Browsing by Author "Yurac, Ratko"
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Item Accuracy and reliability of the AO Spine subaxial cervical spine classifcation system grading subaxial cervical facet injury morphology(2021) Cabrera, Juan; Yurac, Ratko; Guiroy, Alfredo; Joaquim, Andrei; Carazzo, Charles; Zamorano, Juan; White, Kevin; Valacco, Marcelo; The AO Spine Latin America Trauma Study GroupPurpose: A classification system was recently developed by the international association AO Spine for assessing subaxial cervical spine fractures. Significant variability exists between users of the facet component, which consists of four morphological types (F1-F4). The primary aims of this study were to assess the diagnostic accuracy and reliability of this new system's facet injury morphological classifications. Methods: A survey consisting of 16 computed tomography (CT) scans of patients with cervical facet fractures was distributed to spine surgeon members of AO Spine Latin America. To provide a gold standard diagnosis for comparison, all 16 injuries had been classified previously by six co-authors and only were included after total consensus was achieved. Demographic and surgical practice characteristics of all respondents were analyzed, and diagnostic accuracy calculated. Inter- and intra-observer agreement rates were calculated across two survey rounds, conducted one month apart. Results: A total of 135 surgeons completed both surveys, among whom the mean age was 41.6 years (range 26-71), 130 (96.3%) were men, and 83 (61.5%) were orthopedic surgeons. The mean time in practice as a spine surgeon was 9.7 years (1-30). The overall diagnostic accuracy of all responses was 65.4%. Inter-observer and intra-observer agreement rates for F1/F2/F3/F4 were 55.4%/47.6%/64.0%/94.7% and 60.0%/49.1%/58.0%/93.0%, respectively. Conclusion: This study evaluates the AO Spine Classification System specifically for facet injuries involving the subaxial cervical spine in a large sample of spine surgeons. There was significant variability in diagnostic accuracy for F1 through F3-type fractures, whereas almost universal agreement was achieved for F4-type injuries.Publication An analytical review of contributory factors in intervertebral disc degeneration(2022) Kumar, Vishal; Neradi, Deepak; Maheshwari, Shivam; Quinteros, Guisela; Yurac, RatkoObjective: To summarize current trends in the pathogenesis and management of disc degeneration and suggest areas where more researchwould be of benefit. Methods: The available literature relevant to Lumbar disc degeneration (LDD) was reviewed. PubMed, MEDLINE, OVID, EMBASE, Cochrane, and Google Scholar databases were used to review the literature. Institutional Review Board approval was not applicable for this study. Results: This article summarizes trends in the pathogenesis and factors associated with disc degeneration. Conclusions: The genetic contribution to lumbar disc degeneration is a newer concept, still being researched in different populations around the world. Investigators have demonstrated a familial predisposition in the etiology of lumbar disc degeneration. The effect sizes of most genetic variants are small and, thus, individual gene-environment studies must have very large sample sizes to provide compelling evidence of any interactionPublication An independent inter- and intra-observer agreement assessment of the AOSpine upper cervical injury classification system(2022) Urrutia, Julio; Delgado, Byron; Camino, Gaston; Guiroy, Alfredo; Astur, Nelson; Valacco, Marcelo; Zamorano, Juan; Vidal, Catalina; Yurac, RatkoBackground context: The complex anatomy of the upper cervical spine resulted in numerous separate classification systems of upper cervical spine trauma. The AOSpine upper cervical classification system (UCCS) was recently described; however, an independent agreement assessment has not been performed. Purpose: To perform an independent evaluation of the AOSpine UCCS. Study design: Agreement study. Patient sample: Eighty four patients with upper cervical spine injuries. Outcome measures: Inter-observer agreement; intra-observer agreement. Methods: Complete imaging studies of 84 patients with upper cervical spine injuries, including all morphological types of injuries defined by the AOSpine UCCS were selected and classified by six evaluators (from three different countries). The 84 cases were presented to the same raters randomly after a 4-week interval for repeat evaluation. The Kappa coefficient (κ) was used to determine inter- and intra-observer agreement. Results: The interobserver agreement was almost perfect when considering the fracture site (I, II or III), with κ=0.82 (0.78-0.83), but the agreement according to the site and type level was moderate, κ=0.57 (0.55-0.65). The intra-observer agreement was almost perfect considering the injury, with κ=0.83 (0.78-0.86), while according to site and type was substantial, κ=0.69 (0.67-0.71). Conclusions: We observed only a moderate inter-observer agreement using this classification. We believe our results can be explained because this classification attempted to organize many different injury types into a single scheme.Item An independent inter- and intraobserver agreement assessment of the AOSpine sacral fracture classification system(2021) Urrutia, Julio; Meissner-Haecker, Arturo; Astur, Nestor; Valencia, Manuel; Yurac, Ratko; Camino-Willhuber, Gaston; Valacco, MarceloBACKGROUND CONTEXT: The AOSpine sacral classification scheme was recently described. It demonstrated substantial interobserver and excellent intraobserver agreement in the study describing it; however, an independent assessment has not been performed. PURPOSE: To perform an independent inter- and intraobserver agreement evaluation of the AOSpine sacral fracture classification system. STUDY DESIGN: Agreement study. METHODS: Complete computerized tomography (CT) scans, including axial images, with coronal and sagittal reconstructions of 80 patients with sacral fractures were selected and classified using the morphologic grading of the AOSpine sacral classification system by six evaluators (from three different countries). Neurological modifiers and case-specific modifiers were not assessed. After a four-week interval, the 80 cases were presented to the same raters in a random sequence for repeat assessment. We used the Kappa coefficient (k) to establish the inter- and intraobserver agreement. RESULTS: The interobserver agreement was substantial when considering the fracture severity types (A, B, or C), with k=0.68 (0.63−0.72), but moderate when considering the subtypes: k=0.52 (0.49−0.54). The intraobserver agreement was substantial considering the fracture types, with k=0.69 (0.63−0.75), and considering subtypes, k=0.61(0.56−0.67). CONCLUSION: The sacral classification system allows adequate interobserver agreement at the type level, but only moderate at the subtypes level. Future prospective studies should evaluate whether this classification system allows surgeons to decide the best treatment and to establish prognosis in patients with sacral fractures.Item An independent inter- and intraobserver agreement evaluation of the AOSpine subaxial cervical spine injury classification system(Lippincott Williams & Wilkins, 2017) Urrutia, Julio; Zamora, Tomas; Yurac, Ratko; Campos, Mauricio; Palma, Joaquin; Mobarec, Sebastian; Prada, CarlosSTUDY DESIGN: An agreement study. OBJECTIVE: The aim of this study was to perform an independent interobserver and intraobserver agreement assessment of the AOSpine subaxial cervical spine injury classification system. SUMMARY OF BACKGROUND DATA: The AOSpine subaxial cervical spine injury classification system was recently described. It showed substantial inter- and intraobserver agreement in the study describing it; however, an independent evaluation has not been performed. METHODS: Anteroposterior and lateral radiographs, computed tomography scans, and magnetic resonance imaging of 65 patients with acute traumatic subaxial cervical spine injuries were selected and classified using the morphologic grading of the subaxial cervical spine injury classification system by 6 evaluators (3 spine surgeons and 3 orthopedic surgery residents). After a 6-week interval, the 65 cases were presented to the same evaluators in a random sequence for repeat evaluation. The kappa coefficient (κ) was used to determine the inter- and intraobserver agreement. RESULTS: The interobserver agreement was substantial when considering the fracture main types (A, B, C, or F), with κ = 0.61 (0.57-0.64), but moderate when considering the subtypes: κ = 0.57 (0.54-0.60). The intraobserver agreement was substantial considering the fracture types, with κ = 0.68 (0.62-0.74) and considering subtypes, κ = 0.62 (0.57-0.66). No significant differences were observed between spine surgeons and orthopedic residents in the overall inter- and intraobserver agreement, or in the inter- and intraobserver agreement of specific A, B, C, or