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1.
Pan Afr Med J ; 38: 128, 2021.
Artigo em Francês | MEDLINE | ID: mdl-33912298

RESUMO

Intraspinal tumors are uncommon. Positive diagnosis is based on medical imaging exams, in particular MRI. Anatomopathological examination allows for definitive diagnosis. Surgery is the treatment of choice for most of them. Prognosis is related to the histological type and patient´s initial clinical condition. We here report the histological profile and progression of intraspinal tumors in our department. We conducted a retrospective study over a period of 10 years. All operated patients with histology-confirmed intraspinal tumor (23 cases) were enrolled. Four unworkable records were excluded. The median time from symptom onset and first consultation was 79 days. Patients presented with spinal cord compression. In 11 cases this was characterized by slow onset. Seven CT scan and 14 MRI were performed, which showed 4 intramedullary tumors, 9 intradural, 1 extradural, and 5 of unknown site. Histological examination showed meningioma in 11 cases, neurinoma in 3 cases. In 7 cases, it confirmed the diagnosis based on Imaging tests (4 CT and 3 MRI). Macroscopically complete resection was performed in 14 cases; it was partial in 5 cases. After a 6-month follow-up period 6 patients had fully recovered, 9 partially. This study highlights diagnosis delays. MRI better defined the lesion, but its histological approach was limited. Meningiomas dominated. Complete resection was most often performed. The postoperative course was uneventful.


Assuntos
Neoplasias Meníngeas/patologia , Meningioma/patologia , Neurilemoma/patologia , Neoplasias da Coluna Vertebral/patologia , Adolescente , Adulto , Idoso , Criança , Progressão da Doença , Feminino , Humanos , Imagem por Ressonância Magnética , Masculino , Neoplasias Meníngeas/diagnóstico por imagem , Neoplasias Meníngeas/cirurgia , Meningioma/diagnóstico por imagem , Meningioma/cirurgia , Pessoa de Meia-Idade , Neurilemoma/diagnóstico por imagem , Neurilemoma/cirurgia , Estudos Retrospectivos , Compressão da Medula Espinal/etiologia , Neoplasias da Coluna Vertebral/diagnóstico por imagem , Neoplasias da Coluna Vertebral/cirurgia , Tomografia Computadorizada por Raios X , Adulto Jovem
3.
Turk Neurosurg ; 31(1): 67-72, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33491169

RESUMO

AIM: To determine the effectiveness of diffusion tensor imaging (DTI) in diagnosing cervical spondylotic myelopathy (CSM) in patients with no findings detected in conventional magnetic resonance imaging (MRI). MATERIAL AND METHODS: Fifty-four patients who presented for cervical MRI between January 2016 and June 2016, with symptoms such as neck pain, paresis, and numbness in hands, were included in the study. The patients were split into four groups based on their degrees of spinal stenosis. The obtained data were examined using special software and color-coded fractional anisotropy (FA), and apparent diffusion coefficient (ADC) maps were formed. Through these maps, using regions of interest (ROIs), FA and ADC values were calculated and the contribution of these values to the diagnosis was evaluated statistically. RESULTS: When all grades of cervical spinal canal stenosis were compared, a statistically significant negative correlation between spinal canal stenosis degree and FA values, and a positive correlation between stenosis degree and ADC values were noted (p < 0.001). In the comparison of stenotic levels and non-stenotic levels for the grade 2 patient group, there was a statistically significant decrease in FA values and an increase in ADC values in stenotic levels compared with prestenotic and poststenotic levels (p < 0.05). CONCLUSION: DTI and quantitative FA and ADC measurements are candidate imaging techniques for the diagnosis of early-stage CSM, which shows no findings in conventional MRI, and determining the degree of spinal cord injury.


