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1.
Artigo em Inglês | MEDLINE | ID: mdl-31792542

RESUMO

BACKGROUND: Multiple options exist for thoracic disc herniation (TDH). However, when a specific technique is chosen, the goal is to avoid the manipulation of the spinal cord, which is already compressed. OBJECTIVE: To describe a hybrid endoscopic technique for intracanal TDH by combining an oblique paraspinal approach (OPA) and transforaminal full-endoscopic discectomy. METHODS: We describe the step-by-step operative technique and present the clinical and radiological outcomes of a case series of hybrid endoscopic thoracic discectomy. RESULTS: A total of 3 patients were treated. We observed the usefulness of an OPA to enlarge the intervertebral foramen through the rigid tubular retractor and the feasibility of a full-endoscopic transforaminal approach to reach intracanal TDHs. CONCLUSION: Early experience with the hybrid endoscopic technique for TDHs demonstrated acceptable clinical and radiological outcomes in the 3 patients treated; however, a larger sample size and a methodologically advantageous study to compare this procedure with conventional options are necessary to probe the full benefits of the hybrid technique.

2.
Neurocirugía (Soc. Luso-Esp. Neurocir.) ; 30(5): 254-258, sept.-oct. 2019. ilus
Artigo em Espanhol | IBECS | ID: ibc-183881

RESUMO

Objetivo: Presentar un caso de histiocitoma fibroso maligno vertebral a nivel de la cuarta vértebra lumbar que recibió tratamiento por una espondilectomía L4 y colocación de expansor intervertebral y fijación posterior. Caso clínico: Paciente masculino de 47 años de edad sin antecedentes de importancia, que presenta dolor lumbar de 2 meses de evolución. Se trata de forma conservadora, con una leve mejoría del dolor; sin embargo, persiste con dolor lumbar con irradiación a miembros pélvicos de predominio izquierdo, acompañado de debilidad y claudicación. Clínicamente presenta paraparesia 3/5 e hipoestesia L4, L5 y S1 de predominio izquierdo. La tomografía axial computarizada de la región lumbosacra evidencia una lesión osteolítica en cuerpo de L4 de predominio izquierdo con invasión a canal lumbar con márgenes poco delimitados. En el estudio de resonancia magnética de columna lumbosacra se observa lesión hiperintensa en T2, heterogénea, de bordes irregulares, que involucra más del 60% del cuerpo vertebral de L4 con invasión al canal raquídeo que ocasiona compresión a raíces. Se manejó con una espondilectomía L4 y la colocación de un expansor intervertebral y fijación posterior. Conclusión: La espondilectomía es una opción viable y efectiva para el tratamiento del histiocitoma fibroso maligno. La localización lumbar baja conlleva abordajes combinados; sin embargo, el desafío es mayor, ya que requiere de un conocimiento de los grandes vasos abdominales y de una intervención multidisciplinaria


Objective: To present a case of spinal malignant fibrous histiocytoma in the fourth lumbar vertebra that received treatment by an L4 spondylectomy and placement of intervertebral expander and posterior fixation. Case report: A 47-year-old male patient with no relevant history presented with lumbar pain of 2 months' evolution. Treated conservatively, with slight improvement in pain, the patient persisted with low back pain irradiation to pelvic members, predominantly left-sided, accompanied by weakness and claudication. Clinically, he presented with paresthesias 3/5, hypoaesthesia L4, L5 and S1, predominantly left-sided. Lumbosacral computerized axial tomography evidence of an osteolytic lesion in the L4 body, predominantly left-sided, with invasion of the lumbar canal with poorly delimited margins; lumbosacral spine MRI showed hyperintense lesion in T2, heterogeneous, with irregular borders involving more than 60% of the vertebral body of L4 with invasion of the spinal canal causing compression to the roots. He was treated with an L4 spondylectomy and placement of intervertebral expander and posterior fixation. Conclusion: Spondylectomy is an effective option for the treatment of spinal malignant fibrous histiocytoma that involves combined approaches. However the challenge is greater since it requires a knowledge of the great abdominal vessels and multidisciplinary intervention


Assuntos
Humanos , Masculino , Pessoa de Meia-Idade , Histiocitoma Fibroso Maligno/diagnóstico por imagem , Histiocitoma Fibroso Maligno/cirurgia , Dor Lombar/etiologia , Paraparesia/complicações , Região Lombossacral/diagnóstico por imagem , Região Lombossacral/patologia , Tomografia Computadorizada de Emissão , Imuno-Histoquímica
3.
J Neurol Surg A Cent Eur Neurosurg ; 80(4): 312-317, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31018228

RESUMO

Chiari malformation type 1 (CM-1) is an ectopia of the cerebellar tonsils below the foramen magnum that causes severe disability due to its neurologic symptoms. The treatment of choice for CM-1 is decompression of the craniovertebral junction (CVJ). In some patients only an extradural decompression by removing the atlanto-occipital ligament may be sufficient. In other patients, duraplasty is necessary. In this case, we report the operative technique used to treat a CM-1 in a 16-year-old male patient who presented with severe headache and gait instability. A micro-decompression of the suboccipital bone and posterior arch osteotomy of C1 through a 2-cm midline incision was performed under surgical microscope magnification. A duraplasty was performed through the same approach. The patient was discharged home after 2 days in the hospital and returned to regular activities at school 3 weeks after surgery. The minimally invasive technique presented here is a viable option for the posterior decompression of the CVJ in patients with CM-1 using a low-cost self-retaining retractor.


