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1.
Medicine (Baltimore) ; 99(10): e19348, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-32150074

RESUMO

RATIONALE: A patient presented the abdominal wall protrusion due to tophaceous gout of the spine. Similar cases were not reported in the literature. This study aimed to report a case of tophaceous gout of the spine with abdominal wall protrusion. PATIENT CONCERNS: A 38-year-old male patient had a 10-year history of gout and hyperuricemia. He complained of back pain and abdominal wall protrusion. DIAGNOSES: The patient was diagnosed with tophaceous gout of the spine with abdominal wall weakness caused by T11 nerve root compression. INTERVENTIONS: A semi-lamina decompression was performed at T11-T12. The pathological examination of the specimen demonstrated tophaceous gout of the spine. OUTCOMES: After the surgery, the patient's back pain was completely relieved and the abdominal wall weakness significant improved. LESSONS: This case highlighted that axial gout could mimic thoracic disk herniation clinically. The abdominal wall weakness might also be due to single T11 nerve compression by the tophaceous gout of the spine. In patients with a history of gout, axial gout should be considered as one of the differential diagnoses.


Assuntos
Parede Abdominal/anormalidades , Gota/cirurgia , Vértebras Torácicas/cirurgia , Parede Abdominal/cirurgia , Humanos , Hiperuricemia/complicações , Hiperuricemia/cirurgia , Laminectomia/métodos , Compressão da Medula Espinal/cirurgia
2.
Anticancer Res ; 40(3): 1475-1479, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-32132046

RESUMO

BACKGROUND/AIM: An increasing number of patients undergo surgical treatment for metastatic spinal cord compression (MSCC). However, the possible role of sex as an independent predictor of long-term survival has not been studied. This study aimed to examine whether sex is associated with long-term survival after surgical treatment in patients with MSCC. PATIENTS AND METHODS: A total of 110 patients were operated on for MSCC from 2005 through 2006. The relation between sex and overall survival was investigated. The follow-up period was 10 years. RESULTS: Survival time was significantly longer for women compared to men (mean±SD: 29±5.2 vs. 14±3.6 month (p=0.01). With adjusted analysis, this difference remained statistically significant. After adjusting for specific primary tumor type and time since surgery, the hazard-ratio of 10-year survival for men compared to women was 1.47 (95% confidence intervaI=1.01-2.18, p=0.048). CONCLUSION: These findings indicate that sex is associated with long-term survival in patients treated for MSCC.


Assuntos
Compressão da Medula Espinal/cirurgia , Neoplasias da Coluna Vertebral/secundário , Neoplasias da Coluna Vertebral/cirurgia , Sobreviventes de Câncer , Estudos de Coortes , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Prognóstico , Estudos Prospectivos , Fatores Sexuais , Compressão da Medula Espinal/patologia
3.
Medicine (Baltimore) ; 99(3): e18794, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-32011480

RESUMO

RATIONALE: Spinal involvement in adult Langerhans cell histiocytosis (LCH) is rare, and epidural involvement is unusual. LCH is mostly indistinguishable from other spinal lesions such as infection, lymphoma, and metastasis. So, it could be easily misdiagnosed without suspicion. PATIENT CONCERNS: We report a case of a 33-year-old man who complained of gait disturbance with weakness in both legs and severe back pain. DIAGNOSES: A continuous enhancing epidural lesion with cord compression from the T7 to L1 level was detected in magnetic resonance imaging. Laboratory analysis indicated the possibility of spinal infectious disease. We assumed that the lesion could be tuberculous spondylitis. INTERVENTIONS AND OUTCOMES: The patient underwent posterior laminectomy with marginal excision of the epidural mass to relieve cord compression. Pathological examination confirmed the diagnosis of LCH. The 12-month follow-up evaluation revealed that the patient was neurologically intact and had no gait disturbance. LESSONS: This case report presents a patient with epidural LCH of the thoracic spinal cord, which can mimic spinal infections such as tuberculous spondylitis with abscess formation. Therefore, LCH could be considered as a possible diagnosis when a patient presents with features of infectious spondylitis with vertebral involvement.


