12-18 months, should be referred for spine surgical evaluation. Partial or complete resection of the coccyx, is a safe procedure, with a satisfactional outcome in most patients.
Sector for Spine Surgery & Research, Middelfart Hospital; Sector for Spine Surgery & Research, Middelfart Hospital; Rygsektionen, Odense Universitets Hospital
Background: Coccydynia caused by falling or giving birth is mostly reported in females in the age 30-60 years. Many treatment modalities have been suggested including special pillows, steroid injections, special physiotherapy and pain medication.
Purpose / Aim of Study: The purpose of this study is to report the outcome, 1 year after surgery with partial or complete removal of the coccyx.
Materials and Methods: Patients with a duration of symptoms more than 12-18 months after trauma, no effect of conservative treatment and reported pain VAS > 3 in sitting position, are referred to treatment. Surgery with full or partially removal of the coccyx bone is suggested. Al patients are treated with 2-3 diagnostic steroid injections prior to surgery, to ensure the coccyx is inducing the pain. All patients are recorded in the Danespine database, and the statistics are performed with Stata version 1.2
Findings / Results: 138 consecutive patients were evaluated 3 and 12 months after surgery. 3 months after surgery, 40 % of the patients are pain free in sitting position, 47 % of the patients are experiencing some degree of discomfort in sitting position but are improved and 13 % of the patients are still experiencing pain while sitting. 99 patients are satisfied, 1 year after the surgery. 22 patients have hoped to have a bigger improvement and 17 patients are not satisfied. 32 patients developed infections after surgery and received antibiotics, 5 reoperations was performed, 3 due to infections and 2 due to rupture of the skin after return to normal daily living 3 months after surgery.
Conclusions: Patients with severe symptoms and pain duration of more than 12-18 months, should be referred for spine surgical evaluation. Partial or complete resection of the coccyx, is a safe procedure, with a satisfactional outcome in most patients.
Peter Frederik Horstmann, Werner Hettwer, Michael Mørk Petersen
Department of Orthopedics, University of Copenhagen, Rigshospitalet; Department of Orthopedics, University of Copenhagen, Rigshospitalet; Department of Orthopedics, University of Copenhagen, Rigshospitalet
Background: Mineral bone graft substitutes enjoy increasing popularity for a variety of indications, however, little objective data is available for most of these products. Dual-energy X-ray Absorptiometry (DXA) is an established method that allows non-invasive, objective and precise quantification of bone mineralization.
Purpose / Aim of Study: To objectively quantify changes in bone mineralization following bone defect reconstruction using a composite bone graft substitute.
Materials and Methods: We performed sequential quantitative bone- mineral-density (BMD) measurements using DXA in a prospective cohort of 17 patients (F/M: 7/10, mean age 46 (17-69) years)) with 18 bone- defects, reconstructed with a composite (60% calcium-sulphate/ 40% calcium-phosphate) bone- graft-substitute (CERAMENT™|BONE VOID FILLER (BVF) or CERAMENT™|G, BONESUPPORT AB) following intralesional curettage of benign bone lesions between July 2014 and March 2016. For comparison, additional control scans of the opposite extremity were performed after 1 year. Results are presented as mean (95% Confidential interval).
Findings / Results: BMD decreased faster in the first 12 weeks (42 mg/cm2/week), compared to the period between week 12 and 52 (3 mg/cm2/week). After one year, BMD-values remained 25% (4-47%) higher on the operated side (p=0.032), when compared to a corresponding area in the contra-lateral extremity, while no differences were seen, when bilateral areas just adjacent to the bone defect was compared (p=0.419).
Conclusions: BMD decreases rapidly during the initial 12 weeks after bone-defect reconstruction with this particular bone-graft substitute, which is likely due to expected resorption of its calcium-sulphate component. Subsequently, the rate of BMD-reduction decelerates, and focal BMD-levels remain at least equal to or higher than the non-operated side after 1 year.
