RESUMO
We studied 51 patients with 64 fractures of the thoracolumbar and lumbar spine undergoing the surgical treatment by percutaneous trans-pedicular fixation and stabilization with minimally invasive technique. Patient follow-up ranged from 6 to 28 months (mean 14.2 months) and the patients were assessed by clinical and radiographic evaluation. The results show that percutaneous trans-pedicular fixation and stabilization with minimally invasive technique is an adequate and satisfactory procedure to be used in specific type of the thoracolumbar and lumbar spine fractures.
Assuntos
Vértebras Lombares/cirurgia , Procedimentos Cirúrgicos Minimamente Invasivos/métodos , Fraturas da Coluna Vertebral/cirurgia , Fusão Vertebral/métodos , Vértebras Torácicas/cirurgia , Adulto , Idoso , Idoso de 80 Anos ou mais , Cimentos Ósseos/uso terapêutico , Parafusos Ósseos/efeitos adversos , Parafusos Ósseos/estatística & dados numéricos , Feminino , Humanos , Fixadores Internos/efeitos adversos , Fixadores Internos/estatística & dados numéricos , Vértebras Lombares/diagnóstico por imagem , Vértebras Lombares/lesões , Masculino , Pessoa de Meia-Idade , Procedimentos Cirúrgicos Minimamente Invasivos/efeitos adversos , Procedimentos Cirúrgicos Minimamente Invasivos/instrumentação , Avaliação de Resultados em Cuidados de Saúde , Dor Pós-Operatória/epidemiologia , Dor Pós-Operatória/reabilitação , Próteses e Implantes/efeitos adversos , Próteses e Implantes/estatística & dados numéricos , Radiografia , Recuperação de Função Fisiológica/fisiologia , Estudos Retrospectivos , Fraturas da Coluna Vertebral/etiologia , Fraturas da Coluna Vertebral/patologia , Fusão Vertebral/efeitos adversos , Fusão Vertebral/instrumentação , Vértebras Torácicas/diagnóstico por imagem , Vértebras Torácicas/lesões , Resultado do Tratamento , Cicatrização/fisiologia , Adulto JovemRESUMO
The authors examine 83 consecutive cases of fracture and dislocation of the lower cervical spine submitted to surgery over a period of 5 years. Sixty-five patients were monitored with minimum 5-months follow-up, 5 died, 13 could not be traced. Lesions were classified based on the method proposed by Argenson3 with the purpose of identifying guidelines for surgical treatment. Thus, different methods are proposed based on the type of lesion and on any neurologic deficit. Intersomatic fusion with anterior approach is the method of choice in most lesions. The exception to this is monoarticular dislocations that cannot be reduced, so that reduction by posterior approach associated with discectomy and anterior fusion are recommended. Circumferential fusion is proposed for traumatic spondylolistheses, complete dislocations with unsatisfactory anterior reduction, in lesions in flexion-extension and rotation associated with complete spinal cord injury, in order to favor functional rehabilitation free from ortheses. The need to review many cases of traumatic lesions of the lower cervical spine (LCS) collected over a relatively short period of time derives from the need to identify guidelines that will help the surgeon in his or her choice of the type of surgery to perform on the patient with emergency injury. The basic premise, as for other sites of traumatic injury, resides in an efficient classification (corresponding to the anatomic injury and of immediate and intuitive application) to which options for treatment may be related. In particular, an evaluation of the type of approach (anterior, posterior, combined) and of the sequence of surgical stages is essential to obtaining effective results with an acceptable complication rate. Finally, treatment must be definitive, and in cases of severe spinal cord injury it must allow for rapid rehabilitation and freedom from the use of ortheses.
