Is S1 Alar Iliac Screw a Feasible Option for Lumbosacral Fixation?: A Technical Note

Zhi Wang,Ghassan Boubez,Daniel Shedid,Sung Jo Yuh,Amer Sebaaly 대한척추외과학회 2018 Asian Spine Journal Vol.12 No.4

Nonunion at the lumbosacral junction is a classic complication of long construct and deformity corrections. Iliac fixations have been extensively studied in the literature and have demonstrated superior biomechanical proprieties and lower complication rates. S2 alar iliac screws address the drawbacks of classical iliac screws but demonstrate similar biomechanical advantage. The main aim of this paper was to describe the S1 alar iliac (S1AI) screw fixation technique while evaluating our early results. S1AI screw fixation technique has the advantage of being able to achieve pelvic fixation without dissection to the S2 pedicle entry and is therefore a viable option for salvage of a failed S1 promontory screw.

Single Posterior Approach for En-Bloc Resection and Stabilization for Locally Advanced Pancoast Tumors Involving the Spine: Single Centre Experience

Fahed Zairi,Tarek Sunna,Moishe Liberman,Ghassan Boubez,Zhi Wang,Daniel Shedid 대한척추외과학회 2016 Asian Spine Journal Vol.10 No.6

Study Design: Monocentric prospective study. Purpose: To assess the safety and effectiveness of the posterior approach for resection of advanced Pancoast tumors. Overview of Literature: In patients with advanced Pancoast tumors invading the spine, most surgical teams consider the combined approach to be necessary for “en-bloc ” resection to control visceral, vascular, and neurological structures. We report our preliminary experience with a single-stage posterior approach. Methods: We included all patients who underwent posterior en-bloc resection of advanced Pancoast tumors invading the spine in our institution between January 2014 and May 2015. All patients had locally advanced tumors without N2 nodes or distant metastases. All patients, except 1, benefited from induction treatment consisting of a combination of concomitant chemotherapy (cisplatin-VP16) and radiation. Results: Five patients were included in this study. There were 2 men and 3 women with a mean age of 55 years (range, 46–61 years). The tumor involved 2 adjacent levels in 1 patient, 3 levels in 1 patient, and 4 levels in 3 patients. There were no intraoperative complications. The mean operative time was 9 hours (range, 8–12 hours), and the mean estimated blood loss was 3.2 L (range, 1.5–7 L). No patient had a worsened neurological condition at discharge. Four complications occurred in 4 patients. Three complications required reoperation and none was lethal. The mean follow-up was 15.5 months (range, 9–24 months). Four patients harbored microscopically negative margins (R0 resection) and remained disease free. One patient harbored a microscopically positive margin (R1 resection) and exhibited local recurrence at 8 months following radiation treatment. Conclusions: The posterior approach was a valuable option that avoided the need for a second-stage operation. Induction chemoradiation is highly suitable for limiting the risk of local recurrence.

Anterolateral Cervical Kyphoplasty for Metastatic Cervical Spine Lesions

Amer Sebaaly,Ahmed Najjar,Zhi Wang,Ghassan Boubez,Laura Masucci,Daniel Shedid 대한척추외과학회 2018 Asian Spine Journal Vol.12 No.5

Study Design: Retrospective case series. Purpose: To evaluate the clinical and radiological efficacy of anterolateral kyphoplasty for cervical spinal metastasis. Overview of Literature: Although the spine is the third most common site of tumor metastasis, the cervical spine is the least commonly affected (incidence, 10%–15%). Surgical decompression is highly challenging because of the proximity of neural and vascular elements. Kyphoplasty for cervical spine metastasis has been described in small case reports with promising results. Methods: Retrospective analysis of a prospective collected single-center spine metastasis database was done for cervical kyphoplasty cases. Data pertaining to age, sex, primary tumor diagnosis, modified Tokuhashi score, Spinal Instability Neoplastic Score (SINS), preoperative Visual Analog Scale (VAS) score, and analgesic medication were extracted. Postoperative data included VAS score at postoperative day 1, duration of hospitalization, self-reported functional outcome, and VAS score at the last follow-up. Results: Eleven patients (mean age, 62.5 years) with cervical spine metastases were treated with 15-level kyphoplasty. Mean Tokuhashi score was 8.1, and mean SINS was 7.85. Mean preoperative pain score was 7.1, and 82% of patients used opioid analgesics. Mean total bleeding volume was 100 mL. Mean complication-free length of stay was 2.6 days with a decrease in postoperative pain (VAS score=2.8, p <0.05). There was a 56% decrease in opioid dosage and the number of consumed analgesics (1.09, p =0.004). Eightytwo percent of the patients reported excellent improvement at the last follow-up self-assessment. Conclusions: To our knowledge, this case series represents the largest series of vertebral augmentation using balloon kyphoplasty for cervical spinal metastasis. This technique is associated with low postoperative complications as well as significant decrease in pain, use of opioids, and length of hospital stay. The main indications for vertebral kyphoplasty are lytic lesions of the cervical spine, painful lesions refractory to medical treatment, SINS score of 6–10, and absence of posterior wall defect.

