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1.
World Neurosurg ; 2021 Oct 12.
Artigo em Inglês | MEDLINE | ID: mdl-34648982

RESUMO

BACKGROUND: The introduction of intraoperative computed tomography (iCT) could improve the surgical results of C1-C2 stabilization by Goel-Harms, especially in patients with complex deformities. This study aims to investigate the impact of iCT on the accuracy of C1-C2 screw positioning and to develop a score based on multiparametric analysis of imaging data (Cervical Screw Placement Accuracy score [CSPAs]). METHODS: Twenty-one patients were retrospectively evaluated. The data obtained with the use of an iCT were compared with the incidence of cases of malpositioning in the literature. Multiparametric imaging criteria were developed: the 82 screw positions were evaluated using the CSPA criteria and 2 additional variables. The CSPAs was obtained from the aggregation of the CSPAs criteria: optimal (CSPAs ≥8), suboptimal (CSPAs = 6-7), malpositioned (CSPAs ≤5). RESULTS: The average incidence of malpositioning in C1-C2 arthrodesis decreased from 13% without iCT to 1.2% with the aid of iCT, considering a monoparametric value. The CSPAs analysis shows a greater discretion and higher number of well-defined categories of the accuracy of C1-C2 screw position: optimal, 80.3%; suboptimal, 17.1%; and malposition, 2.6%. A correlation was observed between the accuracy of the positioning of both right and left screws in C2. Furthermore, the anatomic site of C2 screws was found to be a predictor of cortical invasion. CONCLUSIONS: The results suggest that the introduction of the iCT is associated with a consistent improvement of the accuracy in the positioning of the screws. A multiparametric score (CSPAs) could improve the assessment of screw placement.

3.
Surg Neurol Int ; 12: 122, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33880227

RESUMO

Background: The salivary duct carcinomas (SDCs) are rare, high-grade neoplasms involving major salivary glands. Parotid is the most frequently involved gland (85%). Apocrine phenotype (histological presence of decapitation secretions) and androgen reception expression define SDC. The clinical course of these tumors is characterized by aggressive local behavior with extraglandular extension, high recurrence rates, early metastases, and poor prognoses. Despite aggressive surgical/radiation therapy management, the rates of locoregional and metastatic relapses are high, and the mortality rates over 48 months approach 65%. Notably, there is no treatment algorithm available for managing vertebral metastases from apocrine SDC. Case Description: An elderly male presented with MR/CT findings of an isolated T11 vertebral metastasis attributed to a previously treated parotid SDC. On both CT/MR, it was an osteolytic lesion and demonstrated spinal canal infiltration. The patient underwent surgical biopsy/decompression/resection, following which the lesion histopathologically proved to be a SDC. The patient was subsequently treated with 30 Gy in 10 fractions within 2 weeks of discharge. One-month later, the MRI confirmed adequate epidural decompression without recurrence, and 9 months post-operatively, patient remained disease free. Conclusion: Isolated metastasis attributed to parotid SDC followed by radiation therapy may result in tumor control.

4.
Br J Neurosurg ; : 1-4, 2021 Feb 08.
Artigo em Inglês | MEDLINE | ID: mdl-33554670

RESUMO

The posterior arch of the atlas is usually not considered one of the main stabilizers of the cranio-cervical junction, allowing surgeons to its removal when needed with a relative certainty to preserve the stability of the atlo-axial segment. However, these considerations do not reflect the importance to examine the integrity of the posterior arch in the whole biomechanics of the atlas. Authors like Gebauer and Panjabi revealed, respectively in experimental and clinical conditions, how the atlas responds to an axial loading force, proving that the whole atlas is involved into horizontal conversion of axial forces and providing evidence supporting the preservation of the posterior arch. Other authors evaluated the risk for anterior arch fracture following C1 laminectomy. In this technical note three different techniques of posterior atlas arch reconstruction after surgical iatrogenic disruption are presented, considering both neoplastic and degenerative disease.

