Nicola Papapietro - Academia.edu (original) (raw)

Papers by Nicola Papapietro

Background: Spinal infections are an important clinical problem that often require aggressive med... more Background: Spinal infections are an important clinical problem that often require aggressive medical therapy, and sometimes even surgery. Known risk factors are advanced age, diabetes mellitus, rheumatoid arthritis, immunosuppression, alcoholism, long-term steroid use, concomitant infections, poly-trauma, malignant tumor, and previous surgery or invasive procedures (discography, chemonucleolysis, and surgical procedures involving or adjacent to the intervertebral disc space). The most common level of involvement is at the lumbar spine, followed by the thoracic, cervical and sacral levels: lesions at the thoracic spine tend to lead more frequently to neurological symptoms. Objective: The aim of the current paper is to describe current evidence-based standards of therapy in the management of SD by emphasizing pharmacological therapy and principles and indications for bracing and surgery.

Journal of Medical Ultrasonics, 2013

Schwannomas are benign encapsulated neoplasms of the peripheral nerve sheath. Clinical diagnosis ... more Schwannomas are benign encapsulated neoplasms of the peripheral nerve sheath. Clinical diagnosis is often difficult, and final diagnosis is usually based on histopathological findings. Imaging techniques, such as magnetic resonance imaging and ultrasonography, can be optimized to improve assessment prior to surgical treatment. The present case demonstrates that high-resolution sonography can be useful in assessing the underlying cause of median nerve pathology.

Spine, Jan 20, 2008

Human osteoblast cultures were exposed to a very low intensity static magnetic fields (SMF) to in... more Human osteoblast cultures were exposed to a very low intensity static magnetic fields (SMF) to investigate its effects on osteoblast growth and differentiation. Analysis of the effects of periprosthetic SMF on the growth and differentiation of human osteoblast cell cultures in vitro. The effects of pulsed electromagnetic fields (PEMF) on cell proliferation, especially in human osteoblast-like cells is well described, whereas few data are available on the effects of SMF on osteoblast cell culture. We previously demonstrated that the proliferation of human osteoblast cultures is reduced when cells are exposed to a continuous low intensity SMF comparable to the one that occurs around metal devices (Ti spinal implant) because of the generation of electric currents between the screw (Ti6Al4V) and the rod (Ti). Primary osteoblastic cells were isolated from a human femoral head. Osteoblast cultures were exposed to SMF and alkaline phosphatase activity was evaluated in the osteoblast cell c...

Journal of Spinal Disorders & Techniques, 2002

Sciatic pain caused by endometriosis of the sciatic nerve is an uncommon clinical finding and see... more Sciatic pain caused by endometriosis of the sciatic nerve is an uncommon clinical finding and seems to have been verified histologically in only a few cases. Patients complain of typical signs and symptoms of common sciatica that are cyclic in nature. Suggested compression of lumbar root or sciatic nerve or its plexus could be confirmed by electromyography, computed tomography, or magnetic resonance imaging, and by prompt response to hormonal suppression of ovarian function with regression of the radiologic findings. Patients often have required radical surgery with total hysterectomy and bilateral salpingo-oophorectomy. However, conservative surgery with excision of the endometriosis from the nerve can be successful in selected patients who wish to preserve reproductive function. We report a case of sciatic nerve involvement explored by magnetic resonance imaging, with endometriosis in contact with the nerve in the right sciatic trunk.

Expert Review of Anticancer Therapy, 2013

The purpose of this article is to outline the current approach to patients affected by metastasis... more The purpose of this article is to outline the current approach to patients affected by metastasis to the spine and to present a clinical and surgical algorithm available for clinicians and for future research. A modern approach to the patients affected by spinal metastasis in fact requires a multidisciplinary contest where oncologists, radiotherapists, surgeons and physical therapists cooperate with shared vision to provide the best possible integrated treatments available. The authors of this article constitute the Bone Metastasis Study Group of the Italian Orthopaedic Society (SIOT): a national group of orthopedic tumor surgeons who are dedicated to studying the approach, techniques and outcomes of surgery for metastatic tumors of the musculoskeletal system.