Assuntos
Vértebras Cervicais/lesões , Vértebras Cervicais/cirurgia , Luxações Articulares/cirurgia , Fraturas da Coluna Vertebral/cirurgia , Adulto , Idoso , Feminino , Humanos , Luxações Articulares/classificação , Masculino , Fraturas da Coluna Vertebral/classificaçãoRESUMO
For a total of 123 thoracolumbar traumatic lesions treated surgically in 101 patients over approximately 2 years (all monitored clinically and radiographically up to consolidation by follow-ups after from 6 to 26 months, mean 10 months) the technique used, complications and treatment are reported. The treatment procedure included: emergency surgery decompression, osteosynthesis, and fusion (posterior and possibly intersomatic); immediate recovery of function and loading; clinical and radiographic monitoring within 4-6 weeks, and possible anterior fusion in case of insufficient reconstruction of the anterior column. The complications observed out of 123 fractures were: collapse of the implant (4 cases), infection (5 cases), liquoral fistula (1 case), transitory paralysis of the abdominal muscles homolateral to the lombotomic incision (1 case), TVP (2 cases), bronchial pneumonia (2 cases), paralytic ileum (1 case). There was no sagittal deformity (secondary kyphosis) except for 5 cases of mechanical collapse that were resolved with a new operation. Neurologic deficit was caused by fracture in 49 patients (40% of the fractures or 48% of the patients). Six patients out of 30 affected with spinal cord lesion (20%) and 15 out of 19 affected with cone and/or cauda lesion (79%) improved. There was no progression of the neurologic findings after surgery. The authors conclude by proposing a protocol of posterior osteosynthesis for the use of a system in titanium made up of pedicle screws and hooks connected to a pair of cylindrical bars joined together.
Assuntos
Vértebras Lombares/lesões , Vértebras Lombares/cirurgia , Fraturas da Coluna Vertebral/cirurgia , Vértebras Torácicas/lesões , Vértebras Torácicas/cirurgia , Adolescente , Adulto , Idoso , Feminino , Seguimentos , Humanos , Vértebras Lombares/diagnóstico por imagem , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/epidemiologia , Radiografia , Fraturas da Coluna Vertebral/diagnóstico por imagem , Vértebras Torácicas/diagnóstico por imagemRESUMO
It is the purpose of this study to evaluate the clinical and radiographic medium-term results of a series of 60 patients submitted to intersomatic lumbar fusion by posterior approach, using a system constituted by carbon wedges to be associated with bone grafts for intersomatic fusion, and by steel or titanium plates or bars used for posterior pedicle osteosynthesis. Satisfactory clinical results were obtained in 88.2% of cases and complete radiographic fusion in 91.4% of cases. Complications were generally observed in 8.3% of cases. In light of these results, we may consider intersomatic lumbar fusion by posterior approach a method that is perhaps aggressive, but effective in the treatment of severe lumbar spondylolysis. The use of carbon wedges brings several advantages that favor intersomatic fusion, its progressive control, and the restoration of normal lordosis of the lumbar spine.
Assuntos
Vértebras Lombares , Doenças da Coluna Vertebral/cirurgia , Fusão Vertebral/métodos , Adulto , Idoso , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Fatores de TempoRESUMO
Four families each with two patients with autoimmune myasthenia gravis or related conditions are reported. All clinical forms of myasthenia gravis were represented and different disease types were found within the same family. Either one or two generations could be affected and no association with a single HLA haplotype was found. The frequency of familial autoimmune myasthenia gravis is very low and the genetic factors involved seem to be different from MHC genes.
Assuntos
Autoimunidade/genética , Miastenia Gravis/genética , Adulto , Autoimunidade/imunologia , Feminino , Antígenos de Histocompatibilidade Classe I/análise , Antígenos de Histocompatibilidade Classe II/análise , Humanos , Itália , Masculino , Pessoa de Meia-Idade , Miastenia Gravis/imunologia , Linhagem , Receptores Colinérgicos/imunologiaRESUMO
Patients treated with interferon alfa can develop autoantibodies and autoimmune diseases. We describe two patients who developed myasthenia gravis with abnormal levels of serum anti-acetylcholine receptor antibodies during interferon alfa-2b treatment for malignancies. One of these patients had myopathic findings on EMG and focal deficiency of cytochrome c oxidase on muscle biopsy.
