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1.
World Neurosurg ; 133: 185-187, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31606509

RESUMO

We report a rare case of bony diastematomyelia associated with intraspinal teratoma. The patient was surgically treated with bony diastematomyelia and intradural teratoma resection, followed by lumbar duroplasty, and posterior fusion from L2-L4 in order to maintain the spinal stability of the approached segments. Despite the risks, it was necessary to perform early surgical treatment because of rapid neurologic deterioration. The patient had a good postoperative outcome.


Assuntos
Vértebras Lombares/cirurgia , Defeitos do Tubo Neural/cirurgia , Neoplasias da Medula Espinal/cirurgia , Fusão Vertebral/métodos , Teratoma/cirurgia , Vértebras Torácicas/cirurgia , Adulto , Humanos , Vértebras Lombares/diagnóstico por imagem , Imagem por Ressonância Magnética , Masculino , Defeitos do Tubo Neural/complicações , Defeitos do Tubo Neural/diagnóstico por imagem , Neoplasias da Medula Espinal/complicações , Neoplasias da Medula Espinal/diagnóstico por imagem , Teratoma/complicações , Teratoma/diagnóstico por imagem , Vértebras Torácicas/diagnóstico por imagem , Tomografia Computadorizada por Raios X , Resultado do Tratamento
2.
World Neurosurg ; 133: 275-277, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31629145

RESUMO

We report a rare case of cervicothoracic intramedullary and extramedullary lipoma. Complete resection of the extramedullary lipoma and almost complete resection of the intramedullary lipoma were performed using a microscope, followed by posterior fusion and internal fixation from C4-T2 to maintain the stability of the cervicothoracic junction. Despite the high risk, it was still necessary to perform the decompression surgery and the surgical results were favorable.


Assuntos
Vértebras Cervicais/diagnóstico por imagem , Lipoma/diagnóstico por imagem , Neoplasias da Medula Espinal/diagnóstico por imagem , Vértebras Torácicas/diagnóstico por imagem , Adulto , Vértebras Cervicais/cirurgia , Humanos , Laminectomia , Lipoma/cirurgia , Imagem por Ressonância Magnética , Masculino , Neoplasias da Medula Espinal/cirurgia , Fusão Vertebral , Vértebras Torácicas/cirurgia , Resultado do Tratamento
3.
Clin Interv Aging ; 14: 2295-2299, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31920293

RESUMO

Background: Lumbar disc herniation into the dural space is a very rare phenomenon of degenerative lumbar lesions in the elderly population, and its potential pathogenesis and natural course remain unclear. Case description: We describe a rare case of intradural lumbar disc herniation. A 68-year-old man presented with progressive lower back pain and radiating pain and numbness in both legs for 3 years. Magnetic resonance imaging revealed a large herniated disc at L4-L5. Posterior discectomy and fusion of the L4-L5 was performed after conservative treatment failed. Intraoperatively, only minimal disc fragments in the epidural space were found after meticulous probing following laminectomy of the L4-L5 vertebrae. The dorsal dura mater was saturated, tense, and bulged at the L4-L5 levels; additionally, an intradural mass was palpable and confirmed by intraoperative ultrasonography. Subsequently, dorsal middle durotomy was performed. Upon opening the dural sac, a large cauliflower-like mass similar to nucleus pulposus tissue was found near the arachnoid membrane. The mass was dissociative and could be completely resected. The dorsal dural incisions were closed after careful exploration, followed by fixation and fusion of the L4-L5 levels. Pathological examination revealed disc tissue with central balloon-type cystic degenerative changes. The patient's lower back pain and radiating pain and numbness of both legs improved remarkably postoperatively, and he became asymptomatic at 3 months postoperatively. Conclusion: Intradural lumbar disc herniation should be highly suspected when intraoperative findings are incompatible with findings from the preoperative imaging examination, and it could be further confirmed via intraoperative ultrasonography and pathological examination of the resected tissue from the dural space. Prompt surgery is recommended, and surgical results are usually favorable. We also reviewed the literature and discussed the potential pathogenesis, natural course, diagnosis, and treatment of intradural lumbar disc herniation.

