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1.
Neurosurg Focus ; 50(5): E20, 2021 05.
Artigo em Inglês | MEDLINE | ID: mdl-33932928

RESUMO

OBJECTIVE: The aim of this study was to evaluate functional outcome, surgical morbidity, and factors that affect outcomes of surgically treated patients. METHODS: The authors retrospectively analyzed patients who underwent microsurgical resection for spinal meningiomas between 2009 and 2020. Patient data and potential variables were collected and evaluated consecutively. Functional outcomes were evaluated using univariate and multivariate analyses. RESULTS: A total of 119 patients underwent microsurgical resection of spinal meningioma within the study period. After a mean follow-up of 25.4 ± 37.1 months, the rates of overall complication, tumor recurrence, and poor functional outcome were 9.2%, 7.6%, and 5%, respectively. Age, sex, revision surgery, and tumor recurrence were identified as independent predictors of poor functional outcome. Obesity and surgeon's experience had an impact on the complication rate, whereas extent of resection and tumor calcification affected the rate of tumor recurrence. CONCLUSIONS: Microsurgical resection of spinal meningiomas remains safe. Nevertheless, some aspects, such as obesity and experience of the surgeons that result in a higher complication rate and ultimately affect clinical outcome, should be considered when performing surgery.


Assuntos
Neoplasias Meníngeas , Meningioma , Humanos , Neoplasias Meníngeas/cirurgia , Meningioma/cirurgia , Morbidade , Recidiva Local de Neoplasia , Estudos Retrospectivos , Resultado do Tratamento
2.
Neurosurg Focus ; 46(1): E2, 2019 01 01.
Artigo em Inglês | MEDLINE | ID: mdl-30611162

RESUMO

OBJECTIVEThe incidence of patients with pyogenic spinal infection is increasing. In addition to treatment of the spinal infection, early diagnosis of and therapy for coexisting infections, especially infective endocarditis (IE), is an important issue. The aim of this study was to evaluate the proportion of coexisting IE and the value of routine transesophageal echocardiography (TEE) in the management of these patients.METHODSThe medical history, laboratory data, radiographic findings, treatment modalities, and results of TEE of patients admitted between 2007 and 2017 were analyzed.RESULTSDuring the abovementioned period, 110 of 255 total patients underwent TEE for detection of IE. The detection rate of IE between those patients undergoing and not undergoing TEE was 33% and 3%, respectively (p < 0.0001). Thirty-six percent of patients with IE needed cardiac surgical intervention because of severe valve destruction. Chronic renal failure, heart failure, septic condition at admission, and preexisting heart condition were significantly associated with coexisting IE. The mortality rate in patients with IE was significantly higher than in patients without IE (22% vs 3%, p = 0.002).CONCLUSIONSTEE should be performed routinely in all patients with spondylodiscitis.


Assuntos
Discite , Endocardite Bacteriana/microbiologia , Endocardite/diagnóstico , Endocardite/terapia , Idoso , Idoso de 80 Anos ou mais , Discite/diagnóstico , Discite/epidemiologia , Discite/terapia , Ecocardiografia Transesofagiana/métodos , Endocardite/complicações , Endocardite Bacteriana/complicações , Feminino , Hospitalização/estatística & dados numéricos , Humanos , Incidência , Masculino , Pessoa de Meia-Idade
3.
Neurosurg Focus ; 46(5): E14, 2019 05 01.
Artigo em Inglês | MEDLINE | ID: mdl-31042654

RESUMO

OBJECTIVEThe treatment of patients with spinal stenosis and concurrent degenerative spondylolisthesis is controversial. Two large randomized controlled clinical trials reported contradictory results. The authors hypothesized that a substantial number of patients will show evidence of micro-instability after a sole decompression procedure.METHODSThis study was a retrospective analysis of all cases of lumbar spinal stenosis treated at the Frankfurt University Clinic (Universitätsklinik Frankfurt) from 2010 through 2013. Patients who had associated spondylolisthesis underwent upright MRI studies in flexion and extension for identification of subtle signs of micro-instability. Clinical outcome was assessed by means of SF-36 bodily pain (BP) and physical functioning (PF) scales.RESULTSA total of 21 patients were recruited to undergo upright MRI studies. The mean duration of follow-up was 65 months (SD 16 months). Of these 21 patients, 10 (47%) showed signs of micro-instability as defined by movement of > 4 mm on flexion/extension MRI. Comparison of mean SF-36 BP and PF scores in the group of patients who showed micro-instability versus those who did not showed no statistically significant difference on either scale.CONCLUSIONSThere seems to be a substantial subset of patients who develop morphological micro-instability after sole decompression procedures but do not experience any clinically significant effect of the instability.