Assuntos
Imagem de Tensor de Difusão/métodos , Compressão da Medula Espinal/diagnóstico por imagem , Estenose Espinal/etiologia , Espondilose/diagnóstico por imagem , Adulto , Vértebras Cervicais/patologia , Feminino , Humanos , Interpretação de Imagem Assistida por Computador/métodos , Masculino , Pessoa de Meia-Idade , Compressão da Medula Espinal/etiologia , Espondilose/complicações
4.
Crit Rev Oncol Hematol ; 160: 103205, 2021 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-33387626

RESUMO

Spinal cord compression (SCC) is a devastating complication of multiple myeloma and has the potential to cause loss of neurological function. The common symptoms of SCC are back pain, motor weakness, and sensory change. Once diagnosed, the patient should be managed as soon as possible to prevent permanent loss of neurological function. Currently, there have been a number of studies describing the mechanism and management experience of SCC in patients with myeloma. The clinical features, diagnostic strategies, and the roles of different therapeutic options are herein reviewed.


Assuntos
Mieloma Múltiplo , Compressão da Medula Espinal , Humanos , Mieloma Múltiplo/complicações , Mieloma Múltiplo/terapia , Compressão da Medula Espinal/diagnóstico , Compressão da Medula Espinal/etiologia , Compressão da Medula Espinal/terapia
6.
Rinsho Shinkeigaku ; 60(9): 603-608, 2020 Sep 29.
Artigo em Japonês | MEDLINE | ID: mdl-32779595

RESUMO

We report a 77-year-old man who presented with numbness and weakness of the feet bilaterally, that had progressed over 13 years. He was diagnosed with chronic inflammatory demyelinating polyradiculoneuropathy (CIDP) on the basis of nerve conduction studies and a sural nerve biopsy; however, he was inadequately treated and his weakness had progressed. At 76 years of age, he developed spasticity in the legs as well as bladder and rectal incontinences. Gd-enhanced MRI revealed severe compression of the cervical cord by massively enlarged nerve roots. A cervical laminectomy was performed to decompress the cervical cord. A fascicular biopsy of the C5 dorsal root showed a prominent lymphocyte infiltration and edema. Repeated methylprednisolone pulse therapy and IVIg ameliorated the weakness. We concluded that the main cause of nerve root hypertrophy in this patient was active inflammation.


Assuntos
Polirradiculoneuropatia Desmielinizante Inflamatória Crônica/etiologia , Polirradiculoneuropatia Desmielinizante Inflamatória Crônica/terapia , Compressão da Medula Espinal/etiologia , Doenças da Medula Espinal/etiologia , Doenças da Medula Espinal/terapia , Raízes Nervosas Espinhais/patologia , Idoso , Vértebras Cervicais , Edema , Humanos , Imunoglobulinas Intravenosas/administração & dosagem , Laminectomia , Linfócitos/patologia , Masculino , Metilprednisolona/administração & dosagem , Pulsoterapia , Compressão da Medula Espinal/terapia , Resultado do Tratamento
7.
Gan To Kagaku Ryoho ; 47(6): 875-880, 2020 Jun.
Artigo em Japonês | MEDLINE | ID: mdl-32541159

RESUMO

Malignant spinal cord compression(MSCC)is defined as a compression of the spinal cord or cauda equina with neuropathy caused by tumor spreading to the vertebral body. The common symptoms of MSCC are back pain, neck pain, muscle weakness, sensory reduction, bladder and rectal disturbance. The risk of MSCC is relatively high in patients with lung cancer, breast cancer, and prostate cancer. MSCC is one of the oncologic emergencies that requires prompt diagnosis and treatment to preserve and improve neurological function. Evaluation by magnetic resonance imaging(MRI)and computed tomography( CT)are useful for the diagnosis. The prognosis of these patients is often poor at the time of diagnosis of MSCC, thus it is important for deciding the treatment strategy to consider the prognosis and background of the patient in addition to the objective findings including the degree of MSCC and spinal instability. Treatment options consist of medical, surgical, and radiation therapy. We need a multidisciplinary approach because the pathology of MSCC involves multiple departments, such as medical oncology, orthopedics, and radiology. Supportive care including rehabilitation and preventing skeletal related events are also important. The cancer board, in which each physician and multidisciplinary health care professionals regularly have a discussion and review the cases, is required.