F type of injuries. CONCLUSION: This classification allows adequate agreement among different observers and by the same observer on separate occasions. Future prospective studies should determine whether this classification allows surgeons to decide the best treatment for patients with subaxial cervical spine injuries. LEVEL OF EVIDENCE: 3.Publication AO Spine-DGOU Osteoporotic Fracture Classification System: Internal Validation by the AO Spine Knowledge Forum Trauma(2024) Scherer, Julian; Joaquim, Andrei; Vaccaro, Alex; Kanna, Rishi; El-Sharkawi, Mohammad; Takahata, Masahiko; Aly, Mohamed; Camino, Gaston; Spiegl, Ulrich; Oner, Cumhur; Canseco, Jose; Yurac, Ratko; Benneker, Lorin; Popescu, Eugen; Bransford, Richard; Chhabra, Harvinder; Kandziora, Frank; Neva, Marko; Schnake, KlausStudy design: Cross-sectional survey. Objectives: Injury classifications are important tools to identify fracture patterns, guide treatment-decisions and aid to identify optimal treatment plans. The AO Spine-DGOU Osteoporotic Fracture (OF) classification system was developed, and the aim of this study was to assess the reliability of this new classification system. Methods: 23 Members of the AO Spine Knowledge Forum Trauma participated in the validation process. Participants were asked to rate 33 cases according to the OF classification at 2 time points, 4 weeks apart (assessment 1 and 2). The kappa statistic (κ) was calculated to assess inter-observer reliability and intra-rater reproducibility. The gold master key for each case was determined by approval of at least 5 out of 7 members of the DGOU. Results: A total of 1386 ratings (21 raters) were performed. The overall inter-rater agreement was moderate with a combined kappa statistic for the OF classification of 0.496 in assessment 1 and 0.482 in assessment 2. The combined percentage of correct ratings (compared to gold-standard) in assessment 1 was 71.4% and 67.4% in assessment 2. The average intra-rater reproducibility was substantial (κ = 0.74, median 0.76, range 0.55 to 1.00, SD 0.13) for the assessed fracture types. Conclusions: The assessed overall inter-rater reliability was moderate and substantial in some instances. The average intra-rater reproducibility is substantial. It seems that appropriate training of the classification system can enhance inter- and intra-rater reliability.Publication [Artículo traducido] Lesiones vertebrales por proyectil de arma de fuego: estudio de cohorte retrospectivo, multicéntrico(2024) Ricciardi, Guillermo; Cabrera, Juan; Martinez, Oscar; Matta, Javier; Jimenez, Jose; Vilchis, Hugo; Tejerina, Veronica; Yurac, RatkoIntroducción y objetivo: Describir las características clínico-demográficas y el tratamiento de pacientes con heridas vertebrales por proyectil de arma de fuego en una cohorte retrospectiva de centros de Iberoamérica. Materiales y métodos: Estudio de cohorte, multicéntrico, retrospectivo de pacientes tratados por lesiones vertebrales por proyectil de arma de fuego en 12 instituciones entre enero de 2015 y enero de 2022. Se registraron datos demográficos y clínicos, incluidos tiempo de la lesión, evaluación inicial, variables balísticas y tratamiento. Resultados: Se analizó a 423 pacientes con lesiones vertebrales por arma de fuego de instituciones en México (82%), Argentina, Brasil, Colombia y Venezuela. Predominaban los varones, civiles, con profesiones con bajo riesgo de violencia y estatus social medio/bajo. La mayoría, por disparos de armas de fuego de baja energía. Lesiones frecuentemente torácicas y lumbares. Lesión neurológica en 320 (76%) pacientes, con lesión medular en 269 (63%). El tratamiento solía ser conservador, con solo 90 (21%) casos quirúrgicos. Las características que distinguieron los casos quirúrgicos de los no quirúrgicos fueron el compromiso neurológico (p = 0,004), compromiso del canal (p < 0,001), heridas sucias (p < 0,001), restos de fragmentos de bala o hueso en el canal espinal (p < 0,001) y el patrón de la lesión (p < 0,001). Las variables mencionadas se mantuvieron estadísticamente significativas, luego del análisis multivariado, excepto el compromiso neurológico. Conclusiones: En este estudio multicéntrico de víctimas de lesiones vertebrales por proyectil de arma de fuego, la mayoría recibió tratamiento no quirúrgico, a pesar de la lesión neurológica en el 76% y la lesión en la columna en el 63% de los pacientes. Introduction and objective: To describe the demographic and clinical characteristics and treatment of patients