Assuntos
Descompressão Cirúrgica , Vértebras Lombares , Imageamento por Ressonância Magnética , Postura , Estenose Espinal/diagnóstico por imagem , Espondilolistese/diagnóstico por imagem , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Posicionamento do Paciente , Estudos Retrospectivos , Estenose Espinal/complicações , Estenose Espinal/cirurgia , Espondilolistese/complicações , Espondilolistese/cirurgia
4.
Acta Neurochir (Wien) ; 161(7): 1381-1384, 2019 07.
Artigo em Inglês | MEDLINE | ID: mdl-31111214

RESUMO

BACKGROUND: Ventriculoatrial shunt (VA) insertion is one of the possible surgical procedures to treat hydrocephalus. However, it is also associated with several complications such as obstruction and shunt infection as well as life-threatening complications like intraatrial thrombus or thrombosis on the distal catheter. In this case report, we share a rare case of a patient with a VA shunt, who was admitted to our hospital with a stroke. CASE DESCRIPTION: A 56-year-old female patient with suspected acute stroke was admitted to the stroke unit. CT and MRI scans showed multiple cerebral infarctions in both hemispheres. The transesophageal echocardiography (TEE) showed at the tip of the VA shunt catheter, which was implanted about 30 years ago due to aqueduct stenosis, also a thrombotic formation as the reason of stroke. Interestingly, the tip of the catheter was not in the right atrium as expected, but in the left atrium. Further evaluation showed a patent foramen ovale (PFO), through which the catheter migrated from the right to the left side. At first, conservative treatment with anticoagulation was started with the aim to dissolve the thrombotic formation; however, a control TEE showed an unchanged mass at the catheter tip. Therefore, a ventriculoperitoneal shunt was implanted and the proximal shunt catheter was removed with an additional closure of the PFO by our heart surgeons. Postoperatively, the patient was discharged 10 days later in good condition to a rehabilitation center. CONCLUSIONS: Thromboembolic events due to a PFO are rare but possible life-threatening complication after VA shunt insertion. Therefore, preoperative cardiac diagnostic might be clinically relevant prior to a VA shunt implantation to avoid such complications.


Assuntos
Derivações do Líquido Cefalorraquidiano/efeitos adversos , Forame Oval Patente/complicações , Hidrocefalia/cirurgia , Complicações Pós-Operatórias/etiologia , Acidente Vascular Cerebral/etiologia , Tromboembolia/etiologia , Ecocardiografia Transesofagiana , Feminino , Forame Oval Patente/diagnóstico por imagem , Humanos , Pessoa de Meia-Idade , Complicações Pós-Operatórias/diagnóstico por imagem , Próteses e Implantes/efeitos adversos , Acidente Vascular Cerebral/diagnóstico por imagem , Tromboembolia/diagnóstico por imagem
5.
J Neurooncol ; 135(1): 93-98, 2017 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-28667596

RESUMO

Surgical resection of intramedullary spinal cord ependymoma still remains the standard of care but is challenging and occasionally associated with poor outcome. The aim of this study is therefore to provide additional information regarding the natural history of conservatively treated symptomatic intramedullary spinal cord ependymoma. Retrospective, single center review of all patients with intramedullary spinal cord ependymoma treated conservatively (wait and see) between 1980 and 2016. The neurological outcomes at first presentation, as well as in long-term follow-up, were assessed using the modified McCormick Disability Scale and modified Rankin Scale. Thirteen of 41 patients were managed conservatively and were included in the study. Mean age at the admission was 49 years. There were seven women and six men. All patients were symptomatic at the time of presentation. The mean follow-up from admission to the last neurological examination was 47.9 months. The mean modified McCormick score in conservatively treated patients was 1.3 at admission and 1.6 (p = 0.3) at last follow-up. There was no significant neurological detoriation over time in conservatively managed patients as assessed by the modified Rankin Scale at first presentation and last follow-up (mRS scores of 0-2, 100 vs 92%; p = 0.9). This cohort of conservatively managed patients with symptomatic intramedullary spinal cord ependymoma was clinically stable throughout the follow-up period. Our data provide additional information for counseling patients with intramedullary spinal cord tumors who chose a nonoperative treatment.


Assuntos
Ependimoma/terapia , Neoplasias da Medula Espinal/terapia , Tratamento Conservador , Progressão da Doença , Ependimoma/epidemiologia , Ependimoma/fisiopatologia , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Exame Neurológico , Preferência do Paciente , Estudos Retrospectivos , Índice de Gravidade de Doença , Neoplasias da Medula Espinal/epidemiologia , Neoplasias da Medula Espinal/fisiopatologia , Resultado do Tratamento
6.
Cancer Control ; 21(2): 158-67, 2014 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-24667403

