Abstract

Background

Clinical guidelines recommend epidural steroid injection (ESI) as a treatment option for severe disc-related sciatica, but there is considerable uncertainty about its effectiveness. Currently, we know very little about factors that might be associated with good or poor outcomes from ESI. The aim of this systematic review was to synthesize and appraise the evidence investigating prognostic factors associated with outcomes following ESI for patients with imaging confirmed disc-related sciatica.

Spinal metastases are seen in 10–30% of cancer patients. Twenty percent of these metastases occur in the lumbo-sacral spine. Lumbo-sacral spine has different mechanical properties and encloses the cauda equina. Few studies took interest in this spinal segment. The objective of this study is to evaluate prognostic factors of lumbo-sacral spinal metastasis treated in our center.

We retrospectively reviewed 376 patients who were operated in our center from 2010 to 2018. Eighty-nine patients presented lumbo-sacral metastases and thus were included. Data collected included age, smoking, tumor histology, American spinal injury association (ASIA) score, modified Tokuhashi score, modified Bauer score, ambulation status and adjuvant treatment.

The mean population age was 60.9 years old (35–85). The tumor histology was predominantly lung (19 patients, 21.3%), breast (13 patients, 14.6%), kidney (11 patients, 12.4%) and prostate (9 patients 10.1%). Twenty-two patients (24.7%) were unable to walk preoperatively. Seventy-nine patients (88.8%) underwent a posterior open approach with corpectomy in 65 patients (73%). Eighteen patients regained ambulation post-operatively (81.8%). The mean survival was 24.03 months (CI95% 17,38–30,67, Range 0–90) and the median of survival was 9 months (CI95% 4.38–13.62). Better preoperative ASIA score had a significant favorable effect (p=0.03) on survival. Patients who regained their ability to walk had better survival (25.1 months (CI95% 18.2–32) VS 0.5 months (CI95% 0–1.1). Postoperative radiotherapy had a benefic effect on survival (p=0.019): Survival Increased from 10.5 months (CI95% 2.4–18.7) to 27.6 months (CI95% 19.5–35.8). The modified Tokuhashi and the modified Bauer scores underestimated the survival of the patients with lumbosacral metastases.

Lumbosacral spinal metastases has better survival than expected by Tokuhashi and Bauer score. Surgical procedure have an important impact on survival and the ability to walk.

Aim

Debridement, antibiotic, and implant retention (DAIR) is an accepted treatment of early and late acute Total Knee Arthroplasty (TKA) infections. DAIR failure may adversely affect the outcome of a subsequent two-stage exchange arthroplasty. Controversy exists on risk factors that can affect DAIR's results.

The aim of the study is to review presurgical, intrasurgical and postsurgical variables that could affect DAIR's result.

Purpose of the study: To analyze survival and prognostic factors in a series of patients treated for chondrosarcoma of the pelvis.

Material and methods: The series included 106 patients (53 women and 53 men) treated for non-metastatic chondrosarcoma of the pelvis. Minimum follow-up was two years. Mean age at diagnosis was 44 years. Tumors were grade 1 (n=47), grade 2 (n=37), grade 3 (n=22). Conservative surgery was performed in 73 patients (resection with or without reconstruction) and interilio-abdominal disarticulation for 33.

Results: Resection margins were sufficient for 34 patients (wide or radical resection), marginal for 35, and intratumoral or malignant for 37. Local recurrence was noted in 39 patients (37%). Prognostic factors affecting local recurrence were: quality of resection (p=0.03), grade (p=0.01). Overall survival at 5, 10 and 15 years were 72, 56, and 46% respectively. Survival was strongly correlated with grade (p=0.08) and survival after five years was also correlated with resection margins.

Conclusions: In this series, tumor grade was the most important prognostic factor for patients with chondrosarcoma of the pelvis but achieving satisfactory resection with wide margins also has a significant effect on prognosis for local recurrence and long-term survival.

