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1.
Childs Nerv Syst ; 2024 Sep 09.
Artigo em Inglês | MEDLINE | ID: mdl-39249509

RESUMO

PURPOSE: This study describes the surgical outcome of pediatric primary spinal arachnoid cysts (SACs) presenting with compressive myelopathy and gives an update on the classification and management of these rare lesions. METHODS: We performed a single-center retrospective analysis of pediatric patients operated for primary spinal arachnoid cysts. The clinical and radiologic profiles and surgical outcomes of these children were analyzed. Subgroup analysis was done in the laminoplasty vs laminectomy groups to see for the development of spinal deformity. RESULTS: There were 10 males and seven females with a mean age of 10.4 years (range:6-14 years). The cysts extended to an average of 5.2 levels (range:2-8). They were extradural in seven (41%) and intradural in 10 (59%). Six intradural and four extradural cysts underwent laminectomy (n = 10) while four intradural and three extradural cysts underwent laminoplasty (n = 7). Although three out of 10 cases in the laminectomy group and none in the laminoplasty group had post-operative spinal deformity, this result was not statistically significant (p = 0.110). There was a moderate negative correlation between post-operative cord occupancy ratio (COR) and post-operative McCormick grade (Pearson correlation coefficient = -0.453, p = 0.068), suggesting that higher CORs are associated with lower McCormick grades. CONCLUSION: Symptomatic pediatric primary spinal arachnoid cysts are safely and effectively managed by marsupialization or microsurgical excision. Considering the growing age group, laminoplasty rather than laminectomy should be the standard surgical procedure to prevent late postoperative spinal deformity. Clinically significant recurrences are rare in the setting of adequate cord expansion and restored subarachnoid CSF flow following surgery.

2.
Childs Nerv Syst ; 40(7): 2093-2100, 2024 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-38536450

RESUMO

PURPOSE: Chiari II malformation (CM-II) is a congenital malformation of the posterior fossa associated with myelomeningocele. Of the symptomatic patients, 10-33% require surgical treatment. To this date, there is not a consensus about the best surgical technique, and whether to do duroplasty. METHODS: A literature search of the PubMed database and crossed references was performed, per PRISMA guidelines. Data regarding demographic features, extent of cervicomedullary deformity, clinical presentation, surgical techniques, and clinical outcomes were extracted. Pearson's chi-squared test was applied. The p-values under 0.05 were considered statistically significant. RESULTS: Twenty studies (N = 330) were analyzed. C3 and C4 levels represented 56.4% of the lowest tonsil displacement. The most reported symptom was dysphagia/swallowing dysfunction (53.8%). Suboccipital craniectomy (SOC) and cervical spine expansion (CSE) with duroplasty were the most reported technique. Dural augmentation was performed in 57.4% of the patients. After surgery, 59.6% observed an improvement in symptoms and quality of life, 12.5% were unchanged, and 27.8% had a worsened clinical status. The mortality rate was 2.5% during the first month after surgery, and 17.4% at the last follow-up evaluation. Patients who underwent CSE presented a better clinical outcome (p = 0.002). The SOC procedure could not be correlated with symptom improvement (p = 0.06). CONCLUSION: CM-II is associated with high morbidity and mortality. An early onset symptomatic CM-II demands intervention, which provided an improvement of outcome in most patients included in this review. The best surgical technique and the exact effect of the surgical management of CM-II on mortality are not yet clear.


Assuntos
Malformação de Arnold-Chiari , Humanos , Malformação de Arnold-Chiari/cirurgia , Procedimentos Neurocirúrgicos/métodos , Resultado do Tratamento
3.
Neurosurg Rev ; 47(1): 345, 2024 Jul 22.
Artigo em Inglês | MEDLINE | ID: mdl-39037535

RESUMO

In recent years, there has been growing interest in an alternative approach for treating TOLF, such as endoscopic decompression, which minimizes the disruption of surrounding tissues. It is important to understand the advantages, disadvantages, and potential differences in outcomes associated with each approach. This comparative study aims to evaluate and contrast the effectiveness, safety, and outcomes of these two surgical techniques, open laminectomy and endoscopic decompression, in the management of thoracic OLF. The literature review was conducted on Embase, PubMed, Scopus and Google Scholar databases. After a thorough screening of all search results, 14 studies were shortlisted, from which data was extracted, and statistical analysis was done. Pooled analysis was done to ascertain the intra-operative and post-operative outcomes after surgery for TOLF. Overall, 351 patients were included in the study for evaluation. 174 patients were operated on by open laminectomy, and 177 patients were seen in the endoscopy group. Decreased operative time was seen in the endoscopic subgroup. The mean length of hospital stay of 6.6 days. Both groups showed improvement in mJOA and VAS score. The recovery rate for the reported study cohort was 66.8%, with the Endoscopic surgical approach showing a positive correlation with the mean recovery rate. The dural tear was the most common complication, with a rate of 6.6%. The mean estimated infection rate was 2.7% and postoperative CSF leak was 3.7%, with a trend of significantly higher rates in the open subgroup. Both of the groups showed improvement in functional scores, VAS scores, and cross-sectional area. However, the Endoscopic decompression group experienced reduced hospital stays, operating times, and intraoperative blood loss. The most frequent side effects were CSF leak and dural tear. A few cases showed revision and infection. None of the problems differed between the groups.


