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1.
BMC Anesthesiol ; 19(1): 54, 2019 04 11.
Artículo en Inglés | MEDLINE | ID: mdl-30975081

RESUMEN

BACKGROUND: Spinal epidural hematoma is a rare but serious complication of epidural anaesthesia and neurological impairment. Epidural hematoma usually becomes evident within a few hours of the procedure. Delayed clinical presentation of spinal epidural hematoma is even rarer and insidious. CASE PRESENTATION: We reported a case of a 44-year-old woman who underwent a caesarean section for a twin pregnancy during which a delayed dorsal spinal epidural hematoma occurred. Symptoms were reported 5 days after surgery and 72 h after removal of the epidural catheter. An MRI scan showed a dorsal epidural hematoma. The patient was moved to the Neurosurgical Department and underwent decompression surgery. CONCLUSION: The possibility of the delayed onset of a spinal epidural hematoma in a pregnant woman who undergoes epidural anaesthesia in labour must always be taken into consideration. In order to achieve the best clinical result, we stress the importance of a timely diagnosis and prompt surgical treatment.


Asunto(s)
Anestesia Epidural/efectos adversos , Anestesia Raquidea/efectos adversos , Hematoma Espinal Epidural/diagnóstico por imagen , Trastornos Puerperales/diagnóstico por imagen , Adulto , Anestesia Epidural/tendencias , Anestesia Raquidea/tendencias , Cesárea/efectos adversos , Cesárea/tendencias , Diagnóstico Diferencial , Quimioterapia Combinada , Femenino , Hematoma Espinal Epidural/etiología , Hematoma Espinal Epidural/cirugía , Humanos , Periodo Posparto/fisiología , Embarazo , Trastornos Puerperales/etiología , Trastornos Puerperales/cirugía
2.
Spine (Phila Pa 1976) ; 35(6): 709-13, 2010 Mar 15.
Artículo en Inglés | MEDLINE | ID: mdl-20195211

RESUMEN

STUDY DESIGN: A retrospective analysis of 9 patients who underwent a modified surgical procedure for the treatment of far lateral lumbar disc herniations. OBJECTIVES: To illustrate a modified technique for approaching the neural foramen from the contralateral side, minimizing muscle retraction and bone/ligament resection, and to analyze clinical results. SUMMARY OF BACKGROUND DATA: The most commonly used surgical techniques for the removal of far lateral lumbar disc herniations are ipsilateral approaches, that require partial or complete facet resection and/or intertransverse ligament resection, which may result in vertebral instability and/or chronic back pain. METHODS: Nine patients with intraforaminal or intra/extraforaminal lumbar disc herniation underwent surgery using a modified contralateral approach. There was unilateral muscle retraction and no medial facetectomy nor intertransverse/interspinous ligament resection. Preoperative and postoperative Oswestry functional status evaluation and complications were reviewed and Macnab's postoperative categories were assigned to evaluate the efficacy and safety of the surgery. RESULTS: No serious complications were noted. The mean preoperative and postoperative Oswestry scores were 44 and 14 respectively (P < 0.01). Overall excellent-to-good results were 100%. CONCLUSION: This modified contralateral approach offered a wide exposure of intervertebral foramen region and allowed to remove the herniated disc material with minimal resection of osseous and ligamentous structures. Successful results were achieved in all patients treated by this technique.


Asunto(s)
Discectomía/métodos , Desplazamiento del Disco Intervertebral/cirugía , Vértebras Lumbares/cirugía , Adulto , Anciano , Evaluación de la Discapacidad , Femenino , Estudios de Seguimiento , Humanos , Desplazamiento del Disco Intervertebral/diagnóstico por imagen , Vértebras Lumbares/diagnóstico por imagen , Imagen por Resonancia Magnética , Masculino , Persona de Mediana Edad , Reproducibilidad de los Resultados , Estudios Retrospectivos , Encuestas y Cuestionarios , Tomografía Computarizada por Rayos X , Resultado del Tratamiento
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