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2.
Khirurgiia (Mosk) ; (6): 60-70, 2020.
Artigo em Russo | MEDLINE | ID: mdl-32573534

RESUMO

OBJECTIVE: To perform a meta-analysis of studies examining the effectiveness of the local application of vancomycin powder for the prophylaxis of surgical site infections (SSIs) in spine surgery. MATERIAL AND METHODS: Retrospective cohort studies and prospective randomized clinical trials were searched for in the Pubmed, EMBASE, Cochrane Library and eLibrary databases published from 2008 to December 2018. For the resulting variables, the odds ratio and 95% confidence interval were calculated using random and fixed effects models. Estimation of the degree of heterogeneity is estimated using the coefficient I2. Statistically significant differences were considered differences p<0.05. RESULTS: The meta-analysis included 28 clinical studies that included the results of the local application of vancomycin powder in 17,469 patients after performing various spinal surgical interventions. Two publications had a prospective, randomized, controlled study design. Topical application of vancomycin powder reduces the incidence of SSIs after spine surgery (p<0.0001). The use of vancomycin powder reduces the incidence of SSIs in patients operated on with stabilizing implants (p=0.004). On the other hand, the topical application of vancomycin powder did not affect the prevalence of SSIs in respondents who were operated on without the use of stabilizing implants (p=0.12) or due to deformities of the spine (p=0.06). CONCLUSION: Topical application of vancomycin powder is highly effective in preventing the development of SSIs in patients after spinal surgical interventions.


Assuntos
Antibacterianos/administração & dosagem , Coluna Vertebral/cirurgia , Infecção da Ferida Cirúrgica/prevenção & controle , Vancomicina/administração & dosagem , Administração Tópica , Antibioticoprofilaxia , Humanos , Pós/administração & dosagem , Ensaios Clínicos Controlados Aleatórios como Assunto , Doenças da Coluna Vertebral/cirurgia , Infecção da Ferida Cirúrgica/etiologia
4.
Bone Joint J ; 102-B(5): 568-572, 2020 May.
Artigo em Inglês | MEDLINE | ID: mdl-32349598

RESUMO

Continuous technical improvement in spinal surgical procedures, with the aim of enhancing patient outcomes, can be assisted by the deployment of advanced technologies including navigation, intraoperative CT imaging, and surgical robots. The latest generation of robotic surgical systems allows the simultaneous application of a range of digital features that provide the surgeon with an improved view of the surgical field, often through a narrow portal. There is emerging evidence that procedure-related complications and intraoperative blood loss can be reduced if the new technologies are used by appropriately trained surgeons. Acceptance of the role of surgical robots has increased in recent years among a number of surgical specialities including general surgery, neurosurgery, and orthopaedic surgeons performing major joint arthroplasty. However, ethical challenges have emerged with the rollout of these innovations, such as ensuring surgeon competence in the use of surgical robotics and avoiding financial conflicts of interest. Therefore, it is essential that trainees aspiring to become spinal surgeons as well as established spinal specialists should develop the necessary skills to use robotic technology safely and effectively and understand the ethical framework within which the technology is introduced. Traditional and more recently developed platforms exist to aid skill acquisition and surgical training which are described. The aim of this narrative review is to describe the role of surgical robotics in spinal surgery, describe measures of proficiency, and present the range of training platforms that institutions can use to ensure they employ confident spine surgeons adequately prepared for the era of robotic spinal surgery. Cite this article: Bone Joint J 2020;102-B(5):568-572.


Assuntos
Competência Clínica , Procedimentos Cirúrgicos Robóticos/educação , Procedimentos Cirúrgicos Robóticos/normas , Doenças da Coluna Vertebral/cirurgia , Humanos , Complicações Intraoperatórias/prevenção & controle , Complicações Pós-Operatórias/prevenção & controle
5.
Brain Nerve ; 72(3): 251-258, 2020 Mar.
Artigo em Japonês | MEDLINE | ID: mdl-32152258

RESUMO

Cervicogenic headache (CEH) is a lateralized non-pulsative headache syndrome caused by cervical spine disorders. The headache is initiated in the neck, which subsequently spreads to the occipital, frontal, and orbital regions, and is accompanied by ipsilateral shoulder pain. The prevalence of CEH is considered to be 15-20% among cases of chronic headache. With regard to the mechanism of CEH, convergence of upper cervical nerves and trigeminocervical complex might play an important role. However, CEH in many patients has been reported to be associated with middle to lower cervical disorders, which cannot be explained by this theory. We therefore proposed the possibility that the condition reported here is another type of CEH. The treatment of CEH requires a multidisciplinary approach, because pharmacological treatment is often ineffective. (Received August 16 2019; Accepted November 25, 2019; Published March 1, 2020).


