Ultrasonic Bone Scalpel versus Conventional Technique for Thoracolumbar Spinal Decompression: A Prospective Randomized Controlled Trial / Bisturi ósseo ultrassônico versus técnica convencional para descompressão espinhal torácica: Um teste controlado randomizado prospectivo

Abstract Objective The purpose of the present study is to compare intraoperative blood loss, operating time, laminectomy time, hospital length of stay, and complications in thoracolumbar spinal decompression using ultrasonic bone scalpels (UBSs) with conventional procedures. Methods Forty-two patients who underwent decompressive laminectomy and pedicular screw fusion with a surgical level of 1-5 levels between February 1, 2020, and June 30, 2022, in a single institution were evaluated for eligibility, and 11 were excluded due to a history of spinal surgery (n= 3), spinal tumor (n= 3), and spinal infection (n= 5). A total of 31 patients were randomly divided into the UBS group (n =15) and the conventional group (n =16). Intraoperative blood loss, operating time, laminectomy time, hospital length of stay, and complications were recorded. Results Intraoperative blood loss and laminectomy time were significantly lower in the UBS group (656.0 ± 167.6 ml, 54.5 ± 27.4 minutes, respectively) than in the conventional group (936.9 ± 413.2 ml, 73.4 ± 28.1 minutes, respectively). Overall operation time, hospital length of stay, and complications were all similar between the groups. Conclusion The UBS is a useful instrument for procedures performed near the dura mater or other neural tissue without excessive heat or mechanical injury. This device is recommended for various spinal surgeries in addition to high-speed burrs and Kerrison rongeurs.

Resumo Objetivo O objetivo do presente estudo é comparar perda de sangue intraoperatória, tempo de operação, tempo de laminectomia, tempo de internação hospitalar e complicações na descompressão espinhal torácica utilizando bisturis ósseos ultrassônicos (BOUs) em relação aos procedimentos convencionais. Métodos Quarenta e dois pacientes submetidos a laminectomia descompressiva e fusão pedicular do parafuso com um nível cirúrgico de 1 a 5, entre 1° de fevereiro de 2020 e 30 de junho de 2022 em uma única instituição, foram avaliados para elegibilidade e 11 foram excluídos devido ao histórico de cirurgia espinhal (n= 3), tumor espinhal (n= 3) e infecção espinhal (n= 5). Perda de sangue intraoperatória, tempo de operação, tempo de laminectomia, tempo de internação e complicações foram registradas. Resultados A perda de sangue intraoperatória e o tempo de laminectomia foram significativamente menores no grupo BOU (656,0 ± 167,6 ml, 54,5 ± 27,4 min, respectivamente) do que no grupo convencional (936,9 ± 413,2 ml, 73,4 ± 28,1 min, respectivamente). O tempo de funcionamento total, o tempo de internação e as complicações foram todos semelhantes entre os grupos. Conclusão O bisturi ósseo ultrassônico é um instrumento útil para procedimentos realizados próximos à dura-máter ou outro tecido neural sem calor excessivo ou lesão mecânica. Este dispositivo é recomendado para várias cirurgias de coluna vertebral, juntamente com rebarbas de alta velocidade e pinça Kerrison.

Rara presentación de un linfoma espinal: informe de caso y diagnóstico mediante resonancia magnética / Rare presentation of a spinal lymphoma: case report and diagnosis by magnetic resonance imaging

El linfoma primario del sistema nervioso central es una forma de enfermedad extraganglionar originada en el cerebro, la leptomeninges, la médula espinal o los ojos. Los tumores espinales son neoplasias de baja prevalencia y pueden causar una morbimortalidad neurológica considerable. El linfoma aislado que surge dentro del conducto dural es la forma menos común de linfoma primario del sistema nervioso central: representa aproximadamente el 1% de los casos y se observa más a menudo en el contexto de diseminación secundaria que como el sitio primario de origen. Los síntomas son inespecíficos y dependen del nivel espinal involucrado. La presentación es insidiosa e incluye dorsalgia, debilidad y dificultad progresiva para la deambulación. La resonancia magnética es la modalidad de elección para búsqueda de lesiones dentro del conducto espinal/raquídeo, en pacientes que presentan síntomas neurológicos. El tratamiento quirúrgico no resulta útil, y el objetivo principal de la cirugía es conocer el diagnóstico histológico. (AU)

A primary central nervous system lymphoma is a form of extranodal disease originating in the brain, leptomeninges, spinal cord, or eyes. Spinal tumors are low-prevalence neoplasms and can cause considerable neurological morbidity and mortality. An isolated lymphoma emerging within the dural canal is the rarest form of primary central nervous system lymphoma: it accounts for approximately 1% of cases occurring more often in the context of secondary dissemination than as the primary site of origin. Symptoms are nonspecific and depend on the spinal level involved. The presentation is insidious and includes dorsalgia, weakness, and progressive difficulty in ambulatory function. MRI is the modality of choice to search for lesions within the spinal/rachial canal in patients presenting with neurological symptoms. Surgical treatment is not helpful, and the main objective of surgery is to know the histological diagnosis. (AU)

