Examinando por Autor "Molina, Marcelo"

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    Analysis of predictors for spinal fusion in degenerative lumbar stenosis in Chile based on diagnosis-related groups
    (Gavin Publishers, 2024-01-03) Molina, Marcelo; Salvo, Lorena; Arriola, Constanza; Rioseco, Bernardita
    Introduction: Degenerative Lumbar spinal stenosis (DLSS) is the most common cause of spine surgery for patients above 55 years. Surgery options include decompression alone or with spinal fusion. The DRG system uses classification algorithms that categorize patients into groups with similar clinical and resource consumption characteristics, using ICD-10 nomenclature for diagnoses and ICD-9-CM for procedures. Objective: Identify clinical and epidemiological variables of DLSS surgery patients based on Chile’s DRG system data and define factors associated with arthrodesis as a complement to decompression. Study Design: Retrospective observational study. Methods: This study used the national DRG database to analyze factors predicting the need for fusion in patients with DLSS. Data from 31 public hospitals in Chile were analyzed for patients discharged between 2020 and 2022. Variables considered included age, gender, presence of other spinal pathologies, and attending physician specialty. For the descriptive analysis of qualitative variables, frequencies and percentages were used.The study used univariate and multivariate logistic regression analysis. A statistical significance level of less than 0.05 was considered. Results: We analyzed 1024 patients with lumbar spinal stenosis and found that 54.6% were female and 45.4% were male (p= 0.0034). The majority of the patients (57.4%) were aged between 60 and 79 years. 75% of orthopedic surgeons opted for decompression plus arthrodesis, while neurosurgeons preferred decompression alone in 73% of cases. The most significant predictors for decompression with fusion were the physician’s specialty in orthopedic surgery, female sex, and the presence of other spinal pathologies such as scoliosis, herniated disc, and spondylolisthesis. Patients treated by an Orthopedic Surgeon had an 8.2 times greater probability of undergoing decompression plus arthrodesis as compared to those treated by a Neurosurgeon. Additionally, the presence of spondylolisthesis increased the probability of decompression with fusion by 6.2 times, and the presence of scoliosis increased it by 6.6 times. Neurosurgeons opted for decompression alone in 89.7% of the cases with DLSS stenosis and herniated disc, while only 48.9% of orthopedic surgeons opted for the same option (p=0.0000). Conclusion: Our study based on DRG records from public hospitals in Chile has identified certain factors linked to a higher frequency of spinal arthrodesis. These factors include the surgery being performed by orthopedic surgeons, patients aged between 40 and 60 years old, the presence of degenerative spondylolisthesis and degenerative scoliosis, and the absence of a herniated disc.
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    Low-grade cartilaginous vertebral tumor: a rare cause of spinal cord compression
    (Gavin Publishers, 2023-12-19) Molina, Marcelo; Ceballos, Oscar; Pereira, Mariana
    Introduction: Osteochondroma is the most common benign primary neoplasm, representing up to 36% of benign bone tumors. Its location in the spine is rare, occurring in 4% to 7% of primary tumors in this location, and of these, around one-third present myelopathy secondary to spinal cord compression. Despite its low prevalence described in the literature, in recent years there has been an increase in reported cases. Objectives: To present a rare low-grade cartilaginous tumor with intracanal extension as an etiology of spinal cord compression syndrome with myelopathy. Treatment options were discussed. Material and Method: Informed consent was approved by the patient. Clinical information and images were obtained from the electronic file. A review of the literature was done for its analysis and discussion. Results: 52-year-old man, no medical history. He consulted for a 2-month history of progressive loss of strength on the left lower extremity (LLE). On physical examination, it presents hypoesthesia and 3/5 strength from L2 to S1 myotomes in the LLE. Neurological evaluation, spine CT, and MRI were done. Images show a T7 vertebral body tumor with a large extruded calcified mass occupying 80% of the canal at T6T7 with severe compression of the spinal cord. Surgical management was decided by performing posterior arthrodesis from T4 to T10 with posterolateral tumor resection and spinal cord decompression. The patient woke up with paraplegia after surgery. There was a gradual and significant improvement in the patient’s condition over the first four weeks. After a 6-month of following an intensive rehabilitation program, the patient progressed favorably, pain-free, with normal sensitivity, full recovery to 5/5 strength, walking independently, and some degree of spasticity. At 2 years follow up the patient has only mild gait disturbance secondary to spasticity. Discussion: A case of solitary osteochondroma as a cause of progressive compressive myelopathy was presented. Surgical options are evaluated depending on the location of the tumor, presence of mechanical pain, radiographic spinal alignment, vertebral collapse, posterolateral involvement, and neurological compromise of the spine. Most of the similar published reports show that this clinical picture is more frequent in the context of multiple hereditary exostoses and 132 new cases have been published from 2004 to 2016, which shows a 2.4-fold increase since 2003, of which, 27.2% presented with myelopathic symptoms. Conclusion: Osteochondroma is a rare spine tumor that can produce radicular or myelopathic symptoms. Surgery is recommended in spinal cord compression cases. Surgical options are evaluated depending on the location, morbidity, and complications.