Assuntos
Interferon-alfa/efeitos adversos , Linfoma não Hodgkin/tratamento farmacológico , Miastenia Gravis/induzido quimicamente , Neoplasias da Bexiga Urinária/terapia , Deficiência de Citocromo-c Oxidase , Eletromiografia , Complexo IV da Cadeia de Transporte de Elétrons/análise , Humanos , Interferon alfa-2 , Interferon-alfa/uso terapêutico , Masculino , Pessoa de Meia-Idade , Fibras Musculares Esqueléticas/enzimologia , Fibras Musculares Esqueléticas/patologia , Miastenia Gravis/patologia , Miastenia Gravis/fisiopatologia , Proteínas Recombinantes , Succinato Desidrogenase/análise , Neoplasias da Bexiga Urinária/cirurgiaRESUMO
A 38-year-old man affected with generalized myasthenia gravis (MG) was submitted to thymectomy. At surgery thymic Hodgkin's disease (granulomatous thymoma) and an area of thymic hyperplasia were found. Subsequently, after treatment with anticholinesterase and corticosteroids, the patient achieved clinical remission. The development of MG in this patient could be related to the presence of thymic hyperplasia, rather than to the granulomatous thymoma. Family history revealed that a brother of the patient was affected by non-Hodgkin T-cell lymphoma. Human leukocyte antigens (HLA) were identical in the two affected siblings. The present report suggests a possible link between MG and lymphoproliferative disorders whose mechanism still needs to be clarified.
Assuntos
Doença de Hodgkin/genética , Linfoma de Células T/genética , Miastenia Gravis/genética , Neoplasias do Timo/genética , Adulto , Antígenos HLA/genética , Haplótipos , Doença de Hodgkin/patologia , Humanos , Linfoma de Células T/patologia , Masculino , Miastenia Gravis/patologia , Timo/patologia , Hiperplasia do Timo/genética , Hiperplasia do Timo/patologia , Neoplasias do Timo/patologiaRESUMO
We studied 111 myasthenic patients with thymoma followed over the last 20 years. Most patients were affected with severe myasthenia gravis (MG) and had been treated with immunosuppressive drugs. At the end of the follow-up, we observed good therapeutic results in 74% of patients, but a complete remission in only 10% of cases. The survival rate in thymoma patients was significantly lower than in nonthymoma cases. Clinical parameters, MG response to treatment and survival rate did not differ in patients with invasive and noninvasive thymic neoplasms. Patients with invasive thymoma showed slightly higher surgical mortality and a 10% incidence of tumor relapse.
Assuntos
Miastenia Gravis/diagnóstico , Timoma/diagnóstico , Neoplasias do Timo/diagnóstico , Adulto , Idoso , Autoanticorpos/análise , Inibidores da Colinesterase/uso terapêutico , Terapia Combinada , Feminino , Seguimentos , Humanos , Imunossupressores/uso terapêutico , Masculino , Pessoa de Meia-Idade , Miastenia Gravis/mortalidade , Miastenia Gravis/terapia , Receptores Colinérgicos/imunologia , Taxa de Sobrevida , Timectomia , Timoma/mortalidade , Timoma/terapia , Neoplasias do Timo/mortalidade , Neoplasias do Timo/terapiaRESUMO
The effects of high-dose intravenous immunoglobulin (i.v.Ig) in 12 MG patients were studied. All patients had severe symptoms. In two cases anti-acetylcholine receptor antibodies (anti-AChR abs) were not detectable. I.v.Ig was administered to 9 patients already on long-term immunosuppressive therapy and to 3 patients at the beginning of azathioprine treatment. 10 patients (83%) improved; the duration of improvement was longer in immunosuppressed patients. Anti-AChR abs generally decreased after infusion but we did not find a constant correlation between reduction in ab titers and clinical improvement. Side effects included one case of severe hemolysis. In our experience i.v.Ig therapy is effective in MG. The chief indication for its use appears to be the treatment of deterioration of the disease in patients already on immunosuppressive therapy.