Research progress of different minimally invasive spinal decompression in lumbar spinal stenosis / 中国修复重建外科杂志

OBJECTIVE@#To review the application and progress of different minimally invasive spinal decompression in the treatment of lumbar spinal stenosis (LSS).@*METHODS@#The domestic and foreign literature on the application of different minimally invasive spinal decompression in the treatment of LSS was extensively reviewed, and the advantages, disadvantages, and complications of different surgical methods were summarized.@*RESULTS@#At present, minimally invasive spinal decompression mainly includes microscopic bilateral decompression, microendoscopic decompression, percutaneous endoscopic lumbar decompression, unilateral biportal endoscopy, and so on. Compared with traditional open surgery, different minimally invasive spinal decompression techniques can reduce the operation time, intraoperative blood loss, and postoperative pain of patients, thereby reducing hospital stay and saving treatment costs.@*CONCLUSION@#The indications of different minimally invasive spinal decompression are different, but there are certain advantages and disadvantages. When patients have clear surgical indications, individualized treatment plans should be formulated according to the symptoms and signs of patients, combined with imaging manifestations.

Early-effectiveness of unilateral biportal endoscopic laminectomy in treatment of two-level lumbar spinal stenosis / 中国修复重建外科杂志

OBJECTIVE@#To analyze the early effectiveness of unilateral biportal endoscopy (UBE) laminectomy in the treatment of two-level lumbar spinal stenosis (LSS).@*METHODS@#The clinical data of 98 patients with two-level LSS treated with UBE between September 2020 and December 2021 were retrospectively analyzed. There were 53 males and 45 females with an average age of 59.9 years (range, 32-79 years). Among them, there were 56 cases of mixed spinal stenosis, 23 cases of central spinal canal stenosis, and 19 cases of nerve root canal stenosis. The duration of symptoms was 1.5- 10 years, with an average of 5.4 years. The operative segments were L 2, 3 and L 3, 4 in 2 cases, L 3, 4 and L 4, 5 in 29 cases, L 4, 5 and L 5, S 1 in 67 cases. All patients had different degrees of low back pain, among of which 76 cases were with unilateral lower extremity symptoms and 22 cases were with bilateral lower extremity symptoms. There were 29 cases of bilateral decompression in both segments, 63 cases of unilateral decompression in both segments, and 6 cases of unilateral decompression and bilateral decompression of each segment. The operation time, intraoperative blood loss, total incision length, hospitalization stay, ambulation time, and related complications were recorded. Visual analogue scale (VAS) score was used to assess the low back and leg pain before operation and at 3 days, 3 months after operation, and at last follow-up. The Oswestry disability index (ODI) was used to evaluate the functional recovery of lumbar spine before operation and at 3 months and last follow-up after operation. Modified MacNab criteria was used to evaluate clinical outcomes at last follow-up. Imaging examinations were performed before and after operation to measure the preservation rate of articular process, modified Pfirrmann scale, disc height (DH), lumbar lordosis angle (LLA), and cross-sectional area of the canal (CAC), and the CAC improvement rate was calculated.@*RESULTS@#All patients underwent surgery successfully. The operation time was (106.7±25.1) minutes, the intraoperative blood loss was (67.7±14.2) mL, and the total incision length was (3.2±0.4) cm. The hospitalization stay was 8 (7, 9) days, and the ambulation time was 3 (3, 4) days. All the wounds healed by first intention. Dural tear occurred in 1 case during operation, and mild headache occurred in 1 case after operation. All patients were followed up 13-28 months with an average of 19.3 months, and there was no recurrence or reoperation during the follow-up. At last follow-up, the preservation rate of articular process was 84.7%±7.3%. The modified Pfirrmann scale and DH were significantly different from those before operation ( P<0.05), while the LLA was not significantly different from that before operation ( P=0.050). The CAC significantly improved ( P<0.05), and the CAC improvement rate was 108.1%±17.8%. The VAS scores of low back pain and leg pain and ODI at each time point after operation significantly improved when compared with those before operation, and the differences between each time points were significant ( P<0.05). According to the modified MacNab criteria, 63 cases were excellent, 25 cases were good, and 10 cases were fair, with an excellent and good rate of 89.8%.@*CONCLUSION@#UBE laminectomy is a safe and effective technique with little trauma and fast recovery for two-level LSS and the early effectiveness is satisfactory.

