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1.
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
2.
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
3.
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
4.
Eur Radiol ; 30(1): 357-369, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31350584

RESUMO

OBJECTIVES: To investigate the effect of cervical spondylosis (CS) in the brain with a combination of advanced neuroimaging techniques. METHODS: Twenty-seven patients with CS and 24 age- and gender-matched healthy controls were studied. Disease severity was quantified using the Modified Japanese Orthopaedic Association Scoring System (mJOHA). Magnetic resonance (MR) imaging of the brain and spinal cord, functional MR imaging (fMRI) with a bilateral rest/finger-tapping paradigm, brain diffusion tensor imaging (DTI), voxel-based morphometry (VBM), and MR spectroscopy of the sensorimotor cortex were performed. RESULTS: A total of 92.3% of patients had more than one herniated disc. In the MRI, 33.33% presented signs of myelopathy. The mJOHA score was 13.03 ± 2.83. Compared with controls, DTI results showed significant lower FA values in Corpus callosum, both corticospinal tracts and middle cerebellar peduncles (p < 0.05 corrected). Only in CS patients fMRI results showed activation in both globus pallidi, caudate nucleus, and left thalamus (p < 0.001). Subject-specific activation of the BOLD signal showed in CS patients lower activation in the sensorimotor cortex and increased activation in both cerebellum hemispheres (p < 0.05 corrected). VBM showed bilateral clusters of gray matter loss in the sensorimotor cortex and pulvinar nucleus (p < 0.05 corrected) of CS patients. NAA/Cr was reduced in the sensorimotor cortex of CS patients (p < 0.05). Linear discriminant and support vector machine analyses were able to classify > 97% of CS patients with parameters obtained from the fMRI, DTI, and MRS results. CONCLUSION: CS may lead to distal brain damage affecting the white and gray matter of the sensorimotor cortex causing brain atrophy and functional adaptive changes. KEY POINTS: • This study suggests that patients with cervical spondylosis may present anatomical and functional adaptive changes in the brain. • Cervical spondylosis may lead to white matter damage, gray matter volume loss, and functional adaptive changes in the sensorimotor cortex. • The results reported in this work may be of value to better understand the effect of prolonged cervical spine compression in the brain.


Assuntos
Encéfalo/diagnóstico por imagem , Encéfalo/patologia , Imagem de Tensor de Difusão , Imagem por Ressonância Magnética , Espectroscopia de Ressonância Magnética , Compressão da Medula Espinal/diagnóstico por imagem , Espondilose/diagnóstico por imagem , Substância Branca/diagnóstico por imagem , Idoso , Atrofia/diagnóstico por imagem , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Compressão da Medula Espinal/patologia , Compressão da Medula Espinal/fisiopatologia , Espondilose/patologia , Espondilose/fisiopatologia , Substância Branca/patologia
5.
Medicine (Baltimore) ; 98(50): e18413, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31852164

RESUMO

RATIONALE: Chondrosarcoma of the sacrum is a highly unusual disease without standard curative managements yet. The objective of this study is to report a very rare case of chondrosarcoma of the sacrum successfully operated by percutaneous vertebroplasty. The management of these unique cases has yet to be well-documented. PATIENT CONCERNS: A 45-year-old woman presented with a five-month history of continuous and progressive pain and numbness of left extremity. A lytic, expanding lesion of the sacrum and paraspinal region with severe epidural spinal cord compression was identified. DIAGNOSIS: MRI of spine showed spinal cord compression secondary to the epidural componant of the giant mass, with increased marrow infiltration of the left S2 vertebral and paravertebral region, which presented as a solid tumor. Post-operative pathology confirmed the diagnosis of sacral well-differentiated chondrosarcoma (stage I B). INTERVENTIONS: The patient underwent percutaneous vertebroplasty and cement augmentation of sacrum via a posterior approach. OUTCOMES: The patient's neurological deficits improved significantly after the surgery, but the patient died of multiple systemic metastases at the 2-year follow-up visit. There were no complications associated with the operation during the follow-up period. LESSONS: Taken together, the lesion's clinical features, imaging results, and pathological characteristics are unique. Combined efforts of specialists from orthopedics, radiology, neurosurgery, pathology, and medical oncology led to the successful diagnosis and management of this patient. Giant sacral chondrosarcoma, although rare, should be part of the differential diagnosis when the patient presents with back pain and radiculopathy. We recommend the posterior approach for spinal decompression of the sacral chondrosarcoma when the tumor has caused neurological deficits or other severe symptoms. Osteoplasty by cement augmentation is also a good choice for surgical treatment.


