Publications by authors named "Matias Petracchi"

12 Publications

  • Page 1 of 1

Symptomatic Atlas Hypoplasia in a Latin-American Patient: Case Report and Literature Review.

J Am Acad Orthop Surg Glob Res Rev 2021 May 4;5(5):e21.00041. Epub 2021 May 4.

From the Hospital Italiano de Buenos Aires, Spinal Pathology Service, Almagro, CABA, Argentina. Orthopedic Institute "Prof. Dr. Carlos E. Ottolengui", Adult Spine Pathology Service, Hospital Italiano de Buenos Aires, CABA, Argentina.

Background: Atlas hypoplasia is an infrequent cause of upper cervical stenosis. Only 24 cases in nonsyndromic adult population have been published. We are not aware of previous reports describing isolated fully formed atlas hypoplasia in a Latin-American patient. The purpose of this work was to report a case of an 80-year-old Argentinian woman with cervical myelopathy because of atlas hypoplasia and a literature review about this subject.

Methods: A clinical case and an extended review of the literature are presented. We assessed from each case: age, sex, posterior atlanto-dens interval, surgical treatment, outcomes, and follow-up period.

Results: Neurologic symptoms markedly improved after posterior decompression from severe to moderate in the Japanese Orthopaedic Association Scoring System and from four to three on the Nurick scale. Twenty-five patients were analyzed (mean 58.4 years, 32% female). The mean posterior atlanto-dens interval was 8.8 mm. Twenty-three patients underwent decompression alone, and two needed posterior fusion. All patients reported clinical improvement at an average follow-up of 13 months.

Conclusion: Cervical myelopathy caused by fully formed atlas hypoplasia is not an exclusive pathology of far east population, and it may present in nonsyndromic patients. Surgical treatment by C1 laminectomy improved neurologic impairment.

Study Design: Case report and literature review.
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http://dx.doi.org/10.5435/JAAOSGlobal-D-21-00041DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8099396PMC
May 2021

La Frailty as a predictor index in spine surgery

Rev Fac Cien Med Univ Nac Cordoba 2021 03 12;78(1):9-16. Epub 2021 Mar 12.

Hospita Italiano de Buenos Aires.

Introduction: Frailty is a term used to quantify the physiological age of patients. Higher levels of frailty correlate with higher complications and mortality rates after different surgical procedures. The objective of this work is to evaluate the relationship between frailty and the complications and mortality rates after elective spinal surgeries within 90 days.

Material And Methods: A retrospective observational analytical study of patients older than 18 years with elective spine surgery was performed. The following variables were analyzed differentially according to their Modified Frailty Index (mFI) with a cut-off point of 0,18: age, sex, body mass index, ASA score, details of the procedures, length of stay, complications, unscheduled rehospitalizations, reoperations, and mortality within 90 postoperative days.

Results: 257 patients were included. Within the 30 complications, 16 occurred in the non-frail group (8%) and 14 in frail patients (24.5%), (p = 0.02). Six complications were infectious in the group of frail patients (10.5%) and 4 in the non-frail patients (2%), (p = 0.009). No significant differences were detected regarding the duration of surgeries, the length of stay or the reoperations, re-hospitalizations or mortality rates.

Conclusion: Patients with a modified Frailty Index ≥0,18 who underwent elective spine surgery were 3 times more likely to present complications, particularly, infectious ones.
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http://dx.doi.org/10.31053/1853.0605.v78.n1.30371DOI Listing
March 2021

Chylothorax, a rare complication after anterior lumbar interbody fusion. Case report

Rev Fac Cien Med Univ Nac Cordoba 2020 12 21;77(4):381-384. Epub 2020 Dec 21.

Hospital Italiano de Buenos Aires.

Introduction: Chylous leakage into the retroperitoneum is a rare complication after spinal surgery using an anterior retroperitoneal approach. Chylothorax is the presence of lymphatic fluid in the pleural cavity and it is even less frequent during these surgeries. The aim of this work is to report the first case of isolated left chylothorax after a retroperitoneal Left Oblique Lumbar Interbody Fusion in supine position in an adult female patient.

Case: A female 30-years-old patient underwent L4-L5 anterior interbody fusion. Four days after the intervention she was diagnosed with isolated left chylothorax that was drained and treated conservatively with good outcomes.

