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
OBJECTIVE: To evaluate the effectiveness and safety of skip corpectomy in surgical treatment of cervical spondylotic myelopathy. MATERIAL AND METHODS: The study included 7 patients with cervical myelopathy following extended cervical spine stenosis. All patients underwent skip corpectomy. Clinical examination included degree of neurological disorders according to the modified scale of the Japanese Orthopedic Association (JOA) with assessment of recovery rate and Nurick score, as well as VAS score of pain syndrome. Verification of diagnosis was based on the data of spondylography, magnetic resonance and computed tomography. The indications for surgical treatment were conduction disorders and their spondylotic genesis confirmed by neuroimaging methods. RESULTS. VAS: Score of pain syndrome decreased by 2-4 points (mean 3.1) in long-term postoperative period. The JOA, Nurick scores and recovery rate (mean 42.5%) demonstrated significant improvement of neurological status in all patients. In all cases, the follow-up examination confirmed adequate decompression and spinal fusion. CONCLUSION: Skip corpectomy provides adequate spinal cord decompression in case of extended cervical spine stenosis and minimizes the risk of complications typical for multilevel corpectomy. Recovery rate indicates the effectiveness of this method in surgical treatment of cervical myelopathy caused by multilevel stenosis. However, further studies on sufficient clinical material are needed.
Subject(s)
Spinal Cord Diseases , Spinal Fusion , Spinal Stenosis , Spondylosis , Humans , Constriction, Pathologic/pathology , Constriction, Pathologic/surgery , Spinal Cord Diseases/diagnostic imaging , Spinal Cord Diseases/surgery , Decompression, Surgical/methods , Spinal Stenosis/diagnostic imaging , Spinal Stenosis/surgery , Spinal Fusion/methods , Spondylosis/diagnostic imaging , Spondylosis/surgery , Spondylosis/pathology , Cervical Vertebrae/diagnostic imaging , Cervical Vertebrae/surgery , Cervical Vertebrae/pathology , Pain/pathology , Pain/surgery , Treatment Outcome , Retrospective StudiesABSTRACT
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.
Subject(s)
Neuroma , Spinal Neoplasms , Humans , Thoracic Vertebrae/diagnostic imaging , Thoracic Vertebrae/surgery , Thoracic Vertebrae/pathology , Neuroma/pathology , Spinal Neoplasms/surgeryABSTRACT
OBJECTIVE: To analyze the results of herniated thoracic disc resection via transthoracic extrapleural approach. MATERIAL AND METHODS: The study included 16 patients with 18 symptomatic herniated thoracic discs wo underwent transthoracic extrapleural surgery. In 11 cases, clinical pattern of disease was represented by myelopathy with radicular or axial pain syndrome. Five patients had radiculopathy alone. Median localization of hernias was observed in 8 (44.4%) cases, paramedian hernias - in 10 (55.6%) cases. There were 10 (55.6%) ossified hernias, 5 (27.7%) giant, 10 (55.5%) large and 3 (16.6%) medium hernias. RESULTS: In most patients, VAS score of pain syndrome decreased by 2-6 points (mean 3.6). In 4 patients, this value remained the same. Among 11 patients with myelopathy, regression of conduction disorders in 1 year after surgery was achieved in 9 (82%) cases including complete recovery in 6 (55%) patients (Frankel E, Nurick - 0-I). In 2 patients, neurological status was equal to preoperative one. In all cases, the follow-up examination confirmed total removal of compressive substrate and found no signs of spine instability. Surgery time varied from 80 to 210 min (mean 161), blood loss - from 300 to 800 ml (mean 378 ml). Two patients had transient neurological deterioration. There was damage to dura mater in 4 cases. Intercostal neuralgia was observed in 3 patients. CONCLUSION: While retaining the advantages of open thoracotomy, transthoracic extrapleural approach is less traumatic, allows complete spinal cord decompression, minimizes the risk of iatrogenic spinal cord injury and avoids certain postoperative complications.
Subject(s)
Intervertebral Disc Displacement , Neuralgia , Spinal Cord Diseases , Humans , Intervertebral Disc Displacement/diagnostic imaging , Intervertebral Disc Displacement/surgery , Neuralgia/etiology , Retrospective Studies , Spinal Cord Diseases/surgery , Thoracic Vertebrae/diagnostic imaging , Thoracic Vertebrae/surgery , Treatment OutcomeABSTRACT
The authors describe the result of combined surgical treatment of a patient with symptomatic multiple-level cervical spine stenosis following ossification of posterior longitudinal ligament. The first stage included decompressive laminectomy and cervical spine fusion using a screw. At the second stage, CIV-CV-CVI-CVII corporectomy with total resection of the ossified posterior longitudinal ligament and CIII-ThI corporodesis with a bone autograft were carried out. This approach was valuable to minimize the risk of iatrogenic damage to the spinal cord, eliminate long spinal stenosis and perform circular fusion of the cervical spine. These measures led to regression of cervical myelopathy symptoms. A brief review is presented.