Assuntos
Condrossarcoma/cirurgia , Sacro/cirurgia , Neoplasias da Coluna Vertebral/cirurgia , Condrossarcoma/diagnóstico , Condrossarcoma/patologia , Evolução Fatal , Feminino , Humanos , Dor Lombar/etiologia , Imagem por Ressonância Magnética , Pessoa de Meia-Idade , Sacro/diagnóstico por imagem , Compressão da Medula Espinal/diagnóstico por imagem , Compressão da Medula Espinal/etiologia , Neoplasias da Coluna Vertebral/diagnóstico , Neoplasias da Coluna Vertebral/patologia , Vertebroplastia/métodos
6.
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
7.
J Pediatr Orthop ; 39(9): e680-e686, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31503224

RESUMO

BACKGROUND: Cervical spine deformity in rhizomelic chondrodysplasia punctata (RCDP) has been described with different findings reported in the literature. However, available literature provides limited data from a few cases with magnetic resonance imaging (MRI) of the cervical spine. Our report describes the MRI findings in a group of children with RCDP, aiming to reach a better understanding of this pathology. METHODS: An Institutional Review Board-approved RCDP Registry was created at our institution with the goal of identifying pertinent medical issues over the lifespan of individuals with RCDP. Records of children within the registry were evaluated, and magnetic resonance images obtained between 2004 and 2015, were available for review. The levels of spinal canal stenosis were recorded and the severity of the stenosis was decided based on adults' parameters. Cord compression and myelomalacia were confirmed on the axial images. Sagittal lumbar spine magnetic resonance images were also evaluated when available, and the presence of tethered cord and fatty filum was recorded. RESULTS: Twenty-six children (15 boys and 11 girls) were identified in the RCDP Registry. Eleven children (6 boys and 5 girls) had sagittal MRI of the cervical spine available for review. Age at the time of MRI study was variable (1 wk to 32 mo). All patients except 1 had stenosis of the cervical spinal canal. Myelomalacia of the cord was noted only in this patient. CONCLUSIONS: This study suggests that, in children with RCDP, cervical spinal stenosis and cord compression are a real risk, and children with this diagnosis should have monitoring for these issues. Tethered cord is also a possible finding that needs to be evaluated. Full sagittal spine MRI is necessary to detect the possible deformities at the cervical and lumbar levels.


Assuntos
Vértebras Cervicais/patologia , Condrodisplasia Punctata Rizomélica/complicações , Compressão da Medula Espinal/etiologia , Estenose Espinal/etiologia , Vértebras Cervicais/diagnóstico por imagem , Pré-Escolar , Condrodisplasia Punctata Rizomélica/diagnóstico por imagem , Condrodisplasia Punctata Rizomélica/patologia , Constrição Patológica , Feminino , Humanos , Lactente , Vértebras Lombares/diagnóstico por imagem , Vértebras Lombares/patologia , Imagem por Ressonância Magnética , Masculino , Canal Vertebral/diagnóstico por imagem , Canal Vertebral/patologia , Compressão da Medula Espinal/diagnóstico por imagem , Compressão da Medula Espinal/patologia , Doenças da Medula Espinal , Estenose Espinal/diagnóstico por imagem , Estenose Espinal/patologia
8.
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
9.
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
10.
J Vet Intern Med ; 33(5): 2312-2318, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31490026

RESUMO

BACKGROUND: Transcranial magnetic stimulation (TMS) and recording of magnetic motor evoked potentials (MMEP) can detect neurological dysfunction in horses but cutoff values based on confirmed spinal cord dysfunction are lacking. OBJECTIVES: To determine latency time cutoff for neurological dysfunction. ANIMALS: Five control horses and 17 horses with proprioceptive ataxia. METHODS: Case-control study with receiver operating characteristic curve analysis, based on diagnostic imaging, TMS, and histopathological findings. Horses were included if all 3 examinations were performed. RESULTS: Diagnostic imaging and histopathology did not show abnormalities in the control group but confirmed spinal cord compression in 14 of 17 ataxic horses. In the remaining 3 horses, histopathological lesions were mild to severe, but diagnostic imaging did not confirm spinal cord compression. In control horses, latency time values of thoracic and pelvic limbs were significantly lower than in ataxic horses (20 ± 1 vs 34 ± 16 milliseconds, P = .05; and 39 ± 1 vs 78 ± 26 milliseconds, P = .004). Optimal cutoff values to detect spinal cord dysfunction were 22 milliseconds (sensitivity [95% CI interval], 88% [73%-100%]; specificity, 100% [100%-100%]) in thoracic and 40 milliseconds (sensitivity, 94% [83%-100%]; specificity, 100% [100%-100%]) in pelvic limbs. To detect spinal cord dysfunction caused by compression, the optimal cutoff for thoracic limbs remained 22 milliseconds, while it increased to 43 milliseconds in pelvic limbs (sensitivity, 100% [100%-100%]; specificity, 100% [100%-100%] for thoracic and pelvic limbs). CONCLUSIONS AND CLINICAL IMPORTANCE: Magnetic motor evoked potential analysis using these cutoff values is a promising diagnostic tool for spinal cord dysfunction diagnosis in horses.