Assuntos
Compressão da Medula Espinal , Neoplasias da Coluna Vertebral , Humanos , Imagem por Ressonância Magnética , Masculino , Prognóstico , Compressão da Medula Espinal/etiologia , Neoplasias da Coluna Vertebral/complicações , Tomografia Computadorizada por Raios X
8.
Saudi Med J ; 41(6): 652-656, 2020 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-32518934

RESUMO

Immunoglobulin G4-related disease (IgG4-RD) is rare disease entity and has recently been recognized as an inflammatory disorder with the tendency to affect multiple organs. Pachymeningitis of spine caused by IgG4-related disease is extremely rare. Neck pain and spinal cord compression symptoms consist of usual presentation of IgG4-related spinal pachymeningitis; however, polyarthritis is an unusual presentation of this disease, and it was reported in only one case that mimicked psoriatic arthritis. In this report, we describe a case of IgG4-related spinal pachymeningitis in a middle-age male who presented initially with neck pain and  rheumatoid arthritis-like symptoms and later on developed both right upper and lower limb weakness. He was found to had pachymeningeal thickening on a cervical magnetic resonance image (MRI) and elevated serum IgG4 levels. He was treated with glucocorticoids and rituximab, which led to a significantly positive radiological response.


Assuntos
Doença Relacionada a Imunoglobulina G4/complicações , Meningite/etiologia , Adulto , Artrite Reumatoide/etiologia , Biomarcadores/sangue , Vértebras Cervicais , Extremidades , Glucocorticoides/uso terapêutico , Humanos , Imunoglobulina G/sangue , Imagem por Ressonância Magnética , Masculino , Meningite/diagnóstico , Meningite/tratamento farmacológico , Debilidade Muscular/etiologia , Cervicalgia/etiologia , Rituximab/uso terapêutico , Compressão da Medula Espinal/etiologia , Resultado do Tratamento
9.
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
10.
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
11.
Med Clin North Am ; 104(3): 525-538, 2020 May.
Artigo em Inglês | MEDLINE | ID: mdl-32312413

RESUMO

Medical emergencies at the end of life require recognition of patients at risk, so that a comprehensive assessment and plan of care can be put in place. Frequently, the interventions depend on the patient's underlying prognosis, location of care, and goals of care. The mere presence of a medical emergency often rapidly changes an estimated prognosis. Education of the patient and family may help empower them to adequately handle many situations when clinicians are not available.


Assuntos
Emergências/epidemiologia , Cuidados Paliativos na Terminalidade da Vida/normas , Planejamento de Assistência ao Paciente/normas , Assistência Terminal/métodos , Idoso , Idoso de 80 Anos ou mais , Anticonvulsivantes/administração & dosagem , Anticonvulsivantes/uso terapêutico , Diagnóstico Diferencial , Hemorragia/etiologia , Hemorragia/terapia , Humanos , Hipercalcemia/etiologia , Pessoa de Meia-Idade , Neoplasias/complicações , Cuidados Paliativos/normas , Cuidados Paliativos/estatística & dados numéricos , Planejamento de Assistência ao Paciente/tendências , Prognóstico , Fatores de Risco , Compressão da Medula Espinal/etiologia , Compressão da Medula Espinal/terapia , Estado Epiléptico/tratamento farmacológico , Estado Epiléptico/etiologia , Síndrome da Veia Cava Superior/etiologia , Síndrome da Veia Cava Superior/terapia
12.
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
13.
Rev Med Liege ; 75(4): 201-202, 2020 04.
Artigo em Francês | MEDLINE | ID: mdl-32267105

RESUMO

We presented a case of a 73-year-old woman presenting to the emergency department with a spinal cord compression secondary to a T2 mass lesion and needing emergency surgery. The lesion was consistent with a papillary thyroid carcinoma. The patient had a previous history of thyroidectomy in a setting of a multinodular goiter 6 years before. A rereading of the previous anatomopathological thyroid tissue confirmed the presence of a papillary thyroid carcinoma that was initially misdiagnosed.


