Conventional Radiotherapy Timing and Wound Complication Avoidance After Surgery for Metastatic Spine Disease. A LatAm Modified Delphi Study.

Background: Combining surgery and radiotherapy is the gold standard in treating spinal metastasis when spinal stabilization or surgical decompression is required. Determining the optimal timing for radiotherapy postsurgery is crucial to balance treatment efficacy minimizing wound complications. The study aimed to identify consensus and nonconsensus areas among Latin American spinal surgeons regarding the use, timing, risks, and surgical approach to conventional external beam radiotherapy (cEBRT) following spinal surgery for metastases, specifically focusing on the risk of radiotherapy-related wound complications.

Time to Surgery for Subaxial Cervical Fractures: A Multicenter Study.

Objective: To identify delays for surgery to stabilize subaxial cervical fractures and the main reasons for them across Latin America.

Methods: This is a retrospective multicenter cohort study of patients surgically treated for subaxial cervical fractures from 13 spine centers across Latin America from January 1, 2014 to January 1, 2023. Causes of delay to surgery beyond 24 hours were documented.

Management of C2 fractures following multiple classifications, a narrative review.

Introduction: Classifications are helpful for surgeons as they can be a resource for decision-making, often providing the individual indicators that may deem a case necessary for surgery. However, when there are multiple classifications, the decision-making might be compromised. That is the case with C2 fractures.

Understanding the Landscape of Spinal Injections: Insights and Challenges from Latin America.

Background: Low back pain and neck pain are primary causes of disability, with low back pain being a frequent reason for medical consultations. After conservative and pharmacological treatments, spinal injections are considered the next option. Despite multiple guidelines, spinal blocks remain controversial in terms of indication, technique, and operator, leading to considerable interinstitutional variability.

Analyzing the L4-5 Segmental Alignment Change of Two Minimally Invasive Prone-Based Interbody Fusions.

Study Design: Retrospective Cohort Study.

Objective: Restoration of lumbar lordosis (LL) is a principal objective during spinal fusion procedures, traditionally focusing on achieving an LL within 10° of the pelvic incidence (PI). Recent studies have demonstrated a relatively constant L4-S1 alignment of 35-40° at L4-S1 and at least 15° at L4-5, regardless of PI.

Does Minimally Invasive Hemilaminectomy for Intradural Extramedullary Tumor Resection Prevent Postlaminectomy Kyphosis or Lordosis Loss?

Background: Minimally invasive hemilaminectomy is a safe and effective alternative to open laminectomy for treating intradural extramedullary tumors. There are no reports of postoperative kyphosis after this approach. This study aims to determine whether performing minimally invasive spine surgery hemilaminectomy for intradural extramedullary tumors can prevent the development of postlaminectomy kyphosis (PLK) or lordosis loss.

Endoscopic Treatment of Lumbar Degenerative Disc Disease: A Narrative Review of Full-Endoscopic and Unilateral Biportal Endoscopic Spine Surgery.

Background: Degenerative lumbar spine disease is the leading cause of disability and work absenteeism worldwide. Lumbar microdiscectomy became the standard treatment for herniated discs and stenotic disease. With the evolution of different techniques, endoscopic spinal surgery emerged to minimize the surgical footprint while providing at least non-inferior results.

Orthopedic postoperative infection profile and antibiotic sensitivity of 2038 patients across 24 countries - Call for region and institution specific surgical antimicrobial prophylaxis.

Purpose: Improper utilization of surgical antimicrobial prophylaxis frequently leads to increased risks of morbidity and mortality.This study aims to understand the common causative organism of postoperative orthopedic infection and document the surgical antimicrobial prophylaxis protocol across various institutions in to order to strengthen surgical antimicrobial prophylaxis practice and provide higher-quality surgical care.

Methods: This multicentric multinational retrospective study, includes 24 countries from five different regions (Asia Pacific, South Eastern Africa, Western Africa, Latin America, and Middle East).

Artificial Intelligence Assistance for the Measurement of Full Alignment Parameters in Whole-Spine Lateral Radiographs.

Background: Measuring spinal alignment with radiological parameters is essential in patients with spinal conditions likely to be treated surgically. These evaluations are not usually included in the radiological report. As a result, spinal surgeons commonly perform the measurement, which is time-consuming and subject to errors.

Navigating the Indeterminate Zone: Surgeons' Decision-Making Factors in Treating Vertebral Metastases with Spinal Instability Scores of 7-12.

Background: The Spinal Instability Neoplastic Score (SINS) classification system is a validated and the most widely accepted instrument for defining instability in vertebral metastasis (VM), in which lesions scoring between 7 and 12 are defined as indeterminate and the treatment is controversial. This study aimed to determine which variables more frequently are considered by spine surgeons for choosing between the conservative and the surgical treatment of VMs among patients with an indeterminate SINS.

Methods: A single-round online survey was conducted with 10 spine surgeons with expertise in the management of VMs from our AO Spine Region.

Assessing the Accessibility, Engagement, and Value of the Virtual Global Spine Conference as an Educational Platform for Spine: A Three-Year Review.