Assuntos
Descompressão Cirúrgica , Laminectomia , Ligamento Amarelo , Vértebras Torácicas , Humanos , Descompressão Cirúrgica/métodos , Endoscopia/métodos , Laminectomia/métodos , Ligamento Amarelo/cirurgia , Neuroendoscopia/métodos , Ossificação Heterotópica/cirurgia , Complicações Pós-Operatórias/epidemiologia , Vértebras Torácicas/cirurgia , Resultado do Tratamento
4.
Eur Spine J ; 33(4): 1385-1390, 2024 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-38438586

RESUMO

PURPOSE: To describe the complications and the outcome of patients with achondroplasia undergoing thoracolumbar spinal surgery. METHODS: Retrospective analysis of prospectively collected data of all patients with achondroplasia undergoing surgery within the years 1992-2021 at the thoracic and/or lumbar spine. The outcome was measured by analyzing the surgical complications and revisions. The patient-rated outcome was assessed with the COMI score from 2005 onwards. RESULTS: A total of 15 patients were included in this study undergoing a total of 31 surgeries at 79 thoracolumbar levels. 12/31 surgeries had intraoperative complications consisting of 11 dural tears and one excessive intraoperative bleeding. 4/18 revision surgeries were conducted due to post-decompression hyperkyphosis. The COMI score decreased from 7.5 IQR 1.4 (range 7.1-9.8) preoperatively to 5.3 IQR 4.1 (2.5-7.5) after 2 years (p = 0.046). CONCLUSION: Patients with achondroplasia, the most common skeletal dysplasia condition with short-limb dwarfism, are burdened with a congenitally narrow spinal canal and are commonly in need of spinal surgery. However, surgery in these patients is often associated with complications, namely dural tears and post-decompression kyphosis. Despite these complications, patients benefit from surgical treatment at a follow-up of 2 years after surgery.


Assuntos
Acondroplasia , Cifose , Doenças Musculoesqueléticas , Estenose Espinal , Adulto , Humanos , Estenose Espinal/complicações , Estenose Espinal/cirurgia , Estudos Retrospectivos , Vértebras Torácicas/diagnóstico por imagem , Vértebras Torácicas/cirurgia , Descompressão Cirúrgica/efeitos adversos , Acondroplasia/complicações , Acondroplasia/cirurgia , Vértebras Lombares/diagnóstico por imagem , Vértebras Lombares/cirurgia , Cifose/cirurgia , Doenças Musculoesqueléticas/complicações , Doenças Musculoesqueléticas/cirurgia , Resultado do Tratamento
5.
Eur Spine J ; 33(8): 3109-3116, 2024 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-38825607

RESUMO

BACKGROUND: Cervical posterior instrumentation and fusion is often performed to avoid post-laminectomy kyphosis. However, larger comparative analyses of cervical laminectomy with or without fusion are sparse. METHODS: A retrospective, two-center, comparative cohort study included patients after stand-alone dorsal laminectomy with (n = 91) or without (n = 46) additional fusion for degenerative cervical myelopathy with a median follow-up of 59 (interquartile range (IQR) 52) months. The primary outcome was the C2-7 Cobb angle and secondary outcomes were Neck Disability Index (NDI), modified Japanese Orthopaedic Association (mJOA) scale, revision rates, T1 slope and C2-7 sagittal vertical axis (C2-7 SVA) at final follow-up. Logistic regression analysis adjusted for potential confounders (i.e. age, operated levels, and follow-up). RESULTS: Preoperative C2-7 Cobb angle and T1 slope were higher in the laminectomy group, while the C2-7 SVA was similar. The decrease in C2-7 Cobb angle from pre- to postoperatively was more pronounced in the laminectomy group (- 6° (IQR 20) versus -1° (IQR 7), p = 0.002). When adjusting for confounders, the decrease in C2-7 Cobb angle remained higher in the laminectomy group (coefficient - 12 (95% confidence interval (CI) -18 to -5), p = 0.001). However, there were no adjusted differences for postoperative NDI (- 11 (- 23 to 2), p = 0.10), mJOA, revision rates, T1 slope and C2-7 SVA. CONCLUSION: Posterior cervical laminectomy without fusion is associated with mild loss of cervical lordosis of around 6° in the mid-term after approximately five years, however without any clinical relevance regarding NDI or mJOA in well-selected patients (particularly in shorter segment laminectomies of < 3 levels).


