Your browser doesn't support javascript.
loading
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 583
Filtrar
1.
Mymensingh Med J ; 29(3): 560-567, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32844794

RESUMO

Variety of conditions may be responsible for low back pain but lumber spinal canal stenosis is an important cause of low back pain. Lumber spinal canal stenosis usually presents with low backache with neurogenic claudication and shortness of walking distance in adult patient. Surgical management of lumbar spinal canal stenosis by decompression surgery is effective method. This prospective interventional study was performed in patient with clinical features like low back pain with radicular pain, neurogenic claudication, signs of root compression, positive MRI findings attending in department of Orthopaedic Surgery Mymensingh Medical College Hospital and Private Hospital from July 2016 to June 2019. Thirty patients were evaluated among those 20(66.6%) were 50 years and above. The mean age was 47.5±1.6 years. Male to female ratio was roughly 8:1. Almost all of the patients had low backache with radiation to the back of the thigh and leg with motor weakness (60%). About 66.6% of the patients had sensory deficit and 83.3% had neurogenic claudication. Majority (80.0%) of the patients at presentation had a suffering of 12 or >12 months. The mean duration of suffering was 14.7±5.1 months. About 55% of the patients were able to perform heel-walking and 36.0% tip-toe walking. Nearly 57% of the patients had sensory deficit along the distribution of 1st sacral nerve and 53.3% along the distribution of lumber 5 nerves. Diagnosis shows that 16.6% of patients had L4 lesion, 50% L5, 10.0% patients had L4 & L5 and 46.6% S1. Laminectomy was done in 26.6% of patients, laminectomy and disectomy in 33.3% and laminectomy, discectomy & foraminal decompression in 40.0% of patients. Twenty five (83.5%) of patients was free from symptoms. Eighty percent (80.0%) of patients shows minimal disability and 20.0% moderate disability on the basis of Oswestry Disability Index, while by MacNab criteria, most (80%) of patients was excellent, 10% good and another 10% fair. Repeated measure ANOVA statistics showed that mean Oswestry score decreased significantly from 54.5% at baseline to 22% at the end of 1 year (p<0.001).


Assuntos
Laminectomia , Estenose Espinal/cirurgia , Adulto , Constrição Patológica , Descompressão Cirúrgica , Feminino , Humanos , Vértebras Lombares/cirurgia , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Canal Vertebral/cirurgia , Resultado do Tratamento
3.
BMC Neurol ; 20(1): 151, 2020 Apr 23.
Artigo em Inglês | MEDLINE | ID: mdl-32326909

RESUMO

BACKGROUND: Intracranial hypotension is a disorder characterized by low cerebrospinal fluid (CSF) pressure typically caused by loss of CSF. Although some mechanisms account for the CSF leakage have been elucidated, spinal canal stenosis has never been reported as a pathological cause of intracranial hypotension. C1-C2 sign is a characteristic imaging feature, which indicates CSF collection between the spinous processes of C1 and C2, occasionally observed on magnetic resonance imaging (MRI) in patients with intracranial hypotension. CASE PRESENTATION: A 58-year-old man was presented to our institute with complaints of posterior cervical pain persisting for 3 months, along with numbness and muscle weakness of extremities. A fat suppression T2-weighted image of MRI illustrated fluid collection in the retrospinal region at C1-C2 level, and an 111In-DTPA cisternoscintigram clearly revealed the presence of CSF leakage into the same region. The MRI also showed stenosis in spinal canal at C3/4 level, and a computed tomography (CT) myelogram suggested a blockage at the same level. We gave a diagnosis as intracranial hypotension due to the CSF leakage, which might be caused by the spinal canal stenosis at C3/4 level. Despite 72 h of conservative therapy, a brain CT showed the development of bilateral subdural hematomas. We, therefore, performed burr-hole drainage of the subdural hematoma, blood-patch therapy at C1/2 level, and laminoplasty at C3-4 at the same time. Improvement of symptoms and imaging features which suggested the CSF leak and subdural hematoma were obtained post-operatively. CONCLUSION: The present case suggested the mechanism where the CSF leakage was revealed as fluid collection in the retrospinal region at C1-C2 level. Increased intradural pressure due to the spinal canal stenosis resulted in dural tear. CSF leaked into the epidural space and subsequently to the retrospinal region at C1-C2 level, due to the presence of spinal canal stenosis caudally as well as the vulnerability of the tissue structure in the retrospinal region at C1-C2 level. Thus, our theory supports the mechanisms of previously reported CSF dynamics associated to C1-C2 sign, and also, we suggest spinal canal stenosis as a novel etiology of intracranial hypotension.