5.
Eur Neurol ; 83(6): 626-629, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33296894

RESUMO

Cervical spondylogenic myelopathy (CSM) represents a common differential diagnosis for spinal onset Amyotrophic Lateral Sclerosis (ALS). Identifying occurrence of ALS in patients with CSM may be challenging. We evaluated the accuracy of Awaji criteria in the diagnosis of ALS in a cohort of patients with CSM. We screened all patients attending Turin ALS Center during the 2006-2018 period. We selected only patients for whom cervical cord MRI showed radiological signs of CSM. All patients underwent electromyography (EMG), and Awaji criteria were used for diagnosis of clinically probable ALS. All patients were followed up clinically for at least 6 months, and ALS diagnosis was eventually confirmed according to El-Escorial revised criteria, based on disease progression. Of 2,059 patients screened, in 42 cases, MRI showed signs of CSM; CSM incidence and prevalence risks were 0.16 and 2.04%, respectively. Based on clinical progression, 72.7% of patients were diagnosed as CSM and 27.3% as CSM + ALS. At EMG 6 (18.2%) patients fulfilled the criteria for ALS, 5 of them (83.3%) during clinical follow-up were diagnosed as clinical definite ALS + CSM. Accuracy of Awaji criteria in diagnosing ALS was good (AUC = 0.757, p = 0.03). Sensitivity and specificity of Awaji criteria were, respectively, 55.6 and 95.8%. Positive predictive value was 83.3%, while negative predictive value was 85.2%. CSM-ALS comorbidity is a relatively common problem in clinical practice. To better choose patients who could benefit from surgery, EMG should be performed in CSM patients, due to its good accuracy in recognizing ALS.


Assuntos
Esclerose Amiotrófica Lateral/diagnóstico , Esclerose Amiotrófica Lateral/epidemiologia , Doenças da Medula Espinal/epidemiologia , Adulto , Idoso , Estudos de Coortes , Comorbidade , Eletromiografia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade
6.
J Bone Oncol ; 25: 100320, 2020 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-33088700

RESUMO

Introduction: The new concept of separation surgery has changed the surgical paradigms for the treatment of metastatic epidural spinal cord compression (MESCC), shifting from aggressive cytoreductive surgery towards less invasive surgery with the aim to achieve circumferential separation of the spinal cord and create a safe target for high dose Stereotactic Body Radiation Therapy (SBRT), which turned out to be the real game-changer for disease's local control. Discussion: In this review a qualitative analysis of the English literature has been performed according to the rating of evidence, with the aim to underline the increasingly role of the concept of separation surgery in MESCC treatment. A review of the main steps in the evolution of both radiotherapy and surgery fields have been described, highlighting the important results deriving from their integration. Conclusion: Compared with more aggressive surgical approaches, the concept of separation surgery together with the advancements of radiotherapy and the use of SBRT for the treatment of MESCC showed promising results in order to achieve a valuable local control while reducing surgical related morbidities and complications.

7.
Oper Neurosurg (Hagerstown) ; 19(6): E600-E601, 2020 Nov 16.
Artigo em Inglês | MEDLINE | ID: mdl-32717072

RESUMO

Cortical bone trajectory (CBT) screw fixation is an attractive technique.1-4 However, the ideal insertion of those screws could be technically demanding.5,6 The use of 3-dimensional (3D) patient-matched guides increase safety for CBT screws implantation.7 In this video, the case of a 46 yr old male is presented. He complained low back pain with left sciatica. magnetic resonance imaging showed an L5/S1 degenerative disc disease with left herniation. The patient was positioned prone; the L5 spinous process was identified under fluoroscopic guidance than skin incision was performed. Preserving the cranial facet joints, spinous processes and laminae of L5 and S1 vertebrae were exposed. Guides were positioned on the corresponding vertebra and the contact areas checked to avoid any discrepancy. With a high-speed drill the cortical bone was violated through the guide tubes. The drill itself has a stop mechanism provided by the guides. With this mechanism the drilling can be safely performed up to the planned depth. Guidewires were than introduced into the pedicle and body of the vertebra; undertapping could be performed with cannulated instrument. Laminectomy and facetectomy were performed. Diskectomy was performed, then a titanium kidney-shaped pivoting cage was implanted. Four Screws were finally placed. Proper positioning of the implants were verified on fluoroscopy and on the postoperative computed tomography scan confirming the accuracy of the trajectory. All procedures performed for this study were in accordance with the ethical standards of our Institute and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. Written informed consent was obtained from the patient who is operated in this video.