Assuntos
Malformação de Arnold-Chiari/cirurgia , Vértebras Cervicais , Descompressão Cirúrgica/métodos , Microcirurgia/métodos , Procedimentos Neurocirúrgicos/métodos , Adolescente , Humanos , Masculino
4.
J Neurol Surg A Cent Eur Neurosurg ; 80(3): 162-168, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-30677786

RESUMO

PURPOSE OF STUDY: Standard treatment protocols for lumbar degenerative lesions in the setting of rheumatoid arthritis (RA) are lacking. The purpose of this study was to evaluate the clinical and radiologic outcomes of minimally invasive oblique lumbar interbody fusion (MI-OLIF) in RA patients having degenerative lumbar spine lesions. METHODS: This was a retrospective hospital-based case series (evidence level 4). Eight patients with degenerative lumbar disease with significant back pain and neurologic claudication underwent MI-OLIFwith polyetheretherketone cage insertion and posterior pedicle screw instrumentation. The clinical outcomes were measured by the numerical rating scale (NRS) for back and leg pain and the Oswestry Disability Index (ODI), and radiologic outcomes were studied on radiographs, computed tomography, and magnetic resonance imaging. Minimum follow-up duration was 1 year. RESULTS: Mean NRS results for back and leg pain preoperatively were 6.3 and 7.1 that improved to 2.6 and 2 for back and leg pain, respectively, at last follow-up. The mean ODI scores preoperatively were 58.02 that improved to 39.06 at last follow-up. All patients had good functional outcomes, good fusion rates, and were able to continue their activities of daily living without much disability at last follow-up. CONCLUSION: MI-OLIF in patients with symptomatic lumbar spine degenerative lesions with RA seems to provide good short-term clinical and radiologic outcomes.


Assuntos
Artrite Reumatoide/cirurgia , Degeneração do Disco Intervertebral/cirurgia , Vértebras Lombares/cirurgia , Fusão Vertebral/métodos , Atividades Cotidianas , Idoso , Artrite Reumatoide/complicações , Artrite Reumatoide/diagnóstico por imagem , Feminino , Humanos , Degeneração do Disco Intervertebral/complicações , Degeneração do Disco Intervertebral/diagnóstico por imagem , Vértebras Lombares/diagnóstico por imagem , Imagem por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Parafusos Pediculares , Estudos Retrospectivos , Tomografia Computadorizada por Raios X , Resultado do Tratamento
5.
Neurocirugia (Astur) ; 30(5): 254-258, 2019.
Artigo em Inglês, Espanhol | MEDLINE | ID: mdl-30527900

RESUMO

OBJECTIVE: To present a case of spinal malignant fibrous histiocytoma in the fourth lumbar vertebra that received treatment by an L4 spondylectomy and placement of intervertebral expander and posterior fixation. CASE REPORT: A 47-year-old male patient with no relevant history presented with lumbar pain of 2 months' evolution. Treated conservatively, with slight improvement in pain, the patient persisted with low back pain irradiation to pelvic members, predominantly left-sided, accompanied by weakness and claudication. Clinically, he presented with paresthesias 3/5, hypoaesthesia L4, L5 and S1, predominantly left-sided. Lumbosacral computerized axial tomography evidence of an osteolytic lesion in the L4 body, predominantly left-sided, with invasion of the lumbar canal with poorly delimited margins; lumbosacral spine MRI showed hyperintense lesion in T2, heterogeneous, with irregular borders involving more than 60% of the vertebral body of L4 with invasion of the spinal canal causing compression to the roots. He was treated with an L4 spondylectomy and placement of intervertebral expander and posterior fixation. CONCLUSION: Spondylectomy is an effective option for the treatment of spinal malignant fibrous histiocytoma that involves combined approaches. However the challenge is greater since it requires a knowledge of the great abdominal vessels and multidisciplinary intervention.

