Search Results (489)

Background: Multisegmental lumbar degenerative disease (ms-LDD) is a common condition in older adults, often requiring surgical intervention. While rigid stabilization remains the gold standard, it is associated with complications such as adjacent segment disease (ASD), higher blood loss, and longer recovery times. The Dynesys dynamic stabilization system offers an alternative by preserving motion while stabilizing the spine. However, data comparing Dynesys with fusion in multisegmental cases are limited. Objective: This study evaluates the clinical and radiographic outcomes of Dynesys dynamic stabilization versus rigid stabilization in the treatment of ms-LDD. Methods: A retrospective analysis was conducted on 53 patients (mean age: 62.25 ± 15.37 years) who underwent either Dynesys dynamic stabilization (n = 27) or PLIF (n = 26) for ms-LDD involving at least seven motion segments. Clinical outcomes were assessed using the Visual Analog Scale (VAS) and Oswestry Disability Index (ODI), while radiological parameters such as lumbar lordosis (LL), sagittal vertical axis (SVA), and spinopelvic parameters (pelvic incidence, pelvic tilt and, sacral slope) were analyzed. A two-stage surgical approach was employed in the Dynesys group to enhance osseointegration, particularly in elderly osteoporotic patients. Results: Both groups showed significant improvements in VAS and ODI scores postoperatively (p < 0.001), with no significant differences between them. However, the Dynesys group demonstrated superior sagittal alignment correction, with a significant increase in LL (p < 0.002) and a significant decrease in SVA (p < 0.0015), whereas changes in the rigid stabilization group were not statistically significant. Additionally, the Dynesys group had fewer complications, including a lower incidence of ASD (0 vs. 6 cases). The two-stage technique facilitated improved screw osseointegration and reduced surgical risks in osteoporotic patients. Conclusions: Dynesys dynamic stabilization is an effective alternative to rigid stabilization in ms-LDD, offering comparable pain relief and functional improvement while preserving motion and reducing ASD risk. The two-stage approach enhances long-term stability, making it particularly suitable for elderly or osteoporotic patients. Further long-term studies are needed to confirm these findings. Full article

Background/Objectives: Radial head arthroplasty is a commonly preferred treatment for complex, unreconstructable radial head fractures. Recent studies have raised the question of whether factors such as bone resorption may be related to failure. This observational, retrospective, multicenter, spontaneous, and non-profit study aims to assess radiological outcomes, focusing on bone resorption around the stem, for radial head replacement using a modular, cementless radial head prosthesis with interconnected porosity. Methods: A series of 42 cases was available for review. Patients underwent radial head arthroplasty using a three-dimensional-printed radial head prosthesis. Patients were eligible for inclusion if they had undergone at least one follow-up between 6 and 15 months post-operatively. A scoring system to detect bone resorption was developed and administered by two independent evaluators. Results: Forty-two patients (14 males, 28 females), with an average age of 59 ± 11 years (range: 39–80 years), were analyzed with a minimum of six months’ and a maximum of 32 months’ follow-up. At follow-up, 50 radiological evaluations were collected, with 29 showing ≤3 mm and 12 showing 3–6 mm resorption around the stem. The average resorption was 3.5 mm ± 2.3. No correlation was found between the extent of resorption and the time of follow-up. The developed scoring system allowed for a high level of correlation between the evaluators’ measurements of bone resorption. Conclusions: Radial head prosthesis with interconnected porosity provided a low stem resorption rate for patients after a radial head fracture at short-to-mid-term follow-up after the definition of a reliable and easy-to-use radiological-based classification approach. (Level of Evidence: Level IV). Full article