Assuntos
Compressão da Medula Espinal , Neoplasias da Coluna Vertebral , Câncer Papilífero da Tireoide , Neoplasias da Glândula Tireoide , Idoso , Feminino , Humanos , Compressão da Medula Espinal/etiologia , Neoplasias da Coluna Vertebral/complicações , Neoplasias da Coluna Vertebral/secundário , Câncer Papilífero da Tireoide/secundário , Neoplasias da Glândula Tireoide/patologia , Tireoidectomia
14.
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
15.
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
17.
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
18.
World Neurosurg ; 137: 214-217, 2020 05.
Artigo em Inglês | MEDLINE | ID: mdl-32058108

RESUMO

BACKGROUND: Pregnancy is a known risk factor for spontaneous spinal epidural hematoma. During cesarean section or vaginal delivery, the unstable hemodynamic status that may occur owing to fluctuation of intra-abdominal pressure increases the possibility of spontaneous spinal epidural hematoma. During labor and the postpartum period, neurologic symptoms may be masked by labor pain or anesthesia block, which makes early diagnosis difficult, especially in the obstetric clinic without a neurologist or neurosurgeon. CASE DESCRIPTION: A 28-year-old woman who had a normal spontaneous delivery under epidural anesthesia developed bilateral lower limb flaccid paralysis and loss of sensation 12.5 hours after delivery. Magnetic resonance imaging showed a 5.2 × 0.9 × 2 cm spinal epidural hematoma with severe spinal cord stenosis at the T2-T5 level with no evidence of a vascular anomaly. After emergent evacuation of the spinal epidural hematoma, lower limb muscle power improved from 0/5 to 1/5, and sensation gradually returned to bilateral lower limbs 22 days postoperatively. Deep vein thrombosis developed at 35 days postoperatively, and an inferior vena cava filter was implanted with urokinase infusion for thrombolytic therapy. She was discharged on day 52 after admission, and lower limb muscle power returned to normal after 3 months. CONCLUSIONS: Clinicians should observe postpartum women for signs of myelopathy or back tenderness and closely monitor neurologic function until anesthesia has run its course. A prompt diagnosis can enable prompt intervention.


Assuntos
Descompressão Cirúrgica , Parto Obstétrico , Hematoma Epidural Espinal/cirurgia , Laminectomia , Transtornos Puerperais/cirurgia , Compressão da Medula Espinal/cirurgia , Adulto , Analgesia Epidural , Anestesia Epidural , Inibidores do Fator Xa/uso terapêutico , Feminino , Fibrinolíticos/uso terapêutico , Hematoma Epidural Espinal/complicações , Hematoma Epidural Espinal/diagnóstico por imagem , Humanos , Hipestesia/etiologia , Extremidade Inferior , Angiografia por Ressonância Magnética , Imagem por Ressonância Magnética , Paraplegia , Complicações Pós-Operatórias/terapia , Gravidez , Transtornos Puerperais/diagnóstico por imagem , Recuperação de Função Fisiológica , Rivaroxabana/uso terapêutico , Compressão da Medula Espinal/diagnóstico por imagem , Compressão da Medula Espinal/etiologia , Terapia Trombolítica , Ativador de Plasminogênio Tipo Uroquinase/uso terapêutico , Filtros de Veia Cava , Trombose Venosa/terapia
19.
Spine Deform ; 8(2): 339-344, 2020 04.
Artigo em Inglês | MEDLINE | ID: mdl-32048217

RESUMO

DESIGN: Case report (retrospective). OBJECTIVE: These two cases of paralysis secondary to aneurysmal bone cysts (ABCs) demonstrated complete neurologic recovery following decompression and posterior spinal fusion. Although neurologic injury from ABCs has been described, information about the prognosis in the pediatric population is limited. METHODS: We review two cases of paralysis caused by ABCs in the thoracic spine in pediatric patients. RESULTS: Two patients (aged 12 and 13 years) presented to our emergency department with inability to ambulate and 0/5 strength in their lower extremities due to spinal cord compression from ABCs in their thoracic spine. Both patients had been unable to ambulate (case 1: nonambulatory for 2 weeks before presentation; case 2: nonambulatory for 1 week before presentation). The second patient also had loss of bowel and bladder control. They were managed with decompression and posterior spinal fusion. Both patients made complete neurologic recoveries. CONCLUSIONS: It is unclear whether age, chronicity of compression, or other factors contributed; nevertheless, the recovery in these two similar patients far exceeded initial expectations, especially in the case that presented as an American Spinal Injury Association Impairment Scale class A. LEVEL OF EVIDENCE: Level V.