Purpose: The purpose of this work was to analyse survival and prognostic factors in a series of patients treated for pelvic chondrosarcoma.

Material and methods: This series included 67 patients (27 women and 40 men) treated between 1971 and 1996 for pelvic chondrosarcoma. Mean age at diagnosis was 45 years (range 18–78). Forty percent of the tumours were grade I. The most frequent localisation was the iliac bone. Conservative surgery was performed in 45 patients. The only surgical treatment possible in 22 patients was an inter-ilioabdominal disarticulation. Resection margins were adequate for only 19 patients (wide resection). Marginal resection was noted in 14 patients with intra-tumour resection in 17.

Results: Overall 5- and 8-year survival was 65% and 58% respectively. Local recurrence rate was 40%, occurring a mean 27 months after initial surgery. Statistical analysis did not reveal any correlation between tumour size, tumour grade, type of surgery, resection margin, and local recurrence. Results were nevertheless less favourable in case of inadequate surgical margins. Tumour grade, tumour size, patient age, gender, and quality of resection did not have a significant effect on overall survival. Local recurrence was the only negative factor predictive of survival (p< 0.05).

Discussion: Development of local recurrence appears to be the most important negative predictive factor in patients with pelvic chondrosarcoma. In this localisation, satisfactory resection margins are often difficult to achieve. Most authors propose inter-ilioabdominal disarticulation as a last resort procedure. The question of the indication for more aggressive initial surgery to obtain more radical resection margins remains open.

AIMS: Parosteal osteosarcoma is a surface osteogenic sarcoma less agressive than conventional osteosarcoma. Most cases begin to show symptoms in the third and fourth decades, and it affects females more often than males. The tumor affected long bones of the limbs, with evident predilection for the distal femur. The aim of this study is to analyze the prognosis of parosteal osteosarcoma, studying its evolution to know its better treatment.

Methods: This is a retrospective study of 25 patients with parosteal osteosarcoma. 23 cases have been treated at our institution from 1983 through June 2009, and 2 cases were treated in another center with a follow-up of at least 1 year. We studied the relation between different aspects of these patients: time of evolution, medullar canal invasion, size of tumor, dedifferentiated parosteal osteosarcoma or recurrence, images of RMI and kind of parosteal osteosarcoma, diagnoses with biopsy, relation between surgery and recurrences.

Results: We had 4 men and 21 women with a mean age of 30,48 years (13–56).6 cases were dedifferentiated parosteal osteosarcoma. We observed hyperintensity sign in 57,1% cases of dedifferentiated parosteal osteosarcoma. From 18 trephine biopsies, only 9 cases were diagnosed with parosteal osteosarcoma, 8 cases out of 8 incisional biopsies were also diagnosed as parosteal osteosarcoma. There were 5 local recurrences in the first year follow-up. All patients with marginal excision recurred. All patients were alive, free from disease and without metastatic lesions when the study finished. There was relation between the time of evolution of the tumor and the medular canal invasion and the dedifferentiation, but we not found any relation with the tumoral recurrence. The presence of dedifferentiation and the recurrence were more common in bigger tumours. 3 patients were treated with chemotherapy.

Conclusions: Parosteal osteosarcoma is a slow-growing tumor with a significantly better prognosis than the conventional osteosarcoma. The diagnosis of parosteal osteosarcoma requires an overall evaluation of the clinical, radiology and pathology findings. The initial study by RMI could help to guide our selective biopsy. First surgical procedure performed is a very important prognosis factor. Wide resection allows a better local control of the disease with fewer recurrences. Time of evolution and canal medullar invasion are more frequent in dedifferentiated parosteal osteosarcoma, but they not affect the rate of recurrence if the initial resection has been appropiate. In our opinion, postoperative chemotherapy should be given to patients with dedifferentiation and canal medular invasion in parosteal osteosarcoma.

Aim: To identify prognostic factors for patients with sarcomas.

