STUDY DESIGN: A retrospective study of radiographic parameters of patients who underwent lumbar spinal pedicle screw insertion.PURPOSE: The optimal length of pedicle screws is often determined by the lateral radiograph during minimally invasive surgery (MIS). Compared with open techniques, measuring the precise length of screws or assessing the cortical breach is challenging. This study aims to ascertain the optimal pedicle screw lengths on intraoperative lateral radiographs for L1–L5.OVERVIEW OF LITERATURE: Research has revealed that optimal pedicle screw length is essential to optimize fixation, especially in osteoporotic patients; however, it must be balanced against unintentional breach of the anterior cortex, risking injury to adjacent neurovascular structures as demonstrated by case reports.METHODS: We reviewed intra- and postoperative computed tomography scans of 225 patients who underwent lumbar pedicle screw insertion to ascertain which of the inserted screws were ‘optimal screws.’ The corresponding lengths of these screws were analyzed on postoperative lateral radiographs to ascertain the ideal position that a screw should attain (expressed as a percentage of the entire vertebral body length).RESULTS: We reviewed 880 screws of which 771 were optimal screws. We noted a decreasing trend in average optimal percentages of insertion into the vertebral body for pedicle screws going from L1 (average=87.60%) to L5 (average=78.87%). The subgroup analysis revealed that there was an increasing percentage of screws directed in a straight trajectory from L1 to L5, compared to a medially directed trajectory.CONCLUSIONS: During MIS pedicle screw fixation, this study recommends that pedicle screws should not exceed 85% of the vertebral body length on the lateral view for L1, 80% for L2–L4, and 75% for L5; this will minimize the risk of anterior cortical breach yet maximize pedicle screw purchase for fixation stability.
Humans ; Lumbar Vertebrae ; Minimally Invasive Surgical Procedures ; Pedicle Screws ; Radiography ; Retrospective Studies

Overexpression of human epidermal growth factor receptor-2 (HER2) in metastatic breast cancer (MBC) is associated with poor prognosis. This single-arm open-label trial (EGF109491; NCT00508274) was designed to confirm the efficacy and safety of lapatinib in combination with capecitabine in 52 heavily pretreated Chinese patients with HER2-positive MBC. The primary endpoint was clinical benefit rate (CBR). Secondary endpoints included progression-free survival (PFS), time to response (TTR), duration of response (DoR), central nervous system (CNS) as first site of relapse, and safety. The results showed that there were 23 patients with partial responses and 7 patients with stable disease, resulting in a CBR of 57.7%. The median PFS was 6.34 months (95% confidence interval, 4.93-9.82 months). The median TTR and DoR were 4.07 months (range, 0.03-14.78 months) and 6.93 months (range, 1.45-9.72 months), respectively. Thirteen (25.0%) patients had new lesions as disease progression. Among them, 2 (3.8%) patients had CNS disease reported as the first relapse. The most common toxicities were palmar-plantar erythrodysesthesia (59.6%), diarrhea (48.1%), rash (48.1%), hyperbilirubinemia (34.6%), and fatigue (30.8%). Exploratory analyses of oncogenic mutations of PIK3CA suggested that of 38 patients providing a tumor sample, baseline PIK3CA mutation status was not associated with CBR (P = 0.639) or PFS (P = 0.989). These data confirm that the lapatinib plus capecitabine combination is an effective and well-tolerated treatment option for Chinese women with heavily pretreated MBC, irrespective of PIK3CA status.
Adult ; Aged ; Antineoplastic Combined Chemotherapy Protocols ; adverse effects ; therapeutic use ; Asian Continental Ancestry Group ; Breast Neoplasms ; drug therapy ; genetics ; metabolism ; pathology ; Capecitabine ; Class I Phosphatidylinositol 3-Kinases ; Deoxycytidine ; administration & dosage ; adverse effects ; analogs & derivatives ; Diarrhea ; chemically induced ; Disease Progression ; Disease-Free Survival ; Exanthema ; chemically induced ; Female ; Fluorouracil ; administration & dosage ; adverse effects ; analogs & derivatives ; Hand-Foot Syndrome ; etiology ; Humans ; Middle Aged ; Mutation ; Neoplasm Staging ; Phosphatidylinositol 3-Kinases ; genetics ; Quinazolines ; administration & dosage ; adverse effects ; Receptor, ErbB-2 ; metabolism ; Remission Induction

Humans ; Encephalomyelitis, Acute Disseminated/complications* ; COVID-19/complications* ; SARS-CoV-2 ; Brain

INTRODUCTIONIntrathecal baclofen (ITB) therapy is a proven, effective treatment for disabling cortical spasticity. We describe the first local series of five patients with acquired brain injury (ABI) who received ITB and were followed up for 63.8 months.

METHODSA retrospective review of medical and rehabilitation records of patients who received ITB therapy was carried out. Data studied included baseline demographic and injury variables, implantation data, spasticity and function, ITB dosage over time and complications.

RESULTSFrom 2006 to 2010, a total of five patients received ITB therapy via implanted pumps about 39.4 months after ABI. Four out of five patients experienced significant reductions in their lower limb spasticity scores and improvements in global function and dependency. One patient had minor adverse events associated with baclofen-related sedation. The mean ITB dose at one year was 182.7 ± 65.6 mcg/day.

CONCLUSIONOur preliminary study showed encouraging long-term outcomes and safety for ITB therapy after ABI-related intractable spasticity. Individual ITB responses over time were variable, with gender differences. The outcomes experienced by our centre were comparable to those in the general ABI population, supporting the efficacy of ITB therapy for chronic disabling spasticity.

Baclofen ; administration & dosage ; Brain Injuries ; complications ; drug therapy ; Dose-Response Relationship, Drug ; Female ; Follow-Up Studies ; Humans ; Infusion Pumps, Implantable ; Injections, Spinal ; Male ; Muscle Relaxants, Central ; administration & dosage ; Muscle Spasticity ; diagnosis ; drug therapy ; etiology ; Retrospective Studies ; Severity of Illness Index ; Singapore ; epidemiology ; Tertiary Care Centers ; Treatment Outcome