with spinal gunshot wounds across Latin America. Material and methods: Retrospective, multicenter cohort study of patients treated for gunshot wounds to the spine spanning 12 institutions across Latin America between January 2015 and January 2022. Demographic and clinical data were recorded, including the time of injury, initial assessment, characteristics of the vertebral gunshot injury, and treatment. Results: Data on 423 patients with spinal gunshot injuries were extracted from institutions in Mexico (82%), Argentina, Brazil, Colombia, and Venezuela. Patients were predominantly male civilians in low-risk-of-violence professions, and of lower/middle social status, and a sizeable majority of gunshots were from low-energy firearms. Vertebral injuries mainly affected the thoracic and lumbar spine. Neurological injury was documented in 320 (76%) patients, with spinal cord injuries in 269 (63%). Treatment was largely conservative, with just 90 (21%) patients treated surgically, principally using posterior open midline approach to the spine (79; 87%). Injury features distinguishing surgical from non-surgical cases were neurological compromise (P = 0.004), canal compromise (P < 0.001), dirty wounds (P < 0.001), bullet or bone fragment remains in the spinal canal (P < 0.001) and injury pattern (P < 0.001). After a multivariate analysis through a binary logistic regression model, the aforementioned variables remained statistically significant except neurological compromise. Conclusions: In this multicenter study of spinal gunshot victims, most were treated nonsurgically, despite neurological injury in 76% and spinal injury in 63% of patientsPublication CT Scan in Subaxial Cervical Facet Injury: Is It Enough for Decision-Making?(2023) Cabrera, Juan P.; Yurac, Ratko; Joaquim, Andrei F.; Guiroy, Alfredo; Carazzo, Charles A.; Zamorano, Juan Jose; Valacco, Marcelo; AO Spine Latin America Trauma Study GroupStudy Design: Cross-sectional survey. Objectives: Assessment of subaxial cervical facet injuries using the AO Spine Subaxial Cervical Spine Injury Classification System is based on CT scan findings. However, additional radiological evaluations are not directly considered. The aim of this study is to determine situations in which spine surgeons request additional radiological exams after a facet fracture. Methods: A survey was sent to AO Spine members from Latin America. The evaluation considered demographic variables, routine use of the Classification, as well as the timepoint at which surgeons requested a cervical MRI, a vascular study, and/ or dynamic radiographs before treatment of facet fractures. Results: There was 229 participants, mean age 42.9 ± 10.2 years; 93.4% were men. Orthopedic surgeons 57.6% with 10.7 ± 8.7 years of experience in spine surgery. A total of 86% used the Classification in daily practice. An additional study (MRI/vascular study/and dynamic radiographs) was requested in 53.3%/9.6%/43.7% in F1 facet injuries; 76.0%/20.1%/50.2% in F2; 89.1%/65.1%/28.4% in F3; and 94.8%/66.4%/16.6% in F4. An additional study was frequently required: F1 72.5%, F2 86.9%, F3 94.7%, and F4 96.1%. Conclusions: Spine surgeons generally requested additional radiological evaluations in facet injuries, and MRI was the most common. Dynamic radiographs had a higher prevalence for F1/F2 fractures; vascular studies were more common for F3/F4 especially among surgeons with fewer years of experience. Private hospitals had a lower spine trauma cases/year and requested more MRI and more dynamic radiographs in F1/F2. Neurosurgeons had more vascular studies and dynamic radiographs than orthopedic surgeons in all facet fractures.Item CT Scan in Subaxial Cervical Facet Injury: Is It Enough for Decision-Making?(2021) Cabrera, Juan; Yurac, Ratko; Joaquim, Andrei; Guiroy, Alfredo; Carazzo, Charles; Zamorano, Juan; Valacco, Marcelo; And the AO Spine Latin America Trauma Study GroupObjectives: Assessment of subaxial cervical facet injuries using the AO Spine Subaxial Cervical Spine Injury Classification System is based on CT scan findings. However, additional radiological evaluations are not directly considered. The aim of this study is to determine situations in which spine surgeons request additional radiological exams after a facet fracture. Methods: A survey was sent to AO Spine members from Latin America. The evaluation considered demographic variables, routine use of the Classification, as well as the timepoint at which surgeons requested a cervical MRI, a