Assuntos
Cefaleia Pós-Traumática/etiologia , Doenças da Coluna Vertebral/complicações , Vértebras Cervicais , Humanos , Pescoço , Prevalência
8.
Instr Course Lect ; 69: 349-362, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32017737

RESUMO

Back pain and spinal deformity in the pediatric and adolescent patient population are common reasons for presentation to the orthopaedic surgeon, and although most conditions are benign and self-limiting, a standardized approach to the history and physical examination can identify concerning signs and symptoms as well as aid in determining the final diagnosis and a recommended treatment plan. The most common and concerning etiologies of back pain and spinal deformity will be reviewed, along with nonsurgical and surgical management of these conditions.


Assuntos
Exame Físico , Doenças da Coluna Vertebral , Coluna Vertebral , Adolescente , Criança , Humanos
9.
Praxis (Bern 1994) ; 109(2): 87-95, 2020 Feb.
Artigo em Alemão | MEDLINE | ID: mdl-32019459

RESUMO

Everyone Has Low Back Pain: Degenerative Lumbar Spinal Disorders and Their Treatment Options Abstract. Back pain is one of the most widespread diseases. Up to 84 % of people have low back pain at some point in their lives. Unspecific back pain is treated conservatively. As supportive measure, interventional pain therapy can be performed. Surgery for low back pain should be considered in selected cases only. However, accompanying neurological symptoms are frequent, such as radiation, i.e. sciatica. Typical etiologies are disc herniation or - increasingly frequent, and due to the aging population increasingly frequent - spinal canal stenosis. Surgery has a better prognosis in cases where conservative management failed. If severe neurological symptoms are present, surgery is indicated. Osteoporotic compression fractures cause acute back pain. The decision whether these patients should undergo kypho- or vertebroplasty should be based on guidelines.


Assuntos
Dor Lombar , Doenças da Coluna Vertebral , Estenose Espinal , Idoso , Humanos , Dor Lombar/etiologia , Dor Lombar/terapia , Vértebras Lombares , Prognóstico , Doenças da Coluna Vertebral/complicações , Doenças da Coluna Vertebral/terapia , Estenose Espinal/complicações , Estenose Espinal/terapia
10.
Medicine (Baltimore) ; 99(5): e19055, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-32000453

RESUMO

To investigate the outcomes and reliability of hybrid surgery (HS) versus anterior cervical discectomy and fusion (ACDF) for the treatment of multilevel cervical spondylosis and disc diseases.Hybrid surgery, combining cervical disc arthroplasty (CDA) with fusion, is a novel treatment to multilevel cervical degenerated disc disease in recent years. However, the effect and reliability of HS are still unclear compared with ACDF.To investigate the studies of HS versus ACDF in patients with multilevel cervical disease, electronic databases (Medline, Embase, Pubmed, Cochrane library, and Cochrane Central Register of Controlled Trials) were searched. Studies were included when they compared HS with ACDF and reported at least one of the following outcomes: functionality, neck pain, arm pain, cervical range of motion (ROM), quality of life, and incidence of complications. No language restrictions were used. Two authors independently assessed the methodological quality of included studies and extracted the relevant data.Seven clinical controlled trials were included in this study. Two trials were prospective and the other 5 were retrospective. The results of the meta-analysis indicated that HS achieved better recovery of NDI score (P = 0.038) and similar recovery of VAS score (P = 0.058) compared with ACDF at 2 years follow-up. Moreover, the total cervical ROM (C2-C7) after HS was preserved significantly more than the cervical ROM after ACDF (P = 0.000) at 2 years follow-up. Notably, the compensatory increase of the ROM of superior and inferior adjacent segments was significant in ACDF groups at 2-year follow-up (P < 0.01), compared with HS.The results demonstrate that HS provides equivalent outcomes and functional recovery for cervical disc diseases, and significantly better preservation of cervical ROM compared with ACDF in 2-year follow-up. This suggests the HS is an effective alternative invention for the treatment of multilevel cervical spondylosis to preserve cervical ROM and reduce the risk of adjacent disc degeneration. Nonetheless, more well-designed studies with large groups of patients are required to provide further evidence for the benefit and reliability of HS for the treatment of cervical disk diseases.