RESUMO

BACKGROUND: The preferred treatment for locally aggressive lung cancers is triple modality therapy with concurrent and induction chemotherapy with radiation therapy followed by surgery. Patients with locally advanced T4 Pancoast tumors with spine involvement, without mediastinal N2 lymph node involvement and without distant metastases, are appropriate candidates for complete resection with subsequent spine reconstruction. This review addresses the questions of whether triple modality therapy with complete en bloc resection of locally advanced Pancoast tumors offers an advantage in terms of overall survival and complication rates compared with other therapeutic modalities or therapies with incomplete resection. METHODS: A comprehensive literature search was conducted using common medical databases. Inclusion and exclusion criteria for the articles were prospectively defined. The articles were independently reviewed and a consensus decision was made about each article. Selected papers were graded by level of evidence. RESULTS: A total of 1,001 abstracts and 93 articles fulfilled the criteria; from these studies, 14 were included in this systematic review. No level 1 study was found in this search. Four level 2 studies and 10 level 3 retrospective case series were found. The overall 5-year survival rate reported in these studies ranged from 37% to 59% and the mortality rate ranged from 0% to 6.9%. CONCLUSIONS: Evidence suggests that triple modality therapy with complete resection of locally advanced Pancoast tumors with involvement of the spine offers an advantage over other therapeutic modalities or therapies with incomplete resections.


Assuntos
Síndrome de Pancoast/terapia , Neoplasias da Coluna Vertebral/terapia , Terapia Combinada , Humanos , Metástase Linfática , Prognóstico , Estudos Prospectivos , Taxa de Sobrevida
7.
Stereotact Funct Neurosurg ; 92(2): 80-5, 2014.
Artigo em Inglês | MEDLINE | ID: mdl-24481033

RESUMO

BACKGROUND: Stereotactic biopsies are procedures with a high diagnostic yield and a low but serious risk of hemorrhage. Postoperative management remains controversial. OBJECTIVES: To evaluate the predictive value of intraoperative bleeding and its implication on postoperative management. METHODS: Cases of intraoperative bleeding were prospectively documented in a consecutive series comprising 303 patients. Categories were as follows: no bleeding, single drop, ≤10 drops and >10 drops. Incidence, size of hemorrhage and neurological deterioration were noted. Hemorrhage on routine postoperative CT scans was correlated with intraoperative findings, sample size, location and pathology. RESULTS: A total of 93 patients (30.7%) showed intraoperative bleeding and 68 (22.4%) showed blood on postoperative CT. In 13 patients (4.3%) the diameter was >1 cm; 19 patients (6.3%) experienced neurological worsening, 9 (3.0%) having postoperative hemorrhage and 3 (1.0%) permanent neurological deficits. Bleeding was associated with postoperative hemorrhage (p < 0.0001). The negative predictive values to rule out any postoperative hemorrhage or hemorrhages >1 cm were 92 and 100%, respectively. Number of samples, location and pathology had no significant influence on postoperative hemorrhage. CONCLUSION: Stereotactic biopsies have a low risk of symptomatic hemorrhages. Intraoperative bleeding is a surveillance parameter of hemorrhage on CT. Therefore, routine postoperative CT may be restricted to patients who show intraoperative bleeding.


Assuntos
Perda Sanguínea Cirúrgica , Encéfalo/cirurgia , Hemorragia Cerebral/diagnóstico por imagem , Técnicas Estereotáxicas/efeitos adversos , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Biópsia , Encéfalo/diagnóstico por imagem , Criança , Pré-Escolar , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Período Pós-Operatório , Radiografia , Adulto Jovem
8.
Acta Neurochir (Wien) ; 156(3): 581-8, 2014 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-24142196

RESUMO

BACKGROUND: To assess the precision and accuracy of 3D fluoroscopy (XT) in phantoms and patients compared to computed tomography (CT) in localizing stereotactic probes. METHODS: Approval was obtained from the institutional research ethics board. The prospective phantom study was compared to a retrospective patient cohort. Accuracy was assessed by the mean error and precision by the mean dispersion between XT and CT with a cubic or a skull phantom containing metallic spheres installed on plates or along trajectories. Significance was assessed by Friedman's and Levene's test. Secondary endpoints were Euclidean error, other influences e.g. installed frame and radiation exposure. RESULTS: A total of 3,342 distances were assessed in 17 XT and 13 CT phantom scans. The cubic phantom showed mean distance errors of 0.33 mm (SD + -0.46 mm) for XT compared to 0.19 mm (SD + -0.83 mm) for CT scans (p = 0.0004) and a dispersion of 0.22 mm (XT) and 0.70 mm (CT). The dispersion was 0.36 mm with and 0.63 mm without a stereotactic frame (p < 0.0001). The mean Euclidean error was 0.72 mm (SD + -0.59 mm) in the skull phantom and 1.34 mm (SD + -0.82 mm) in the patient cohort. The effective dose was 0.65 mSv for the XT and 1.12 mSv for the CT. CONCLUSIONS: The accuracy of XT imaging in phantoms revealed a slightly lower accuracy but higher precision than the CT. The overall accuracy of XT was higher than that of the stereotactic frame allowing stereotactic localization with about half of the effective dose of a CT-scan.


