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1.
J Orthop Surg Res ; 14(1): 291, 2019 Sep 03.
Artigo em Inglês | MEDLINE | ID: mdl-31481077

RESUMO

BACKGROUND: Therapeutic intervention has recently been actively performed for metastatic spine tumor even though spinal cord paralysis is not clearly observed, but there has been no report in which the degree of spinal cord compression by tumor was taken into consideration for the paralysis-preventing effect of treatment. Thus, we investigated the neurological outcome after treatment of patients with spinal cord compression in a state of impending paralysis. METHODS: A retrospective cohort study. The subjects were 88 patients with epidural spinal cord compression (ESCC) scale 1b or severer compression with American Spinal Injury Association (ASIA) E spinal metastasis. The neurological outcome after the therapeutic intervention was investigated at regular intervals until death. The therapeutic intervention was posterior decompression and stabilization in 18 patients, stabilization without posterior decompression in 15, and radiotherapy in 55 patients (3 groups). RESULTS: The ASIA aggravation group was comprised of 15 patients, and the severity of paralysis was ASIA A in 3, B in 3, C in 6, and D in 3. Paralysis appeared in 16.7% in the posterior decompression and stabilization group, 13.3% in the posterior stabilization without decompression group, and 18.8% in the radiotherapy group. In the transverse view, the incidence was high in cases with advancement to the intervertebral foramen and circumferential-type advancement, and paralysis developed in more than 20% of ESCC 1c or severer cases. Factors influencing neurological aggravation were investigated, but there was no significant factor. CONCLUSION: In ESCC 1b or severer cases with ASIA E spinal metastasis, paralysis aggravated after therapeutic intervention in 16.7% in the posterior decompression and stabilization group, 13.3% in the stabilization without decompression group, and 16.7% in the radiotherapy group. There was no significant factor influencing the development of paralysis.


Assuntos
Descompressão Cirúrgica/tendências , Espaço Epidural/cirurgia , Paralisia/cirurgia , Compressão da Medula Espinal/cirurgia , Neoplasias da Coluna Vertebral/cirurgia , Adulto , Idoso , Idoso de 80 Anos ou mais , Descompressão Cirúrgica/métodos , Espaço Epidural/diagnóstico por imagem , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Procedimentos Neurocirúrgicos/métodos , Procedimentos Neurocirúrgicos/tendências , Paralisia/diagnóstico por imagem , Paralisia/etiologia , Estudos Prospectivos , Estudos Retrospectivos , Compressão da Medula Espinal/diagnóstico por imagem , Compressão da Medula Espinal/etiologia , Neoplasias da Coluna Vertebral/complicações , Neoplasias da Coluna Vertebral/diagnóstico por imagem , Resultado do Tratamento
2.
BMC Musculoskelet Disord ; 20(1): 259, 2019 May 29.
Artigo em Inglês | MEDLINE | ID: mdl-31142312

RESUMO

BACKGROUND: There have been only a few reports of subsequent postoperative vertebral fracture following posterior spinal instrumentation fusion, especially in elderly female patients. This study attempted to evaluate the long-term prevalence of subsequent postoperative vertebral fracture in female patients aged 70 years and older who underwent spine decompression and fusion surgery with pedicle screw fixation. METHODS: We retrospectively reviewed prospectively collected data from 125 patients who met our inclusion and exclusion criteria. Patients were divided into 2 groups according to age: patients aged 70 years and older (Group A) and patients aged under 70 years of age (Group B). We evaluated incidence of subsequent postoperative vertebral fractures, type and timing of vertebral fractures, preoperative bone mineral density (BMD), preoperative diagnosis, surgical procedure, number of levels fused, extension of fusion to the lumbosacral junction, and presence of a transverse fixator. RESULTS: Baseline characteristics excluding patients' age were not statistically different between the two groups. Preoperative BMD of Group A was an average 81.7% of the young adult mean (YAM) value and that of Group B was an average 85.1% YAM value. Subsequent postoperative vertebral fractures occurred in 22 (41.5%) of 53 in Group A. On the other hand, fracture occurred in 17 (23.6%) of 72 in Group B. There were significant differences between the groups (p = 0.02). The odds ratio for subsequent vertebral fracture was 2.4 (95% confidence interval: 1.1-5.2) in favor of Group A. Survival analysis showed that the rate of subsequent vertebral fracture was significantly higher in Group A (log-rank test, P = 0.007). CONCLUSIONS: The incidence of subsequent vertebral fracture in patients aged 70 years and older was significantly higher than in patients aged under 70 years of age. In the case of pedicle screw fixation in elderly female patients, it is necessary to note the high risk of subsequent vertebral fracture despite short or non-rigid fusion. Vertebral fracture after posterior fusion surgery even for degenerative lumbar pathology could occur in more than one-third of female patients aged 70 years and older.