Department of Orthopedics, University of Copenhagen, Rigshospitalet; Department of Orthopedics, University of Copenhagen, Rigshospitalet; Department of Orthopedics, University of Copenhagen, Rigshospitalet
Background: Mineral bone graft substitutes enjoy increasing popularity for a variety of indications, however, little objective data is available for most of these products. Dual-energy X-ray Absorptiometry (DXA) is an established method that allows non-invasive, objective and precise quantification of bone mineralization.
Purpose / Aim of Study: To objectively quantify changes in bone mineralization following bone defect reconstruction using a composite bone graft substitute.
Materials and Methods: We performed sequential quantitative bone- mineral-density (BMD) measurements using DXA in a prospective cohort of 17 patients (F/M: 7/10, mean age 46 (17-69) years)) with 18 bone- defects, reconstructed with a composite (60% calcium-sulphate/ 40% calcium-phosphate) bone- graft-substitute (CERAMENT™|BONE VOID FILLER (BVF) or CERAMENT™|G, BONESUPPORT AB) following intralesional curettage of benign bone lesions between July 2014 and March 2016. For comparison, additional control scans of the opposite extremity were performed after 1 year. Results are presented as mean (95% Confidential interval).
Findings / Results: BMD decreased faster in the first 12 weeks (42 mg/cm2/week), compared to the period between week 12 and 52 (3 mg/cm2/week). After one year, BMD-values remained 25% (4-47%) higher on the operated side (p=0.032), when compared to a corresponding area in the contra-lateral extremity, while no differences were seen, when bilateral areas just adjacent to the bone defect was compared (p=0.419).
Conclusions: BMD decreases rapidly during the initial 12 weeks after bone-defect reconstruction with this particular bone-graft substitute, which is likely due to expected resorption of its calcium-sulphate component. Subsequently, the rate of BMD-reduction decelerates, and focal BMD-levels remain at least equal to or higher than the non-operated side after 1 year.
Simon Toftgaard Skov, Sebastiaan P.J. Wijdicks, Moyo C. Kruyt , Li Haisheng, René M. Castelein , Jan H.D. Rölfing , Ebbe S. Hansen , Kristian Høy , Peter Helmig, Cody Bünger
Department of Orthopaedic Surgery, Aarhus University Hospital; Department of Orthopaedic Surgery, University Medical Clinic Utrecht, The Netherlands; Department of Orthopaedic Surgery, University Medical Clinic Utrecht, The Netherlands; Department of Orthopaedic Surgery, Aarhus University Hospital; Department of Orthopaedic Surgery, University Medical Clinic Utrecht, The Netherlands; Department of Orthopaedic Surgery, Aarhus University Hospital; Department of Orthopaedic Surgery, Aarhus University Hospital; Department of Orthopaedic Surgery, Aarhus University Hospital; Department of Orthopaedic Surgery, Aarhus University Hospital; Department of Orthopaedic Surgery, Aarhus University Hospital
Background: The application of MCGR in severe EOS has increased over the last years worldwide.
Purpose / Aim of Study: Our aim was to compare non-surgical 3- month interval MCGR lengthening to 6- month interval intraoperative manual lengthening in EOS; focusing on spinal growth and 3D correction.
Materials and Methods: Two cohorts of each 18 children were analyzed. The MCGR-hybrid-cohort, median age 9 (6.4-15.8) received a new MCGR hybrid principle, using a single MCGR to drive concave distraction combined with an apical control passive sliding rod construct on the convexity, median follow-up 1.3 years (0.5-2.1). The second cohort, median age 10 (4.5- 14.8) received a similar apical control construct (the CB system), using conventional open surgical distraction, median follow-up 1,5 years (0.9-1.9).
Findings / Results: Frontal Cobb angle improved in both groups; from mean 64 to 31 after MCGR-Hybrid, (p<0.01), and from mean 77 to 38 after conventional technique, (p<0.01). This 51% initial correction after MCGR-Hybrid vs. 49% after conventional technique was maintained in both groups. The mean apical vertebral rotation (Nash-Moe method) improved significantly in both groups, but was partially lost. There was a significant decrease in thoracic kyphosis from 27 to 20 after MCGR-hybrid and from 33 to 17 after conventional technique, and largely unchanged lordosis. T1-S1 spine growth rate was 11 mm/year in the MCGR-Hybrid-group vs. 7mm/year in the conventional-group, (NS).