Profil clinique, thérapeutique et devenir des traumatismes vertèbro-médullaires aux Cliniques Universitaires de Kinshasa en République Démocratique du Congo / Clinical, therapeutic and outcome of vertebro medullary traumas at Kinshasa University Hospital, in the Democratic Republic of Congo

Les traumatismes vertébromédullaires (TVM) en Afrique subsaharienne sont très peu documentés. L'objectif de ce travail était de décrire les aspects cliniques, thérapeutiques et évolutifs de TVM. Méthodes. C'était une série analytique des cas de TVM soignés aux Cliniques Universitaires de Kinshasa (CUK) entre 2016 et 2022. Les variables d'intérêt englobaient les données cliniques, thérapeutiques, le score ASIA à l'admission et à la sortie, et le devenir. Nous avons recouru au test de Chi carré de Pearson pour comparer les proportions. Résultats. Sur les 123 patients opérés pour lésions vertébro-médullaires, 62 cas étaient traumatiques (50,4 %). Le sexe masculin était prépondérant (75,8 %). Leur âge moyen était de 36,0 ± 13,0 ans. Les accidents de la voie publique (74,2 %) en étaient la principale cause. A l'admission, il y avait 58,1% des paraplégiques et 21 % des tétraplégiques. Vingt-sept patients (43,5 %) ont été admis 1 à 2 mois après le traumatisme. Les patients classés ASIA A représentait 62,9 % des cas. Vingt traumatismes (32,3 %) ont siégé sur le rachis cervical inférieur et 25 (40,3%), à la charnière thoraco-lombaire. Au niveau cervical, 10 cas étaient classés Argenson B (16,1 %) et en thoraco-lombaire, il y avait 17 fractures Magerl A (27,4 %) et 22 Magerl B (35,5 %) avec 63,6 % d'antélisthésis. La laminectomie (59,8 %) et la corporectomie (25,8 %) avec fixation rachidienne étaient les procédures les plus pratiquées. Les suites opératoires étaient simples dans 68,4 %. Il y a eu 9 cas d'infection du site opératoire (14,5 %), 2 cas de fistules de LCS (3,2 %), 3 cas d'escarres (4,8 %) de décubitus et 5 décès (8,1%). Le score ASIA à la sortie était significativement amélioré par rapport à celui de départ dans 33,9 % de cas (p <0,001). Conclusion. Les traumatismes vertébro-médullaires consécutifs aux accidents de trafic routier demeurent des lésions assez fréquentes nécessitant un traitement chirurgical. Les jeunes de sexe masculin sont les plus touchés. Le déficit neurologique est souvent complet. La laminectomie ou la corporectomie suivies de la fixation rachidienne sont couramment réalisées avec une récupération neurologique satisfaisante dans un tiers de cas.

Traitement chirurgical du Mal de Pott et de ses séquelles au Centre Hospitalier de l'Ordre de Malte Dakar / Surgical treatm ent of Pott's diseaseand its sequelae at the Hospital of the Order of Malta/Daka

Introduction. Evaluer les résultats du traitement chirurgical du Mal de Pott et de ses séquelles au Centre hospitalier de l'ordre de Malte de Dakar. Patients et méthodes. Nous présentons les résultats préliminaires d'une série consécutive de 23 patients (13 hommes et 10 femmes) d'âge moyen de 32,35 ans [6 ­70 ans] présentant des Maux de Pott ou de leurs séquelles nécessitant un traitement chirurgical. L'échelle d'incapacité d'Oswestry, l'échelle visuelle analogique et le score ASIA ont été utilisés pour l'évaluation clinique. Les radiographies pré opératoires, post opératoires et au recul ont été utilisés pour les résultats anatomiques. Tous ces patients ont été opérés selon trois stratégies opératoires sur une période de 67 mois (Avril 2014- Novembre 2019). Nous avons réalisé une laminectomie arthrodèse postérieure dans 52,2% ; une laminectomie plus OTP et arthrodèse postérieure dans 43,5% ; une discectomie et hémicorporectomie avec arthrodèse antérieure par plaque vissée de Roy Camille à l'étage cervical dans 4,3%. Résultats. La symptomatologie était dominée par la douleur rachidienne, la cyphose et les troubles neurologiques. La cyphose post opératoire était significativement améliorée (la moyenne passe de 48,52° en pré opératoire à 17,09° en post opératoire). On a obtenu 100% de fusion vertébrale. On note une nette amélioration de la douleur rachidienne (avec une baisse au recul de 55,44 points pour l'OID et de 5,66 pour l'EVA) ; 78,3% des patients étaient très satisfaits, 17,4% satisfaits et 4,3% mécontents. Conclusion. Le traitement chirurgical du Mal de Pott et de ses séquelles a fortement amélioré les rachis au Centre hospitalier de l'Ordre de Malte.

Introduction. To evaluate the results of the surgical treatment of Pott's disease and its sequelae at the Hospital Center of the Order of Malta in Dakar. Patients and methods. We present the preliminary results of a consecutive series of 23 patients (13 men and 10 women) with an average age of 32.35 years [6-70 years] presenting with Pott's disease or its sequelae requiring treatment. surgical treatment. Oswestry Disability Scale, Visual Analogue Scale and ASIA score were used for clinical assessment. Preoperative, postoperative and followup radiographs were used for anatomical results. All these patients were operated according to three operating strategies over a period of 67 months (April 2014- November 2019). We performed posterior laminectomy-arthrodesis in 52.2%; laminectomy plus OTP and posterior arthrodesis in 43.5%; discectomy and hemicorpectomy with anterior arthrodesis by Roy Camille screwed plate at the cervical level in 4.3%. Results. The symptomatology was dominated by spinal pain, kyphosis and neurological disorders. Postoperative kyphosis was significantly improved (the average goes from 48.52° preoperatively to 17.09° postoperatively). We got 100% spinal fusion. There is a clear improvement in spinal pain (with a drop at follow-up of 55.44 points for the OID and 5.66 for the EVA); 78.3% of patients were very satisfied, 17.4% satisfied and 4.3% dissatisfied. Conclusion. The surgical treatment of Pott's disease and its sequelae greatly improved the spines at the Hospital Center of the Order of Malta.