Assuntos
Globo Pálido/diagnóstico por imagem , Imageamento Tridimensional/métodos , Monitorização Intraoperatória/métodos , Radiocirurgia/métodos , Núcleo Subtalâmico/diagnóstico por imagem , Cirurgia Assistida por Computador/métodos , Núcleos Ventrais do Tálamo/diagnóstico por imagem , Estimulação Encefálica Profunda , Eletrodos , Fluoroscopia , Humanos , Transtornos dos Movimentos/terapia , Imagens de Fantasmas , Estudos Prospectivos , Estudos Retrospectivos , Tomografia Computadorizada por Raios X/métodos
9.
J Spine Surg ; 10(1): 80-88, 2024 Mar 20.
Artigo em Inglês | MEDLINE | ID: mdl-38567005

RESUMO

Background: Anterior cervical discectomy and fusion (ACDF) is a commonly implemented surgical intervention for a variety of pathologies affecting the cervical spine. The current literature and daily practice reveal variations on patient head positioning for this procedure with both rigid fixations in the Mayfield skull clamp as well as use of a padded headrest being used. In this study, we therefore examine whether patients undergoing surgery using head positioning in the Mayfield skull clamp versus a padded headrest differ in regard to adverse events, surgical parameters and clinical outcome. Methods: A single-center, retrospective analysis of 121 patients treated with ACDF for degenerative disease, traumatic cervical spine injury and infectious disease between November 2019 and March 2023 was performed. Clinical and imaging data for 59 patients positioned in the Mayfield skull clamp and 62 patients positioned in a padded headrest were evaluated using electronic medical records. In addition to demographic data, surgical indications, procedures performed were analyzed for both groups. Level of training (chief, attending and resident), length of surgery and intraoperative radiation exposure (measured by dose area product and total radiation time) were also examined. Finally, modified Rankin Scale (mRS) preoperatively and at last follow-up as well as adverse events were compared between groups. Results: We found no statistically significant differences between the Mayfield and headrest groups regarding surgical indications (P=0.583), procedures performed (P=0.069), level of training of the surgeon (P=0.218), length of surgery (P=0.752), adverse events (P=0.619) or neurological impairment (P=0.080) following surgical intervention. There was a significant difference regarding dose area product between both groups with patients positioned in the Mayfield skull clamp showing lower mean levels of radiation than those in the headrest group (99 versus 131 cGy/cm2; P=0.003). Conclusions: Patient positioning using the Mayfield skull clamp may reduce required radiation exposure during ACDF procedures versus use of a padded headrest.

10.
J Clin Med ; 13(4)2024 Feb 11.
Artigo em Inglês | MEDLINE | ID: mdl-38398352

RESUMO

Background incidence of pyogenic spinal infections has increased in recent years. In addition to treating the spinal infection, optimal care also includes identifying the source of the pyogenic spinal infection and the presence of other infections. The aim of this study is to elucidate the prevalence of oral cavity infection (OCI) within this patient cohort. Methods As part of a prospective study conducted from 2016 to 2021, the number of patients with dental infections was investigated by means of an orthopantomogram (OPG) and subsequent dental examination. Results The presence of an oral infection was investigated in 55 (47%) of 118 patients by an OPG, 29 (53%) of whom had a corresponding abnormality of the oral cavity. In addition to the spinal infection, patients with an oral cavity infection revealed an increased incidence of endocarditis, sepsis and brain abscess. A spinal epidural abscess, a multilevel affection of the infection, and an elevated CRP value were also found in patients with a co-existing oral cavity infection. Back pain assessed at admission and 3 months after surgery was also more pronounced in patients with an oral cavity infection. Neurological deficits were often present in patients with spinal and oral cavity infection. Conclusions The presence of an oral cavity infection has proven to be one of the important factors in the detection of the source of the pyogenic spinal infection. In addition, a pronounced spinal affection and frequent co-infections were seen in patients with an oral cavity infection.

11.
J Neurol Surg A Cent Eur Neurosurg ; 84(1): 14-20, 2023 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-33690878

RESUMO

OBJECT: The management and recommendations for treatment strategies of pyogenic spinal infection are still a highly controversial issue. The purpose of this study was to evaluate patient's quality of life (QoL) after surgical and conservative treatment of spinal infection. MATERIALS AND METHODS: We conducted a retrospective, single-center study. All patients treated between 2009 and 2016 were included in this study. For evaluation of QoL, we recorded each patient's satisfaction according to the 36-Item Short Form Health Survey (SF-36) questionnaire. Scores were compared with a U.S. standard population. RESULTS: Two hundred and ten adult patients with spondylodiskitis were identified. Of these, 155 (74%) underwent surgery and 55 (26%) were treated conservatively. The mean overall age was 68.6 (23-98) years. Seventy-two patients were females and 138 patients were males. The mean outcome values in the surgical group did not reach the level of the normative sample in one of eight items, whereas the conservative group revealed a reduced QoL in all items. Intergroup comparison revealed significant differences in all items (p < 0.05). CONCLUSION: In the patient population we investigated, QoL in surgically treated patients was better than that in conservatively managed patients.