Assuntos
Vazamento de Líquido Cefalorraquidiano , Vértebras Cervicais , Canal Vertebral , Estenose Espinal , Vazamento de Líquido Cefalorraquidiano/diagnóstico , Vazamento de Líquido Cefalorraquidiano/etiologia , Vazamento de Líquido Cefalorraquidiano/cirurgia , Vértebras Cervicais/diagnóstico por imagem , Vértebras Cervicais/fisiopatologia , Vértebras Cervicais/cirurgia , Drenagem , Hematoma Subdural/diagnóstico por imagem , Hematoma Subdural/etiologia , Hematoma Subdural/cirurgia , Humanos , Imagem por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Canal Vertebral/diagnóstico por imagem , Canal Vertebral/fisiopatologia , Canal Vertebral/cirurgia , Estenose Espinal/complicações , Estenose Espinal/diagnóstico , Estenose Espinal/cirurgia
4.
Acta Neurochir (Wien) ; 162(2): 311-315, 2020 02.
Artigo em Inglês | MEDLINE | ID: mdl-31823120

RESUMO

BACKGROUND: Cervical laminectomy is a common strategy to decompress the spinal canal. METHODS: The anatomy of the cervical spine and surrounding critical structures as viewed from the posterior approach is described. The use of a high-speed drill with a footplate attachment to make laminar troughs with an en-bloc subaxial cervical laminectomy is described with a discussion on surgical technique and complication avoidance. CONCLUSION: This technique allows for a safe, comfortable, and rapid decompression of the cervical spine with minimal risk. For routine cases, this may potentially be more safe and cost-effective than using a cutting bur or bone scalpel attachment.


Assuntos
Vértebras Cervicais/cirurgia , Descompressão Cirúrgica/métodos , Laminectomia/métodos , Idoso , Descompressão Cirúrgica/instrumentação , Feminino , Humanos , Laminectomia/instrumentação , Masculino , Pessoa de Meia-Idade , Canal Vertebral/cirurgia , Instrumentos Cirúrgicos
5.
Spine (Phila Pa 1976) ; 45(10): 657-665, 2020 May 15.
Artigo em Inglês | MEDLINE | ID: mdl-31809470

RESUMO

STUDY DESIGN: Retrospective review of prospectively collected data. OBJECTIVE: To evaluate (1) if the segmental resection of the content of the spinal canal could provide an Enneking appropriate tumor-free margin for local control of primary bone tumors surrounding and invading the canal and (2) the safety profile of the segmental resection of the neurostructures. SUMMARY OF BACKGROUND DATA: Treatment outcomes of primary malignant and benign aggressive bone tumors of the spine have been dramatically changed by the application of the musculoskeletal oncologic principles described by Enneking. However, the efficacy of spinal oncology surgery might be limited by unique features of spinal anatomy. METHODS: Database search was conducted with the following inclusion criteria: en bloc resection, segmental inclusion of the spinal canal content in the surgical specimen, histologically proven diagnosis, minimum follow-up of 2 years. Exclusion criteria were piecemeal excision of the tumor (debulking) and diagnosis other than primary bone tumors (metastasis, or local extension of extraosseous tumors). RESULTS: A consecutive cohort of eight patients (three men, five women) was available for review. Two patients died within 3 months from the surgery for systemic disease progression or sequelae of the surgery. En bloc resection with segmental spinal canal content inclusion was able to achieve local control of the disease in four out of remaining six cases (66.7%) at an average follow-up of 68.7 months (range 12-174 mo). Three patients in whom local control was achieved are free from disease at an average follow-up of 98.7 months (range 38-174), and one died for systemic disease progression (after 38 mo). Seven out of 8 patients (87.5%) experienced overall 16 complications. CONCLUSION: En bloc resection including the spinal canal content (spinal amputation) to achieve a tumor-free margin might be considered to perform an Enneking appropriate treatment for motivated patients. LEVEL OF EVIDENCE: 4.


Assuntos
Amputação/métodos , Canal Vertebral/diagnóstico por imagem , Canal Vertebral/cirurgia , Neoplasias da Coluna Vertebral/diagnóstico por imagem , Neoplasias da Coluna Vertebral/cirurgia , Adolescente , Adulto , Idoso , Estudos de Coortes , Feminino , Seguimentos , Humanos , Vértebras Lombares/diagnóstico por imagem , Vértebras Lombares/cirurgia , Masculino , Pessoa de Meia-Idade , Recidiva Local de Neoplasia/diagnóstico por imagem , Recidiva Local de Neoplasia/cirurgia , Estudos Prospectivos , Estudos Retrospectivos , Vértebras Torácicas/diagnóstico por imagem , Vértebras Torácicas/cirurgia , Resultado do Tratamento , Adulto Jovem
6.
J Neurol Surg A Cent Eur Neurosurg ; 81(1): 71-74, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31127594