4.
Brain Res Bull ; 142: 216-223, 2018 09.
Artigo em Inglês | MEDLINE | ID: mdl-30075199

RESUMO

Lanthionine synthetase C-like protein 1 (LanCL1) is homologous to prokaryotic lanthionine cyclases, and has been shown to have novel functions in neuronal redox homeostasis. A recent study showed that LanCL1 expression was developmental and activity-dependent regulated, and LanCL1 transgene protected neurons against oxidative stress. In the present study, the potential protective effects of LanCL1 against ischemia was investigated in an in vitro model mimicked by oxygen and glucose deprivation (OGD) in neuronal HT22 cells. We found that OGD exposure induced a temporal increase and persistent decreases in the expression of LanCL1 at both mRNA and protein levels. Overexpression of LanCL1 by lentivirus (LV-LanCL1) transfection preserved cell viability, reduced lactate dehydrogenase (LDH) release and attenuated apoptosis after OGD. These protective effects were accompanied by decreased protein radical formation, lipid peroxidation and mitochondrial dysfunction. In addition, LanCL1 significantly stimulated mitochondrial enzyme activities and SOD2 deacetylation in a Sirt3-dependent manner. The results of western blot analysis showed that LanCL1-induced activation of Sirt3 was dependent on Akt-PGC-1α pathway. Knockdown of PGC-1α expression using small interfering RNA (siRNA) or blocking Akt activation using specific antagonist partially prevented the protective effects of LanCL1 in HT22 cells. Taken together, our results show that LanCL1 protects against OGD through activating the Akt-PGC-1α-Sirt3 pathway, and may have potential therapeutic value for ischemic stroke.


Assuntos
Hipóxia Celular/fisiologia , Mitocôndrias/metabolismo , Estresse Oxidativo/fisiologia , Receptores Acoplados a Proteínas-G/metabolismo , Sirtuína 3/metabolismo , Apoptose/fisiologia , Sobrevivência Celular/fisiologia , Expressão Gênica , Glucose/deficiência , Células HT29 , Humanos , Mitocôndrias/patologia , Neuroproteção/fisiologia , RNA Mensageiro/metabolismo , Receptores Acoplados a Proteínas-G/genética , Superóxido Dismutase/metabolismo , Transfecção
5.
Med Sci Monit ; 24: 1072-1079, 2018 Feb 21.
Artigo em Inglês | MEDLINE | ID: mdl-29463783

RESUMO

BACKGROUND The purpose of this study was to compare the efficacy of percutaneous kyphoplasty (PKP) and bone cement-augmented short segmental fixation (BCA+SSF) for treating Kümmell disease. MATERIAL AND METHODS Between June 2013 and December 2015, 60 patients were treated with PKP or BCA+SSF. All patients were followed up for 12-36 months. We retrospectively reviewed outcomes, including Oswestry Disability Index (ODI), visual analogue scale (VAS), and kyphotic Cobb angle. RESULTS VAS, ODI, and Cobb angle, measured postoperatively and at the final follow-up, were lower than those measured preoperatively in both groups (P<0.05). VAS, ODI, and Cobb angle measured postoperatively demonstrated no significant differences when compared with those measured at the final follow-up in the PKP group (P>0.05). In the BCA+SSF group, VAS and ODI at the final follow-up were lower than those measured postoperatively (P<0.05), but no significant difference was found in the Cobb angle (P>0.05). The PKP group had better VAS and ODI than the BCA+SSF group, postoperatively (P<0.05). No significant difference was found in VAS and ODI at the final follow-up (P>0.05) or the Cobb angle measured postoperatively and at the final follow-up (P>0.05) between the 2 groups. Operative time, blood loss, and hospital stay in the PKP group were lower than those in the BCA+SSF group (P<0.05). No significant difference was found in complications (P>0.05). CONCLUSIONS PKP patients had better early clinical outcomes, shorter operation times and hospital admission times, and decreased blood loss, but had similar complications, radiographic results, and long-term clinical outcomes compared with BCA+SSF patients.


Assuntos
Cimentos para Ossos/uso terapêutico , Fixação Interna de Fraturas/métodos , Fraturas por Compressão/patologia , Cifoplastia/métodos , Fraturas por Osteoporose/patologia , Parafusos Pediculares , Idoso , Idoso de 80 Anos ou mais , Feminino , Fraturas por Compressão/cirurgia , Humanos , Vértebras Lombares/cirurgia , Masculino , Pessoa de Meia-Idade , Osteoporose/cirurgia , Fraturas por Osteoporose/cirurgia , Estudos Retrospectivos , Fraturas da Coluna Vertebral/cirurgia , Vértebras Torácicas/cirurgia , Resultado do Tratamento
6.
Med Sci Monit ; 24: 928-935, 2018 Feb 14.
Artigo em Inglês | MEDLINE | ID: mdl-29443957