Assuntos
Tratamento Conservador , Qualidade de Vida , Adulto , Masculino , Feminino , Humanos , Idoso , Idoso de 80 Anos ou mais , Estudos Retrospectivos , Coluna Vertebral/cirurgia , Inquéritos e Questionários , Resultado do Tratamento
12.
Sci Rep ; 13(1): 7000, 2023 04 28.
Artigo em Inglês | MEDLINE | ID: mdl-37117321

RESUMO

Spinal tuberculosis is due to globalization no longer a disease limited to developing nations. It remains in Germany a rarity and still a difficult diagnosis. Here we analyzed patients with spinal tuberculosis treated at our neurosurgical department. According to the infected anatomic segment, patients were assigned in one of three groups. Surgery was performed when neurological deficit due to mechanical compression, deformity, instability, severe pain, necrotic bone or failure to respond to anti-tuberculous treatment were observed. We identified 34 patients with spinal tuberculosis who underwent surgical treatment. In the cervical spinal tuberculosis group, there were 15 cases (46.9%) In most cases treatment consisted of spinal instrumentation. In the thoracic group, 10 cases (29.4%) were observed. The treatment was performed by dorsolateral spinal instrumentation. For the thoracolumbar group, 9 cases (26.4%) were observed. In most cases dorsolateral spinal instrumentation was performed. One patient in the first group and one patient in the third group relapsed after operation. A second surgery was necessary. Patients with chronic back pain, immigration background and/or neurological deficit spinal TB should be considered as a differential diagnosis. Combined surgical intervention and medical treatment is associated with a favorable outcome.


Assuntos
Fusão Vertebral , Tuberculose da Coluna Vertebral , Humanos , Adulto , Tuberculose da Coluna Vertebral/cirurgia , Vértebras Torácicas/cirurgia , Vértebras Lombares/cirurgia , Resultado do Tratamento , Estudos Retrospectivos
13.
Front Med (Lausanne) ; 10: 1202969, 2023.
Artigo em Inglês | MEDLINE | ID: mdl-37942421

RESUMO

Objective: Outpatient parenteral antimicrobial therapy (OPAT) is a well-established and cost-effective method for improving the efficient use of healthcare resources. However, only a few centres in Germany perform it. Here we analysed OPAT for the treatment of patients with cranial infections in our neurosurgical department. Methods: This retrospective study analysed patients with cranial infections and the need for intravenous (i.v.) antimicrobial treatment between 2018 and 2021.All diagnosed intracranial infections were defined into two infection categories such as long-term antimicrobial treatment and short-term antimicrobial treatment. All included patients were discharged with a peripherally inserted central catheter (PICC) line. Prior to discharge, all patients received training in the safe administration of their medications via the PICC line. The duration of OPAT and the rate of readmission after OPAT were analysed. Results: We identified a total of 45 patients treated with OPAT for cranial infections. Intradural involvement was present in 40 cases (88.9%). The average length of hospital stay for this cohort after surgical treatment was 45 ± 15 days. 5 patients were treated for soft tissue/skin infection. Surgery was not required in this cohort. The mean hospital stay for this cohort was 8 ± 6 days. Gram-positive organisms were isolated in most cases (53.3%). The most common pathogens were Staphylococcus aureus followed by other Staphylococcus species. For all included patients, OPAT was performed after discharge for an average of 43.1 ± 14 days. There were five cases of readmission due to treatment failure. No serious adverse events or complications of OPAT were observed. Conclusion: OPAT enables better patient-centred healthcare close to home. The length of hospital stay can be reduced and adverse events due to prolonged hospitalisation can be avoided.

