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    Clinical and Radiological Factors Affecting Thoracolumbar Fractures Outcome: WFNS Spine Committee Recommendations
    (Korean Spinal Neurosurgery Soc, 2021) Costa, Francesco; Sharif, Salman; Bajamal, Abdul Hafid; Shaikh, Yousuf; Anania, Carla D.; Zileli, Mehmet
    To obtain a list of recommendations about clinical and radiological factors affecting outcome in thoraco-lumbar fractures with the aim of helping spine surgeons in daily practice. A systematic literature search in PubMed and Google Scholar database was done from 2010 to 2020 on the topic thoracolumbar fracture AND radiology AND surgical outcomes and thoracolumbar fracture AND radiology AND surgical outcomes. A total of 58 papers were analyzed and WFNS (World Federation of Neurosurgical Societies) Spine Committee organized 2 consensus meetings to formulate the specific recommendations the first in Peshawar in December 2019 and in a subsequent virtual meeting in June 2020 to reach an agreement. Both meetings utilized the Delphi method to analyze preliminary literature review statements based on the current evidence levels to generate recommendations through a comprehensive voting session. Eight statements were presented and reached the consensus about this topic. A variety of clinical factors is known to influence outcome of patients with thoracolumbar fractures. Some of these are well-known established factors such as blood pressure augmentation and patient age, while some are not well studied. Overall, the quality of evidence is low and we need more randomized controlled studies to validate our results. Similarly, radiological factors that can predict outcome are well stated and there is a high accordance worldwide. In reverse, still under debate is the application to choose which surgical treatment is advisable based on them.
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    Early Management of Spinal Cord Injury: WFNS Spine Committee Recommendations
    (Korean Spinal Neurosurgery Soc, 2020) Soriano Sanchez, Jose Antonio; Sharif, Salman; Costa, Francesco; Romero Rangel, Jose Alberto Israel; Anania, Carla Daniela; Zileli, Mehmet
    Scientific knowledge today is being generated more rapidly than we can assimilate thus requiring continuous review of gold-standards for diagnosis and treatment of specific pathologies. The aim of this paper is to provide an update on the best early management of spinal cord injury (SCI), in order to produce acceptable worldwide recommendations to standardize clinical practice as much as possible. The WFNS Spine Committee voted recommendations regarding management of SCI based on literature review of the last 10 years. The committee stated 9 recommendations on 3 main topics: (1) clinical assessment and classification of SCI; (2) emergency care and early management; (3) cardiopulmonary management. American Spinal Injury Association impairment scale, Spinal Cord Independence Measure, and International Spinal Cord Injury Basic Pain Data Set are considered the most useful and feasible in emergency evaluation and follow-up in case of SCI. Magnetic resonance imaging is the most indicated examination to evaluate patients with symptomatic SCI. in early phase, correction of hypotension (systolic blood pressure < 90 mmHg), and bradycardia are strongly recommended. Surgical decompression should be performed as soon as possible with the ideal surgical time being within 8 hours for both complete and incomplete lesions.
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    Epidemiology,natural course, and preventive measures of osteoporotic vertebral fractures: WFNS Spine Committee Recommendations
    (Edizioni Minerva Medica, 2022) Zileli, Mehmet; Fornari, Maurizio; Costa, Francesco; Anania, Carla D.; Parthiban, Jutty; Sharif, Salman
    INTRODUCTION: This review aims to search for up-to-date information on epidemiology, natural course, and preventive measures of osteoporotic spine fractures. EVIDENCE ACQUISITION: We reviewed the literature of the last ten years using keywords natural course and osteoporotic vertebral fractures, epidemiology and osteoporotic vertebral fractures and prevention and osteoporotic vertebral fractures. We then discussed the search results to reach an agreement in two consensus meetings on January and February 2021 of the World Federation of Neurosurgical Societies (WENS) Spine Committee. Finally, we utilized the Delphi method to administer the questionnaire to preserve a high degree of validity. We summarized seven papers on the natural course, 15 articles on epidemiology, and 84 papers on preventing osteoporotic vertebral fractures. Finally, the consensus results after voting are presented. EVIDENCE SYNTHESIS: Natural course of acute osteopomtic vertebral fractures is benign; many patients may have sufficient pain relief during the first three months with conservative treatment. At the end of one year of conservative treatment, 40% may still have pain with VAS-scores >= 4. Since the populations are aging, the incidence of OVF continues to rise. Although the prevalence varies across the globe, the highest rates are from North America and some countries of Asia. Preventive treatment of OVF must involve an active lifestyle, adequate nutrition, prevention of immobilization with physical therapy. and pharmacological therapy. Oral calcium and vitamin D are first-line interventions to prevent the bone mass loss, especially in postmenopausal women. There are many pharmacological treatment options: the decision must be made by fracture risk assessment (clinical factors + BMD + BMI) alone or along with DXA (dual-energy X-ray absorptiometry) or history of previous fragility fractures. The indication of one respect to the others is based on patient preference, compliance, and risk of discontinuation related to adverse events and administration method. CONCLUSIONS: The incidence of osteopomtic vertebral fractures increases with age and other factors. The natural course shows that most patients benefit from conservative therapy without any surgical intervention during the first three months. Preventive measures must include active lifestyle, adequate nutrition, prevention of immobilization with physical therapy, oral calcium, and vitamin D intake, and pharmacological therapy after fracture risk assessment.