Current Medical Research and Opinion, 2012

Spinal infections are an important clinical problem that often require aggressive medical therapy... more Spinal infections are an important clinical problem that often require aggressive medical therapy, and sometimes even surgery. Known risk factors are advanced age, diabetes mellitus, rheumatoid arthritis, immunosuppression, alcoholism, long-term steroid use, concomitant infections, poly-trauma, malignant tumor, and previous surgery or invasive procedures (discography, chemonucleolysis, and surgical procedures involving or adjacent to the intervertebral disc space). The most common level of involvement is at the lumbar spine, followed by the thoracic, cervical and sacral levels: lesions at the thoracic spine tend to lead more frequently to neurological symptoms. The aim of the current paper is to describe current evidence-based standards of therapy in the management of SD by emphasizing pharmacological therapy and principles and indications for bracing and surgery. A PubMed and Google Scholar search using various forms and combinations of the key words: spondylodiscitis, spine, infection, therapy, surgery, radiology, treatment. Reference citations from publications identified in the literature search were reviewed. Publications highlighted in this article were extracted based on relevancy to established, putative, and emerging diagnostic and therapeutic standards, either conservative (antibiotic therapy and bracing) or surgical. To date, conservative therapy, based on targeted antibiotic therapy plus bracing, represents the mainstay in the management of SD. Proper diagnosis and tailored therapy can improve clinical results and decrease the chance of failure. Surgery should be an option only for patients with complications of this disease, namely deformity, neural compression and neurological compromise. Current standards in the setting of SD are continuously evolving, as can be seen in the recent advances in the field of radiological diagnostics, and the use of growth factors and cell-therapy strategies to promote infection eradication and bone healing after surgery.

Journal of experimental & clinical cancer research : CR, 2007

Von Hippel-Lindau disease is a rare autosomic dominant hereditary tumoral syndrome characterized ... more Von Hippel-Lindau disease is a rare autosomic dominant hereditary tumoral syndrome characterized by mutation of the VHL gene. Here follows the first reported case of a patient (20 year old male) affected by Von Hippel-Lindau (VHL) disease, was referred to our Department because of the occurrence of a hard lump at the right aspect of the pelvis, who presented a primary mildly differentiated chondrosarcoma of the right iliac wing (confirmed by CT scan). Chondrosarcoma of the iliac wing, treated by surgical resection and reconstruction of the pelvis with appropriately shaped bone allograft fixed with plates and screws. At one year follow-up, the patient shows no signs of recurrence. Conventional treatment for chondrosarcoma of the iliac wing would be either wide or radical resection (hemipelvectomy), or amputation. The described treatment is unusual in that it is dependent on patient's choice to privilege quality of life due to the awareness of being affected by a genetic disease w...

The Spine Journal, 2014

A 36-year-old woman complained of mild low back pain and left sciatica at the first trimester of ... more A 36-year-old woman complained of mild low back pain and left sciatica at the first trimester of pregnancy, which worsened after delivery. A lumbar magnetic resonance imaging showed an L5‐S1 disc degeneration. Low back pain resolved after two epidural steroid injections, but she developed a refractory sciatica worsened by supine and sitting positions. Physically, the patient had pain and contracture over the left piriformis muscle. Straight Leg Raising test was negative. No neurologic deficits were detectable. A pelvic and hip magnetic resonance imaging scan revealed the presence of a varicosity of the left gluteal vein, which contacts and compresses the sciatic nerve just behind the left hip (Figure). The patient refused surgery and was managed by diet finalized to weight loss, physical therapy, and centrally acting muscle relaxants (pridinol mesylate) with complete resolution of the symptoms in 1 month. The presence of an atypical sciatica in the absence of low back pain is a clinical challenge and should rise the suspect of an extraspinal disease such as gluteal varicosity [1‐3].

Riassunto Obiettivo di questo articolo di aggiornamento è la descrizione degli standard attuali d... more Riassunto Obiettivo di questo articolo di aggiornamento è la descrizione degli standard attuali di terapia nel trattamento delle spondilodisciti (SD), sottolineando il trattamento farmacologico, i principi e le indi-cazioni per il trattamento ortesico e per la chirurgia. Ad oggi, il trattamento conservativo delle SD si basa sulla terapia antibiotica mirata assieme al trattamento ortesico, ed è la base del trattamento delle spondilodisciti. Una diagnosi adeguata ed un trattamento personalizzato possono migliorare i quadri clinici e diminuire le probabilità di fallimento del trattamento. Il trattamento chirurgico dovreb-be essere una opzione riservata solo per i pazienti che presentano complicanze delle SD: deformità e compressione mieloradicolare, con deterioramento neurologico. Contribuiscono ad un migliore trattamento delle SD i recenti sviluppi nel campo della diagnostica radiologica, e l'uso di fattori di crescita e terapie cellulari per promuovere l'eradicazione delle in...

