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1.
Medicine (Baltimore) ; 100(11): e25177, 2021 Mar 19.
Artigo em Inglês | MEDLINE | ID: mdl-33726007

RESUMO

RATIONALE: Hydatid cyst is a disease caused by the larvae of Echinococcus spp. The larvae often reside in the liver, lungs, and brain. Occasionally, a primary isolated thoracic vertebral hydatid cyst is reported to cause severe complications. Various diseases may lead to the development of progressive compressive myelopathy. Herein, we report a rare case of a primary isolated thoracic vertebral hydatid cyst with compressive myelopathy. PATIENT CONCERNS: A 57-year-old female had numbness and weakness in the lower limbs for a span of 3-months. DIAGNOSIS: Thoracic magnetic resonance imaging (MRI) showed that an isolated mass was observed in the T5 vertebral body, which compressed the spinal cord. The diagnosis was confirmed after surgical excision, and Echinococcus granulosus was found to be the etiologic factor. INTERVENTIONS: The patient underwent laminectomy with no complications. OUTCOMES: After surgical decompression, the patient made slow and measurable progress. While relatively rare in the non-pastoral area, the primary isolated thoracic vertebral column hydatid cyst may be considered as a possible etiology of atypical extradural spinal compression. LESSONS: This case illustrates the complexity of spinal echinococcosis manifestations and the necessity of an interdisciplinary approach.


Assuntos
Equinococose/complicações , Echinococcus granulosus , Compressão da Medula Espinal/parasitologia , Animais , Equinococose/parasitologia , Equinococose/cirurgia , Feminino , Humanos , Laminectomia , Pessoa de Meia-Idade , Compressão da Medula Espinal/cirurgia , Vértebras Torácicas/parasitologia , Vértebras Torácicas/cirurgia
2.
Lancet Neurol ; 20(2): 98-106, 2021 02.
Artigo em Inglês | MEDLINE | ID: mdl-33357512

RESUMO

BACKGROUND: Degenerative cervical myelopathy represents the most common form of non-traumatic spinal cord injury. This trial investigated whether riluzole enhances outcomes in patients undergoing decompression surgery for degenerative cervical myelopathy. METHODS: This multicentre, double-blind, placebo-controlled, randomised, phase 3 trial was done at 16 university-affiliated centres in Canada and the USA. Patients with moderate-to-severe degenerative cervical myelopathy aged 18-80 years, who had a modified Japanese Orthopaedic Association (mJOA) score of 8-14, were eligible. Patients were randomly assigned (1:1) to receive either oral riluzole (50 mg twice a day for 14 days before surgery and then for 28 days after surgery) or placebo. Randomisation was done using permuted blocks stratified by study site. Patients, physicians, and outcome assessors remained masked to treatment group allocation. The primary endpoint was change in mJOA score from baseline to 6 months in the intention-to-treat (ITT) population, defined as all individuals who underwent randomisation and surgical decompression. Adverse events were analysed in the modified intention-to-treat (mITT) population, defined as all patients who underwent randomisation, including those who did not ultimately undergo surgical decompression. This study is registered with ClinicalTrials.gov, NCT01257828. FINDINGS: From Jan 31, 2012, to May 16, 2017, 408 patients were screened. Of those screened, 300 were eligible (mITT population); 290 patients underwent decompression surgery (ITT population) and received either riluzole (n=141) or placebo (n=149). There was no difference between the riluzole and placebo groups in the primary endpoint of change in mJOA score at 6-month follow-up: 2·45 points (95% CI 2·08 to 2·82 points) versus 2·83 points (2·47 to 3·19), difference -0·38 points (-0·90 to 0·13; p=0·14). The most common adverse events were neck or arm or shoulder pain, arm paraesthesia, dysphagia, and worsening of myelopathy. There were 43 serious adverse events in 33 (22%) of 147 patients in the riluzole group and 34 serious adverse events in 29 (19%) of 153 patients in the placebo group. The most frequent severe adverse events were osteoarthrosis of non-spinal joints, worsening of myelopathy, and wound complications. INTERPRETATION: In this trial, adjuvant treatment for 6 weeks perioperatively with riluzole did not improve functional recovery beyond decompressive surgery in patients with moderate-to-severe degenerative cervical myelopathy. Whether riluzole has other benefits in this patient population merits further study. FUNDING: AOSpine North America.