RESUMO

Ectopic adrenal cortical neoplasms of the spinal cord are extremely rare. To date only 10 such cases have been described. We present a case of a 46-year-old woman with lower back pain radiating to the right gluteal and posterior femoral regions, without a history of traumatic injury. Magnetic resonance imaging (MRI) of the thoracic and lumbar spine showed an intradural, extramedullary, well-circumscribed, contrast-enhancing lesion located in the T12-L1 region, hypo- to isointense on T2-weighted imaging, and isointense on T1. Complete surgical removal of the lesion, measuring 3 × 2.5 × 1 cm, was performed. The histopathologic findings revealed the lesion was an ectopic adrenal cortical adenoma, with sheets and nests of round and polygonal cells, mostly round regular nuclei, abundant eosinophilic cytoplasm, 1 mitosis per 10 high-power fields, and without necrosis. These tumors have nonspecific MRI features and therefore can be easily confused with other common spinal tumor types such as ependymoma, schwannoma, meningioma, and metastasis. Although rare, ectopic adrenal spinal cord adenomas should be taken into account in the differential diagnosis of spinal canal intradural neoplasms.


Assuntos
Adenoma Adrenocortical/diagnóstico por imagem , Canal Vertebral/diagnóstico por imagem , Neoplasias da Medula Espinal/diagnóstico por imagem , Adenoma Adrenocortical/patologia , Adenoma Adrenocortical/cirurgia , Feminino , Humanos , Vértebras Lombares/diagnóstico por imagem , Vértebras Lombares/patologia , Vértebras Lombares/cirurgia , Imagem por Ressonância Magnética , Pessoa de Meia-Idade , Canal Vertebral/patologia , Canal Vertebral/cirurgia , Neoplasias da Medula Espinal/patologia , Neoplasias da Medula Espinal/cirurgia , Vértebras Torácicas/diagnóstico por imagem , Vértebras Torácicas/patologia , Vértebras Torácicas/cirurgia , Resultado do Tratamento
7.
Spine (Phila Pa 1976) ; 45(7): 474-482, 2020 Apr 01.
Artigo em Inglês | MEDLINE | ID: mdl-31651687

RESUMO

STUDY DESIGN: Database analysis. OBJECTIVE: To evaluate complications and mortality in patients undergoing surgical management of extradural spinal tumors in New York State. SUMMARY OF BACKGROUND DATA: Metastatic spine surgery has a high rate of complications but most studies are limited to single institutions. METHODS: The Statewide Planning and Research Cooperative System was used to identify patients with extradural spinal tumors undergoing surgery in New York State from 2006 to 2015. Bivariate and multivariate logistic regression analyses were used to estimate outcomes. RESULTS: Four thousand seven hundred sixty-seven patients were identified, the majority of patients were male and white a median age of 61. The complication rate was 17.6% and the mortality rate within 30 days of discharge was 12.2%. Multivariate analysis showed the odds of complications were higher in males compared with females (odds ratio [OR]: 1.27; 95% confidence interval [CI]: 1.05-1.52, P = 0.01), and patients on Medicaid compared with patients on private insurance (OR: 1.42; 95% CI: 1.03-1.96, P = 0.03). Analysis of hospital characteristics showed lower volume hospitals (OR 1.48; 95% CI: 1.03-2.13, P value = 0.03), and teaching hospitals (OR: 1.47; 95% CI: 1.03-2.09, P = 0.04), have higher odds of complications compared with high-volume hospitals and nonteaching hospitals. Multivariate analysis showed higher odds of mortality within 30 days of discharge in patients of older age (OR: 1.02; 95% CI: 1.01-1.03, P value = 0.001), low-volume hospitals compared with high-volume hospitals (OR: 1.36; 95% CI: 1.09-1.79, P value = 0.02), hospitals with low bed size compared with high bed size (OR: 1.43; 95% CI: 1.12-1.83, P value = 0.01), and urban hospitals compared with rural hospitals (OR: 3.04; 95% CI: 2.03-4.56, P value = 0.001). CONCLUSION: Low-volume hospitals are associated with complications and mortality in patients with metastatic spine disease. LEVEL OF EVIDENCE: 3.


Assuntos
Gerenciamento Clínico , Mortalidade Hospitalar/tendências , Hospitais com Baixo Volume de Atendimentos/tendências , Complicações Pós-Operatórias/mortalidade , Neoplasias da Coluna Vertebral/mortalidade , Neoplasias da Coluna Vertebral/cirurgia , Idoso , Bases de Dados Factuais/tendências , Feminino , Hospitais com Alto Volume de Atendimentos/tendências , Hospitais de Ensino/tendências , Humanos , Masculino , Medicaid/tendências , Pessoa de Meia-Idade , New York/epidemiologia , Alta do Paciente/tendências , Complicações Pós-Operatórias/etiologia , Estudos Retrospectivos , Canal Vertebral/patologia , Canal Vertebral/cirurgia , Neoplasias da Coluna Vertebral/diagnóstico por imagem , Estados Unidos/epidemiologia
8.
Med Sci Monit ; 25: 7370-7375, 2019 Oct 01.
Artigo em Inglês | MEDLINE | ID: mdl-31571675