Background: Transforaminal lumbar interbody fusion (TLIF) with static cages is a frequently performed procedure. Larger series focusing on the use of expandable TLIF spacers are less common. Methods: This retrospective, single-center observational cohort study reviewed consecutive patients treated by TLIF using expandable titanium interbody implants (ALTERA™, Globus Medical Inc., Audubon, PA, USA) for degenerative pathologies from L2-S1 between 11/2018 and 09/2023. Surgical parameters, adverse events, radiological outcomes (fusion rate, segmental lordosis, spinopelvic parameters), and clinical outcomes were analyzed through a mean postoperative follow-up of 12 months. Results: This study identified 270 patients (mean age 65 years, 50.4% female) who underwent TLIF with expandable interbody spacers at 324 levels. Clinical outcomes were good or excellent in 74.1% of patients at 3 months and 71.8% at 12 months. Radiographic fusion was achieved in 73.1% of assessable segments at 12 months. Segmental lordosis increased significantly from 17.8° preoperatively to 20.0° at 12 months (p < 0.001). Adverse event (AE) rates were acceptable across all timepoints, with no device failures or device-associated complications observed. Conclusions: This study demonstrates that TLIF with expandable titanium interbody implants was safe, associated with high fusion rates, and enabled significant restoration of segmental lordosis that was maintained during follow-up. Full article

Background: Recurrent anterior shoulder instability is a common problem and may be associated with glenoid bone defects. Surgical procedures, including Latarjet, are the usual treatment for anterior shoulder instability, associated with significant glenoid bone defects. The aim of this study was to evaluate the clinical outcome and glenohumeral arthritis progression in patients with recurrent anterior shoulder instability and significant bone loss treated by a modified Latarjet procedure. Methods: From July 2018 to November 2021, a prospective observational case series was carried out on 21 patients with recurrent anterior shoulder instability associated with significant bone defects treated by a modified Latarjet procedure in which the coracoid process was rotated 90° on its longitudinal axis and the subscapularis muscle was horizontally split. Patients with a glenoid defect of more than 21% were included. Post-operatively, the patients were clinically assessed using modified Rowe scoring. Glenohumeral arthritis, graft position, union, and resorption were radiologically evaluated. Results: The mean age at the time of surgery was 28.52 ± 8.0 (range: 19–45) years. The mean number of dislocations was 18.33 ± 8.67 (range: 6–35) times. The mean glenoid defect size was 26.19 ± 4.85 (range: 21–37) % and Hill–Sachs lesions were off-track in 19 cases. The mean follow-up period was 30.67 ± 7.53 (range: 16–40) months. Eighteen patients (85.7%) showed good to excellent results. The mean modified Rowe score was 85.00 ± 18.77 (range: 30–100) points. The mean external rotation loss was 8.09 ± 5.11° (range: 0–20°). No cases of recurrent instability were observed, and there was no progression of glenohumeral arthritis. Conclusions: The modified Latarjet is an effective and reliable surgical option to treat traumatic anterior shoulder instability with significant bone loss. Most of the reported complications associated with this procedure did not affect the functional outcome. Full article

Objectives: Residual postoperative pleural space (RPPS) is a common event after pulmonary lobectomy. Uniportal video-assisted thoracoscopic surgery (VATS) lobectomy has been associated with a higher incidence of RPPS. This study aims to evaluate the incidence, the predictors, and potential clinical implications of RPPS following Uniportal VATS lobectomy. Methods: Patients who underwent Uniportal VATS lobectomy, without any previous neoadjuvant treatment, from June 2016 to March 2020, were retrospectively analyzed. RPPS was assessed using the last chest X-Ray prior to discharge and measured by Collins method (%). Results: Among 492 patients who underwent Uniportal VATS lobectomy, 325 (66.1%) developed RPPS. The mean RPPS volume measured by the Collins method was 15.46 ± 8.59% (vs. Collins = 4.2% in no-PRPS). An RPPS > 10.5% of Collins was significantly associated with a higher risk of postoperative air leak (AUC: 0.69, sensitivity: 69%, specificity: 54%, p < 0.001). Multivariable analysis identified the following predictors of RPPS > 10.5%: right-sided surgery (p < 0.001), upper lobectomy (p = 0.01), and prolonged air leak (p = 0.003). Patients with RPPS had a higher risk of only radiologically visible postoperative subcutaneous emphysema on the final chest X-ray (p = 0.041) and were more frequently discharged with a chest tube connected to a Heimlich valve (p < 0.001). Within 90 days post-discharge, 24 (4.9%) patients were readmitted due to increased RPPS (1.4%, requiring drainage in 5 cases [1%]), progression of subcutaneous emphysema (1.6%), and pleural effusion (1.8%, requiring drainage in 6 cases [1.2%]). However, RPPS was not associated with an increased overall risk of postoperative complications (p = 0.31) or 90-day readmission (p = 0.43). Conclusions: RPPS is a common occurrence following Uniportal VATS lobectomy but is not associated with clinically significant complications. The current study findings identified BMI, active smoking, right-sided surgery, and prolonged air leak as significant predictors of RPPS. Full article