Assuntos
Histiocitose de Células de Langerhans/complicações , Histiocitose de Células de Langerhans/diagnóstico , Compressão da Medula Espinal/diagnóstico , Compressão da Medula Espinal/etiologia , Adulto , Diagnóstico Diferencial , Histiocitose de Células de Langerhans/patologia , Histiocitose de Células de Langerhans/cirurgia , Humanos , Masculino , Medula Espinal/diagnóstico por imagem , Compressão da Medula Espinal/patologia , Compressão da Medula Espinal/cirurgia , Vértebras Torácicas
4.
Medicine (Baltimore) ; 99(3): e18800, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-32011484

RESUMO

RATIONALE: Low-grade malignant fibrous myxoid sarcoma (LGFMS) is a malignant tumor that originates from soft tissues and has specific clinical and histopathological characteristics. Paravertebral LGFMS is rarely reported. PATIENT CONCERNS: A 60-year-old woman had pain in the lower back and right anterior thigh for more than 3 years. DIAGNOSIS: Paravertebral LGFMS. INTERVENTIONS: Tumor resection, vertebral canal decompression and pedicle screw fixation. OUTCOMES: The tumor was excised, and the vertebral arch was fixed with pedicle screws at the root. Chemoradiotherapy was not performed. Her postoperative visual analogue scale (VAS) score decreased from 7 points at admission to 2 points at follow-up. The patient was discharged at postoperative day 13, and no recurrence was observed at the 6-month follow-up. LESSONS: Although LGFMS is rare, it should be considered in differential diagnosis of other soft tissue tumors to avoid misdiagnosis and inappropriate treatment.


Assuntos
Sarcoma/diagnóstico , Sarcoma/cirurgia , Neoplasias de Tecidos Moles/diagnóstico , Neoplasias de Tecidos Moles/cirurgia , Diagnóstico Diferencial , Feminino , Humanos , Pessoa de Meia-Idade , Sarcoma/complicações , Neoplasias de Tecidos Moles/complicações , Compressão da Medula Espinal/diagnóstico , Compressão da Medula Espinal/etiologia , Compressão da Medula Espinal/cirurgia , Coluna Vertebral
5.
Medicine (Baltimore) ; 99(3): e18817, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-32011490

RESUMO

RATIONALE: Although C5 palsy is a common complication of cervical spine surgery, its cause has not been confirmed. There are various hypotheses for its mechanism, including spinal cord impairment and nerve involvement. Therefore, prophylactic foraminotomy is one of the methods recommended for preventing C5 palsy. However, we describe a patient who experienced C5 palsy after microendoscopic foraminotomy between the left C5/6 and C6/7 levels. PATIENT CONCERNS: A 43-year-old man presented with a 14-month history of progressive numbness in the left upper limb. We performed microendoscopic left foraminal decompressions at the C5/6/7 levels to treat the left C6 and C7 radiculopathy. On the postoperative day 1, we observed weak motor strength of the left deltoid, left biceps, and left forearm pronator, while the motor strength of the other muscles was normal. DIAGNOSES: C5 palsy following C5/6/7 left foraminotomy. INTERVENTION: Follow-up rehabilitation with muscle strength training and range of motion training. OUTCOME: The patient recovered his motor strength completely within 3 months postoperatively. LESSONS: In this case, the C5 palsy could not be adequately explained by the theory of nerve root impingement or disruption in blood circulation following spinal cord decompression. We hypothesized that the patient had drill heat-induced C5 palsy. Regarding the C5 palsy without C5 nerve root decompression, we hypothesize that the C5 palsy in C5/6/7 foraminotomy could be related to variations in the formation of the brachial plexus. Prophylactic foraminotomy for cervical posterior surgery should be performed with care, limiting its use in patients who are at a risk of developing C5 palsy because the prophylactic procedure can cause C5 palsy. We must also consider that even without decompression at the C4/5 level, there is a possibility of C5 palsy occurring.


Assuntos
Vértebras Cervicais/cirurgia , Foraminotomia , Paralisia/etiologia , Paralisia/reabilitação , Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/reabilitação , Compressão da Medula Espinal/cirurgia , Adulto , Humanos , Masculino , Recuperação de Função Fisiológica
6.
World Neurosurg ; 133: 69-73, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31550540

RESUMO

BACKGROUND: Rosai-Dorfman disease (RDD), also known as sinus histiocytosis with massive lymphadenopathy, is a rare non-Langerhans cell reactive histiocytic disorder that rarely occurs in the central nervous system (CNS). Extranodal RDD most frequently involves the skin, upper respiratory tract, soft tissue, gastrointestinal tracts, bones, breast, and CNS. CASE DESCRIPTION: RDD of the CNS infiltrates most commonly the dura of the sella, cavernous sinus, and the periclival regions. It is usually clinically and radiologically mistaken for meningioma because of its focal dural-based aspect. RDD is confirmed histologically by lymphoplasmacytic cells and histiocytes of varying size showing emperipolesis (lymphocytophagocytosis). To date, only 4 cases of RDD displaying spinal cord compression secondary to craniocervical junction involvement have been reported. CONCLUSION: We report the case of a patient diagnosed with RDD localized at the foramen magnum extending to the base of the odontoid process and involving the V4 segment vertebral artery.