vascular study, and/ or dynamic radiographs before treatment of facet fractures. Results: There was 229 participants, mean age 42.9 ± 10.2 years; 93.4% were men. Orthopedic surgeons 57.6% with 10.7 ± 8.7 years of experience in spine surgery. A total of 86% used the Classification in daily practice. An additional study (MRI/vascular study/and dynamic radiographs) was requested in 53.3%/9.6%/43.7% in F1 facet injuries; 76.0%/20.1%/50.2% in F2; 89.1%/65.1%/28.4% in F3; and 94.8%/66.4%/16.6% in F4. An additional study was frequently required: F1 72.5%, F2 86.9%, F3 94.7%, and F4 96.1%. Conclusions: Spine surgeons generally requested additional radiological evaluations in facet injuries, and MRI was the most common. Dynamic radiographs had a higher prevalence for F1/F2 fractures; vascular studies were more common for F3/F4 especially among surgeons with fewer years of experience. Private hospitals had a lower spine trauma cases/year and requested more MRI and more dynamic radiographs in F1/F2. Neurosurgeons had more vascular studies and dynamic radiographs than orthopedic surgeons in all facet fractures.Publication Espondilodiscitis por Haemophilus parainfluenzae: Un reporte de caso(2022) Yurac, Ratko; Santorcuato, Macarena; Quinteros, Guisela; Zamorano, Juan; Marré, BartoloméIntroduction Haemophilus parainfluenzae (HP) is a gram-negative coccobacillus andan opportunistic pathogen. It is rarely associated with spinal- and musculoskeletal-site infections, and very little reported in the literature. Case Presentation An otherwise healthy, 45-year-old woman who presented with a two-week history of progressive low back pain, fever, coryza and nasal congestion, was found to have intervertebral discitis caused by HP, confirmed by two positive blood cultures and progressive lumbar spine magnetic resonance imaging (MRI) findings. The MRI findings were atypical, consisting of a psoas abscess and small anterior epidural and intraspinal fluid collections associated with spondylodiscitis. The initial diagnosis was delayed because the initial MRI failed to reveal findings suggestive of an infectious process. The treatment consisted of a long course of intravenous followed by oral antibiotics, ultimately yielding a good clinical response. Discussion and Conclusion Haemophilus parainfluenzae is a very rare pathogen inspondylodiscitis. Nonetheless, it should be considered, especially in patients presenting with low back pain and fever and/or gram negative bacteremia. Theinitial work-up should include contrast-enhanced MRI of the spine. Although rare, spondylodiscitis and a psoas abscess can present concomitantly. Prolonged antibiotics are the mainstay of treatment.Publication Granuloma eosinofílico cervical en el adolescente: Reporte de un caso y revisión de la literatura(2022) Yurac, Ratko; Zamorano, Juan; Calvo, Rafael; Castoldi, María; De la Barra, Camila; Quinteros, Guisela; Novoa, FelipeIntroducción El granuloma eosinofílico (GE) es una patología infrecuente, sobre todo en adultos, que puede afectar la columna cervical. A pesar de la vasta literatura, esta enfermedad afecta principalmente a la población infantil, y no hay un consenso sobre el manejo en adultos. Con el objetivo de aportar conocimiento respecto a esta patología poco frecuente, se presenta un caso clínico de GE cervical en un paciente de 16 años, a quien se trató de manera conservadora, con buenos resultados y retorno completo a sus actividades. Caso Clínico Un hombre de 16 años, seleccionado de rugby, consultó por dolor cervical axial persistente y nocturno de 6 semanas de evolución, sin trauma evidente. Al examen, destacó dolor a la compresión axial sin compromiso neurológico asociado. Los exámenes de tomografía computarizada (TC) y resonancia magnética (RM) revelaron lesión lítica en el cuerpo de C3 de características agresivas, de presentación monostótica en tomografía por emisión de positrones-tomografía computada (TEPTC) compatible con tumor primario vertebral. Se decidió realizar biopsia percutánea bajo TC, para definir el diagnóstico y manejo adecuado, la cual fue compatible con células de Langerhans. Al no presentar clínica ni imagenología de inestabilidad ósea evidente o compromiso neurológico, se manejó con tratamiento conservador, inmovilización cervical, analgesia oral, y seguimiento estrecho. A los cuatro meses de evolución, se presentó con una TC con cambios reparativos del cuerpo vertebral y sin dolor, y logró retomar sus actividades habituales. Conclusiones El diagnóstico