ABSTRACT
OBJECTIVE: To analyze surgical strategy for nonspecific spondylitis of the craniovertebral region (CVR) taking into account clinical features and morphological signs of disease. MATERIAL AND METHODS: Eight patients with nonspecific spondylitis of CVR underwent surgery (4 women and 4 men aged 31-75 years). Three patients had pain syndrome, 5 ones - conduction disorders. Combined interventions were performed in 5 patients with neurological disorders. Of these, 3 patients underwent transoral decompression with subsequent occipitospondylodesis. In other cases, stages of surgical treatment were reverse. Four patients underwent simultaneous interventions, 1 patient - with 7-day interval. Patients with pain syndrome underwent occipitospondylodesis. RESULTS: In all patients, postoperative VAS score of pain syndrome decreased by 5-7 points (mean 5.5). Among 5 patients with conduction symptoms, regression of neurological disorders 1 year after surgery was achieved in 2 cases, and complete recovery was observed in 3 patients (Frankel E). In all cases, examination confirmed relief of inflammatory process and no compression of the spinal cord and medulla oblongata. One patient had a dehiscence of the wound edges of posterior pharyngeal wall, and another one had implant fracture in 3 years after surgery. CONCLUSION: Active surgical approach is reasonable for nonspecific spondylitis of CVR. Craniocervical fixation eliminates pain and risk of neurological complications following atlantoaxial instability. Conduction disorders require simultaneous transoral decompression and occipitospondylodesis in patients with nonspecific purulent craniovertebral lesions. Impaired head tilt complicates transoral stage. In this regard, it is more rational to carry out craniocervical fixation at the last stage.
Subject(s)
Spondylitis , Humans , Male , Female , Middle Aged , Aged , Adult , Spondylitis/surgery , Spondylitis/diagnostic imaging , Decompression, Surgical/methods , Spinal Fusion/methodsABSTRACT
The authors report total resection of aggressive hemangioma of Th7 vertebra in a patient with severe conduction disorders in the lower extremities. Total Th7 spondylectomy (Tomita procedure) was performed. This method provided simultaneous en bloc resection of the vertebra and tumor via the same approach, eliminate spinal cord compression and perform stable circular fusion. Postoperative follow-up period was 6 months. Neurological disorders were evaluated using the Frankel scale, pain syndrome - visual analogue scale, muscle strength - MRC scale. Pain syndrome and motor disorders in the lower extremities regressed in 6 months after surgery. CT confirmed spinal fusion without signs of continued tumor growth. Literature data on surgical treatment of aggressive hemangiomas are reviewed.
Subject(s)
Hemangioma , Spinal Neoplasms , Humans , Follow-Up Studies , Spinal Neoplasms/diagnostic imaging , Spinal Neoplasms/surgery , Spine , Hemangioma/diagnostic imaging , Hemangioma/surgery , Pain , Thoracic Vertebrae/diagnostic imaging , Thoracic Vertebrae/surgery , Thoracic Vertebrae/pathology , Treatment OutcomeABSTRACT
The authors describe surgical treatment of a patient with giant neuroma of thoracic spine. The patient underwent en-bloc resection of tumor via transthoracic extrapleural access. Technical nuances of surgery and operational capabilities of transthoracic extrapleural access for resection of neurogenic tumors of posterior mediastinum are demonstrated. Capabilities of transthoracic extrapleural access are comparable to thoracotomy. The first experience of transthoracic extrapleural access showed its effectiveness in resection of giant neuromas of thoracic spine. Indisputable advantage of this access is less surgical injury compared to thoracotomy. A brief literature review is presented.
