Person: Yurac, Ratko
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Publication Streamlining the Journey of Research Into Clinical Practice: Making Your Patients and Practice Flourish Optimizing Management and Minimizing Risk of Osteoporotic Vertebral Fractures - Perspectives of the AO Spine KF Trauma and Infection Group Key Opinion Leaders(2024) Joaquim, Andrei; Bigdon, Sebastian; Bransford, Richard; Chhabra, Harvinder; Yurac, Ratko; Kumar, Vishal; El-Sharkawi, Mohammad; Benneker, Lorin; Karamian, Brian; Canseco, Jose; Scherer, Julian; Hassan, Ahmed; Schroeder, Gregory; Öner, Cumhur; Rajasekaran, Shanmuganathan; Vialle, Emiliano; Kanna, Rishi; Vaccaro, Alexander; Tee, Jin; Camino, Gaston; Fisher, Charles; Dvorak, Marcel; Schnake, Klaus; AO Spine Knowledge Forum Trauma & InfectionStudy design: Literature review with clinical recommendations. Objective: To highlight important studies about osteoporotic spinal fractures (OF) that may be integrated into clinical practice based on the assessment of the AO Spine KF Trauma and Infection group key opinion leaders. Methods: 4 important studies about OF that may affect current clinical practice of spinal surgeons were selected and reviewed with the aim of providing clinical recommendations to streamline the journey of research into clinical practice. Recommendations were graded as strong or conditional following the GRADE methodology. Results: 4 studies were selected. Article 1: a validation of the Osteoporotic Fracture (OF)-score to treat OF fractures. Conditional recommendation to incorporate the OF score in the management of fractures to improve clinical results. Article 2: a randomized multicenter study comparing romosozumab/alendronate vs alendronate to decrease the incidence of new vertebral fractures. Strong recommendation that the group receiving romosozumab/alendronate had a decreased risk of new OF when compared with the alendronate only group only. Article 3: a systematic literature review of spinal orthoses in the management of. Conditional recommendation to prescribe a spinal orthosis to decrease pain and improve quality of life. Article 4: post-traumatic deformity after OF. A conditional recommendation that middle column injury and pre-injury use of steroids may lead to high risk of post-traumatic deformity after OF. Conclusions: Management of patients with OF is still complex and challenging. This review provides some recommendations that may help surgeons to better manage these patients and improve their clinical practice.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 Risk Factors for Failure of Non-operative Management in Isolated Unilateral Non-displaced Facet Fractures of the Subaxial Cervical Spine: Systematic Review and Meta-Analysis(2024) Cirillo, Ignacio; Ricciardi, Alejandro; Cabrera, Juan Pablo; López Muñoz, Felipe; Romero Vlverde, Lyanne; Joaquim, Andrei; Carazzo, Charles; Yurac, RatkoStudy Design: systematic review.Objective: To evaluate risk factors associated with failure of non-operative management of isolated unilateral facet fractures ofthe subaxial cervical spine in neurologically intact patients.Methods: A systematic review of the PubMed, Embase, LILACS, and Cochrane Library databases was conducted in order todetermine risk factors associated with failure of non-operative management in isolated unilateral facet fractures of the subaxialcervical spine without facet and/or vertebral displacement, in neurologically intact patients. Our research was in line with thePRISMA Statement and registered on PROSPERO (CRD42023405699).Results: A total of 1639 studies were identified through a database search on May 5, 2023. In total, 7 studies from the databaseswere included, along with 1 study found through a manual citation search. The evidence showed high clinical heterogeneity, aserious risk of bias according to the ROBINS-I tool, and a predominance of retrospective cohort studies. In comparison to lesscomplex facet fractures, lateral floating mass fractures were found to have 5.41 times higher odds of failure of non-operativemanagement (OR = 5.41; 95% CI = 1.32, 22.19). We calculated the potential association between lower absolute fracture heightand non-operative treatment success [Fracture height (percentage) Mean Difference = 17.51 ( 28.22, 6.79 95% CI); Absolute height Mean Difference: 0.46 ( 0.60, 0.31 95% CI)]. Other risk factors were not included in the meta-analysis dueto lack of data. The level of certainty was rated as “very low”.Conclusions: Lateral floating mass cervical facet fractures and larger fracture fragment size (measured either in absolute termsor as a percentage) are significant risk factors for failure of non-operative treatment.