Assuntos
Degeneração do Disco Intervertebral/cirurgia , Vértebras Lombares/lesões , Complicações Pós-Operatórias/epidemiologia , Fraturas da Coluna Vertebral/epidemiologia , Fusão Vertebral/efeitos adversos , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Incidência , Disco Intervertebral/patologia , Degeneração do Disco Intervertebral/patologia , Vértebras Lombares/patologia , Vértebras Lombares/cirurgia , Pessoa de Meia-Idade , Parafusos Pediculares/efeitos adversos , Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/cirurgia , Estudos Prospectivos , Reoperação/estatística & dados numéricos , Estudos Retrospectivos , Fatores de Risco , Fraturas da Coluna Vertebral/etiologia , Fraturas da Coluna Vertebral/cirurgia , Fusão Vertebral/instrumentação , Fusão Vertebral/métodos
3.
Childs Nerv Syst ; 35(2): 379-383, 2019 02.
Artigo em Inglês | MEDLINE | ID: mdl-30196393

RESUMO

Spontaneous spinal epidural hematoma (SSEH) very rarely develops in infants younger than 1 year old. To our knowledge, no previous case of delayed-onset paralysis induced by SSEH communicated with hematoma in the paraspinal muscle has been reported in the literature. The authors present the case of a 6-month-old girl with a tumor mass on her back who developed a paresis of her bilateral lower limbs. On spinal magnetic resonance imaging, the epidural mass appeared to be a dumbbell type and communicated with the mass in the paraspinal muscle through T12/L1 intervertebral foramen at the right side. After excision of the mass in the paraspinal muscle, hemi-laminectomy of T10-L3 was performed. No solid lesion was also present in the spinal canal and it was found to be an epidural hematoma. No malignancy was observed on pathological examination, and vascular and nerve system tumors were negative. When a tumor mass suddenly develops on the back of an infant and motor impairment of the lower limbs develops as the mass gradually enlarges, differential diagnosis should be performed taking SSEH into consideration.

4.
Biomed Res Int ; 2018: 1258706, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-30533425

RESUMO

Purpose: Minimally invasive spine stabilization (MISt) using percutaneous pedicle screws plays a significant role in palliative surgery for metastatic spinal tumors. However, few studies have investigated surgical outcomes based on the epidural spinal cord compression scale (ESCCS). The purpose of this study was to examine outcomes of metastatic spinal tumors as evaluated by ESCCS in patients treated by MISt. Methods: The subjects were 56 patients who underwent MISt for metastatic spinal tumors, including 34 patients with ESCCS 2 or milder (group A) and 22 patients with ESCCS 3 (group B). We analyzed baseline characteristics, perioperative factors and clinical results such as postoperative survival time, neurological outcomes, Barthel Index for activities of daily living (ADL), visual analogue scale (VAS), and the rate of discharge to home. Results: The baseline age (P=0.07), tumor diagnosis (P=0.23), spinal level of compression (P=0.35), American Spinal Injury Association classification (P=0.49), revised Tokuhashi score (P=0.92), spinal instability neoplastic score (P=0.28), VAS (P=0.35), Barthel Index (P=0.07), American Society of Anesthesiologists physical status classification (P=0.76), and type of surgery (P=0.40) did not differ significantly between the two groups. The median postoperative survival time did not differ significantly between the groups (12.0 versus 15.0 months, P=0.60). Neurological improvement by at least 1 grade or maintenance of grade E was favorable in group A. Patients in group A had less posterior decompression (P=0.006), a higher rate of chemotherapy (P=0.009), a higher postoperative Barthel Index (P=0.04), and a higher rate of discharge to home (P=0.01) and no patients died in the hospital (P=0.004). Conclusions: No significant difference was noted in the postoperative survival time between the 2 groups. Patients in the ESCCS 2 or milder group had favorable neurological improvement, higher rates of chemotherapy, better postoperative ADL, and the higher rate of discharge to home.


Assuntos
Procedimentos Cirúrgicos Minimamente Invasivos , Compressão da Medula Espinal/cirurgia , Neoplasias da Coluna Vertebral/secundário , Neoplasias da Coluna Vertebral/cirurgia , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Estimativa de Kaplan-Meier , Vértebras Lombares/patologia , Vértebras Lombares/cirurgia , Masculino , Pessoa de Meia-Idade , Assistência Perioperatória , Recuperação de Função Fisiológica , Compressão da Medula Espinal/fisiopatologia , Neoplasias da Coluna Vertebral/fisiopatologia
5.
J Orthop Surg Res ; 13(1): 252, 2018 Oct 12.
Artigo em Inglês | MEDLINE | ID: mdl-30314520