Cystic paraganglioma of the filum terminale / Paraganglioma quístico del filum terminal

Spinal Paragangliomas are rare tumors, most frequently involving the cauda equina and the filum terminale. We report the case of a 62-year old woman presenting with a one month's lower back pain, left sciatica and leg weakness. Spinal magnetic resonance imaging showed a extramedullary lesion at L3-L4 level, measuring 37 x 52 x 21 mm with contrast enhancement. It presented an unenhancing intradural cystic lesion in the upper pole. The patient underwent lumbar laminectomy, and with neurofisiologic monitorization the tumor was completely resected. Microscopic examination of the tumor revealed a paraganglioma. In a review of the literature, we found only five previous reported cases in which the tumor is accompanied by a cyst.

Los paragangliomas son tumores poco frecuentes que se localizan en la región de la cauda equina y filum terminal. Presentamos el caso de una mujer de 62 años con una historia de 1 mes de evolución de lumbalgia, ciática y debilidad en el miembro inferior izquierdo. Una resonancia magnética lumbar mostró una tumoración extramedular en el nivel L3-L4 que medía 37 x 52 x 21 mm que se realzaba con contraste. Presentaba así mismo una lesión quística en el polo superior del tumor. Se realizó una laminectomía lumbar y bajo control neurofisiológico se realizó una extirpación completa el tumor. El estudio microscópico revelo que se trataba de un paraganglioma. Realizamos una revisión de la literatura encontrando únicamente otros cinco casos de paraganglioma espinal con lesión quística acompañante

Solitary Dorsal Intramedullary Schwanomma ­ A Rare Lesion

Intramedullary schwanommas are rare, and most cases are reported in cervical region. Less than 20 dorsal intramedullary schwanommas have been reported till date in literature. This is due to their cell of origin, the Schwann cell, which is not normally found within the parenchyma of the brain and spinal cord; therefore it is not surprising that these lesions are rare. We report a rare solitary dorsal intramedullary schwanomma in a young adult patient who presented with paraplegia.

A case-control study:the clinical efficacy of total laminectomy with lateral mass screw fixation and single open-door laminoplasty for cervical spinal cord injury without fracture and dislocation / 中国骨伤

OBJECTIVE@#To compare the clinical effects of total laminectomy with lateral mass screw fixation and single open-door laminoplasty in the treatment of cervical spinal cord injury without fracture and dislocation.@*METHODS@#The clinical data of 75 patients with cervical spinal cord injury without fracture and dislocation treated from December 2014 to April 2020 were retrospectively analyzed, including 65 males and 10 females, aged from 33 to 83 years old with an average of (60.1±11.4) years. According to surgical method, the patients were divided into observation group (36 cases) and control group (39 cases). The observation group was treated with C3-C6 single open-door laminoplasty. In the control group, the C3-C6 whole lamina was opened by "uncovering", and the lateral mass screw was fixed and fused. The general conditions including operation time, intraoperative blood loss, hospital stay and complications such as axial pain, cerebrospinal fluid leakage, postoperative C5 nerve palsy were recorded. Visual analogue scale(VAS), Nurick pain scale, Japanese Orthopaedic Association(JOA) scores and American Spinal Injury Association(AISA) injury scale were used to evaluate the improvement of clinical symptoms and related functional recovery 12 months after operation.@*RESULTS@#There were no statistically significant differences in operation time, intraoperative blood loss and hospital stay between two groups(P>0.05). There were statistically significant differences in JOA, VAS, ASIA and Nurick scores of the all patients between 12 months after surgery and before surgery (P<0.05), and there was no significant difference between groups. There was significant difference in the incidence of C5 nerve root palsy and axial pain between two groups(P<0.05), but there was no significant difference in the complications of cerebrospinal fluid leakage between two groups (P>0.05).@*CONCLUSION@#Total laminectomy with lateral mass screw fixation and single open-door laminoplasty in treating cervical spinal cord injury without fracture and dislocation can obtain satisfactory results in restoring nerve function, alleviating pain and improving daily behavior, but single open-door laminoplasty has the advantages of less trauma and low incidence of complications.