de GE es infrecuente a esta edad, y se debe plantear entre diagnósticos diferenciales de lesiones líticas agresivas primarias vertebrales. Es necesario el uso de imágenes, y la biopsia vertebral es fundamental para confirmar el diagnóstico. Su manejo va a depender de la sintomatología, del compromiso de estructuras vecinas, y de la estabilidad de la vértebra afectada. El manejo conservador con seguimiento clínico e imagenológico es una opción viable.Publication Inter- and intra-observer agreement using the new AOSpine sacral fracture classification, with a comparison between spine and pelvic trauma surgeons(2021) Meissner, Arturo; Diaz, Claudio; Klaber, Ianiv; Zamora, Tomas; Valencia, Manuel; Camino, Gaston; Astu, Nelson; Yurac, Ratko; Valacco, Marcelo; Urrutia, JulioBackground: Sacral fractures treatment frequently involves both spine and pelvic trauma surgeons; therefore, a consistent communication among surgical specialists is required. We independently assessed the new AOSpine sacral fracture classification's agreement from the perspective of spine and pelvic trauma surgeons. Methods: Complete computerized tomography (CT) scans of 80 patients with sacral fractures were selected and classified using the new AOSpine sacral classification system by six spine surgeons and three pelvic trauma surgeons. After four weeks, the 80 cases were presented and reassessed by the same raters in a new random sequence. The Kappa coefficient (κ) was used to measure the inter-and intra-observer agreement. Results: The inter-observer agreement considering the fracture severity types (A, B, or C) was substantial for spine surgeons (κ= 0.68 [0.63 - 0.72]) and pelvic trauma surgeons (κ= 0.74 (0.64 - 0.84). Regarding the subtypes, both groups achieved moderate agreement with κ= 0.52 (0.49 - 0.54) for spine surgeons and κ= 0.51 (0.45 - 0.57) for pelvic trauma surgeons. The intra-observer agreement considering the fracture types was substantial for spine surgeons (κ= 0.74 [0.63 - 0.75]) and almost perfect for pelvic trauma surgeons (κ= 0.84 [0.74 - 0.93]). Concerning the subtypes, both groups achieved substantial agreement with, κ= 0.61 (0.56 - 0.67) for spine surgeons and κ= 0.68 (0.62 - 0.74) for pelvic trauma surgeons. Conclusion: This classification allows an adequate communication for spine surgeons and pelvic trauma surgeons at the fracture severity type, but the agreement is only moderate at the subtype level. Future prospective studies are required to evaluate whether this classification allows for treatment recommendations and establishing prognosis in patients with sacral fractures.Item Letter to the Editor: Is COVID-19 the Cause of Delayed Surgical Treatment of Spine Trauma in Latin America?(2020) Cabrera, Juan P.; Yurac, Ratko; Guiroy, Alfredo; Carazzo, Charles A.; Joaquim, Andrei F.; Zamorano, Juan; Valacco, Marcelo; AO Spine Latin America Trauma Study GroupLetter to the EditorItem 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.Item Management of lumbar disc herniation with radiculopathy: Results of an Iberian-Latin American survey(2021) Quinteros, Guisela; Yurac, Ratko; Zamorano, Juan; Díez, Máximo; Pudles, Edson; Marré, BartoloméBackground: Lumbar disc herniation (LDH)/radiculopathy is the most frequent cause of lost workdays in people under 50 years of age. Although there is consensus about how to assess these patients, the optimal management strategy is still debated. Methods: An online survey was sent to spine surgeons who are members of the Iberian-Latin American Spine Society to assess how they treat LDH with radiculopathy. Results: There were 718 surgeons who answered the survey; 66% reported that 76-100% of their monthly clinic work was due to spine issues. The most frequently used conservative treatment modalities included non-opioid analgesics and nonsteroidal anti-inflammatory drugs (NSAIDs) (90.5%), followed by physical therapy (55.2%) and pregabalin (41.4%). Notably, 40% of surgeons in the public sector believed that conservative treatment failed if symptoms persisted beyond 6-12 weeks, while 39% of private surgeons deemed conservative management insufficient if it had failed to provide symptomatic relief with 3-6 weeks. Of interest, 78% utilized epidural steroid injections (ESI); 51.7% preferred the transforaminal, 27.2% the interlaminar, and 7.5% the caudal approaches. The most frequent indications for surgery included: cauda equina syndrome, progressive neurological deficits, and intractable pain. Traditional microdiscectomy