RESUMO

BACKGROUND: Proximal junctional kyphosis (PJK) following adult spinal deformity (ASD) surgery in elderly patients is markedly influenced by osteoporosis causing additional vertebral fracture and loosening of pedicle screws (PS). This study aimed to investigate the association between mean bone density represented in Hounsfield units (HU) on spinal computed tomography (CT) and revision surgery for PJK or postoperative additional vertebral fracture following ASD surgery in elderly patients. METHODS: The subjects were 54 ASD patients aged 65 years or older who were treated with correction and fusion surgery of four or more levels and could be followed for 2 years or longer. Bone density was measured before surgery using lumbar dual-energy X-ray absorptiometry (DXA) and spinal CT in all patients. The patients were divided into group A (n = 14) in which revision surgery was required for PJK or additional vertebral fracture and group B (n = 40) in which revision surgery was not required. We retrospectively investigated incidences of PJK, additional vertebral fracture, and PS loosening, perioperative parameters, radiographic parameters before and after surgery, and osteoporosis treatment administration rate. RESULTS: No significant difference was noted in young adult mean (YAM) on DXA between groups A and B, respectively (P = 0.62), but the mean bone densities represented in HU of the T8 (P = 0.002) and T9 (P = 0.01) vertebral bodies on spinal CT were significantly lower in group A, whereas those of the L4 (P = 0.002) and L5 (P = 0.01) vertebral bodies were significantly higher in group A. The incidence of PJK was not significantly different (P = 0.07), but the incidence of additional vertebral fracture was significantly higher in group A (P < 0.001). The incidences of uppermost PS loosening within 3 months after surgery were 71% and 40% in groups A and B, respectively (P = 0.04). CONCLUSIONS: In elderly patients who required revision surgery, the mean bone densities of vertebral bodies at T8 and T9 were significantly lower. The mean bone density represented in HU on spinal CT may be useful for risk assessment of and countermeasures against revision surgery after ASD surgery in elderly patients.


Assuntos
Cifose/cirurgia , Complicações Pós-Operatórias/cirurgia , Reoperação/tendências , Fraturas da Coluna Vertebral/cirurgia , Fusão Vertebral/tendências , Idoso , Idoso de 80 Anos ou mais , Estudos de Coortes , Feminino , Seguimentos , Humanos , Cifose/diagnóstico por imagem , Vértebras Lombares/diagnóstico por imagem , Vértebras Lombares/lesões , Vértebras Lombares/cirurgia , Masculino , Complicações Pós-Operatórias/diagnóstico por imagem , Valor Preditivo dos Testes , Estudos Prospectivos , Estudos Retrospectivos , Sacro/diagnóstico por imagem , Sacro/lesões , Sacro/cirurgia , Fraturas da Coluna Vertebral/diagnóstico por imagem , Fusão Vertebral/efeitos adversos , Vértebras Torácicas/diagnóstico por imagem , Vértebras Torácicas/lesões , Vértebras Torácicas/cirurgia
6.
J Int Med Res ; 46(11): 4852-4859, 2018 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-30282498

RESUMO

Metastases to the skull or upper cervical spine from hepatocellular carcinoma (HCC) are very rare. We herein report a unique case of two-site surgery for both skull and upper cervical spine metastases from HCC. The patient was a 64-year-old man with cervical pain. Computed tomography (CT) revealed osteolytic change related to metastatic cervical spine and occipital bone tumors. Two-stage surgery involving posterior occipitocervical fusion and occipital bone tumor resection was performed. The patient's pain decreased in severity, and postoperative radiotherapy and chemotherapy could be conducted. The postoperative course was favorable, and the patient exhibited improvement in his activities of daily living. Neither cervical spine X-ray examination nor CT showed any instrumentation failure, such as screw loosening, before the patient died of liver failure 13 months after surgery. Patients with both skull and upper cervical spine metastases from liver cancer may have a markedly unfavorable prognosis. Even in these patients, however, surgery as an aggressive palliative treatment may prolong the survival period or maintain the quality of life as long as the patient's general condition permits.


Assuntos
Carcinoma Hepatocelular/patologia , Vértebras Cervicais/cirurgia , Neoplasias Hepáticas/patologia , Neoplasias Cranianas/secundário , Neoplasias Cranianas/cirurgia , Neoplasias da Coluna Vertebral/secundário , Neoplasias da Coluna Vertebral/cirurgia , Vértebras Cervicais/diagnóstico por imagem , Vértebras Cervicais/patologia , Humanos , Imagem por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Cuidados Pós-Operatórios , Neoplasias Cranianas/diagnóstico por imagem , Neoplasias da Coluna Vertebral/diagnóstico por imagem , Tomografia Computadorizada por Raios X
7.
J Orthop Surg Res ; 13(1): 273, 2018 Oct 29.
Artigo em Inglês | MEDLINE | ID: mdl-30373599