Assuntos
Potencial Evocado Motor , Doenças dos Cavalos/fisiopatologia , Doenças da Medula Espinal/veterinária , Estimulação Magnética Transcraniana/veterinária , Animais , Ataxia/diagnóstico por imagem , Ataxia/fisiopatologia , Ataxia/veterinária , Estudos de Casos e Controles , Feminino , Doenças dos Cavalos/diagnóstico por imagem , Cavalos , Masculino , Medula Espinal/diagnóstico por imagem , Medula Espinal/fisiopatologia , Compressão da Medula Espinal/diagnóstico por imagem , Compressão da Medula Espinal/fisiopatologia , Compressão da Medula Espinal/veterinária , Doenças da Medula Espinal/diagnóstico por imagem , Doenças da Medula Espinal/fisiopatologia
11.
World Neurosurg ; 132: 303-308, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31394361

RESUMO

BACKGROUND: Primary Ewing sarcoma of the mobile spine is a rare disease. Its management requires careful surgical planning, because radical, margin-free excision is directly correlated with prognosis. Extensive bone removal in the cervical spine can lead to instability and cause postoperative iatrogenic cervical deformity. Thus, spinal instrumentation plays an important role in restoring postresection spinal stability and improving quality of life. METHODS: We present a novel technique that allows successful removal of a large Ewing sarcoma of the subaxial cervical spine, infiltrating and traversing the posterior bone elements, and extending into the paraspinal muscles. This technique involves radical en bloc resection of posteriorly located cervical tumors via multilevel pediculotomy, with terminal vertebrae pedicle screw reconstruction. RESULTS: Terminal vertebrae cervical pedicle screw reconstruction allowed wide surgical excision with satisfactory oncologic and mechanical results. CONCLUSIONS: This technique enables 1-stage total tumor resection and stabilization and may be a viable alternative to radical en bloc resection of posteriorly located epidural malignant lesions of the cervical spine in selected cases.


Assuntos
Vértebras Cervicais/cirurgia , Procedimentos Neurocirúrgicos/métodos , Parafusos Pediculares , Procedimentos Cirúrgicos Reconstrutivos/métodos , Sarcoma de Ewing/cirurgia , Neoplasias da Coluna Vertebral/cirurgia , Adolescente , Vértebras Cervicais/diagnóstico por imagem , Humanos , Masculino , Osteotomia/métodos , Sarcoma de Ewing/complicações , Sarcoma de Ewing/diagnóstico por imagem , Compressão da Medula Espinal/diagnóstico por imagem , Compressão da Medula Espinal/etiologia , Neoplasias da Coluna Vertebral/complicações , Neoplasias da Coluna Vertebral/diagnóstico por imagem
12.
World Neurosurg ; 132: 47-52, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31442650

RESUMO

BACKGROUND: With the continuous advancement of the spinal endoscopic technique in recent years, full-endoscopic operations provide a new approach for the treatment of migrated cervical disk herniation. CASE DESCRIPTION: A 42-year-old man presented with nuchal pain and limb numbness for 2 months, with recently developed symptoms of unstable walking. Physical examination revealed a diminished skin sensitivity to pain and temperature, beginning at the C4 dermatome. The muscle strength of both upper limbs decreased to grade 4, and the muscle strength was grade 4 on both sides of the lower limbs. Hoffmann sign and ankle clonus were positive. Magnetic resonance imaging (MRI) and computed tomography (CT) scan demonstrated that a large piece of a segmental disk had migrated to the rear area of the C4 vertebral body and seriously compressed the spinal cord. A percutaneous full-endoscopic anterior transcorporeal cervical diskectomy was performed on the patient. CONCLUSIONS: The postoperative Japanese Orthopaedic Association (JOA) score increased from 8 to 11 points. At 2-year follow-up, the JOA score was 16 points, the improvement rate was 88.9%, and cervical vertebrae MRI, cervical CT scan, and 3-dimensional reconstruction showed that the cervical vertebrae channel healed without vertebral fractures, bony channel collapse, adjacent segment degeneration, or intervertebral space height.