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    Posterior hemivertebrectomy for correction of congenital kyphosis in adulthood: case report and literature review
    (Gavin Publishers, 2023-12-19) Molina, Marcelo; Pereira, Mariana; Khek, Pablo; Ballesteros, José Vicente
    Congenital kyphosis is an infrequent cause of kyphosis with a potential severe progressive deformity and neurological damage. There are few reports in the literature about congenital kyphosis focusing on adults. Case presentation: 24-year-old male with progressive dorsal pain, paresthesias, and numbness in his legs. Physical examination demonstrated a rigid kyphotic deformity with tenderness on the apex, neurologically intact. The diagnosis was a T10 butterfly posterior hemivertebra with segmental kyphosis of 48 degrees. The patient was treated surgically with a single posterior procedure, performing a complete T10 hemivertebrectomy and instrumented fixation from T8 to T12. The postoperative assessment demonstrated a segmental kyphosis of 14 degrees with 34º of correction, without surgical complications, and good functional results during 4 years of follow-up. Conclusion: Posterior-only hemivertebra resection is an effective procedure for treating congenital kyphosis, providing an excellent correction of the deformity with a good functional outcome. Intraoperative imaging tools, such as CT scans and navigation systems, can aid in performing the surgery and improve outcomes.
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    Radiological classification for degenerative lumbar spine disease: a literature review of the main systems
    (Fortune Journals, 2023-12-29) Molina, Marcelo; Vial, Sebastián
    Study Design: Systematic review Objectives: Performed a systematic review of available lumbar spinal degenerative disease classifications. Methods: We performed a systematic literature review search for papers that proposed or described radiological classification systems for degenerative lumbar spine disease, such as lumbar disc herniation, facet joint arthritis, spondylolisthesis, and lumbar stenosis. The literature was performed in MEDLINE and EMBASE, limited to English articles published from 1980 to the present. The reliability tests of the reviewed articles were assessed with the “Intraclass Correlation Coefficients” (ICC) and “Cohen's Kappa coefficient” (k). Results: We found 1873 articles. A total of 64 articles were reviewed, identifying 31 radiological classification systems. We found 7 classifications for degenerative disc disease, 7 for disc herniation, 7 for facet joint osteoarthritis, 8 for degenerative spinal stenosis, and 2 for degenerative spondylolisthesis. Of the 31 systems found, 24 had interrater agreement studies. The clinical orientation of the classification was analyzed when appropriate. Discussion: Reliability studies play a crucial role in evaluating a classification system as they enable reproducibility among evaluators, thereby fortifying the system. Classifications should not only be endorsed based on their validation and reliability studies, but it is also crucial to assess their feasibility for practical implementation in clinical settings. Conclusions: A classification system should have a reliability with Kappa or ICC over 0.60 to be recommended. It should provide a clinical orientation to make therapeutic decisions and form part of a guideline. Continued research on classification development is essential to improve systems, enhancing their clinical utility and bolstering their reliability
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    RECOSAN tumors study: analysis of patients with spine surgery due to oncologic pathology
    (Fortune Journals, 2024-11-01) Molina, Marcelo; Ceballos, Oscar; Pereira, Mariana; Lobos, Daniel; Yurac, Ratko; Otto, Juan Pablo; Barahona, Maximiliano
    Introduction: Primary bone tumors of the spine are rare and account for 2.8 to 13% of all bone tumors. On the other hand, the spine is a frequent location for metastatic disease. As local control of the primary tumor pathology continues to improve, survival rates improve, and, by extension, the chance of metastasis increases. Breast, lung, and prostate cancer are the main causes of spinal metastases. The RECOSAN (Santiago Spine Surgery Registry) project is the first multicenter, prospective, and national registry of spinal surgeries in Chile. Purpose: The objective was to describe the epidemiological, diagnostic, surgical information, complications, and biopsy results of patients operated on for tumor pathology in the RECOSAN registry. Materials and methods: The RedCap database of the RECOSAN project’s was used to obtain information on patients who underwent spinal surgery due to tumor pathology in five Chilean hospitals. Information on the biopsies of these patients was requested from the respective hospitals and clinics where they were admitted. Demographic data, surgical history, and results of biopsies performed were collected. Results: Out of 1225 patients admitted to the registry, 82 correspond to spinal surgeries due to tumor pathology. Biopsy reports were obtained from 63 patients who underwent surgical biopsy plus tumor resection and instrumentation. 