Assuntos
Histiocitose Sinusal/cirurgia , Neoplasias Meníngeas/diagnóstico por imagem , Meningioma/diagnóstico por imagem , Compressão da Medula Espinal/cirurgia , Artéria Vertebral/cirurgia , Diagnóstico Diferencial , Histiocitose Sinusal/diagnóstico por imagem , Histiocitose Sinusal/patologia , Humanos , Imagem por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Compressão da Medula Espinal/diagnóstico por imagem , Compressão da Medula Espinal/patologia , Artéria Vertebral/diagnóstico por imagem , Artéria Vertebral/patologia
7.
World Neurosurg ; 133: 253-255, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31629150

RESUMO

Rare anomalous courses of vertebral arteries in the craniovertebral junction may compress the spinal cord causing myelopathy. We report here the severest form of this pathologic condition successfully treated with transposition of bilateral vertebral artery using Gore-Tex tapes. A 73-year-old man presented with progressive tetraparesis and gait disturbance. Imaging studies showed bilateral atresia of the C1 transverse foramina and the both vertebral arteries penetrating the dura below the C1 lamina. Pinched by the vertebral artery loops on both sides, the spinal cord was severely deformed. Through the standard midline approach, we carefully transposed both vertebral arteries off the spinal cord, placing them at the optimal position using Tanaka et al's Gore-Tex tape technique originally reported for microvascular decompression. The Gore-Tex tape transposition technique proved to be versatile and useful for safe transposition of the vertebral artery in this challenging case.


Assuntos
Descompressão Cirúrgica/métodos , Politetrafluoretileno , Quadriplegia/cirurgia , Compressão da Medula Espinal/cirurgia , Artéria Vertebral/anormalidades , Idoso , Progressão da Doença , Humanos , Masculino , Quadriplegia/diagnóstico por imagem , Compressão da Medula Espinal/diagnóstico por imagem , Tomografia Computadorizada por Raios X , Resultado do Tratamento , Artéria Vertebral/diagnóstico por imagem
8.
World Neurosurg ; 133: e225-e232, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31493599

RESUMO

OBJECTIVE: To identify and reveal the sensitivity and efficiency of dynamic somatosensory evoked potentials (DSSEPs) in the diagnosis of cervical spondylotic myelopathy (CSM). METHODS: This retrospective study included 31 CSM and 15 control patients. All patients received SSEP examination with stimulation of median and ulnar nerves at neutral, flexed, and extended cervical positions; latency and amplitude were recorded at the C2 and C5 spinous processes and in the scalp over the primary sensory area (C3'/4'). The percentage changes in latency and amplitude with dynamic motion were examined for each lead and compared between groups; the diagnostic cutoff values were determined using receiver operating characteristic curve analysis. RESULTS: All the patients with CSM received surgeries and were followed up for 1 year. Amplitude parameters varied with a dynamic position in both groups; all recorded dynamic SSEP indices except right median stimulus recorded at C5 spinous process, right ulnar stimulus recorded at scalp point C3, and right ulnar stimulus recorded at C2 spinous process were significantly different between groups (P < 0.05), but latency was not (P > 0.05). At the neutral position, the amplitude of left media stimulus recorded at C2 spinous process (LMC2) was associated with CSM, but with low diagnostic accuracy (area under the curve = 0.199). At a dynamic position, the percentage change in amplitude of LMC2 and of left ulnar stimulus recorded at C2 spinous process (LUC2) were determined to be diagnostic of CSM (P < 0.05), with areas under the curve of 0.891 and 0.912, respectively. Both records had high sensitivity and specificity in the diagnosis of CSM; the diagnostic cutoff values of LMC2 and LUC2 were calculated as 10.2% and 19.25%, respectively. CONCLUSIONS: The percentage change in amplitude was obvious during cervical dynamic motion, with records from LMC2 and LUC2 being predictive of CSM diagnosis; dynamic SSEPs provided a simple, accurate, and noninvasive supplementary test for the diagnosis of complicated CSM.