Assuntos
Vértebras Cervicais/cirurgia , Discotomia Percutânea/métodos , Deslocamento do Disco Intervertebral/cirurgia , Neuroendoscopia/métodos , Compressão da Medula Espinal/cirurgia , Adulto , Vértebras Cervicais/diagnóstico por imagem , Humanos , Deslocamento do Disco Intervertebral/complicações , Deslocamento do Disco Intervertebral/diagnóstico por imagem , Masculino , Compressão da Medula Espinal/diagnóstico por imagem , Compressão da Medula Espinal/etiologia
13.
J Cancer Res Ther ; 15(4): 807-812, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31436235

RESUMO

Background: This study evaluated the clinical efficacy of computed tomography (CT)-guided radioactive iodine-125 (125 I) seed implantation in patients with metastatic epidural spinal cord compression (MESCC). Materials and Methods: A cohort of 22 patients with MESCC were retrospectively enrolled. All patients underwent CT-guided 125 I seed implantation therapy via standard procedures. Clinical indexes, including the University of Texas MD Anderson Cancer Center (MDA) criteria for tumor responses, numerical rating scale (NRS) for the degree of pain, Karnofsky Performance Status (KPS) for quality of life, American Spinal Injury Association (ASIA) impairment scale, grade of ESCC, and radiation dose, were evaluated and recorded pre- and post-operation. A follow-up evaluation was performed at least 3 months after the operation. Finally, pre- and post-operative differences in these clinical indexes were compared. Overall survival was recorded. Results: Operations were successfully performed on all patients. A median of 48 (range, 7-103) seeds were implanted in lesions, and the postoperative target verified dose D90 was 11,072.4 ± 1773.5 cGy. Patients were followed for a median of 6 months (range, 3-38 months). The median survival time was 10 months; the response rate was 18/22 (82%); the local control rates at 3, 6, and 12 months were 91.3%, 81.9%, and 81.9%, respectively; and the survival rates were 80%, 50.0%, and 21.9% at 6, 12, and 18 months, respectively. The ESCC grade was significantly lower (P < 0.05). Based on the ASIA impairment scale, the nerve functional reservation, recovery, and decline rates were 63.7% (14/22), 27.3% (6/22), and 9% (2/22), respectively. The NRS and KPS were both significantly improved in the 3rd month of follow-up (P < 0.05). Conclusion: CT-guided 125 I seed implantation represents an effective and safe palliative care for patients with MESCC, which can effectively relieve pain and spinal cord compression and improve nerve function and quality of life.


Assuntos
Neoplasias Epidurais/radioterapia , Radioisótopos do Iodo/uso terapêutico , Inoculação de Neoplasia , Neoplasias/radioterapia , Radioterapia Guiada por Imagem/métodos , Compressão da Medula Espinal/radioterapia , Neoplasias da Coluna Vertebral/radioterapia , Tomografia Computadorizada por Raios X/métodos , Adulto , Idoso , Neoplasias Epidurais/diagnóstico por imagem , Neoplasias Epidurais/secundário , Feminino , Seguimentos , Humanos , Metástase Linfática , Masculino , Pessoa de Meia-Idade , Neoplasias/diagnóstico por imagem , Neoplasias/patologia , Dosagem Radioterapêutica , Planejamento da Radioterapia Assistida por Computador/métodos , Estudos Retrospectivos , Compressão da Medula Espinal/diagnóstico por imagem , Compressão da Medula Espinal/patologia , Neoplasias da Coluna Vertebral/diagnóstico por imagem , Neoplasias da Coluna Vertebral/secundário , Taxa de Sobrevida , Resultado do Tratamento
14.
World Neurosurg ; 132: 12-13, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31450000

RESUMO

BACKGROUND: Only a few cases of spinal cord compression after cervical laminectomy have been reported. CASE DESCRIPTION: We report a case of tetraparesis after executing a C3-C6 anterior and posterior decompression and fusion. Cervical magnetic resonance imaging demonstrated a spinal cord compression due to the impingement of the paraspinal muscles through the laminectomy. The patient experienced a spontaneous neurological recovery and the follow-up cervical magnetic resonance imaging showed resolution of the spinal cord compression. CONCLUSIONS: This rare complication should be considered among the others after executing a cervical laminectomy.