was the most common technique (68.5%) utilized, followed by 7.5% advocating endoscopic disc resection, and just 6.4% favoring the tubular discectomy. Conclusion: There is considerable heterogeneity among Iberian and Latin American spine surgeons in the treatment of LDH/radiculopathy. Although most begin with the utilization of NSAIDs and non-opioid analgesics, followed by ESI (88%), surgery was recommended for persistent symptoms/signs for those failing between 3 and 6 weeks (private sector) versus 6-12 weeks (public sector) of conservative therapy.Publication Management of mild degenerative cervical myelopathy and asymptomatic spinal cord compression: an international survey(2024) Brannigan, Jamie; Davie, Benjamin; Mowforth, Oliver; Yurac, Ratko; Kumar, Vishal; Dejaeghe, Joost; Zamorano, Juan; Murphy, Rory; Tripath, Manjul; Anderson, David; Harrop, James; Molliqaj, Granit; Wynne-Jones, Guy; Joefrey, Jose; Kato, So; Ito, Manabu; Wilson, Jefferson; Romelean, Ronie; Dea, Nicolas; Graves, Daniel; Tessitore, Enrico; Martin, Allan; Nouri, AriaObjective: Currently there is limited evidence and guidance on the management of mild degenerative cervical myelopathy (DCM) and asymptomatic spinal cord compression (ASCC). Anecdotal evidence suggest variance in clinical practice. The objectives of this study were to assess current practice and to quantify the variability in clinical practice. Methods: Spinal surgeons and some additional health professionals completed a web-based survey distributed by email to members of AO Spine and the Cervical Spine Research Society (CSRS) North American Society. Questions captured experience with DCM, frequency of DCM patient encounters, and standard of practice in the assessment of DCM. Further questions assessed the definition and management of mild DCM, and the management of ASCC. Results: A total of 699 respondents, mostly surgeons, completed the survey. Every world region was represented in the responses. Half (50.1%, n = 359) had greater than 10 years of professional experience with DCM. For mild DCM, standardised follow-up for non-operative patients was reported by 488 respondents (69.5%). Follow-up included a heterogeneous mix of investigations, most often at 6-month intervals (32.9%, n = 158). There was some inconsistency regarding which clinical features would cause a surgeon to counsel a patient towards surgery. Practice for ASCC aligned closely with mild DCM. Finally, there were some contradictory definitions of mild DCM provided in the form of free text. Conclusions: Professionals typically offer outpatient follow up for patients with mild DCM and/or asymptomatic ASCC. However, what this constitutes varies widely. Further research is needed to define best practice and support patient care.Item Management of type II odontoid fractures: experience from latin american spine centers(Elsevier, 2017) Falavigna, Asdrubal; Righesso, Orlando; Guarise da Silva, Pedro; Rocca Siri, Carlos; Daniel, Jefferson; Esteves Veiga, Jose Carlos; Borges Laurindo de Azevedo, Gustavo; Carelli, Luis Eduardo; Yurac, Ratko; Sanchez Chavez, Felix Adolfo; Sfreddo, Ericson; Cecchini, Andre; Martins do Reis, Marcelo; Jimenez Avila, Jose Maria; Riew, DanielOBJECTIVE: To analyze characteristics of type II odontoid fracture (TII-OF), including clinical and radiographic factors, that influence surgical planning in 8 Latin American centers. METHODS: Retrospective chart review was performed of 88 patients with TII-OF between 2004 and 2015 from 8 Latin American centers. Parameters studied included 1) demographic data and causes of TII-OF, 2) clinical and neurologic presentation, 3) characteristics of fracture (degree of odontoid displacement, displacement of odontoid relative to C2 body, anatomy of fracture line, distance between fragments, presence of comminution, contact area between odontoid and C2 body), 4) type of treatment, and 5) clinical and radiographic outcome. Bone fusion was assessed using computed tomography. RESULTS: Mean patient age was 45.33 years ± 23.54; 78.4% of patients were male. Surgery was the primary treatment in 65 patients (73.8%), with an anterior approach in 64.6%. Surgery was usually preferred in patients with posterior or horizontal oblique fracture lines, local pain, and a smaller bone contact surface between the odontoid and the body of C2. A posterior approach was chosen when distance between the fractured bone fragments was >2 mm or after failed conservative or anterior odontoid screw treatment in a