Assuntos
Vértebras Cervicais/cirurgia , Craniectomia Descompressiva/métodos , Degeneração do Disco Intervertebral/tratamento farmacológico , Degeneração do Disco Intervertebral/cirurgia , Fármacos Neuroprotetores/uso terapêutico , Procedimentos Neurocirúrgicos/métodos , Riluzol/uso terapêutico , Compressão da Medula Espinal/tratamento farmacológico , Compressão da Medula Espinal/cirurgia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Terapia Combinada , Método Duplo-Cego , Determinação de Ponto Final , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Fármacos Neuroprotetores/efeitos adversos , Dor Pós-Operatória/epidemiologia , Riluzol/efeitos adversos , Resultado do Tratamento
3.
Anticancer Res ; 40(10): 5673-5678, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-32988892

RESUMO

BACKGROUND/AIM: We conducted a randomized controlled trial to investigate whether minimally access spine surgery (MASS) is less morbid than open surgery (OS) in patients with metastatic spinal cord compression (MSCC). PATIENTS AND METHODS: A total of 49 MSCC patients were included in the trial. The outcome measures were bleeding (L), operation time (min), re-operations and prolonged wound healing. RESULTS: The median age was 67 years (range=42-85 years) and 40% were men. The peri-operative blood loss in the MASS-group was significantly lower than that in the OS-group; 0.175L vs. 0.500L, (p=0.002). The median operation time for MASS was 142 min (range=72-203 min) vs. 103 (range=59-435 min) for OS (p=0.001). There was no significant difference between the two groups concerning revision surgery or delayed wound healing. CONCLUSION: The MASS technique in MSCC patients is associated with less blood loss, but a longer operation time when compared to the OS technique.


Assuntos
Procedimentos Cirúrgicos Minimamente Invasivos/métodos , Compressão da Medula Espinal/cirurgia , Disrafismo Espinal/cirurgia , Neoplasias da Coluna Vertebral/cirurgia , Adulto , Idoso , Idoso de 80 Anos ou mais , Perda Sanguínea Cirúrgica/fisiopatologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Procedimentos Cirúrgicos Minimamente Invasivos/efeitos adversos , Duração da Cirurgia , Avaliação de Resultados em Cuidados de Saúde , Reoperação/métodos , Compressão da Medula Espinal/sangue , Compressão da Medula Espinal/fisiopatologia , Disrafismo Espinal/sangue , Disrafismo Espinal/fisiopatologia , Neoplasias da Coluna Vertebral/sangue , Neoplasias da Coluna Vertebral/fisiopatologia , Neoplasias da Coluna Vertebral/secundário , Resultado do Tratamento
4.
Bone Joint J ; 102-B(9): 1210-1218, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-32862690

RESUMO

AIMS: The aim of this study was to use diffusion tensor imaging (DTI) to investigate changes in diffusion metrics in patients with cervical spondylotic myelopathy (CSM) up to five years after decompressive surgery. We correlated these changes with clinical outcomes as scored by the Modified Japanese Orthopedic Association (mJOA) method, Neck Disability Index (NDI), and Visual Analogue Scale (VAS). METHODS: We used multi-shot, high-resolution, diffusion tensor imaging (ms-DTI) in patients with cervical spondylotic myelopathy (CSM) to investigate the change in diffusion metrics and clinical outcomes up to five years after anterior cervical interbody discectomy and fusion (ACDF). High signal intensity was identified on T2-weighted imaging, along with DTI metrics such as fractional anisotropy (FA). MJOA, NDI, and VAS scores were also collected and compared at each follow-up point. Spearman correlations identified correspondence between FA and clinical outcome scores. RESULTS: Significant differences in mJOA scores and FA values were found between preoperative and postoperative timepoints up to two years after surgery. FA at the level of maximum cord compression (MCL) preoperatively was significantly correlated with the preoperative mJOA score. FA postoperatively was also significantly correlated with the postoperative mJOA score. There was no statistical relationship between NDI and mJOA or VAS. CONCLUSION: ms-DTI can detect microstructural changes in affected cord segments and reflect functional improvement. Both FA values and mJOA scores showed maximum recovery two years after surgery. The DTI metrics are significantly associated with pre- and postoperative mJOA scores. DTI metrics are a more sensitive, timely, and quantifiable surrogate for evaluating patients with CSM and a potential quantifiable biomarker for spinal cord dysfunction. Cite this article: Bone Joint J 2020;102-B(9):1210-1218.


