RESUMO
INTRODUCTION: Outcomes after anterior cervical diskectomy and fusion (ACDF) and cervical total disk arthroplasty (TDA) are satisfactory, but related morbidity and revision surgery rates are notable. This study sought to determine complication variations among ACDF, TDA, and combined ACDF-TDA as well as predictors of postoperative complications. METHODS: Patients undergoing 1- to 2-level ACDF and/or TDA with at least a 2-year follow-up from 2009 to 2011 were identified from the Statewide Planning and Research Cooperative System database. Patient demographics, hospital-related parameters, mortality, and postoperative outcomes were compared, and their predictors were identified using multivariate logistic regression. RESULTS: A total of 16,510 and 449 individuals underwent ACDF and cervical TDA, respectively, and 201 underwent ACDF-TDA. ACDF-TDA patients had the highest rates of cardiac complications and pulmonary embolism (PE) (P ≤ 0.006), whereas TDA patients had higher individual surgical and device/implant/internal fixation complications (P ≤ 0.025). ACDF-TDA patients experienced the lowest rate of revisions. Cervical TDA increased the odds of any surgical complications (OR = 2.5, P = 0.002), overall complications (OR = 1.57, P = 0.034), and revisions (OR = 2.29, P < 0.001). Deyo index predicted any medical/surgical complications (OR = 1.43 and 1.19, respectively). Female sex was associated with increased odds of readmission (OR 1.30, P < 0.001) but was protective against medical complications (OR = 0.81, P = 0.013). DISCUSSION: Combined ACDF-TDA procedures were not associated with increases in 2-year individual or overall complications, readmissions, or revisions. LEVEL OF EVIDENCE: Level 3-Therapeutic study.
Assuntos
Discotomia/efeitos adversos , Resultados Negativos , Complicações Pós-Operatórias/epidemiologia , Fusão Vertebral/efeitos adversos , Substituição Total de Disco/efeitos adversos , Adulto , Vértebras Cervicais , Estudos de Coortes , Discotomia/métodos , Feminino , Seguimentos , Cardiopatias/epidemiologia , Cardiopatias/etiologia , Humanos , Masculino , Pessoa de Meia-Idade , Readmissão do Paciente/estatística & dados numéricos , Complicações Pós-Operatórias/etiologia , Falha de Prótese , Embolia Pulmonar/epidemiologia , Embolia Pulmonar/etiologia , Reoperação/estatística & dados numéricos , Fusão Vertebral/métodos , Fatores de Tempo , Substituição Total de Disco/métodosRESUMO
BACKGROUND: This study aimed to define changes occurring in axial plane motion after scoliosis surgery in patients with adolescent idiopathic scoliosis (AIS) using gait analysis. Pre- and postoperative axial plane motion was compared to healthy/control subjects. This may potentially improve our understanding of how motion is impacted by deformity and subsequent surgical realignment. METHODS: 15 subjects with AIS underwent pre- and postoperative radiographic and gait analysis, with focus on axial plane motion (clockwise [CW] and counterclockwise [CCW]). Age, weight, and gender-matched controls (n = 13) were identified for gait analysis. Control, preoperative and postoperative groups were compared with paired student's t-tests. RESULTS: Surgical realignment resulted in significantly decreased in upper thoracic, thoracic, thoracolumbar and lumbar Cobb angles pre-to-postoperatively (36.7° vs. 15.2°, 60.1° vs. 25.6°, 47.7° vs. 17.7° and 27.2° vs. 4.8°, respectively) (all p < 0.05), with no significant change in thoracic kyphosis, lumbar lordosis, central sacral vertical line, pelvic incidence, and sagittal vertical axis. However, pelvic tilt significantly increased from 4.9° to 8.1° (p = 0.035). Using gait analysis: preoperative thoracic axial rotation differed (mean CW and CCW rotation was 1.9° and 3.1° [p = 0.01]), whereas mean CW & CCW pelvic rotation remained symmetric (2.0° and 3.0°; p = 0.44). Postoperatively, CCW thoracic rotation range of motion decreased (CW: 0.6° and CCW: 1.4°; p = 0.31). No significant difference in postoperative pelvic rotation occurred (1.1° and 3.4°; p = 0.10). Compared to controls, AIS patients demonstrated no significant difference in total CW & CCW thoracic motion relative to the pelvis both pre- (14.9° and 12.3°, respectively; p = 0.45) and postoperatively (12.9° and 12.3°, respectively; p = 0.82). SIGNIFICANCE: AIS patients demonstrated abnormal gait patterns in the axial plane compared to normal controls. After surgical realignment and de-rotation, marked improvement in axial plane motion was observed, highlighting how motion analysis can afford surgeons three-dimensional perspective into the patient's functional status.