Recent studies have been reported that angiogenesis suppression may play a role in developing bis... more Recent studies have been reported that angiogenesis suppression may play a role in developing bisphosphonate-related osteonecrosis of the jaw (B-ONJ). According to these evidence we evaluated the role of VEGF as predictive marker of B-ONJ onset. Of the 81 patients, 6 developed B-ONJ following bisphosphonate treatment. These patients showed a strongest decrease in VEGF circulating levels at day 7 and at day 21 after the first administration. These data demonstrated for the first time that the anti-angiogenic properties of bisphosphonates are directly linked to B-ONJ pathogenesis and serum VEGF levels could represent an effective early predictive marker.

License, which permits unrestricted use, distribution, and reproduction in any medium, provided t... more License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Intervertebral disc degeneration (IVD) is a frequent pathological condition. Conservative management often fails, and patients with IVD degeneration may require surgical intervention. Several treatment strategies have been proposed, although only surgical discectomy and arthrodesis have been proved to be predictably effective. The aim of biological strategies is to prevent and manage IVD degeneration, improve the function, the anabolic and reparative capabilities of the nucleus pulposus and annulus fibrosus cells, and inhibit matrix degradation. At present, clinical applications are still in their infancy. Further studies are required to clarify the role of mesenchymal stem cells and gene therapy for the prevention and treatment of IVD degeneration. 1.

European Spine Journal, 2014

Purpose Aim of this study is to estimate the risk for symptomatic adjacent segment degeneration (... more Purpose Aim of this study is to estimate the risk for symptomatic adjacent segment degeneration (ASD) and examine the association between spino-pelvic parameters and ASD. Methods 22 patients operated upon by instrumented lumbar or lumbosacral spinal fusion and re-operated upon for ASD were enrolled in the study. 83 consecutive patients with the same surgery and never re-operated upon were the controls. Pelvic incidence, sacral slope (SS), pelvic tilt (PT), and lumbar lordosis were calculated. Results Patients with ASD had significantly lower SS (p = 0.005) and higher PT values (p \ 0.001). Patients with SS \39°or PT [21°, were at higher risk for symptomatic ASD (relative risk 1.73 for SS and 3.663 for PT). Conclusions In patients re-operated upon for ASD, pelvic retroversion and hyperlordosis are the main mechanisms of compensation for the unbalanced spine. Patients with PT above 21°and SS below 39°are at higher risk for symptomatic ASD.

European Journal of Orthopaedic Surgery & Traumatology, 1999

We report a rare case of macrodystrophia lipomatosis of the forefoot (and and 3rd toes) and discu... more We report a rare case of macrodystrophia lipomatosis of the forefoot (and and 3rd toes) and discuss the role of ultrasound and MRI studies in the diagnosis, the therapeutic indications and the surgical technique of correction of the malformation.

European journal of orthopaedic surgery & traumatology : orthopédie traumatologie, 2014

A trabecular metal screw has been suggested to treat avascular osteonecrosis of the femoral head.... more A trabecular metal screw has been suggested to treat avascular osteonecrosis of the femoral head. Non-surgical management with partial weight bearing can only be selected for early stages and very small lesions. Even in such cases, it has been proven to be ineffective in 80-90 % of patients. Conversely, the results with trabecular metal implants are not always clinically satisfactory, and some patients can show emerging pain and activity limitations that could require conversion to a total hip arthroplasty. Hereby we report the results of 6 patients who underwent this implant and describe the histopathology of the bone at the femoral neck and to speculate on the causes of complications encountered during arthroplasty surgery. The necrosis was stopped in 1 case, and 5 hips showed disease progression. Two protrusions of the screw apex were observed. In one case, rupture of the greater trochanter during prosthesis implant occurred. After trabecular metal implants for avascular osteonec...