Background and Objectives: Idiopathic normal-pressure hydrocephalus (NPH) is a treatable, but diagnostically challenging condition in the elderly marked by gait disturbance, cognitive decline, and urinary incontinence. Ventriculoperitoneal (VP) shunting is effective, but the prognostic significance of symptom duration before surgery remains unclear. This systematic review evaluates symptom duration in NPH patients with postoperative outcomes. Methods: A systematic search of PubMed, Scopus, and Embase was conducted per PRISMA guidelines. Studies were included if they assessed clinical or radiological outcomes of VP shunting in adult NPH patients, reported symptom duration, and had a follow-up of at least one month. Clinical outcomes (MMSE, TUG, NPH score) were qualitatively analyzed due to study heterogeneity. Results: Twenty-four studies comprising 1169 patients were included (mean age: 72.45 years; mean symptom duration: 33.04 months). Most studies reported clinical improvement after VP shunting. However, few directly evaluated the effect of symptom duration, yielding inconsistent findings: some suggested better outcomes with shorter symptom duration, while others found no clear correlation. Larger studies often lacked conclusive data, and no randomized controlled trials were identified. Conclusions: VP shunting remains an effective intervention for NPH; however, evidence supporting the predictive value of preoperative symptom length is inconclusive. This review highlights the need for standardized diagnostic protocols and larger prospective studies to clarify this association and optimize surgical timing. Full article

Background/Objectives: Mandibular coronoid process hypertrophy (MCPH) is a rare condition characterized by an abnormal enlargement of the mandibular coronoid process, resulting in restricted mouth opening and reduced lateral mandibular movements due to interference with the zygomatic bone. The objective of this paper is to evaluate the functional outcomes of intraoral coronoidectomy followed by physiotherapy in five consecutive patients with MCPH. Methods: Five male patients (mean age 38 ± 18.7 years) with radiologically confirmed bilateral MCPH underwent intraoral coronoidectomy between May 2020 and December 2022. Maximal inter-incisal opening (MIO) was measured pre-operatively, on postoperative day 1, and at 6-month follow-up. A standardized 5-10-60 mouth-opening exercise protocol using a Heister mouth gag was administered from postoperative day 1. Results: The hyperplastic mandibular coronoid processes were removed intraorally without any long-lasting complications. All patients demonstrated a postoperative increase in mouth opening. Notably, patients with more severe mouth-opening limitations showed greater improvement compared with those with milder initial restrictions. Conclusions: Intraoral coronoidectomy, combined with early and intensive physiotherapy, represents a safe and effective treatment for MCPH. Early diagnosis and timely surgical intervention are crucial to prevent ineffective non-surgical management. Additionally, a modest initial postoperative increase in mouth opening should not be considered the final outcome, as these patients often achieve substantial long-term functional improvement. Full article

Carotid stenosis is a common pathology in clinical practice and unfortunately carries a high risk of serious cerebrovascular events. The early recognition of carotid plaque and, consequently, a careful analysis by means of multimodal imaging are the necessary steps to undertake a correct management pathway, aimed at preventing or, if not possible, reducing the risk of atherogenic phenomena responsible for cerebral infarction. In particular, the presence or absence of clinical symptoms, understood as the occurrence of events such as TIAs in the last 6 months, non-disabling strokes or repeated episodes of amaurosis fugax, and the degree of carotid stenosis, are certainly the most studied parameters, and as reported by several international guidelines, can lead to the best therapeutic strategy: whether to rely on conservative medical therapy or to resort to mechanical revascularization of the carotid stenosis. According to the recommendations of the European Society of Vascular Surgery, mechanical revascularization is recommended for stenosis > 50% in symptomatic patients and stenosis > 60% in asymptomatic patients. In contrast, the latest findings on plaque vulnerability have focused attention on individual patient characteristics and clinical comorbidities that may be responsible for plaque inflammation and should therefore be taken into consideration to decide if revascularization treatment is needed even in those subjects who present stenosis with less degree than reported as critical value. Moreover, further radiological investigations are fundamental to finding the presence of entities such as plaque ulceration, plaque neo-vascularization, fibrous caps, and intraplaque lipid core that are responsible for increased vulnerability. Medical therapy involves interventions aimed at eliminating cardiovascular risk factors by administering drugs that control the comorbidities responsible for worsening carotid stenosis. Recent studies are also evaluating the effectiveness of new plaque-modifying drugs or targeted anti-inflammatory agents in reducing the risk of plaque development and complications. Revascularization therapies, on the other hand, include surgery (CEA), the endovascular technique (CAS), and a new hybrid technique (TCAR): they are all valid alternatives for the treatment of carotid stenosis, each with specific technical difficulties, but on the whole with comparable safety profiles and risk rates of postoperative complications, although some recent emergencies have focused attention on possible short- and long-term gender-dependent outcome differences. The aim of this manuscript is to present the state of the art in the management of patients with carotid stenosis and to take a closer look at revascularization options. In our opinion, the choice of one strategy over another should therefore depend on gender, anatomical features of the patient, preoperative comorbidities, and last but not least, the experience of the center and the multidisciplinary team involved in the management of the patient. Full article