Buckling of the Ligamentum Flavum as a Rare Complication of Anterior Cervical Corpectomy and Fusion: A Case Report

Introduction and Importance Neurological deterioration due to buckling of the ligamentum flavum (LF) is an uncommon complication after anterior cervical corpectomy or discectomy with fusion. Case Presentation In this report, we present the case of a 66-year-old male who underwent anterior cervical partial corpectomy of C5 and discectomy of prolapsed C5- C6 with fusion. Postsurgery, the patient displayed signs of neurological deterioration. Upon immediate cervical magnetic resonance imaging (MRI), posterior canal stenosis and severe compression with cord signal due to LF buckling were detected. A posterior laminectomy procedure and canal decompression at the C5-C6 level with bone fusion were performed. Clinical Discussion Patient presented with walking difficulty, then walking disability, followed by bilateral upper and lower limb paresthesia with burning sensation. Examination showed ⅘ muscle strength in both handgrips. Further investigation showed brisk deep tendon reflexes, positive Hoffman sign unilaterally, equivocal Babinski sign, and progressive quadriparesis. Magnetic resonance imaging showed mild and diffuse building of some cervical discs, with spinal cord progression. We performed an anterior cervical corpectomy and fusion (ACCF) and anterior cervical discectomy and fusion (ACDF); a titanium mesh with plates and screws was used for fusion, with removal of a calcified and herniated subligamentous disc. Postoperatively, upper and lower limb strength deteriorated; immediate cervical and thoracic MRI showed LF buckling, which caused canal stenosis and severe compression. Urgent posterior laminectomy and canal decompression with bone fusion was scheduled on the same day. The patient underwent physiotherapy and regained upper and lower limb strength and his ability to walk. Conclusion This indicates the possibility of neurological deterioration as a result of LF buckling, whichmay be a result of LF thickening accompanied by hyperextension in the cervical region. In this regard, immediate imaging following signs of neurological complications after anterior cervical corpectomy or discectomy warrants early detection, which results in a better prognosis.

Candida Tropicalis Spondylodiscits in an Immunocompetent Host: A Case Report and Literature Review

Background Fungal spondylodiscitis is not common but should be suspected in some cases. Candida tropicalis infections are being more frequently diagnosed due to some factors related to the microorganism. Case Description A C. tropicalis spondylodiscitis is described in a 72-year-old man who was treated with a combination of echinocandin (micafungin) and surgery. Conclusion The presence of some risk factors should promptly raise the suspicion of fungal spondylodiscitis. Treatment should be instituted as early as possible for the best outcome for the patient.

Reporte de caso: Quiste neuroentérico intradural/extramedular en paciente joven / Case report: Intradural/extramedullary neurenteric cyst in a young patient

Introducción: Los quistes neuroentéricos son lesiones congénitas, benignas, solitarias e infrecuentes del eje espinal, compuestas de tejido endodérmico heterotópico, productos del cierre incompleto del tubo neural. Se presentan, principalmente, en hombres durante la primera y segunda década de vida. Se localizan mayoritariamente en el espacio intradural/extramedular, ventralmente a la médula espinal, a nivel cervical bajo o torácico superior. La sintomatología neurológica depende de la localización del quiste. El diagnóstico presuntivo se realiza con una resonancia magnética, y el definitivo con un estudio histopatológico, llevado a cabo posterior a la exéresis completa o parcial de la muestra, con abordaje posterior, en la mayoría de los casos. Caso: Se describe el caso de una paciente de 35 años, quien tiene antecedente de haber presentado a los 14 años un quiste neuroentérico intradural/extramedular, a nivel cervial bajo. Había debutado con cervicalgia irradiada a miembros superiores e inferiores, radiculopatía, pérdida de la fuerza muscular, e hiperreflexia. Se realizó en ese momento una resonancia magnética, evidenciando una lesión ocupante de espacio en C5 y C6, la cual fue intervenida quirúrgicamente a través de una laminectomía en C5-C6 con abordaje posterior. Se realizó exéresis completa de la misma. El estudio anatomopatológico reportó quiste neuroentérico intradural/extramedular, sin atipias celulares. La evolución posoperatoria de la paciente resultó satisfactoria. Conclusión: Se describe este caso clínico, resaltando su importancia, al tratarse de lesiones sumamente infrecuentes en la literatura médica, con sintomatología poco específica, pudiendo confundirse con otras patologías, y recidivar, incluso después de haberse extraído completamente

Introduction: Neuroenteric cysts are congenital, benign, solitary, and infrequent lesions of the spinal axis, composed of heterotopic endodermic tissue, resulting from an incomplete closure of the neural tube. They mainly occur in men, during the first or second decade of life. Most of these cysts are located in the intradural/extramedullary compartment, ventrally to the spinal cord, especially at the lower cervical or upper thoracic spine. The neurological symptomatology varies depending on the location of the cyst. The presumptive diagnosis is made with magnetic resonance imaging, and the definitive diagnosis is made with a histopathological assessment, which is done after a complete or partial resection of the mass, generally with a posterior approach. Case presentation: We describe the case of a 35-year-old female patient, with the medical history of presenting an intradural/extramedullary neuroenteric cyst, located at the lower cervical level, at the age of 14. She presented cervical pain irradiated to upper and lower limbs, radicular pain, loss of muscular strength, and hyperreflexia. A magnetic resonance imaging was indicated, showing a space-occupying lesion at the C5 and C6 levels, which was surgically intervened through a posterior cervical (C5-C6) laminectomy. A complete resection of this mass was performed. The histopathological assessment reported an intradural/extramedullary neuroenteric cyst, with no cellular atypia. The patient's postoperative progress and development were satisfactory. Conclusion: The objective is to describe this case, highlighting its importance, since these lesions are extremely infrequent in the medical literature, with a non-specific symptomatology, which is why they can be confused with other pathologies, and recur, even after their complete resection.