Conclusions: We demonstrated significant early 3D scoliosis correction by double rod systems with apical control. Spinal growth seemed to be superior following short interval MCGR lengthening. This may underline the negative effect of posterior tethering following long interval distraction.
Department of Orthopaedic Surgery, Aarhus University Hospital; Department of Orthopaedic Surgery, University Medical Clinic Utrecht, The Netherlands; Department of Orthopaedic Surgery, University Medical Clinic Utrecht, The Netherlands; Department of Orthopaedic Surgery, Aarhus University Hospital; Department of Orthopaedic Surgery, University Medical Clinic Utrecht, The Netherlands; Department of Orthopaedic Surgery, Aarhus University Hospital; Department of Orthopaedic Surgery, Aarhus University Hospital; Department of Orthopaedic Surgery, Aarhus University Hospital; Department of Orthopaedic Surgery, Aarhus University Hospital; Department of Orthopaedic Surgery, Aarhus University Hospital
Background: The application of MCGR in severe EOS has increased over the last years worldwide.
Purpose / Aim of Study: Our aim was to compare non-surgical 3- month interval MCGR lengthening to 6- month interval intraoperative manual lengthening in EOS; focusing on spinal growth and 3D correction.
Materials and Methods: Two cohorts of each 18 children were analyzed. The MCGR-hybrid-cohort, median age 9 (6.4-15.8) received a new MCGR hybrid principle, using a single MCGR to drive concave distraction combined with an apical control passive sliding rod construct on the convexity, median follow-up 1.3 years (0.5-2.1). The second cohort, median age 10 (4.5- 14.8) received a similar apical control construct (the CB system), using conventional open surgical distraction, median follow-up 1,5 years (0.9-1.9).
Findings / Results: Frontal Cobb angle improved in both groups; from mean 64 to 31 after MCGR-Hybrid, (p<0.01), and from mean 77 to 38 after conventional technique, (p<0.01). This 51% initial correction after MCGR-Hybrid vs. 49% after conventional technique was maintained in both groups. The mean apical vertebral rotation (Nash-Moe method) improved significantly in both groups, but was partially lost. There was a significant decrease in thoracic kyphosis from 27 to 20 after MCGR-hybrid and from 33 to 17 after conventional technique, and largely unchanged lordosis. T1-S1 spine growth rate was 11 mm/year in the MCGR-Hybrid-group vs. 7mm/year in the conventional-group, (NS).
Conclusions: We demonstrated significant early 3D scoliosis correction by double rod systems with apical control. Spinal growth seemed to be superior following short interval MCGR lengthening. This may underline the negative effect of posterior tethering following long interval distraction.
Søren Ohrt-Nissen, Casper Dragsted, Benny Dahl, John Ferguson, Martin Gehrchen
Orthopaedic Surgery, Rigshospitalet; Orthopaedic Surgery, Rigshospitalet; Department of Orthopedics and Scoliosis Surgery, Texas Children¡¯s Hospital; , Starship Children's Hospital; Orthopaedic Surgery, Rigshospitalet
Background: All-pedicle screw instrumentation has been shown to induce hypokyphosis in adolescent idiopathic scoliosis (AIS).
Purpose / Aim of Study: Compare postoperative sagittal alignment between three rod constructs with different rigidity profiles.
Materials and Methods: A dual-center retrospective cohort study was conducted involving two consecutive cohorts operated with all- pedicle screw instrumentation for AIS. Three different rod constructs were used: A hybrid construct (HC) consisting of a normal circular rod on the convex side and a beam-like rod (BR) on the concave side, a standard construct (SC) using bilateral BRs in the full length of the fusion and a modified construct (MC) where the rod transitions from a beam-like shape to a circular shape at the cranial fusion levels. Radiographs were analyzed preoperatively and at the first postoperative follow-up.
