RESUMO
PURPOSE: To report a unique case of incomplete CES following a rebar penetrating injury in perineal region with retro-pulsed fragment, which was treated with anterior approach and discuss suitable surgical approach. METHODS: Incomplete cauda equina syndrome caused by non-missile penetrating injury is extremely rare. A 26-year-old male patient presented incomplete cauda equina syndrome due to a penetrating rebar wound from his perineal region to the lumbosacral spine. Computed tomography demonstrated a bony fragment broken from S1 body compressing into the spinal canal. RESULTS: By anterior approach, we performed partial corpectomy of L5, decompression by retrieving the bony fragment and L5-S1 interbody fusion. The patient had a significant recovery, and no clinical complication was found after over 2-year follow-up. CONCLUSION: It is challenging to determine the optimal strategy of surgical treatment for penetrating spinal injuries with retained foreign bodies, here we suggest an anterior approach situation that has the advantage of being able to effectively perform decompression and prevent iatrogenic damages of thecal sac and nerve rootlets.
Assuntos
Síndrome da Cauda Equina , Vértebras Lombares , Ferimentos Perfurantes , Humanos , Masculino , Adulto , Síndrome da Cauda Equina/cirurgia , Síndrome da Cauda Equina/etiologia , Ferimentos Perfurantes/cirurgia , Ferimentos Perfurantes/complicações , Ferimentos Perfurantes/diagnóstico por imagem , Vértebras Lombares/cirurgia , Vértebras Lombares/lesões , Vértebras Lombares/diagnóstico por imagem , Descompressão Cirúrgica/métodos , Fusão Vertebral/métodos , Traumatismos da Coluna Vertebral/cirurgia , Traumatismos da Coluna Vertebral/complicações , Traumatismos da Coluna Vertebral/diagnóstico por imagem , Resultado do Tratamento , Ferimentos Penetrantes/cirurgia , Ferimentos Penetrantes/diagnóstico por imagem , Ferimentos Penetrantes/complicaçõesRESUMO
PURPOSE: We present a rare clinical case of a metastatic spinal tumor in the 7th thoracic spine from male breast cancer (MBC). METHOD: A 62-year-old man was referred as an outpatient, complaining of continuous pain in the back and right flank that began 2 weeks earlier. The patient had no neurologic signs or symptoms but had a medical history of left breast modified radical mastectomy because of MBC. Computed tomography and magnetic resonance imaging showed metastasis in the T7 vertebra and no other metastasis on positron emission tomography/computed tomography or bone scan. Separation surgery was performed with posterior corpectomy of T7 (en bloc excision), followed by stabilization with an expandable titanium cage and pedicle screws. The pathological examination of the excised T7 vertebra confirmed metastatic carcinoma with neuroendocrine differentiation from the breast. Adjuvant chemo-radiotherapy was performed after surgery. RESULTS: The patient had no symptoms at the 21-month follow-up. Radiologic studies showed no evidence of recurrent or metastatic lesions. CONCLUSION: MBC is extremely rare, with fewer cases of spinal metastases. Among these, patients who undergo separation surgery are even rarer. This case shows that radical surgery can be an option for MBC with spine metastasis if indicated.
Assuntos
Neoplasias da Mama Masculina , Neoplasias da Coluna Vertebral , Humanos , Masculino , Pessoa de Meia-Idade , Neoplasias da Mama Masculina/cirurgia , Neoplasias da Mama Masculina/patologia , Mastectomia , Vértebras Torácicas/cirurgia , Vértebras Torácicas/patologia , Neoplasias da Coluna Vertebral/diagnóstico por imagem , Neoplasias da Coluna Vertebral/cirurgia , Neoplasias da Coluna Vertebral/patologia , Imageamento por Ressonância MagnéticaRESUMO
BACKGROUND: The purpose of this study was to evaluate clinical and radiological outcomes at skeletal maturity after a calcaneo-cuboid-cuneiform osteotomy (triple C osteotomy) for symptomatic flatfoot deformity compared with healthy young adult controls. METHODS: Nineteen patients (30 feet) who undergone a triple C osteotomy for idiopathic symptomatic flatfeet from July 2006 to April 2013 were compared with 19 controls (38 feet). Radiographic measurements at preoperative examination, 1-year postoperative follow-up, and follow-up at skeletal maturity were evaluated. Functional outcomes were assessed by using the validated visual analog scale foot and ankle (VAS-FA) and the modified American Orthopaedic Foot and Ankle Surgery (AOFAS) score. RESULTS: In the triple C osteotomy group, 11 of 12 radiographic measurements were significantly improved at 1 year postoperatively and the last follow-up (p < 0.001). There was no recurrence at skeletal maturity (p > 0.05). There were no significant differences in nine of 12 radiographic measurements between the triple C osteotomy group at maturity and the control group (p > 0.05). Average VAS-FA and AOFAS scores were significantly improved at the time of skeletal maturity (p < 0.001). CONCLUSIONS: Surgical correction of symptomatic flatfoot deformity in childhood resulted in favorable outcomes after the triple C osteotomy. Deformity correction was also maintained during follow-up at skeletal maturity.