Gangliocytic Paraganglioma of the Filum Terminale. A Rare Entity

Paragangliomas are rare, benign and slow-growing neuroendocrine tumors that can arise from the adrenal medulla (85­90%) or from the extra-adrenal paraganglia. In the central nervous system (CNS), they can be found at several sites, but more often at the cauda equina and filum terminale region, where they account for between 2.5 and 3.8% of total tumor cases of that region. There are only 8 cases described in the literature that mention the presence of the gangliocytic variant of this entity at the filum terminale. We present the case of a 41-year-old man with chronic lumbar pain refractory to medical treatment, without any associated neurological deficits. Magnetic resonance imaging (MRI) revealed an intradural, extramedullar oval lesion with regular contours and homogeneous caption of contrast at L1 level. He was submitted to surgical treatment, with complete resection of the lesion. The histological analysis revealed a gangliocytic paraganglioma of the filum terminale. At 5 years of follow-up, he remains asymptomatic and without any signs of relapse. These are lesions with an overall good prognosis with gross total resection. Although the recurrence rate is extremely low, prolonged observation is recommended due to the slow-growing nature of the tumor, being estimated that between 1 and 4% can recur even after gross total removal.

Intradural Spinal Arachnoid Cyst in a Pediatric Patient: A Case Report

The present case reports a 13-year-old patient with an intradural arachnoid cyst, which manifested itself with a sudden loss of strength and sensitivity in the lower and upper limbs and a severe pain in the cervical and thoracic region. On examination, a lesion displayed as an intradural hematoma; however, a laminotomy was performed and it was realized that the lesion was an arachnoid spinal cyst of the cervical-dorsal spine.

Minimally invasive treatment of cervical1-2 epidural neurilemmoma / 北京大学学报(医学版)

OBJECTIVE@#To explore the minimally invasive surgical method for cervical1-2 epidural neurilemmoma.@*METHODS@#The clinical features, imaging characteristics and surgical methods of 63 cases of cervical1-2 epidural neurilemmoma from July 2010 to December 2018 were reviewed and analyzed. Pain and numbness in occipitocervical region were the common clinical symptoms. There were 58 cases with pain, 30 cases with numbness, 3 cases with limb weakness and 2 cases with asymptomatic mass. Magnetic resonance imaging (MRI) showed that the tumors located in the cervical1-2 epidural space with diameter of 1-3 cm. The equal or slightly lower T1 and equal or slightly higher T2 signals were found on MRI. The tumors had obvious enhancement. Individualized laminotomy was performed according to the location and size of the tumors, and axis spinous processes were preserved as far as possible. Resection of tumor was performed strictly within the capsule.@*RESULTS@#Total and subtotal resection of tumor were achieved in 60 and 3 cases respectively, and no vertebral artery injury was found. The operation time ranged from 60 to 180 minutes, with an average of 92.83 minutes. The hospitalization time ranged from 3 to 9 days, with an average of 5.97 days. All tumors were confirmed as neurilemmoma by pathology. There was no postoperative infection or cerebrospinal fluid leakage. There was no new-onset dysfunction except 9 cases of numbness in the nerve innervation area. The period of follow-up ranged from 6 months to 8 years (median: 3 years). All the new-onset dysfunction recovered completely. Pain disappeared in all of the 58 patients with pain. Numbness recovered completely in 27 patients while slight numbness remained in another 3 patients. Three patients with muscle weakness recovered completely. The spinal function of all the patients restored to McCormick grade Ⅰ. No recurrence was found on MRI. No cervical spine instability or deformity was found on X-rays.@*CONCLUSION@#It is feasible to resect cervical1-2 epidural neurilemmoma by full use of the anatomical space between atlas and axis and individual laminotomy. It is helpful to prevent cervical instability or deformity by minimizing the destruction of cervical2 bone and preserving normal muscle attachment to cervical2 spinous process. Strict intracapsular resection can effectively prevent vertebral artery injury.

Analysis of clinical efficacy of C expanded half lamina excision combined with unilateral open-door laminoplasty for multiple segmental cervical spinal cord compression syndrome / 中国骨伤