Findings / Results: The HC, SC and MC groups included 23, 70 and 46 patients, respectively. The groups did not differ significantly in preoperative radiographic parameters, mean preoperative main curve or mean curve correction. The mean postoperative TK was 23.1±6.3º, 19.6±7.6º and 23.4±6.9º in the HC, SC and MC groups, respectively (p=0.013) and the mean change in TK was -3.5±11.3º, -7.1±11.6º and 0.1±10.9º, respectively (p=0.005). The MC group had significantly higher postoperative TK and less loss of TK compared to the SC group (p≤0.018). A postoperative TK ≤ 10º was found in 12 patients (17%) in the SC group, one patient (5%) in the HC group and one patient (2%) in the MC group (p=0.021).
Conclusions: We found significantly better restoration of kyphosis with the use of bilateral modified rods compared to bilateral standard rods. In the modified- and hybrid construct group the rate of severe postoperative hypokyphosis was significantly lower than in the standard group.
Orthopaedic Surgery, Rigshospitalet; Orthopaedic Surgery, Rigshospitalet; Department of Orthopedics and Scoliosis Surgery, Texas Children¡¯s Hospital; , Starship Children's Hospital; Orthopaedic Surgery, Rigshospitalet
Background: All-pedicle screw instrumentation has been shown to induce hypokyphosis in adolescent idiopathic scoliosis (AIS).
Purpose / Aim of Study: Compare postoperative sagittal alignment between three rod constructs with different rigidity profiles.
Materials and Methods: A dual-center retrospective cohort study was conducted involving two consecutive cohorts operated with all- pedicle screw instrumentation for AIS. Three different rod constructs were used: A hybrid construct (HC) consisting of a normal circular rod on the convex side and a beam-like rod (BR) on the concave side, a standard construct (SC) using bilateral BRs in the full length of the fusion and a modified construct (MC) where the rod transitions from a beam-like shape to a circular shape at the cranial fusion levels. Radiographs were analyzed preoperatively and at the first postoperative follow-up.
Findings / Results: The HC, SC and MC groups included 23, 70 and 46 patients, respectively. The groups did not differ significantly in preoperative radiographic parameters, mean preoperative main curve or mean curve correction. The mean postoperative TK was 23.1±6.3º, 19.6±7.6º and 23.4±6.9º in the HC, SC and MC groups, respectively (p=0.013) and the mean change in TK was -3.5±11.3º, -7.1±11.6º and 0.1±10.9º, respectively (p=0.005). The MC group had significantly higher postoperative TK and less loss of TK compared to the SC group (p≤0.018). A postoperative TK ≤ 10º was found in 12 patients (17%) in the SC group, one patient (5%) in the HC group and one patient (2%) in the MC group (p=0.021).
Conclusions: We found significantly better restoration of kyphosis with the use of bilateral modified rods compared to bilateral standard rods. In the modified- and hybrid construct group the rate of severe postoperative hypokyphosis was significantly lower than in the standard group.
Casper Sæbye, Johnny Keller, Thomas Baad-Hansen
Department of Orthopaedic Surgery, Sarcoma Center at Aarhus University Hospital, Aarhus, Denmark; Department of Orthopaedic Surgery, Sarcoma Center at Aarhus University Hospital, Aarhus, Denmark; Department of Orthopaedic Surgery, Sarcoma Center at Aarhus University Hospital, Aarhus, Denmark
Background: The Musculoskeletal Tumour Society Score (MSTS) questionnaire is a physician/patient-completed questionnaire designed to assess functional outcome for patients with sarcomas in the extremities.
Purpose / Aim of Study: The purpose of this study was to validate the Danish version of the MSTS questionnaire.
Materials and Methods: The MSTS was translated according to international guidelines. Patients operated for sarcomas and aggressive benign tumours were invited to participate in the study. The psychometric properties of the Danish version of the MSTS were tested in terms of validity and reliability. Spearman’s rank coefficient was used to test the validity by comparing with the Toronto Extremity Salvage Score (TESS). The Intraclass Correlation Coefficient (ICC) was used to evaluate inter- and intra-rater reliability. Cronbach’s alpha was used to test for internal consistency. Spearman’s rank coefficient was used to compare the MSTS lower extremity version with the objective test, Timed Up & Go (TUG).