14.
Sci Rep ; 13(1): 6863, 2023 04 26.
Artigo em Inglês | MEDLINE | ID: mdl-37100824

RESUMO

Outpatient parenteral antimicrobial therapy (OPAT) is a cost-effective method of administering intravenous antimicrobial therapy. Although OPAT is well established in the UK and US healthcare systems, few centres in Europe perform it. Here we analysed OPAT for the treatment of patients with spinal infections at our institution. In this retrospective study, patients with spinal infection who required intravenous (i.v.) antimicrobial treatment between 2018 and 2021 were analysed. The duration of short-term antimicrobial treatment for skin and soft tissue infections and complex infections requiring long-term antimicrobial treatment, such as spinal bone or joint infections, were analysed. All patients were discharged with a peripherally inserted central catheter (PICC) line. Prior to discharge, all patients received training in the safe administration of their medications via the PICC line. The duration of OPAT and the rate of readmission after OPAT were analysed. For this study a total of 52 patients who were treated via OPAT due to spinal infections were analyzed. In 35 cases (69.2%) complex spinal infection was reason for i.v. antimicrobial therapy. Surgery was required in 23 of these 35 patients (65.7%). The average hospital stay for these patients was 12 ± 6 days. The remaining 17 patients were treated for an infection of the soft tissue or the skin and hospital stay for these patients was on average 8 ± 4 days. Gram-positive organisms were isolated in 64.4%. Staphylococcus aureus followed by other Staphylococcus species, was the most common detected organism. After discharging i.v. antimicrobial treatment was given for an average of 20 ± 14 days. The duration of antimicrobial treatment for soft tissue was 10.8 ± 8 days, and for complex infections 25.1 ± 18 days. The mean follow-up was 21 ± 14 months. There was one case of readmission due to treatment failure. There were no difficulties encountered in implementing OPAT. OPAT is a feasible and effective option for delivering intravenous antimicrobial therapy to patients with spinal infections who can be managed without hospitalisation. OPAT offers patient-centred treatment at home while avoiding the risks associated with hospitalisation, with high levels of patient satisfaction.


Assuntos
Anti-Infecciosos , Infecções dos Tecidos Moles , Humanos , Pacientes Ambulatoriais , Estudos Retrospectivos , Estudos de Viabilidade , Anti-Infecciosos/efeitos adversos , Infecções dos Tecidos Moles/tratamento farmacológico , Antibacterianos/uso terapêutico , Infusões Parenterais/métodos
15.
J Clin Med ; 12(8)2023 Apr 10.
Artigo em Inglês | MEDLINE | ID: mdl-37109141

RESUMO

OBJECTIVE: While outcomes of surgical treatment for spinal meningiomas are well-described within the literature, factors affecting early return to work as well as long-term health related quality of life remain unclear. METHODS: In this retrospective study, patients with spinal meningioma and surgical treatment from two university-level neurosurgical institutions between 2008 and 2021 were analyzed. Time to return to work, physical activities and long-term health related quality of life (assessed by telephone interviews using the EQ-5D-5L health status measure and visual analogue scale (EQ VAS) were analyzed. RESULTS: We identified a total of 196 patients who underwent microsurgical resection of spinal meningioma between January 2008 and December 2021. Of those, 130 patients of working age were included and analyzed. The median follow-up time was 96 months. All included patients returned to work. The median time of return to work was 45 days for the whole cohort. Patients who preoperatively performed physical activity returned to work significantly earlier compared to patients who did not (p < 0.001). Furthermore, younger age (p = 0.033) and absence of obesity (p = 0.023) correlated significantly with earlier return to work. Significant differences were also observed in all 5 EQ-5D-5L dimensions between patients with and without preoperative physical activity. CONCLUSIONS: Despite the benign nature of spinal meningioma preoperative physical activity and physiological body weight are associated with favorable postoperative outcome, higher quality of life and early return to work.

16.
Eur Spine J ; 21(4): 660-5, 2012 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-22179754

RESUMO

PURPOSE: Far-lateral extraforaminal lumbar disc herniation is an uncommon cause of nerve root entrapment, and studies addressing the long-term outcome of surgically treated patients are few. The purpose of this study was to analyze the ultra-long-term outcome of patients who were treated via a lateral approach. METHODS: The medical reports of 138 consecutive patients were analyzed with regard to signs and symptoms, operative findings, complications, and short-term outcome (6 weeks). To assess long-term results, standardized telephone interviews were performed using a structured questionnaire. The patients were questioned about pain using the verbal rating scale and persisting symptoms, if any. Other queries were related to the Oswestry Disability Index. Subjective satisfaction with the result of surgery was classified as excellent (no pain), good (some pain), fair (moderate pain), and poor (unchanged or worse) based on MacNab classification. RESULTS: At short-term follow-up, major and moderate leg pain had decreased from 99.3 to 5.1% and low back pain from 97.8 to 2.8%. Sensory and motor deficits, however, were still present in the majority of patients. A total of 87 telephone interviews were conducted, and the mean follow-up was 146 months. As many as 49 patients (56.3%) reported complete relief of symptoms, 14 patients (16.1%) had minor ailments under physical stress, and 24 patients (27.6%) had permanent residual symptoms. The most common complaint was remaining sensory disturbance. Despite residual symptoms, the vast majority of patients expressed satisfaction with the result of surgery. The outcome was subjectively rated as follows: 75.9% excellent (66 patients), 18.4% good (16 patients), 4.6% fair (4 patients), and 1.1% poor (1 patient). CONCLUSIONS: The lateral approach is a minimally invasive and safe procedure with low complication rates. The profit from surgery is maintained beyond the usual postoperative observation periods. Thus, ultimate outcome at ultra-long-term follow-up is very gratifying in the vast majority of patients.