RESUMO

BACKGROUND: The Magerl and Goel-Harms techniques have been reported to produce excellent treatment outcomes in cases of atlantoaxial subluxation, but they also carry a risk of vertebral artery injuries. In order to completely prevent such injuries, we developed a surgical procedure, involving bone grafting between the C1 posterior arch and C2 lamina with clamp- or hook-and-rod-based fixation combined with the insertion of an interference screw into the posterior atlantoaxial joint. METHODS: This was a retrospective single-center study. The subjects were 58 patients in whom atlantoaxial subluxation was treated with the abovementioned procedure after 1995 (33 patients with rheumatoid arthritis (RA group) and 25 patients without rheumatoid arthritis (non-RA group)). The clinical outcomes and imaging findings of anterior subluxation at ≥ 2 years after surgery were compared between the RA and non-RA groups. RESULTS: No vertebral artery injuries occurred during surgery. Seven and two patients died during the follow-up period in the RA and non-RA groups, respectively, but none of these deaths were associated with surgery. At ≥ 2 years after surgery, the visual analogue scale score, Japanese Orthopaedic Association score, and Ranawat classification had significantly improved in both groups (p < 0.001). Radiologically, bone fusion was noted in all patients. Significant changes in the atlas-dens interval (ADI) were seen immediately after surgery in both groups (p < 0.001). In the non-RA group, significant changes in the corrected atlantoaxial height were observed immediately after surgery (p < 0.01), and loss of correction was seen at the final follow-up, but it was not significant (p = 0.1965). No significant changes were noted in any other parameter. Regarding the postoperative alignment of the cervical spine, lordosis tended to decrease, but additional surgery was only performed in one patient, who had developmental stenosis at the mid-lower level and belonged to the RA group. No reoperations due to fused adjacent segmental disease or exacerbated curvature were required. CONCLUSION: In the present study, no vertebral artery injuries occurred during surgery, and no major perioperative complications developed. Favorable clinical outcomes were observed at ≥ 2 postoperative years although the patients' diseases varied. This procedure produced superior outcomes, especially in terms of spinal correction and the maintenance of the ADI.


Assuntos
Articulação Atlantoaxial/cirurgia , Luxações Articulares/cirurgia , Procedimentos Ortopédicos/métodos , Adolescente , Adulto , Idoso , Artrite Reumatoide/complicações , Articulação Atlantoaxial/diagnóstico por imagem , Parafusos Ósseos , Feminino , Humanos , Luxações Articulares/etiologia , Masculino , Pessoa de Meia-Idade , Procedimentos Ortopédicos/instrumentação , Radiografia , Estudos Retrospectivos , Adulto Jovem
8.
J Neurosurg Spine ; 29(2): 150-156, 2018 08.
Artigo em Inglês | MEDLINE | ID: mdl-29726802

RESUMO

OBJECTIVE The range of decompression in posterior decompression and fixation for ossification of the posterior longitudinal ligament in the thoracic spine (T-OPLL) can be established using an index of spinal cord decompression based on the ossification-kyphosis angle (OKA) measured in the sagittal view on MRI. However, an appropriate OKA cannot be achieved in some cases, and posterior fixation is applied in cases with insufficient decompression. Moreover, it is unclear whether spinal cord decompression of the ventral side is essential for the treatment of OPLL. In this retrospective analysis, the efficacy of posterior decompression and fixation performed for T-OPLL was investigated after the range of posterior decompression had been set using the OKA. METHODS The MRI-based OKA is the angle from the superior margin at the cranial vertebral body of the decompression site and from the lower posterior margin at the caudal vertebral body of the decompression site to the prominence of the maximum OPLL. Posterior decompression and fixation were performed in 20 patients. The decompression range was set so that the OKA was ≤ 23° or the minimum if this value could not be achieved. Cases in which an OKA ≤ 23° could and could not be achieved were designated as groups U (13 patients) and O (7 patients), respectively. The mean patient ages were 50.5 and 62.1 years (p = 0.03) and the mean preoperative Japanese Orthopaedic Association (JOA) scores were 5.9 and 6.0 (p = 0.9) in groups U and O, respectively. The postoperative JOA score, rate of improvement of the JOA score, number of levels fused, number of decompression levels, presence of an echo-free space during surgery, operative time, intraoperative blood loss, and perioperative complications were examined. RESULTS In groups U and O, the mean rates of improvement in the JOA score were 50.0% and 45.6% (p = 0.3), the numbers of levels fused were 6.7 and 6.4 (p = 0.8), the numbers of decompression levels were 5.9 and 7.4 (p = 0.3), an echo-free space was noted during surgery in 92.3% and 42.9% of cases (p = 0.03), the operative times were 292 and 238 minutes (p = 0.3), and the intraoperative blood losses were 422 and 649 ml (p = 0.7), and transient aggravation of paralysis occurred as a perioperative complication in 2 and 1 patient, respectively. CONCLUSIONS There was no significant difference with regard to the recovery rate of the JOA score between patients with (group U) and without (group O) sufficient spinal cord decompression. The first-line surgical procedure of posterior decompression and fixation with the range of posterior decompression set as an OKA ≤ 23° before surgery involves less risk of postoperative aggravation of paralysis and may result in a better outcome.