Assuntos
Vértebras Cervicais , Potenciais Somatossensoriais Evocados , Compressão da Medula Espinal/diagnóstico , Espondilose/complicações , Espondilose/diagnóstico por imagem , Vértebras Cervicais/diagnóstico por imagem , Vértebras Cervicais/cirurgia , Descompressão Cirúrgica , Discotomia , Feminino , Humanos , Imagem por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Posicionamento do Paciente , Tempo de Reação , Estudos Retrospectivos , Sensibilidade e Especificidade , Compressão da Medula Espinal/etiologia , Compressão da Medula Espinal/fisiopatologia , Compressão da Medula Espinal/cirurgia , Fusão Vertebral , Espondilose/cirurgia
9.
World Neurosurg ; 133: 17-20, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31491575

RESUMO

BACKGROUND: Systemic mastocytosis is a hematopoietic disorder of mast cell deposits in various systemic tissues that can include skin, spleen, liver, and bone marrow. When accumulation occurs within bone it has been reported to cause osteoporosis, osteosclerosis, or sometimes a mixed pattern. In exceptionally rare circumstances, it has been reported to present as an exophytic mass causing neural compression. CASE DESCRIPTION: A 72-year-old man was admitted with progressive worsening in his mobility and heavy and numb sensation in his bilateral lower limbs that worsened on walking. His weakness subsequently progressed such that he was no longer able to mobilize for 48 hours prior to admission. On examination he was found to be myelopathic with a sensory level noted at approximately the T10/11 area. Whole spine magnetic resonance imaging was conducted, which revealed a heterogeneous lesion involving the vertebral body and posterior elements of T10. The patient underwent T9-T11 laminecetomy with intralesional debulking of metastatic spinal column tumor. Postoperatively, the patient was noted to have improved anti-gravity power in the lower limbs. Intraoperative biopsy samples revealed focal paratrabecular infiltrates of abnormal mast cells with collagen fibrosis and focal bone destruction, along with cytogenetic features in keeping with systemic mastocytosis. CONCLUSIONS: We describe a rare case of systemic mastocytosis presenting as an extradural lesion causing compressive myelopathy and paraparesis. To our knowledge, this has only been described once before in literature. The patient underwent decompression surgery with improvement in neurology postoperatively. He was subsequently referred to the hematology team for further investigation and management.


Assuntos
Descompressão Cirúrgica , Mastocitose/complicações , Compressão da Medula Espinal/etiologia , Vértebras Torácicas/cirurgia , Idoso , Humanos , Imagem por Ressonância Magnética , Masculino , Mastocitose/diagnóstico por imagem , Mastocitose/cirurgia , Compressão da Medula Espinal/diagnóstico por imagem , Compressão da Medula Espinal/cirurgia , Vértebras Torácicas/diagnóstico por imagem , Resultado do Tratamento
10.
World Neurosurg ; 133: e412-e420, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31536811

RESUMO

OBJECTIVE: The cervical extensor musculature is important in cases of neck pain and loss of cervical lordosis after laminoplasty. Therefore, various surgical methods have been developed to preserve the muscle during laminoplasty. We have developed a posterior cervical muscle-preserving interspinous process (MIS) approach and decompression method. We have described the operation details and clinical outcomes of selected patients who have undergone this procedure. METHODS: The MIS approach and decompression method were performed in 20 consecutive patients who had only required central decompression for cervical stenosis. This procedure includes an approach to the interspinous space that is similar to Shiraishi's method but includes decompression without fracturing the spina bifida. RESULTS: The patients had no complications and did not require conversion to conventional laminoplasty. The mean operative time and mean blood loss was 53.0 minutes and 63.0 mL per level, respectively, and the mean hospital stay was 4.0 days. The mean preoperative and 3-month postoperative modified Japanese Orthopedic Association scores were 12.6 and 16.2, and the mean preoperative and 3-month postoperative neck disability index scores were 15.4 and 2.5, respectively. The postoperative neck visual analog scale score was 0.8. The mean preoperative and postoperative sagittal vertical axis was 1.6 and 1.8 cm, respectively. The mean loss of lordosis was 1.0°, and the mean cervical range of motion did not change from preoperatively to postoperatively. CONCLUSIONS: The MIS approach and decompression method was less invasive than both conventional laminoplasty and Shiraishi's selective laminectomy. It is a safe and effective minimally invasive technique for central stenosis caused by cervical spondylotic myelopathy.