Assuntos
Imunização Passiva , Imunoglobulinas/administração & dosagem , Miastenia Gravis/terapia , Adolescente , Adulto , Idoso , Anticorpos/análise , Relação Dose-Resposta a Droga , Feminino , Humanos , Injeções Intravenosas , Masculino , Pessoa de Meia-Idade , Miastenia Gravis/imunologia , Receptores Colinérgicos/imunologiaRESUMO
Intraoperative ultrasonography was conducted in 20 patients; the technique of intraoperative ultrasonography for use in spinal surgery is described. The authors emphasize that this non-invasive method obtains real time images of considerable diagnostic importance, allowing for a significantly minor use of image intensifier, with a consequent reduction in doses for both the patient and the staff.
Assuntos
Coluna Vertebral/diagnóstico por imagem , Coluna Vertebral/cirurgia , Adulto , Idoso , Criança , Estudos de Avaliação como Assunto , Humanos , Deslocamento do Disco Intervertebral/diagnóstico por imagem , Deslocamento do Disco Intervertebral/cirurgia , Pessoa de Meia-Idade , Monitorização Intraoperatória , Doenças da Coluna Vertebral/diagnóstico por imagem , Doenças da Coluna Vertebral/cirurgia , Fraturas da Coluna Vertebral/diagnóstico por imagem , Fraturas da Coluna Vertebral/cirurgia , UltrassonografiaRESUMO
We studied the long-term outcome of prednisone therapy in 104 patients with myasthenia gravis (MG). At the end of the follow-up period, good therapeutic results were recorded in 85 patients (81.7%), poor results in 13 (12.5%) and no significant change of MG status in 6 (5.8%). We found a correlation between the duration of treatment and the incidence of steroid side effects. The presence of thymoma and severe forms of MG were associated with relapsing disease requiring prolonged corticosteroid regimens. The age at the start of therapy did not influence significantly the response to treatment.
Assuntos
Miastenia Gravis/tratamento farmacológico , Prednisona/administração & dosagem , Adulto , Terapia Combinada , Relação Dose-Resposta a Droga , Esquema de Medicação , Feminino , Seguimentos , Humanos , Assistência de Longa Duração , Masculino , Miastenia Gravis/diagnóstico , Exame Neurológico , Prednisona/efeitos adversos , TimectomiaRESUMO
Surgical treatment of vertebral deformity due to myelomeningocele has always presented important technical problems. Many complications, the foremost of which pseudarthrosis and infection, are reported in the literature. The authors discuss 14 patients with vertebral deformity from myelomeningocele who were treated with different surgical methods and reviewed after an average of eight years. The only conclusion that can be drawn on the basis of both the literature and the present study is that posterior surgery alone is incapable of guaranteeing stable correction over time for severe deformity. Combined anterior and posterior surgery with spinal fusion up to the sacrum yields better results, and the patient is not required to wear a corset afterward.
Assuntos
Cifose/cirurgia , Meningomielocele/complicações , Escoliose/cirurgia , Fusão Vertebral/normas , Adolescente , Feminino , Seguimentos , Humanos , Cifose/diagnóstico por imagem , Cifose/etiologia , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/etiologia , Radiografia , Escoliose/diagnóstico por imagem , Escoliose/etiologia , Fusão Vertebral/efeitos adversos , Fusão Vertebral/instrumentaçãoRESUMO
The authors examined 25 fractures of the dens epistrophei treated conservatively by several methods in order to evaluate the most suitable treatment for this lesion. A Minerva plaster cast proved to be effective in the treatment of type III fractures, while the halo plaster system obtained the best results in type II fractures.
