Introduction to Thoracolumbar Spine Fractures: WFNS Spine Committee Recommendations

Salman Sharif,Mehmet Zileli 대한척추신경외과학회 2021 Neurospine Vol.18 No.4

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Subaxial Cervical Spine Injuries: WFNS Spine Committee Recommendations

Salman Sharif,Muhammad Yassar Jazaib Ali,Ibet Marie Y. Sih,Jutty Parthiban,Óscar L. Alves 대한척추신경외과학회 2020 Neurospine Vol.17 No.4

To formulate specific guidelines for the recommendation of subaxial cervical spine injuries concerning classification, management, posttraumatic locked facets and vertebral artery injury. Computerized literature was searched on PubMed and google scholar database from 2009 to 2020. For classification, keywords “Sub Axial Cervical Spine Classification,” resulting in 22 articles related to subaxial cervical spine injury classification system (SLICS) system and 11 articles related to AO (Arbeitsgemeinschaft für Osteosynthesefragen, German for “Association for the Study of Internal Fixation”) Spine system. The literature search yielded 210 and 78 articles on “management of subaxial cervical spine injuries” and the role of “SLICS” and “AO Spine” respectively. Keywords “management of traumatic facet locks” were searched and closed reduction, traction, approaches and techniques were studied. “Vertebral artery injury and cervical fracture” exhibited 2,328 references from the last 15 years. The objective was to identify the appropriate diagnostic tests and optimal treatment. Up-to-date information was reviewed, and statements were produced to reach a consensus in 2 separate consensus meetings of World Federation of Neurosurgical Societies (WFNS) Spine Committee. The statements were voted and reached a positive or negative consensus using Delphi method. Based on the most relevant literature, panelists in Moscow consensus meeting conducted in May 2019 drafted the statements, and after a preliminary voting session, the consensus was identified on various statements. Another meeting was conducted at Peshawar in November 2019, where in addition to previous statements, few other statements were discussed and voted. Specific recommendations were then formulated guiding classification, management, locked facets and vertebral artery injuries. This review summarizes the WFNS Spine Committee recommendations on subaxial cervical spine injuries.

Surgical Techniques for Thoracolumbar Spine Fractures: WFNS Spine Committee Recommendations

Salman Sharif,Yousuf Shaikh,Onur Yaman,Mehmet Zileli 대한척추신경외과학회 2021 Neurospine Vol.18 No.4

To formulate the specific guidelines for the recommendation of thoracolumbar fracture regarding surgical techniques and nonfusion surgery. WFNS (World Federation of Neurosurgical Societies) Spine Committee organized 2 consensus meeting. For nonfusion surgery and thoracolumbar fracture, a systematic literature search in PubMed and Google Scholar database was done from 2010 to 2020. The search was further refined by excluding the articles which were duplicate, not in English or were based on animal or cadaveric subjects. After thorough shortlisting, only 50 articles were selected for full review in this consensus meeting. To generate a consensus, the levels of agreement or disagreement on each item were voted independently in a blind fashion through a Likert-type scale from 1 to 5. The consensus was achieved when the sum for disagreement or agreement was ≥66%. Each consensus point was clearly defined with evidence strength, recommendation grade, and consensus level provided. A magnitude of prospective papers were analyzed to formulate consensus on various surgical techniques that can be employed to address different types of thoracolumbar fractures. Surgical treatment of thoracolumbar fractures can be a better option over the nonoperative approach, especially for those who cannot tolerate months in an orthosis or cast, such as those with multiple extremity injuries, skin lesions, obesity, and so forth. It generally allows early mobilization, less hospital stay, reduced pulmonary complications, and better correction of sagittal balance. Current available literature fails to demonstrate any statistically significant benefit of fusion surgery over nonfusion in thoracolumbar fractures.

Clinical and Radiological Factors Affecting Thoracolumbar Fractures Outcome: WFNS Spine Committee Recommendations

Francesco Costa,Salman Sharif,Abdul Hafid Bajamal,Yousuf Shaikh,Carla D. Anania,Mehmet Zileli 대한척추신경외과학회 2021 Neurospine Vol.18 No.4

To obtain a list of recommendations about clinical and radiological factors affecting outcome in thoraco-lumbar fractures with the aim of helping spine surgeons in daily practice. A systematic literature search in PubMed and Google Scholar database was done from 2010 to 2020 on the topic “thoracolumbar fracture AND radiology AND surgical outcomes” and “thoracolumbar fracture AND radiology AND surgical outcomes.” A total of 58 papers were analyzed and WFNS (World Federation of Neurosurgical Societies) Spine Committee organized 2 consensus meetings to formulate the specific recommendations the first in Peshawar in December 2019 and in a subsequent virtual meeting in June 2020 to reach an agreement. Both meetings utilized the Delphi method to analyze preliminary literature review statements based on the current evidence levels to generate recommendations through a comprehensive voting session. Eight statements were presented and reached the consensus about this topic. A variety of clinical factors is known to influence outcome of patients with thoracolumbar fractures. Some of these are well-known established factors such as blood pressure augmentation and patient age, while some are not well studied. Overall, the quality of evidence is low and we need more randomized controlled studies to validate our results. Similarly, radiological factors that can predict outcome are well stated and there is a high accordance worldwide. In reverse, still under debate is the application to choose which surgical treatment is advisable based on them.