Assuntos
Imagem de Tensor de Difusão , Compressão da Medula Espinal/diagnóstico por imagem , Espondilose/diagnóstico por imagem , Vértebras Cervicais , Imagem de Tensor de Difusão/métodos , Discotomia , Feminino , Humanos , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Compressão da Medula Espinal/complicações , Compressão da Medula Espinal/cirurgia , Espondilose/complicações , Fatores de Tempo
5.
Orv Hetil ; 161(31): 1302-1306, 2020 08.
Artigo em Húngaro | MEDLINE | ID: mdl-32750016

RESUMO

Our objective is to propose a novel surgical technique, the microscope-assisted odontoid resection via submandibular retropharyngeal "key-hole" approach. The patient suffered a traumatic cervical spine injury due to a motorcycle accident. We removed the upper two-thirds of the CII vertebra's odontoid process along with the cortical fragment causing the medullar compression. With this surgical technique the velopharyngeal insufficiency, occurring at the traditional transoral surgery, is avoidable while the access to the odontoid process is insured. The MRI confirmed ventral injury to the meninges, which increases the risk of wound healing complications and sepsis so along with the high risk of velopharyngeal insufficiency occurring at the transoral surgery, stood in favour of the new method. During the submandibular "key-hole" technique besides the use of tissue-glue, tamponing the meninges damage with multiple layers of viable soft tissue could be performed. The postoperative CT and MR imaging confirmed the complete decompression of the medulla oblongata. The patient's tetraplegic state entirely regressed, and eight months after the surgery he became self-sufficient. From now on, the surgical method we used could be a considerable alternative to the classic transoral transpharyngeal or endoscopic endonasal odontoid resection. Orv Hetil. 2020; 161(31): 1302-1306.


Assuntos
Descompressão Cirúrgica/métodos , Endoscopia/métodos , Processo Odontoide/cirurgia , Compressão da Medula Espinal/cirurgia , Vértebras Cervicais/diagnóstico por imagem , Humanos , Imagem por Ressonância Magnética , Masculino , Processo Odontoide/diagnóstico por imagem , Período Pós-Operatório , Compressão da Medula Espinal/diagnóstico por imagem , Resultado do Tratamento
6.
Neurocirugía (Soc. Luso-Esp. Neurocir.) ; 31(4): 195-200, jul.-ago. 2020. ilus, tab
Artigo em Espanhol | IBECS | ID: ibc-193900

RESUMO

Los quistes aracnoideos espinales son entidades raras y casi siempre tienen una etiología congénita o espontánea. Los casos secundarios son muy poco frecuentes y muchas veces constituyen una causa de deterioro neurológico tras varios meses o años de un traumatismo espinal. Presentamos el caso de un varón diagnosticado de quiste aracnoideo espinal de etiología traumática, agrupamos los casos descritos hasta el momento en la literatura y revisamos las distintas opciones quirúrgicas relacionándolas con las teorías fisiopatológicas que tratan de explicar la génesis de estas lesiones


Spinal arachnoid cysts are rare entities, most of which have a congenital or spontaneous etiology. Secondary cases are infrequent and can constitute a cause of neurological deterioration several months or years after spinal trauma. We present the case of a male patient with traumatic spinal arachnoid cyst, together with a review of the cases published to date. Finally, we explain the different surgical options for this pathology relating them to the physiopathological theories that try to explain the origin of these lesions


Assuntos
Humanos , Masculino , Idoso , Compressão da Medula Espinal/diagnóstico por imagem , Compressão da Medula Espinal/cirurgia , Cistos Aracnóideos/cirurgia , Cistos Aracnóideos/etiologia , Cistos Aracnóideos/diagnóstico , Dor Lombar/etiologia , Espectroscopia de Ressonância Magnética , Distúrbios Somatossensoriais/diagnóstico por imagem , Propriocepção
7.
J Clin Neurosci ; 78: 73-78, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-32600973