Assuntos
Vértebras Cervicais/cirurgia , Discotomia/métodos , Doenças da Coluna Vertebral/cirurgia , Fusão Vertebral/métodos , Humanos , Degeneração do Disco Intervertebral/cirurgia , Deslocamento do Disco Intervertebral/cirurgia , Espondilose/cirurgia
11.
PLoS One ; 15(2): e0228422, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32027680

RESUMO

This paper focuses on the application of machine learning algorithms for predicting spinal abnormalities. As a data preprocessing step, univariate feature selection as a filter based feature selection, and principal component analysis (PCA) as a feature extraction algorithm are considered. A number of machine learning approaches namely support vector machine (SVM), logistic regression (LR), bagging ensemble methods are considered for the diagnosis of spinal abnormality. The SVM, LR, bagging SVM and bagging LR models are applied on a dataset of 310 samples publicly available in Kaggle repository. The performance of classification of abnormal and normal spinal patients is evaluated in terms of a number of factors including training and testing accuracy, recall, and miss rate. The classifier models are also evaluated by optimizing the kernel parameters, and by using the results of receiver operating characteristic (ROC) and precision-recall curves. Results indicate that when 78% data are used for training, the observed training accuracies for SVM, LR, bagging SVM and bagging LR are 86.30%, 85.47%, 86.72% and 85.06%, respectively. On the other hand, the accuracies for the test dataset for SVM, LR, bagging SVM and bagging LR are the same being 86.96%. However, bagging SVM is the most attractive as it has a higher recall value and a lower miss rate compared to others. Hence, bagging SVM is suitable for the classification of spinal patients when applied on the most five important features of spinal samples.


Assuntos
Algoritmos , Conjuntos de Dados como Assunto/estatística & dados numéricos , Diagnóstico por Computador/métodos , Doenças da Coluna Vertebral/diagnóstico , Coluna Vertebral/anormalidades , Coluna Vertebral/diagnóstico por imagem , Diagnóstico Diferencial , Humanos , Interpretação de Imagem Assistida por Computador/métodos , Modelos Logísticos , Aprendizado de Máquina , Postura/fisiologia , Valor Preditivo dos Testes , Reprodutibilidade dos Testes , Doenças da Coluna Vertebral/epidemiologia , Máquina de Vetores de Suporte
12.
BMC Health Serv Res ; 20(1): 135, 2020 Feb 22.
Artigo em Inglês | MEDLINE | ID: mdl-32087710

RESUMO

BACKGROUND: A vast body of literature has documented regional variations in healthcare utilization rates. The extent to which such variations are "unwarranted" critically depends on whether there are corresponding variations in patients' needs. Using a unique medical registry, the current paper investigated any associations between utilization rates and patients' needs, as measured by two patient-reported outcome measures (PROMs). METHODS: This observational panel study merged patient-level data from the Norwegian Patient Registry (NPR), Statistics Norway, and the Norwegian Registry for Spine Surgery (NORspine) for individuals who received surgery for degenerative lumbar spine disorders in 2010-2015. NPR consists of hospital administration data. NORspine includes two PROMs: the generic health-related quality of life instrument EQ-5D and the disease-specific, health-related quality of life instrument Oswestry Disability Index (ODI). Measurements were assessed at baseline and at 3 and 12 months post-surgery and included a wide range of patient characteristics. Our case sample included 15,810 individuals. We analyzed all data using generalized estimating equations. RESULTS: Our results show that as treatment rates increase, patients have better health at baseline. Furthermore, increased treatment rates are associated with smaller health gain. CONCLUSION: The correlation between treatment rates and patients health indicate the presence of unwarranted variation in treatment rates for lumbar spine disorders.


