Adriana Palacio Giraldo

Background/Objectives: The perioperative management of a patient’s blood values involves the optimization of anemia management in the pre-, intra-, and postoperative periods to avoid blood transfusions. The purpose of this study was to determine the prevalence of pre- and postoperative anemia in patients undergoing elective knee and hip arthroplasty, and explore the change in hemoglobin levels in transfused and non-transfused patients over the course of their hospital stay. Methods: In this retrospective study, data on anemia-influencing factors were collected and examined using multiple regression analysis (OLS model) to determine if they are associated with the average hemoglobin change in 801 patients who underwent a primary knee or hip arthroplasty. The study group was screened for the prevalence of preoperative anemia, and the incidence of postoperative anemia was examined. Results: A total of 801 patients were retrospectively investigated. The length of stay for the two different procedures was significantly different (p < 0.001). There was a markedly higher transfusion rate in the cases requiring longer-than-usual hospital stays. In total, 37 patients (5%) received perioperative erythrocyte transfusions. Total hip replacement (THR) was associated with significantly more erythrocyte transfusions (8%) in comparison with total knee replacement (TKR) (2%) (p < 0.001). Conclusions: Satisfactory results for the prevalence and incidence of anemia in the context of primary knee or hip arthroplasties were obtained in this study. The collected values indicate the need for better implementation and awareness of the importance of adequate patient blood management.

Background: The advent of novel cancer therapies has significantly improved both life expectancy and quality of life for cancer patients. However, this has also led to an increased incidence of metastases, particularly spinal metastases, which pose a significant clinical challenge due to their potential to compromise spinal stability, mobility and neurological function. Objective: The aim of this study is to identify current symptom scores, determine the diagnosis, evaluate treatment modalities, and review prognostic scores and management algorithms for spinal metastases to aid in therapeutic decision making. Methods: A systematic literature review was conducted in PubMed focusing on available full-text review articles published in English between 1 January 2012 and 1 July 2022. The search terms were “spinal metastasis OR spinal metastases OR spine metastasis OR spine metastases AND treatment OR management”. Results: Several treatment algorithms, including NOMS (neurology, oncology, mechanical stability, and systemic disease) and LMNOP (localization, mechanical instability, neurology, oncology), have been proposed to guide clinical decision making. However, the development of prognostic scores that incorporate the impact of newer treatment modalities remains an important area of research. Conclusions: Effective management of spinal metastases requires a multidisciplinary approach, with emphasis on early diagnosis. Treatment decisions are individualized. Further research is essential to refine treatment strategies and improve patient outcomes.

Background: This study investigated the efficacy of stereotactic radiosurgery (SRS) in managing spinal metastasis. Traditionally, surgery was the primary approach, but SRS has emerged as a promising alternative. Objective: The study aims to evaluate the efficacy of stereotactic radiosurgery in the management of spinal metastasis in terms of local tumor control, patient survival, and quality of life, identifying both advantages and limitations of SRS. Methods: Through an extensive literature search in PubMed with cross-referencing, relevant full-text-available papers published between 2012 and 2022 in English or German were included. The search string used was “metastatic spine diseases AND SRS OR stereotactic radiosurgery”. Results: There is growing evidence of SRS as a precise and effective treatment. SRS delivers high radiation doses while minimizing exposure to critical neural structures, offering benefits like pain relief, limited tumor growth, and a low complication rate, even for tumors resistant to traditional radiation therapies. SRS can be a primary treatment for certain metastatic cases, particularly those without spinal cord compression. Conclusions: SRS appears to be a preferable option for oligometastasis and radioresistant lesions, assuming there are no contraindications. Further research is necessary to refine treatment protocols, determine optimal radiation dose and fractionation schemes, and assess the long-term effects of SRS on neural structures.