ABSTRACT
BACKGROUND AND PURPOSE: Anterior lumbar approaches are recommended for clinical conditions that require interbody stability, spinal deformity corrections or a large fusion area. Anterior lumbar interbody fusion in lateral decubitus position (LatALIF) has gained progressive interest in the last years. The study aims to describe the current habit, the perception of safety and the perceptions of need of vascular surgeons according to experienced spine surgeons by comparing LatALIF to the standard L5-S1 supine ALIF (SupALIF). METHODS: A two-round Delphi method study was conducted to assess the consensus, within expert spine surgeons, regarding the perception of safety, the preoperative planning, the complications management and the need for vascular surgeons by performing anterior approaches (SupALIF vs LatALIF). RESULTS: A total of 14 experts voluntary were involved in the survey. From 82 sentences voted in the first round, a consensus was reached for 38 items. This included the feasibility of safe LatALIF without systematic involvement of vascular surgeon for routine cases (while for revision cases the involvement of the vascular surgeon is an appropriate option) and the appropriateness of standard MRI to evaluate the accessibility of the vascular window. Thirteen sentences reached the final consensus in the second round, whereas no consensus was reached for the remaining 20 statements. CONCLUSIONS: The Delphi study collected the consensus on several points, such as the consolidated required experience on anterior approaches, the accurate study of vascular anatomy with MRI, the management of complications and the significant reduction of the surgical times of the LatALIF if compared to SupALIF in combined procedures. Furthermore, the study group agrees that LatALIF can be performed without the need for a vascular surgeon in routine cases.
Subject(s)
Spinal Fusion , Surgeons , Delphi Technique , Humans , Lumbar Vertebrae/diagnostic imaging , Lumbar Vertebrae/surgery , Spinal Fusion/methods , Treatment OutcomeABSTRACT
BACKGROUND: liposarcoma is a malignant tumor of soft tissue and the most common sarcoma in the adult life. The myxoid liposarcoma accounts for 30 to 35 % of all liposarcomas. It is commonly seen on the thighs. Only two cases in which the liposarcoma was found in the vertebral column have been reported. CLINICAL CASE: this is a 28 year old woman with symptoms of spinal cord injury by compression (tottering gait, weakness 4/5 and decreased sensibility in right leg). The MRI showed a right paravertebral multinodular mass from L4 to S2, with solid and cystic aspects, following the S1 and S2 intervertebral foramen to the presacral space, with low signal intensity on T1 and high on T2. The diagnosis of neurofibroma was concluded. The patient was scheduled for surgery. Extra and intraspinal excision was performed and a mass was removed. Histopathologic study reported myxoid liposarcoma. CONCLUSIONS: liposarcoma is a malignant tumor of soft tissues. The spine is a rare location for this neoplasm, even for metastases. It is difficult to achieve a complete resection in this localization, so the recurrence rate is high.
Introducción: el liposarcoma es un tumor maligno de tejidos blandos que constituye el grupo más numeroso de sarcomas en el adulto. La variante mixoide representa 30 a 35 % de todos los liposarcomas. Comúnmente se observa en los muslos. En la literatura se han informado solo dos pacientes con liposarcoma en la columna vertebral. Caso clínico: mujer de 28 años de edad con síntomas de compresión medular (marcha claudicante, fuerza en la extremidad derecha 4/5, disminución de la sensibilidad). La imagen por resonancia magnética confirmó una masa paravertebral derecha que se extendía desde L4 hasta S2, multinodular, sólido quística, que seguía el trayecto de los forámenes de conjunción de S1 y S2 hacia el espacio presacro, con señales hipointensas en T1 e hiperintensas en T2. Con los estudios radiológicos se concluyó que presentaba un neurofibroma. Se realizó resección extra e intrarraquídea, de la que se extrajo un tumor. El estudio histopatológico definitivo indicó que se trataba de un liposarcoma mixoide. Conclusiones: la columna vertebral es una localización poco frecuente para esta neoplasia, así como para sus metástasis. Es difícil lograr una resección completa en este sitio, por lo que la tasa de recurrencia es alta.