Assuntos
Discotomia/métodos , Deslocamento do Disco Intervertebral/patologia , Deslocamento do Disco Intervertebral/cirurgia , Vértebras Lombares/patologia , Vértebras Lombares/cirurgia , Procedimentos Cirúrgicos Minimamente Invasivos/métodos , Adulto , Idoso , Idoso de 80 Anos ou mais , Dor nas Costas/epidemiologia , Avaliação da Deficiência , Feminino , Seguimentos , Humanos , Entrevistas como Assunto , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Satisfação do Paciente , Prevalência , Estudos Retrospectivos , Inquéritos e Questionários , Resultado do Tratamento
17.
Clin Spine Surg ; 35(6): E534-E538, 2022 07 01.
Artigo em Inglês | MEDLINE | ID: mdl-35276717

RESUMO

STUDY DESIGN: Single-center series. OBJECTIVE: Intraspinal facet joint cysts can lead to nerve root compression symptoms with severe discomfort and disability. Permanent improvement can be achieved by surgical resection of the cyst. However, cerebrospinal fluid (CSF) leakage is a common problem in resection of facet joint cyst.The aim of the study was to investigate the frequency of CSF leak after resection of a joint cyst and to determine predictive factors. METHODS: A total of 176 consecutive patients underwent surgery for lumbar spinal facet joint cyst in our institution between 1997 and 2018. Patients with a CSF leak were compared with patients without a CSF leak (control group). RESULTS: CSF leakage occurred in 14 patients (8.0%) In 2 of the cases (14.3%), the CSF leak was recognized only postoperatively, in 12 cases (85.7%), the CSF leak was detected intraoperatively. Despite intraoperative dura repair, 4 of these 12 patients (33.3%) presented with CSF leakage postoperatively. Altogether 6 patients had postoperative CSF leakage. Compared with patients without CSF leak, there were no differences in preoperative symptoms, surgical technique, complications, or postoperative findings. Adhesion of the cyst to the dura mater was present in all 14 patients with CSF leakage (100%), but only 61.7% of the control group ( P <0.005). All patients in the CSF leak group showed an improvement of their preoperative symptoms. CONCLUSIONS: The rate of CSF leakage in resection of spinal facet joint cyst was 8% in the present study. The occurrence of a CSF leakage was independent of clinical factors, level, or side of the cyst, but significantly correlated to dural adhesion of the cyst.Since neither clinical recovery nor recurrence rates do depend on complete removal of the cyst, aggressive resection of dural adherend parts of the cyst wall should be avoided to prevent CSF leakage.


Assuntos
Cistos , Articulação Zigapofisária , Vazamento de Líquido Cefalorraquidiano/epidemiologia , Vazamento de Líquido Cefalorraquidiano/etiologia , Vazamento de Líquido Cefalorraquidiano/cirurgia , Humanos , Incidência , Complicações Pós-Operatórias/epidemiologia , Prognóstico , Estudos Retrospectivos , Articulação Zigapofisária/cirurgia
18.
J Spinal Disord Tech ; 24(2): 76-82, 2011 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-20634734

RESUMO

STUDY DESIGN: Surgical technique article with retrospective case series. SUMMARY OF BACKGROUND DATA: Sacral insufficiency fractures are commonly encountered in oncologic patients and constitute a cause for persistent lower back and pelvic pain. OBJECTIVE: The aim of this study is to describe the modified technique of navigated percutaneous sacroiliac (SI) fixation using multiple long screws per level that cross both SI joints and engage bilateral iliac bones; furthermore to evaluate its safety and efficacy in oncologic patients with sacral insufficiency fractures. METHODS: Six oncologic patients (3 male, 3 female, mean age: 58.8 y) with sacral insufficiency fractures who had undergone additional radiation therapy were operated with navigated percutaneous fixation. Two patients had failed preoperative sacroplasty and 1 had failed SI pinning. Eighteen SI screws were placed (15 at S1 level and 3 at S2). In the majority of cases the screws were long enough to engage bilateral ilium and sacrum. Additionally, 1 patient underwent percutaneous iliolumbar instrumentation and in 4 patients we performed concomitant sacroplasty or polymethylmethacrylate screw augmentation. The patients were followed for 18.8 months in average (range: 12-30 mo). Outcome was assessed using the Karnofsky Performance Status score (KPS), pain scale (0-10) and detailed neurologic examination. RESULTS: In 1 case, a revision of a screw was required due to radiculopathy. There was no perioperative morbidity or mortality. No hardware failure was encountered. There was significant improvement in KPS (P=0.04) and pain levels (P=0.02). CONCLUSIONS: These preliminary data suggest that navigated percutaneous SI screw fixation is a safe and effective intervention in terms of pain control and performance status improvement in oncologic patients with sacral insufficiency fractures. For optimal fixation, multiple long screws that engage both iliac bones may be inserted through the S1 level in a safe manner. The technique may be combined with sacroplasty or closed posterior instrumentation to augment the screw fixation. Further investigation is needed to compare this technique with other treatment modalities.