Assuntos
Análise da Marcha/métodos , Escoliose/fisiopatologia , Fusão Vertebral/métodos , Coluna Vertebral/fisiopatologia , Adolescente , Criança , Feminino , Marcha/fisiologia , Humanos , Masculino , Pelve/fisiopatologia , Estudos Prospectivos , Amplitude de Movimento Articular/fisiologia , Escoliose/cirurgia , Fusão Vertebral/efeitos adversos , Coluna Vertebral/cirurgia , Resultado do Tratamento , Adulto JovemAssuntos
Marcha , Imageamento Tridimensional , Equilíbrio Postural/fisiologia , Curvaturas da Coluna Vertebral/diagnóstico por imagem , Curvaturas da Coluna Vertebral/cirurgia , Fusão Vertebral , Estudos de Tempo e Movimento , Fenômenos Biomecânicos , Marcha/fisiologia , Humanos , Imageamento Tridimensional/métodos , Força Muscular , Procedimentos Neurocirúrgicos , Escoliose/diagnóstico por imagem , Escoliose/fisiopatologia , Escoliose/cirurgia , Curvaturas da Coluna Vertebral/fisiopatologiaRESUMO
BACKGROUND CONTEXT: Large cell neuroendocrine carcinoma of the lung is an aggressive tumor with unique histopathological features. It is not known to metastasize to the spine. PURPOSE: To report a metastatic case of this rare tumor to the cauda equina. STUDY DESIGN: Case report. METHODS: Retrospective case review and review of the literature. RESULTS: The authors report a rare case of a large cell neuroendocrine lung metastasis to the lumbar spine, causing right foot drop. Magnetic resonance imaging revealed a heterogeneously enhancing intradural extramedullary mass at L2/L3 level compressing the surrounding nerve roots. During surgery, the identified nerve roots were encased by the tumor, and the dissection was tedious. Postoperatively, the patient reported significantly improved back pain and he had severe foot weakness. The functional outcome was poor because the patient lost entirely his foot function; however, his back pain improved significantly after surgery. CONCLUSIONS: This is the first published study in which the authors described a metastasis of a rather uncommon lung cancer to the cauda equina. When a lesion of the cauda equina presents with a rapid progressive neurological deficit, leptomeningeal metastasis should be in the differential diagnosis.
Assuntos
Carcinoma de Células Grandes/secundário , Carcinoma Neuroendócrino/secundário , Cauda Equina/patologia , Neoplasias Pulmonares/patologia , Neoplasias do Sistema Nervoso Periférico/secundário , Carcinoma de Células Grandes/radioterapia , Carcinoma de Células Grandes/cirurgia , Carcinoma Neuroendócrino/radioterapia , Carcinoma Neuroendócrino/cirurgia , Cauda Equina/cirurgia , Terapia Combinada , Humanos , Neoplasias Pulmonares/radioterapia , Neoplasias Pulmonares/cirurgia , Imageamento por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Neoplasias do Sistema Nervoso Periférico/radioterapia , Neoplasias do Sistema Nervoso Periférico/cirurgia , Doença Pulmonar Obstrutiva Crônica/complicações , Fumar/efeitos adversosRESUMO
OBJECTIVE: Transient paraplegia in the immediate postoperative period after lipomyelomeningocele repair is uncommon and is not discussed in the literature. We present the unique case of a patient who developed transient paraplegia 48 hours after lipomyelomeningocele repair attributable to the acute development of a thoracic syrinx. CLINICAL PRESENTATION: At birth, the patient was noted to have a large skin-covered mass in the lumbosacral region. On neurological examination, both iliopsoas and quadriceps exhibited 3/5 motor function, and the plantar flexors and dorsiflexors exhibited 1/5 motor function. Urodynamic studies were normal. Magnetic resonance imaging demonstrated the presence of a lipomyelomeningocele associated with tethering of the spinal cord in the lumbosacral region. INTERVENTION: At 5 months of age, the patient underwent repair of the lipomyelomeningocele. After surgery, the patient developed progressive paraplegia along with bowel and bladder dysfunction. Given the concern about a postoperative hematoma resulting in cauda equina syndrome, the patient returned to the operating room for a wound exploration. No compressive lesion such as a hematoma was found at surgery. A postoperative magnetic resonance imaging scan obtained afterward, however, demonstrated the presence of a large thoracic syrinx. CONCLUSION: Syrinx formation can occur as early as 48 hours after lipomyelomeningocele repair, leading to progressive lower extremity weakness and bowel and bladder incontinence. In the immediate postoperative period, an acute syrinx can mimic cauda equina syndrome, and a magnetic resonance imaging scan is necessary to distinguish between these two entities. In this patient, the syrinx was transient and resolved without a shunting procedure.
