The Unit of Spine Surgery, operating at the Rizzoli Orthopaedic Institute since September 2009, is a division dedicated to the diagnosis and the treatment of rachis pathologies of oncologic, degenerative and post-traumatic origin. It is presently led by Dr. Alessandro Gasbarrini and is equipped with 12 beds.

The employed orthopedic surgeons have been trained at the Rizzoli Orthopedic Institute under the guidance of Prof. Mario Campanacci, Prof. Romolo Savini and Dr. Stefano Boriani, and have also performed extensive spine surgery activity at the Hospital “Maggiore” of Bologna.

Clinical activity

The clinical activity concerns the field of spinal column pathologies, particularly:

• Oncologic pathologies: primary and secondary tumors of the mobile rachis and the sacrum, hematopoietic tumors with vertebral localization;
• Degenerative pathologies: degenerative discopathy of the lumbo-sacral rachis, herniated lumbar disc, spondylolisthesis, thoracic-lumbar stenosis, herniated thoracic-rachis disc, pathologies of the cervical rachis;
• Deformities in adults;
• Traumatic fractures and insufficiency fractures (osteoporosis);
• Hematogenic spondylodiscites.

Along the years, numerous surgical techniques and innovative instrumentations have been introduced, developed and perfectioned, allowing to intervene effectively, through both radical and mini-invasive surgical procedures, depending on the case and on the treated pathology.

From 2009 to date, approximately 2500 surgical interventions have been performed at the Unit, 55% of which for oncological pathologies, 40% for degenerative pathologies, and 5% for traumas or hematogenic spondylodiscites.

Particularly in the last years, the Unit has hosted over 100 Vertebrectomies, a complex and radical intervention consisting in the removal of the vertebra affected by a tumor and in its reconstruction.

For the vertebral reconstruction, “custom-made” vertebral prostheses in titanium have been recently designed at our Structure, and realized in collaboration with the Technological Institute of the Canary Islands; created through a 3D printing process starting from the pre-operative CAT images of the patient, such prostheses present the advantages of a perfect adaptation to the patient’s anatomical structure, and of a reduction of surgical times. Their stability, compared to commercial prostheses, is under evaluation through a clinical study approved by the Ethical Committee of the IOR.

In parallel, several modern techniques of mini-invasive surgery have been developed and applied, allowing a percutaneous access for the insertion and fixing of peduncular screws in the rachis, the insertion of synthetic cement in a vertebra (vertebroplasty) and the abscission of both newly formed and older tissue, in case it compresses the nervous structures, possibly causing disabilities and/or pain.

These techniques allow to perform surgical interventions that are less burdensome for the patient, during both the procedure and the post-operative recovery; they can be applied to the treatment of several types of pathologies, both oncologic (palliative intervention, asportation of benign tumors) and degenerative (insufficiency fractures, herniated disc, degenerative discopathies).

A dissemination video (in Italian) was dedicated to the treatment of degenerative pathologies of the spinal column, addressing patients and non-specialist fellow doctors, having to evaluate this kind of pathology that are always more frequent among the population, due to the increase in average life expectancy.
The expertise gained along the years by the Equipe doctors have led to the development of diagnostic evaluation and therapeutic planning procedures, which are progressively perfectioned and updated:

• A staging system for primary tumors of the spinal column according to WBB (Weinstein-Biagini-Boriani);
• An evaluation system for vertebral instability in patients suffering from spinal tumors, especially metastases (SINS score);
• An algorithm for the management of vertebral metastases, providing a multi-disciplinary approach realized through the collaboration of our team with other teams of specialist oncologists and radiotherapists from different city hospital and structures;
• An algorithm for the treatment of spondylodiscites (infections of the spine column), also providing a multidisciplinary approach in strict collaboration with specialists in infectious diseases, and the utilization of modern diagnostic imaging techniques (PET-CAT);
• An accurate evaluation of hospitalized patients, and the planning of the programmed surgical interventions, through a daily, views-exchanging meeting among all Doctors of the team, together with nursing personnel and rehabilitation therapists;
• A collaboration with other therapeutic Centers in Bologna and in Italy (the Hospital “Maggiore” of Bologna for selective arterial embolization; the Hospital “Bellaria” and the General Hospital “S. Orsola” of Bologna for oncologic and radiotherapeutic treatments; the Center for Hadrontherapy – CNAO – of Pavia for hadrontherapy with carbonium ions, and so forth);
• The development of international relationships with the main Oncology and Spine Surgery centers (National Center for Spinal Disorders, Budapest; UMC Utrecht; Mayo Clinic, Rochester; MD Anderson Cancer Centre, Houston; Vancouver Spine Center; John Hopkins, Baltimore; Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire) and of surgical collaboration with numerous hospitals in Italy and abroad (Turin, Padua, Florence, Pisa, Catania, Narni, Campo S. Piero, Verona, Thiene, Giulianova, Modena, Udine, Munich, Murnai, Tutzing, Den Haag, Oviedo);
• The participation to international conventions and meetings, to remain at the forefront of therapeutic and surgical progresses.

Research activity

The Unit of Spine Surgery is the reference center for AOSpine International, a scientific association of vertebral surgeons gathering over 40.000 members worldwide, and favorite destination for all-around specialists for the study and in-depth analysis of the surgical techniques applied.
The scientific activity has consisted in over 100 publications from 2009 to 2017, and numerous participations to international conventions.

In the last few years, the Unit of Spine Surgery prevalently Oncologic and Degenerative has organized some conventions of relevant scientific interest under the aegis of the Rizzoli Orthopedic Institute:

• Theoretical-practical course for operating room personnel – Nursing Round, which has reached its 9th edition;
• Degenerative pathology of the rachis: which-how-when-why, IOR, Sept. 10th, 2015;
• Biomaterials and biotechnologies in orthopedic surgery. IOR, Feb. 17th, 2017.
• Patient’s safety in orthopedic surgery. Is this checklist any useful? IOR, Feb. 9th, 2018.   

In addition, starting from 2010, numerous spontaneous and sponsored clinical studies, both monocenter and multicenter, have been launched under the responsibilities of the Unit’s doctors, and approved by the IOR Ethical Committee: to date, accurate data are being collected through internal databases and international registries, offering a significant support to scientific research. In particular, the Division participates to the international multicenter Registry for the collection of data on primary tumors of the spinal column (PTRON) and to the international multicenter Registry for the collection of data on metastatic tumors of the spinal column (MTRON), both promoted by the international scientific Association AOSpine Foundation; to the international database for spinal column pathologies “SpineTango”, promoted by the International Association EuroSpine; to the international multicenter study promoted by the Italian Sarcoma Group on the comparison between surgical and radiotherapy treatment of the sacrum chordoma.