Assuntos
Vértebras Cervicais/cirurgia , Laminectomia/métodos , Músculos do Pescoço/cirurgia , Procedimentos Neurocirúrgicos/métodos , Tratamentos com Preservação do Órgão/métodos , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Laminectomia/efeitos adversos , Masculino , Pessoa de Meia-Idade , Procedimentos Cirúrgicos Minimamente Invasivos/métodos , Procedimentos Neurocirúrgicos/efeitos adversos , Satisfação do Paciente , Complicações Pós-Operatórias/prevenção & controle , Estudos Retrospectivos , Compressão da Medula Espinal/etiologia , Compressão da Medula Espinal/cirurgia , Estenose Espinal/cirurgia , Adulto Jovem
12.
Medicine (Baltimore) ; 98(50): e18285, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31852104

RESUMO

RATIONALE: Compressive myelopathy and compression fracture of aggressive vertebral hemangioma after parturition is a rare condition. Vertebral body compression fracture and high serum progesterone lead to extraosseous hemangioma enlargment cause narrowing the spinal canal which contribute to compressive myelopathy relate to pregnancy. PATIENT CONCERNS: We report a case of compressive myelopathy and compression fracture of aggressive vertebral hemangioma after parturition in a 35-year-old woman. The patient complained unable to walk and experienced intense pain in the back. DIAGNOSIS: Based on the clinical features and imaging studies, the patient underwent a T4-T6 laminectomy. Histopathology consistent with vertebral hemangioma. INTERVENTIONS: The patient underwent laminectomy for decompression. After subperiosteal dissection of the paraspinal muscles and exposure of the laminae, there was no involvement of the lamina by the tumor. The epidural tumor was removed through the spaces lateral to the thecal sac. Vertebroplasty was performed through T5 pedicles bilaterally and 7 ml of polymethylmethacrylate (PMMA) cement was injected. T4-T6 pedicle screw fixation was performed for segmental fixation and fusion. OUTCOMES: Six months after resection of the tumor the patient remained asymptomatic. She reported no low back pain and had returned to her normal daily activities, with no radiographic evidence of recurrence on MRI. Physical examination revealed that superficial and deep sensation was restored to normal levels in the lower extremities. LESSONS: The occurrence of compressive myelopathy of pregnancy related vertebral hemangiomas is quite unusual. It can lead to serious neurologic deficits if not treated immediately. So, prompt diagnosis is important in planning optimal therapy and preventing morbidity for patients.


Assuntos
Fraturas por Compressão/complicações , Hemangioma/complicações , Parto , Compressão da Medula Espinal/etiologia , Fraturas da Coluna Vertebral/complicações , Neoplasias da Coluna Vertebral/complicações , Vértebras Torácicas , Adulto , Descompressão Cirúrgica/métodos , Feminino , Fraturas por Compressão/diagnóstico , Fraturas por Compressão/cirurgia , Hemangioma/diagnóstico , Hemangioma/cirurgia , Humanos , Imagem por Ressonância Magnética , Tomografia Computadorizada com Tomografia por Emissão de Pósitrons , Compressão da Medula Espinal/diagnóstico , Compressão da Medula Espinal/cirurgia , Fraturas da Coluna Vertebral/diagnóstico , Fraturas da Coluna Vertebral/cirurgia , Neoplasias da Coluna Vertebral/diagnóstico , Neoplasias da Coluna Vertebral/cirurgia , Vertebroplastia/métodos
13.
PLoS One ; 14(12): e0226020, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31877151

RESUMO

OBJECTIVES: The mainstay treatment for Degenerative Cervical Myelopathy (DCM) is surgical decompression. Not all cases, however, are suitable for surgery. Recent international guidelines advise surgery for moderate to severe disease as well as progressive mild disease. The goal of this study was to examine the factors in current practice that drive the decision to operate in DCM. STUDY DESIGN: Retrospective cohort study. METHODS: 1 year of cervical spine MRI scans (N = 1123) were reviewed to identify patients with DCM with sufficient clinical documentation (N = 39). Variables at surgical assessment were recorded: age, sex, clinical signs and symptoms of DCM, disease severity, and quantitative MRI measures of cord compression. Bivariate correlations were used to compare each variable with the decision to offer the patient an operation. Subsequent multivariable analysis incorporated all significant bivariate correlations. RESULTS: Of the 39 patients identified, 25 (64%) were offered an operation. The decision to operate was significantly associated with narrower non-pathological canal and cord diameters as well as cord compression ratio, explaining 50% of the variance. In a multivariable model, only cord compression ratio was significant (p = 0.017). Examination findings, symptoms, functional disability, disease severity, disease progression, and demographic factors were all non-significant. CONCLUSIONS: Cord compression emerged as the main factor in surgical decision-making prior to the publication of recent guidelines. Newly identified predictors of post-operative outcome were not significantly associated with decision to operate.


