Examinando por Autor "Yurac, Ratko"

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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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    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.