Assuntos
Meningomielocele/cirurgia , Complicações Pós-Operatórias/patologia , Siringomielia/etiologia , Doença Aguda , Humanos , Lactente , Região Lombossacral/anormalidades , Imageamento por Ressonância Magnética , Meningomielocele/patologia , Paraplegia/etiologia , Paraplegia/patologia , Complicações Pós-Operatórias/cirurgia , Reoperação , Siringomielia/patologia , Siringomielia/cirurgiaRESUMO
OBJECT: Although transforaminal lumbar interbody fusion (TLIF) is an increasingly popular surgical technique, there are a limited number of studies in which investigators have stratified outcome data with respect to surgical indications or documented radiographically proven and clinical results with respect to disc space height (DSH). The authors conducted a study to evaluate the long-term outcomes after TLIF with respect to surgical indication and radiographic/neuroimaging results. METHODS: Thirty-three consecutive TLIF-treated patients underwent follow-up investigation for a mean of 37 months. Isthmic spondylolysis was present in eight patients, recurrent disc herniation in 14, and degenerative disc disease (DDD) in 11. The operative technique involved the placement of interbody structural allograft, pedicle screw instrumentation, and morcellized autograft in the anterior interbody space and the contralateral intertransverse gutter. Surgery was performed at L4-5 in 16 patients, L5-S1 in 14, L3-4 in two, and both L4-5 and L5-S1 in one patient. Preoperative symptoms were back pain (in 91% of cases), leg pain (in 94%), sensory loss (in 67%), and motor deficits (in 30%). Postoperatively, back pain was improved in 67% of the patients, unchanged in 27%, and worsened in 7%. Leg pain improved in 80% of patients, was unchanged in 10%, and worsened in 10%. Outcome, as measured using the Prolo Functional and Economic Scales, improved from a score of 4.9 to 7. In patients with spondylolysis and recurrent disc herniation outcomes were better than in those with DDD only. There was no correlation of outcome with symptom duration, patient age, or level of surgery. In an independent review of pre- and late postoperative radiographs no significant differences in lordosis angles, Cobb angles, or DSHs were found. Fusion occurred in all cases. CONCLUSIONS: The TLIF procedure was associated with good clinical outcomes and a high fusion rate but no change in the DSH. Patients who present with spondylolysis and recurrent herniations experience better outcome than those with degenerative disease alone.
Assuntos
Fusão Vertebral , Espondilolistese/diagnóstico por imagem , Espondilolistese/cirurgia , Adulto , Parafusos Ósseos , Feminino , Seguimentos , Humanos , Fixadores Internos , Laminectomia/métodos , Vértebras Lombares/diagnóstico por imagem , Vértebras Lombares/cirurgia , Região Lombossacral/diagnóstico por imagem , Região Lombossacral/cirurgia , Masculino , Pessoa de Meia-Idade , Radiografia , Estudos Retrospectivos , Fusão Vertebral/métodos , Espondilolistese/complicações , Resultado do TratamentoRESUMO
Cerebrospinal fluid (CSF) drainage catheters can cause a myriad of complications, in large part because they may migrate from their normal location to almost anywhere in the body. We present the unique case of a female patient who had previously undergone bilateral breast augmentation who experienced sudden painless swelling of her right breast 6 weeks after placement of a ventriculoperitoneal shunt. Radiologic examination demonstrated ensnarement of the distal aspect of the shunt around her implant, with subsequent formation of a CSF pseudocyst. Management of this patient included replacement of the shunt, drainage of the CSF pseudocyst, and preservation of the implant.