6.
World Neurosurg ; 122: 474-479, 2019 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-30458327

RESUMO

BACKGROUND: Use of a contralateral sublaminar endoscopic approach may minimize facet violation and better visualize the dura and cystic lesions during operation. The aim of this study was to introduce a surgical technique for contralateral sublaminar endoscopic removal of lumbar juxtafacet cysts using a percutaneous biportal endoscopic approach. METHODS: Ten cases of lumbar juxtafacet cyst were consecutively treated via a contralateral sublaminar endoscopic approach using percutaneous biportal endoscopic surgery. Postoperative magnetic resonance imaging scans were evaluated on postoperative day 1 for optimal removal of cysts and neural decompression status. Clinical findings were evaluated in preoperative and postoperative periods using a visual analog scale for leg pain and the Oswestry Disability Index. RESULTS: Ten lumbar juxtafacet cysts in 10 patients were treated using the contralateral sublaminar biportal endoscopic approach. Postoperative magnetic resonance imaging depicted complete removal of juxtafacet cysts and optimal neural decompression of treated segments in all patients. Preoperative visual analog scale and Oswestry Disability Index scores improved significantly after surgery: visual analog scale scores changed from 7.64 ± 0.71 preoperatively to 1.63 ± 1.28 at last follow-up visit (P < 0.05), and Oswestry Disability Index scores changed from 45.35 ± 16.15 to 15.82 ± 10.21 (P < 0.05). Mean operative time was 60.1 ± 23.4 minutes. CONCLUSIONS: A contralateral sublaminar approach using percutaneous biportal endoscopy may be an alternative treatment for symptomatic lumbar juxtafacet cysts. This approach may minimize iatrogenic facet violation and traumatization of posterior musculoligamentous structures.


Assuntos
Vértebras Lombares/cirurgia , Região Lombossacral/cirurgia , Neuroendoscopia , Procedimentos Neurocirúrgicos , Estenose Espinal/cirurgia , Adulto , Idoso , Idoso de 80 Anos ou mais , Cistos/cirurgia , Descompressão Cirúrgica/métodos , Dura-Máter/cirurgia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Neuroendoscopia/métodos
7.
Surg Radiol Anat ; 40(12): 1383-1390, 2018 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-30182307

RESUMO

PURPOSE: To measure the morphological dimensions of the spinous process (SP) and interspinous space, and provide a basis for the development of interspinous devices for the Korean or East Asian populations. METHODS: We retrospectively analyzed the anatomical parameters of 120 patients. The parameters included height, length, and width of SP, interspinous distance (supine, standing, and dynamic), cortical thickness of SP, and spino-laminar (S-L) angle. Correlations between measurements, age, and gender were investigated. RESULTS: The largest height, length, and cortical thickness and S-L angle were noted at L3. The largest width was observed at S1. The interspinous distance decreased significantly from L2-3 to L5-S1 and was significantly larger in the supine than in standing posture for L5-S1. Cortical thickness was gradually tapered from the anterior to the posterior position. The S-L angle at L2 and L3 was similar and significantly decreased from L3 to S1. An increased trend in width with aging and a decreased trend in distance (supine) were noted. A significant increase in height, length, and distance in males compared with females was also observed. CONCLUSIONS: The interspinous space is wider at the anterior, and the cortex is thicker anteriorly. Accordingly, it appears that the optimized implant position lies in the interspinous space anteriorly. The varying interspinous space with different postures and gradually narrowing with age suggest the need for caution when sizing the device. Gender differences also need to be considered when designing implantable devices.


Assuntos
Vértebras Lombares/anatomia & histologia , Estenose Espinal/cirurgia , Adulto , Idoso , Variação Anatômica , Grupo com Ancestrais do Continente Asiático , Desenho de Equipamento , Feminino , Humanos , Vértebras Lombares/diagnóstico por imagem , Masculino , Pessoa de Meia-Idade , Próteses e Implantes , Interpretação de Imagem Radiográfica Assistida por Computador , Estudos Retrospectivos , Tomografia Computadorizada por Raios X
8.
World Neurosurg ; 120: e684-e689, 2018 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-30165228

RESUMO

OBJECTIVE: Recently, full-endoscopic lumbar decompression has shown encouraging clinical outcomes. However, there are no reports as to whether sufficient lumbar decompression through full-endoscopic procedures can be achieved. The purpose of this study is to investigate the radiologic outcomes of percutaneous biportal endoscopic decompression compared with those of conventional microscopic decompressive surgery. METHODS: A case-control prospective study was carried out. Patients were classified into 2 groups regarding the operation method (microscope group and endoscopic group). The cross-sectional area of the dura was measured both preoperatively and postoperatively at 5 axial cuts of T2-weighted magnetic resonance images in all subjects. In addition, clinical outcomes using visual analog scale for back and leg pain and Oswestry Disability Index were analyzed. Radiologic and clinical results were compared between groups. RESULTS: A total of 88 patients were enrolled in the study. Forty-two patients were assigned to the microscope group and 46 patients were assigned to the endoscopic group. Postoperatively, the dura was significantly expanded in each group (P < 0.05). Visual analog scale and Oswestry Disability Index scores improved after surgery in both groups (P < 0.05). In addition, there was no significant difference of dura expansion between the 2 groups (P > 0.05). Immediate postoperative pain score was significantly greater in the microscope group than in the endoscopic group (P < 0.05). CONCLUSIONS: Full-endoscopic lumbar decompression using percutaneous biportal endoscopic approach is a safe and effective treatment for lumbar spinal stenosis. Decompression can be achieved with the percutaneous endoscopic technique at a similar rate to that achieved by the microscopic approach.