Assuntos
Processo Odontoide/lesões , Fraturas da Coluna Vertebral/terapia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Moldes Cirúrgicos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Processo Odontoide/diagnóstico por imagem , Radiografia , Fraturas da Coluna Vertebral/diagnóstico por imagemRESUMO
Based on their observation of 5 cases of acute posttraumatic cervical disc herniation with medullary lesion, as well as on what is reported in the literature, the authors examine the clinical features of the disease, at the same time evaluating and comparing the major diagnostic studies. What emerges from the study is the importance of NMR and CAT in the diagnosis of the lesion. Finally, the authors emphasize the importance of early surgical treatment.
Assuntos
Vértebras Cervicais , Deslocamento do Disco Intervertebral/complicações , Disco Intervertebral/lesões , Compressão da Medula Espinal/etiologia , Adulto , Criança , Feminino , Seguimentos , Humanos , Deslocamento do Disco Intervertebral/diagnóstico , Deslocamento do Disco Intervertebral/cirurgia , Imageamento por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Fatores de Tempo , Tomografia Computadorizada por Raios XRESUMO
We studied 59 children with myasthenia gravis (MG). Disease onset was pre-pubertal in 26 patients and post-pubertal in 33. The male to female ratio was 0.62 in the early- and 0.17 in the late-onset groups. The frequency of ocular MG was higher in patients with prepubertal onset. Patients with generalized MG generally showed a good response to thymectomy and corticosteroid therapy proved effective with no major side-effects. In our experience early-onset MG has the same course as in adult life. We recommend thymectomy for generalized disease in childhood, except in very young children on account of possible long-term effects on immunological development. Immunosuppressive therapy should be considered in severely affected patients who do not respond adequately to other therapies.
Assuntos
Miastenia Gravis/fisiopatologia , Prednisona/uso terapêutico , Timectomia , Adolescente , Fatores Etários , Criança , Pré-Escolar , Inibidores da Colinesterase/uso terapêutico , Oftalmopatias/etiologia , Feminino , Seguimentos , Humanos , Lactente , Masculino , Miastenia Gravis/tratamento farmacológico , Miastenia Gravis/cirurgia , Troca PlasmáticaRESUMO
Most of the halo connection devices currently used with both the halo-plaster and halo-vest cannot be adjusted on the different displacement planes during reduction treatment. This makes it difficult to obtain good radiograms for the interposition of connection bars. The connection device designed by the Rizzoli Orthopaedic Institute (D.R. IOR) allows for movements in rotation and translation, preventing loosening of the system. Moreover, radiographic monitoring may be obtained in the best conditions possible, by moving the connection rods backwards or forwards without changing the spinal axis.
Assuntos
Vértebras Cervicais/lesões , Dispositivos de Fixação Ortopédica , Tração/instrumentação , Desenho de Equipamento , Humanos , Luxações Articulares/etiologia , Luxações Articulares/terapiaRESUMO
Based on anatomo-pathological findings in fractures in bones affected with Paget's disease, the authors discuss problems related to treatment. One case is reported in which treatment involved intramedullary osteosynthesis with locked nailing and corrective osteotomy. This type of treatment achieved a dual purpose of obtaining fracture consolidation within a short amount of time, and correcting the deformity.
Assuntos
Fraturas do Fêmur/cirurgia , Fixação Intramedular de Fraturas , Osteíte Deformante/complicações , Pinos Ortopédicos , Parafusos Ósseos , Fraturas do Fêmur/etiologia , Humanos , Masculino , Pessoa de Meia-IdadeRESUMO
The authors report the results obtained in a review of all of the young patients who have been found to be affected with vertebral deformity in an epidemiological study conducted during the academic years 1983-84 and 1984-85. There is predilection for the female sex, which is also more vulnerable to the risk of progression. Menarchal age constitutes the most important period for the progression of the deformity. The most frequent type of curve observed is the double primary one, in particular, right thoracic and left lumbar, which proved to be that most vulnerable to angular progression. The cases which in a previous screening had been defined risk cases were followed-up, and thanks to early diagnosis and suitable treatment surgery was not required in any of these.