Findings / Results: 240 patients (78 upper/162 lower extremity) participated in the study. 38% and 23% of the patients scored maximum in the upper and lower extremity version of the MSTS, respectively. The validity was found to be good. The inter-rater reliability and the intra-rater reliability was found to be excellent for the upper and lower extremity version of the MSTS. The internal consistency for the upper and lower extremity version was good. When comparing the lower extremity MSTS score with the TUG, we found a poor correlation.
Conclusions: The psychometric properties have shown good validity and reliability of the Danish MSTS version. However, this study found a ceiling effect in the MSTS score. Furthermore, the MSTS score seems not to be an expression of objective functional outcome.
Department of Orthopaedic Surgery, Sarcoma Center at Aarhus University Hospital, Aarhus, Denmark; Department of Orthopaedic Surgery, Sarcoma Center at Aarhus University Hospital, Aarhus, Denmark; Department of Orthopaedic Surgery, Sarcoma Center at Aarhus University Hospital, Aarhus, Denmark
Background: The Musculoskeletal Tumour Society Score (MSTS) questionnaire is a physician/patient-completed questionnaire designed to assess functional outcome for patients with sarcomas in the extremities.
Purpose / Aim of Study: The purpose of this study was to validate the Danish version of the MSTS questionnaire.
Materials and Methods: The MSTS was translated according to international guidelines. Patients operated for sarcomas and aggressive benign tumours were invited to participate in the study. The psychometric properties of the Danish version of the MSTS were tested in terms of validity and reliability. Spearman’s rank coefficient was used to test the validity by comparing with the Toronto Extremity Salvage Score (TESS). The Intraclass Correlation Coefficient (ICC) was used to evaluate inter- and intra-rater reliability. Cronbach’s alpha was used to test for internal consistency. Spearman’s rank coefficient was used to compare the MSTS lower extremity version with the objective test, Timed Up & Go (TUG).
Findings / Results: 240 patients (78 upper/162 lower extremity) participated in the study. 38% and 23% of the patients scored maximum in the upper and lower extremity version of the MSTS, respectively. The validity was found to be good. The inter-rater reliability and the intra-rater reliability was found to be excellent for the upper and lower extremity version of the MSTS. The internal consistency for the upper and lower extremity version was good. When comparing the lower extremity MSTS score with the TUG, we found a poor correlation.
Conclusions: The psychometric properties have shown good validity and reliability of the Danish MSTS version. However, this study found a ceiling effect in the MSTS score. Furthermore, the MSTS score seems not to be an expression of objective functional outcome.
Thea Bechmann Hovgaard, Peter Frederik Horstmann, Michael Mørk Petersen, Michala Skovlund Sørensen
Musculoskeletal Tumor Section, Department of Orthopedic Surgery, Rigshospitalet, University of Copenhagen; Musculoskeletal Tumor Section, Department of Orthopedic Surgery, Rigshospitalet, University of Copenhagen; Musculoskeletal Tumor Section, Department of Orthopedic Surgery, Rigshospitalet, University of Copenhagen; Musculoskeletal Tumor Section, Department of Orthopedic Surgery, Rigshospitalet, University of Copenhagen
Background: Patients experiencing a pathological fracture or painful bony lesion due to metastatic bone disease in the appendicular skeleton (MBDA) are frequently treated with a total joint replacement (TJR), which is in risk of revision surgery.
Purpose / Aim of Study: To estimate implant and patient survival after primary and revision TJR due to MBDA.
Materials and Methods: A retrospective study of patients having primary and revision TJR due to MBDA from 01/01/03 to 31/12/13. 287 patients (mean age 64 (21-90) years, 170 males/117 females) received 289 primary TJR (in 270 patients) and 22 revision TJR (in 17 patients). Survival time was calculated from the day of surgery until death or end of study (09/30/16). Statistics: Kaplan-Meier survival analysis (95%-CI) and log-rank test for comparison of subgroups.