Assuntos
Medula Cervical/fisiopatologia , Compressão da Medula Espinal/patologia , Idoso , Medula Cervical/diagnóstico por imagem , Tomada de Decisões , Descompressão Cirúrgica , Feminino , Humanos , Imagem por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Índice de Gravidade de Doença , Compressão da Medula Espinal/diagnóstico por imagem , Compressão da Medula Espinal/cirurgia
14.
Pan Afr Med J ; 33: 199, 2019.
Artigo em Francês | MEDLINE | ID: mdl-31692754

RESUMO

Spinal schwannomas are benign tumors accounting for 30% of all spinal tumors. They originate from the shwann cells of the spinal roots. We report our experience in managing patients with spinal shwannomas, from diagnosis to treatment modalities, in the Department of Neurosurgery at the University Hospital Hassan II in Fez over a period of 13 years. The patients with spinal shwannomas accounted for 19.5% of those with spinal cord compression treated surgically over the same period. The average age of patients was 45 years, with a discreet female predominance. Spinal schwannomas had an insidious onset, then the median of consultation time was 18 months. The main symptoms were spinal and radicular pain. Half of our patients had neurological deficits. Medullary MRI was performed in all of our patients. Spinal schwannomas occurred predominantly in the chest (40%); 62% of shwannomas were intradural lesions, rarely extradural lesions (8%) and mixed lesions(4%). Complete Surgical resection was performed in 96% of cases with osteosynthesis in two cases and arthrodesis in a single case. Histological examination confirmed the diagnosis of benign neurinoma in 23 cases, malignant shwannoma in one case and neurofibroma in one case. Outcome was favorable in the majority of cases, two patients had complications, an infection of the wall and neurological worsening. The interest in the subject of our study is to highlight the features of these lesions and to compare the results of our case series with the data in the literature.


Assuntos
Neurilemoma/diagnóstico , Compressão da Medula Espinal/etiologia , Neoplasias da Coluna Vertebral/diagnóstico , Adolescente , Adulto , Idoso , Criança , Feminino , Humanos , Imagem por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Neurilemoma/patologia , Neurilemoma/cirurgia , Neurofibroma/diagnóstico , Neurofibroma/cirurgia , Estudos Retrospectivos , Compressão da Medula Espinal/cirurgia , Neoplasias da Coluna Vertebral/patologia , Neoplasias da Coluna Vertebral/cirurgia , Adulto Jovem
15.
Medicine (Baltimore) ; 98(42): e17505, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31626106

RESUMO

The purpose of the study was to identify risk factors of cage subsidence and evaluate surgical outcome by at least 12 months postoperative follow-up.We retrospectively investigated 113 consecutive patients who underwent anterior surgery to relieve spine cord compression resulted from localized heterotopic ossification, from July, 2011 to February, 2016. We divided the patients into 2 groups: cage subsidence <2 mm group and ≥2 mm group. According to magnetic resonance imaging (MRI), the severity of increased signal intensity (ISI) was classified into grade 0, 1, and 2. Clinical outcome was assessed by the Japanese Orthopedic Association (JOA) scoring system. Logistic regression analysis and receiver-operating characteristic (ROC) curve were utilized for predicting risk factors of cage subsidence, and the recovery rate was evaluated by Kruskal-Wallis test or Mann-Whitney U test.Logistic regression with cage subsidence as the dependent variable showed independent risks associated with a cervical sagittal malalignment (odds ratio [OR] 11.23, 95% confidence interval [CI] 3.595-35.064, P < .001), thoracic 1 (T1) slope angle (OR 1.59, 95% CI 1.259-1.945, P < .001), and excisional thickness (OR 2.38, 95% CI 1.163-4.888.0, P = .018). The cut-off values of T1 slope and excisional thickness were 19.65 angle and 3.7 mm, respectively. Patients with high occupying ratio (P = .001) and high ISI grade (P = .012) are more likely to occur lower recovery rate.Patients with high T1 slope angle or preoperative kyphotic deformity should avoid excessive removal of endplate and vertebral body so as to reduce the occurrence of cage subsidence. Poor outcome was closely related to cervical sagittal malalignment and higher ISI grade.