RESUMO

BACKGROUND Many clinical studies have assessed the association of laminoplasty opening size (LOS) with sagittal canal diameter (SCD) based on single-door cervical laminoplasty (SDCL). Nevertheless, the "worn-off" lamina extracted in SDCL was neglected in these reports. We aimed to develop a simple mathematical model to analyze the relationship between the effective LOS and SCD, taking into consideration the worn-off lamina. MATERIAL AND METHODS A total of 106 patients treated by SDCL at our hospital were included in this study. Pre-operative and post-operative SCDs were assessed using a picture archiving and communication system (PACS) based on computed tomography scans. Mini-plate sizes as well as drill bit diameters were recorded in detail in order to determine the effective LOS for each vertebral lamina involved. RESULTS SCD in all patients was increased significantly after SDCL (P<0.01). A linear correlation was found between effective LOS and the post-operative SCD increment from C3 to C7 (R²>0.933, P<0.001). The 12 mm mini-plate was most often used in SDCL, accounting for 64.45% of all cases, whereas 10 mm and 16 mm mini-plates were the least used, accounting for 3.85% and 3.00%, respectively. CONCLUSIONS There is a strong linear correlation between effective LOS and the post-operative SCD increment. The SCD was increased by about 0.5 mm per mm increase in effective LOS. Thus, post-operative SCD could be precisely calculated and predicted, enabling the selection of optimal mini-plate prior to SDCL.


Assuntos
Vértebras Cervicais/cirurgia , Laminectomia/métodos , Laminoplastia/métodos , Placas Ósseas , China , Humanos , Modelos Teóricos , Canal Vertebral/cirurgia , Estenose Espinal/cirurgia
9.
Acta Neurochir (Wien) ; 161(11): 2375-2380, 2019 11.
Artigo em Inglês | MEDLINE | ID: mdl-31506727

RESUMO

BACKGROUND: Bilateral lumbar spinal canal decompression via unilateral approach is a surgical way to treat degenerative spinal canal stenosis. METHOD: We report the treatment of degenerative lumbar spinal canal stenosis by removing overgrown ligaments, bone, and other compromising tissue on both sides of the spinal canal, using one side approach, avoiding surgical trauma of the counter side of the spine. CONCLUSION: This technique allows to achieve perfect results using common microsurgical instruments and Caspar distractor for one or multilevel surgery.


Assuntos
Descompressão Cirúrgica/métodos , Microcirurgia/métodos , Complicações Pós-Operatórias/prevenção & controle , Canal Vertebral/cirurgia , Estenose Espinal/cirurgia , Descompressão Cirúrgica/efeitos adversos , Humanos , Vértebras Lombares/cirurgia , Microcirurgia/efeitos adversos , Complicações Pós-Operatórias/etiologia
10.
World Neurosurg ; 131: 62-64, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31356981

RESUMO

BACKGROUND: Gunshot wounds to the spine are devastating injuries. Rarely, the bullet has been reported to migrate. Migration is associated with progressive neurologic deficits that often improve with bullet removal. The authors report a case of removal of a migrating lumbar spine bullet. This is supplemented by an operative video and a review of the literature. CASE DESCRIPTION: A 31-year-old man presented to the emergency department with multiple gunshot wounds and lower-extremity paresthesia. A ballistic injury occurred with an entry wound in the right posterior soft tissues, traversing the right paraspinal muscle and fracturing the left lumbar 5 pedicle and left lumbar 4 transverse process. The bullet was positioned within the spinal canal at the lumbar 3/4 interspace. His spinal injury was managed nonoperatively due to his traumatic injuries and findings of minimal neurologic deficit without cerebrospinal fluid leak. The patient returned to the neurosurgery clinic a year later and was found to have worsening low back pain, decreased sensation throughout the left leg, and radiating pain throughout the right leg. Imaging demonstrated the bullet had migrated caudally to the midlumbar 5 vertebral body. Given the patient's progressive symptoms and migration of the bullet fragment, informed consent was obtained for a laminectomy and removal of the intradural bullet fragment. CONCLUSIONS: Neurosurgical treatment for gunshot wounds remains controversial. Cauda equina or lumbosacral level wounds are often incomplete and may improve with surgical decompression and bullet removal. Migrating bullet fragments throughout the spine and brain lead to worsened neurologic function, which can be reversed by removal. Movement of the bullet during surgery should be expected, and intraoperative fluoroscopy and patient positioning can help to properly localize the bullet and aid in its removal.


