Browsing by Author "Hem, Santiago"
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Publication Conventional Radiotherapy Timing and Wound Complication Avoidance After Surgery for Metastatic Spine Disease. A LatAm Modified Delphi Study(2025) Landriel, Federico; White, Kevin; Padilla Lichtenberger, Fernando; Guiroy, Alfredo; Teles, Alisson; Laos Plasier, Eduardo; Buzetti Milano, Jerônimo; Risso, Marcelo; Astur, Nelson; González, Oscar; Yurac, Ratko; Páez, Rodolfo; Teixeira, William; Toscano, Maximiliano; Hem, SantiagoBackground 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. Methods A modified Delphi survey was conducted. The expert panel included active members of AOSpine Latin America with extensive experience in vertebral metastasis surgery. The surveys include 37 statements covering areas of interest. Inter-expert consensus was considered weak (70-79.9%), moderate (80-89.9%), and strong (≥90%). Results At least 70% consensus was reached on 32 of the 37 statements (86.5%). This included strong consensus on 10 statements, moderate on 13, and weaker on nine. There was high consensus on sutures and lower consensus on risk factors for cEBRT delay. Experts reached strong agreement on the importance of poor nutrition as a risk factor for cEBRT-related wound complications. Perception of wound risk was greater with a posterior midline approach compared to other approaches, and the highest perceived complication risks were for junctional locations and sacral spine. Conclusions We report strong agreements among the experts on important issues such as waiting times and risk factors for cEBRT. The findings underscore the significance of considering factors such as, spinal levels, surgical approaches, and sutures when making clinical decisions.Publication How to Avoid and Handle Problems in the Placement of Cement-Augmented Fenestrated Percutaneous Pedicle Screws?(2024) Padilla, Fernando; Landriel, Federico; Guiroy, Alfredo; Casimiro, Miguel; Silva, Alvaro; Hem, SantiagoBACKGROUND AND OBJECTIVES: Pedicle screws with a central cannula and fenestrations allow cement augmentation, providing lower risk for screw loosening and pullout, especially in these patients with poor bone quality. This study aims to offer suggestions for resolving issues and reducing complications associated with the use of cement-augmented fenestrated pedicle screws. METHODS: A retrospective study was conducted across multiple centers on patients who received fenestrated pedicle screws with cement augmentation (CAFPS). Using 2-dimensional fluoroscopy guidance, we placed over 800 screws in 137 patients. Based on our analysis of common challenges and complications, 10 tips were compiled, that we believe are crucial for successfully implementing this technique, regardless of the brand or instrument used. RESULTS: The 10 tips included the following: (1) Indications of cement-augmented fenestrated pedicle screws; (2) use the K-wire blunt end in osteoporotic vertebrae; (3) know the longitude and diameter of the screw, by the measurement of the vertebrae to treat; (4) do not go bicortical; (5) clean the way of the screws fenestrae with saline; (6) protecting screw extensors with gauze; (7) measuring time and volume; (8) gently and smoothly introduce the cement; (9) do not panic. The presence of cement in the posterosuperior area adjacent to the pedicle does not necessarily indicate a leakage into the canal; and (10) fenestrated screw removal. CONCLUSION: The implementation of these tips could enhance technique performance and minimize complications in cement-augmented fenestrated pedicle screw placement.Item Low Implant Failure Rate of Percutaneous Fixation for Spinal Metastases: A Multicenter Retrospective Study(2021) Silva, Álvaro; Yurac, Ratko; Guiroy, Alfredo; Bravo, Oscar; Morales, Alejandro; Landriel, Federico; Hem, SantiagoOBJECTIVE: To evaluate incidence and types of implant failure observed in a series of patients with spinal metastases (SM) treated with minimally invasive stabilizationsurgery without fusion. METHODS: In this multicenter, retrospective, observational study, we reviewed the files of patients >18 years old who underwent surgery for SM using percutaneous spinal stabilization without fusion with a minimum 3-month followup. The following variables were included: demographics,clinical findings, prior radiation history, SM location, epidural spinal cord compression scale, Spinal Instability Neoplastic Scale, neurological examination, and surgeryrelated data. Primary outcome measure was implant failure rate, as observed in patients’ last computed tomography scan. Multivariable analysis was performed to identify baseline factors and factors associated with implant failure. RESULTS: Analysis included 72 patients. Mean age of patients was 62 years, 39 patients were men, and 75% of patients had an intermediate Spinal Instability Neoplastic Scale score. Tumor separation surgery was performed in 48.6% of patients. Short instrumentation was indicated in 54.2% of patients. Three patients (4.2%) experienced implant failure (2 screw loosening, 1 screw cut-out); none of them required revision surgery. In 73.6% of cases, survival was >6 months. No significant predictors of failure were identified in the multivariate analysis. CONCLUSIONS: A low implant failure rate was observed over the short and medium term, even when short instrumentations without fusion were performed. These findings suggest that minimally invasive stabilization surgery without fusion may be an effective and safe way to treat complicated SM.