Introduction: The Coronavirus disease 2019 pandemic ushered a paradigm shift in medical education, accelerating the transition to virtual learning in select cases. The Virtual Global Spine Conference (VGSC), launched at the height of the pandemic, is a testament to this evolution, providing an independent educational series for spine care professionals worldwide. This study assesses VGSC's 3-year performance, focusing on accessibility, engagement, and educational value.

Treatment of unilateral cervical facet fractures without evidence of dislocation or subluxation: a narrative review and proposed treatment algorithm.

Isolated cervical spine facet fractures are often overlooked. The primary imaging modality for diagnosing these injuries is a computed tomography scan. Treatment of unilateral cervical facet fractures without evidence of dislocation or subluxation remains controversial.

Single-Position Prone Lateral Lumbar Interbody Fusion Technique Guide: Surgical Tips and Tricks.

Lateral lumbar interbody fusion (LLIF) is a popular technique as it allows for the placement of a large interbody implant through a retroperitoneal, transpsoas working corridor. Historically, the interbody is placed with the patient in lateral decubitus and then repositioned to prone for the posterior instrumentation. While this has been an effective and successful technique, removing the interoperative flip would improve the efficiency of these cases.

Lumbar Tubular Decompression: Barriers and Limitations Hampering the Technique's Dissemination Across Latin America.

Objectives: We sought to explore the barriers and limitations preventing the widespread use of tubular lumbar spine decompressions in Latin America.

Methods: A cross-sectional study was performed using a survey designed specifically by the authors. This survey was mailed to all spine surgeons who are members of AO Spine Latin America.

Technical Nuances of Anterior Column Construction for the Treatment of Osteomyelitis-Induced Cervical Kyphoscoliotic Deformity: An Operative Video Illustration.

Pyogenic vertebral osteomyelitis is a bacterial infection of the vertebral body often caused by hematogenous spread from a distant site with 3%-11% of cases affecting the cervical spine. Patients at risk for osteomyelitis are intravenous drug users, patients with diabetes, patients in dialysis, and males older than 50 years of age. In severe cases where infection causes osseous destruction of the vertebral column lending to a loss of normal sagittal and coronal plane alignment, neurologic impairment, or spinal instability, surgical correction may be required.

Minimally Invasive Approaches for Lumbosacral Plexus Schwannomas.

Background And Objectives: Lumbosacral plexus schwannomas (LSPSs) are benign, slow-growing tumors that arise from the myelin sheath of the lumbar or sacral plexus nerves. Surgery is the treatment of choice for symptomatic LSPSs. Conventional retroperitoneal or transabdominal approaches provide wide exposure of the lesion but are often associated with complications in the abdominal wall, lumbar or sacral plexus, ureter, and intraperitoneal organs.

Minimally Invasive Surgery for Traumatic Thoracolumbar Fractures: A Cross-Sectional Study of Spine Surgeons.

Objective: To describe the perceived feasibility of minimally invasive surgical treatment of thoracolumbar fractures among spine surgeons in Latin American centers.

Methods: This is a cross-sectional study on minimally invasive surgical treatment for unstable thoracolumbar fractures. We conducted an online survey of spine surgeons working in Latin American centers, administered between December 16, 2022 and January 15, 2023.

Pedicle subtraction metallectomy with complex posterior reconstruction for fixed cervicothoracic kyphosis: illustrative case.

Background: Iatrogenic cervical deformity is a devastating complication that can result from a well-intended operation but a poor understanding of the individual biomechanics of a patient's spine. Patient factors, such as bone fragility, high T1 slope, and undiagnosed myopathies often play a role in perpetuating a deformity despite an otherwise successful surgery. This imbalance can lead to significant morbidity and a decreased quality of life.

Intramedullary histoplasmosis of the thoracic cord as an isolated lesion: A rare case report and literature review.

Background: Disseminated histoplasmosis involving the central nervous system occurs in 5-10% of cases. However, intramedullary spinal cord lesions are extremely rare. Here, 45-year-old female with a T8-9 intramedullary lesion did well following surgical extirpation.

Time to surgery for adolescent idiopathic scoliosis: How long does it take? A multicenter study.

Study Design: Retrospective review of multicentric data.

Objectives: To estimate the time from initial visit to surgery in adolescent idiopathic scoliosis (AIS) patients and the main reasons for the time to surgery in a multicenter study.

Methods: This retrospective study evaluated 509 patients with AIS from 16 hospitals across six Latin American countries.

Single-Position Transpsoas Corpectomy and Posterior Instrumentation in the Thoracolumbar Spine for Different Clinical Scenarios.

Background: The concept of single-position spine surgery has been gaining momentum because it has proven to reduce operative time, blood loss, and hospital length of stay with similar or better outcomes than traditional dual-position surgery. The latest development in single-position spine surgery techniques combines either open or posterior pedicle screw fixation with transpsoas corpectomy while in the lateral or prone positioning.

Objective: To provide, through a multicenter study, the results of our first patients treated by single-position corpectomy.

Why are frailty indices not used systematically during preoperative spine consultations?

Introduction: Frailty indices are highly predictive of major medical and mechanical complications, lengths of hospital stay, and mortality rates after spine procedures. However, several barriers limit the extent to which spine surgeons employ these indices. The main purposes of the current study were to assess the use of frailty indices by Latin-American spine surgeons and identify the main barriers perceived to restrict their clinical application.