Assuntos
Migração de Corpo Estranho/cirurgia , Vértebras Lombares/cirurgia , Canal Vertebral/cirurgia , Ferimentos por Arma de Fogo , Adulto , Migração de Corpo Estranho/complicações , Humanos , Hipestesia/etiologia , Laminectomia , Perna (Membro) , Dor Lombar/etiologia , Masculino , Dor/etiologia , Parestesia/etiologia
11.
World Neurosurg ; 130: e90-e97, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31173916

RESUMO

OBJECTIVE: Few studies have addressed the causes of poor expansion of the spinal canal after open-door laminoplasty (ODL) that require revision surgery. The aim of this study is to identify the reasons of poor expansion of the spinal canal after ODL and to discuss the surgical methods and clinical outcomes of the posterior revision surgery. METHODS: All patients who underwent posterior revision surgery because of poor expansion of the spinal canal after ODL were retrospectively reviewed at our spine center. Clinical data, radiologic findings, method of surgical revision, interval between surgeries, Japanese Orthopaedic Association (JOA) score, and complications were analyzed. RESULTS: We identified 16 patients that underwent posterior revision surgery because of poor expansion of the spinal canal after ODL. The main causes of poor expansion of the spinal canal included inadequate expansion degree of the spinal canal (75%, 12/16) and improper expansion range of the spinal canal (25%, 4/16). Revision surgery was performed with posterior ODL, laminectomy and fusion (LCF), or laminectomy of responsible lamina. The interval between the initial procedure and revision surgery was 72.2 months (range, 0.5-168 months). The mean JOA score was restored from 10.6 (range, 8-13) to 14.3 (range, 13-17) after the revision surgery. CONCLUSIONS: The main causes of poor expansion of the spinal canal after ODL were inadequate expansion degree of the spinal canal and improper expanded range of the spinal canal. Posterior revision surgeries, such as ODL, LCF, and laminectomy of responsible lamina, could guarantee fine clinical results.


Assuntos
Medula Cervical/cirurgia , Laminoplastia/métodos , Reoperação , Canal Vertebral/cirurgia , Doenças da Medula Espinal/cirurgia , Adulto , Idoso , Feminino , Humanos , Laminoplastia/efeitos adversos , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/etiologia , Estudos Retrospectivos , Canal Vertebral/patologia , Resultado do Tratamento
12.
Orthopade ; 48(10): 824-830, 2019 Oct.
Artigo em Alemão | MEDLINE | ID: mdl-31053867

RESUMO

BACKGROUND: Lumbar spinal canal stenosis is frequently found among elderly patients and significantly limits their quality of life. Non-surgical therapy is an initial treatment option; however, it does not eliminate the underlying pathology. Surgical decompression of the spinal canal has now become the treatment of choice. OBJECTIVE: Minimalization of surgical approach strategies with maintaining sufficient decompression of the spinal canal and avoiding disadvantages of macrosurgical techniques, monolateral paravertebral approach with bilateral intraspinal decompression, specific surgical techniques. MATERIALS AND METHODS: Minimally invasive decompression techniques using a microscope or an endoscope are presented and different surgical strategies depending on both the extent (mono-, bi-, and multisegmental) and the location of the stenosis (intraspinal central, lateral recess, foraminal) are described. RESULTS: Minimally invasive microscopic or endoscopic decompression procedures enable sufficient widening of the spinal canal. Disadvantages of macrosurgical procedures (e. g., postoperative instability) can be avoided. The complication spectrum overlaps partially with that of macrosurgical interventions, albeit with significantly less marked severity. Subjective patient outcome is clearly improved. CONCLUSIONS: Referring to modern minimally invasive decompression procedures, surgery of lumbar spinal canal stenosis represents a rational and logical treatment alternative, since causal treatment of the pathology is only possible with surgery.


Assuntos
Descompressão Cirúrgica/métodos , Vértebras Lombares/cirurgia , Procedimentos Cirúrgicos Minimamente Invasivos/métodos , Canal Vertebral/cirurgia , Estenose Espinal/cirurgia , Idoso , Constrição Patológica , Humanos , Laminectomia , Vértebras Lombares/patologia , Vértebras Lombares/fisiopatologia , Avaliação de Resultados em Cuidados de Saúde , Qualidade de Vida , Canal Vertebral/patologia , Canal Vertebral/fisiopatologia , Medula Espinal , Estenose Espinal/patologia , Estenose Espinal/fisiopatologia , Espondilolistese/cirurgia , Resultado do Tratamento
13.
BMC Musculoskelet Disord ; 20(1): 205, 2019 May 10.
Artigo em Inglês | MEDLINE | ID: mdl-31077170