Findings / Results: The 1-, 2- and 5-year survival rates after surgery for primary TJR was 44% (95%-CI: 39-50), 32% (95%-CI: 26-37), and 13% (95%-CI: 8-17) and 45% (95%-CI: 23-67), 30% (95%-CI: 10-50), and 10% (95%-CI: 0- 23) for revision TJR, p=0.465. No difference in the amount of major complications between primary TJR (17 major complications=5.88%) and revision TJR (2 major complications=9.09%). The cumulative 1-, 2- and 5-years implant survival rate for primary TJR was 98% (95%-CI: 96-100), 93% (95%-CI: 89-98), and 85% (95%-CI: 76-94) and 90% (95%- CI: 71-100), 90% (95%-CI: 71-100) and NA for revision TJR (p=0.273).
Conclusions: No differences in implant or patient survival were found between primary and revision TJR. It indicates that MBDA-surgery does not reduce patients expected survival even though several procedures are performed. We suggest not refraining from revision surgery in MBDA patients, and always choosing a primary implant that is expected to outlive the patient.
Musculoskeletal Tumor Section, Department of Orthopedic Surgery, Rigshospitalet, University of Copenhagen; Musculoskeletal Tumor Section, Department of Orthopedic Surgery, Rigshospitalet, University of Copenhagen; Musculoskeletal Tumor Section, Department of Orthopedic Surgery, Rigshospitalet, University of Copenhagen; Musculoskeletal Tumor Section, Department of Orthopedic Surgery, Rigshospitalet, University of Copenhagen
Background: Patients experiencing a pathological fracture or painful bony lesion due to metastatic bone disease in the appendicular skeleton (MBDA) are frequently treated with a total joint replacement (TJR), which is in risk of revision surgery.
Purpose / Aim of Study: To estimate implant and patient survival after primary and revision TJR due to MBDA.
Materials and Methods: A retrospective study of patients having primary and revision TJR due to MBDA from 01/01/03 to 31/12/13. 287 patients (mean age 64 (21-90) years, 170 males/117 females) received 289 primary TJR (in 270 patients) and 22 revision TJR (in 17 patients). Survival time was calculated from the day of surgery until death or end of study (09/30/16). Statistics: Kaplan-Meier survival analysis (95%-CI) and log-rank test for comparison of subgroups.
Findings / Results: The 1-, 2- and 5-year survival rates after surgery for primary TJR was 44% (95%-CI: 39-50), 32% (95%-CI: 26-37), and 13% (95%-CI: 8-17) and 45% (95%-CI: 23-67), 30% (95%-CI: 10-50), and 10% (95%-CI: 0- 23) for revision TJR, p=0.465. No difference in the amount of major complications between primary TJR (17 major complications=5.88%) and revision TJR (2 major complications=9.09%). The cumulative 1-, 2- and 5-years implant survival rate for primary TJR was 98% (95%-CI: 96-100), 93% (95%-CI: 89-98), and 85% (95%-CI: 76-94) and 90% (95%- CI: 71-100), 90% (95%-CI: 71-100) and NA for revision TJR (p=0.273).
Conclusions: No differences in implant or patient survival were found between primary and revision TJR. It indicates that MBDA-surgery does not reduce patients expected survival even though several procedures are performed. We suggest not refraining from revision surgery in MBDA patients, and always choosing a primary implant that is expected to outlive the patient.
Tine Rytter Sørensen, Mathias Rædkjær, Peter Holmberg Jørgensen, Thomas Baad-Hansen
, ; Department of Orthopaedic Surgery, Aarhus University Hospital ; Department of Orthopaedic Surgery , Aarhus University Hospital ; Department of Orthopaedic Oncology, Aarhus University Hospital
Background: Soft tissue sarcomas (STS) of the thoracic wall are often studied in combination with either sarcomas of the extremities, or with bone tumors of the thoracic wall.