symptomatic patient. CONCLUSION: The treatment of choice for TII-OF in 8 Latin American trauma centers was surgery through an anterior approach using screw fixation. Posterior segmental C1-C2 fixation was indicated when distance between bone fragments was >2 mm and in symptomatic patients with nonunion.Item Manejo actual de las metástasis vertebrales: un trabajo en equipo(2021) Silva, Álvaro; Bravo, Oscar; Salas, Claudio; Yurac, Ratko; Valencia, Javiera; Goset, Karen; Harbst, Hans; Córdova, AndrésLa enfermedad metastásica vertebral es frecuente en los pacientes con cáncer avanzado, y conlleva a complicaciones inherentes a su progresión, como lo son la fractura patológica vertebral y la compresión neural metastásica. Se realizó una revisión de los aspectos terapéuticos actuales del manejo de la progresión y de las complicaciones de la enfermedad metastásica vertebral, enfatizando su enfrentamiento sistémico y personalizado. Nuestro objetivo principal es proporcionar información sobre el tratamiento actual de esta afección y la utilidad del manejo sistémico y multidisciplinario.Publication Mielopatía cervical degenerativa: una patología cada vez más frecuente y que requiere diagnóstico y manejo precoz(2022) Zamorano, Juan José; Yurac, Ratko; Matamala, José Manuel; Harrop, James S.; Davies, Benjamin M.; Nouri, Aria; Fehlings, Michael G.Degenerative cervical myelopathy (DCM) is the most common cause of spinal cord dysfunction in adults. Its prevalence is increasing as a result of population aging. The diagnosis of DCM is often delayed or overlooked, resulting in secondary neurologic morbidity. The natural course of DCM typically presents as a gradual neurological deterioration, with symptoms ranging from muscle weakness to complete paralysis, with variable degrees of sensory deficits and sphincter dysfunction. Magnetic resonance imaging (MRI) and electrophysiological studies allow the assessment of spinal cord function and its structural damage to determine treatment and clinical outcomes. All patients with signs and symptoms consistent with DCM should be referred to a spine surgeon for assessment and tailored treatment. Those patients with mild DCM can be managed non-operatively but require close monitoring and education about potentially alarming signs and symptoms. Surgery is not currently recommended for asymptomatic patients with evidence of spinal cord compression or cervical spinal stenosis on MRI, but they require a structured follow-up. Patients with moderate or severe DCM require surgical decompression to avoid further progression. The objective of this review is to raise awareness of degenerative cervical myelopathy and its increasing prevalence as well as to aid non-surgical healthcare workers for a timely diagnosis and management of this disabling condition.Publication Mielopatía cervical degenerativa: una patología cada vez más frecuente y que requiere diagnóstico y manejo precoz(2022) Yurac, Ratko; Matamala, José; Zamorano, Juan; Harrop, James; Davies, Benjamin; Nouri, Aria; Fehlings, MichaelDegenerative cervical myelopathy (DCM) is the most common cause of spinal cord dysfunction in adults. Its prevalence is increasing as a result of population aging. The diagnosis of DCM is often delayed or overlooked, resulting in secondary neurologic morbidity. The natural course of DCM typically presents as a gradual neurological deterioration, with symptoms ranging from muscle weakness to complete paralysis, with variable degrees of sensory deficits and sphincter dysfunction. Magnetic resonance imaging (MRI) and electrophysiological studies allow the assessment of spinal cord function and its structural damage to determine treatment and clinical outcomes. All patients with signs and symptoms consistent with DCM should be referred to a spine surgeon for assessment and tailored treatment. Those patients with mild DCM can be managed non-operatively but require close monitoring and education about potentially alarming signs and symptoms. Surgery is not currently recommended for asymptomatic patients with evidence of spinal cord compression or cervical spinal stenosis on MRI, but they require a structured follow-up. Patients with moderate or severe DCM require surgical decompression to avoid further progression. The objective of this review is to raise awareness of degenerative cervical myelopathy and its increasing prevalence as well as to aid non-surgical healthcare workers for a timely diagnosis and management of this disabling condition.