Assuntos
Cistos Ósseos Aneurismáticos/complicações , Cistos Ósseos Aneurismáticos/cirurgia , Paralisia/etiologia , Paralisia/cirurgia , Compressão da Medula Espinal/etiologia , Compressão da Medula Espinal/cirurgia , Vértebras Torácicas/cirurgia , Adolescente , Criança , Descompressão Cirúrgica/métodos , Feminino , Humanos , Recuperação de Função Fisiológica , Estudos Retrospectivos , Fusão Vertebral/métodos , Resultado do Tratamento
20.
BMC Musculoskelet Disord ; 21(1): 75, 2020 Feb 05.
Artigo em Inglês | MEDLINE | ID: mdl-32024507

RESUMO

BACKGROUND: For patients with spinal canal stenosis in the upper cervical spine who undergo C3-7 laminoplasty alone, it remains impossible to achieve full decompression due to its limited range. This study explores the extension of expansive open-door laminoplasty (EODL) to C1 and C2 for the treatment of cervical spinal stenosis of the upper cervical spine and its effects on cervical sagittal parameters. METHODS: A retrospective analysis of 33 patients presenting with symptoms of cervical spondylosis myelopathy (CSM) and ossification in the posterior longitudinal ligament (OPLL) of the upper cervical spine from February 2013 to December 2015 was performed. Furthermore, the changes in the C0-2 Cobb angle, C1-2 Cobb angle, C2-7 Cobb angle, C2-7 SVA, and T1-Slope in lateral X-rays of the cervical spine were measured before, immediately after, and 1 year after the operation. JOA and NDI scores were used to evaluate spinal cord function. RESULTS: The C0-2 and C1-2 Cobb angles did not significantly increase (P = 0.190 and P = 0.081), but the C2-7 Cobb angle (P = 0.001), C2-7 SVA (P < 0.001), and T1-Slope (P < 0.001) significantly increased from preoperative to 1 year postoperative. In addition, C2-7 SVA was significantly correlated with the T1-Slope (Pearson = 0.376, P < 0.001) and C0-2 Cobb angle (Pearson = 0.287, P = 0.004), and the C2-7 SVA was negatively correlated with the C2-7 Cobb angle (Pearson = - 0.295, P < 0.001). The average preoperative and postoperative JOA scores were 8.3 ± 1.6 and 14.6 ± 1.4 points, respectively, indicating in a postoperative neurological improvement rate of approximately 91.6%. The average preoperative and final follow-up NDI scores were 12.62 ± 2.34 and 7.61 ± 1.23. CONCLUSIONS: The sagittal parameters of patients who underwent EODL extended to C1 and C2 included loss of cervical curvature, increased cervical anteversion and compensatory posterior extension of the upper cervical spine to maintain visual balance in the field of vision. However, the changes in cervical spine parameters were far less substantial than the alarm thresholds reported in previous studies. We believe that EODL extended to C1 and C2 for the treatment of patients with spinal canal stenosis in the upper cervical spine is a feasible and safe procedure with excellent outcomes.


Assuntos
Vértebras Cervicais/diagnóstico por imagem , Descompressão Cirúrgica/métodos , Laminoplastia/métodos , Ossificação do Ligamento Longitudinal Posterior/cirurgia , Compressão da Medula Espinal/cirurgia , Espondilose/cirurgia , Idoso , Vértebras Cervicais/cirurgia , Descompressão Cirúrgica/efeitos adversos , Estudos de Viabilidade , Feminino , Seguimentos , Humanos , Laminoplastia/efeitos adversos , Masculino , Pessoa de Meia-Idade , Ossificação do Ligamento Longitudinal Posterior/complicações , Período Pós-Operatório , Radiografia , Estudos Retrospectivos , Compressão da Medula Espinal/etiologia , Espondilose/complicações , Resultado do Tratamento
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