RESUMO

BACKGROUND: This study aimed to evaluate the safety and feasibility of subaxial cervical pedicle screw (CPS) insertion by comparing the morphological parameters between developmental canal stenosis (DCS) and non-developmental canal stenosis (NDCS) patients. METHODS: A total of 120 Chinese patients who had undergone cervical spinal multiplanar CT imaging from September 2010 to December 2014 were included in this study. According to the Pavlov ratio (PR), participants were classified into a DCS group (PR < 0.82) and an NDCS group (PR ≥0.82). CT reconstruction images of the cervical pedicles from C3 to C7 were selected for further analysis, and detailed morphological parameters for subaxial CPS insertion including pedicle outer width (POW), tiny cervical pedicle (TCP), pedicle transverse angle (PTA), and range of safe angle (RSA) were measured and compared in these two groups. RESULTS: A total of 600 images (1200 pedicles) from these 120 patients were measured. The POW in the DCS group was wider than that in the NDCS group at each level, while the number of TCPs in the DCS group was significantly less than that in the NDCS group at the C3, C4, and C5 vertebrae. There was no significant difference in PTA at any level between the two groups, however the RSA in the DCS group was greater than that in the NDCS group from C4 to C7. CONCLUSIONS: Subaxial CPS for DCS patients may be safer and more feasible than that for NDCS patients. However, as the subaxial cervical pedicle is relatively small, CPS insertion is difficult and preoperative CT evaluation is recommended for both DCS and NDCS patients.


Assuntos
Procedimentos Ortopédicos/métodos , Parafusos Pediculares , Canal Vertebral/cirurgia , Compressão da Medula Espinal/cirurgia , Estenose Espinal/cirurgia , Adulto , Idoso , Vértebras Cervicais/diagnóstico por imagem , Vértebras Cervicais/cirurgia , Estudos de Viabilidade , Feminino , Humanos , Processamento de Imagem Assistida por Computador , Masculino , Pessoa de Meia-Idade , Procedimentos Ortopédicos/efeitos adversos , Procedimentos Ortopédicos/instrumentação , Canal Vertebral/diagnóstico por imagem , Canal Vertebral/crescimento & desenvolvimento , Compressão da Medula Espinal/etiologia , Estenose Espinal/diagnóstico por imagem , Estenose Espinal/etiologia , Tomografia Computadorizada por Raios X , Resultado do Tratamento
14.
World Neurosurg ; 128: e315-e321, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31028987

RESUMO

OBJECTIVE: To describe the operative methods and to investigate the efficacy of ventral neural decompression under microscopic vision with oblique lumbar interbody fusion (OLIF). METHODS: Twelve patients with extruded or sequestered disk were treated with ventral neural decompression under microscopic vision via the working corridor of routine OLIF. Their clinical data were gathered and analyzed retrospectively. The clinical efficacy was evaluated by the Oswestry Disability Index (ODI), visual analog scale (VAS), and relevant radiographic parameters. RESULTS: All operations went smoothly, with an average operative time of 151.7 ± 24.5 minutes and blood loss of 58.5 ± 21.3 mL. Well-decompressed canal observed in postoperative magnetic resonance imaging, significant improvements in VAS score for leg (P < 0.01) and ODI score (P < 0.01) confirmed satisfactory ventral neural decompression. Radiographic parameters including disk height (P < 0.01) and segmental disk angle improved significantly (P < 0.01). There was no significant difference between pre- and postoperative lumbar lordosis (P = 0.255). During the follow-up, end plate fracture was observed in 1 case. No major vessels, neural, or dural injury was observed. CONCLUSIONS: Microscopic ventral neural decompression with OLIF could achieve satisfactory clinical results with minimal complications in selected patients with extruded or sequestered disk.


Assuntos
Descompressão Cirúrgica/métodos , Discotomia/métodos , Deslocamento do Disco Intervertebral/cirurgia , Vértebras Lombares/cirurgia , Radiculopatia/cirurgia , Canal Vertebral/cirurgia , Fusão Vertebral/métodos , Feminino , Humanos , Deslocamento do Disco Intervertebral/complicações , Masculino , Microcirurgia , Pessoa de Meia-Idade , Radiculopatia/etiologia
15.
Vet Surg ; 48(4): 607-614, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-30828843

RESUMO

OBJECTIVE: To report the combined use of novel and commercially available implants for ventral distraction-stabilization of 5 continuous compressive sites in a Great Dane with cervical spondylomyelopathy (CSM). STUDY DESIGN: Case report. ANIMALS: One 4-year-old male Great Dane weighing 78 kg. METHODS: A tetraparetic 4-year-old Great Dane with osseous-associated CSM (OA-CSM) with 5 sites of dorsolateral compression was presented for surgical intervention. Custom designed Fitz intervertebral traction screws (FITS) and a commercially available polyaxial spinal system were used for ventral distraction-stabilization of all lesions. Multiple neurological reevaluations were performed, with the final evaluation at 27 months postoperatively. Preoperative, immediate-postoperative, and 27 month-postoperative computed tomography (CT) images were retrospectively reviewed to compare the vertebral canal dimensions at the affected sites. RESULTS: Multilevel distraction-stabilization technique resulted in improvement of the dog's neurological function by 10 days postoperatively. The vertebral canal measurements were revealed to have improved in over half of the measured variables when the 27-month-postoperative images were compared with the preoperative CT images. Increased vertebral canal dimensions were observed immediately after surgery, and some of these measurements continued to improve by 27 months postoperatively. CONCLUSION: Ventral distraction-stabilization technique with custom-designed FITS and a polyaxial spinal system resulted in both clinical improvement and objective improvement in spinal canal measurements in an OA-CSM-affected Great Dane. CLINICAL SIGNIFICANCE: An indirect decompression technique can eliminate dynamic movements and result in regression of vertebral canal bony proliferation in dogs with OA-CSM.