8.
Clin Neurol Neurosurg ; 195: 105896, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32526620

RESUMO

OBJECTIVE: The aim of this study was to translate new evidence about management of spinal metastases in a practical and reliable score for surgeons, radiation oncologists and oncologists, able to establish the need for surgery regardless the available technology and settings. PATIENTS AND METHODS: Three main items were identified and graded: Neurological status (0-5 points), Stability of the spine according to the Spinal Instability Neoplastic Score (SINS) Score (0-5 points), and Epidural compression according to the Epidural Spinal Cord Compression (ESCC) scale (0-3 points). Patients were considered suitable for surgery with ASA score < 4 and ECOG score <3. A retrospective clinical validation of the NSE score was made on 145 patients that underwent surgical or non surgical treatment. RESULTS: Agreement between the undertaken treatment and the score (88.3% of patients), resulted in a strong association with improvement or preservation of clinical status (neurological functions and mechanical pain) (p < 0.001) at 3 and 6 months. In the non-agreement group no association was recorded at the 3 and 6 months follow-up (p 0.486 and 0.343 for neurological functions, 0.063 and 0.858 for mechanical pain). CONCLUSION: Functional outcomes of the study group showed that the proposed NSE score could represent a practical and reliable tool to establish the need for surgery. Agreement between the score and the performed treatments resulted in better clinical outcomes, when compared with patients without agreement. Further validation is needed with a larger number of patients and to assess reproducibility among surgeons, radiation oncologists, and oncologists.


Assuntos
Tomada de Decisão Clínica/métodos , Compressão da Medula Espinal/cirurgia , Neoplasias da Coluna Vertebral/complicações , Neoplasias da Coluna Vertebral/secundário , Neoplasias da Coluna Vertebral/cirurgia , Descompressão Cirúrgica/métodos , Humanos , Instabilidade Articular/etiologia , Instabilidade Articular/cirurgia , Neurologia/métodos , Radiocirurgia/métodos , Estudos Retrospectivos , Índice de Gravidade de Doença , Compressão da Medula Espinal/etiologia
9.
J Clin Neurosci ; 76: 25-30, 2020 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-32331945

RESUMO

Cortical Bone Trajectory screws allow a limited soft tissue dissection with mechanical properties comparable to traditional pedicle screws. However, clinical results are still reported on limited samples. The study aimed to evaluate perioperative and mid-term follow up outcomes, clinical results and complications in 238 consecutive patients underwent CBT fusion for degenerative lumbosacral disease. Pre- and intraoperative data, clinical outcomes and complications were collected. The patients were stratified in three groups. The original technique was performed in the first 43 cases without a preoperative CT scan planning. The second group includes the patients who underwent preoperative CT scan for entry point and screw trajectory planning (158 patients). Surgical procedures in the last group were performed with patient-matched 3D printed guide (37 patients). The accuracy in screws positioning was evaluated on postoperative CT scan. The mean follow-up was 32.3 months. Mean ODI and VAS index improved with statistical significance. Mean procedural time was 187, 142 and 124 min in the three subgroups. The total amount of recorded complications was 4.2% (16.3%, 3.8% and 0.0% respectively). Screws entirely within the cortex of the pedicle were 78.9%, 90.5% and 93.9% in the three groups. Fusion was obtained in 92.4% of cases. The CBT technique is a safe procedure, especially with an accurate preoperative CT scan-based planning. This seems more evident with the 3D template patient-matched guide. More studies are needed to directly compare traditional pedicle screws and CBT screws on long-term outcomes.


