Remote cerebellar haemorrhage after lumbar spine surgery: case report.

Remote cerebellar haemorrhage (RCH) is a well-described complication of supratentorial surgical procedures with an incidence ranging between 0.2 and 4.9 %, but is a rare complication of spinal surgery. We report a case of RCH in a 65-year-old woman who showed sudden mental deterioration 48 h after lumbar spinal surgery, which was complicated by incidental dural tearing with minimal CSF loss. Brain CT scan revealed hypodense areas compatible with acute infarction involving mostly the left cerebellar hemisphere. No cerebral bleeding was observed. MRI was also performed revealing small cerebellar areas of acute infarction mainly relating the vermis and the left postero-inferior cerebellar hemisphere with haemorrhagic transformation and mass effect in the posterior fossa producing acute hydrocephalus. Haematoma removal was initially attempted by means of a suboccipital craniotomy. An external ventricular derivation was placed in a second procedure 24 h later due to the persistence of ventricular dilatation. At discharge the patient was only showing a slight dysmetria with the fine motor skills of hands and fingers. All cases of RCH after spinal surgery reported in the literature are invariably associated to iatrogenic dural tearing; although CSF loss seems to play the key role in the pathogenesis of this rare complication, the exact pathophysiology of this condition still remains undetermined.

The protective role of dynamic stabilization on the adjacent disc to a rigid instrumented level. An in vitro biomechanical analysis.

OBJECTIVES: To assess the changes of intradiscal pressure at the bridged and at the adjacent levels to a lumbar two-level hybrid instrumentation. INTRODUCTION: The elimination of motion produced by spinal fusion may have potential consequences beyond the index level overloading the juxtaposed spinal motion segments and leading to the appearance of degenerative changes. Degeneration of the segments adjacent to instrumented levels has become a topic of increasing interest in the literature over the last years. In order to prevent degenerative disc changes at the adjacent segments to a fused level, a broad scope of techniques have been developed, one of them is hybrid constructs. METHODS: In 6 human cadaveric lumbosacral specimens, pressure transducers quantified intradiscal pressure changes at three levels (L3-L4, L4-L5 and L5-S1) under axial compression (0-750 N), anterior flexion (+12°) and extension (-12°) in three different situations of spinal stability: intact, L5-S1 rigid rod pedicle screw instrumentation and L4-S1 two-level hybrid instrumentation (rigid at L5-S1 and dynamic at L4-L5). RESULTS: Once the L5-S1 segment had implanted the rigid instrumentation system (Diapason), the intradiscal pressure at this level decreased by 65 % while the intradiscal pressure at the disc above (L4-L5) increased 20 %. After augmenting the L5-S1 posterior construct with a dynamic stabilization device (Dynesys) at the superior adjacent level, the intradiscal pressure at this level, L4-L5, decreased by 50 % whereas intradiscal pressure at its adjacent level, L3-L4, only experienced a slight increase of 10 %. CONCLUSIONS: The raise of intradiscal pressure at the adjacent segment to a rigid instrumented segment can be reduced when the rigid construct is augmented with a dynamic stabilization device. Hybrid constructs might have a possible protecting role preventing the occurrence of degenerative disc changes at the adjacent segment to a rigid instrumented level. Augmentation with a dynamic stabilization device might protect the disc above a rigid rod pedicle screw construct.

Parsonage-Turner Syndrome After COVID-19 Vaccination in a Child.

Parsonage-Turner syndrome (PTS) is a peripheral neuropathy involving the brachial plexus very rare in childhood. To date, no cases of PTS after COVID-19 vaccination have been reported in children. We report a case of a 15-year-old boy affected by PTS after the second dose of the BNT162b2 (Comirnaty, Pfizer-BioNTech) COVID-19 vaccine.

[Translated article] Sagittal imbalance influences outcome of vertebroplasty in patients with osteoporotic vertebral compression fracture.

BACKGROUND AND OBJECTIVES: The correlation between sagittal balance of the spine and clinical outcome after vertebroplasty (VP) in patients with osteoporotic vertebral compression fractures (OVCF) is poorly investigated. We analysed the clinical outcome of patients with OVCF undergoing VP taking into account sagittal balance. METHODS: The primary endpoint was the change in axial back pain; disability and health-related quality of life using VAS, ODI and SF-36 respectively in correlation to the parameters that define sagittal balance (SVA). Radiographic assessment included full spine standing lateral films. Imaging and clinical data were collected pre and post procedure at 1, 3 and 12 months. RESULTS: Fifty-one patients were included presenting a total of 113 OVCF. Thirty patients (60.7%) had multiple OVCF. Comparing the evolution of VAS and ODI throughout the follow-up it does not seem that there are significant differences in their behaviour between the SVA>50mm and the SVA<50mm groups (p>0.05). On the contrary, preVP SF-36 scores showed worst results in the SVA>50mm group in the physical functioning section (PF) (p<0.05) and in the physical component score (PCS) (p<0.05). These differences were maintained until 3 months of follow-up in the case of the PCS and until the end of follow-up in the case of the PF (p<0.05). CONCLUSIONS: Patients with a SVA>50mm showed a slower recovery of their quality of life after VP for OVCF, but without significant differences with respect to pain or disability, when compared with patients with SVA<50mm.