Conclusion: Chylothorax is an extremely rare complication after anterior lumbar spine procedures, and it is usually secondary to a chyloretroperitoneum. We present a unique case of isolated chylothorax after anterior retroperitoneal lumbar approach successfully treated in a conservative manner. Key Words chylothorax; spine; lumbosacral region; arthrodesis.
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http://dx.doi.org/10.31053/1853.0605.v77.n4.27982DOI Listing
December 2020

Development of a New Therapy-Oriented Classification of Intervertebral Vacuum Phenomenon With Evaluation of Intra- and Interobserver Reliabilities.

Global Spine J 2021 May 13;11(4):480-487. Epub 2020 Mar 13.

Institute of Orthopedics "Carlos E. Ottolenghi" 37533Hospital Italiano de Buenos Aires, Buenos Aires, Argentina.

Study Design: Diagnostic study, level of evidence III.

Objectives: Low back pain is a common cause of disability among elderly patients. Percutaneous discoplasty has been developed as a tool to treat degenerative disease when conservative management is not successful. Indications for this procedure include low back pain and the presence of vacuum phenomenon. The objective of this study was to describe a new classification of vacuum phenomenon based on computed tomography scan in order to improve the indications for percutaneous discoplasty.

Methods: We developed a classification of vacuum phenomenon based on computed tomography scan images. We describe 3 types of vacuum based on the relationship between vacuum and the superior/inferior endplates and 2 subtypes based on the presence of significant subchondral sclerosis. A validation study was conducted selecting 10 orthopedic residents with spine surgery training to analyze 25 vacuum scenarios. Inter- and intraobserver reliabilities were assessed through the Fleiss's and Cohen's kappa statistics, respectively.

Results: The overall Fleiss's κ value for interobserver reliability was 0.85 (95% CI 0.82-0.86) in the first reading and 0.93 (95% CI 0.92-0.95) in the second reading. Cohen's κ for intraobserver reliability was 0.88 (95% CI 0.77-0.99).

Conclusion: The new classification has shown almost perfect inter- and intraobserver reliabilities for grading the vacuum phenomenon and could be an important tool to improve the indications for percutaneous cement discoplasty.
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http://dx.doi.org/10.1177/2192568220913006DOI Listing
May 2021

Percutaneous Cement Discoplasty for the Treatment of Advanced Degenerative Disc Conditions: A Case Series Analysis.

Global Spine J 2020 Sep 6;10(6):729-734. Epub 2019 Sep 6.

Hospital Italiano de Buenos Aires, Buenos Aires, Argentina.

Study Design: Retrospective analysis. Level of evidence III.

Objectives: To describe the results after a minimum 1-year follow-up in patients treated with percutaneous discoplasty (PD), a minimally invasive technique to treat low back pain in elderly patients with advanced degenerative disc disease. The procedure consists in improving stability by injecting bone cement in a severely degenerated pneumodisc. There are few reports in the literature about this technique.

Methods: Fifty-four patients with advanced disc disease with/without degenerative scoliosis treated with PD with at least 1 year follow-up were studied, variables included clinical (visual analogue scale [VAS] and Owestry Disability Index [ODI]) and radiological parameters (lumbar lordosis and Cobb angle), as well as hospital length of stay and complications.

Results: At 1-year postoperation, significant pain reduction (VAS: preoperative 7.8 ± 0.90; postoperative 4.4 ± 2.18) and improvement in the ODI (preoperative 62 ± 7.12; postoperative 36.2 ± 15.47) were observed with partial correction of radiological parameters (5° mean increase in lumbar lordosis and decrease in Cobb angle). Mean surgical time was 38 minutes, and the mean length of hospital stay was 1.2 days.

Conclusion: PD, currently not a very well-known technique, appears to be-at least in the short-term follow-up-an effective treatment option in selected cases with low back pain due to advanced degenerative disc disease.
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http://dx.doi.org/10.1177/2192568219873885DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7383797PMC
September 2020

Short-term complication rate following orthopedic surgery in a tertiary care center in Argentina.

SICOT J 2018 29;4:26. Epub 2018 Jun 29.

Hospital Italiano de San Justo "Agustin Rocca", Buenos Aires, Argentina.

Introduction: Registration of adverse events following orthopedic surgery has a critical role in patient safety and has received increasing attention. The purpose of this study was to determine the prevalence and severity of postoperative complications in the department of orthopedic unit in a tertiary hospital.