Method: A retrospective analysis of all patients with newly diagnosed referred to a specialist musculoskeletal tumour centre, with a minimum 5 year follow up. Factors affecting survival and recurrence were identified.

Results: There were 1175 patients with soft tissue sarcomas and the most common diagnoses were liposarcoma (22%) followed by mfh (12%) and leiomyosarcoma (11%). 55% were high grade, 25% intermediate and 20% low grade. The most common site was the thigh (44%). 9% had metastases at diagnosis and of these only 10% survived 5 years. Prognostic factors were analyzed in the remaining 1075 patients. The 5 year disease specific survival was 87% for low grade, 66% for intermediate grade and 48% for high grade sarcomas. Prognostic factors (p< 0.05) on univariate analysis were grade, depth, size, age, sex, wide margins of excision, limb salvage (vs amputation), having had a previous excision (whoops). Many of these factors however were inter-related and on multivariate analysis it was found that the following were still significant: Grade, size, depth, age and buttock location (all p< 0.0005). There were 2320 bone tumours (954 with osteosarcoma, 454 with chondrosarcoma and 463 with Ewings). Prognostic factors for all tumours were size, good response to chemotherapy and limb salvage (as opposed to amputation)

Conclusion: This study has confirmed the generally held factors for prognosis of sarcomas. It is largely tumour factors, not treatment factors which dictate outcome. Of all the factors leading to a poor prognosis, size is the only one which can appreciably be altered – by earlier diagnosis.

Aim of the study

Aim of this study was to find out which factors influence the outcome after both column fractures of the acetabulum.

Synovial sarcoma is a morphologically well-defined neoplasm that most commonly occurs in soft tissue accounting for 5% to 10 % of all soft tissue sarcomas. We reviewed 156 patients with synovial sarcoma of soft tissues treated at a supra-regional centre to determine survival and prognostic factors.

There were 77men and 79 women with mean age at presentation of 38 years (3 to 84). Follow-up periods ranged from 3 to 494 months (median 43 months). Tumor was located in lower extremities in 111patients, upper extremities in 34 patients, and trunk and pelvis in 11 patients. Overall survival was 66% at 5 years and 48% at 10 years. The 5 and 10 year survival for the 23 patients who had metastases at the time of diagnosis was 13% and 0% respectively compared to 75% and 54% for those without metastases at diagnosis. Local recurrence occurred in 18 patients (13%). The significant prognostic factors for survival included presence of metastases at diagnosis and development of local recurrence. Tumour size and depth, age of patients and use of chemotherapy did not significantly influence survival.

We conclude that the clinical factors which influence survival of patients with synovial sarcoma are different from those of soft tissue sarcomas in general. Biological factors may better predict prognostic survival than the usual clinical factors.

Introduction

Dedifferentiated chondrosarcoma (D.C.) has a very poor prognosis. The efficacy of chemotherapy is still debated. Aim of this study was to evaluate the survival of patients with D.C. and to evaluate possible prognostic factors.

Background

There is a paucity of prognosis research in patients with neuropathic low back-related leg pain (LBLP) in primary care.

Background

It is common practice nowadays to treat patients with metastatic epidural spinal cord compression (MESCC) surgically. Extend and type of surgery should be in proper relation to the expected survival time of the patient. It is still difficult to predict patient's survival time and different scoring systems are used. Reliable prediction of survival is mandatory, in that way adjustable surgical treatment can be established.

Introduction

Subchondral insufficiency fracture of the femoral head (SIF) often occurs in osteoporotic elderly patients. Patients usually suffer from acute hip pain without any obvious antecedent trauma. Radiologically, a subchondral fracture is seen mainly in the superolateral portion of the femoral head. The T1-weighted magnetic resonance (MR) images show a low-intensity band in the subchondral area of the femoral head, which tends to be irregular, disconnected, and convex to the articular surface. This low-intensity band in SIF was histologically proven to correspond to the fracture line with associated repair tissue. Some cases of SIF resolve after conservative treatment, while others progress until collapse, thereby requiring surgical treatment. The prognosis of SIF remains unclear. This study investigated the risk factors that influence the prognosis of SIF based on the progression of the collapse.