Purpose / Aim of Study: The aim was to assess the impact of surgical margin and malignancy grade on survival and local recurrence for STS of the thoracic wall and compare results with studies of STS in extremities.
Materials and Methods: 86 patients were diagnosed with a non- metastatic STS located in the thoracic wall and treated surgically at the Aarhus Sarcoma Centre between 1995-2013. Overall survival (OS) and local recurrence free rate (LRFR) were estimated using the Kaplan-Meier method. Cox proportional hazards model was used to determine prognostic factors for survival and local recurrence.
Findings / Results: 5-year OS was 56%. Intralesional/marginal resection resultet in an increased mortality (multivariate cox: HR 3,09, CI 95%: 1,25- 7,63) compared to wide resection. Patients with intermediate/high grade tumors had a higher risk of dying (multivariate cox: HR=8,24, CI 95%: 1,02-66,87) compared to patients with low grade tumors. 5-year LRFR for intermediate/high grade tumors was 80%. None of the patients with low grade tumor had local recurrence. Intralesional/marginal resection had no significant impact on local recurrence (HR = 1,00 CI 95%: 0,24- 4,16). Studies including STS of extremities have shown higher 5- year OS rates and 5-year LRFR.
Conclusions: Intermediate/high malignancy grade was an unfavourable prognostic factor for survival and local recurrence. Wide margin increased survival, but did not affect local recurrence. STS of the thoracic wall showed lower mortality and higher local recurrence rate compared to STS of the extremities, suggesting that the removal of STS of the thoracic wall should be more aggressively to increase mortality and reduce local recurrence.
, ; Department of Orthopaedic Surgery, Aarhus University Hospital ; Department of Orthopaedic Surgery , Aarhus University Hospital ; Department of Orthopaedic Oncology, Aarhus University Hospital
Background: Soft tissue sarcomas (STS) of the thoracic wall are often studied in combination with either sarcomas of the extremities, or with bone tumors of the thoracic wall.
Purpose / Aim of Study: The aim was to assess the impact of surgical margin and malignancy grade on survival and local recurrence for STS of the thoracic wall and compare results with studies of STS in extremities.
Materials and Methods: 86 patients were diagnosed with a non- metastatic STS located in the thoracic wall and treated surgically at the Aarhus Sarcoma Centre between 1995-2013. Overall survival (OS) and local recurrence free rate (LRFR) were estimated using the Kaplan-Meier method. Cox proportional hazards model was used to determine prognostic factors for survival and local recurrence.
Findings / Results: 5-year OS was 56%. Intralesional/marginal resection resultet in an increased mortality (multivariate cox: HR 3,09, CI 95%: 1,25- 7,63) compared to wide resection. Patients with intermediate/high grade tumors had a higher risk of dying (multivariate cox: HR=8,24, CI 95%: 1,02-66,87) compared to patients with low grade tumors. 5-year LRFR for intermediate/high grade tumors was 80%. None of the patients with low grade tumor had local recurrence. Intralesional/marginal resection had no significant impact on local recurrence (HR = 1,00 CI 95%: 0,24- 4,16). Studies including STS of extremities have shown higher 5- year OS rates and 5-year LRFR.
Conclusions: Intermediate/high malignancy grade was an unfavourable prognostic factor for survival and local recurrence. Wide margin increased survival, but did not affect local recurrence. STS of the thoracic wall showed lower mortality and higher local recurrence rate compared to STS of the extremities, suggesting that the removal of STS of the thoracic wall should be more aggressively to increase mortality and reduce local recurrence.
Thea Bechmann Hovgaard, Peter Frederik Horstmann, Michael Mørk Petersen, Michala Skovlund Sørensen
Musculoskeletal Tumor Section, Department of Orthopedic Surgery, Rigshospitalet, University of Copenhagen; Musculoskeletal Tumor Section, Department of Orthopedic Surgery, Rigshospitalet, University of Copenhagen; Musculoskeletal Tumor Section, Department of Orthopedic Surgery, Rigshospitalet, University of Copenhagen; Musculoskeletal Tumor Section, Department of Orthopedic Surgery, Musculoskeletal Tumor Section, Department of Orthopedic Surgery
Background: Patients suffering from a pathological/impending fracture due to metastatic bone disease in the appendicular skeleton (MBDA) will often benefit from a total joint replacement (TJR). We hypothesize that improvements in primary cancer treatment will be reflected in an improved survival for patients who undergoes TJR due to MBDA.