Assuntos
Fixação Interna de Fraturas/métodos , Fraturas de Estresse/cirurgia , Ílio/cirurgia , Articulação Sacroilíaca/lesões , Articulação Sacroilíaca/cirurgia , Sacro/cirurgia , Adulto , Idoso , Parafusos Ósseos , Feminino , Fluoroscopia , Fraturas de Estresse/diagnóstico por imagem , Humanos , Ílio/diagnóstico por imagem , Masculino , Pessoa de Meia-Idade , Articulação Sacroilíaca/diagnóstico por imagem , Sacro/diagnóstico por imagem , Resultado do Tratamento
19.
Front Neurol ; 12: 628256, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34017299

RESUMO

Background: The incidence of pyogenic spinal infection has increased in recent years. In addition to treatment of the spinal infection, early diagnosis and therapy of coexisting infections, especially of secondary brain infection, are important. The aim of this study is to elucidate the added value of routine cerebral imaging in the management of these patients. Methods: This was a retrospective single-center study. Cerebral imaging consisting of cerebral magnetic resonance imaging (cMRI) was performed to detect brain infection in patients with a primary pyogenic spinal infection. Results: We analyzed a cohort of 61 patients undergoing cerebral imaging after diagnosis of primary pyogenic spinal infection. The mean age in this cohort was 68.7 years and the gender distribution consisted of 44 males and 17 females. Spinal epidural abscess was proven in 32 (52.4%) patients. Overall positive blood culture was obtained in 29 (47.5%) patients, infective endocarditis was detected in 23 (37.7%) patients and septic condition at admission was present in 12 (19.7%) Patients. Coexisting brain infection was detected in 2 (3.3%) patients. Both patients revealed clinical signs of severe sepsis, reduced level of consciousness (GCS score 3), were intubated, and died due to multi-organ failure. Conclusions: Brain infection in patients with spinal infection is very rare. Of 61 patients with pyogenic spinal infection, two patients had signs of cerebral infection shown by imaging, both of whom were in a coma (GCS 3), and sepsis.

20.
Eur Spine J ; 19(2): 257-62, 2010 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-19823877

RESUMO

The goal of this study was to assess surgical clinical and radiographic outcomes of using a posterior transpedicular approach (posterolateral) for ventral malignant tumors of the cervical spine. Access to ventral lesions of the cervical spine can be challenging in patients with malignant tumors. Anterior approaches are the gold standard for ventral pathology in the cervical spine, however, there are cases, where a posterior approach is indicated due to multilevel disease, previous radiation, swallowing difficulty with difficulty in retraction of trachea and esophagus, and in cases where circumferential fusion cannot be done due to patients' poor medical condition. A single approach could provide spinal stabilization and removal of tumor. Eight cases of ventral cervical spine malignant tumors (7 metastatic and 1 chordoma) underwent corpectomy through a posterior transpedicular (posterolateral) approach. Tumors involved C2 (5), C3 (1), C5 (1), and C7 (1). Six cases had anterior reconstruction and three column fusion, and two cases had posterior fusion alone. Gross total resection was achieved in all cases. No hardware failure or worsening of neurological condition was seen (4 patient were neurologically intact and remained intact after surgery and 4 patients improved in their Frankel grade). Pain improved in all patients, mean visual analog scale preoperative was 86 and improved to 22 after surgery. In two patients the vertebral artery was ligated without sequelae. We conclude that cervical spine transpedicular (posterolateral) approach is useful in cases where an anterior approach or a circumferential approach is not an option. It avoids the morbidity of anterior transcervical, transternal, and transoral procedures while providing decompression of neural elements and allowing three column stabilization when needed.


Assuntos
Vértebras Cervicais/patologia , Vértebras Cervicais/cirurgia , Procedimentos Neurocirúrgicos/métodos , Neoplasias da Coluna Vertebral/cirurgia , Vertebroplastia/métodos , Idoso , Cordoma/patologia , Cordoma/cirurgia , Feminino , Humanos , Laminectomia/métodos , Laminectomia/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Cervicalgia/etiologia , Cervicalgia/fisiopatologia , Cervicalgia/cirurgia , Metástase Neoplásica/patologia , Metástase Neoplásica/fisiopatologia , Metástase Neoplásica/terapia , Procedimentos Neurocirúrgicos/estatística & dados numéricos , Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/fisiopatologia , Procedimentos de Cirurgia Plástica , Estudos Retrospectivos , Compressão da Medula Espinal/patologia , Compressão da Medula Espinal/prevenção & controle , Compressão da Medula Espinal/cirurgia , Fusão Vertebral/métodos , Fusão Vertebral/estatística & dados numéricos , Neoplasias da Coluna Vertebral/secundário , Resultado do Tratamento , Vertebroplastia/estatística & dados numéricos
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