History of Spinal Neurosurgery and Spine Societies

Mehmet Zileli,Salman Sharif,Fornari Maurizio,Premenand Ramani,Fengzeng Jian,Richard Fessler,김세훈,Toshihiro Takami,Nobuyuki Shimokawa,Gilbert Dechambenoit,Mahmood Qureshi,Nikolay Konovalov,Marcos Masini 대한척추신경외과학회 2020 Neurospine Vol.17 No.4

Incidence and Epidemiology of Thoracolumbar Spine Fractures: WFNS Spine Committee Recommendations

Mehmet Zileli,Salman Sharif,Maurizio Fornari 대한척추신경외과학회 2021 Neurospine Vol.18 No.4

This review aims to search the epidemiology and incidence rates of thoracolumbar spine fractures. A systematic review of the literature of the last 10 years gave 586 results with “incidence,” and 387 results with “epidemiology,” of which 39 papers were analyzed. The review results were discussed and voted in 2 consensus meetings of the WFNS (World Federation of Neurosurgical Societies) Spine Committee. Out of 39 studies, 15 studies have focused on thoracolumbar trauma, remaining 24 studies have looked at all spine trauma. Most were retrospective in nature; few were prospective and multicenter. Some studies have focused on specific injuries. The annual incidence of TL fractures is about 30/100,000 inhabitants including osteoporotic fractures. There is a trend to increase the fractures in elderly population especially in developed countries, while an increase of motor vehicle accidents in developing countries. The mortality rate among male elderly patients is relatively high. The incidence of thoracolumbar spine fractures is increasing because of low-velocity falls in the elderly population. The main reasons are falls and traffic accidents. Learning the regional differences and some special forms of trauma such as extreme sports, war, and gunshot injuries will help the prevention of the thoracolumbar spine fractures.

Reply to Commentary on “History of Spinal Neurosurgery and Spine Societies”

Mehmet Zileli,Salman Sharif,Maurizio Fornari,Premenand Ramani,Fengzeng Jian,Richard Fessler,Se-Hoon Kim,Toshihiro Takami,Nobuyuki Shimokawa,Gilbert Dechambenoit,Mahmood Qureshi,Nikolay Konovalov,Marco 대한척추신경외과학회 2021 Neurospine Vol.18 No.1

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Cervical Spine Trauma and Spinal Cord Injury Recommendations of WFNS Spine Committee

Mehmet Zileli,Nikolay Konovalov,Salman Sharif 대한척추신경외과학회 2020 Neurospine Vol.17 No.4

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Early Management of Spinal Cord Injury: WFNS Spine Committee Recommendations

José Antonio Soriano-Sánchez,Salman Sharif,Francesco Costa,Jose Alberto Israel Romero Rangel,Carla Daniela Anania,Mehmet Zileli 대한척추신경외과학회 2020 Neurospine Vol.17 No.4

Scientific knowledge today is being generated more rapidly than we can assimilate thus requiring continuous review of gold-standards for diagnosis and treatment of specific pathologies. The aim of this paper is to provide an update on the best early management of spinal cord injury (SCI), in order to produce acceptable worldwide recommendations to standardize clinical practice as much as possible.The WFNS Spine Committee voted recommendations regarding management of SCI based on literature review of the last 10 years. The committee stated 9 recommendations on 3 main topics: (1) clinical assessment and classification of SCI; (2) emergency care and early management; (3) cardiopulmonary management. American Spinal Injury Association impairment scale, Spinal Cord Independence Measure, and International Spinal Cord Injury Basic Pain Data Set are considered the most useful and feasible in emergency evaluation and follow-up in case of SCI. Magnetic resonance imaging is the most indicated examination to evaluate patients with symptomatic SCI. In early phase, correction of hypotension (systolic blood pressure<90 mmHg), and bradycardia are strongly recommended. Surgical decompression should be performed as soon as possible with the ideal surgical time being within 8 hours for both complete and incomplete lesions.

Variation in Outcome in Tethered Cord Syndrome

Noorulain Iqbal,Mohsin Qadeer,Salman Yousuf Sharif 대한척추외과학회 2016 Asian Spine Journal Vol.10 No.4

Study Design: Fifty patients surgically treated for tethered cord syndrome (TCS) were retrospectively studied at Liaquat National Hospital, Karachi from 2010 until 2014. Purpose: To assess the common presentations of TCS in our part of the world and the surgical outcome of the different presentations. Overview of Literature: TCS is a stretch-induced functional disorder of the spinal cord with its caudal part anchored by an inelastic structure, which results in characteristic symptoms and signs. Due to the variety of lesions and clinical presentations and the absence of high-quality clinical outcome data, the decision regarding treatment is difficult. Methods: Fifty consecutive patients with TCS were reviewed retrospectively with a follow-up period of 12–48 months. The majority of the patients were 0-15 years of age with the mean age of 4 years. The presenting complaints and the associated pathologies were documented, and the patients were assessed using the new Karachi TCS severity scale for clinical assessment. Results: Eighty five percent of the patients with thickened filum terminale improved. Sixty six percent of the patients with diastematomyelia, 60% with lipoma and only 46% with myelomeningocele showed clinical improvement postoperatively. Sixty two percent of the patients who presented with paraperesis improved following surgery while 37% remained stable and only one patient deteriorated. Back and leg pain improved in 93% of patients and 50% of patients with urinary impairment improved. Conclusions: Outcome of patients with TCS varies according to pathology and severity of symptoms. Diastematomyelia and thickened filum had the best outcome. The Karachi TCS severity scale is a valid tool for future studies.