Background and Aim: Floating aortic thrombi are rare but potentially life-threatening entities, associated with a high risk of systemic embolization and subsequent complications such as ischemic stroke or mesenteric infarction. Therapeutic strategies range from urgent surgical intervention to conservative medical management with anticoagulation, depending on the patient’s clinical status and thrombus morphology. This report presents two cases of floating aortic thrombi managed with distinct approaches, surgical and medical, underscoring the importance of individualized treatment guided by embolic risk and comorbidities. Patients and Methods: The first case involves a 59-year-old male presenting with abdominal pain and emesis. Imaging confirmed mesenteric ischemia, necessitating emergent laparotomy and extensive jejunal resection. Postoperative imaging identified a mobile thrombus at the ascending aorta–aortic arch junction, with evidence of cerebral embolism. The patient underwent urgent surgical thrombectomy, ascending aortic resection, and hemiarch replacement. The second case describes an 88-year-old male who presented with bilateral upper limb paresthesia. Neuroimaging revealed acute supra- and infratentorial ischemic lesions suggestive of embolic stroke. A floating thrombus was identified in the ascending aorta, with an additional thrombus in the descending thoracic aorta. Given the patient’s advanced age, comorbid conditions, and thrombus stability, a conservative approach with systemic anticoagulation and close radiologic surveillance was chosen. Conclusions: These cases illustrate the need for tailored management of floating aortic thrombi. While surgical resection remains indicated in unstable or high-risk embolic cases, anticoagulation may suffice for stable lesions in patients with elevated surgical risk. Further studies are needed to establish standardized therapeutic guidelines. Full article

Background/Objectives: Degenerative lumbar spinal stenosis (LSS) is a prevalent cause of disability in elderly populations, often treated with decompressive surgery. However, postoperative functional outcomes are variable and influenced by factors beyond neural compression alone. This study aimed to investigate the prognostic significance of the Goutallier Classification System (GS), a radiological index of paravertebral muscle fatty degeneration, in predicting long-term postoperative disability and pain in elderly patients undergoing decompression for LSS. Methods: A retrospective cohort study was conducted on 100 elderly patients who underwent primary lumbar decompression surgery for LSS between January 2020 and July 2022, with a minimum two-year follow-up. Patients were stratified according to their preoperative GS grades assessed via MRI. The Oswestry Disability Index (ODI) and Visual Analog Scale (VAS) for pain were collected preoperatively and at follow-up. Changes in the ODI and VAS (ΔODI and ΔVAS) were analyzed to evaluate associations between GS grades and functional outcomes. Results: Significant improvements in the ODI (from 41.0 ± 17.5 to 16.9 ± 8.2) and VAS (from 6.23 ± 2.52 to 3.75 ± 2.38) were observed postoperatively (p < 0.01). However, higher GS grades were associated with greater residual disability and pain at follow-up, as well as with smaller postoperative improvements in these scores (p < 0.01 for ODI; p = 0.01 for VAS). Gender differences were noted, with females predominating in higher GS grades. No significant differences in comorbidities or complication rates were identified across GS subgroups. Conclusions: Preoperative paravertebral muscle degeneration, as measured by the GS, emerged as a significant predictor of postoperative disability and pain in elderly LSS patients. Incorporating GS assessment into preoperative planning may refine surgical risk stratification and inform shared decision-making to optimize long-term functional recovery. Full article