Assuntos
Vértebras Cervicais , Cifose , Laminectomia , Fusão Vertebral , Humanos , Laminectomia/efeitos adversos , Laminectomia/métodos , Masculino , Vértebras Cervicais/cirurgia , Vértebras Cervicais/diagnóstico por imagem , Feminino , Fusão Vertebral/efeitos adversos , Fusão Vertebral/métodos , Pessoa de Meia-Idade , Cifose/cirurgia , Cifose/diagnóstico por imagem , Cifose/etiologia , Estudos Retrospectivos , Idoso , Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/diagnóstico por imagem , Complicações Pós-Operatórias/epidemiologia , Doenças da Medula Espinal/cirurgia , Doenças da Medula Espinal/diagnóstico por imagem , Doenças da Medula Espinal/etiologia , Resultado do Tratamento
6.
Eur Spine J ; 33(10): 3915-3932, 2024 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-39122847

RESUMO

PURPOSE: Laminoplasty (LP) combined with C3 laminectomy (LN) can effectively achieve spinal cord decompression while maintaining the integrity of the posterior ligament-muscle complex, thereby minimizing cervical muscle damage. However, its necessity and safety remain controversial. This study aimed to compare the safety and efficacy of LP and LP combined with C3 LN in the treatment of patients with multilevel degenerative cervical spondylotic myelopathy (DCM). METHODS: A systematic review and meta-analysis of the literature was performed. A search of PubMed, Web of Science, Embase, and the Cochrane Library databases was conducted from inception through December 2023 and updated in February 2024. Search terms included laminoplasty, laminectomy, C3 and degenerative cervical spondylosis. The literature search yielded 14 studies that met our inclusion criteria. Outcomes included radiographic results, neck pain, neurologic function, surgical parameters, and postoperative complications. We also assessed methodologic quality, publication bias, and quality of evidence. RESULTS: Fourteen studies were identified, including 590 patients who underwent LP combined with C3 LN (modified group, MG) compared to 669 patients who underwent LP (traditional group, TG). The results of the study indicated a statistically significant improvement in cervical range of motion (WMD = 3.62, 95% CI: 0.39 to 6.85) and cervical sagittal angle (WMD = 2.07, 95% CI: 0.40 to 3.74) in the MG compared to the TG at the last follow-up (very low-level evidence). The TG had a higher number of patients with complications, especially C2-3 bone fusion. There was no significant difference found in improvement of neck pain, JOA, NDI, cSVA, T1 slope at latest follow-up. CONCLUSION: LP combined with C3 LN is an effective and necessary surgical method for multilevel DCM patients to maintain cervical sagittal balance. However, due to the low quality of evidence in existing studies, more and higher quality research on the technology is needed in the future.


Assuntos
Vértebras Cervicais , Laminectomia , Laminoplastia , Espondilose , Humanos , Laminoplastia/métodos , Laminectomia/métodos , Vértebras Cervicais/cirurgia , Espondilose/cirurgia , Espondilose/diagnóstico por imagem , Doenças da Medula Espinal/cirurgia , Resultado do Tratamento , Descompressão Cirúrgica/métodos
7.
BMC Musculoskelet Disord ; 25(1): 1, 2024 Jan 02.
Artigo em Inglês | MEDLINE | ID: mdl-38166792

RESUMO

BACKGROUND: For patients with multilevel degenerative cervical myelopathy, laminectomy and posterior cervical fusions (PCF) with instrumentation are widely accepted techniques for symptom relief. However, hardware failure is not rare and results in neck pain or even permanent neurological lesions. There are no in-depth studies of hardware-related complications following laminectomy and PCF with instrumentation. METHODS: The present study was a retrospective, single centre, observational study. Patients who underwent laminectomy and PCF with instrumentation in a single institution between January 2019 and January 2021 were included. Patients were divided into hardware failure and no hardware failure group according to whether there was a hardware failure. Data, including sex, age, screw density, end vertebra (C7 or T1), cervical sagittal alignment parameters (C2-C7 cervical lordosis, C2-C7 sagittal vertical axis, T1 slope, Cervical lordosis correction), regional Hounsfield units (HU) of the screw trajectory and osteoporosis status, were collected and compared between the two groups. RESULTS: We analysed the clinical data of 56 patients in total. The mean overall follow-up duration was 20.6 months (range, 12-30 months). Patients were divided into the hardware failure group (n = 14) and no hardware failure group (n = 42). There were no significant differences in the general information (age, sex, follow-up period) of patients between the two groups. The differences in fusion rate, fixation levels, and screw density between the two groups were not statistically significant (p > 0.05). The failure rate of fixation ending at T1 was lower than that at C7 (9% vs. 36.3%) (p = 0.019). The regional HU values of the pedicle screw (PS) and lateral mass screw (LMS) in the failure group were lower than those in the no failure group (PS: 267 ± 45 vs. 368 ± 43, p = 0.001; LMS: 308 ± 53 vs. 412 ± 41, p = 0.001). The sagittal alignment parameters did not show significant differences between the two groups before surgery or at the final follow-up (p > 0.05). The hardware failure rate in patients without osteoporosis was lower than that in patients with osteoporosis (14.3% vs. 57.1%) (p = 0.001). CONCLUSIONS: Osteoporosis, fixation ending at C7, and low regional HU value of the screw trajectory were the independent risk factors of hardware failure after laminectomy and PCF. Future studies should illuminate if preventive measures targeting these factors can help reduce hardware failure and identified more risk factors, and perform long-term follow-up.