Journal of Orthopaedics and Traumatology, 2004

Osteochondroma of the rib is not frequent and usually small and asymptomatic. Complications resul... more Osteochondroma of the rib is not frequent and usually small and asymptomatic. Complications result from mechanical interference with neighboring anatomical structures. Only 5 cases of spinal cord compression, 2 of brachial plexus paralysis and 7 of hemothorax in the pediatric and adolescent age have been reported in the literature. Malignant transformation is also possible. We report the case of a 17-year-old boy with osteochondroma of the third rib developing into the thoracic cavity. The irregular radiographic appearance of the lesion and the presence of local pain after the patient had reached skeletal maturity gave us the indication for surgical resection.

Orthopedic Clinics of North America, 2009

Thoracoscopy has been used worldwide for many years by thoracic surgeons. Despite a long learning... more Thoracoscopy has been used worldwide for many years by thoracic surgeons. Despite a long learning curve and technical demands of the procedure, thoracoscopy has several advantages, including better cosmesis, adequate exposure to all levels of the thoracic spine from T2 to L 1, better illumination and magnification at the site of surgery, less damage to the tissue adjacent to the surgical field, less morbidity when compared with standard thoracotomy in terms of respiratory problems, pain, blood loss, muscle and chest wall damages, consequent shorter recovery time, less postoperative pulmonary function impairment, and shorter hospitalization. Good results at short- and medium-term follow-up need to be confirmed at long-term follow-up.

The Spine Journal, 2014

A 36-year-old woman complained of mild low back pain and left sciatica at the first trimester of ... more A 36-year-old woman complained of mild low back pain and left sciatica at the first trimester of pregnancy, which worsened after delivery. A lumbar magnetic resonance imaging showed an L5‐S1 disc degeneration. Low back pain resolved after two epidural steroid injections, but she developed a refractory sciatica worsened by supine and sitting positions. Physically, the patient had pain and contracture over the left piriformis muscle. Straight Leg Raising test was negative. No neurologic deficits were detectable. A pelvic and hip magnetic resonance imaging scan revealed the presence of a varicosity of the left gluteal vein, which contacts and compresses the sciatic nerve just behind the left hip (Figure). The patient refused surgery and was managed by diet finalized to weight loss, physical therapy, and centrally acting muscle relaxants (pridinol mesylate) with complete resolution of the symptoms in 1 month. The presence of an atypical sciatica in the absence of low back pain is a clinical challenge and should rise the suspect of an extraspinal disease such as gluteal varicosity [1‐3].

Background: Spinal infections are an important clinical problem that often require aggressive med... more Background: Spinal infections are an important clinical problem that often require aggressive medical therapy, and sometimes even surgery. Known risk factors are advanced age, diabetes mellitus, rheumatoid arthritis, immunosuppression, alcoholism, long-term steroid use, concomitant infections, poly-trauma, malignant tumor, and previous surgery or invasive procedures (discography, chemonucleolysis, and surgical procedures involving or adjacent to the intervertebral disc space). The most common level of involvement is at the lumbar spine, followed by the thoracic, cervical and sacral levels: lesions at the thoracic spine tend to lead more frequently to neurological symptoms. Objective: The aim of the current paper is to describe current evidence-based standards of therapy in the management of SD by emphasizing pharmacological therapy and principles and indications for bracing and surgery.

Journal of Medical Ultrasonics, 2013

Schwannomas are benign encapsulated neoplasms of the peripheral nerve sheath. Clinical diagnosis ... more Schwannomas are benign encapsulated neoplasms of the peripheral nerve sheath. Clinical diagnosis is often difficult, and final diagnosis is usually based on histopathological findings. Imaging techniques, such as magnetic resonance imaging and ultrasonography, can be optimized to improve assessment prior to surgical treatment. The present case demonstrates that high-resolution sonography can be useful in assessing the underlying cause of median nerve pathology.

Spine, Jan 20, 2008

Human osteoblast cultures were exposed to a very low intensity static magnetic fields (SMF) to in... more Human osteoblast cultures were exposed to a very low intensity static magnetic fields (SMF) to investigate its effects on osteoblast growth and differentiation. Analysis of the effects of periprosthetic SMF on the growth and differentiation of human osteoblast cell cultures in vitro. The effects of pulsed electromagnetic fields (PEMF) on cell proliferation, especially in human osteoblast-like cells is well described, whereas few data are available on the effects of SMF on osteoblast cell culture. We previously demonstrated that the proliferation of human osteoblast cultures is reduced when cells are exposed to a continuous low intensity SMF comparable to the one that occurs around metal devices (Ti spinal implant) because of the generation of electric currents between the screw (Ti6Al4V) and the rod (Ti). Primary osteoblastic cells were isolated from a human femoral head. Osteoblast cultures were exposed to SMF and alkaline phosphatase activity was evaluated in the osteoblast cell c...

