Riccardo Raganato

Purpose Pedicle subtraction osteotomies (PSOs) are well-established for rigid sagittal deformities, but the efficacy and safety of biplanar PSOs (BiPSOs) remain uncertain. This study aims to evaluate whether BiPSOs compromise sagittal correction or elevate surgical morbidity or complication rates. Methods A retrospective analysis of a prospective multicentric adult spinal deformity database included patients who underwent a single Schwab-3/4 PSO with at least two years of follow-up. BiPSOs were defined by segmental angular changes (SAD) greater than 5° in both the sagittal and coronal planes, while uniplanar (UPSOs) had SAD greater than 5° in one plane. Demographic, surgical, and outcome variables were compared. Results The study included 33 BiPSOs and 123 UPSOs. No differences were found for baseline demographic characteristics. UPSOs were more common in patients with prior spinal surgery (57.6% vs. 80.5%) with less L4-S1 lordosis (29.5° vs. 22°), meanwhile BiPSOs’ patients showed worse preoperative coronal alignment (C7-SVL 37.2 vs. 25.2 mm) and greater Cobb angles (44.6° vs. 24°). Comparable coronal and sagittal alignment were obtained postoperatively according to C7-CSVL (19.1 vs. 17.0 mm) and GAP Score (5.1 vs. 5.6 points, − 48.6% vs. − 43.8%). Comparable surgical aggressiveness including surgical time, blood loss, or hospitalization stays was observed. Neurological complications were comparable between the groups (15.2% BiPSOs vs. 19.5% UPSOs), with no significant differences in motor deficits. Overall complication rates and patient-reported outcomes were comparable, though BiPSOs had higher satisfaction at final follow-up. Conclusions BiPSOs effectively treat rigid biplanar deformities, achieving optimal coronal correction without compromising sagittal alignment restoration or increasing surgical morbidity and neurological risks.

Background Mechanical complications after adult deformity surgery are typically considered as a composite variable. This study aims to differentiate their characteristics and analyze their behavioral patterns based on time-to-onset and predisposing factors. Methods This retrospective observational study analyzed patients from a prospective multicenter database. Operated patients were analyzed for proximal junctional kyphosis (PJK), proximal junctional failure (PJF), pseudarthrosis (PA), rod breakage (RB), and no complications. Kaplan–Meier survival analysis and multivariate Cox regression models encompassing clinical, biological, radiographic, and surgical parameters were utilized to identify complication-related factors. Results Among 1,505 patients analyzed, 260 (17.3%) developed mechanical complications: PJK (65), PJF (43), PA (56), and RB (96). Similar time-to-event patterns were observed for PJK and PJF (Log-Rank test p = 0.446) (160 days [Q1 = 72; Q3 = 492]), and PA and RB (Log-Rank test p = 0.782) (695 days [Q1 = 371; Q3 = 1059]), clustering them in pairs. Proximal junctional problems (PJK/PJF) and failure of fusion (PA/RB) demonstrated different survival curves (Log-Rank test p < 0.001). Multivariate models associated (p < 0.05) proximal junctional problems with age (OR = 1.039), SF36-PCS (OR = 0.963), number of instrumented levels (OR = 1.123), and immediate postoperative alignment (Relative Lumbar Lordosis [OR = 1.025] and Relative Spinopelvic Alignment [OR = 1.064]). Failure of fusion occurrence was associated (p < 0.05) with number of instrumented levels (OR = 1.127) and 1-year postoperative: age (OR = 1.017), body mass index (OR = 1.044), SF36-PCS (OR = 0.975) and Relative Spinopelvic Alignment (OR = 1.034). Conclusion Time-to-onset differed between proximal junctional problems and failure of fusion, and predisposing factors overlap. Nevertheless, the former was associated with immediate postoperative lumbar and global sagittal misalignment, the latter with mid-term biological factors and global sagittal misalignment.

Introduction Poor restoration of pelvic version after adult spinal deformity (ASD) surgery is associated with an increased risk of mechanical complications and worse quality of life. We studied the factors linked to the improvement of postoperative pelvic version. Materials and methods This is a retrospective analysis of a prospective multicenter ASD database. Selection criteria were: operated patients having preoperative severe pelvic retroversion as per GAP score (Relative Pelvic Version-RPV < − 15°); panlumbar fusions to the pelvis; 2-year follow-up. Group A comprised patients with any postoperative improvement of RPV score, and group B had no improvement. Groups were compared regarding baseline characteristics, surgical factors, and postoperative sagittal parameters. Parametric and non-parametric analyses were employed. Results 177 patients were studied, median age 67 years (61; 72.5), 83.6% female. Groups were homogeneous in baseline demographics, comorbidities, and preoperative sagittal parameters (p > 0.05). The difference in RPV improvement was 11.56º. Group A (137 patients) underwent a higher percentage of ALIF procedures (OR = 6.66; p = 0.049), and posterior osteotomies (OR = 4.96; p < 0.001) especially tricolumnar (OR = 2.31; p = 0.041). It also showed a lower percentage of TLIF procedures (OR = 0.45; p = 0.028), and posterior decompression (OR = 0.44; p = 0.024). Group A displayed better postoperative L4–S1 angle and relative lumbar lordosis (RLL), leading to improved sacral slope (and RPV), and global alignment (RSA). Group A patients had longer instrumentations (11.45 vs 10; p = 0.047) and hospitalization time (13 vs 11; p = 0.045). All postoperative sagittal parameters remained significantly better in group A through follow-up. However, differences between the groups narrowed over time. Conclusions ALIF procedures and posterior column osteotomies improved pelvic version postoperatively, and associated better L4–S1 and lumbar lordosis restoration, indirectly improving all other sagittal parameters. However, these improvements seemed to fade during the 2-year follow-up.