Assuntos
Vértebras Cervicais/cirurgia , Descompressão Cirúrgica , Laminectomia , Músculos Paraespinais/diagnóstico por imagem , Complicações Pós-Operatórias/diagnóstico por imagem , Compressão da Medula Espinal/diagnóstico por imagem , Fusão Vertebral , Humanos , Imagem por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Quadriplegia/etiologia , Compressão da Medula Espinal/complicações , Compressão da Medula Espinal/cirurgia
15.
J Vet Intern Med ; 33(5): 2160-2166, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31469206

RESUMO

BACKGROUND: Cervical spondylomyelopathy (CSM) occurs because of compression of the cervical spinal cord, nerve roots, or both, usually affecting young adult to older large and giant breed dogs. Juvenile dogs are affected infrequently. OBJECTIVE: To describe clinical and magnetic resonance imaging (MRI) findings in juvenile dogs (≤ 12 months) with cervical spondylomyelopathy. ANIMALS: Twenty CSM-affected juvenile dogs. METHODS: Medical and imaging records for juvenile dogs with CSM were reviewed. History and neurologic examination findings were obtained, including follow-up data. The MRI studies were reviewed for cause and site of spinal cord compression, intervertebral disk protrusion or degeneration, articular process degenerative changes, intervertebral foraminal stenosis, and spinal cord signal changes. RESULTS: Mean (median) age at the time of diagnosis was 9.4 (10) months. There were 16 giant breed dogs. Eighteen dogs had a chronic presentation, 18/20 had proprioceptive ataxia, and 9/20 had cervical pain. On MRI, the principal spinal cord compression occurred at C5-C6, C6-C7, or both in most dogs; 12/20 dogs had ≥2 sites of spinal cord compression. The cause of compression was articular process proliferation in 8/20 dogs and disk protrusion in 2/20 dogs. Intervertebral disk degeneration was seen in 9/20 dogs. Follow-up was obtained for 12/20 dogs: 10/12 were managed medically and 2/12 surgically. CONCLUSIONS AND CLINICAL IMPORTANCE: Cervical spondylomyelopathy in juvenile dogs was characterized mostly by osseous-associated spinal cord compression and multiple compressive sites. Almost half of the dogs had intervertebral disk degeneration. Intervertebral disk protrusion was seen in both giant and large breed dogs.


Assuntos
Vértebras Cervicais/diagnóstico por imagem , Doenças do Cão/diagnóstico por imagem , Degeneração do Disco Intervertebral/veterinária , Deslocamento do Disco Intervertebral/veterinária , Compressão da Medula Espinal/veterinária , Animais , Vértebras Cervicais/patologia , Doenças do Cão/patologia , Cães , Feminino , Degeneração do Disco Intervertebral/diagnóstico por imagem , Deslocamento do Disco Intervertebral/diagnóstico por imagem , Imagem por Ressonância Magnética/veterinária , Masculino , Cervicalgia/veterinária , Compressão da Medula Espinal/diagnóstico por imagem , Estenose Espinal/diagnóstico por imagem , Estenose Espinal/veterinária
18.
World Neurosurg ; 130: e709-e714, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31279106

RESUMO

OBJECTIVE: We sought to investigate the relationship between cervical cord compression and factors related to whole-spine sagittal balance. METHODS: This retrospective single-center study included patients who visited our clinic for the evaluation of lumbar pathology including trauma and degeneration. Patients aged 60-89 years who underwent whole-spine sagittal T2 scout magnetic resonance imaging and whole-spine radiograph between 2014 and 2018 were included in our study. We consecutively enrolled 100 patients for our study without any prejudice. We collected data on patient characteristics, diagnosis, cervical cord compression index (CCI), sagittal vertical axis (C7-S1, C2-7), and other parameters related to sagittal balance such as pelvic incidence minus lumbar lordosis. Pearson correlation coefficients were calculated to compare CCI with each whole-spine sagittal balance parameter. RESULTS: Of the 100 patients, 44 were men. The mean age was 74.21 years. On the basis of Pearson correlation coefficients, CCI showed the strongest positive linear correlation with C7-S1 sagittal vertical axis (r = 0.688; P < 0.01), followed by the C2-7 sagittal vertical axis (r = 0.563; P < 0.01). CONCLUSIONS: Cervical cord compression is more likely to develop in patients with sagittal imbalance. It is important to use whole-spine radiograph and whole-spine T2 scout magnetic resonance imaging to analyze CCI in these patients.