Assuntos
Pé Chato/cirurgia , Osteotomia/métodos , Ossos do Tarso/cirurgia , Adolescente , Adulto , Determinação da Idade pelo Esqueleto , Avaliação da Deficiência , Feminino , Pé Chato/diagnóstico por imagem , Humanos , Masculino , Medição da Dor , Estudos Retrospectivos , Ossos do Tarso/diagnóstico por imagem , Resultado do Tratamento , Adulto JovemRESUMO
OBJECTIVE: To analyze hardware-related problems and their prognoses after anterior cervical discectomy and fusion (ACDF) using cages and plates for degenerative and traumatic cervical disc diseases. METHODS: The study included 808 patients who underwent anterior cervical discectomy and fusion for degenerative and traumatic disc diseases with >1 year of follow-up. We investigated time of onset and progression of problems associated with instrumentation and cage usage. The mean follow-up time was 3.4 years. Type of plate, range and level of fusion, patient factors (age, sex, body mass index, and bone mineral density), and local kyphosis were evaluated. RESULTS: Complications were found in 132 cases (16.5%), including subsidence in 69 cases, plate loosening in 8 cases, screw loosening in 8 cases, screw breakage in 1 case, and multiple complications in 36 cases. In 3 cases, additional posterior cervical surgery was performed. One case needed hardware revision. There were no esophageal, tracheal, or neurovascular structural injuries secondary to metal failure. There were no significant differences in type of plate, level of surgery, or patient factors. The greater the number of fusion segments, the greater the incidence of complications (P = 0.001). The clinical outcomes improved regardless of the complications (P = 0.083). CONCLUSIONS: Most hardware-related complications are not symptomatic and can be treated conservatively. Only a few cases need revision surgery. Precise surgical techniques are needed in multilevel anterior cervical discectomy and fusion (>3 levels) because of the increased complication rate.
Assuntos
Placas Ósseas/efeitos adversos , Vértebras Cervicais/diagnóstico por imagem , Discotomia/efeitos adversos , Falha de Prótese/efeitos adversos , Fusão Vertebral/efeitos adversos , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Placas Ósseas/tendências , Vértebras Cervicais/cirurgia , Discotomia/instrumentação , Discotomia/tendências , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Prognóstico , Falha de Prótese/tendências , Estudos Retrospectivos , Fusão Vertebral/instrumentação , Fusão Vertebral/tendências , Adulto JovemRESUMO
RATIONALE: Intra-articular corticosteroid injection (IACI) is a cost-effective conservative treatment of mild-to-moderate osteoarthritis. Adverse events after this procedure range from life-threatening systemic reactions to self-limiting local reactions. To our knowledge, this is the 1st report of osteonecrosis (ON) in the medial tibial plateau after IACI. PATIENT CONCERNS: An 81-year-old female visited our hospital due to left knee pain of increasing intensity. She presented the sudden onset of severe acute knee pain with long lasting knee pain for several years. DIAGNOSIS: The diagnosis was confirmed ON of medial tibial plateau of knee joint by pathologic finding. INTERVENTIONS: We conducted a posterior stabilized total-knee arthroplasty with no requirement for bone grafting or additional prosthesis, such as metal augments or stems. OUTCOMES: At the postoperative 1 year follow-up, the patient was satisfied with the surgery and had no pain during walking and active knee motion. LESSONS: This case especially stress the possibility of ON in medial tibia plateau after IACI. Therefore, clinicians should monitor symptoms after IACI to enable early detection of this complication.