RESUMO

Breast cancer spinal metastases (BCSM) are common and require proper treatment that leads to an improvement of the quality of life and contributes to the quod vitam prognosis. Surgical treatment is often required for intractable pain, spinal cord compression or spinal instability. The aim of this retrospective study is to identify which prognostic factors could affect postoperative overall survival in patients affected by BCSM. We report a retrospective cohort study of patients with BCSM, surgically treated from September 2009 to May 2018. Demographic and clinical data were collected. Kaplan-Meier method was used to estimate overall survival, and the log-rank test was used to compare survival curves. A total of 77 patients were studied. The median age at the time of surgery was 54 years. The median follow-up was 49 months. The 3-year and 5-year overall survival rates were 61% (95%CI: 47.5-72.1) and 43.3% (95%CI: 28.8-57.1). Metastatic bone disease (p = 0.0196), preoperative neurological impairment (p = 0.0029), Karnofsky status <70 (p = 0.0241) reduce survival. With multivariate analysis, the effect of Karnofsky score loses statistical significance. The presence of concurrent bone metastases and a preoperative neurological deficit are independent prognostic factors. Therapeutic choices are based on a multidisciplinary assessment that takes into consideration several factors, including an accurate study of prognostic factors.


Assuntos
Neoplasias da Mama , Neoplasias da Coluna Vertebral/mortalidade , Neoplasias da Coluna Vertebral/secundário , Neoplasias da Coluna Vertebral/cirurgia , Adulto , Idoso , Feminino , Humanos , Avaliação de Estado de Karnofsky , Masculino , Pessoa de Meia-Idade , Dor Intratável/cirurgia , Prognóstico , Qualidade de Vida , Estudos Retrospectivos , Compressão da Medula Espinal/cirurgia , Neoplasias da Coluna Vertebral/diagnóstico , Coluna Vertebral/cirurgia , Taxa de Sobrevida
8.
BMC Neurol ; 20(1): 221, 2020 May 30.
Artigo em Inglês | MEDLINE | ID: mdl-32473653

RESUMO

BACKGROUND: Surgery is usually the treatment of choice for patients with cervical compressive myelopathy (CCM). Motor evoked potential (MEP) has proved to be helpful tool in evaluating intraoperative cervical spinal cord function change of those patients. This study aims to describe and evaluate different MEP baseline phenotypes for predicting MEP changes during CCM surgery. METHODS: A total of 105 consecutive CCM patients underwent posterior cervical spine decompression were prospectively collected between December 2012 and November 2016. All intraoperative MEP baselines recorded before spinal cord decompression were classified into 5 types (I to V) that were carefully designed according to the different MEP parameters. The postoperative neurologic status of each patient was assessed immediately after surgery. RESULTS: The mean intraoperative MEP changes range were 10.2% ± 5.8, 14.7% ± 9.2, 54.8% ± 31.9, 74.1% ± 24.3, and 110% ± 40 in Type I, II, III, IV, and V, respectively. There was a significant correlation of the intraoperative MEP change rate with different MEP baseline phenotypes (r = 0.84, P < 0.01). Postoperative transient new spinal deficits were found 0/31 case in Type I, 0/21 in Type II, 1/14 in Type III, 2/24 in Type IV, and 4/15 in Type V. No permanent neurological injury was found in our cases series. CONCLUSIONS: The MEP baselines categories for predicting intraoperative cervical cord function change is proposed through this work. The more serious the MEP baseline abnormality, the higher the probability of intraoperative MEP changes, which is beneficial to early warning for the cervical cord injury.


Assuntos
Medula Cervical/fisiopatologia , Medula Cervical/cirurgia , Monitorização Neurofisiológica Intraoperatória/métodos , Compressão da Medula Espinal/fisiopatologia , Compressão da Medula Espinal/cirurgia , Adulto , Idoso , Vértebras Cervicais , Descompressão Cirúrgica/métodos , Potencial Evocado Motor/fisiologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Procedimentos Neurocirúrgicos/métodos
9.
Neurocirugía (Soc. Luso-Esp. Neurocir.) ; 31(3): 119-131, mayo-jun. 2020. ilus, tab, graf
Artigo em Espanhol | IBECS | ID: ibc-192416