Chondrosarcoma is a malignant tumour and accounts for approximately 20% of bone sarcomas. The pelvis is one of the commonest sites. Chondrosarcoma of the pelvis lends itself to surgical excision and is relatively resistant to irradiation and chemotherapy. A long term survival analysis of this challenging condition is rarely reported in literature. We review and evaluate the oncological and functional results of all the patients operated at our centre and we analyse the survival analysis of these patients with special focus on the prognostic factors.

Fifty-four consecutive patients with chondrosarcoma of the pelvis who were treated at the Royal National Orthopaedic Hospital, Stanmore, UK between 1987 and 2001 were included in the study. Demographic data, case notes, histopathological results and follow-up data were obtained and statistically analysed.

There were 38 males and 16 females with a mean age of 48.4 years [18-77]. The chondrosarcomas were primary [n=38], secondary [n-7] or recurrences [n=9]. The anatomical sites in the pelvis were in the epicentre I [n=24], II [n=20] and III [n=10]. The surgical procedures performed were local resection [n=28], local resection and hip arthroplasty [n=6], hemipelvectomy (+endoprothesis) [n=16], hemipelvectomy [+fibular strut graf] [n=2] and hinquarter amputation [n=2]. The histological grade was Gr [n=27], Gr 2[n=20] and Gr 3 [n=7]. The complication rate was 24%:wound revision [9%], dislocation [8%] and infection [7%]. There was a 5, 10 and 15 year cumulative survival rate of 74%, 65% and 40%. The overall recurrence rate was 24%.

The factors associated with a worse prognosis were high histologic tumour grade, increasing patient age, anatomical location in site I and III, primary surgery outside of tumour centre, inadequate surgical margins, and those treated by local extension. Aggressive surgical approach significantly improves the prognosis of the patients with chondrosarcoma of the pelvis.

Aim

The optimal treatment of streptococcal prosthetic joint infections (PJIs) is unclear. Poorer outcome has been associated with Streptococcus agalactiae species, comorbidities and polyethylene exchange for conservative approach. Rifampicin use may be associated with higher remission rate but results are sparse.

Background: It is common practice nowadays to treat patients with metastatic epidural spinal cord compression (MESCC) surgically. Extend and type of surgery should be in proper relation to the expected survival time of the patient. It is still difficult to predict patient’s survival time and several scoring systems are evaluated in literature.

Purpose: To evaluate potential prognostic factors for survival after surgery of metastatic spinal cord compression

Material and Methods: In this retrospective study we included all patients who underwent surgery for MESCC in two hospitals in the Netherlands between 2001 and 2007 (n = 56). Medical records were studied for the origin of the primary tumor, the sex, the location of MESCC, the presence of other bone or visceral metastases, the Karnofsky score and the ASA score. Survival data were obtained by computing the time difference between the date of surgery and death. Patients were divided in three groups for the localization of the primary tumor; fast (n=21), moderate (n=19) and slow (n=13) growing tumors. The group of fast growing tumors contains lung cancer, moderate contains renal cancer and slow growing contains breast cancer. Furthermore, groups were made for the location of MESCC and groups were made for the Karnofsky score. Survival times were compared with log-rank tests or cox regression.

Results: The overall median survival after surgery was 7,8 months, with a minimal follow-up time of nineteen months. The difference in survival time between the groups of primary tumors was highly significant (p < 0,001). Patients with fast growing tumors had a much shorter survival time (median 3,5 months) than patients with slow growing tumors (median 60 months), and moderate growing tumors (median 15 months). Patients with visceral metastases had a significant shorter survival time, compared to patients without visceral metastases (p = 0,01). The presence of other bone metastases however, was of no influence, as was the location of MESCC. Patients with a baseline Karnofsky score of 80% or higher had a significant longer survival time than patients with a score of 70% or lower (p=0,022). Sex and ASA score are not significantly associated with survival time.