Assuntos
Descompressão Cirúrgica/métodos , Cifose/diagnóstico por imagem , Cifose/cirurgia , Imagem por Ressonância Magnética , Ossificação do Ligamento Longitudinal Posterior/diagnóstico por imagem , Ossificação do Ligamento Longitudinal Posterior/cirurgia , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Paralisia/diagnóstico por imagem , Paralisia/cirurgia , Compressão da Medula Espinal/diagnóstico por imagem , Compressão da Medula Espinal/cirurgia , Fusão Vertebral/métodos , Cirurgia Assistida por Computador , Vértebras Torácicas , Resultado do Tratamento
9.
J Orthop Surg Res ; 13(1): 87, 2018 Apr 16.
Artigo em Inglês | MEDLINE | ID: mdl-29661205

RESUMO

BACKGROUND: Posterior decompression and stabilization plays significant roles in palliative surgery for metastatic spinal tumor. However, the indication for addition of posterior decompression have not been examined. The purpose of this study was to investigate a retrospective cohort of outcomes of metastatic spinal tumor treated with minimally invasive spine stabilization (MISt) with or without posterior decompression. METHODS: The subjects were 40 patients who underwent MISt using percutaneous pedicle screws for metastatic spinal tumor, including 20 patients treated with stabilization alone (group A) and 20 patients with added posterior decompression (group B). We analyzed baseline characteristics, postoperative survival time, and perioperative factors such as neurological outcomes, Barthel Index, VAS, and rate of discharge to home. RESULTS: The mean ages were 70 and 66 years old (P = 0.06), the mean revised Tokuhashi scores were 7.2 and 5.8 (P = 0.1), the mean spinal instability neoplastic scores (SINS) were 10.5 and 9.0 (P = 0.04), and the mean Barthel Index for ADL were 65.5 and 41.0 (P = 0.06) in groups A and B, respectively. The median postoperative survival time did not differ significantly between groups A and B (12.0 vs. 6.0 months, P = 0.09). Patients in group A had a significantly shorter operation time (166 vs. 232 min, P = 0.004) and lower intraoperative blood loss (120 vs. 478 mL, P < 0.001). Postoperative paralysis (P = 0.1), paralysis improvement rate (P = 0.09), postoperative Barthel Index (P = 0.06), and postoperative VAS (P = 0.6) did not differ significantly between the groups. The modified Frankel classification improved from D1 or D2 before surgery to D3 or E after surgery in 4 of 10 cases (40%) in group A and 8 of 8 patients (100%) in group B (P = 0.01). Significantly more patients were discharged to home in group A (P = 0.02), whereas significantly more patients died in the hospital in group B (P = 0.02). CONCLUSIONS: Patients treated without decompression had a shorter operation time, less blood loss, a higher rate of discharge to home, and lower in-hospital mortality, indicating a procedure with lower invasiveness. MISt without decompression is advantageous for patients with D3 or milder paralysis, but decompression is necessary for patients with D2 or severer paralysis.


Assuntos
Descompressão Cirúrgica/tendências , Gerenciamento Clínico , Procedimentos Cirúrgicos Minimamente Invasivos/tendências , Neoplasias da Coluna Vertebral/cirurgia , Idoso , Idoso de 80 Anos ou mais , Estudos de Coortes , Descompressão Cirúrgica/mortalidade , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Procedimentos Cirúrgicos Minimamente Invasivos/mortalidade , Procedimentos Neurocirúrgicos/mortalidade , Procedimentos Neurocirúrgicos/tendências , Estudos Retrospectivos , Neoplasias da Coluna Vertebral/mortalidade , Neoplasias da Coluna Vertebral/secundário , Taxa de Sobrevida/tendências , Resultado do Tratamento
10.
Int J Clin Oncol ; 23(5): 886-893, 2018 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-29654428

RESUMO

BACKGROUND: The prognosis of hepatocellular carcinoma (HCC) used to be poor, but it has recently improved, which has meant that clinicians have greater opportunity to treat spinal metastases and the associated epidural spinal cord compression. However, there have been few systematic functional studies about HCC-derived spinal metastases. The treatment outcomes of surgical treatment for HCC-derived metastatic spinal tumors were investigated. METHODS: The post-treatment survival period and pain, paralysis, and disturbance of activities of daily living (ADL) were investigated in 60 patients (surgery 25, conservative treatment 35). RESULTS: The mean post-treatment survival period was 7.4 ± 8.2 months (range 0.3-36 months). Univariate analysis indicated that the following factors influenced survival: the patient's general condition, presence/absence of major internal organ metastasis, serum albumin level, Child-Pugh classification, surgical treatment for spinal metastasis, and bone-modifying agent treatment. In the multivariate analysis of these 6 items, 3 significant factors were extracted: the patient's general condition, the serum albumin level, and bone-modifying agent treatment. Pain significantly improved in both groups (p < 0.001). Paralysis did not change significantly in the surgical group (p = 0.575), but it was significantly aggravated in the conservative treatment group (p = 0.047). The ADL abilities of the surgical group improved significantly (p < 0.001). CONCLUSION: Most patients exhibited poor survival. In the conservative treatment group, paralysis was significantly aggravated, and little improvement was seen in the patients' ADL abilities. In the surgical group, the patients' ADL abilities improved significantly, but their paralysis did not. Therefore, surgery should be actively performed for HCC-derived spinal metastasis whenever it is indicated.