Assuntos
Parafusos Ósseos , Vértebras Lombares/cirurgia , Fusão Vertebral/métodos , Adulto , Idoso , Osso Cortical/cirurgia , Feminino , Humanos , Pessoa de Meia-Idade , Impressão Tridimensional , Estudos Retrospectivos , Tomografia Computadorizada por Raios X
10.
J Clin Neurosci ; 75: 106-111, 2020 May.
Artigo em Inglês | MEDLINE | ID: mdl-32173153

RESUMO

In spinal oncology traditional titanium implants could significantly impair evaluation of postoperative imaging because of artifacts, potentially affecting proper planning and execution of radiotherapy and adequate radiological follow-up to rule out progression of the disease. This is why carbon fiber reinforced (CFR)-PEEK implants have been developed for spinal fixation. The advantages of this system include fewer artifacts on imaging, potentially improving the execution and quality of radiotherapy, with also a reduced scattering effect to neighboring tissues. A comparative clinical and radiological study between new CFR-PEEK and standard titanium implants is described. Data recorded for each case included patient demographics, clinical, radiological and surgical data, intra- and postoperative complications, follow-up information. The goal of this study was to verify the safety and effectiveness of CFR-PEEK devices compared to standard titanium implants. A total number of 78 patients were reviewed. 36 patients underwent CFR-PEEK fixation, while titanium implants were used for 42 patients. Functional recovery was obtained in both groups and registered at last follow-up in terms of axial pain and neurological status. No significative differences were found between the two groups in terms of post-operative clinical complications and hardware-related complications. CFR-PEEK implants constitute a feasible and effective way to restore stability in metastatic spine tumors. This study found a non inferior favorable profile in terms of intraoperative and postoperative complications and functional recovery, compared to titanium. Further prospective studies are needed to clarify the potential oncological advantage of their radiolucency.


Assuntos
Fibra de Carbono/uso terapêutico , Cetonas , Polietilenoglicóis , Próteses e Implantes , Fusão Vertebral/instrumentação , Titânio , Adulto , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Neoplasias da Coluna Vertebral/secundário , Neoplasias da Coluna Vertebral/cirurgia
11.
Neurosurg Rev ; 43(1): 351-360, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31713701

RESUMO

Surgery for spinal metastases has undergone multiple transformations in terms of surgical technique. The need for a more aggressive surgical strategy for local control of the disease, given the advances in radiosurgery and immunotherapy, has met the incorporation of many different technological adjuncts. Separation surgery has become one of the main targets to achieve for surgeons in the treatment of spinal metastases. In this paper a prospective series of 3D endoscope-assisted transpedicular thoracic corpectomies is described. Adult patients with a diagnosis of single-level thoracic metastases requiring surgery for epidural compression were included. Data recorded for each case concerned patient demographics, surgical technique, clinical, radiological and surgical data, intra- and postoperative complications, follow-up. The goal of this study was to verify the achievement of separation surgery with this technique, while confirming the safety and feasibility of the procedure. A total number of nine patients were treated from January to April 2019 with a 3D endoscope-assisted procedure. A circumferential bilateral decompression was achieved in seven cases, while monolateral in the other two. A proper separation between the tumor and the spinal cord was achieved in all cases as confirmed by imaging. Axial pain always improved after the procedure as well as neurological functions, when compromised before surgery. No intra-operative and postoperative complications were recorded. Mean hospital stay was 4 days after surgery with early mobilization. At last follow-up no local recurrences were registered. According to preliminary results, the transpedicular 3D endoscope-assisted approach for corpectomies appeared to be a safe and effective technique to achieve proper circumferential decompression and valid separation surgery in thoracic metastases, potentially decreasing the need for costotransversectomy.