Journal of Spinal Disorders & Techniques, 2002

Sciatic pain caused by endometriosis of the sciatic nerve is an uncommon clinical finding and see... more Sciatic pain caused by endometriosis of the sciatic nerve is an uncommon clinical finding and seems to have been verified histologically in only a few cases. Patients complain of typical signs and symptoms of common sciatica that are cyclic in nature. Suggested compression of lumbar root or sciatic nerve or its plexus could be confirmed by electromyography, computed tomography, or magnetic resonance imaging, and by prompt response to hormonal suppression of ovarian function with regression of the radiologic findings. Patients often have required radical surgery with total hysterectomy and bilateral salpingo-oophorectomy. However, conservative surgery with excision of the endometriosis from the nerve can be successful in selected patients who wish to preserve reproductive function. We report a case of sciatic nerve involvement explored by magnetic resonance imaging, with endometriosis in contact with the nerve in the right sciatic trunk.

Expert Review of Anticancer Therapy, 2013

The purpose of this article is to outline the current approach to patients affected by metastasis... more The purpose of this article is to outline the current approach to patients affected by metastasis to the spine and to present a clinical and surgical algorithm available for clinicians and for future research. A modern approach to the patients affected by spinal metastasis in fact requires a multidisciplinary contest where oncologists, radiotherapists, surgeons and physical therapists cooperate with shared vision to provide the best possible integrated treatments available. The authors of this article constitute the Bone Metastasis Study Group of the Italian Orthopaedic Society (SIOT): a national group of orthopedic tumor surgeons who are dedicated to studying the approach, techniques and outcomes of surgery for metastatic tumors of the musculoskeletal system.

Current Medical Research and Opinion, 2012

Spinal infections are an important clinical problem that often require aggressive medical therapy... more Spinal infections are an important clinical problem that often require aggressive medical therapy, and sometimes even surgery. Known risk factors are advanced age, diabetes mellitus, rheumatoid arthritis, immunosuppression, alcoholism, long-term steroid use, concomitant infections, poly-trauma, malignant tumor, and previous surgery or invasive procedures (discography, chemonucleolysis, and surgical procedures involving or adjacent to the intervertebral disc space). The most common level of involvement is at the lumbar spine, followed by the thoracic, cervical and sacral levels: lesions at the thoracic spine tend to lead more frequently to neurological symptoms. The aim of the current paper is to describe current evidence-based standards of therapy in the management of SD by emphasizing pharmacological therapy and principles and indications for bracing and surgery. A PubMed and Google Scholar search using various forms and combinations of the key words: spondylodiscitis, spine, infection, therapy, surgery, radiology, treatment. Reference citations from publications identified in the literature search were reviewed. Publications highlighted in this article were extracted based on relevancy to established, putative, and emerging diagnostic and therapeutic standards, either conservative (antibiotic therapy and bracing) or surgical. To date, conservative therapy, based on targeted antibiotic therapy plus bracing, represents the mainstay in the management of SD. Proper diagnosis and tailored therapy can improve clinical results and decrease the chance of failure. Surgery should be an option only for patients with complications of this disease, namely deformity, neural compression and neurological compromise. Current standards in the setting of SD are continuously evolving, as can be seen in the recent advances in the field of radiological diagnostics, and the use of growth factors and cell-therapy strategies to promote infection eradication and bone healing after surgery.

Journal of experimental & clinical cancer research : CR, 2007

Von Hippel-Lindau disease is a rare autosomic dominant hereditary tumoral syndrome characterized ... more Von Hippel-Lindau disease is a rare autosomic dominant hereditary tumoral syndrome characterized by mutation of the VHL gene. Here follows the first reported case of a patient (20 year old male) affected by Von Hippel-Lindau (VHL) disease, was referred to our Department because of the occurrence of a hard lump at the right aspect of the pelvis, who presented a primary mildly differentiated chondrosarcoma of the right iliac wing (confirmed by CT scan). Chondrosarcoma of the iliac wing, treated by surgical resection and reconstruction of the pelvis with appropriately shaped bone allograft fixed with plates and screws. At one year follow-up, the patient shows no signs of recurrence. Conventional treatment for chondrosarcoma of the iliac wing would be either wide or radical resection (hemipelvectomy), or amputation. The described treatment is unusual in that it is dependent on patient's choice to privilege quality of life due to the awareness of being affected by a genetic disease w...