52% of the patients were male, and the mean age was 57 years. 44% of the biopsies were in the dorsal spine and 40% in the lumbar spine. Of the total number of biopsies performed, 84.1% resulted in tumor lesions. Of these, 66% corresponded to metastases and 34% to primary tumors. The most frequent histological diagnoses were breast carcinoma (20.8%), prostate carcinoma (11.3%) and plasma cell neoplasia (9.4%). The percentage of intraoperative complications of the instrumented patients was 18%, and the percentage of reoperation was 4.7%. There was agreement between the preoperative and final diagnoses based on the biopsy of 66% of the cases, reaching a moderate concordance (Kappa=0.42). Conclusion: Vertebral biopsy is an essential procedure for histological diagnosis in both primary and metastatic tumor lesions. This is the first national multicenter registry in Chile for patients undergoing surgery for tumors. It covers epidemiological data, clinical information, surgical techniques, biopsy results, as well as intraoperative and postoperative complications. In this series, the most frequent histological diagnoses coincide with those reported in the literature. The concordance between the preoperative diagnosis and the biopsy is moderate, which supports the importance of obtaining a biopsy for the treatment of spinal tumor pathology.
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    Reply to letter to the editor regarding “Wound drain in lumbar arthrodesis for degenerative disease: an experimental, multicenter, randomized controlled trial”
    (Elsevier, 2024) Molina, Marcelo
    We would like to thank Dr Alexander Hammer and Dr. Klaus John Schnake for their interest and perceptive insights concerning our study. In your letter, you raise interesting points of view that we will address in this response.
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    Survey on spinal injections for lumbar degenerative stenosis among spine surgeons in Latin America
    (Fortune Journals, 2023-11-09) Molina, Marcelo; Torres, Ramon; Yurac, Ratko; Pantoja, Samuel; Gonzales, Lucio
    Introduction: Epidural and facet joint injections are usually used as part of the treatment algorithm for low back and radicular pain. Current clinical practice in Latin America is not well described in the literature. Objectives: Evaluate the indications and techniques of spinal injections (SI) in patients with degenerative lumbar spinal stenosis (DLSS) among spine surgeons in Latin America. Study Design: Cross-sectional, international survey, narrative literature review. Methods: An online survey was sent to spine surgeons and members of the AOSpine Latin America. Data included surgeon geographic information, specialty, time in professional activity, SI indications, and techniques in different scenarios of pain and stenosis localization. Results: A total of 446 surgeons, 291 (65%) orthopedic surgeons, and 155 (35%) neurosurgeons replied to the survey. 92% of spine surgeons indicated a spinal steroid injection to treat DLSS. Most spinal surgeons (54%) would simultaneously perform both peridural and intraarticular lumbar facet (combined) steroid injections in patients with low back pain and radicular pain. Foraminal injection is a preferred technique for patients with central and foraminal stenosis. There are no significant differences in most of the answers between orthopedic surgeons and neurosurgeons. Almost 80% of respondents expect a good result from the injection. However, 86% of surgeons believe injection effects last less than 6 months, and only 12% think surgery will not be necessary in the future. Only 15% of spine surgeons irrespective of specialty adhere to a guideline on spine injections for DLSS. Conclusion: This study provides a global perspective on how Latin American spine surgeons treat patients with DLSS concerning the use of spinal steroid injections. We observed that more than 90% of respondents use this procedure to treat DLSS. There are almost no differences between orthopedic spine surgeons and neurosurgeons when performing SI. A foraminal injection is preferred for lateral recess and foraminal stenosis. Most of the respondents expect to achieve positive results with the procedure, but they believe that its effect will last for less than 6 months and possible need for surgery.