Assuntos
Descompressão Cirúrgica/instrumentação , Endoscópios , Procedimentos Neurocirúrgicos/instrumentação , Neoplasias da Coluna Vertebral/cirurgia , Vértebras Torácicas , Idoso , Descompressão Cirúrgica/métodos , Estudos de Viabilidade , Feminino , Humanos , Tempo de Internação , Masculino , Pessoa de Meia-Idade , Procedimentos Neurocirúrgicos/métodos , Estudos Prospectivos , Radiografia , Neoplasias da Coluna Vertebral/secundário , Resultado do Tratamento
12.
World Neurosurg ; 134: 14-24, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31639506

RESUMO

The use of cortical bone trajectory (CBT) pedicle screws for posterior fixation and fusion seems to constitute a viable alternative for spinal procedures, with the potential to mitigate risks, be minimally invasive, and cause less tissue damage than the traditional technique. This review analyzes the literature regarding CBT according to the rate of evidence of articles and their main focus. CBT has proved to be a safe and viable option for screw fixation in spine surgery. Given the denser bone interception, high-quality biomechanics studies show equal or even better properties compared with classic pedicle screw fixation, depending on several factors such as screw size and length. Through the years, surgical technique has improved to gain a longer and safer trajectory than first described. Level 2 and 3 clinical studies suggest equal clinical and radiologic outcomes compared with pedicle trajectory fixation, but high-quality, level 1, randomized controlled trials are needed to confirm these results.


Assuntos
Osso Cortical/cirurgia , Parafusos Pediculares , Fusão Vertebral/instrumentação , Coluna Vertebral/cirurgia , Fenômenos Biomecânicos , Parafusos Ósseos , Humanos , Procedimentos Neurocirúrgicos/instrumentação , Procedimentos Neurocirúrgicos/métodos , Fusão Vertebral/métodos
13.
Cancer Control ; 26(1): 1073274819870549, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31865766

RESUMO

In the last few years, the treatment of spinal metastases has significantly changed. This is due to the advancements in surgical technique, radiotherapy, and chemotherapy which have enriched the multidisciplinary management. Above all, the field of molecular biology of tumors is in continuous and prosperous evolution. In this review, the molecular markers and new approaches that have radically modified the chemotherapeutic strategy of the most common metastatic neoplasms will be examined together with clinical and surgical implications. The experience and skills of several different medical professionals are mandatory: an interdisciplinary oncology team represents the winning strategy in the treatment of patients with spinal metastases.


Assuntos
Neoplasias da Coluna Vertebral/complicações , Neoplasias da Coluna Vertebral/cirurgia , Cirurgiões/normas , Humanos , Metástase Neoplásica
14.
World Neurosurg ; 130: 499-505, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31295597

RESUMO

BACKGROUND: Syringobulbia is an uncommon lesion that occurs in the central nervous system; it is often defined as a pathologic cavitation in the brainstem. The cases with partial blockage of the cerebrospinal fluid pathways at the level of the foramen magnum are more common and the most important group. The most common treatment of syringobulbia is craniovertebral decompression. CASE DESCRIPTION: This paper reports a case of a symptomatic syringobulbia in which an urgent endoscopic endonasal approach to the craniovertebral junction (CVJ) was done to limit bulbo-medullary compression and rapid neurologic deterioration. A 69-year-old man was admitted to the hospital because of acute onset of dysphonia, dysphagia, imbalance, and vomiting. Magnetic resonance imaging revealed a cystic lesion in the brainstem, suggestive of a syringobulbia in Klippel Feil syndrome with CVJ stenosis. CONCLUSIONS: This case report details the successful use of endoscopic endonasal anterior decompression to treat syringobulbia, and adds to the growing literature in support of the endonasal endoscopic approach as a safe and feasible means for decompressing the craniocervical junction, even in the setting of urgency. However, prudent patient selection, combined with sound clinical judgment, access to instrumentation, and intraoperative imaging cannot be overemphasized.