Assuntos
Lordose , Osteoporose , Parafusos Pediculares , Fusão Vertebral , Humanos , Laminectomia/efeitos adversos , Laminectomia/métodos , Lordose/diagnóstico por imagem , Lordose/etiologia , Lordose/cirurgia , Estudos Retrospectivos , Vértebras Cervicais/diagnóstico por imagem , Vértebras Cervicais/cirurgia , Vértebras Cervicais/patologia , Fusão Vertebral/efeitos adversos , Fusão Vertebral/métodos , Parafusos Pediculares/efeitos adversos , Osteoporose/complicações
8.
Acta Neurochir (Wien) ; 166(1): 352, 2024 Aug 27.
Artigo em Inglês | MEDLINE | ID: mdl-39192063

RESUMO

BACKGROUND: Type 1 Spinal dural arteriovenous fistula (dAVF) is a rare but curable vascular cause of myelopathy. Microneurosurgery is a very efficacious modality in treating them. METHOD: A 26 year old gentleman with progressive flaccid paraparesis (LMN type) and urinary incontinence underwent surgery using exoscope for a right side T9-10 dAVF. A dilated vein was seen accompanying the exiting nerve root intraoperatively, consistent with the preoperative angiographic findings. The vein was ligated and divided leading to restitution of spinal cord vasculature on table and excellent postoperative outcome. CONCLUSION: Surgical resection is a straightforward and highly effective treatment in spinal dAVF.


Assuntos
Malformações Vasculares do Sistema Nervoso Central , Microcirurgia , Humanos , Malformações Vasculares do Sistema Nervoso Central/cirurgia , Malformações Vasculares do Sistema Nervoso Central/diagnóstico por imagem , Masculino , Adulto , Microcirurgia/métodos , Ligadura/métodos , Medula Espinal/cirurgia , Medula Espinal/irrigação sanguínea , Medula Espinal/diagnóstico por imagem , Resultado do Tratamento , Procedimentos Neurocirúrgicos/métodos
9.
Acta Neurochir (Wien) ; 166(1): 277, 2024 Jun 28.
Artigo em Inglês | MEDLINE | ID: mdl-38937326

RESUMO

PURPOSE: Spontaneous spinal epidural hematoma (SSEH) is a rare pathology characterized by a hemorrhage in the spinal epidural space without prior surgical or interventional procedure. Recent literature reported contradictory findings regarding the clinical, radiological and surgical factors determining the outcome, hence the objective of this retrospective analysis was to re-assess these outcome-determining factors. METHODS: Patients surgically treated for SSEH at our institution from 2010 - 2022 were screened and retrospectively assessed regarding management including the time-to-treatment, the pre-and post-treatment clinical status, the radiological findings as well as other patient-specific parameters. The outcome was assessed using the modified McCormick Scale. Statistical analyses included binary logistic regression and Fisher's exact test. RESULTS: In total, 26 patients (17 men [65%], 9 women [35%], median age 70 years [interquartile range 26.5]) were included for analysis. The SSEHs were located cervically in 31%, cervicothoracically in 42% and thoracically in 27%. Twenty-four patients (92%) improved after surgery. Fifteen patients (58%) had a postoperative modified McCormick Scale grade of I (no residual symptoms) and 8 patients (31%) had a grade of II (mild symptoms). Only 3 (12%) patients remained with a modified McCormick Scale grade of IV or V (severe motor deficits / paraplegic). Neither time-to-treatment, craniocaudal hematoma expansion, axial hematoma occupation of the spinal canal, anticoagulation or antiplatelet drugs, nor the preoperative clinical status were significantly associated with the patients' outcomes. CONCLUSION: Early surgical evacuation of SSEH generally leads to favorable clinical outcomes. Surgical hematoma evacuation should be indicated in all patients with symptomatic SSEH.