The Spine Journal, 2014

A 36-year-old woman complained of mild low back pain and left sciatica at the first trimester of ... more A 36-year-old woman complained of mild low back pain and left sciatica at the first trimester of pregnancy, which worsened after delivery. A lumbar magnetic resonance imaging showed an L5‐S1 disc degeneration. Low back pain resolved after two epidural steroid injections, but she developed a refractory sciatica worsened by supine and sitting positions. Physically, the patient had pain and contracture over the left piriformis muscle. Straight Leg Raising test was negative. No neurologic deficits were detectable. A pelvic and hip magnetic resonance imaging scan revealed the presence of a varicosity of the left gluteal vein, which contacts and compresses the sciatic nerve just behind the left hip (Figure). The patient refused surgery and was managed by diet finalized to weight loss, physical therapy, and centrally acting muscle relaxants (pridinol mesylate) with complete resolution of the symptoms in 1 month. The presence of an atypical sciatica in the absence of low back pain is a clinical challenge and should rise the suspect of an extraspinal disease such as gluteal varicosity [1‐3].

Riassunto Obiettivo di questo articolo di aggiornamento è la descrizione degli standard attuali d... more Riassunto Obiettivo di questo articolo di aggiornamento è la descrizione degli standard attuali di terapia nel trattamento delle spondilodisciti (SD), sottolineando il trattamento farmacologico, i principi e le indi-cazioni per il trattamento ortesico e per la chirurgia. Ad oggi, il trattamento conservativo delle SD si basa sulla terapia antibiotica mirata assieme al trattamento ortesico, ed è la base del trattamento delle spondilodisciti. Una diagnosi adeguata ed un trattamento personalizzato possono migliorare i quadri clinici e diminuire le probabilità di fallimento del trattamento. Il trattamento chirurgico dovreb-be essere una opzione riservata solo per i pazienti che presentano complicanze delle SD: deformità e compressione mieloradicolare, con deterioramento neurologico. Contribuiscono ad un migliore trattamento delle SD i recenti sviluppi nel campo della diagnostica radiologica, e l'uso di fattori di crescita e terapie cellulari per promuovere l'eradicazione delle in...

Recent studies have been reported that angiogenesis suppression may play a role in developing bis... more Recent studies have been reported that angiogenesis suppression may play a role in developing bisphosphonate-related osteonecrosis of the jaw (B-ONJ). According to these evidence we evaluated the role of VEGF as predictive marker of B-ONJ onset. Of the 81 patients, 6 developed B-ONJ following bisphosphonate treatment. These patients showed a strongest decrease in VEGF circulating levels at day 7 and at day 21 after the first administration. These data demonstrated for the first time that the anti-angiogenic properties of bisphosphonates are directly linked to B-ONJ pathogenesis and serum VEGF levels could represent an effective early predictive marker.

License, which permits unrestricted use, distribution, and reproduction in any medium, provided t... more License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Intervertebral disc degeneration (IVD) is a frequent pathological condition. Conservative management often fails, and patients with IVD degeneration may require surgical intervention. Several treatment strategies have been proposed, although only surgical discectomy and arthrodesis have been proved to be predictably effective. The aim of biological strategies is to prevent and manage IVD degeneration, improve the function, the anabolic and reparative capabilities of the nucleus pulposus and annulus fibrosus cells, and inhibit matrix degradation. At present, clinical applications are still in their infancy. Further studies are required to clarify the role of mesenchymal stem cells and gene therapy for the prevention and treatment of IVD degeneration. 1.

European Spine Journal, 2014

Purpose Aim of this study is to estimate the risk for symptomatic adjacent segment degeneration (... more Purpose Aim of this study is to estimate the risk for symptomatic adjacent segment degeneration (ASD) and examine the association between spino-pelvic parameters and ASD. Methods 22 patients operated upon by instrumented lumbar or lumbosacral spinal fusion and re-operated upon for ASD were enrolled in the study. 83 consecutive patients with the same surgery and never re-operated upon were the controls. Pelvic incidence, sacral slope (SS), pelvic tilt (PT), and lumbar lordosis were calculated. Results Patients with ASD had significantly lower SS (p = 0.005) and higher PT values (p \ 0.001). Patients with SS \39°or PT [21°, were at higher risk for symptomatic ASD (relative risk 1.73 for SS and 3.663 for PT). Conclusions In patients re-operated upon for ASD, pelvic retroversion and hyperlordosis are the main mechanisms of compensation for the unbalanced spine. Patients with PT above 21°and SS below 39°are at higher risk for symptomatic ASD.