Objective: In recent years, a significant increase in the incidence of both total hip arthroplasty and acetabular revision surgery has been observed. A substantial proportion of patients requiring these revision procedures present with major bone deficits and extensive osteolysis. In light of these challenges, this study aims to provide a comprehensive comparison between two commonly utilized methods: trabecular titanium shell implants and Burch–Schneider acetabular reinforcement cages. Methods: Participants of both sexes were included through a retrospective review of medical records. The sole inclusion criterion was that the patient had undergone revision hip arthroplasty using either Burch–Schneider acetabular reinforcement cages or Regenerex trabecular titanium shell within the past 18 years. No exclusion criteria were applied concerning patient age, laterality, ethnicity, or post-operative status. Each patient was evaluated based on nine predictive factors, including the Paprosky classification, duration of surgery, perioperative blood loss, number of bone grafts and screws used, as well as pre- and post-operative Harris Hip Score (HHS) and Visual Analogue Scale (VAS). Results: A total of 220 patients were included in the analysis, with 75% (n = 165) comprising the group treated with trabecular titanium implants and 25% (n = 55) treated with Burch–Schneider cages. The use of Regenerex trabecular titanium was associated with a 32.40% (n = 23.13 mL) reduction in bone graft tissue required and a 13.7% (n = 0.59) increase in the number of screws needed. Additionally, the trabecular titanium group experienced a 15.93% (n = 179.64 mL) reduction in perioperative blood loss compared to the Burch–Schneider cage group. The other parameters analyzed in the study did not demonstrate statistical significance. Conclusions: The use of a trabecular titanium acetabular shell may be an effective option, particularly in patients with severe acetabular deficits, as it provides favorable clinical and radiological outcomes. Additionally, it reduces the number of bone grafts required and allows for faster and more immediate partial weight-bearing on the operated limb. Full article

Objectives: This study investigated the potential of Hounsfield unit (HU) values obtained from computed tomography (CT) scans as predictors of mechanical complications (MCs) in patients undergoing long-segment spinal fusion involving the pelvis. Additionally, it identified a threshold HU value associated with an increased risk of MCs. Methods: We conducted a retrospective, multicenter review of patients who underwent long-segment spinal fusion involving the pelvis, with a minimum follow-up period of two years. Patients were categorized based on the presence or absence of postoperative MCs. Both preoperative and postoperative radiographic parameters were analyzed, and HU values were quantified from CT images. Logistic regression modeling was used to identify independent risk factors for MCs. Results: Among 129 patients, 33 (25.6%) developed MCs, including proximal and distal junctional failures, rod fractures, and cases necessitating re-operation. The HU values were significantly lower in the MC group, whereas conventional bone mineral density (BMD) measurements showed no significant difference. Global alignment parameters, such as the sagittal vertical axis (SVA) and global tilt (GT), were consistently higher in patients with MCs. Receiver operating characteristic analysis identified 131 HU as the optimal cut-off, yielding a sensitivity of 56.4% and a specificity of 69.7%. Multivariate analysis confirmed that lower HU values were independently associated with the occurrence of MCs. Conclusions: Lower HU values and larger radiological global alignment parameters are significant predictors of MCs in patients undergoing surgery for adult spinal deformity. These findings underscore the importance of CT-based quantitative assessments in preoperative planning. Full article