OBJECTIVE@#To explore the clinical efficacy of C expanded half lamina excision combined with unilateral open door laminoplasty for multiple segmental cervical spinal cord compression syndrome.@*METHODS@#The clinical data of 58 patients with multiple segmental cervical spinal cord compression syndrome underwent surgical treatment between September 2014 and May 2018 were retrospectively analyzed. There were 34 males and 24 females with a mean age of 64.4 years old (ranged from 46 to 78 years old). Among them, 28 cases received the surgery of C expanded half lamina excision combined with C-C unilateral open-door laminoplasty (improvedgroup), and 30 cases received a single C-C unilateral open-door laminoplasty (traditional group). Operation time, intraoperative blood loss, complications including C nerve root palsy and axial symptoms were compared between two groups. To evaluate the situation of the imaging indicators by measuring the space available for the spinal cord through cross sectional MRI of cervical spine at the narrowest segment of C (including intervertebral disc levels of C). Pre- and post-operative Japanese Orthopedic Association(JOA) score, Neck Disability Index(NDI) score, and improvement rate of neurological function, were recorded and analyzed between the two groups.@*RESULTS@#All the patients were followed up for 12 to 18 months with an average of(14.5±1.8) months for improved group and (14.5±1.9) months for traditional group, and no significant difference was found between the two groups (>0.05). There was no significant difference in intraoperative blood loss and C nerve root palsy between the two groups (>0.05). The operation time (119±10) min vs (126±12) min and axial symptoms 7.1%(2/28) vs 26.6%(8/30) was significant difference between the two groups (0.05).@*CONCLUSION@#C expanded half lamina excision combined with unilateral open-door laminoplasty is an effective method to treat multiple segmental cervical spinal cord compression syndrome, for it can not only fully relieved spinal cord compression, but also achievedgood effect in preventing complications such as axial symptoms by reducing stripping of muscles from C2 spinous process.

Preliminary results of vertebral canal decompression by spinous process splitting / Resultados preliminares da descompressão do canal vertebral por separação do processo espinhoso / Resultados preliminares de la descompresión del canal vertebral por separación del proceso espinoso

ABSTRACT Objective Considering that the technique of spinous process splitting has been advocated as a less invasive treatment of lumbar stenosis, the objective of this study was to evaluate the preliminary results of this technique in the surgical treatment of lumbar canal stenosis. Methods Twenty patients with lumbar spinal canal stenosis who underwent surgical treatment for lumbar canal decompression with the spinous process splitting technique were assessed in the preoperative period and on postoperative days 1, 7 and 30 for VAS for lower back and lower limbs pain and radiographic evaluation of the operated segment. Results The mean visual analogue scale score for lumbar pain in the preoperative assessment was 4.2 ± 3.37 and 0.85 ± 0.88, 1.05 ± 1.19 and 1.15 ± 1.04 after 1, 7 and 30 postoperative days, respectively. The mean VAS score for lower limb pain was 8 ± 1.72 preoperatively, and 0.7 ± 1.13, 0.85 ± 1.04, and 1.05 ± 1 after 1, 7, and 30 postoperative days, respectively. There were no radiographic signs of instability of the vertebral segment operated in the radiographic evaluation. Conclusions Decompression of the lumbar canal through the spinous process splitting technique in patients with lumbar canal stenosis had good immediate and short-term results in relation to low back and lower limbs pain. Level of evidence IV; Therapeutic Study.

RESUMO Objetivo A técnica da separação do processo espinhoso tem sido preconizada como técnica menos invasiva para o tratamento da estenose lombar. Objetivo é avaliar os resultados preliminares dessa técnica no tratamento cirúrgico da estenose do canal lombar. Métodos Vinte pacientes portadores de estenose do canal vertebral lombar e submetidos ao tratamento cirúrgico para descompressão do canal lombar, por meio da técnica da separação do processo espinhoso, foram avaliados no período pré-operatório, um, sete e trinta dias de pós-operatório, por meio da escala visual de avaliação da dor lombar e dor nos membros inferiores e avaliação radiográfica do segmento operado. Resultados O escore médio da escala visual analógica da dor lombar na avaliação pré-operatória foi 4,2 ± 3,37 e, respectivamente, 0,85 ± 0,88; 1,05 ± 1,19 e 1,15 ± 1,04 após um, sete e trinta dias de pós-operatório. O escore médio da escala visual analógica da dor nos membros inferiores foi 8 ± 1,72 no pré-operatório e, respectivamente, 0,7 ± 1,13; 0,85 ± 1,04 e 1,05 ± ١ após um, sete e trinta dias de pós-operatório. Não foram observados sinais radiográficos de instabilidade do segmento vertebral operado na avaliação radiográfica. Conclusão A descompressão do canal lombar por meio da técnica da separação do processo espinhoso nos pacientes com estenose do canal lombar apresentou bons resultados imediatos e a curto prazo, em relação à dor lombar e dor nos membros inferiores . Nível de evidência IV; Estudo Terapêutico.