Assuntos
Vértebras Cervicais/cirurgia , Descompressão Cirúrgica/veterinária , Doenças do Cão/cirurgia , Compressão da Medula Espinal/veterinária , Estenose Espinal/veterinária , Animais , Descompressão Cirúrgica/métodos , Cães , Masculino , Período Pós-Operatório , Estudos Retrospectivos , Canal Vertebral/cirurgia , Estenose Espinal/cirurgia , Tomografia Computadorizada por Raios X
16.
Biomed Res Int ; 2019: 9528102, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30719454

RESUMO

Introduction. The multifocal lumbar pathology including disc herniation and stenosis in the spinal canal or foramen has been considered the most difficult to approach surgically. It often requires mandatory dual approaches and/or fusion techniques. Traditional percutaneous endoscopic lumbar transforaminal and interlaminar approach has been focused on unifocal disc herniation. However, the development of endoscopic spinal instruments and surgical technique has broadened surgical indication and therapeutic boundary in endoscopic spine surgery. Cases Presentation. The authors present outcomes of four patients with multilumbar pathology including highly inferior migrated disc combined with lateral recess stenosis, multifocal disc herniation, bilateral disc herniations in spinal canal and foraminal disc herniation combined with central canal stenosis. They were successfully treated by percutaneous uniportal full endoscopic approach with single incision. Conclusion. Percutaneous endoscopic spine surgery is a safe and effective tool to figure out multilumbar pathology in a minimal invasive way.


Assuntos
Endoscopia/métodos , Vértebras Lombares/patologia , Vértebras Lombares/cirurgia , Idoso , Feminino , Humanos , Degeneração do Disco Intervertebral/patologia , Degeneração do Disco Intervertebral/cirurgia , Deslocamento do Disco Intervertebral/patologia , Deslocamento do Disco Intervertebral/cirurgia , Pessoa de Meia-Idade , Canal Vertebral/patologia , Canal Vertebral/cirurgia
17.
World Neurosurg ; 123: 283-285, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-30580065

RESUMO

BACKGROUND: Neurofibromatosis type 1 (NF-1) is an autosomal dominant disease caused by mutation on chromosome 17, which affects the skin, vascular system, nervous system, and skeleton system. Arteriovenous fistula (AVF) is one of the recognized complications of NF-1. CASE DESCRIPTION: We report a case of a 33-year-old woman with NF-1 with cervical spine AVF inside the cervical spinal canal who presented with progressive spinal cord compression which was abnormal. After sufficient preparation, the patient underwent vascular embolization, and then symptoms of spinal cord compression significantly improved. CONCLUSIONS: This report reminds readers of the possibility of AVF if there is a space-occupying lesion inside the cervical spinal canal and to do computed tomography angiography examination when necessary.


Assuntos
Fístula Arteriovenosa/complicações , Fístula Arteriovenosa/patologia , Neurofibromatose 1/complicações , Canal Vertebral/patologia , Adulto , Fístula Arteriovenosa/diagnóstico por imagem , Fístula Arteriovenosa/cirurgia , Angiografia por Tomografia Computadorizada , Embolização Terapêutica/métodos , Feminino , Humanos , Imagem por Ressonância Magnética , Neurofibromatose 1/diagnóstico por imagem , Neurofibromatose 1/cirurgia , Canal Vertebral/diagnóstico por imagem , Canal Vertebral/cirurgia
18.
Vet Surg ; 48(S1): O52-O58, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-30370552

