Epidemiology of Cervical Spine Injuries Requiring Surgical Treatment in Plovdiv and Plovdiv Region, Bulgaria.

Objective: Cervical spine injuries (CSI) are associated with high rates of permanent disability and mortality, which increase the socioeconomic burden on healthcare systems worldwide. We aimed to investigate the epidemiology of CSI, frequency of operative treatment, and incidence of associated neurological deficits at regional level. Methods: We performed a retrospective monocentric study of patients with sustained CSI from January 2017 to December 2021, carried out only in a first-level trauma center in the Plovdiv metro region. Demographic, clinical, and imaging data from the medical records were thoroughly analyzed. Based on the assumption that all patients with CSI were hospitalized in single trauma center, the percentage of cases indicated for surgical treatment was calculated based on the population of the entire Plovdiv metro area. Results: One hundred forty-nine patients permanently residing in the Plovdiv metro region were included in this study. Of the 149 patients, 97 (65.1%) were surgically treated and 61 (62.9%) were over 60 years of age. The frequency of operative interventions for CSI was 2.9/100,000 patients. Annually, 10.6 people from the Plovdiv metro region suffer from neurological deficits as a result of neck injuries (1.6/100,000 residents). The number of patients with complete spinal cord injury in the surgically treated group was 11 (11.3%); that is, the regional frequency was 2.2 people per year. Conclusion: In the Plovdiv metro region, a significant annual frequency of neurological deficits requiring surgical intervention for CSI has been established, especially in patients aged >60 years.

Sacral nerve root metastasis in a patient with lung carcinoma resembling neurinoma - a case report and literature review.

Intradural extramedullary metastases from systemic neoplasms are very rare, with an incidence ranging from 2% to 5% of all secondary spinal diseases. We present the case of a 53-year-old man diagnosed with lung adenocarcinoma with symptoms of severe back pain and tibial paresis. The magnetic resonance imaging (MRI) revealed an intradural lesion originating from the right S1 nerve root mimicking neurinoma. Total tumor removal was achieved via posterior midline approach. The histological examination was consistent with lung carcinoma metastasis. Due to the rarity of single nodular nerve root metastases, MRI images may be misinterpreted as nerve sheath tumors, such as schwannomas or neurofibromas. We performed a brief literature review outlining the mainstay of diagnosis, therapeutic approach, and the prognosis of these rare lesions.

Short-term outcome of treatment of elderly patients with epidural hematomas.

INTRODUCTION: There is substantial literature data dedicated to intracranial epidural hematomas affecting young and middle-aged individuals, but studies focusing on their characteristics in elderly patients are scarce, assuming that old age is a poor prognostic factor.

Analysis of characteristics and surgical outcome of intradural extramedullary tumors - a retrospective cohort study of 52 patients.

INTRODUCTION: Although intradural extramedullary tumors (IET) are relatively well studied, research on the typical epidemiological, demographic, and clinical characteristics of these malignancies is scanty. AIM: The aim of this study was to investigate retrospectively the epidemiology, demographics, clinical presentation, imaging data, type of surgery, and the outcome of treatment of IETs. MATERIALS AND METHODS: We performed retrospective chart review of medical history, clinical presentation, paraclinical and imaging data, and operative protocols of operated patients with IETs from January 2011 to August 2020. Special attention was paid to the onset of symptoms, clinical presentation at admission, imaging data, localization, type of surgery, histology, and outcome of the disease. The degree of neurological deficit and disability of the patients at admission, discharge, and follow-up was assessed by the Modified McCormick Scale and the Modified Rankin Scale, respectively. The follow-up period varied from 1 to 105 months (mean 43 months). RESULTS: Fifty-two patients (mean age 58 years, range 14-78 years) with IETs were surgically treated for the study period. At admission to the clinic, 48 patients (92.3%) had vertebralgia, 34 (65.4%) had concurrent radicular pain, 42 (80.8%) had motor deficit, and 18 (34.6%) had sphincter disorders. Total tumor removal was achieved in 47 patients (90.4%). Favourable outcome was registered in 43 patients (82.7%). The degree of disability (mRS) at admission (p=0.0001), the McCormick grade at admission (p=0.0001), gender (p=0.042), and age (p=0.047) of patients were significantly correlated with the functional status assessed by McCormick scale at discharge. CONCLUSIONS: Most of the IETs can be successfully removed via a standard posterior or posterolateral surgical access. Favourable outcome of treatment depends on early diagnosis and total tumor resection.