Assuntos
Discotomia/efeitos adversos , Ossificação Heterotópica/cirurgia , Complicações Pós-Operatórias/etiologia , Compressão da Medula Espinal/cirurgia , Fusão Vertebral/efeitos adversos , Vértebras Cervicais/cirurgia , Discotomia/métodos , Feminino , Seguimentos , Humanos , Cifose/fisiopatologia , Cifose/cirurgia , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Ossificação Heterotópica/fisiopatologia , Complicações Pós-Operatórias/epidemiologia , Equilíbrio Postural , Estudos Retrospectivos , Caixa Torácica/cirurgia , Fatores de Risco , Compressão da Medula Espinal/fisiopatologia , Fusão Vertebral/métodos , Resultado do Tratamento
16.
World Neurosurg ; 132: e162-e168, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31513953

RESUMO

BACKGROUND: Common signs and symptoms of cervical myelopathy (CM) predominantly manifest in the upper extremities and include hand numbness, hand clumsiness, and distal upper extremity weakness. CM manifesting without symptoms in the upper extremities is rare. This study aimed to better understand the incidence and character of such cases. METHODS: A retrospective review of surgeries for CM from disc herniation, spondylosis, or ossification of posterior longitudinal ligament over a 12-year period was performed to identify patients presenting without symptoms in the upper extremities. RESULTS: Of 982 surgically treated patients with CM, 12 (1.2%) had no upper extremity symptoms. All had difficulty ambulating, and 7 of 12 (58%) patients had objective lower extremity weakness. Ten (83%) patients had a history of lumbar degenerative disease. On sensory examination, 4 (33%) patients had a discernible midthoracic pin level, 3 (25%) had loss of sensation from the upper leg and genital area down, and 2 (17%) had only genital/upper thigh area sensory loss. All patients demonstrated neurologic improvement after decompressive surgery. CONCLUSIONS: Patients with CM may rarely present without symptoms in the upper extremities, presenting with numbness perceived from the upper trunk, waist area, or perineum and legs in addition to leg weakness and gait difficulty. All patients had cervical cord compression at either C5-6 or C6-7 level, accounting for 1% of all patients undergoing cervical surgery. Awareness of this atypical pattern of presentation may aid in clinical assessment of a subset of patients with cervical cord compression.


Assuntos
Vértebras Cervicais/cirurgia , Doenças da Medula Espinal/cirurgia , Extremidade Superior , Adulto , Idoso , Vértebras Cervicais/diagnóstico por imagem , Descompressão Cirúrgica , Feminino , Humanos , Hipestesia/etiologia , Incidência , Degeneração do Disco Intervertebral/complicações , Imagem por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Limitação da Mobilidade , Debilidade Muscular/etiologia , Estudos Retrospectivos , Compressão da Medula Espinal/diagnóstico , Compressão da Medula Espinal/epidemiologia , Compressão da Medula Espinal/cirurgia , Doenças da Medula Espinal/diagnóstico , Doenças da Medula Espinal/epidemiologia , Resultado do Tratamento
17.
World Neurosurg ; 132: 67-68, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31479794

RESUMO

Ehlers-Danlos syndrome can be associated with cerebrospinal fluid (CSF) disturbances including recurrent CSF leak and Chiari I malformations. Persistent pseudomeningoceles are known to be associated with raised intracranial pressure. We present an unusual case of a compressive epidural CSF collection occurring after a computed tomography-guided L5 nerve root block and describe an effective management strategy.


Assuntos
Vazamento de Líquido Cefalorraquidiano/etiologia , Síndrome de Ehlers-Danlos/complicações , Injeções Epidurais/efeitos adversos , Hipertensão Intracraniana/complicações , Compressão da Medula Espinal/etiologia , Adulto , Malformação de Arnold-Chiari/complicações , Vazamento de Líquido Cefalorraquidiano/diagnóstico por imagem , Vazamento de Líquido Cefalorraquidiano/cirurgia , Feminino , Humanos , Vértebras Lombares , Bloqueio Nervoso , Radiculopatia/tratamento farmacológico , Radiculopatia/etiologia , Compressão da Medula Espinal/diagnóstico por imagem , Compressão da Medula Espinal/cirurgia , Espondilolistese/complicações , Tomografia Computadorizada por Raios X
18.
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
19.
World Neurosurg ; 132: e852-e861, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31394355