RESUMEN Objetivo Teniendo en cuenta que la técnica de separación del proceso espinoso ha sido recomendada para el tratamiento menos invasivo de la estenosis lumbar, el objetivo de este estudio fue evaluar los resultados preliminares de esta técnica en el tratamiento quirúrgico de la estenosis del canal lumbar. Métodos Veinte pacientes con estenosis del canal espinal lumbar que se sometieron a tratamiento quirúrgico para descompresión del canal lumbar con la técnica de separación del proceso espinoso se evaluaron en el período preoperatorio y en los días 1, 7 y 30 postoperatorios mediante EVA para del dolor lumbar y de los miembros inferiores y evaluación radiográfica del segmento operado. Resultados La puntuación promedio de la escala visual analógica del dolor lumbar en la evaluación preoperatoria fue de 4,2 ± 3,37 y 0,85 ± 0,88; 1,05 ± 1,19 y 1,15 ± 1,04 después de 1, 7 y 30 días postoperatorios. La puntuación promedio de la EVA para el dolor de las extremidades inferiores fue 8 ± 1,72 en el preoperatorio y de 0,7 ± 1,13; 0,85 ± 1,04 y 1,05 ± 1 después de 1, 7 y 30 días postoperatorios, respectivamente. No se observaron signos radiográficos de inestabilidad del segmento vertebral operado en la evaluación radiográfica. Conclusiones La descompresión del canal lumbar por medio de la técnica de separación del proceso espinoso en pacientes con estenosis del canal lumbar tuvo buenos resultados inmediatos y a corto plazo con relación al dolor lumbar y las extremidades inferiores. Nivel de evidencia IV; Estudio Terapéutico.

Restoration of the Spinous Process Following Muscle-Preserving Posterior Lumbar Decompression via Sagittal Splitting of the Spinous Process

BACKGROUND: In lumbar spinal stenosis, spinous process-splitting decompression has demonstrated good clinical outcomes with preservation of the posterior ligamentous complex and paraspinal muscles in comparison to conventional laminectomy, but the radiological consequence and clinical impact of the split spinous processes have not been fully understood. METHODS: Seventy-three patients who underwent spinous process-splitting decompression were included. The bone union rate and pattern were evaluated by computed tomography performed 6–18 months after surgery and compared among subgroups divided according to the number of levels decompressed and the extent of spinous process splitting. The bone union pattern was classified into three categories: complete union, partial union, and nonunion. The visual analog scale (VAS) score, Oswestry disability index (ODI), and walking distance assessed both before and 24–36 months after surgery were compared among subgroups divided according to the union pattern of the split spinous process. RESULTS: Overall, the rates of complete union, partial union, and nonunion were 51.7%, 43.2%, and 5.1%, respectively. In the subgroup with partial splitting of the spinous process, the rates were 85.7%, 14.3%, and 0%, respectively; those of the subgroup with total splitting of the spinous process were 32.9%, 59.2%, and 7.9%, respectively. With single-level decompression, a higher rate of union was observed compared with multilevel decompression. The VAS, ODI, and walking distance were significantly improved after surgery and did not differ according to the degree of union of the split spinous process. CONCLUSIONS: We found that the single-level operation and partial splitting of the spinous process were favourable factors for obtaining complete restoration of the posterior bony structure of the lumbar spine in spinous process-splitting decompression.

Astrocitoma medular de alto grado no infiltrante / Astrocitoma medular não infiltrativo. Apresentação do caso / Non-infiltrating medullary astrocytoma. Case presentation

Se presentó el caso de una paciente femenina de 20 años de edad que acudió al servicio de Neurocirugía por presentar dolor en la región lumbar. Al interrogatorio la paciente refirió tener constipación, retención urinaria y dolor lumbar. En los exámenes complementarios lo más significativo fue la resonancia magnética nuclear que mostró una imagen hiperdensa a nivel de D12-L5. Se realizó laminectomía de D12-L5, durotomía y extracción tumoral, fijación transpedicular con tornillos ubicados en T12-L1-L3-L4 con barras de titanio, se obtuvo un diagnóstico de astrocitoma grado II-III. Al analizar los diferentes aspectos del caso en cuestión, los investigadores concluyen que con la conducta terapéutica tomada con este caso se sientan las bases para un correcto manejo de posteriores pacientes(AU)

The case of a 20-year-old female patient who went to the Neurosurgery department for presenting pain in the lumbar region was presented. At the interrogation, the patient reported having constipation, urinary retention and low back pain. In the complementary tests, the most significant was nuclear magnetic resonance, which showed a hyperdense image at the level of D12-L5. Laminectomy of D12-L5, durotomy and tumor extraction, transpedicular fixation with screws located in T12-L1-L3-L4 with titanium bars was performed, a diagnosis of grade II-III astrocytoma was obtained. When analyzing the different aspects of the case in question, the researchers conclude that with the therapeutic behavior taken with this case, the basis is laid for the correct management of subsequent patients(AU)

Foi apresentado o caso de uma paciente de 20 anos que foi ao departamento de Neurocirurgia por apresentar dor na região lombar. No interrogatório, o paciente relatou constipação, retenção urinária e lombalgia. Nos testes complementares, o mais significativo foi a ressonância magnética nuclear, que mostrou uma imagem hiperdensa ao nível de D12-L5. Foi realizada laminectomia de D12-L5, durotomia e extração de tumores, fixação transpedicular com parafusos localizados em T12-L1-L3-L4 com barras de titânio e foi obtido o diagnóstico de astrocitoma grau II-III. Ao analisar os diferentes aspectos do caso em questão, os pesquisadores concluem que, com o comportamento terapêutico adotado neste caso, é lançada a base para o manejo correto dos pacientes subsequentes)AU=