RESUMO

BACKGROUND This study aimed to explore the feasibility and efficacy of bone cement-augmented short-segmental pedicle screw fixation in treating Kümmell disease. MATERIAL AND METHODS From June 2012 to June 2015, 18 patients with Kümmell disease with spinal canal stenosis were enrolled in this study. Each patient was treated with bone cement-augmented short-segment fixation and posterolateral bone grafting, and posterior decompression was performed when needed. All patients were followed up for 12-36 months. We retrospectively reviewed outcomes, including the Oswestry disability index (ODI), visual analog scale (VAS) score, anterior and posterior heights of fractured vertebrae, kyphotic Cobb angle, and neurological function by Frankel classification. RESULTS The VAS grades, ODI scores, anterior heights of affected vertebrae, and kyphotic Cobb angles showed statistically significant differences between pre- and postoperative and between preoperative and final follow-up values (P<0.05), whereas the differences between postoperative and final follow-up values were not statistically significant (P>0.05). The differences between posterior vertebral heights at each time point were not statistically significant (P>0.05). Improved neurological function was observed in 12 cases at final follow-up. Three cases had complications, including asymptomatic cement leakage in 2 patients and delayed wound infection in 1 patient. CONCLUSIONS Bone cement-augmented short-segment pedicle screw fixation is safe and effective for treating Kümmell disease, and can achieve satisfactory correction of kyphosis and vertebral height, with pain relief and improvement in neurological function, with few complications.


Assuntos
Cimentos para Ossos/uso terapêutico , Fixação Interna de Fraturas , Parafusos Pediculares , Canal Vertebral/patologia , Canal Vertebral/cirurgia , Fraturas da Coluna Vertebral/tratamento farmacológico , Fraturas da Coluna Vertebral/cirurgia , Idoso , Idoso de 80 Anos ou mais , Constrição Patológica , Descompressão Cirúrgica , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Cuidados Pós-Operatórios , Canal Vertebral/diagnóstico por imagem , Fraturas da Coluna Vertebral/diagnóstico por imagem , Tomografia Computadorizada por Raios X
7.
Medicine (Baltimore) ; 96(10): e6296, 2017 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-28272256

RESUMO

Cervical disc arthroplasty is a common method of treating cervical degenerative disease. However, the footprints of most prosthesis dimensions are obtained from data of Caucasian individuals. Besides, there is a large discrepancy between footprints of currently available cervical disc prostheses and anatomic dimensions of cervical endplates. We aimed to detail the three-dimensional (3D) anatomic morphology of the subaxial cervical vertebral endplate, utilizing high-precision, high-resolution scanning equipment, and provide a theoretical basis for designing appropriate disc prostheses for Chinese patients.A total of 138 cervical vertebral endplates were studied. Each endplate was digitized using a non-contact optical 3D range scanning system and then reconstructed to quantify diameters and surface area for the whole endplate and its components (central endplate and epiphyseal rim). The whole endplate and mid-plane concavity depth were measured.There is marked morphologic asymmetry, in that the cranial endplate is more concave than the corresponding caudal endplate, with endplate concavity depths of 2.04 and 0.69 mm, respectively. For the caudal endplates, the endplate concavity apex locations were always located in the posterior portion (81.42%), while in cranial endplates relatively even. The central endplate was approximately 60% of the area of the whole endplate and the anterior section of the ring was the widest. From C3/4 down to C6/7 discs, the vertebral endplate gradually became more elliptical. Chinese cervical endplate anatomic sizes are generally smaller than that of Caucasians. Although Korean and Chinese individuals both belong to the Asian population subgroup, the majority of anatomic dimensions differ. Singaporean cervical endplate morphology is very similar to that of Chinese patients.We performed a comprehensive and accurate quantitative description of the cervical endplate, which provide references to shape and profile an artificial cervical disc without sacrificing valuable bone stock. To design a device with footprint as large as possible to distribute the axial load, we suggest that additional attention should be paid to the marginal rim. It is essential to specifically design appropriate disc prosthesis for Chinese patients. To fit the morphologic and biomechanical variations, we also propose that the disc prostheses for different vertebral segments should be separately designed.