RESUMO

El objetivo principal del tratamiento en las metástasis espinales es el control local de la enfermedad, el alivio del dolor y el mantenimiento de la deambulación. Clásicamente, se ha recomendado una resección quirúrgica del tumor lo más amplia posible seguida de radioterapia o quimioterapia adyuvante. En la actualidad, la radioterapia estereotáxica corporal (SBRT) en dosis única o hipofraccionada proporciona tasas globales de control local al año superiores al 95% con mínima morbilidad, incluso en histologías que suelen considerarse radiorresistentes. Por otro lado, mediante cirugía de descompresión circunferencial posterolateral y estabilización de la columna es factible crear un espacio de 2-3 mm entre el borde tumoral y la duramadre (separation surgery) suficiente para permitir administrar de forma segura SBRT a dosis ablativas. Dado que con frecuencia se trata de pacientes frágiles, dicha cirugía puede realizarse mediante técnicas mínimamente invasivas, que reducen la agresividad quirúrgica y ayudan a minimizar el retraso de eventuales tratamientos sistémicos


The main goal of treatment in spinal metastatic patients is local control of the disease, pain relief and the maintenance of ambulation. Traditionally, wide surgical resection of the tumour followed by adjuvant radiation and/or chemotherapy has been recommended. Currently, single-fraction or hypofractionated stereotactic body radiation therapy (SBRT) yields a one-year local control rate of over 95% with minimum morbidity, even for tumours previously considered radioresistant. In addition, by posterolateral and circumferential decompression and stabilisation of the spinal cord, it is feasible to create a 2 to 3 mm epidural margin between the dura mater and the tumour (separation surgery), enough to deliver safe and ablative doses of SBRT to the vertebrae. As these patients tend to be frail, such interventions should ideally be minimally invasive, thereby reducing surgical aggressiveness and helping to minimise the delay of any systemic therapies


Assuntos
Humanos , Feminino , Adulto , Idoso , Técnicas Estereotáxicas/instrumentação , Procedimentos Cirúrgicos Minimamente Invasivos/métodos , Neoplasias da Medula Espinal/cirurgia , Metástase Neoplásica , Manejo da Dor , Transtornos Neurológicos da Marcha/terapia , Qualidade de Vida , Algoritmos , Radiocirurgia/efeitos adversos , Compressão da Medula Espinal/diagnóstico por imagem , Compressão da Medula Espinal/cirurgia , Cifose/diagnóstico por imagem , Imunoterapia
10.
Am J Med Sci ; 360(2): 206-207, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32387118

Assuntos
Fraturas por Compressão/etiologia , Fraturas Espontâneas/etiologia , Plasmocitoma/complicações , Fraturas da Coluna Vertebral/etiologia , Neoplasias da Coluna Vertebral/complicações , Adulto , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Bortezomib/administração & dosagem , Descompressão Cirúrgica , Dexametasona/administração & dosagem , Progressão da Doença , Feminino , Fraturas por Compressão/diagnóstico por imagem , Fraturas Espontâneas/diagnóstico por imagem , Humanos , Fraturas do Úmero/etiologia , Fraturas do Úmero/cirurgia , Imunoglobulina A/sangue , Imunoglobulina G/sangue , Imunoglobulina M/sangue , Laminectomia , Lenalidomida/administração & dosagem , Mieloma Múltiplo/sangue , Mieloma Múltiplo/complicações , Mieloma Múltiplo/diagnóstico por imagem , Mieloma Múltiplo/tratamento farmacológico , Plasmocitoma/diagnóstico por imagem , Plasmocitoma/patologia , Plasmocitoma/cirurgia , Tomografia por Emissão de Pósitrons , Compressão da Medula Espinal/diagnóstico por imagem , Compressão da Medula Espinal/etiologia , Compressão da Medula Espinal/patologia , Compressão da Medula Espinal/cirurgia , Fraturas da Coluna Vertebral/diagnóstico por imagem , Neoplasias da Coluna Vertebral/diagnóstico por imagem , Neoplasias da Coluna Vertebral/patologia , Neoplasias da Coluna Vertebral/cirurgia , Vértebras Torácicas/diagnóstico por imagem , Vértebras Torácicas/cirurgia , Tomografia Computadorizada por Raios X
12.
World Neurosurg ; 140: 162-165, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32389872