Sagittal imbalance influences outcome of vertebroplasty in patients with osteoporotic vertebral compression fracture. / Influencia del desequilibrio sagital en el resultado clínico de la vertebroplastia en pacientes con fractura por compresión vertebral osteoporótica.

BACKGROUND AND OBJECTIVES: The correlation between sagittal balance of the spine and clinical outcome after vertebroplasty (VP) in patients with osteoporotic vertebral compression fractures (OVCF) is poorly investigated. We analysed the clinical outcome of patients with OVCF undergoing VP taking into account sagittal balance. MATERIAL AND METHOD: The primary endpoint was the change in axial back pain, disability and health-related quality-of-life using Visual Analogue Scale (VAS), Oswestry Disability Index (ODI) and SF-36, respectively, in correlation to the parameters that define sagittal balance (SVA). Radiographic assessment included full spine standing lateral films. Imaging and clinical data were collected pre- and post-procedure at 1, 3 and 12 months. RESULTS: 51 patients were included presenting a total of 113 OVCF. 30 patients (60.7%) had multiple OVCF. Comparing the evolution of VAS and ODI throughout the follow-up it does not seem that there are significant differences in their behaviour between the SVA>50mm and the SVA<50mm groups (p>0.05). On the contrary, pre-VP SF-36 scores showed worst results in the SVA>50mm group in the physical functioning (PF) section (p<0.05) and in the physical component score (PCS) (p<0.05). These differences were maintained until 3 months of follow-up in the case of the PCS and until the end of follow-up in the case of the PF (p<0.05). CONCLUSIONS: Patients with a SVA>50mm showed a slower recovery of their quality-of-life after VP for OVCF, but without significant differences with respect to pain or disability, when compared patients with SVA<50mm.

Bilateral compartment syndrome in thighs and legs by methanol intoxication: a case report.

Methanol intoxication is infrequent even though it is easily obtainable. One of the complications in locomotor apparatus is the development of a compartment syndrome of the lower extremities. A case is reported of a 49-year-old man with a compartment syndrome in all compartments of both legs and the anterior compartment of both thighs due to methanol intoxication. The patient underwent a bilateral fasciotomy of the legs and thighs. He also had haemodialysis sessions because of acute renal insufficiency. After 4 weeks of haemodialysis, covering of the fasciotomies with cutaneous autograft and rehabilitation treatment, the patient was able to walk on his own again. Early recognition and treatment of compartment syndrome are essential to avoid complications.

Clavicular fracture in the newborn: Is fracture location a risk factor for obstetric brachial palsy?

BACKGROUND: The incidence of clavicle fracture in the newborn population ranges from 0.2 to 3.5% with an associated rate of obstetric brachial palsy (OBP) ranging from 4 to 13% . METHODS: The aim of this study was to describe the anatomical location of the fracture in the clavicle and its possible correlation with OBP. We retrospectively reviewed all perinatal clavicle fractures diagnosed at our institution over thirteen years. RESULTS: A total of 155 clavicle fractures were identified among 23508 live newborns representing an incidence of 0.67% . Fracture location was categorized according to the Allman classification. The most frequent location was the mid-shaft (Allman I) (92.90%), followed by the medial third (Allman III) (5.81%) and finally by the lateral third (Allman II) (1.29%). 17 cases had an associated OBP (10.97%). 13 of these cases (76.47%) involved the medial third, 4 involved the midshaft (23.53%) whilst none of the cases with a clavicle fracture involving the lateral third was associated to OBP. We could determine a significant association between the occurrence of OBP and fracture of the clavicle medial third (Allman type III) (p < 0.05). CONCLUSIONS: To the best of our knowledge this is the first study describing the anatomical location of the fracture in the clavicle and its possible association with OBP. A fracture involving the medial clavicle third in a newborn might alert of the possible event of OBP. Nevertheless, more studies with larger samples will be necessary to confirm these results.