ABSTRACT
Retro-odontoid pseudotumors are lesions caused by inflammatory granulation or reactive soft tissue hypertrophy from chronic atlantoaxial subluxation. However, one-third of the cases reported in the medical literature did not show atlantoaxial instability clearly. The authors present the case of a 76-year-old man previously diagnosed with diffuse idiopathic skeletal hyperostosis who presented with severe progressive myelopathy. A magnetic resonance imaging of his cervical spine revealed a retro-odontoid predural mass, which caused a severe compression of the cervical spinal cord. The patient underwent a posterior laminectomy of the atlas and an occipitocervical fusion. After surgery, the pseudotumor was considerably smaller and the neurological symptoms improved.
Subject(s)
Cervical Atlas/surgery , Granuloma, Plasma Cell/surgery , Hyperostosis, Diffuse Idiopathic Skeletal/complications , Odontoid Process , Spinal Cord Compression/etiology , Aged , Disease Progression , Granuloma, Plasma Cell/diagnosis , Granuloma, Plasma Cell/etiology , Humans , Laminectomy , Magnetic Resonance Imaging , Male , Muscle Spasticity , Quadriplegia/etiology , Quadriplegia/rehabilitation , Reflex, Abnormal , Spinal FusionABSTRACT
OBJECTIVES: The use of transpedicular screw fixation has been widely accepted for the treatment of degenerative and traumatic pathology of the lumbar spine. Complications of spinal instrumentation can be serious. Screw misplacement can result in unintended durotomy, nerve root and/or cauda equina injury. In comparison to fluoroscopy-assisted screw placement, computer-assisted image guidance has been shown to achieve overall higher rates of accuracy. The O-arm is able to obtain computed tomography (CT)-type images with multiplanar reconstruction. In this study we evaluated a cohort of patients who underwent posterior lumbar fusion with pedicle screws utilizing the O-arm imaging system. METHODS: A retrospective review of 40 consecutive patients who underwent posterior lumbar fusion surgery with O-arm utilization, was performed. The study population included 14 males and 26 females. Age range was 39-85 years with an average of 63.8 years. Twenty one patients had degenerative lumbar stenosis (52.5%) and 19 had spondylolisthesis (47.5%). Intraoperative CT-images were obtained. The mean time for surgery and screw placement was assessed. RESULTS: A total of 252 pedicle screws were sited using O-arm navigation system, with a mean of 6.3 screws per patient (range 4-10). On the basis of intraoperative CT, 3 screws were redirected, representing a 98.81% accuracy rate. The mean duration of surgery was 157.2 (90-240) minutes and the mean time for screw placement was 7.13 (3.08-15) minutes per screw. Three patients (7.5%) developed superficial wound infections which were treated conservatively. No patients required a return to the operating room because of screw malposition. CONCLUSION: The use of intraoperative O-arm imaging system with computer-assisted navigation significantly increases the surgical accuracy and safety of pedicle screw placement in lumbar fusion surgery.
Subject(s)
Lumbar Vertebrae/diagnostic imaging , Neuronavigation/instrumentation , Radiography, Interventional/instrumentation , Spinal Fusion/methods , Surgery, Computer-Assisted/instrumentation , Tomography, X-Ray Computed/instrumentation , Adult , Aged , Aged, 80 and over , Bone Screws , Equipment Design , Female , Fluoroscopy/methods , Humans , Male , Middle Aged , Multimodal Imaging/instrumentation , Multimodal Imaging/methods , Neuronavigation/methods , Operative Time , Radiography, Interventional/methods , Retrospective Studies , Spinal Stenosis/surgery , Spondylolisthesis/surgery , Surgery, Computer-Assisted/methods , Tomography, X-Ray Computed/methods , UltrasonographyABSTRACT
Lipomatous ganglioneuromas are a rare variant of ganglioneuromas characterized by a mature adipocytic component admixed with a conventional ganglioneuroma component. We present the case of a 34 year old patient with a paravertebral right lesion L1-L4 with intraspinal extension and secondary neurological deficit, who underwent surgery in our hospital. The pathological anatomy showed a yellowish encapsulated neoplasm, which under microscopic evaluation showed areas of ganglioneuroma admixed with areas of mature fat. In the follow up, the patient was asymptomatic, had recovered paresis in the right lower extremity and in the last image control did not present data of lesion recurrence. Fewer than 10 cases of lipomatous ganglioneuromas have been reported in the literature, being this the first paravertebral case wih intraspinal extension and with neurological deficit, hence the interest of this work.