RESUMO

BACKGROUND: Paraplegia after lumbar spinal surgery has been previously described. It was generally provoked by a missed thoracic compression because of degenerative processes, arachnoid cyst, and spinal cord tumor such as meningioma. We describe here a case of a patient with neurofibromatosis type 2 (NF-2) with multiple spinal meningiomas that developed postoperative paraplegia because of decompensation of spinal cord compression below and far from the operated level. CASE DESCRIPTION: A 54-year-old woman with NF-2 was followed-up for multiple spinal meningiomas (C7-T1, T6-7, T9-10 levels). Surgery for the symptomatic and larger lesion (C7-T1) was scheduled. Postoperatively, the patient was found to have paraplegia with sensor anesthesia below the level of the T6 vertebra. An urgent spinal magnetic resonance imaging (MRI) scan was performed revealing the absence of complication at the operated level (C7-T1) but the appearance of a marked intramedullary hyperintensity at the T6-7 level. An urgent T6-7 laminectomy and removal of the meningioma was performed. The postoperative phase was marked by a poor recuperation. Spinal MRI scan at 3 months clearly showed a severely injured spinal cord at the T6-7 level consistent with the neurologic status of the patient. CONCLUSIONS: We report here the first case of acute neurologic deterioration after decompensation of a spinal cord compression below the operated level in spinal intradural surgery. Neurosurgeons must be aware of this possible complication when treating patients with multiple spinal meningiomas.


Assuntos
Meningioma/cirurgia , Neurofibromatose 2/cirurgia , Procedimentos Neurocirúrgicos/efeitos adversos , Paraplegia/etiologia , Compressão da Medula Espinal/etiologia , Neoplasias da Medula Espinal/cirurgia , Feminino , Humanos , Laminectomia , Imagem por Ressonância Magnética , Pessoa de Meia-Idade , Paraplegia/diagnóstico por imagem , Paraplegia/cirurgia , Complicações Pós-Operatórias/diagnóstico por imagem , Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/cirurgia , Compressão da Medula Espinal/diagnóstico por imagem , Compressão da Medula Espinal/cirurgia , Vértebras Torácicas/diagnóstico por imagem , Vértebras Torácicas/cirurgia
13.
Bone Joint J ; 102-B(6): 671-676, 2020 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-32323563

RESUMO

AIMS: The current pandemic caused by COVID-19 is the biggest challenge for national health systems for a century. While most medical resources are allocated to treat COVID-19 patients, several non-COVID-19 medical emergencies still need to be treated, including vertebral fractures and spinal cord compression. The aim of this paper is to report the early experience and an organizational protocol for emergency spinal surgery currently being used in a large metropolitan area by an integrated team of orthopaedic surgeons and neurosurgeons. METHODS: An organizational model is presented based on case centralization in hub hospitals and early management of surgical cases to reduce hospital stay. Data from all the patients admitted for emergency spinal surgery from the beginning of the outbreak were prospectively collected and compared to data from patients admitted for the same reason in the same time span in the previous year, and treated by the same integrated team. RESULTS: A total of 19 patients (11 males and eight females, with a mean age of 49.9 years (14 to 83)) were admitted either for vertebral fracture or spinal cord compression in a 19-day period, compared to the ten admitted in the previous year. No COVID-19 patients were treated. The mean time between admission and surgery was 1.7 days, significantly lower than 6.8 days the previous year (p < 0.001). CONCLUSION: The structural organization and the management protocol we describe allowed us to reduce the time to surgery and ultimately hospital stay, thereby maximizing the already stretched medical resources available. We hope that our early experience can be of value to the medical communities that will soon be in the same emergency situation. Cite this article: Bone Joint J 2020;102-B(6):671-676.


Assuntos
Infecções por Coronavirus , Modelos Organizacionais , Procedimentos Neurocirúrgicos , Procedimentos Ortopédicos , Pandemias , Equipe de Assistência ao Paciente/organização & administração , Pneumonia Viral , Compressão da Medula Espinal/cirurgia , Fraturas da Coluna Vertebral/cirurgia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Procedimentos Clínicos/organização & administração , Eficiência Organizacional , Emergências , Feminino , Alocação de Recursos para a Atenção à Saúde/organização & administração , Hospitais Urbanos , Humanos , Itália , Tempo de Internação/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Avaliação de Processos e Resultados em Cuidados de Saúde , Estudos Prospectivos , Tempo para o Tratamento/estatística & dados numéricos , Adulto Jovem
14.
World Neurosurg ; 139: 268-273, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-32278818