RESUMO

OBJECTIVE: To define boundaries of minimally invasive integrated endoscopic hemilaminectomy at 4 sites in the canine thoracolumbar spine. STUDY DESIGN: Experimental, randomized cadaveric study. ANIMALS: Six cadaver dogs that had been humanely euthanized for reasons unrelated to this study. METHODS: Hemilaminectomy was performed with an integrated endoscopic system at T11-12, T12-13, L1-2, and L2-3, 1 at each site, on the left or right side of each dog. Each site was randomly assigned either a 19-mm or a 23-mm cannula. The entire procedure, including soft tissue dissection, was performed through the cannula. Afterward, spines were imaged by computed tomography (CT) to measure the cranial and caudal extent of the hemilaminectomy from the center of the disc space. RESULTS: The mean ± SD cranial extent of the hemilaminectomy was 4.5 ± 1.4 mm for the 19-mm cannula and 5.6 ± 1.4 mm for the 23-mm cannulas (P = .0757). The caudal extent of the hemilaminectomy was 9.5 ± 2.2 mm for the 19-mm cannula and 10.3 ± 1.6 mm for the 23-mm cannula (P = .206). The mean length of the hemilaminectomy was 13.0 ± 1.5 mm for the 19-mm cannula and 15.0 ± 2.1 mm for the 23-mm cannula (P = .022). CONCLUSION: Integrated endoscopic systems were reliably used to access the spinal canal within the range of the above measurements relative to the disc space as identified by CT or magnetic resonance imaging. CLINICAL SIGNIFICANCE: Integrated endoscopy can be considered as an option in dogs with thoracolumbar disc extrusions or other pathology measuring within the parameters defined by this study. Access may be possible beyond the dimensions defined in this study with probing and repositioning.


Assuntos
Cães/cirurgia , Endoscopia/veterinária , Laminectomia/veterinária , Imagem por Ressonância Magnética/veterinária , Tomografia Computadorizada por Raios X/veterinária , Animais , Cadáver , Doenças do Cão/cirurgia , Endoscopia/instrumentação , Endoscopia/métodos , Deslocamento do Disco Intervertebral/cirurgia , Deslocamento do Disco Intervertebral/veterinária , Laminectomia/instrumentação , Laminectomia/métodos , Vértebras Lombares/cirurgia , Canal Vertebral/cirurgia , Vértebras Torácicas/cirurgia
19.
Medicine (Baltimore) ; 97(41): e12586, 2018 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-30313044

RESUMO

INTRODUCTION: This study aims to investigate the pathological features of a patient with paraganglioma in the lumbar spinal canal. CASE PRESENTATION: The patient was 36 years old male with electrical pain in the waist and buttock which occurred intermittently, and was not relieved under oral use of analgesics. Immunohistochemical staining was performed to diagnose the disease. The results revealed that the size of the tumor was 3.4 × 1.6 × 1.4 cm. The hematoxylin and eosin (H&E)-stained tumor cells mainly presented with an organ-like arrangement under low power microscope, showing prominent chrysanthemum-like, pseudo glandular or pseudo papillary arrangements. The surrounding area of the nest presented with sinusoids, and fibrosis and focal calcification could be observed in the interstitial space among the lesions. Immunohistochemistry results showed that the chief cells were positive for neuron-specific enolase (NSE), Syn and CgA, and Sertoli cells were positive for S-100. CONCLUSION: Paraganglioma is a very rare malignant tumor. This tumor should be distinguished from ependymoma, meningioma and hemangioblastoma, to avoid misdiagnosis, and missed diagnosis.


Assuntos
Paraganglioma/patologia , Canal Vertebral/patologia , Neoplasias da Coluna Vertebral/patologia , Adulto , Diagnóstico Diferencial , Humanos , Imuno-Histoquímica , Vértebras Lombares , Masculino , Paraganglioma/cirurgia , Canal Vertebral/cirurgia , Neoplasias da Coluna Vertebral/cirurgia , Carga Tumoral
20.
J Neurosurg Spine ; 29(5): 535-540, 2018 Nov 01.
Artigo em Inglês | MEDLINE | ID: mdl-30095382

RESUMO

The authors report the case of a 70-year-old woman with lumbar spinal epidural arteriovenous fistula (SEDAVF) who experienced subarachnoid hemorrhage (SAH) after a diagnostic lumbar puncture. According to the literature, perimedullary spinal vein enlargement is a hallmark of spinal vascular diseases; however, there are certain cases in which routine sagittal MRI fails to disclose signal flow voids. In such cases, patients may undergo a lumbar tap to investigate the possible causes of spinal inflammatory or demyelinating disease. Recognizing this phenomenon is essential because lumbar puncture of the epidural venous pouch or an enlarged intradural vein in SEDAVF may induce severe SAH. A high clinical index of suspicion can prevent similar cases in lumbar SEDAVF.


Assuntos
Fístula Arteriovenosa/cirurgia , Embolização Terapêutica/efeitos adversos , Canal Vertebral/cirurgia , Hemorragia Subaracnóidea/etiologia , Idoso , Fístula Arteriovenosa/diagnóstico , Espaço Epidural/cirurgia , Feminino , Humanos , Região Lombossacral/cirurgia , Medula Espinal/irrigação sanguínea , Medula Espinal/cirurgia , Hemorragia Subaracnóidea/diagnóstico , Hemorragia Subaracnóidea/cirurgia
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA
...