Assuntos
Descompressão Cirúrgica , Endoscopia , Degeneração do Disco Intervertebral/cirurgia , Vértebras Lombares/cirurgia , Estenose Espinal/cirurgia , Idoso , Estudos de Casos e Controles , Dura-Máter/diagnóstico por imagem , Feminino , Seguimentos , Humanos , Degeneração do Disco Intervertebral/diagnóstico por imagem , Vértebras Lombares/diagnóstico por imagem , Imagem por Ressonância Magnética , Masculino , Microcirurgia , Pessoa de Meia-Idade , Dor Pós-Operatória , Estudos Prospectivos , Estenose Espinal/diagnóstico por imagem
9.
World Neurosurg ; 119: 315-320, 2018 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-30144597

RESUMO

BACKGROUND: Percutaneous endoscopic lumbar diskectomy (PELD) has evolved over the last decades and has become an effective treatment for soft disk herniations. However, while its use increases, newer complications have been discovered. CASE DESCRIPTION: We present the unique case of a woman who underwent PELD/foraminotomy to treat right-side foraminal disk herniations on L4-5 and L5-S1 in the same procedure. Ten days after surgery, the patient developed fever and severe low back pain radiated down her right leg. Magnetic resonance imaging showed a right pseudomeningocele arising from L4-5 and a nerve root herniated through the dural sac at the same lumbar segment. Blood cultures and fluid culture obtained from pseudomeningocele drainage depicted infection. Specific antibiotics were administrated, direct dura repair under the microscope was performed, and the patient improved symptomatically. CONCLUSIONS: PELD combined with foraminotomy is a relatively new and skill-demanding surgery which is indicated only in cases where foraminal disk herniation is combined with foraminal stenosis. This surgical strategy requires experience by the endoscopic surgeon to prevent procedure-related complications. Although rare, these complications can lead to increased morbidity.


Assuntos
Infecções Bacterianas/etiologia , Discotomia Percutânea/efeitos adversos , Endoscopia/efeitos adversos , Pseudomonadaceae/patogenicidade , Infecções Bacterianas/diagnóstico por imagem , Feminino , Humanos , Imagem por Ressonância Magnética , Pessoa de Meia-Idade
10.
World Neurosurg ; 119: e898-e909, 2018 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-30099187

RESUMO

OBJECTIVE: To compare the radiologic and clinical outcomes between oblique lumbar interbody fusion (OLIF) without laminectomy and minimally invasive transforaminal lumbar interbody fusion (MI-TLIF). METHODS: This was a retrospective study. Between April 2012 and January 2017, 25 patients in each of the MI-TLIF and OLIF groups were recruited as matched pairs. Clinical outcomes included visual analogue scale, Oswestry Disability Index, and satisfaction rates. Radiographic outcomes comprised disc height (DH) and fusion status. Intraoperative data and complications were collected. All patients completed the clinical and radiologic outcomes. Outcomes were compared preoperatively and postoperatively. RESULTS: Matched pairs were compared between 2 groups in terms of demographic data and preoperative measurements; less blood loss and shorter operative time were found in OLIF versus MI-TLIF (P < 0.001). The total complication rate was 36% in OLIF and 32% in MI-TLIF (P = 0.77). The outcomes of visual analogue scale and Oswestry Disability Index were significantly improved in both groups, and there was no significant difference between 2 groups. Satisfaction rates of the both groups were more than 90%. OLIF was superior to MI-TLIF with respect its capability to restore DH (P < 0.001). Earlier time of fusion was observed in OLIF (80%) compared with MI-TLIF (52%) at 6 months (P = 0.04). CONCLUSIONS: OLIF may achieve equivalent clinical and radiologic outcomes compared with MI-TLIF when the stenosis is minimal because the decompression performed is indirect. Furthermore, the OLIF shows less blood loss and shorter operative time, better restoration of DH, and earlier time to fusion than the MI-TLIF.


Assuntos
Descompressão Cirúrgica/métodos , Vértebras Lombares/cirurgia , Fusão Vertebral/métodos , Espondilolistese/cirurgia , Dor nas Costas/etiologia , Perda Sanguínea Cirúrgica/estatística & dados numéricos , Feminino , Humanos , Degeneração do Disco Intervertebral/cirurgia , Tempo de Internação/estatística & dados numéricos , Vértebras Lombares/patologia , Masculino , Pessoa de Meia-Idade , Neuroendoscopia/métodos , Duração da Cirurgia , Medição da Dor , Dor Pós-Operatória/etiologia , Satisfação do Paciente , Cuidados Pré-Operatórios , Estudos Retrospectivos , Espondilolistese/patologia , Resultado do Tratamento
11.
Acta Neurochir (Wien) ; 160(8): 1603-1607, 2018 08.
Artigo em Inglês | MEDLINE | ID: mdl-29926249

RESUMO

BACKGROUND: Surgical options for removing high-grade down-migrated lumbar disc herniations located medial to the pedicle include an extensive laminectomy and facetectomy. A direct percutaneous endoscopic approach through the pedicle for reaching the herniated disc without risk of iatrogenic instability is feasible. METHOD: The transpedicular approach consists of creating a tunnel through the pedicle. Subsequently, access to the parapedicular epidural space is obtained, and downward migrated disc can be removed. CONCLUSION: This technique allows to reach migrated herniations medially to the pedicle safely and effectively.