Assuntos
Carcinoma Hepatocelular/terapia , Neoplasias Hepáticas/terapia , Dor/epidemiologia , Paralisia/epidemiologia , Neoplasias da Coluna Vertebral/terapia , Atividades Cotidianas , Adulto , Idoso , Idoso de 80 Anos ou mais , Carcinoma Hepatocelular/patologia , Terapia Combinada , Feminino , Humanos , Incidência , Japão/epidemiologia , Neoplasias Hepáticas/patologia , Masculino , Pessoa de Meia-Idade , Neoplasias da Coluna Vertebral/secundário , Taxa de Sobrevida , Resultado do Tratamento
11.
Osteoporos Int ; 29(5): 1211-1215, 2018 05.
Artigo em Inglês | MEDLINE | ID: mdl-29476202

RESUMO

Surgical treatment of multiple vertebral fractures in patients with glucocorticoid-induced osteoporosis is difficult because of a high rate of secondary fracture postoperatively. A case is described in which initial treatment with teriparatide to improve osteoporosis followed by treatment of kyphosis with correction fusion achieved a favorable outcome. INTRODUCTION: Secondary fracture frequently occurs after treatment of vertebral fracture with vertebroplasty and balloon kyphoplasty in patients with glucocorticoid-induced osteoporosis, but effective treatment of multiple vertebral fractures has rarely been reported. Thus, a treatment of kyphosis following multiple vertebral fractures associated with glucocorticoid-induced osteoporosis is required. METHODS: The patient was a 24-year-old woman diagnosed with glucocorticoid-induced osteoporosis who was under treatment with oral alendronate, vitamin D, and elcatonin injection. Secondary multiple vertebral fractures occurred despite these treatments and low back pain gradually aggravated. RESULTS: Vertebroplasty or balloon kyphoplasty was not performed in the early phase. Instead, treatment with teriparatide was used for initial improvement of osteoporosis. Kyphosis in the center of the residual thoracolumbar junction was then treated with posterior correction fusion. At 2 years after surgery, the corrected position has been maintained and no new fracture has occurred. CONCLUSION: There is no established method for treatment of multiple vertebral fractures caused by glucocorticoid-induced osteoporosis. Initial treatment with teriparatide to improve osteoporosis followed by treatment of kyphosis with correction fusion may result in a more favorable outcome.


Assuntos
Glucocorticoides/efeitos adversos , Osteoporose/induzido quimicamente , Fraturas por Osteoporose/terapia , Fraturas da Coluna Vertebral/terapia , Fusão Vertebral/métodos , Terapia Combinada , Feminino , Fraturas por Compressão/etiologia , Fraturas por Compressão/terapia , Humanos , Cifose/etiologia , Cifose/cirurgia , Osteoporose/complicações , Osteoporose/tratamento farmacológico , Fraturas por Osteoporose/etiologia , Recidiva , Prevenção Secundária/métodos , Fraturas da Coluna Vertebral/etiologia , Adulto Jovem
12.
J Orthop Surg Res ; 13(1): 30, 2018 Feb 05.
Artigo em Inglês | MEDLINE | ID: mdl-29402333

RESUMO

BACKGROUND: Surgeries performed for metastatic spinal tumor are mostly palliative and are controversial for patients with short life expectancy. We investigated whether palliative posterior spinal stabilization surgery with postoperative multidisciplinary therapy results in improvement of life prognosis and activities of daily living (ADL) in patients with metastatic spinal tumor. METHODS: The subjects were 55 patients who underwent palliative posterior-only instrumentation surgery for metastatic spinal tumor at our hospital between 2012 and 2015. Postoperative survival, early paralysis improvement, ADL improvement, and rate of discharge to home were examined. RESULTS: The patients included 37 males and 18 females, and the mean age at the time of surgery was 66.8 years old. The mean Tokuhashi score was 7.1, the mean spinal instability neoplastic score (SINS) was 9.4, and the epidural spinal cord compression scale (ESCCS) was grade 3 in 20 patients (36.3%). The mean Barthel index for ADL was 48.7. The median postoperative survival time determined using the Kaplan-Meier method was 12.0 months (95% confidence interval 2.4-21.5). Regarding improvement of paralysis, the modified Frankel scale was improved by one grade or more or grade E was maintained in 35 patients (63.6%), whereas paralysis aggravated in 2 (3.6%). In surgery, conventional posterior decompression and fixation were applied in 31 patients (56.3%), and minimally invasive spine stabilization was applied in 24 (43.6%). Postoperative chemotherapy was performed in 31 patients (56.3%), radiotherapy was used in 38 (69.0%), and a bone-modifying agent was administered in 39 (70.2%). Regarding ADL, the mean Barthel index improved from 48.5 before surgery to 74.5 after surgery. Thirty-seven patients (67.2%) were discharged to home. CONCLUSIONS: ADL improved and allowed discharge to home, and postoperative adjuvant therapy could be administered at a high rate in patients who received palliative posterior spinal stabilization surgery. Survival time extended beyond the preoperative life expectancy in many patients. Patients with a metastatic spinal tumor have short life expectancy and paralysis caused by spinal instability and spinal cord compression. However, multidisciplinary therapy including palliative posterior spinal stabilization surgery with reduced invasiveness and postoperative adjuvant therapy are effective in these patients.