Purpose / Aim of Study: To test if patient survival has improved over time after TJR due to MBDA.
Materials and Methods: A retrospective study of patients receiving primary TJR due to MBDA from 01/01/03 to 31/12/13. Survival was calculated from the day of surgery until death or to end of study (09/30/16). Statistics: Kaplan-Meier survival analysis (with 95%-CI), log-rank test and non-parametric tests for comparison of subgroups: patients having TJR in the early period between 2003-2008 (n=130) and patients having TJR in the late period between 2009-2013 (n=140).
Findings / Results: 270 patients (mean age 64 (21-90) years, 160 males/110 females) received 270 primary TJR. The cumulative 1-, 2- and 5- year survival rates after surgery for the early cohort was 41% (95%-CI: 32-49), 29% (95%-CI: 21-37), and 13% (95%-CI: 7-19) and 48% (95%-CI: 40-56), 34% (95%-CI: 26-42), and 11% (95% CI: 5-17) for the late cohort, p=0.458. The time from diagnosis of cancer to MBDA-surgery was shorter in the early cohort (p<0.001). A minor difference was found when comparing residual cancer disease after MBD surgery (p=0.045), showing a greater amount of patients was cancer-free after surgery in the late cohort.
Conclusions: Our study indicates that improved treatment of primary disease postpone time to surgical intervention for MBDA, but does not prolong the survival after surgical intervention. These findings can be due to lead time bias and further studies are needed.
Musculoskeletal Tumor Section, Department of Orthopedic Surgery, Rigshospitalet, University of Copenhagen; Musculoskeletal Tumor Section, Department of Orthopedic Surgery, Rigshospitalet, University of Copenhagen; Musculoskeletal Tumor Section, Department of Orthopedic Surgery, Rigshospitalet, University of Copenhagen; Musculoskeletal Tumor Section, Department of Orthopedic Surgery, Musculoskeletal Tumor Section, Department of Orthopedic Surgery
Background: Patients suffering from a pathological/impending fracture due to metastatic bone disease in the appendicular skeleton (MBDA) will often benefit from a total joint replacement (TJR). We hypothesize that improvements in primary cancer treatment will be reflected in an improved survival for patients who undergoes TJR due to MBDA.
Purpose / Aim of Study: To test if patient survival has improved over time after TJR due to MBDA.
Materials and Methods: A retrospective study of patients receiving primary TJR due to MBDA from 01/01/03 to 31/12/13. Survival was calculated from the day of surgery until death or to end of study (09/30/16). Statistics: Kaplan-Meier survival analysis (with 95%-CI), log-rank test and non-parametric tests for comparison of subgroups: patients having TJR in the early period between 2003-2008 (n=130) and patients having TJR in the late period between 2009-2013 (n=140).
Findings / Results: 270 patients (mean age 64 (21-90) years, 160 males/110 females) received 270 primary TJR. The cumulative 1-, 2- and 5- year survival rates after surgery for the early cohort was 41% (95%-CI: 32-49), 29% (95%-CI: 21-37), and 13% (95%-CI: 7-19) and 48% (95%-CI: 40-56), 34% (95%-CI: 26-42), and 11% (95% CI: 5-17) for the late cohort, p=0.458. The time from diagnosis of cancer to MBDA-surgery was shorter in the early cohort (p<0.001). A minor difference was found when comparing residual cancer disease after MBD surgery (p=0.045), showing a greater amount of patients was cancer-free after surgery in the late cohort.
Conclusions: Our study indicates that improved treatment of primary disease postpone time to surgical intervention for MBDA, but does not prolong the survival after surgical intervention. These findings can be due to lead time bias and further studies are needed.