Assuntos
Vértebras Cervicais/anatomia & histologia , Variação Anatômica , Vértebras Cervicais/diagnóstico por imagem , Humanos , Imagem Tridimensional , Valores de Referência
8.
Medicine (Baltimore) ; 95(40): e4995, 2016 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-27749558

RESUMO

OBJECTIVE: The aim of the study was to evaluate the efficacy and safety of transforaminal lumbar interbody fusion (TLIF) versus posterolateral fusion (PLF) in degenerative lumbar spondylosis. METHODS: A systematic literature review was performed to obtain randomized controlled trials (RCTs) and observational studies (OSs) of TLIF and PLF for degenerative lumbar spondylosis. Trials performed before November 2015 were retrieved from the Medline, EMBASE, Cochrane library, and Chinese databases. Data extraction and quality evaluation of the trials were performed independently by 2 investigators. A meta-analysis was performed using STATA version 12.0. RESULTS: Two RCTs and 5 OSs of 630 patients were included. Of these subjects, 325 were in the TLIF and 305 were in the PLF group. Results showed that TLIF did not increase the fusion rate based on RCTs (relative risk [RR] = 1.06; 95% confidence interval [CI]: 0.95-1.18; P = 0.321), but increased it based on OSs (RR = 1.14; 95% CI: 1.07-1.23; P = 0.000) and overall (RR = 1.11; 95% CI: 1.05-1.18; P = 0.001) as compared with PLF. TLIF was able to improve the clinical outcomes based on 1 RCT (RR = 1.33; 95% CI: 1.11-1.59, P = 0.002) and overall (RR = 1.19; 95% CI: 1.07-1.33; P = 0.001), but not based on OSs (RR = 1.11; 95% CI: 0.97-1.27; P = 0.129) as compared with PLF. There were no differences between TLIF and PLF in terms of visual analogue scale, Oswestry Disability Index, reoperation, complications, duration of surgical procedure, blood loss, and hospitalization. CONCLUSIONS: In conclusion, evidence is not sufficient to support that TLIF provides higher fusion rate than PLF, and this poor evidence indicates that TLIF might improve only clinical outcomes. Higher quality, multicenter RCTs are needed to better define the role of TLIF and PLF.


Assuntos
Vértebras Lombares/cirurgia , Fusão Vertebral/métodos , Espondilólise/cirurgia , Ensaios Clínicos como Assunto , Humanos , Duração da Cirurgia , Complicações Pós-Operatórias/epidemiologia , Fusão Vertebral/efeitos adversos
9.
Medicine (Baltimore) ; 95(11): e2940, 2016 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-26986102

RESUMO

Tuberculous spondylitis of the augmented vertebral column following percutaneous vertebroplasty or kyphoplasty has rarely been described. We report an unusual case of tuberculous spondylitis diagnosed after percutaneous kyphoplasty (PKP). A 61-year-old woman presented to our institution complaining of back pain following a fall 7 days before. Radiologic studies revealed an acute osteoporotic compression L1 fracture. The patient denied history of pulmonary tuberculosis (TB) and there were no signs of infection. The patient was discharged from hospital 4 days after undergoing L1 PKP with a dramatic improvement in her back pain. Two years later, the patient was readmitted with a 1 year history of recurrent back pain. Imaging examinations demonstrated long segmental bony destruction involving L1 vertebra with massive paravertebral abscess formation. The tentative diagnosis of tuberculous spondylitis was made, after a serum T-SPOT. The TB test was found to be positive. Anterior debridement, L1 corpectomy, decompression, and autologous rib graft interposition, and posterior T8-L4 instrumentation were performed. The histologic examination of the resected tissue results confirmed the diagnosis of spinal TB. Anti-TB medications were administered for 12 months and the patient recovered without sequelae. Spinal TB and osteoporotic vertebral compression fractures are similar clinically and radiologically. Spinal surgeons should consider this disease entity to avoid misdiagnosis or complications. Early surgical intervention and anti-TB treatment should be instituted as soon as the diagnosis of spinal TB after vertebral augmentation is made.


Assuntos
Antituberculosos/administração & dosagem , Fraturas por Compressão , Cifoplastia , Vértebras Lombares , Fraturas por Osteoporose/diagnóstico , Fraturas da Coluna Vertebral , Tuberculose da Coluna Vertebral , Dor nas Costas/fisiopatologia , Desbridamento/métodos , Descompressão Cirúrgica/métodos , Diagnóstico Diferencial , Feminino , Fraturas por Compressão/diagnóstico , Fraturas por Compressão/fisiopatologia , Fraturas por Compressão/cirurgia , Humanos , Cifoplastia/efeitos adversos , Cifoplastia/métodos , Vértebras Lombares/patologia , Vértebras Lombares/cirurgia , Pessoa de Meia-Idade , Fraturas da Coluna Vertebral/diagnóstico , Fraturas da Coluna Vertebral/fisiopatologia , Fraturas da Coluna Vertebral/cirurgia , Resultado do Tratamento , Tuberculose da Coluna Vertebral/diagnóstico , Tuberculose da Coluna Vertebral/fisiopatologia , Tuberculose da Coluna Vertebral/cirurgia
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