Assuntos
Neoplasias do Tronco Encefálico/cirurgia , Vértebras Cervicais/cirurgia , Descompressão Cirúrgica/métodos , Cirurgia Endoscópica por Orifício Natural/métodos , Procedimentos Neurocirúrgicos/métodos , Compressão da Medula Espinal/cirurgia , Idoso , Neoplasias do Tronco Encefálico/complicações , Humanos , Síndrome de Klippel-Feil/complicações , Síndrome de Klippel-Feil/cirurgia , Masculino , Nariz/cirurgia , Estenose Espinal/complicações , Estenose Espinal/cirurgia , Resultado do Tratamento
15.
World Neurosurg ; 130: e98-e104, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31307931

RESUMO

BACKGROUND: Cortical bone trajectory (CBT) screw is an attractive technique in terms of fixation strength and less invasiveness. However, the insertion of a pedicle screw penetrating cortical bone on the ideal trajectory is technically demanding. The use of 3-dimensional (3D) patient-matched guides may facilitate the use of this technique. In this technical note and case series, the use of a patient-matched 3D targeting guide for a circumferential fixation with CBT screws is described. METHODS: Eleven patients with a mean age of 49 years were treated. The MySpine MC (Medacta International SA, Castel San Pietro, Switzerland) technology was used to place CBT screws. A computed tomography (CT) scan-derived 3D model of the patient vertebra was created after the surgeons planned the best custom CBT screw trajectory. Then, scaffolds were printed and used during surgery to guide the screw through the patient pedicle. An intersomatic arthrodesis was also performed. RESULTS: The images of the planned trajectory were superimposed on the postoperative CT scan, confirming the accuracy of the trajectory. The mean deviation from the planned pedicle midpoint was 0.91 mm; 85.2% of the screws were placed within 2° from the planned trajectory. There were 2 grade A (<2 mm) and no grade B or C perforations. The actual entry point was always within 2 mm from the planned entry point. CONCLUSIONS: This technical note and case series is the first clinical description on the use of a patient-matched guide for posterior CBT screw placement. The use of these devices could also improve placement accuracy and decrease the risk of nerve damage.


Assuntos
Osso Cortical/cirurgia , Vértebras Lombares/cirurgia , Procedimentos Neurocirúrgicos/instrumentação , Procedimentos Neurocirúrgicos/métodos , Parafusos Pediculares , Impressão Tridimensional , Doenças da Coluna Vertebral/cirurgia , Adulto , Osso Cortical/diagnóstico por imagem , Humanos , Imageamento Tridimensional , Vértebras Lombares/diagnóstico por imagem , Pessoa de Meia-Idade , Modelos Anatômicos , Fusão Vertebral/métodos , Cirurgia Assistida por Computador , Tomografia Computadorizada por Raios X , Resultado do Tratamento
16.
World Neurosurg ; 126: e1468-e1474, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-30904792

RESUMO

BACKGROUND: Pedicle screw instrumentation is a standard procedure in lumbar spinal fusion. The cortical bone trajectory (CBT) screw is an alternative technique, less invasive but harder to perform. The identification of the entry point and the appropriate direction can be tricky especially to the surgeons just at the beginning. Therefore, the aim of this study is to evaluate the reliability of preoperative computed tomography (CT) planning in the CBT screw placement. METHODS: We retrospectively evaluated 82 patients who underwent a single-level posterior lumbar arthrodesis with CBT screws. The correct entry point and the best trajectory were identified on a 3-dimensional (3D) multiplanar reconstruction CT view. The concordance between achieved and planned trajectories was assessed on a postoperative CT. RESULTS: A total of 328 screws was positioned. The average entry point distance from the target was 1.1 mm (standard deviation, ±0.15 mm). In 301 screws (91.8%), the obtained trajectory differed no more than 2° from the planned one. No screws misplaced or new neurological deficit was recorded. CONCLUSIONS: The CBT screw placement is a great alternative to the pedicle screw. Accurate preoperative 3D planning is useful to predict the entry point and the direction with accuracy similar to navigation systems, avoiding its costs and technical difficulties. The 3D CT planning is helpful in the customization of spine surgery, and the results underline the radiological reliability of this technique.