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    Traumatic Spine Injury: Which Discrepancy Between the Research Output and the Actual Burden of the Disease?
    (Elsevier Science Inc, 2020) Tropeano, Maria Pia; Spaggiari, Riccardo; Ileyassoff, Hernan; Mabunda, Delisile J. D.; Anania, Carla D.; Costa, Francesco; Servadei, Franco
    OBJECTIVE: Traumatic spinal injury (TSI) is a global health issue contributing to morbidity and mortality, especially in low- and middle-income countries. the aim of this study is to compare the epidemiological estimates of TSI with the corresponding amount of published papers for different regions. METHODS: A bibliometric analysis was performed by collecting the number of publications concerning TSI from the PubMed database. Results were sorted according to the different geographical World Health Organization regions. A "publication-to-volume ratio" was obtained by comparing the average number of documents per year with the number of TSI cases across each region. RESULTS: A total of 2304 articles were detected from 2008 to 2018. the major publishing regions were North America (AMR-US/Can: 843 articles, 36.6%) and Europe (EUR: 833, 36.2%), then Western Pacific (WPR: 410, 17.8%), Eastern Mediterranean (EMR: 73, 3.2%), South-East Asia (SEAR: 71, 3.1%), Latin America (AMR-L: 55, 2.4%), Africa (AFR: 19, 0.8%). the United States is the most publishing country in AMR-US/Can (86.0%), and Germany in EUR (22.4%). in 2018, EUR published 36.6% of papers versus AMR-US/Can 26.5% and WPR 25.7%, thanks to an increase in Chinese publications. the highest publication ratios of 4.63 and 2.68 were found for AMR-US/Can and EUR, respectively. the other were EMR (0.22), WPR (0.18), AMR-L (0.07), SEAR (0.03), and AFR (0.01). CONCLUSIONS: A marked divide is currently found between countries with a high burden of TSI and those where there is most research interest, estimated as amount of publications. Data demonstrate the need for increased inclusiveness in guidelines generation from high-income countries including collection and analysis from low- and middle-income countries.
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    Vertebral augmentation in osteoporotic spine fractures: WFNS Spine Committee recommendations
    (Edizioni Minerva Medica, 2022) Sharif, Salman; Ali, Muhammad Y.; Costa, Francesco; Zileli, Mehmet; Parthiban, Jutty
    INTRODUCTION: The aim of this study was to formulate the WFNS Spine Committee guidelines on indications. outcomes, and complications of vertebral augmentation in osteoporotic spine fractures. EVIDENCE ACQUISITION: Computerized literature was searched from 2010 to 2021 using keywords vertebral augmentation, osteoporotic fracture, technique, surgery, complication, and outcome. PubMed yielded 92 articles whereas Google scholar resulted in 120 articles. 29 articles were studied in detail. The studies comprised of seventeen RCT's, two prospective non-randomized studies, three retrospective studies, and seven systematic reviews. The statements were produced to reach a consensus in two separate meetings of WFNS Spine Committee. The statements were voted and reached a positive or negative consensus using Delphi method. EVIDENCE SYNTHESIS: Drafted statements on Vertebral Augmentation in osteoporotic Spine Fractures were voted upon by expert panelists in Virtual WFNS Spine Committee Consensus Meetings conducted on January 11, 2021, and February 13, 2021. Statements reaching positive consensus provided the basis for the WFNS guidelines regarding vertebral augmentation in osteoporotic spine fractures. CONCLUSIONS: WFNS Spine Committee recommendations on vertebral augmentation in osteoporotic spine fractures are summarized in this article. Vertebral augmentation is superior to conservative treatment for vertebral osteoporotic fractures but has conflicting results on comparison with placebo. Both vertebroplasty and kyphoplasty are equally effective. Most of the studies regarding the efficacy of vertebral augmentation procedures to reduce pain have been largely inconclusive. It is suggested that further high quality, better designed randomized controlled studies are required to establish the role of vertebral augmentation in spine osteoporotic compression fractures.