European Journal of Orthopaedic Surgery & Traumatology, 1999

We report a rare case of macrodystrophia lipomatosis of the forefoot (and and 3rd toes) and discu... more We report a rare case of macrodystrophia lipomatosis of the forefoot (and and 3rd toes) and discuss the role of ultrasound and MRI studies in the diagnosis, the therapeutic indications and the surgical technique of correction of the malformation.

European journal of orthopaedic surgery & traumatology : orthopédie traumatologie, 2014

A trabecular metal screw has been suggested to treat avascular osteonecrosis of the femoral head.... more A trabecular metal screw has been suggested to treat avascular osteonecrosis of the femoral head. Non-surgical management with partial weight bearing can only be selected for early stages and very small lesions. Even in such cases, it has been proven to be ineffective in 80-90 % of patients. Conversely, the results with trabecular metal implants are not always clinically satisfactory, and some patients can show emerging pain and activity limitations that could require conversion to a total hip arthroplasty. Hereby we report the results of 6 patients who underwent this implant and describe the histopathology of the bone at the femoral neck and to speculate on the causes of complications encountered during arthroplasty surgery. The necrosis was stopped in 1 case, and 5 hips showed disease progression. Two protrusions of the screw apex were observed. In one case, rupture of the greater trochanter during prosthesis implant occurred. After trabecular metal implants for avascular osteonec...

Journal of Orthopaedics and Traumatology, 2004

Osteochondroma of the rib is not frequent and usually small and asymptomatic. Complications resul... more Osteochondroma of the rib is not frequent and usually small and asymptomatic. Complications result from mechanical interference with neighboring anatomical structures. Only 5 cases of spinal cord compression, 2 of brachial plexus paralysis and 7 of hemothorax in the pediatric and adolescent age have been reported in the literature. Malignant transformation is also possible. We report the case of a 17-year-old boy with osteochondroma of the third rib developing into the thoracic cavity. The irregular radiographic appearance of the lesion and the presence of local pain after the patient had reached skeletal maturity gave us the indication for surgical resection.

Orthopedic Clinics of North America, 2009

Thoracoscopy has been used worldwide for many years by thoracic surgeons. Despite a long learning... more Thoracoscopy has been used worldwide for many years by thoracic surgeons. Despite a long learning curve and technical demands of the procedure, thoracoscopy has several advantages, including better cosmesis, adequate exposure to all levels of the thoracic spine from T2 to L 1, better illumination and magnification at the site of surgery, less damage to the tissue adjacent to the surgical field, less morbidity when compared with standard thoracotomy in terms of respiratory problems, pain, blood loss, muscle and chest wall damages, consequent shorter recovery time, less postoperative pulmonary function impairment, and shorter hospitalization. Good results at short- and medium-term follow-up need to be confirmed at long-term follow-up.

The Spine Journal, 2014

A 36-year-old woman complained of mild low back pain and left sciatica at the first trimester of ... more A 36-year-old woman complained of mild low back pain and left sciatica at the first trimester of pregnancy, which worsened after delivery. A lumbar magnetic resonance imaging showed an L5‐S1 disc degeneration. Low back pain resolved after two epidural steroid injections, but she developed a refractory sciatica worsened by supine and sitting positions. Physically, the patient had pain and contracture over the left piriformis muscle. Straight Leg Raising test was negative. No neurologic deficits were detectable. A pelvic and hip magnetic resonance imaging scan revealed the presence of a varicosity of the left gluteal vein, which contacts and compresses the sciatic nerve just behind the left hip (Figure). The patient refused surgery and was managed by diet finalized to weight loss, physical therapy, and centrally acting muscle relaxants (pridinol mesylate) with complete resolution of the symptoms in 1 month. The presence of an atypical sciatica in the absence of low back pain is a clinical challenge and should rise the suspect of an extraspinal disease such as gluteal varicosity [1‐3].