RESUMO

BACKGROUND: No formalized surgical treatment strategy exists for a thoracic epidural abscess. Although endoscopic approaches have been described for the treatment of spinal infections, this is the first report of an endoscopic transforaminal approach for the drainage of a thoracic/lumbar epidural abscess with placement of indwelling abscess drain. We present a novel use of a known endoscopic approach and describe a minimally invasive surgical option for ventrally located thoracic epidural abscesses. CASE DESCRIPTION: A patient with ventrally located T5-L5 epidural abscess with cord compression was taken for endoscopic transforaminal drainage at the right T9-10 level. A drain was left in the abscess cavity and tunneled subcutaneously for continued postoperative drainage. Immediate postoperative radiographic results showed significant reduction in the abscess size. The patient tolerated the procedure well with return to neurologic baseline. CONCLUSIONS: Endoscopic transforaminal drainage of ventrally located thoracic epidural abscess is a safe procedure that may be an option for patients with a purulent-filled abscess. This procedure should be considered an option to avoid more invasive procedures that would require decompression and possibly instrumented fusion.


Assuntos
Abscesso Epidural/cirurgia , Neuroendoscopia/métodos , Descompressão Cirúrgica/métodos , Drenagem/métodos , Feminino , Humanos , Pessoa de Meia-Idade , Compressão da Medula Espinal/etiologia , Compressão da Medula Espinal/cirurgia , Infecções Estafilocócicas/cirurgia , Vértebras Torácicas
15.
World Neurosurg ; 139: 266-267, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-32289505

RESUMO

A 39-year-old man with a history of recurrent pituitary tumor, Cushing disease, and Nelson syndrome presented with neck stiffness. He previously had bilateral adrenalectomy and hypophysectomy 27 years ago. He subsequently had repeat pituitary surgery, stereotactic radiosurgery, and chemotherapy for recurrent pituitary tumor. During follow-up, he was noted to have rising basal adrenocorticotrophin (ACTH) level. On examination, he was neurologically intact with no signs of myelopathy. Magnetic resonance imaging of the spine showed a large intradural extramedullary lesion causing cord compression at the C2-3 level. He underwent a cervical laminectomy and debulking of the lesion under continuous monitoring of motor-evoked and somatosensory-evoked potentials. He remained neurologically intact postoperatively. Histologic analysis revealed a tumor of pituitary origin with synaptophysin and ACTH expression. Pituitary drop metastasis is a rare entity and should raise a high index of suspicion given this clinical presentation. The radiologic appearance can mimic benign lesions such as meningioma or schwannoma.


Assuntos
Carcinoma/secundário , Neoplasias Hipofisárias/patologia , Compressão da Medula Espinal/etiologia , Neoplasias da Medula Espinal/secundário , Adulto , Carcinoma/cirurgia , Descompressão Cirúrgica , Humanos , Laminectomia , Masculino , Compressão da Medula Espinal/cirurgia , Neoplasias da Medula Espinal/complicações , Neoplasias da Medula Espinal/cirurgia
16.
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
17.
World Neurosurg ; 138: e282-e288, 2020 06.
Artigo em Inglês | MEDLINE | ID: mdl-32112938

RESUMO

BACKGROUND: Spinal epidural abscess is a rare pathology with an incidence that has tripled in the past 2 decades. Ventral cervical epidural abscesses (vCEA) of the cervical spine pose particular treatment challenges because of the anatomical location. The aim of this report is to identify trends in the surgical management of these patients and to determine whether concomitant spondylodiscitis warrants fusion at the index surgery. METHODS: Patients presenting to a quaternary care institution from January 2009 to December 2018 with isolated vCEA were identified. Patients were excluded if they had dorsal or circumferential epidural abscesses. Clinical and radiographic data were collected. Patients with vCEA were stratified by the presence or absence of spondylodiscitis upon presentation. Clinical outcomes analyzed included neurological sequelae and the need for revision surgery. RESULTS: During the 10-year study period, 36 patients presented with symptomatic isolated vCEA and constituted the study cohort; 16 (44%) had concurrent spondylodiscitis. All 36 patients underwent surgical decompression; the initial surgical approach was anterior-only for 7 patients (19%), posterior-only for 27 patients (75%), and and a combined approach for 2 patients (6%). Four patients from the total cohort (11%) ultimately required a revision operation; all 4 were from the subset with concurrent spondylodiscitis (25% vs. 0%, P = 0.03). CONCLUSIONS: vCEA can be evacuated safely and effectively by a variety of strategies in patients with neurologic deficits. Concomitant spondylodiscitis with cervical epidural abscess may warrant instrumented fusion as part of the initial surgical strategy.