Assuntos
Hematoma Epidural Espinal , Humanos , Hematoma Epidural Espinal/cirurgia , Hematoma Epidural Espinal/diagnóstico por imagem , Masculino , Feminino , Idoso , Estudos Retrospectivos , Pessoa de Meia-Idade , Resultado do Tratamento , Adulto , Procedimentos Neurocirúrgicos/métodos
10.
Neuromodulation ; 27(1): 183-187, 2024 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-37632516

RESUMO

OBJECTIVES: Placement of a standard paddle lead for spinal cord stimulation (SCS) requires a laminotomy for positioning of the lead within the epidural space. During initial placement, an additional laminotomy or laminectomy, termed a "skip" laminotomy, may be necessary at a higher level to pass the lead to the appropriate midline position. Patient and radiographic factors that predict the need for a skip laminotomy have yet to be identified. MATERIALS AND METHODS: Participants who underwent SCS paddle placement at Albany Medical Center between 2016 and 2017 were identified. Operative reports were reviewed to identify the paddle type, level of initial laminotomy, target level, and skip laminotomy level. Preoperative thoracic magnetic resonance images (MRIs) were reviewed, and spinal canal diameter, interpedicular distance, and dorsal cerebral spinal fluid thickness were measured for each participant when available. RESULTS: A total of 106 participants underwent thoracic SCS placement. Of these, 97 had thoracic MRIs available for review. Thirty-eight participants required a skip laminotomy for placement of the paddle compared with 68 participants who did not. There was no significant difference in demographic features including age, sex, body mass index, and surgical history. Univariate analyses that suggested trends were selected for further analysis using binary logistic regression. Level of initial laminotomy (odds ratio [OR] = 1.51, p = 0.028), spinal canal diameter (OR = 0.71, p = 0.015), and dorsal cerebrospinal fluid thickness (OR = 0.61, p = 0.011) were correlated with skip laminotomy. Target level (OR = 1.27, p = 0.138) and time from trial (1.01, p = 0.117) suggested potential association. The multivariate regression was statistically significant, X2(10) = 28.02, p = 0.002. The model explained 38.3% of the variance (Nagelkerke R2) and predicted skip laminectomy correctly in 73.3% of cases. However, for the multivariate regression, only a decrease in spinal canal diameter (OR = 0.59, p = 0.041) was associated with a greater odds of skip laminotomy. CONCLUSIONS: This study aims to characterize the patient and radiographic factors that may predict the need to perform a skip laminotomy during the initial placement of SCS paddles. Here, we show that radiographic and anatomic variables, primarily spinal canal diameter, play an important role in predicting the need for a skip laminotomy. Furthermore, we suggest that target level for placement and level of initial laminotomy also may contribute. Further investigation of the predictive factors for performing a skip laminotomy would help optimize surgical planning and preoperative patient selection and counseling.


Assuntos
Estimulação da Medula Espinal , Humanos , Estimulação da Medula Espinal/métodos , Laminectomia/métodos , Espaço Epidural/fisiologia , Sistema Nervoso Central , Medula Espinal/diagnóstico por imagem , Medula Espinal/cirurgia , Medula Espinal/fisiologia , Eletrodos Implantados
11.
Beijing Da Xue Xue Bao Yi Xue Ban ; 56(2): 318-321, 2024 Apr 18.
Artigo em Zh | MEDLINE | ID: mdl-38595251

RESUMO

OBJECTIVE: To explore the application and key points of microchannel approaches in resection of cervical intraspinal tumors. METHODS: A retrospective analysis was performed on 51 cases of cervical spinal canal tumors from February 2017 to March 2020. Among them, 5 cases were located epidural space, 6 cases were located epidural and subdural space, and 40 cases were located under the subdural extramedullary space(6 cases were located on the ventral side of the spinal cord). The maximum diameter ranged from 0.5 to 3.0 cm. The clinical manifestations included neck, shoulder or upper limb pain 43 cases, sensory disturbance (numbness) in 22 cases, and limb weakness in 8 cases. The microchannel keyhole technique was used to expose the tumor, and the tumor was resected microscopically. RESULTS: In this study, 35 patients underwent hemilaminectomy, 12 patients underwent interlaminar fenestration, 2 patients underwent medial 1/4 facetectomy on the basis of hemilaminectomy or interlaminar fenestration. Two tumors were resected through anatomy space (no bone was resected). The degree of tumor resection included total resection in 50 cases and subtotal resection in 1 case. The type of the tumor included 36 schwannomas, 12 meningiomas, 2 enterogenic cysts and 1 dermoid cyst. There was no infection and cerebrospinal fluid leakage postoperatively. Limb numbness occurred in 7 patients. The average follow-up time was 15 months (3 to 36 months). No deformity such as cervical instability or kyphosis was found. The tumor had no recurrence. CONCLUSION: The cervical spinal canal is relatively wide, cervical tumors with no more than three segments can be fully exposed by means of microchannel technology. Besides intramedullary or malignant tumors, they can be microsurgically removed. Preservation of the skeletal muscle structure of cervical spine is beneficial to recover the anatomy and function of cervical spine. The electrophysiological monitoring helps to avoid spinal cord or nerve root injury.