Background/Objectives: In orthopedic (diabetic) foot surgery, the serum C-reactive protein (CRP) level is frequently measured not only as a diagnostic tool, but also as a control inflammatory marker in the follow-up of postoperative surgical-site infections (SSIs) Methods: We investigated the predictive value of the post-debridement routine (control) serum CRP level in adult (diabetic) patients with an SSI in the foot. We excluded community-acquired (diabetic foot) infections and focused on the predictive accuracy of routine (control) CRP measurements in terms of ultimate therapeutic failures. Results: The median pre- and postoperative CRP levels were 25 mg/L and 8.8 mg/L, respectively. In group comparisons and multivariate assessment, neither the immediate (relative and absolute) drop in the serum CRP level, nor its values between 5 and 8 weeks and between 11 and 14 weeks predicted the failure risk of 19%. In contrast, in cases of surprisingly elevated CRP levels, this finding leads to unnecessary radiological (median costs approximatively USD 200), clinical, microbiological urinary sample (median costs USD 50), and laboratory (one CRP sample USD 10) exams. These additional exams also likely prolong the duration of hospitalization by one to two days (e.g., whilst awaiting the microbiological results) and often generate unnecessary consultations among internist and/or infectious diseases experts (USD 50). Conclusions: Routine, postoperative CRP monitoring during the treatment of established orthopedic (diabetic) foot SSIs is unnecessarily costly, and should be avoided in favor of clinical surveillance of the postoperative evolution. Full article

Background/Objectives: This retrospective study evaluates the predictive role of magnetic resonance imaging (MRI) in complications and recurrence in rectal cancer patients undergoing surgery and neoadjuvant therapy, highlighting the impact of structured reporting templates on MRI quality. Compared to traditional free-text reports, structured radiology reports offer a point-by-point evaluation, improving clarity and completeness by thoroughly addressing all relevant findings. MRI is critical in rectal cancer staging, guiding treatment based on tumor characteristics like T stage, sphincter involvement, vascular invasion, and lymph node status. Methods: A retrospective analysis of MRI and reports from 67 rectal cancer patients at the time of diagnosis, who were subsequently treated with neoadjuvant radiochemotherapy and surgery, was conducted. MRI report features, including tumor location, morphology, T stage, sphincter infiltration, mesorectal fascia involvement, lymph nodes, and extramural vascular invasion, were evaluated against European Society of Gastrointestinal and Abdominal Radiology (ESGAR) recommendations. Multivariate and univariate analyses were performed to correlate MRI findings with postoperative outcomes such as complications, local recurrence, bleeding, and 30-day anastomotic leaks. Results: Sphincter involvement showed a strong association with increased complications (multivariate β = 0.410, univariate r = 0.270). Extramural vascular invasion was linked to higher rates of local recurrence (multivariate β = 0.199, univariate r = 0.127). Lymph node involvement correlated with an elevated risk of postoperative bleeding (multivariate β = 0.133, univariate r = 0.293). Additionally, advanced T staging predicted a higher incidence of 30-day anastomotic leaks (multivariate β = 0.210, univariate r = 0.261). These findings may provide clinically relevant insights to support personalized surgical planning and improve preoperative risk stratification. Conclusions: Detailed MRI reporting, aligned with structured templates, significantly guides surgical and therapeutic strategies in rectal cancer management. However, the retrospective nature of the study and the limited sample size may affect the generalizability of the results. Full article

Background: Spinal arachnoid cyst development (SAC) is a rare and debilitating disease with a non-well-defined treatment strategy: a series of five patients diagnosed with SAC and submitted to neurosurgical treatment was retrospectively analyzed. Objectives: SACs represent 1–2% of all spinal neoplasms; they can be extradural, intradural, or intramedullary, with intradural arachnoid cysts (IDACs) comprising only 10% of these cases. The rarity of SACs and the lack of consensus on the best treatment strategies represent a care challenge: the aim of this study is to explore the effectiveness and outcomes of the neurosurgical management in patients with SACs treated at our institution. Methods: Adult patients who underwent surgical treatment for SACs between January 2020 and December 2023 were included in the study: clinical onset, imaging, surgical technique, and neurological long-term status were retrospectively analyzed. Results: Five patients (three males, two females; average age 53.4 years) were included. The most common symptoms described were paresthesia, gait disturbances, and back pain. Radiological imaging indicated that most cysts were at the thoracic level. Surgical interventions primarily involved cyst resection and adhesiolysis. Post-operative outcomes showed overall improvement or stability in Karnofsky Performance Status (KPS) and American Spinal Injury Association Impairment Scale (ASIA) scores in the majority of cases, although complications and recurrences occurred. Conclusions: Surgical resection combined with adhesiolysis may prevent the worsening of neurological impairment and potentially improve pain control and clinical outcomes in patients with SACs. However, careful and tailored management is required due to the high potential of complications and recurrences. Full article