Assuntos
Medula Cervical/diagnóstico por imagem , Imagem por Ressonância Magnética/métodos , Compressão da Medula Espinal/diagnóstico por imagem , Doenças da Coluna Vertebral/diagnóstico por imagem , Idoso , Idoso de 80 Anos ou mais , Medula Cervical/cirurgia , Vértebras Cervicais/diagnóstico por imagem , Vértebras Cervicais/cirurgia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Distribuição Aleatória , Estudos Retrospectivos , Compressão da Medula Espinal/cirurgia , Doenças da Coluna Vertebral/cirurgia
19.
World Neurosurg ; 131: 43-46, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31362104

RESUMO

BACKGROUND: Spinal arachnoiditis and associated arachnoid adhesions can cause debilitating neurological symptoms due to nerve root and spinal cord compression or tethering. Adhesiolysis using a microscopic approach has traditionally been used for this condition. This procedure has been further refined in recent years with the use of flexible endoscopes. CASE DESCRIPTION: We report the case of a patient with progressive thoracic myelopathy secondary to arachnoid adhesions associated with arachnoiditis. A minimally invasive technique of adhesiolysis and placement of a cysto-arachnoid shunt was performed with the assistance of a flexible endoscope. CONCLUSIONS: The present case report has highlighted the advantages of using a flexible endoscope to treat spinal arachnoiditis adhesiolysis and placement of a cysto-arachnoid shunt, including a smaller skin incision and extended visualization.


Assuntos
Cistos Aracnóideos/cirurgia , Aracnoidite/cirurgia , Hematoma Subdural Espinal/cirurgia , Neuroendoscopia/métodos , Complicações Pós-Operatórias/cirurgia , Compressão da Medula Espinal/cirurgia , Aderências Teciduais/cirurgia , Idoso , Cistos Aracnóideos/diagnóstico por imagem , Aracnoidite/diagnóstico por imagem , Feminino , Humanos , Complicações Pós-Operatórias/diagnóstico por imagem , Compressão da Medula Espinal/diagnóstico por imagem , Espaço Subaracnóideo , Aderências Teciduais/diagnóstico por imagem
20.
BMJ Case Rep ; 12(7)2019 Jul 24.
Artigo em Inglês | MEDLINE | ID: mdl-31345829

RESUMO

Multifocal bone Langerhans cell histiocytosis (LCH) is usually treated with prednisolone and vinblastine. We present a case conservatively treated with indomethacin with good clinical and radiological response. A 7-year-old achondroplastic boy presented with worsening thoracic back pain and leg weakness. An admission MRI spine showed a pathological T1 vertebrae fracture with posterior soft tissue extension compressing and distorting the spinal cord. A CT guided biopsy revealed an LCH. Steroids were avoided to reduce osteopenia risk and further vertebral fragility. Considering the risk of a thoracic surgical approach in a child with this background, he was managed conservatively with indomethacin and a Sternal Occipital Mandibular Immobilizer (SOMI) Brace. Pain resolved completely within 6 months and the brace was discontinued. Serial follow-up scans showed progressive resolution of the pathological T1 fracture and complete resolution of the spinal cord compression.


Assuntos
Acondroplasia/fisiopatologia , Anti-Inflamatórios não Esteroides/uso terapêutico , Dor nas Costas/etiologia , Histiocitose de Células de Langerhans/fisiopatologia , Indometacina/uso terapêutico , Compressão da Medula Espinal/fisiopatologia , Vértebras Torácicas/patologia , Acondroplasia/complicações , Dor nas Costas/diagnóstico por imagem , Dor nas Costas/tratamento farmacológico , Braquetes , Criança , Tratamento Conservador , Histiocitose de Células de Langerhans/diagnóstico por imagem , Histiocitose de Células de Langerhans/tratamento farmacológico , Humanos , Imagem por Ressonância Magnética , Masculino , Compressão da Medula Espinal/diagnóstico por imagem , Compressão da Medula Espinal/tratamento farmacológico , Tomografia Computadorizada por Raios X , Resultado do Tratamento
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