Assuntos
Discotomia Percutânea/métodos , Endoscopia/métodos , Deslocamento do Disco Intervertebral/cirurgia , Laminectomia/métodos , Complicações Pós-Operatórias/epidemiologia , Discotomia Percutânea/efeitos adversos , Endoscopia/efeitos adversos , Humanos , Laminectomia/efeitos adversos , Vértebras Lombares/cirurgia , Parafusos Pediculares
12.
Ann Transl Med ; 6(6): 100, 2018 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-29707549

RESUMO

The treatment of cervical disc herniations has evolved in the last 2 decades. While the anterior cervical discectomy and fusion continues being the gold standard for the treatment of radicular pain triggered by cervical disc herniation, other surgical approaches have been developed. Percutaneous endoscopic cervical discectomy has demonstrated the ability to decompress the exiting nerve root and dural sac correctly and encouraging clinical outcomes has been reported in the literature. One of the most important advantages offered by the endoscopic technique is the capability to resolve the patient's symptoms without the need for interbody fusion. Also, a specific and selective decompression under continuous visualization with minimal surgery-related trauma can be achieved. There are two percutaneous endoscopic cervical discectomy approaches: anterior and posterior. The decision to perform each other depends on pathology site. However, the endoscopic technique requires previous surgical training, a steep learning curve, and proper patient selection. The development of new hardware such as endoscopes with better optics, lighting systems, and endoscopic surgical tools have allowed using endoscopic techniques in more complex cases. The objective of this review is the technical description of the anterior and posterior percutaneous endoscopic cervical discectomy.

13.
Ann Transl Med ; 6(6): 101, 2018 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-29707550

RESUMO

Fusion is the cornerstone in the treatment of an unstable degenerative lumbar spinal disease. Various techniques have been developed. Amongst these techniques exists the oblique lumbar interbody fusion (OLIF), which is the ante-psoas approach. Adequate restoration of disc height with large cages placed in the intervertebral space, indirect decompression, and correction of sagittal and coronal alignment can be achieved with OLIF procedure with the advantage of minimal risk for the psoas muscle and lumbar plexus. Nevertheless, this technique entails complications directly associated with the anatomical location where the fusion takes place. This surgical area is a window between the left lateral border of the aorta, or the left common iliac artery, and the anterior belly of the left psoas muscle. Vascular complications associated with the injury of the main vessels, segmental artery or iliolumbar vein of the lumbar spine have been reported, as well as urologic lesions due to ureter transgression, amongst others. Although these complications have been described in the literature, an article that complements this information with technical advice for its avoidance is yet to be published. This article is a review of the most frequent complications associated with the OLIF procedure in L2-L5 lumbar levels, as well as a description of technical strategies for the prevention of such complications.

14.
World Neurosurg ; 110: 17-19, 2018 02.
Artigo em Inglês | MEDLINE | ID: mdl-29107727

RESUMO

Giant intradural extramedullary schwannoma of the cervical spine usually causes severe spinal cord compression. This type of tumor has a low incidence. Patients present progressive loss of strength and other functions of the spinal cord. This article shows the clinical images of a 75-year-old male with the diagnosis of giant intradural extramedullary schwannoma and the cases reported in the literature.


Assuntos
Vértebras Cervicais/patologia , Neurilemoma/complicações , Compressão da Medula Espinal/etiologia , Neoplasias da Medula Espinal/complicações , Idoso , Vértebras Cervicais/diagnóstico por imagem , Bases de Dados Bibliográficas/estatística & dados numéricos , Progressão da Doença , Humanos , Imagem por Ressonância Magnética , Masculino , Compressão da Medula Espinal/cirurgia
15.
J Clin Neurosci ; 48: 218-223, 2018 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-29174757

RESUMO

Cervical spondylotic myelopathy (CSM) is the most common degenerative disease of the spine in elderly patients. Although there are several surgical options for the treatment of this disease, minimally invasive techniques for localized decompression of the true clinical generator of the patient's disease has revolutionized spinal surgery recently. This article presents an alternate application of the anterior transcorporeal tunnel approach in combination with computed tomography (CT)-based intraoperative navigation in the treatment of patients with cervical myelopathy secondary to spondylosis. Three clinical cases are used as examples to demonstrate how this procedure can be used to decompress a localized target in cervical spondylotic myelopathy. Clinical images of each case are shown. Cervical decompression was successfully achieved in all three patients, with the improvement of preoperative symptoms. The anterior transcorporeal tunnel approach combined with the use of CT-based intraoperative spinal navigation may be a feasible minimally invasive procedure for the treatment of cervical spondylotic myelopathy in selected cases.


