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.

Brain abscess caused by Paenibacillus lactis.

We present a case of a 30-year-old male patient who was admitted to our institution with a 4-month history of persistent headache, pain in the left half of the face and the left ear. The initial magnetic resonance imaging detected an inflammatory process in the left pyramid interpreted as petrous apicitis. Subsequently, he developed generalized seizures. Follow-up computed tomography scanning with contrast enhancement demonstrated newly-formed brain abscess in the basal region of the left temporal lobe. The patient underwent microsurgical evacuation and resection of the abscess. Microbiological examination isolated Paenibacillus lactis as a causative microorganism. During the postoperative period, the patient further developed life-threatening meningitis that was successfully managed with prolonged intravenous antimicrobial treatment. Six-months follow-up examination confirmed complete neurological recovery with no signs of recurrence based on Magnetic Resonance Imaging (MRI). To the best of our knowledge, this is the first reported case of brain abscess caused by Paenibacillus lactis in the medical literature.

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.