Correlations between preoperative clinical factors and treatment outcome of spinal meningiomas - A retrospective study of a series of 31 cases.

BACKGROUND: The purpose of the current study is to identify the correlations between the most important preoperative clinical factors and the outcome of surgery of spinal meningiomas (SM). METHODS: We performed a retrospective analysis of the medical history, clinical, paraclinical, neuroimaging, and surgical protocol data in 31 patients with SM who underwent surgical resection at our institution from January 2011 to July 2020. The degree of resection was assessed on the Simpson scale. The modified McCormick scale was used to monitor the effect and outcome of treatment at admission, discharge, and at further follow-up. RESULTS: The average age of the patients was 65 years (37-78). Vertebral pain and motor deficits were the most common initial symptoms that occurred in 26 (89.6%) and 29 (93.5%) patients, respectively. Sphincter disorders were found in 9 (29%) patients. Total resection (Simpson Grade I - II) was achieved in 29 patients (93.5%). We achieved a favorable outcome (McCormick Gr. I to III) in 93.3% of patients. The degree of the neurological deficit (P = 0.026) and the presence of sphincter disorders (P = 0.009) were the preoperative clinical factors that most significantly correlated with the outcome of treatment. CONCLUSION: The outcome from the surgical treatment of SM correlated significantly with the degree of the preoperative neurological deficit. Therefore, patients presenting with more severe symptoms are expected to have worse outcomes.

Contemporary insight into diffuse axonal injury.

Diffuse axonal injury (DAI) is present in approximately 50% of the cases with severe traumatic brain injury. It is one of the leading causes of morbidity and mortality among children and young individuals worldwide. Generally, DAI occurs as a result of high-velocity accidents. Typically, it presents with loss of consciousness for at least 6 hours and neurological deficit dependent on the brain area that is affected by the injury. The final diagnosis is confirmed by neuroimaging studies such as computed tomography and magnetic resonance imaging. According to the injured brain site, DAI is classified into three grades: Grade I-DAI with axonal lesions in the cerebral hemispheres; Grade II-DAI with focal axonal lesions in the corpus callosum; Grade III-DAI with focal or multiple axonal lesions in the brainstem. Each of the three grades is associated with different outcome.Due to the high disability and mortality rate, DAI represents an important medical, personal and social problem. The aim of the current review is to address the unsolved issues connected with the pathogenesis, diagnostics, treatment and outcome of the diffuse axonal injury.

Outcome of Surgical Treatment of Spontaneous Spinal Epidural Abscesses for a 10-year Period.

INTRODUCTION: Spinal epidural abscess is uncommon but potentially debilitating infection. Delay in early diagnosis may be associated with increased morbidity and mortality despite recent advances in medicine. AIM: To present the clinical course and outcome of treatment of spontaneous spinal epidural abscesses. MATERIALS AND METHODS: Thirty-four patients (20 men and 14 women) with clinical, neuroimaging and/or histological data for spinal epidural abscess were treated at the Clinic of Neurosurgery at St George University Hospital, Plovdiv, Bulgaria, for the period 2009-2018. RESULTS: The average age of patients was 62 years (21-76 years) and the ratio of men to women was 1.4:1. All patients (100%) presented with vertebralgia, 13 patients (38.2%) had additional radiculalgia, and 10 patients (29.4%) presented with sensory or motor deficit. The duration of complaints varied from 4 to 180 days. At hospital admission, only 9 patients (26.4%) had intact neurological status. The most common localization of the spinal epidural abscess was in the lumbar and lumbosacral area (52.9%), concomitant spondylodiscitis was present in 31 patients (91.2%). Twenty-four patients (70.6%) underwent emergency surgery within 24 hours, and the rest had planned surgery. Decompressive interlaminotomy or hemilaminectomy was performed in 9 patients (26.5%). The remaining 25 patients (73.5%) underwent laminectomy, in 15 patients (44.1%) it was combined with posterior pedicle screw fixation. After the treatment, 23 patients (67.6%) had a good outcome, the remaining 11 (32.4%) had a poor outcome, and 3 patients died (8.8%). CONCLUSION: In patients with spinal epidural abscess, emergency surgery is the treatment method of choice. It allows decompression of neural structures, correction of the spinal deformity, segmental stabilization and rapid mobilization of patients.