Assuntos
Vértebras Cervicais/cirurgia , Neuronavegação/métodos , Doenças da Medula Espinal/cirurgia , Espondilose/cirurgia , Tomografia Computadorizada por Raios X , Idoso , Descompressão Cirúrgica/métodos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade
16.
Coluna/Columna ; 16(3): 236-239, July-Sept. 2017. tab, graf
Artigo em Inglês | LILACS | ID: biblio-890899

RESUMO

ABSTRACT Objective: To report two cases of multilevel cervical spondylotic myelopathy with monosegmental instability, in which we performed a minimally invasive microsurgical transmuscular approach with tubular retractors to create a single-door plate laminoplasty combined with fixation of the unstable segment with lateral mass screws. Methods: The surgical procedures were performed by the senior author. In both patients, the follow-up was performed using the Oswestry Disability Index (ODI), the Visual Analogue Scale for neck and radicular pain (radVAS, neckVAS), the Neck Disability Index (NDI) and the Short Form 36 (SF-36), in the preoperative (preop) and postoperative (postop) periods, and at 1, 3, 6, 12, 18 and 24 months. A radiological evaluation also was performed, which included AP, lateral and flexion-extension films at 6, 12 and 24 months and CT-scan at 12 months. Results: Case 1 - preop ODI: 40%, 24 months postop ODI: 4%; preop radVAS: 7, 24 months radVAS: 0; preop neckVAS: 8, postop 24 months neckVAS: 0; preopNDI: 43%, 24 months PostopNDI: 8%; SF-36 - preop Physical Functioning (PF): 40, preop Vitality (VT): 40, preop Emotional role functioning (RE): 33.3, Bodily pain (BP): 51, General Health (GH): 57, Social Functioning (SF): 75; postop PF: 95, VT: 95, RE: 100, BP: 74, GH: 87, SF: 100. Case 2 - preopODI: 46%, 24 months postopODI: 10%; preop radVAS: 7, 24m radVAS: 0; preop neckVAS: 9, postop 24 months neckVAS: 0; preopNDI: 56%, 24 months PostopNDI: 15%; SF-36 - preop PF: 39, VT: 45, RE: 33.3, BP: 50, GH: 49, SF: 70; postop PF: 90, VT: 100, RE: 100, BP: 82, GH: 87, SF: 100. No complications, cervical instability or signs of failed surgery were found trough and at final follow-up at 24 months. We found significant clinical improvement in both patients. Conclusions: Minimally invasive cervical laminoplasty combined with lateral mass screw fixation for the unstable segment is a useful technique in cases with multilevel cervical spondylotic myelopathy associated with monosegmental instability. Additional comparative studies are needed to establish its efficacy.


RESUMO Objetivo: Relatar dois casos de mielopatia espondilótica cervical em múltiplos níveis com instabilidade de um só segmento, nos quais realizamos uma microcirurgia minimamente invasiva por via transmuscular com retratores tubulares para criar uma laminoplastia em porta aberta com fixação do segmento instável com parafusos de massa lateral. Métodos: Os procedimentos cirúrgicos foram realizados pelo autor principal. Em ambos os pacientes, o acompanhamento foi realizado usando Índice de Incapacidade de Oswestry (ODI), Escala Visual Analógica para dor cervical e radicular (EVAc e EVArad), Índice de Incapacidade Relacionada ao Pescoço (NDI) e o Short Form 36 (SF-36) nos períodos pré-operatório (pré-op) e pós-operatório (pós-op) e em 1, 3, 6, 9, 12, 18 e 24 meses. Realizou-se também a avaliação radiológica, que incluiu vistas AP, laterais e de flexão-extensão aos 6, 12 e 24 meses e TC aos 12 meses. Resultados: Caso 1 - ODI pré-op: 40%, ODI 24 meses pós-op: 4%; pré-op EVArad: 7, EVArad 4 meses: 0; EVAc pré-op: 8, EVAc pós-op 24 meses: 0; NDI pré-op: 43%, NDI pós-op 24 meses: 8%; SF-36 - capacidade funcional (CF) pré-op: 40, vitalidade (VT) pré-op: 40, aspectos emocionais (AE) pré-op: 33,3, dor (D): 51, estado geral da saúde (ES): 57, aspectos sociais (AS): 75; CF : 95, VT: 95, AE: 100, D: 74, ES: 87, AS: 100 pós-op. Caso 2 - ODI pré-op: 46%, ODI 24 meses pós-op: 10%; EVArad pré-op : 7, EVArad 24 meses: 0; EVAc pré-op: 9, EVAc 24 meses pós-op: 0; NDI pré-op: 56%, NDI 24 meses pós-op: 15%; SF-36 pré-op: CF: 39, VT: 45, AE: 33,3, D: 50, ES: 49, AS: 70; CF: 90, VT: 100, AE: 100, D: 82, ES: 87, AS: 100 pós-op. Não houve complicações, instabilidade cervical ou sinais de falha da cirurgia durante o acompanhamento de 24 meses. Ambos os pacientes apresentaram melhoras significativas. Conclusões: A laminoplastia cervical minimamente invasiva combinada com fixação de parafuso de massa lateral do segmento instável é uma técnica útil nos casos com mielopatia espondilótica cervical em vários níveis associada à instabilidade de um só segmento. É necessário realizar estudos comparativos adicionais para estabelecer a eficácia do procedimento.