Assuntos
Vértebras Lombares/cirurgia , Aceitação pelo Paciente de Cuidados de Saúde/estatística & dados numéricos , Medidas de Resultados Relatados pelo Paciente , Doenças da Coluna Vertebral/cirurgia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Noruega , Qualidade de Vida , Sistema de Registros , Resultado do Tratamento
13.
Radiol Med ; 125(7): 654-667, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32088810

RESUMO

The involvement of the cervical spine in musculoskeletal diseases can be crucial in terms of prognosis and morbidity. Early diagnosis of possible involvement of the craniocervical junction is essential to avoid the onset of neurological complications with poor prognosis. Among inflammatory diseases, rheumatoid arthritis affects the cervical spine frequently (in about 25% of patients). Atlantoaxial inflammatory changes are also detectable in spondyloarthritis. The involvement of the cervical spine in diffuse idiopathic skeletal hyperostosis is recognized as the cause of various clinical manifestations that may involve the pharynx, larynx and esophagus. The cervical spine may be specifically frequently implicated in crystal-associated arthropathies. Spinal cord infections are infrequent diseases that account for 3-4% of all spine infections. This pictorial review attempts to provide insights to interpret the radiological appearances of the craniocervical junction on conventional radiography, computed tomography and magnetic resonance imaging in relation to various musculoskeletal disease processes.


Assuntos
Articulação Atlantoccipital , Vértebras Cervicais , Doenças Musculoesqueléticas/complicações , Doenças da Medula Espinal/diagnóstico por imagem , Doenças da Medula Espinal/etiologia , Doenças da Coluna Vertebral/diagnóstico por imagem , Doenças da Coluna Vertebral/etiologia , Diagnóstico Precoce , Humanos
14.
BMC Health Serv Res ; 20(1): 119, 2020 Feb 14.
Artigo em Inglês | MEDLINE | ID: mdl-32059715

RESUMO

INTRODUCTION: Spinal epidural abscess (SEA) is a rare and life-threatening infection with increasing incidence over the past two decades. Delays in diagnosis can cause significant morbidity and mortality among patients. OBJECTIVE: The objective of this study was to describe trends in time-to-imaging and intervention, risk factors, and outcomes among patients presenting to the emergency department with SEA at a single academic medical center in Portland, Oregon. METHODS: This retrospective cohort study analyzed data from patients with new SEA diagnosis at a single hospital from October 1, 2015 to April 1, 2018. We describe averages to time-to-imaging and interventions, and frequencies of risk factors and outcomes among patients presenting to the emergency department with SEA. RESULTS: Of the 34 patients included, 7 (20%) died or were discharged with plegia during the study period. Those who died or were discharged with plegia (n = 7) had shorter mean time-to-imaging order (20.8 h versus 29.2 h). Patients with a history of intravenous drug use had a longer mean time-to-imaging order (30.2 h versus 23.7 h) as compared to those without intravenous drug use. Patients who died or acquired plegia had longer times from imaging completed to final imaging read (20.9 h versus 7.1 h), but shorter times from final imaging read to surgical intervention among patients who received surgery (4.9 h versus 46.2 h). Further, only three (42.9%) of the seven patients who died or acquired plegia presented with the three-symptom classic triad of fever, neurologic symptoms, and neck or back pain. CONCLUSIONS: SEA is a potentially deadly infection that requires prompt identification and treatment. This research provides baseline data for potential quality improvement work at the study site. Future research should evaluate multi-center approaches for identifying and intervening to treat SEA, particularly among patients with intravenous drug use.


Assuntos
Diagnóstico Tardio/estatística & dados numéricos , Serviço Hospitalar de Emergência , Abscesso Epidural/diagnóstico por imagem , Doenças da Coluna Vertebral/diagnóstico por imagem , Tempo para o Tratamento/estatística & dados numéricos , Centros Médicos Acadêmicos , Adulto , Idoso , Abscesso Epidural/mortalidade , Abscesso Epidural/fisiopatologia , Feminino , Pesquisa sobre Serviços de Saúde , Humanos , Masculino , Pessoa de Meia-Idade , Oregon/epidemiologia , Estudos Retrospectivos , Fatores de Risco , Doenças da Coluna Vertebral/mortalidade , Doenças da Coluna Vertebral/fisiopatologia , Análise de Sobrevida , Fatores de Tempo
15.
AJR Am J Roentgenol ; 214(5): 1139-1145, 2020 05.
Artigo em Inglês | MEDLINE | ID: mdl-32069082