RESUMO

BACKGROUND: Anterior cervical discectomy and fusion (ACDF) is the most common procedure for single-level cervical spondylotic myelopathy (CSM); however, for multilevel CSM, some patients may also undergo anterior cervical corpectomy and fusion (ACCF). We sought to assess differences in clinical outcomes between patients undergoing ACDF and those undergoing ACCF for multilevel CSM. METHODS: The National Surgical Quality Improvement Program (NSQIP) database was queried from 2007 to 2017 to identify patients diagnosed with CSM undergoing 1- or 2-level ACCF and 2- or 3-level ACDF. Three-to-one propensity scoring was used to match patients undergoing 1-level ACCF to those undergoing 2-level ACDF. Multivariable regression was performed to compare 30-day clinical outcomes between ACCF and ACDF recipients. RESULTS: A total of 3708 patients undergoing 1-level ACCF (n = 729; 18.7%) or 2-level ACDF (n = 3179; 81.3%) were identified. On multivariable regression, 1-level ACCF was associated with significantly longer length of stay (coefficient, 0.79; 95% confidence interval [CI], 0.46-1.11; P < 0.001), longer operative time (coefficient, 19.01; 95% CI, 11.94-26.08; P < 0.001), decreased odds of readmissions (odds ratio [OR], 0.95; 95% CI, 0.91-0.99; P = 0.018), and increased odds of complications (OR, 1.02; 95% CI, 1.00-1.04; P = 0.028) compared with those undergoing 2-level ACDF. A total of 939 patients undergoing either 2-level ACCF (n = 348; 37.1%) or 3-level ACDF (n = 591; 62.9%) were identified. On multivariable regression, 2-level ACCF was associated with significantly longer length of stay (coefficient, 1.17; 95% CI, 0.55-1.79; P < 0.001) and increased risk of complications (OR, 1.05; 95% CI, 1.01-1.08; P = 0.004) compared with 3-level ACDF. CONCLUSIONS: Our analyses indicate that ACCF may be associated with worse clinical outcomes than ACDF following multilevel treatment for CSM.


Assuntos
Vértebras Cervicais/cirurgia , Discotomia/métodos , Compressão da Medula Espinal/cirurgia , Fusão Vertebral/métodos , Espondilose/cirurgia , Idoso , Bases de Dados Factuais , Feminino , Humanos , Tempo de Internação/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Duração da Cirurgia , Readmissão do Paciente/estatística & dados numéricos , Complicações Pós-Operatórias/epidemiologia , Pontuação de Propensão , Compressão da Medula Espinal/etiologia , Espondilose/complicações , Resultado do Tratamento
20.
World Neurosurg ; 131: e514-e520, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31394365

RESUMO

BACKGROUND: The cervicothoracic junction (CTJ) has often been identified as an area of biomechanical vulnerability; however, few studies have examined the relative merits of extending fusions across this area. In this study, we sought to investigate the tradeoffs involved in fusing across the CTJ in cases of elective posterior cervical laminectomy and fusion. METHODS: We conducted a single-institution retrospective cohort study of patients undergoing elective, multilevel, posterior cervical decompression and fusion for degenerative cervical stenosis. Data were collected on baseline clinical and radiographic variables as well any subsequent complications or reoperations. Outcomes measures were compared between those who received fusion stopping at C7 with those who received fusion crossing the CTJ, with multivariate logistic regression used to adjust for any known confounders. RESULTS: Patients whose fusion crossed the CTJ were found to have more levels fused (mean: 5.8 vs. 3.5 levels, P < 0.0001), longer surgical times (mean: 216 vs. 149 minutes, P < 0.0001), and higher estimated blood losses (mean: 475 vs. 116 mL, P < 0.0001) despite no significant differences in number of levels decompressed (mean: 4.2 vs. 4.3 levels, P = 0.63). The groups did not differ in overall reoperation rate (10.8% vs. 9.4%, P = 1.00), but crossing the CTJ was associated with a higher rate of wound dehiscence (7.8% vs. 0%, P = 0.03). This difference persisted in multivariate analysis (P < 0.001). CONCLUSIONS: Crossing the CTJ was associated with increased surgical time, estimated blood loss, and the rates of wound dehiscence. These tradeoffs should be considered in planning posterior cervical decompression and fusion procedures.


Assuntos
Vértebras Cervicais/cirurgia , Laminectomia/métodos , Compressão da Medula Espinal/cirurgia , Fusão Vertebral/métodos , Estenose Espinal/cirurgia , Espondilose/cirurgia , Vértebras Torácicas/cirurgia , Idoso , Perda Sanguínea Cirúrgica , Estudos de Coortes , Descompressão Cirúrgica , Feminino , Humanos , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Duração da Cirurgia , Complicações Pós-Operatórias/epidemiologia , Estudos Retrospectivos , Compressão da Medula Espinal/etiologia , Estenose Espinal/complicações , Espondilose/complicações
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