Assuntos
Discite/complicações , Abscesso Epidural/complicações , Abscesso Epidural/cirurgia , Doenças da Coluna Vertebral/complicações , Doenças da Coluna Vertebral/cirurgia , Adulto , Idoso , Idoso de 80 Anos ou mais , Vértebras Cervicais , Descompressão Cirúrgica/métodos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Compressão da Medula Espinal/etiologia , Compressão da Medula Espinal/cirurgia
18.
World Neurosurg ; 139: 23-30, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-32194277

RESUMO

Sacral-alar iliac (SAI) screws constitute a relatively new technique for pelvic fixation. Since their initial description in 2007, SAI screws have gained wide popularity among the spine surgery community. In 2013, we first described the possibility of using both S1 and S2 SAI screws for pelvic fixation in revision surgeries for adult degenerative scoliosis. Although a previous radiological study has suggested the feasibility of S3 and S4 SAI screws, to the best of our knowledge, there has been no report in the literature on the clinical use of such techniques. In this brief technical note, we present the first clinical report of the use of S3 SAI screws as a salvage method for pelvic fixation in a patient with suboptimal anatomy that prevented proper placement of S1 and S2 SAI screws. We also discuss the recommended anatomical entry points and trajectory of such screws.


Assuntos
Parafusos Ósseos , Ílio/cirurgia , Procedimentos Neurocirúrgicos/métodos , Sacro/cirurgia , Compressão da Medula Espinal/cirurgia , Curvaturas da Coluna Vertebral/cirurgia , Estenose Espinal/cirurgia , Vértebras Torácicas/cirurgia , Idoso , Feminino , Humanos , Cifose/diagnóstico por imagem , Cifose/cirurgia , Laminectomia , Lordose/cirurgia , Osteotomia , Compressão da Medula Espinal/diagnóstico por imagem , Compressão da Medula Espinal/fisiopatologia , Curvaturas da Coluna Vertebral/diagnóstico por imagem , Estenose Espinal/diagnóstico por imagem , Estenose Espinal/fisiopatologia , Espondilose/diagnóstico por imagem , Espondilose/cirurgia
19.
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
20.
World Neurosurg ; 137: 367-371, 2020 05.
Artigo em Inglês | MEDLINE | ID: mdl-32084619

RESUMO

BACKGROUND: The distal extent of the spinal cord is most often at the level of the L1 or L2 vertebral body. In rare cases, a low-lying cord extends more distally. In this scenario, pathology that normally causes radiculopathy may cause myelopathy due to compression of the cord rather than nerve roots of the cauda equina. CASE DESCRIPTION: A 40-year-old man presented with progressive leg pain, sensory changes, hyperreflexia, and gait disturbance 1 month after a fall. The patient was myelopathic and had central L1/2 and L2/3 disk herniations. After unsuccessful unilateral laminotomy bilateral decompression, it was decided that an endoscopic diskectomy would be the best technique to remove the disk herniation without trauma to the cord or destabilizing the spine to require fusion. A percutaneous endoscopic lumbar diskectomy at L1/2 was performed under local anesthesia. The patient's leg pain, sensory changes, hyperreflexia, and gait disturbance resolved after surgery, and he was doing well at 6 months' follow-up. CONCLUSIONS: In patients with spina bifida occulta who present with myelopathy, lumbar disk herniation should be considered if the patient has a low-lying cord. This is the first report of percutaneous endoscopic lumbar diskectomy for lumbar disk herniation in the presence of a low-lying spinal cord. We have demonstrated that this approach can treat this condition effectively and safely.


Assuntos
Discotomia/métodos , Deslocamento do Disco Intervertebral/cirurgia , Vértebras Lombares , Espinha Bífida Oculta/complicações , Compressão da Medula Espinal/cirurgia , Adulto , Descompressão Cirúrgica/métodos , Progressão da Doença , Humanos , Deslocamento do Disco Intervertebral/complicações , Deslocamento do Disco Intervertebral/diagnóstico por imagem , Laminectomia/métodos , Imagem por Ressonância Magnética , Masculino , Defeitos do Tubo Neural/complicações , Compressão da Medula Espinal/diagnóstico por imagem , Compressão da Medula Espinal/etiologia
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