Enhanced Visualization of the Cervical Vertebra during Intraoperative Fluoroscopy Using a Shoulder Traction Device

Truong Van Tri,Al-Shakfa Fidaa,Boubez Ghassan,Shedid Daniel,Yuh Sung-Joo,Wang Zhi 대한척추외과학회 2020 Asian Spine Journal Vol.14 No.4

Study Design: A retrospective, matched cohort study of a prospective database.Purpose: To evaluate the efficacy and safety of the Cervision system (Spinologics, Montreal, Canada), a new shoulder traction device that improves the fluoroscopic visualization of the lower cervical spine using caudal traction of the shoulders out of the radiographic field.Overview of Literature: Operating at a wrong level is a common error that may be committed by nearly 50% of surgeons during their career. Intraoperative fluoroscopy of the cervical vertebrae is an extremely important step in cervical spine surgery. Optimal lateral cervical radiography of the C1–T1 vertebrae is not always possible due to overlap of the shoulders.Methods: In this study, a group of patients (n=33, device group) underwent surgery with the new device used to apply caudal traction to both shoulders, and another group of patients (n=33, matched control group) had surgery with the tape traction. Data about the lowest vertebra visible on lateral fluoroscopic view, installation time, skin irritation under the traction area, and postoperative brachial palsy were recorded, and these parameters were analyzed using the <i>t</i>-test.Results: The mean numbers of visible cervical vertebra were 6.3±0.41 in the device group and 5.6±0.32 in the matched control group (<i>p</i> <0.01, unpaired <i>t</i>-test). The mean installation times were 83.9±5.15 minutes in the device group and 73.7±6.32 minutes in the matched control group (<i>p</i> <0.02). Seven patients from the matched control group presented with skin irritation. However, none of the patients from the device group had the condition (p =0.005, Pearson chi-square test). Postoperative brachial palsy was not observed in both groups.Conclusions: The Cervision system is more effective and superior to tape traction in pulling the shoulders down to improve the visualization of the cervical vertebra on lateral fluoroscopic view during cervical spine surgery.

Sagittal Balance Correction Following Lumbar Interbody Fusion: A Comparison of the Three Approaches

Pierre-Olivier Champagne,Camille Walsh,Jocelyne Diabira,Marie-Élaine Plante,Zhi Wang,Ghassan Boubez,Daniel Shedid 대한척추외과학회 2019 Asian Spine Journal Vol.13 No.3

Study Design: Retrospective cohort study. Purpose: The objective of this study was to compare three widely used interbody fusion approaches in regard to their ability to correct sagittal balance, including pelvic parameters. Overview of Literature: Restoration of sagittal balance in lumbar spine surgery is associated with better postoperative outcomes. Various interbody fusion techniques can help to correct sagittal balance, with no clear consensus on which technique offers the best correction. Methods: The charts and imaging of patients who have undergone surgery through either open transforaminal lumbar interbody fusion (TLIF), minimally invasive TLIF (MIS TLIF), or oblique lumbar interbody fusion (OLIF) were retrospectively reviewed. The following sagittal balance parameters were measured pre- and postoperatively: segmental lordosis, lumbar lordosis, disk height, pelvic tilt, and pelvic incidence. Data on postoperative complications were gathered. Results: Only OLIF managed to significantly improve segmental lordosis (4.4°, p<0.001) and lumbar lordosis (4.8°, p=0.049). All approaches significantly augmented disk height, with OLIF having the greatest effect (3.7°, p<0.001). No approaches were shown to significantly correct pelvic tilt. Pelvic incidence remained unchanged in all approaches. Open TLIF was the only approach with a higher rate of postoperative complications (33%, p=0.009). Conclusions: The OLIF approach might offer greater correction of sagittal balance over open and MIS TLIF, mainly in regard to segmental lordosis, lumbar lordosis, and disk height. MIS TLIF, although offering more limited access than open TLIF, was not inferior to open TLIF in regard to sagittal balance correction. A higher rate of complications was shown for open TLIF than the other approaches, possibly due to its more invasive nature.

Single-Stage Posterior Approach for the En Bloc Resection and Spinal Reconstruction of T4 Pancoast Tumors Invading the Spine

Wang Zhi,Truong Van Tri,Liberman Moishe,Al-Shakfa Fidaa,Yuh Sung-Joo,Soder Stephan Adamour,Wu James,Sunna Tarek,Renaud-Charest Émilie,Boubez Ghassan,Shedid Daniel 대한척추외과학회 2022 Asian Spine Journal Vol.16 No.5

Study Design: Retrospective cohort study.Purpose: This study aimed to evaluate the outcomes of patients who had T4 Pancoast tumors invading the spine and underwent en bloc resection and spinal stabilization through a single-stage posterior approach.Overview of Literature: Surgical resection for Pancoast tumors affecting the spine has been successfully performed in two stages involving spinal reconstruction and tumor resection. However, reports have rarely presented the results of en bloc resection combined with spinal stabilization for T4 Pancoast tumors invading the spine through a single-stage posterior approach.Methods: Patients who had T4N0M0 Pancoast tumors invading the spine and underwent a single-stage posterior approach were retrospectively recruited. The following data were obtained and examined: demographics, tumor histology, preoperative and postoperative therapy, complications, spinal reconstruction technique, tumor resection extent, survival time, and disease recurrence.Results: Eighteen patients were included. The mean population age was 61±17 years, and the most common pathological type was adenocarcinoma (61.1%). Complete resection (R0) was obtained in 15 patients (83.3%), positive surgical margins (R1) were found in three patients (16.7%), and the 90-day mortality rate was 0%. Postoperative major complications were detected in 12 patients (66.7%), who required reoperation. The mean survival time was 67±24 months, but the median survival time was not reached. Among the patients, 10 (55.6%) are still alive at the end of the study. The 2- and 5-year actual survival rates were 59% (95% confidence interval [CI], 35.7%–82.3%) and 52.5% (95% CI, 28.4%–76.6%), respectively.Conclusions: <i>En bloc</i> resection and spinal stabilization through a single-stage posterior approach might be effective for T4 Pancoast tumors invading the spine.