Methods: A retrospective review from the postoperative complication registry of a cohort of consecutive patients operated in the department of orthopedic surgery from May 2015 to June 2016 was performed. Short-term complications (3 months after surgery), age gender, types of surgery (elective, scheduled urgency, non-scheduled urgency, and emergency), operative time, surgical start time (morning, afternoon or evening), American Society of Anesthesiologists score and surgeon's experience were assessed. Complications were classified based on their severity according to Dindo-Clavien system: Grade I complications do not require alterations in the postoperative course or additional treatment; Grade II complications require pharmacological treatment; Grade III require surgical, endoscopic, or radiological interventions without (IIIa) or with (IIIb) general anesthesia; Grade IV are life-threatening with single (IVa) or multi-organ (IVb) dysfunction(s), and require ICU management; and Grade V result in death of the patient. Complications were further classified in minor (Dindo I, II, IIIa) and major (Dindo IIIb, IVa, IVb and V), according to clinical severity.

Results: 1960 surgeries were performed. The overall 90-day complication rate was 12.7% (249/1960). Twenty-three complications (9.2 %) were type I, 159 (63.8%) type II, 9 (3.6%) type IIIa, 42 (16.8%) type IIIb, 7 (2.8%) type IVa and 9 (3.6%) were grade V according to Dindo-Clavien classification (DCC). The most frequent complication was anemia that required blood transfusion (27%) followed by wound infection (15.6%) and urinary tract infection (6%).

Discussion: The overall complication rate after orthopedic surgery in our department was 12.7%. The implementation of the DCC following orthopedic surgery was an important tool to measure the standard of care.
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http://dx.doi.org/10.1051/sicotj/2018027DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6024591PMC
June 2018

Percutaneous cement discoplasty for the treatment of advanced degenerative disk disease in elderly patients.

Eur Spine J 2018 Mar 23. Epub 2018 Mar 23.

Orthopaedic and Traumatology Department, Institute of Orthopedics "Carlos E. Ottolenghi", Hospital Italiano de Buenos Aires, Potosi, 4215, Buenos Aires, Argentina.

Purpose: The authors describe a percutaneous technique to treat advanced degenerative disk disease in elderly patients.

Method: A step-by-step technical description based on our experience in selected cases.

Result: Postoperative imaging results are presented as well as indications and recommendations.

Conclusion: Percutaneous discoplasty can result as an alternative minimal invasive strategy for the treatment of advanced degenerative disk disease.
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http://dx.doi.org/10.1007/s00586-018-5547-7DOI Listing
March 2018

Monosegmental combined anterior posterior instrumentation for the treatment of a severe lumbar tuberculous spondylodiscitis: case report and literature review.

Rev Bras Ortop 2017 Nov-Dec;52(6):735-739. Epub 2016 Dec 29.

Italian Hospital of Buenos Aires, Institute of Orthopedics "Carlos E. Ottolenghi", Buenos Aires, Argentina.

Spinal tuberculosis (Pott disease) can produce severe deformities when it is not properly treated. Long instrumentations through single or combined double approaches are usually required to prevent and correct the deformity. The authors present a case of severe deformity secondary to tuberculous spondylodiscitis in the lumbar spine treated with a monosegmental instrumentation through a double approach in a patient with idiopathic scoliosis. Deformity correction and infection resolution through debridement and arthrodesis is observed after one year of follow-up.
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http://dx.doi.org/10.1016/j.rboe.2016.12.010DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5720846PMC
December 2016

Usefulness of Tokuhashi Score in Survival Prediction of Patients Operated for Vertebral Metastatic Disease.

Global Spine J 2017 May 11;7(3):260-265. Epub 2017 Apr 11.

Italian Hospital of Buenos Aires, Buenos Aires, Argentina.

Study Design: Retrospective study.

Objective: Spinal metastasis can produce pain, deformity, neurological compromise and can decrease life expectancy. Surgical management is usually indicated for pain control, neurological decompression, and to avoid deformity progression. Tokuhashi et al created a scoring system to estimate survival and stratify surgical treatment based on established parameters. Our objective was to evaluate the usefulness of Tokuhashi scoring (TS) system by comparing the predicted and real survival times and analyze the survival time according to the type of tumor.

Methods: From 2004 to 2014, 105 patients with vertebral metastasis who underwent surgical treatment were enrolled and retrospectively analyzed. Preoperative TS was performed in all cases. Patients were classified into 3 groups according to TS; group 1 (TS 0-8), group 2 (TS 9-11), and group 3 (TS 12-15). Patients' average age was 61.5 years, main primary tumor site were as follows: kidney (23%), lung (19%), and breast (18%).

Results: The Tokuhashi general concordance was 67.6%. Per group concordance was as follows: group 1 80%, in group 2, only 33% of concordance was observed. In group 3, 100% of concordance was observed. In group 2, the most common primary sites were breast and kidney and the mean survival was 20 and 22.3 months, respectively, both longer than that expected for this group.

