The Preoperative Use of Gabapentinoids for the Treatment of Acute Postoperative Pain Following Lumbar Spine Fixation Surgery.

BACKGROUND: Postoperative pain following posterior fixation is caused not only by tissue injury during surgery and is related to inflammatory, neuropathic, and visceral pain. This study aims to answer the question, "Is there a role for gabapentinoids in reducing postoperative pain?" In addition, it demonstrates which gabapentinoids may be used, for how long, and at what dose. METHODS: The study was planned as a prospective, randomized, double-blind study. Lumbar posterior fixation was included and patients were divided into 9 groups. Gabapentinoids and a placebo were administered. Postoperative pain at hours 1, 6, 12, and 24 was evaluated by visual analog scale (VAS). RESULTS: This study included 252 patients (141 women, 111 men). The median age was 51.62 years. A statistically significant difference was found when VAS-1, VAS-6, VAS-12, and VAS-24 scores were compared between all groups (P ˂ 0.001). Single and low doses of gabapentinoids were found to be ineffective (P > 0.05). Long-term and high-dose gabapentinoids had complications (P ˂ 0.001). Single and high doses of gabapentinoids were effective and safe (P ˂ 0.001). CONCLUSIONS: Postoperative use of gabapentin for controlling early and late-stage pain is safe and effective. Single and high-dose gabapentin was the first choice. A single and high dose of pregabalin is the second choice.

Composite Hemangioendothelioma Settled in the Paraspinal Region: A Rare Case Report.

Composite hemangioendothelioma (CHE) is a very rare, low-grade malignant vascular tumor. It is most commonly seen as one or more nodules on both sides of the fingers and toes. This tumor rarely settles in the paraspinal muscles. The age of onset is usually between 21 and 72 years, with an average age of 39.5-41 years. Treatment is with gross total removal of the lesion. We present a case of a 54-year-old male patient with a 2-year history of low back pain. Lumbar spine magnetic resonance imaging revealed CHE in the right paravertebral muscle in the posterior vicinity of the transverse process between the right paraspinal muscle planes. The entire mass was removed grossly. The definitive diagnosis of CHE was made histopathologically. This is a rare case of CHE that had settled in the paraspinal region.

Spinal Epidural Venous Angioma Presenting Symtomps of Lumbar Disc Herniation: A Case Report.

Spinal epidural venous angiomas are extremely rare. We report the case of a 60-year-old man who presented with disc herniation symptoms, complaining of pain in his left leg and numbness, especially at the base of the knee. On physical examination, the Lasègue test was positive at 45 degrees on the left side and no neurological deficit was detected on the lower extremity. Contrast enhanced magnetic resonance imaging revealed a lesion in the left S1 neural foramen, which was initially evaluated as a schwannoma. However, after the lesion was totally excised, it was pathologically identified as a venous angioma. Here, the clinical presentation, management, and surgical, radiological, and pathological features are discussed.

Remote Cerebellar Haemorrhage after Burr Hole Drainage of Chronic Subdural Haematoma: A Case Report.

Remote cerebellar haemorrhage (RCH) is an unusual complication of supratentorial neurosurgical procedures. Even the rarer is cerebellar haemorrhage occurring after supratentorial burr hole drainage of Chronic Subdural Haematoma (CSDH). The exact mechanism is still unclear despite some possible causative factors such as rapid evacuation of haematoma and overdrainage of CSF (Cerebrospinal Fluid). We report a 80-year-old male patient who developed cerebellar haemorrhage after burr hole drainage of left frontoparietal chronic subdural haematoma and discuss the possible aetiological mechanisms through the review of the current literature.

The Association between Sagittal Index, Canal Compromise, Loss of Vertebral Body Height, and Severity of Spinal Cord Injury in Thoracolumbar Burst Fractures.

AIM: Our aim was to determine whether a combination of sagittal index (SI), canal compromise (CC), and loss of vertebral body height (LVBH) is associated with the severity of neurological injury in patients with thoracolumbar burst fractures. MATERIALS AND METHODS: Seventy-four patients with thoracolumbar burst fracture undergoing instrumentation between 2010 and 2015 were analyzed retrospectively. The degree of neurological injury was determined using the American Spinal Injury Association (ASIA) scoring system. The association between the morphology of the fracture and the severity of neurological injury was analyzed. RESULTS: There was a strong association between fracture morphology and the severity of neurological injury. Of the patients, 77.5% with SI ≥20°, 81.6% with CC ≥40%, and 100% with LVBH ≥50% had lesion according to ASIA. All of 7 patients with ASIA A had SI ≥20°, CC ≥40%, and LVBH ≥50%. On the other hand, 79% of the patients with ASIA E had SI <20°, 83.7% of the patients with ASIA E had CC <40%, and all of the patients with ASIA E had LVBH <50%. SI, CC, and LVBH were lower in neurologically intact patients (ASIA E), whereas they were higher in patients with neurological deficits (ASIA A, B, C, D) (P = 0.001; P < 0.01). These measurements had 100% negative predictive values and relatively high positive predictive values. CONCLUSION: SI, CC, and LVBH are significantly associated with the severity of neurological injury in patients with thoracolumbar burst fractures. The patients with SI >25°, the patients with CC >40%, and the patients with LVBH >50% are likely to have a more severe neurological injury.

Foramen Magnum Decompression and Duraplasty is Superior to Only Foramen Magnum Decompression in Chiari Malformation Type 1 Associated with Syringomyelia in Adults.

STUDY DESIGN: Retrospective cohort study. PURPOSE: To compare surgical results of foramen magnum decompression with and without duraplasty in Chiari malformation type 1 (CM-1) associated syringomyelia (SM). OVERVIEW OF LITERATURE: The optimal surgical treatment of CM-1 associated with SM is unclear. METHODS: Twenty-five cases of CM-1 with SM were included. There were 12 patients (48%) in the non-duraplasty group and 13 patients (52%) in the duraplasty group. The rate of improvement, state of postoperative SM size, amount of tonsillar herniation, preoperative symptom duration, complications and reoperation rates were analysed. RESULTS: The rate of clinical improvement was significantly higher with duraplasty (84.6%) than without (33.3%, p <0.05). The rate of postoperative syrinx regression was significantly higher in the duraplasty group (84.6%) than in the non-duraplasty group (33.3%, p <0.05). One case in the duraplasty group needed a reoperation compared with five cases in the non-duraplasty group (p =0.059). CONCLUSIONS: Duraplasty is superior to non-duraplasty in CM-1 associated with SM despite a slightly higher complication rate.

Complicated fronto-orbital mucopyocele presenting with proptosis: a case report.

Mucoceles are cystic lesions of the paranasal sinuses which develop as a result of accumulation of mucous secretion due to obstruction of the ostium of the sinuses. Despite their benign behavior, they may enlarge progressively and project into adjacent structures by destructing the bony walls of the sinuses. Frontal mucoceles may get infected and extend towards orbital cavity and compress the orbit by eroding the bony walls of the orbital cavity. Endoscopic and external approaches are performed in the surgical treatment. We report a case of complicated fronto-orbital mucopyocele which eroded the orbital roof and extended into the orbital cavity and discuss the surgical treatment strategy under the light of the current literature.