RESUMEN Objetivo: Relatar dos casos de mielopatía espondilótica cervical en múltiples niveles con inestabilidad de un solo segmento, en los que realizamos una microcirugía mínimamente invasiva por vía transmuscular con retractores tubulares para crear una laminoplastia en puerta abierta con fijación del segmento inestable con tornillos de masa lateral. Métodos: Los procedimientos quirúrgicos fueron realizados por el autor principal. En ambos pacientes, el seguimiento fue realizado usando Índice de Discapacidad de Oswestry (ODI), Escala Visual Analógica para dolor en el cuello y radicular (EVAc y EVArad), Índice de Discapacidad Cervical (NDI) y el Short Form 36 (SF-36) en los períodos preoperatorio (preop) y postoperatorio (posop) y en 1, 3, 6, 9, 12, 18 y 24 meses. Se realizó también la evaluación radiológica, que incluyó proyecciones AP, laterales y de flexión-extensión a los 6, 12 y 24 meses y TC a los 12 meses. Resultados: Caso 1 - ODI preop: 40%, ODI 24 meses posop: 4%; EVArad preop: 7, EVArad 4 meses: 0; EVAc preop: 8, EVAc posop 24 meses: 0; NDI preop: 43%, NDI posop 24 meses: 8%; SF-36 - función física (FF) preop: 40, vitalidad (VT) preop: 40, rol emocional (RE) preop: 33,3, dolor corporal (DC): 51, salud general (SG): 57, función social (FS): 75; FF: 95, VT: 95, RE: 100, DC: 74, SG: 87, FS: 100 posop. Caso 2 - ODI preop: 46%, ODI 24 meses posop: 10%; EVArad preop: 7, EVArad 24 meses: 0; EVAc preop: 9, EVAc 24 meses posop: 0; NDI preop: 56%, NDI 24 meses posop: 15%; SF-36 preop: FF: 39, VT: 45, RE: 33,3, D: 50, SG: 49, FS: 70 preop; FF: 90, VT 100, RE 100, DC 82, SG: 87, FS: 100 posop. No hubo complicaciones, inestabilidad cervical o signos de falla de la cirugía durante el seguimiento de 24 meses. Ambos pacientes presentaron mejoras significativas. Conclusiones: La laminoplastia cervical mínimamente invasiva combinada con fijación de tornillo de masa lateral del segmento inestable es una técnica útil en los casos con mielopatía espondilótica cervical en múltiples niveles asociada a la inestabilidad de un solo segmento. Es necesario realizar estudios comparativos adicionales para establecer la eficacia del procedimiento.


Assuntos
Humanos , Procedimentos Cirúrgicos Minimamente Invasivos/métodos , Doenças da Medula Espinal , Parafusos Ósseos , Laminectomia
17.
World Neurosurg ; 106: 174-184, 2017 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-28669872

RESUMO

OBJECTIVE: To compare the outcomes between patients older and younger than 65 years who underwent single-level minimally invasive transforaminal interbody fusion (MI-TLIF) surgery. METHODS: This study is a retrospective analysis of 76 patients who underwent MI-TLIF between April 2012 and June 2016. Group A consisted of 35 patients (<65 years) and group B consisted of 41 patients (≥65 years). Intraoperative data were recorded. The evaluation of clinical outcomes was based on the visual analog scale for back and leg pain and the Oswestry Disability Index. Radiologic outcomes including cage subsidence, end plate cyst formation, and fusion rate were assessed. RESULTS: The mean age of the study subjects was 65.3 years, and the mean duration of follow-up was 18.98 months. Group B had a higher rate of comorbidities compared with group A (90.24% vs. 57.14%, respectively; P < 0.05). There was no statistically significant difference in the rate of complications between the groups (group A, 14.29%; group B, 17.07%). Clinical outcomes significantly improved in both groups postoperatively (P < 0.05). Although bony fusion in group A was slightly higher than that in group B, the fusion rate was not statistically different according to age. There were no statistically significant differences in the rates of cage subsidence or positive cyst sign between the groups. CONCLUSIONS: MI-TLIF presented similar safeness and acceptable outcomes and complication rate in both groups. Cyst formation may be aggravated by cage subsidence, because cage subsidence was a useful potential predictor of cyst formation.