Assuntos
Osteoartrite do Joelho/tratamento farmacológico , Osteonecrose/induzido quimicamente , Osteonecrose/cirurgia , Triancinolona/efeitos adversos , Idoso de 80 Anos ou mais , Artroplastia do Joelho/métodos , Feminino , Humanos , Injeções Intra-Articulares , Triancinolona/uso terapêuticoRESUMO
PURPOSE: The purpose of this retrospective study was to evaluate clinical outcomes of endoscopic nerve decompression in patients with deep gluteal syndromes (DGS). MATERIALS AND METHODS: Between October 2013 and March 2015, 24 patients who underwent surgical treatment of DGS were retrospectively included in this study. The mean age was 47 years (range, 35 to 76 years), and there were 11 males and 13 females. The mean duration of pain was 12 months (range, 5 to 35 months) and the mean follow-up period was 32 months (range, 26 to 45 months). Clinical evaluations included the visual analog scale (VAS) pain score, modified Harris hip score (mHHS), and the symptom-rating scale. RESULTS: Significant improvement in symptoms following endoscopic decompression were achieved as measured using the VAS score (decrease in the mean from 7.1±0.9 to 2.5±1.5; P<0.001) and mHHS (increase from 59.4±6.5 to 85.0±8.3; P<0.001). CONCLUSION: Endoscopic sciatic nerve decompression was satisfactory for treating recalcitrant DGS, making it an effective treatment option to improve symptoms of DGS.
RESUMO
PURPOSE: To verify the clinical applicability of a modified classification system in distractive-extension cervical spine injury that reflects the degrees of soft tissue damage and spinal cord injury while complementing previous Allen classification and subaxial cervical spine injury classification (SLIC) system. METHODS: A total of 195 patients with cervical spine distraction-extension (DE) injury were retrospectively classified. We added stages IIIA (with concomitant spinal cord injury without bony abnormalities) and IIIB (with concomitant additional soft tissue swelling) to the existing stages I and II of the Allen classification. We also supplemented the SLIC system by refining and assigning scores to bony morphology and soft tissue damage. The previous and proposed classification systems were compared by analyzing their scoring performances in terms of clinical features and prognosis. RESULTS: The Allen classification yielded 153 and 42 patients with stage 1 and 42 stage 2 injuries, respectively. Patients classified according to the proposed system were stratified as follows: stage I, 58; stage II, 27; stage IIIA, 33; and stage IIIB, 77. Regarding neurological symptoms and prognosis, stages IIIA and IIIB were poorer than stage I but significantly better than stage II (P < 0.05). On the SLIC system, 146 patients scored ≥5; and 37 and 12 patients scored 4 and ≤3 points, respectively, whereas the numbers of patients who scored ≥5, 4, and ≤3 points on the modified SLIC system were 170, 21, and 4, respectively. CONCLUSIONS: The proposed classification and scoring system to complement the Allen classification and SLIC system with respect to the degrees of soft tissue damage and spinal cord injury is considered effective for diagnosing and determining therapeutic directions and prognosis in cases of cervical spine extension injury.
Assuntos
Vértebras Cervicais/lesões , Traumatismos da Coluna Vertebral/classificação , Adulto , Idoso , Edema/classificação , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Lesões dos Tecidos Moles/classificação , Adulto JovemRESUMO
Most reports on the use of modular femoral stems during revision surgery have involved short follow-up periods. The authors evaluated the clinical and radiographic performance of 59 patients fitted with a distal fix modular stem. The average follow-up period was 8.2 years. Average Harris hip score was improved from 47 to 87.6. Of 19 patients with trochanteric osteotomy, 4 had a displaced greater trochanter. Re-revision was performed in 5 patients, and 3 of these were for subsidence (of these 3, subsidence was associated with dissociation of the coupling part in 1 and with osteotomy nonunion in other 2 [proximal component only]). Modular distally fixed femoral stems were found to offer intraoperative flexibility, but to suffer from subsidence and intraoperative greater trochanter and metaphyseal femoral fractures.
Assuntos
Artroplastia de Quadril , Prótese de Quadril , Desenho de Prótese , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Fêmur/diagnóstico por imagem , Prótese de Quadril/efeitos adversos , Humanos , Masculino , Pessoa de Meia-Idade , Osteólise/diagnóstico por imagem , Osteólise/etiologia , Fraturas Periprotéticas/cirurgia , Falha de Prótese , Radiografia , ReoperaçãoRESUMO
The authors retrospectively analyzed 27 hips with periprosthetic femoral fractures (types B2 and B3) treated with distal fixation using a modular, fluted, femoral stem. The average follow-up was 4.8 years. Most fractures (25 hips) were united (92.6%), and mean Harris Hip Score at follow-up was 84.7. Subsidence was noted in 2 patients within 6 months postoperatively, but despite the subsidence, one achieved union. One patient developed peroneal nerve palsy. Two hips were defined as failure: one nonunion associated with infection, and the other one had 10 mm more subsidence. No dislocation occurred in any of the patients. This technique has proven to be reliable in the treatment of difficult fractures in the acute stage, although concerns regarding the subsidence remain when using this femoral stem.