Assuntos
Parafusos Ósseos , Procedimentos Neurocirúrgicos/métodos , Procedimentos Ortopédicos/métodos , Cuidados Pré-Operatórios , Fusão Vertebral/métodos , Adulto , Idoso , Artrodese , Estudos de Coortes , Feminino , Humanos , Processamento de Imagem Assistida por Computador , Imageamento Tridimensional , Região Lombossacral , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Doenças da Coluna Vertebral/diagnóstico por imagem , Doenças da Coluna Vertebral/cirurgia , Tomografia Computadorizada por Raios X
17.
World Neurosurg ; 126: 447-452, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-30904796

RESUMO

BACKGROUND: Among the posterior techniques, the use of cervical interfacet spacers (CISs) represents a promising technology whose potentialities are still being studied. The purpose of the present review was to assess the available data on CISs. METHODS: A search on PubMed was performed. The search terms were "cervical interfacet spacers," "facet spacers," "DTRAX facet system," "Goel facet spacer," "pseudarthrosis," "cervical lordosis," "iatrogenic kyphosis," "cervical foraminal decompression," "cervical biomechanics," "atlantoaxial instability," and "subaxial instability." RESULTS: Mechanical studies have shown that stand-alone CISs promoted stiffness in all directions, except for extension. Foraminal distraction was recorded in 86% of the cases. Clinical studies have shown that the use of CISs could promote successful arthrodesis, given the large surface area affected by fusion and decreasing the need for autografts. The effectiveness for the treatment of radiculopathy has been confirmed by several clinical studies. In a series of 154 levels of implanted CISs, no evidence of significant loss of cervical lordosis was identified. CISs could help in enhancing fusion in C1-C2 fixation. CONCLUSIONS: Biomechanical studies on specimens showed a positive trend in increasing stiffness of the cervical spine, despite some controversial results. In clinical studies, facet distraction was shown to be a safe and valid option for clinical indirect decompression, although longer follow-up is required for confirmation. No evidence of the loss of cervical lordosis has been recorded. The long-term effects and CIS use in revision procedures as adjuvant implants to treat pseudarthrosis or atlantoaxial instability are currently under investigation, and further studies are needed.


Assuntos
Medula Cervical/cirurgia , Descompressão Cirúrgica/instrumentação , Procedimentos Neurocirúrgicos/instrumentação , Pseudoartrose/cirurgia , Radiculopatia/cirurgia , Fusão Vertebral/instrumentação , Articulação Atlantoaxial/cirurgia , Descompressão Cirúrgica/métodos , Humanos , Lordose/cirurgia , Procedimentos Neurocirúrgicos/métodos , Fusão Vertebral/métodos , Resultado do Tratamento
20.
Neurosurg Rev ; 42(2): 297-307, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-29313181

RESUMO

Neurophysiological monitoring is of undoubted value for the intraoperative safety of neurosurgical procedures. Widely developed and used for cranial surgery, it is equally as effective, though perhaps less commonly employed, for spinal pathology. The most frequently used techniques for intraoperative monitoring during spinal surgery include somatosensory evoked potentials (SSEPs), motor evoked potentials (MEPs) and electromyography, which can either be spontaneous free-running (sEMG) or triggered (tEMG). The knowledge of the benefits and limitations of each modality is essential in optimising the value of intraoperative monitoring during spinal procedures. This review will analyse the single techniques, their anatomical and physiological basis, their use in spinal surgery as reliable indicators of functional injury, their limits and their application to specific procedures in minimally invasive surgery, such as the lateral transpsoas access for interbody fusion and the divergent trajectory for cortico-pedicular screws. In these particular techniques, because of reduced visual exposure, neuromonitoring is indeed essential to exploit the full potential of minimally invasive surgery, while avoiding damage to nervous structures.


Assuntos
Monitorização Neurofisiológica Intraoperatória , Procedimentos Neurocirúrgicos , Coluna Vertebral/cirurgia , Eletromiografia , Potencial Evocado Motor/fisiologia , Potenciais Somatossensoriais Evocados/fisiologia , Humanos , Procedimentos Cirúrgicos Minimamente Invasivos
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