Assuntos
Degeneração do Disco Intervertebral/cirurgia , Vértebras Lombares/cirurgia , Fusão Vertebral/métodos , Adulto , Idoso , Dor nas Costas/etiologia , Perda Sanguínea Cirúrgica , Índice de Massa Corporal , Proteína Morfogenética Óssea 2/metabolismo , Feminino , Humanos , Degeneração do Disco Intervertebral/patologia , Tempo de Internação/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Procedimentos Cirúrgicos Minimamente Invasivos/métodos , Dor Musculoesquelética/etiologia , Duração da Cirurgia , Medição da Dor , Resultado do Tratamento
18.
J Spine Surg ; 3(1): 16-22, 2017 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-28435913

RESUMO

BACKGROUND: Minimally invasive transforaminal lumbar interbody fusion (MI-TLIF) has become one of the standard techniques for approaching ipsilateral decompression, anterior column fusion, and posterior stabilization. This procedure is usually accompanied by the placement of bilateral transpedicular screws in the corresponding segment. The purpose of this study was to evaluate the clinical efficacy of unilateral screw fixation compared with bilateral fixation in patients diagnosed with low-grade symptomatic lumbar spondylolisthesis who underwent an MI-TLIF technique. METHODS: A prospective and comparative study was performed in 67 patients with grade 1 symptomatic lumbar spondylolisthesis. The sample was allocated on both unilateral fixation group (n=33) and bilateral fixation group (n=34). Clinical outcomes were evaluated using Oswestry Disability Index (ODI), visual analogue scale (VAS) for leg and back pain, and Short Form 36 Health Survey (SF-36), preoperatively, and at 1, 3, 6, and 12 months postoperatively. Changes over time and differences between the groups were analyzed. Statistical analyses included: Friedman test, Student's t-test and Mann-Whitney's U. A two-tailed P value of <0.05 was considered significant. RESULTS: During 1-year of evaluation there were no significant clinical differences between both groups. CONCLUSIONS: Patients with grade 1 symptomatic lumbar spondylolisthesis treated with MI-TLIF with unilateral screw fixation had similar clinical results than those treated with bilateral fixation at 12 months postoperatively.

19.
J Spine Surg ; 3(1): 64-70, 2017 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-28435920

RESUMO

Various minimally invasive techniques have been reported as an alternative to conventional lumbar decompression. The major advantage of these minimally invasive procedures lies in their reduction of unnecessary exposure and tissue trauma. Our objective was to describe a minimally invasive procedure for lumbar spinal stenosis decompression by enlarging the lumbar interspinous space, approaching it with a tubular retractor, and assisting with microscopy. Thoracolumbar fascia and paravertebral muscles are preserved throughout the whole procedure. Iatrogenic instability of the spine can be avoided if during the procedure both joints are just undercut in order to decompress the subarticular space. The approach described in this manuscript could be used as an alternate minimally invasive surgical procedure for the treatment of central and lateral lumbar spinal stenosis.

20.
Cir Cir ; 85(6): 544-548, 2017.
Artigo em Espanhol | MEDLINE | ID: mdl-27751507

RESUMO

BACKGROUND: Arachnoid cysts of spine are a very rare occurrence. The aetiology still remains unclear, but the most accepted explanation is the existence of areas of weakness in the spinal dura. Symptoms depend on the location in the spine. Magnetic resonance imaging is used for its diagnosis. Management depends of clinical presentation, and the surgery is reserved for patients with neurological impairment. CLINICAL CASE: A case is described of 67 year-old male with myelopathy and radiculopathy symptoms, both diagnosed simultaneously. The magnetic resonance imaging was used to diagnose a thoracolumbar extradural arachnoid cyst from T12-L2 and lumbar spinal canal stenosis. The patient was treated with a puncture procedure to empty the cyst and decompress the neural elements. There was a clinical improvement of myelopathy syndrome after puncture procedure. One month later, the patient underwent a minimally invasive surgical approach to decompress the neural elements in lumbar spine, achieving improvement of the radiculopathy syndrome and neurogenic claudication in both legs. CONCLUSION: There is currently no standard minimally invasive approach to surgically treat these cysts, but if the patient has mild symptoms, clinical observation is recommended.


Assuntos
Cistos Aracnóideos/cirurgia , Doenças da Coluna Vertebral/cirurgia , Idoso , Cistos Aracnóideos/complicações , Cistos Aracnóideos/diagnóstico por imagem , Descompressão Cirúrgica , Fluoroscopia , Humanos , Claudicação Intermitente/etiologia , Vértebras Lombares , Imagem por Ressonância Magnética , Masculino , Procedimentos Cirúrgicos Minimamente Invasivos , Polirradiculopatia/etiologia , Radiografia Intervencionista , Compressão da Medula Espinal/etiologia , Doenças da Coluna Vertebral/complicações , Doenças da Coluna Vertebral/diagnóstico por imagem , Punção Espinal , Estenose Espinal/etiologia , Vértebras Torácicas
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