Assuntos
Atividades Cotidianas , Quimiorradioterapia Adjuvante/tendências , Cuidados Paliativos/tendências , Equipe de Assistência ao Paciente/tendências , Cuidados Pós-Operatórios/tendências , Neoplasias da Coluna Vertebral/terapia , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Relações Interprofissionais , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Neoplasias da Coluna Vertebral/diagnóstico por imagem , Resultado do Tratamento
13.
Spine (Phila Pa 1976) ; 43(8): E448-E455, 2018 04 15.
Artigo em Inglês | MEDLINE | ID: mdl-28816824

RESUMO

STUDY DESIGN: A retrospective, single-institute, and radiographic study. OBJECTIVE: To evaluate the relationship between the epidural spinal cord compression (ESCC) scale and the severity of metastatic spine tumor-induced paralysis. SUMMARY OF BACKGROUND DATA: The ESCC scale is used to evaluate the grade of spinal cord compression on T2-weighted magnetic resonance imaging (MRI). However, few studies have investigated the relationship between such MRI findings and paralysis. METHODS: The subjects were 467 patients with metastatic spine tumors and grade 1b or worse spinal cord compression according to the ESCC scale. Evaluations using this scale were performed by three spine surgeons, and results that were obtained by two or more surgeons were adopted. We also examined patients whose spinal cord compression deteriorated by one grade or more to American Spinal Injury Association (ASIA) grade C or worse within the first 3 weeks after MRI. RESULTS: The kappa coefficients for inter- and intraexaminer variability were 0.90 and 0.95, respectively. ASIA grade D or worse paralysis developed in at least 50% of the patients with ESCC grade 1b or worse spinal cord compression at the C1-T2 and at least 50% of those with ESCC grade 1c or worse spinal cord compression at the T3-L5. The frequency of ASIA grade C or worse paralysis was high among the patients with ESCC grade 2 or worse spinal cord compression at the C7-L1. Nineteen patients experienced rapid deterioration of one grade or more to ASIA grade C or worse paralysis within the first 3 weeks after MRI. Of these, paralysis occurred in at least 30% of the patients with anterolateral or circumferential cord compression combined with ESCC grade 2 or 3 compression at the C7-L1. CONCLUSION: The severity of paralysis was not correlated with the ESCC scale. Patients with anterolateral or circumferential ESCC grade 2 or 3 cord compression at the C7-L1 are at high risk of rapidly progressive paralysis. LEVEL OF EVIDENCE: 4.


Assuntos
Espaço Epidural/diagnóstico por imagem , Paralisia/diagnóstico por imagem , Compressão da Medula Espinal/diagnóstico por imagem , Neoplasias da Coluna Vertebral/diagnóstico por imagem , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Vértebras Cervicais , Feminino , Humanos , Vértebras Lombares , Masculino , Pessoa de Meia-Idade , Paralisia/etiologia , Estudos Retrospectivos , Sacro , Compressão da Medula Espinal/etiologia , Neoplasias da Coluna Vertebral/complicações , Adulto Jovem
14.
Spine (Phila Pa 1976) ; 42(24): E1446-E1451, 2017 Dec 15.
Artigo em Inglês | MEDLINE | ID: mdl-28816829