RESUMO

OBJECTIVE. The objective of our study was to assess the diagnostic utility of the "salt-and-pepper noise" sign on fat-fraction maps by chemical-shift-encoded MRI (CSE-MRI) compared with the halo sign on fat-suppressed T2-weighted imaging and mean attenuation on CT for differentiating bone islands from osteoblastic metastases. MATERIALS AND METHODS. Twenty-nine patients with 43 sclerotic vertebral bone marrow lesions (26 osteoblastic metastases, 17 bone islands) were included retrospectively. All patients underwent CT and MRI, including a CSE-MRI sequence on a 1.5-T MRI system, from November 2016 to January 2019. The salt-and-pepper noise sign was defined as the speckled appearance of white and black pixels that is similar to the appearance of background air on a fat-fraction map. ROC curves were analyzed to compare the diagnostic performance of the salt-and-pepper noise sign, halo sign, and mean CT attenuation between the two groups. RESULTS. The salt-and-pepper noise sign was significantly associated with bone islands (p < 0.001). The sensitivity, specificity, and accuracy for discriminating bone islands from osteoblastic metastases were 92.31-96.15%, 100%, and 95.35-97.67% for the salt-and-pepper noise sign; 88.46-92.31%, 88.24-94.12%, and 90.70% for the halo sign; and 96.15%, 94.12-100%, and 95.35-97.67% for mean CT attenuation, respectively. There was no statistically significant difference of diagnostic performances among the imaging characteristics for differentiating between bone islands and osteoblastic metastases (p > 0.05). Interobserver agreement for the salt-and-pepper noise sign, halo sign, and mean CT attenuation was almost perfect (κ ≥ 0.953, κ = 0.905, and ICC = 0.966, respectively). CONCLUSION. The salt-and-pepper noise sign is present in bone islands on fat-fraction maps by CSE-MRI and can aid in differentiating bone islands from osteoblastic metastases.


Assuntos
Doenças da Medula Óssea/diagnóstico por imagem , Imagem por Ressonância Magnética/métodos , Doenças da Coluna Vertebral/diagnóstico por imagem , Tecido Adiposo/diagnóstico por imagem , Adulto , Idoso , Idoso de 80 Anos ou mais , Neoplasias Ósseas/diagnóstico por imagem , Diagnóstico Diferencial , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Tomografia Computadorizada por Raios X
16.
Spine (Phila Pa 1976) ; 45(5): E288-E295, 2020 Mar 01.
Artigo em Inglês | MEDLINE | ID: mdl-32045403

RESUMO

STUDY DESIGN: This was a retrospective study using national administrative data from the MarketScan database. OBJECTIVE: To investigate the complication rates, quality outcomes, and costs in a nationwide cohort of patients with movement disorders (MD) who undergo spinal deformity surgery. SUMMARY OF BACKGROUND DATA: Patients with MD often present with spinal deformities, but their tolerance for surgical intervention is unknown. METHODS: The MarketScan administrative claims database was queried to identify adult patients with MD who underwent spinal deformity surgery. A propensity-score match was conducted to create two uniform cohorts and mitigate interpopulation confounders. Perioperative complication rates, 90-day postoperative outcomes, and total costs were compared between patients with MD and controls. RESULTS: A total of 316 patients with MD (1.7%) were identified from the 18,970 undergoing spinal deformity surgery. The complication rate for MD patients was 44.6% and for the controls 35.6% (P = 0.009). The two most common perioperative complications were more likely to occur in MD patients, acute-posthemorrhagic anemia (26.9% vs. 20.8%, P < 0.05) and deficiency anemia (15.5% vs. 8.5%, P < 0.05). At 90 days, MD patients were more likely to be readmitted (17.4% vs. 13.2%, P < 0.05) and have a higher total cost ($94,672 vs. $85,190, P < 0.05). After propensity-score match, the overall complication rate remained higher in the MD group (44.6% vs. 37.6%, P < 0.05). 90-day readmissions and costs also remained significantly higher in the MD cohort. Multivariate modeling revealed MD was an independent predictor of postoperative complication and inpatient readmission. Subgroup analysis revealed that Parkinson disease was an independent predictor of inpatient readmission, reoperation, and increased length of stay. CONCLUSION: Patients with MD who undergo spinal deformity surgery may be at risk of higher rate of perioperative complications and 90-day readmissions compared with patients without these disorders. LEVEL OF EVIDENCE: 3.