Conclusions: Tokuhashi concordance was acceptable in our study, particularly in lower and higher scores. The lesser concordance observed in group 2 (33.3%) was observed in almost all tumors. For our practice, TS constitutes an acceptable tool to define survival, particularly in lower and higher scores.
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http://dx.doi.org/10.1177/2192568217699186DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5476355PMC
May 2017

Use of CT-guided periradicular injection for the treatment of foraminal and extraforaminal disc herniations.

Evid Based Spine Care J 2011 Aug;2(3):19-24

Hospital Italiano of Buenos Aires, Potosi 4215, Buenos Aires, Argentina.

Study Design:  Retrospective case series. Evidence level IV.

Objectives:  To evaluate surgical candidates with foraminal or extraforaminal lumbar disc herniation treated with CT-guided periradicular injection (CTGPI) as a valid treatment option for avoiding surgery.

Methods:  We carried out a retrospective evaluation of 46 consecutive patients with foraminal or extraforaminal disc herniation treated with CTGPI. CTGPI was performed only when radicular pain could not be controlled, or in patients who continued requiring pain medication following an acute episode and whose radicular pain precluded them from resuming their daily activities. Forty-six patients with a minimum 2-year follow-up met the inclusion criteria. There were 21 women and 25 men, with a mean age of 47 years.

Results:  At 1 month after injection, 41 (89%) patients experienced a decrease in radicular pain; 3 experienced no change; and 2 had received surgical treatment. At the final follow-up visit (mean, 74 months) 6 additional patients underwent surgery while 38 (83%) did not require surgery. Pain level comparison between pre-injection and last examination showed that low back pain had decreased a mean of 5 points and radicular pain diminished a mean of 7 points. Twenty-two (58%) of the 38 nonoperated patients had no pain at all and 35 patients had resumed their normal daily activities. No complications were recorded.

Conclusion:  Based on these results, we consider that the use of CTGPI is a reliable alternative before surgery for patients with foraminal or extraforaminal disc herniation without severe motor deficit but with intractable radicular pain. [Table: see text].
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http://dx.doi.org/10.1055/s-0030-1267109DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3604759PMC
August 2011

The influence of anatomy (normal versus scoliosis) on the free-hand placement of pedicle screws: Is misplacement more frequent in patients with anatomical deformity?

Evid Based Spine Care J 2010 Aug;1(2):11-7

Italian Hospital of Buenos Aires, Buenos Aires, Argentina.

Study Design:  Retrospective prognostic study.

Objective:  To evaluate whether patients with anatomical deformity due to scoliosis have a higher frequency of inaccurate pedicle screw insertion and related complications using the free-hand technique compared with those whose normal anatomy had been impacted by trauma.

Methods:  Consecutively treated trauma patients with otherwise normal anatomy (48 patients instrumented with 291 screws, group A) and scoliosis patients (24 patients instrumented with 287 screws, group B) were evaluated. Screw position on CT was evaluated using the classification by Gertzbein and Robbins with modification by Karagoz Guzey. (See web appendix at www.aospine.org/ebsj for complete classification description.) Images were examined by two fellows and one junior staff member none of whom participated in patient management. Screw position was determined by consensus.

Results:  In group A, five (1.7%) out of 289 screws were severely misplaced and 26 (9%) screws caused either medial (3.8%) or lateral (5.2%) cortical breeches. The other 258 (89.3%) screws were fully contained within the cortical boundaries of the pedicle. In group B, seven (2.8%) out of 256 screws were severely misplaced. Thirty-three (13%) screws caused cortical breeches, either medial (9%), lateral (2%), or anterior (2%), and 216 (84.3%) screws were fully contained within the cortical boundaries of the pedicle and the vertebra. Neurological complications were reported in one patient with scoliosis. No vascular complications were reported in either group.

Conclusions:  The percentage of incorrectly placed screws was similar in both groups, trauma and deformity patients. The presence of vertebral anatomical changes related to adult scoliosis was not associated with an increase in the screw-related neurological or vascular complications. [Table: see text] The definiton of the different classes of evidence is available on page 73.
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http://dx.doi.org/10.1055/s-0028-1100909DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3623099PMC
August 2010

Displacement of a cemented polished tapered stem during closed reduction of a dislocated total hip arthroplasty--a case report.

Acta Orthop Scand 2002 Aug;73(4):475-7

Institute of Orthopaedics Carlos E Ottolenghi, Hospital Italiano de Buenos Aires, Argentina.

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http://dx.doi.org/10.1080/00016470216309 DOI Listing
August 2002