Adequate surgical management of malignant endometriosis remains a clinical challenge in gynecology. Age, sonography variables, and tumor biomarkers have been reported as candidates in the clinical decision. This study aims were to analyze the factors of women’s age, body mass index, ultrasound features, and tumor biomarkers to predict endometriosis-associated ovarian cancer in a large series of endometriomas and to study the surgical treatment performed in this cohort. In this retrospective study, we reviewed the medical records of patients with ultrasound diagnosis of ovarian cyst classified as endometrioma (benign as well as with risk of malignancy), surgically treated in the endometriosis unit of Hospital Universitario La Paz (Madrid, Spain) between January 2019 and July 2021. According to the final histology examination, the women were clustered as non-endometriosis-associated ovarian cancer (OE, benign endometriomas, n = 59) and endometriosis-associated ovarian cancer (EAOC) (n = 17). Demographic, clinical, and surgical data were collected from these women. International Ovarian Tumor Analysis (IOTA) criteria were assessed for the ultrasound examination. The age of the women in the EAOC group was 50.0 [43.0; 63.0] years, which was significantly higher than OE (39.0 [34.0; 46.0] years; p-value < 0.001). In addition, the body mass index for the OE group (24.9 ± 5.3 kg/m²) was significantly higher than for the EAOC group (23.3 ± 4.6 kg/m²; p-value < 0.001). However, the tumor biomarker levels (CA 125, CA 19.9 and He4) were not significantly different among the groups. We performed 51.4% cystectomies and 48.6% adnexectomies, with an association between the adnexectomy and EAOC group (p-value < 0.001). In addition, a significant association was found between ultrasound features suspicious for malignancy and the EAOC group. Conclusively, women’s age and ultrasound features, such as papillary projections, septa, and positive echo-Doppler, were the main factors to consider when evaluating the malignancy risk associated with endometriosis.

Background and purpose: The phenomenon of dementia amongst migrants and ethnic minorities represents an emerging concern for European healthcare systems, posing additional challenges in terms of clinical approach, access to care and resource utilization. The aim of the present study was to estimate the cases of dementia amongst immigrant older subjects living in Europe and in each European country.Methods: The estimated cases of dementia amongst older (i.e. 65+) migrants living in the European Union (EU‐28) and European Free Trade Association member states were calculated by multiplying the number of migrants (obtained through the data provided by Eurostat) with the age‐ and sex‐specific prevalence rates (derived by a recent meta‐analysis).Results: Overall, 6 507 360 older migrants lived in Europe in 2017. In addition, 1 204 671 migrants were registered in Germany in 2010. Nearly 475 000 dementia cases (329 028 women, 147 410 men) were estimated in this population by applying age‐ and sex‐specific prevalence rates. When considering each European country, the number of estimated cases ranged from 108 (Iceland) to 119 161 (France). In parallel, the proportion of dementia cases occurring in migrants ranged from 0.9% (Czech Republic) to 51.2% (Liechtenstein).Conclusions: The issue of dementia in migrants and ethnic minorities is emerging but already relevant for European healthcare systems. The magnitude of this phenomenon and its complexities reinforce the need for coordinated initiatives both at a national and continental level. These epidemiological data should ideally be integrated with those coming from ‘real world’ services in order to better calibrate these actions.

In the present study, we explored the relationship between multimorbidity and frailty in a population of older individuals with cognitive disturbances attending a memory clinic. All subjects consecutively attending the Memory Clinic of the Department of Human Neuroscience, “Sapienza” University of Rome, between January 2017 and April 2018 for a first neurological evaluation were considered for the present analysis. Multimorbidity was defined as the simultaneous presence of two or more diseases in the same individual. A Frailty Index was computed by considering 44 age-related, multidimensional health deficits. Overall, 185 subjects were recruited in the study. A condition of multimorbidity was detected in 87.6% of the sample, whereas only the 44.6% of the study population was considered as frail. A poor agreement was observed between multimorbidity and frailty. The present findings confirm that counting diseases or health deficits may provide discordant information concerning the risk profile of older subjects.