Assuntos
Neoplasias Meníngeas , Neoplasias da Medula Espinal , Neoplasias da Coluna Vertebral , Neoplasias do Colo do Útero , Feminino , Humanos , Estudos Retrospectivos , Hipestesia , Resultado do Tratamento , Neoplasias da Coluna Vertebral/cirurgia , Neoplasias da Medula Espinal/cirurgia , Vértebras Cervicais/cirurgia
12.
J Pak Med Assoc ; 74(5): 967-971, 2024 May.
Artigo em Inglês | MEDLINE | ID: mdl-38783448

RESUMO

Lumbar canal stenosis (LCS) is a common spinal disease affecting the elderly. Primarily it is asymptomatic until there is neurogenic claudication. Minimally invasive surgical (MIS) techniques are used to treat patients with lumbar spinal stenosis (LSS), while tubular system with alternative multilevel decompression is specifically used for those with minimal back pain and no mechanical instability on dynamic imaging. The aim of the study is to evaluate surgical outcome of Slalom procedure and complications in Middle East population. One hundred and five patients with lumbar stenosis (61 males and 44 females) underwent the procedure between 2015-2021 who were regularly followed-up using preoperative and postoperative COMI score (the core outcome measure index) at six months after index surgery. Progressive improvement in COMI score from average seven pre-op score to an average of three after six months of index surgery. The postoperative complications were dural tear (6.67%), Postoperative infection (3.81%), mechanical instability (1.9%), postoperative neuritis (8.57%) and death (1.9%).


Assuntos
Descompressão Cirúrgica , Vértebras Lombares , Complicações Pós-Operatórias , Estenose Espinal , Humanos , Estenose Espinal/cirurgia , Feminino , Masculino , Descompressão Cirúrgica/métodos , Pessoa de Meia-Idade , Vértebras Lombares/cirurgia , Complicações Pós-Operatórias/epidemiologia , Idoso , Resultado do Tratamento , Procedimentos Cirúrgicos Minimamente Invasivos/métodos , Procedimentos Cirúrgicos Minimamente Invasivos/efeitos adversos
13.
Pain Med ; 24(7): 796-808, 2023 07 05.
Artigo em Inglês | MEDLINE | ID: mdl-36515491

RESUMO

Intrathecal trialing is used as a screening prognostic measure prior to intrathecal drug delivery system implant. The purpose of this study was to determine the efficacy of a continuous intrathecal infusion of an admixture of bupivacaine and fentanyl in patients with chronic low back pain. Patients with refractory chronic low back pain in the setting of previous lumbar spine surgery and/or chronic vertebral compression fracture(s) were enrolled in a randomized double blind cross-over study comparing saline infusion to infusion of a solution containing bupivacaine combined with low-dose fentanyl over a 14-18 hour period. The primary outcome measure was the change in pain intensity at the end of the screening trial. Patients who experienced significant pain reduction from either infusion relative to baseline pain were offered a permanent implant. In total, 36 patients were enrolled, with 31 patients trialed and 25 implanted. At the end of the screening trial, pain scores, at rest or with activity, decreased appreciably in both groups; however, significantly better improvements occurred in the fentanyl/bupivacaine group compared to saline both with activity and at rest (P = .016 and .006, respectively). Treatment order appeared to affect outcome with saline demonstrating a placebo response. At 12 months following implant, primary and secondary outcome measures continued to be significantly reduced from baseline. Continuous intrathecal delivery of a combination of zlow-dose fentanyl with bupivacaine is superior to saline in screening intrathecal trialing for back pain reduction. With longer term delivery, a sustained reduction of chronic low back pain was also observed.


Assuntos
Fraturas por Compressão , Dor Lombar , Fraturas da Coluna Vertebral , Humanos , Bupivacaína , Fentanila/uso terapêutico , Analgésicos Opioides/uso terapêutico , Dor Lombar/tratamento farmacológico , Estudos Cross-Over , Injeções Espinhais , Anestésicos Locais , Método Duplo-Cego
14.
BMC Anesthesiol ; 23(1): 308, 2023 09 12.
Artigo em Inglês | MEDLINE | ID: mdl-37700233

RESUMO

BACKGROUND: There is still room for improvement of pain management after spinal surgery. The goal of this study was to evaluate adding the erector spinae block to the standard analgesia regimen. Our hypothesis was that the erector spinae plane block will decrease length of hospital stay, reduce opioid need and improve numeric rating scale pain scores. METHODS: This was a single center retrospective cohort study. We included 418 patients undergoing laminectomy or discectomy from January 2019 until December 2021. The erector spinae plane block was introduced in 2016 by Forero and colleagues and added to our clinical practice in October 2020. Patients who did not receive an erector spinae plane block prior to its implementation in October 2020 were used as control group. The primary outcome measure was functional recovery, measured by length of hospital stay. Secondary outcome measures were perioperative opioid consumption, need for patient-controlled analgesia and numeric rating scale pain scores. Postoperative data collection time points were: at the PACU and after 3, 6, 12 and 24 h postoperatively. RESULTS: There was a significant shorter length of hospital stay in patients undergoing single level laminectomy (with erector spinae plane block 29 h (IQR 27-51), without block 53 h (IQR 51-55), p < .001), multiple level laminectomy (with erector spinae plane block 49 h (IQR 31-54), without block 54 h (IQR 52-75), p < .001) and discectomy (with erector spinae plane block 27 h (IQR 25-30), without block 29 h (IQR 28-49), p = .04). CONCLUSIONS: Erector spinae plane block reduces length of stay after laminectomy surgery.