Assuntos
Transtornos dos Movimentos/economia , Transtornos dos Movimentos/cirurgia , Procedimentos Neurocirúrgicos/efeitos adversos , Procedimentos Neurocirúrgicos/economia , Complicações Pós-Operatórias/economia , Pontuação de Propensão , Adulto , Idoso , Estudos de Coortes , Feminino , Custos de Cuidados de Saúde/tendências , Humanos , Masculino , Pessoa de Meia-Idade , Procedimentos Neurocirúrgicos/tendências , Doença de Parkinson/economia , Doença de Parkinson/cirurgia , Complicações Pós-Operatórias/etiologia , Reoperação/economia , Reoperação/tendências , Estudos Retrospectivos , Doenças da Coluna Vertebral/economia , Doenças da Coluna Vertebral/cirurgia , Fusão Vertebral/efeitos adversos , Fusão Vertebral/economia , Fusão Vertebral/tendências , Resultado do Tratamento
18.
World Neurosurg ; 136: e334-e341, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-31926361

RESUMO

BACKGROUND: The opioid crisis has been declared a "public health emergency." Spine surgeons are treating more patients with substance use disorders (SUDs). OBJECTIVE: To investigate the outcomes of patients with SUD who undergo spine surgery. METHODS: A retrospective chart review was performed on patients with SUD who underwent nonelective spine surgery by orthopedic or neurosurgical staff from 2012 to 2017 at a level 1 trauma center and spine referral center. Three elective cases were excluded. RESULTS: A total of 49 patients undergoing 72 surgeries were reviewed. The most common substances of abuse were opioids (44/49 patients; 90%). Of 31 patients using multisubstances (63%), 29 misused opioids. The most common indications for surgery were infection (26/49, 53%), trauma (13/49, 27%), and myelopathy (7/49, 14%). Fusions (35/49, 71%) and irrigation and debridement surgeries (12/49, 24%) predominated. Twenty-nine percent (14/49) of patients had complications, the most common being hardware failure (7/49, 14%). Twenty percent (10/49) of patients left against medical advice and 22% (11/49) did not follow up after hospital discharge. The average length of hospital stay was 22 days. Forty-five percent (22/49) of patients were known to be in a drug program preoperatively versus 39% (19/49) postoperatively. Sixty-five percent (32/49) were prescribed opioids in the immediate postoperative period and 47% (23/49) continued to abuse drugs postoperatively. CONCLUSIONS: Patients with SUD are at increased risk of complications and inadequate follow-up. Additional studies are warranted to determine whether additional perioperative education, psychiatry consultations, or prescription of opioid addiction treatment regimens will improve drug use cessation and outcomes.


Assuntos
Doenças da Coluna Vertebral/complicações , Doenças da Coluna Vertebral/cirurgia , Coluna Vertebral/cirurgia , Transtornos Relacionados ao Uso de Substâncias/complicações , Adulto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Procedimentos Ortopédicos/efeitos adversos , Procedimentos Ortopédicos/métodos , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/etiologia , Estudos Retrospectivos , Adulto Jovem
19.
World Neurosurg ; 136: 341-347, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-31996338

