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    Endocrine assessment, chemotherapy, nonsurgical treatment, and rehabilitation for osteoporotic spine fractures: WFNS spine committee recommendations
    (Edizioni Minerva Medica, 2022) Kim, Se-Hoon; Ramani, Prem S.; Jahagirdar, Vidhya R.; Roitberg, Ben; Zileli, Mehmet
    INTRODUCTION: We reviewed the endocrine assessment, chemotherapy, and rehabilitation of the osteoporotic vertebral fractures (OVF) to create recommendations for the disease. EVIDENCE ACQUISITION: A PubMed and Medline search between 2011 and 2021 was conducted using key words. Case reports, experimental studies, papers other than the English language, and unrelated studies were excluded. Up to date information on endocrine assessment, medical and nonsurgical treatment, and rehabilitation for osteoporotic spine fractures were reviewed, and statements were produced to reach a consensus in two separate virtual consensus meetings of the World Federation of Neurosurgical Societies (WFNS) Spine Committee. The statements were voted and achieved a positive or negative consensus using Delphi method. EVIDENCE SYNTIIESIS: Endocrine assessment of osteoporosis is necessary if it is diagnosed in premenopausal women or men less than 50 years of age. Dual X-Ray absorptiometry (DXA) alone may not be predictive of fracture. Endocrine causes of osteoporosis must also be evaluated if the Z-score <=-2.0. In case of a vertebral fracture in postmenopausal women and men aged 50 years and above, pharmacologic treatment for osteoporosis must be started. Strengthening exercise, balance and gait training, and assistive devices are recommended to prevent and reduce falls in the elderly. In addition, rehabilitation must be a part of the overall treatment to help patients return to function. CONCLUSIONS: Nonsurgical management helps treat OVF. Although there is weak evidence on the type of medical treatment and usage of braces, bed rest, and other measures, current literature supports endocrinological management, medical treatment, and rehabilitation after osteoporotic vertebral fractures.
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    Posterior Surgical Techniques for Cervical Spondylotic Myelopathy: WFNS Spine Committee Recommendations
    (Korean Spinal Neurosurgery Soc, 2019) Bajamal, Abdul Hafid; Kim, Se-Hoon; Arifianto, Mohammad Reza; Faris, Muhammad; Subagio, Eko Agus; Roitberg, Ben; Parthiban, Jutty K. B. C.
    Objective: This study was conducted to determine and recommend the most up-to-date information on the indications, complications, and outcomes of posterior surgical treatments for cervical spondylotic myelopathy (CSM) on the basis of a literature review. Methods: A comprehensive literature search was performed, using the MEDLINE (PubMed), the Cochrane Register of Controlled 'Fria's, and Web of Science databases, for peer-reviewed articles published in English during the last 10 years. Results: Posterior techniques, which include laminectomy alone, laminectomy with fusion, and laminoplasty, are often used in patients with involvement of 3 or more levels. Posterior decompression for CSM is effective for improving patients' neurological function. Complications resulting from posterior cervical spine surgery include injury to the spinal cord and nerve roots, complications related to posterior screw fixation or instrumentation, C5 palsy, spring-back closure of lamina, and postlaminectomy kyphosis. Conclusion: It is necessary to consider multiple factors when deciding on the appropriate operation for a particular patient. Surgeons need to tailor preoperative discussions to ensure that patients are aware of these facts. Further research is needed on the cost-to-benefit analysis of various surgical approaches, the comparative efficacy of surgical approaches using various techniques, and long-term outcomes, as current knowledge is deficient in this regard.