Assuntos
Laminectomia , Bloqueio Nervoso , Humanos , Analgésicos Opioides/uso terapêutico , Estudos Retrospectivos , Analgesia Controlada pelo Paciente , Discotomia , Dor
15.
Childs Nerv Syst ; 39(7): 1935-1939, 2023 07.
Artigo em Inglês | MEDLINE | ID: mdl-36738321

RESUMO

INTRODUCTION: Spontaneous spinal epidural hematoma (SSEH) is a rare entity, especially in toddlers and infants. The nonspecificity of its presenting symptoms in children may be a source of delayed diagnosis. CASE DESCRIPTION: We report the case of a 20-month-old young boy without medical history who presented with irreducible torticollis, worsened a few days later by severe tetraplegia and respiratory distress. Spinal magnetic resonance imaging (MRI) showed a posterior epidural hematoma, extending from C3 to T1 and compressing the spinal cord. An urgent decompressive surgery via an extensive laminectomy and evacuation of the clot was performed. The patient demonstrated a partial neurological recovery on follow-up. CONCLUSION: SSEH is a rare and serious condition that may compromise the functional and vital prognosis of the patient, hence the importance of prompt diagnosis and urgent treatment.


Assuntos
Hematoma Epidural Espinal , Torcicolo , Masculino , Lactente , Humanos , Pré-Escolar , Laminectomia/métodos , Hematoma Epidural Espinal/complicações , Hematoma Epidural Espinal/diagnóstico por imagem , Hematoma Epidural Espinal/cirurgia , Torcicolo/diagnóstico por imagem , Torcicolo/etiologia , Imageamento por Ressonância Magnética/efeitos adversos , Medula Espinal/cirurgia
16.
Childs Nerv Syst ; 39(10): 2687-2700, 2023 10.
Artigo em Inglês | MEDLINE | ID: mdl-37658937

RESUMO

INTRODUCTION: Spinal cord surgery has and always will be a challenging operation with satisfying results, but also with potentially devastating results. Over the last century, there has been an evolution in the way we perceive and conduct spinal cord surgery. The phenomenal evolution in technology from the very first x-ray pictures helps to localize the spinal pathology through the use of high-resolution MRI and ultrasonography that allows for high precision surgery with relatively minimal exposure. METHODS: The advancements in the surgical technique and the utilization of neuromonitoring allow for maximal safe resection of these delicate and intricate tumors. We also are beginning to understand the biology of spinal cord tumors and vascular lesions, as in the recent 2021 WHO classification which identifies specific entities such as spinal ependymomas, MYCN-amplified, as separate entity from the other subtypes of ependymomas. Surgeons have also accepted the importance of maximal safe resection for most of the spinal cord pathologies rather than just performing biopsy and adjuvant treatment. CONCLUSION: There have been significant advances since the first resection of an intramedullary tumor including diagnosis, imaging, and surgical technique for children. These advances have improved the prognosis and outcome in these children.


Assuntos
Ependimoma , Neoplasias da Medula Espinal , Criança , Humanos , Procedimentos Neurocirúrgicos/métodos , Neoplasias da Medula Espinal/diagnóstico por imagem , Neoplasias da Medula Espinal/cirurgia , Prognóstico , Ependimoma/patologia , Medula Espinal/diagnóstico por imagem , Medula Espinal/cirurgia , Medula Espinal/patologia , Resultado do Tratamento
17.
Childs Nerv Syst ; 39(6): 1641-1646, 2023 06.
Artigo em Inglês | MEDLINE | ID: mdl-36757431

RESUMO

BACKGROUND: Laminotomy has been introduced in surgical practice to reduce complications of laminectomy after surgery of tumors in the spinal canal. However, the posterior ligament complex, which is routinely interrupted to remove the laminoplasty segment and gain access to the spinal canal, has a tendency not to heal and can lead to progressive kyphosis and collapse. CASE PRESENTATION: A 5-month-old boy affected by a thoracolumbar extradural tumor extending along seven spinal levels was operated on. The tumor was exposed and completely resected by a one-piece laminotomy with preservation of the integrity of the posterior tension band at both extremities. After 1-year radiological examination ruled out spinal deformity. CONCLUSION: The technique herein presented, which we named in situ laminotomy, allows to fully preserve the posterior tension band without reducing the exposure of the spinal canal in multilevel tumors. Additionally, the technique makes also the reconstruction of the spine elements very easy and rapid. However, longer follow-up is necessary to prove the effectiveness of this procedure in preventing long-term deformity and instability.