Conclusion: The type of the primary tumor seems to be strongly associated with survival time. Besides the type of the primary tumor, the presence of visceral metastases and Karnofksy score are predictors for the survival time after surgery as well. Reliable prediction of survival is mandatory, in that way adjustable surgical treatment can be established.

Introduction:

To date, there have been few reports of the results of revisions for failed metal-on-metal hip arthroplasties (MoM HA's). These series have included relatively modest numbers, and classification of the severity of adverse local tissue reaction (ALTR) has been under-reported. In this study, early outcomes and complications are analyzed as a function of pre-operative MRI grade and intra-operative ALTR severity to determine their prognostic value.

Introduction We have undertaken a retrospective study to identify prognostic factors predictive of neurological recovery after spinal cord injury (SCI).

Methods During the year 1999 to 2000, 403 patients with SCI were admitted and 91 patients could be followed-up for more than one year. Improvement in the motor score (ASIA) were taken as indicative of functional neurological recovery. Prognostic factors were simplified into static (which do not change with time) and dynamic (which may change with time). Variables like age, sex, mode of injury, mechanism of injury and skeletal level were static. Neurological level, sacral sparing, duration of spinal shock, reflex recovery, sensory & motor scores and complications like bedsores, flexor spasms, UTI, URTI, & DVT were dynamic. These were recorded at admission, at weekly intervals until discharge and at three monthly intervals in follow-up. They were correlated for any association with neurological recovery at one year. Regressive analysis of static and dynamic factors was done.

Results No significant correlation of static variables with the neurological recovery was found. First aid and transportation, duration of spinal shock, sacral sparing, rate of reflex recovery, flexor spasms and bedsores had a significant correlation with neurological recovery. Pin-prick sparing, spinal shock of < 24 hours and early appearance of deep tendon reflexes were good prognostic factors. Complete lesion, spinal shock for > 1 week, flexor spasms within three weeks and bedsore within one week were worst prognostic factor. Initial three weeks following injury was the critical period influencing final neurological and functional outcome.

Introduction and purpose: Osteoporotic hip fractures are a major cause of hospital morbidity and mortality in geriatric patients. Our purpose was to study hospital mortality due to osteoporotic hip fractures in persons over 50 in our hospital and evaluate the prognostic factors for mortality.

Materials and methods: We carried out a prospective evaluation of all patients with osteoporotic hip fractures admitted to our hospital between March and September 2004. We emphasised the possible predictive factors for hospital mortality, such as individual background, clinical situation, cognitive aspects, functional and social situation, treatment used and complications. We excluded patients with high-energy or pathological fractures and those who did not want to sign the informed consent form for inclusion in the study. The data were analysed with SPSS statistical software v11.0.

Results: In the six-month period mentioned above, 357 patients were admitted for osteoporotic hip fracture. The female/male ratio was 2.9:1. 37.6% were over 85 and 28.1% had been institutionalised prior to admission. 27 patients died while in hospital (7.6%), with a similar distribution between preoperative and postoperative mortality. The most common causes of death were related to decompensation of the patient’s baseline pathology, mainly of cardiorespiratory origin. Multivariate analysis showed significant prognostic factors independent of hospital mortality (p< 0.05): male sex (RR=4.3), age over 80 (RR=2.9), prior institutionalisation in a care home, the presence of confusional syndrome, low haemoglobin on admission and anaesthetic risk above III.

Conclusions: Hospital mortality was found to be high in cases of hip fracture. This was similar to previous studies carried out in our hospital and others. The prognostic factors for mortality were, above all, those that could not be changed (age, sex, anaesthetic risk, institutionalisation). Patients over 85, men, those coming from a care home and those with high anaesthetic risk have a greater risk of dying while in hospital. We should also be attentive to haemoglobin on admission and the presence of acute confusional syndrome.