RESUMO

BACKGROUND: Spinal sparganosis associated with filum terminale arteriovenous fistula (FTAVF) has not been reported in the literature. In previous studies, these 2 rare diseases were usually reported separately. We report the first case of spinal sparganosis with concomitant FTAVF. CASE DESCRIPTION: Spinal sparganosis associated with FTAVF manifested in a middle-aged man with progressive back pain and paraparesis. Magnetic resonance imaging of the lumbosacral spine revealed large intradural mass-like lesions involving the conus medullaris and entire cauda equina. Additionally, there was degenerative spinal stenosis at the level of L2-3 to L5-S1. Magnetic resonance imaging of the thoracic spine disclosed abnormal hypersignal intensity extending from the level of the conus medullaris to T7 with tortuous intradural flow voids along the ventral more than dorsal surfaces of the spinal cord. Magnetic resonance angiography and spinal angiography confirmed FTAVF at the level of L3-4. The patient underwent surgical removal of the granulation tissues with lysis adhesions and obliteration of the FTAVF simultaneously in the same surgical session. Histologic findings were consistent with sparganosis. CONCLUSIONS: The formation of FTAVF in the present case may have resulted from severe spinal canal stenosis caused by lumbar spondylosis and spinal sparganosis, inducing chronic inflammation and severe adhesion of spinal nerve roots. This evidence indicates that FTAVF may have been acquired.


Assuntos
Fístula Arteriovenosa/complicações , Cauda Equina/diagnóstico por imagem , Esparganose/complicações , Doenças da Coluna Vertebral/complicações , Adulto , Fístula Arteriovenosa/diagnóstico por imagem , Fístula Arteriovenosa/cirurgia , Dor nas Costas/etiologia , Cauda Equina/cirurgia , Tecido de Granulação/patologia , Humanos , Angiografia por Ressonância Magnética , Imagem por Ressonância Magnética , Masculino , Procedimentos Neurocirúrgicos/métodos , Paraparesia/etiologia , Esparganose/diagnóstico por imagem , Esparganose/cirurgia , Compressão da Medula Espinal/patologia , Doenças da Coluna Vertebral/diagnóstico por imagem , Doenças da Coluna Vertebral/cirurgia , Estenose Espinal/diagnóstico por imagem , Estenose Espinal/etiologia , Resultado do Tratamento
20.
World Neurosurg ; 136: e398-e406, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-31931235

RESUMO

BACKGROUND: Preoperative laboratory tests are varied in their administration among physicians, and previous studies have published conflicting reports on their utility. Anterior cervical discectomy and fusion (ACDF) is a commonly performed spine surgery, and patients often undergo preoperative testing. We sought to assess the relationship between preoperative laboratory values and risk for adverse postoperative outcomes after ACDF. METHODS: The American College of Surgeons-National Surgical Quality Improvement Program was queried from 2012 to 2017 to identify patients undergoing elective ACDF. Multivariable logistic regression was performed to assess the association between abnormal laboratory test values and adverse 30-day outcomes. Relative predictor importance was determined using an importance metric defined as Wald χ2 penalized by degrees of freedom. RESULTS: A total of 47,111 patients were included. On multivariable analysis, high creatinine (P = 0.030), anemia (P < 0.001), hyponatremia (P = 0.034), and leukocytosis (P < 0.001) were found to be significantly associated with any 30-day complications. Anemia (P < 0.001), hypernatremia (P = 0.028), hyponatremia (P = 0.016), and leukocytosis (P < 0.001) were found to be significantly associated with serious 30-day complications. High creatinine (P = 0.027), anemia (P < 0.001), hyponatremia (P = 0.047), and leukocytosis (P = 0.004) were found to be significantly associated with 30-day unplanned readmissions. High blood urea nitrogen (P = 0.007), high creatinine (P = 0.028), anemia (P < 0.001), low platelet count (P < 0.001), hyponatremia (P < 0.001), and leukocytosis (P < 0.001) were found to be significantly associated with nonhome discharge. Predictor importance analysis revealed that abnormal preoperative laboratory values were important determinants in predicting these 30-day outcomes. CONCLUSIONS: Our analyses indicate that abnormal preoperative laboratory values are associated with increased risk for adverse outcomes after elective ACDF and can be used in predictive analyses of outcomes.


Assuntos
Discotomia/efeitos adversos , Cuidados Pré-Operatórios/estatística & dados numéricos , Doenças da Coluna Vertebral/cirurgia , Fusão Vertebral/efeitos adversos , Técnicas de Laboratório Clínico/estatística & dados numéricos , Testes Diagnósticos de Rotina , Procedimentos Cirúrgicos Eletivos/efeitos adversos , Feminino , Humanos , Tempo de Internação/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Readmissão do Paciente/estatística & dados numéricos , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/etiologia , Sistema de Registros , Medição de Risco , Estados Unidos/epidemiologia
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