Assuntos
Neoplasias da Medula Espinal , Neoplasias da Coluna Vertebral , Masculino , Humanos , Criança , Lactente , Laminectomia/métodos , Neoplasias da Coluna Vertebral/diagnóstico por imagem , Neoplasias da Coluna Vertebral/cirurgia , Neoplasias da Coluna Vertebral/complicações , Coluna Vertebral/cirurgia , Neoplasias da Medula Espinal/diagnóstico por imagem , Neoplasias da Medula Espinal/cirurgia , Neoplasias da Medula Espinal/complicações , Canal Medular/cirurgia
18.
Childs Nerv Syst ; 39(6): 1691-1694, 2023 06.
Artigo em Inglês | MEDLINE | ID: mdl-36862185

RESUMO

Blue rubber bleb nevus syndrome (BRBNS) is a rare condition that presents with venous malformation blebs throughout the body, most commonly on the skin and gastrointestinal tract. There have only been a limited number of reports of benign BRBNS lesions involving the spine in children, which were detected after chronic symptomatology. We herein present a unique case of a ruptured BRBNS venous malformation into the epidural space of the lumbar spine in a child presenting with acute neurologic deficit and discuss the relevant surgical considerations for operating in the setting of BRBNS.


Assuntos
Hematoma Epidural Espinal , Nevo Azul , Neoplasias Cutâneas , Humanos , Criança , Nevo Azul/complicações , Nevo Azul/cirurgia , Nevo Azul/patologia , Neoplasias Cutâneas/complicações , Neoplasias Cutâneas/cirurgia , Neoplasias Cutâneas/patologia , Pele/patologia
19.
Neurosurg Rev ; 47(1): 5, 2023 Dec 08.
Artigo em Inglês | MEDLINE | ID: mdl-38062318

RESUMO

While multiple studies exist comparing cervical laminoplasty (CLP) and posterior cervical laminectomy with fusion (PCF), no clear consensus exists on which intervention is better. An umbrella review helps provide an overall assessment by analyzing a given condition's multiple interventions and outcomes. It integrates all available information on a topic and allows a consensus to be reached on the intervention of choice. A literature search was conducted using specific search criteria in PubMed, Scopus, and Web of Science databases. Titles and abstracts were screened based on inclusion criteria. A full-text review of articles that passed the initial inclusion criteria was performed. Nine meta-analyses were deemed eligible for the umbrella review. Data was extracted on reported variables from these meta-analyses. Subsequent quality assessment using AMSTAR2 and data analysis using the R package metaumbrella were used to determine the significance of postoperative outcomes. When the meta-analyses were pooled, statistically significant differences between CLP and PCF were found for postoperative overall complications rate and postoperative JOA score. PCF was associated with a lower overall complication rate and a higher postoperative JOA score, both supported by a weak level of evidence (class IV). Data regarding all other outcomes were non-significant. Our umbrella review investigates CLP and PCF by providing a comprehensive overview of existing evidence and evaluating inconsistencies within the literature. This umbrella review revealed that PCF had better outcomes for overall complications rate and postoperative JOA than CLP, but they were classified as being of weak significance.


Assuntos
Laminoplastia , Fusão Vertebral , Humanos , Laminectomia , Vértebras Cervicais/cirurgia , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/cirurgia , Resultado do Tratamento , Descompressão Cirúrgica
20.
Eur Spine J ; 32(2): 475-487, 2023 02.
Artigo em Inglês | MEDLINE | ID: mdl-36437434

RESUMO

BACKGROUND: Microscopic unilateral laminotomy for bilateral decompression (ULBD) is a minimally invasive technique used in the treatment of lumbar spinal stenosis and could limit spinal instability and be associated with better clinical outcomes. However, there is ongoing debate regarding its utility compared to conventional laminectomy (CL). The primary objective was to collate and describe the current evidence base for ULBD, including perioperative parameters, functional outcomes, and complications. The secondary objective was to identify operative techniques. METHODS: A scoping review was conducted between January 1990 and August 2022 according to the PRISMA extension for scoping reviews (PRISMA-ScR) guidelines. Major databases were searched for full text English articles reporting on outcomes following microscopic unilateral laminotomy in patients with lumbar spinal stenosis. RESULTS: Seventeen articles met the inclusion criteria. Two studies were randomised controlled trials. Two studies were prospective data collection and the rest were retrospective analysis. Three studies compared ULBD with CL. ULBD preserves the osteoligamentous complex and may be associated with shorter operative time, less blood loss, and similar clinical outcomes when compared to CL. CONCLUSION: This review highlights that ULBD aims to minimise disruption to the normal posterior spinal anatomy and may have acceptable clinical outcomes. It also highlights that it is difficult to draw valid conclusions given there are limited data available as most studies identified were retrospective or did not have a comparator group.


Assuntos
Descompressão Cirúrgica , Estenose Espinal , Humanos , Descompressão Cirúrgica/métodos , Laminectomia/métodos , Vértebras Lombares/cirurgia , Estudos Retrospectivos , Estenose Espinal/cirurgia , Resultado do Tratamento
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