RESUMO

STUDY DESIGN: A retrospective, single-center study. OBJECTIVE: Investigation of the changes in the treatment outcomes of patients with lung cancer derived metastatic spine tumors. SUMMARY OF BACKGROUND DATA: Metastatic spine tumors derived from lung cancer had been progressive, and their prognosis is poor. It has recently been reported that the use of molecularly targeted drugs and bone-modifying agents (BMAs) improved the treatment outcomes of patients with lung cancer, but no detailed information about the treatment of metastatic spine tumors has been reported. METHODS: Two hundred seven patients with lung cancer derived metastatic spine tumors who were examined after 2000 were analyzed. They were divided into 54 patients who were treated in or before 2005 (surgical treatment: 25 patients, conservative treatment: 29 patients) (group B) and 153 patients who were treated from 2006 onwards, when a molecularly targeted drug and BMA were introduced (surgical treatment: 24, conservative treatment: 129) (group A), and the treatment outcomes of the two groups were compared. RESULTS: Significant differences in age and the affected vertebral level, paralysis grade, and Tokuhashi score (general condition, the number of vertebral metastases, and the total score) were detected between the groups. Regarding treatment outcomes, the mean duration of the post-treatment survival period was 5.1 and 9.3 months in groups B and A, respectively, that is, it was significantly longer in group A (P < 0.05). No significant intergroup difference in pain improvement was noted, and no significant post-treatment improvement in paralysis was achieved in either group. The post-treatment discharge-to-home eligibility rate did not differ significantly between the groups, but the Barthel Index improved significantly after treatment in group A (P < 0.05). CONCLUSION: After molecularly targeted drugs and BMA were introduced as treatments for lung cancer derived metastatic spine tumors, the survival periods of patients with such tumors increased, and their activity of daily living after treatment improved. LEVEL OF EVIDENCE: 4.


Assuntos
Neoplasias Pulmonares/patologia , Neoplasias da Coluna Vertebral/cirurgia , Coluna Vertebral/cirurgia , Atividades Cotidianas , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Neoplasias Pulmonares/mortalidade , Masculino , Pessoa de Meia-Idade , Prognóstico , Estudos Retrospectivos , Neoplasias da Coluna Vertebral/mortalidade , Neoplasias da Coluna Vertebral/secundário , Taxa de Sobrevida , Resultado do Tratamento
15.
Orthopedics ; 40(4): e693-e698, 2017 Jul 01.
Artigo em Inglês | MEDLINE | ID: mdl-28558111

RESUMO

The goal of the study was to evaluate minimally invasive palliative surgery and the effect of postoperative adjuvant therapy for metastatic spinal tumor with a limited vital prognosis. Of the 70 patients who underwent palliative surgery for metastatic spinal tumor at the authors' hospital between March 2012 and May 2016, thirty-three were treated with minimally invasive spine stabilization (MISt) using percutaneous pedicle screws (PPSs) and included in the current study. Of the 33 patients, 26 were men and 7 were women; mean age at surgery was 68.6 years. Intraoperatively, posterior decompression and fusion was performed in 17 (51.5%) patients and fusion only was performed in 16 (48.5%). Mean operative time was 202.5 minutes, mean intraoperative blood loss was 331.6 mL, and intraoperative blood loss was 1500 mL or greater in 2 (6.1%) patients. Median postoperative survival time determined using the Kaplan-Meier method was 11.0 months (95% confidence interval, 7.3-14.6). Regarding improvement of paralysis, neurological deficit was improved by at least 1 Frankel grade for 15 (45.5%) patients, and the number of ambulatory patients increased from 22 (66.7%) to 25 (75.8%). Postoperative adjuvant therapy included chemotherapy in 17 (51.5%) patients, radiotherapy in 21 (63.6%), and bone-modifying agent treatment in 25 (75.8%). The mean Barthel Index for activities of daily living improved from 53.5 preoperatively to 71.5 postoperatively. Discharge to home was possible for 23 (69.7%) patients. Activities of daily living for patients with metastatic spinal tumor were improved by minimally invasive palliative surgery with MISt using PPSs and postoperative adjuvant therapy. [Orthopedics. 2017; 40(4):e693-e698.].


Assuntos
Descompressão Cirúrgica/métodos , Procedimentos Cirúrgicos Minimamente Invasivos/métodos , Parafusos Pediculares , Neoplasias da Coluna Vertebral/cirurgia , Atividades Cotidianas , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Japão , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Neoplasias da Coluna Vertebral/mortalidade , Neoplasias da Coluna Vertebral/psicologia , Neoplasias da Coluna Vertebral/secundário , Análise de Sobrevida , Resultado do Tratamento
16.
Intern Med ; 54(15): 1923-6, 2015.
Artigo em Inglês | MEDLINE | ID: mdl-26234238

RESUMO

A 63-year-old man revealed a four-month history of muscle weakness of the lower limbs, hypoesthesia of the L5 and S1 area and ischuria. On MRI, the spinal cord was compressed by an encircled mass, which showed hypointensity on T1- and T2-weighted images with gadolinium enhancement at the Th11 to Th12 vertebra. Because of the rapid progression of myelopathy, posterior decompression was performed and idiopathic hypertrophic spinal pachymeningitis (HSP) was finally diagnosed. The patient's neurological signs markedly improved with postoperative corticosteroid treatment. Idiopathic HSP is a clinical emergency and early surgical intervention is essential to prevent irreversible damage to the nervous system.


Assuntos
Meningite/diagnóstico , Doenças da Medula Espinal/diagnóstico , Corticosteroides/uso terapêutico , Descompressão Cirúrgica , Diagnóstico Diferencial , Humanos , Imagem por Ressonância Magnética , Masculino , Meningite/tratamento farmacológico , Meningite/cirurgia , Pessoa de Meia-Idade
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