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1.
Medicine (Baltimore) ; 98(50): e18231, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31852084

RESUMO

Surgical decompression and antibiotic therapy are the treatments of choice for patients with spinal epidural abscess (SEA). Surgical treatment included decompression, evacuation of abscess, and debridement. Recently, minimal invasive surgery has been introduced more widely, and biportal endoscopic spinal surgery have shown satisfactory clinical outcomes compared with traditional open surgery. The purpose of this study was to evaluate the efficacy of biportal endoscopic spinal surgery for the treatment of SEA .From January 2016 to June 2017, 13 patients who underwent biportal endoscopic spinal surgery under the diagnosis of SEA were retrospectively enrolled in this study. The surgical indications of the enrolled patients included SEA with or without early stage spondylodiscitis who had neurological symptoms. Periopertaive data and clinical outcomes were assessed by regular serologic testing, imaging studies, physical examination, visual analog scale, Oswestry Disability Index and modified Macnab criteria.Offending pathogens were identified in seven (54%) of 13 biopsy specimens. Appropriate intravenous antibiotics for the identified pathogens isolated from infected tissue biopsy cultures were administrated to patients for at least 30 days. All patients reported satisfactory relief of pain and neurological symptoms after surgery. No surgery-related complications and recurrences were found after 2 years follow up.Biportal endoscopic spinal surgery may be an effective alternative to traditional open surgical decompression for the treatment of SEA.


Assuntos
Desbridamento/métodos , Descompressão Cirúrgica/métodos , Endoscopia/métodos , Abscesso Epidural/cirurgia , Procedimentos Neurocirúrgicos/métodos , Adulto , Idoso , Biópsia , Abscesso Epidural/diagnóstico , Feminino , Seguimentos , Humanos , Vértebras Lombares , Imagem por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Resultado do Tratamento
2.
Medicine (Baltimore) ; 98(50): e18277, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31852100

RESUMO

The aim of the study was to evaluate the clinical effect of the limited area decompression, intervertebral fusion, and pedicle screw fixation for treating degenerative lumbar spinal stenosis (DLSS) with instability. Hemilaminectomy decompression, intervertebral fusion, and pedicle screw fixation for treating DLSS with instability as the control group.Follow-up of 54 patients (26 males and 28 females; average age, 59.74 ±â€Š10.38 years) with DLSS with instability treated by limited area decompression, intervertebral fusion, and pedicle screw fixation (LIFP group), and 52 patients as control group with hemilaminectomy decompression, intervertebral fusion, and pedicle screw fixation (HIFP group). We assessed clinical effect according to the patients' functional outcome grading (good to excellent, fair, or poor), Oswestry Disability Index (ODI) and visual analogue scale (VAS) for low back pain and lower limb pain, which was administered preoperatively and at 3, 6, and 12 months postoperatively. Fusion status was assessed by radiologists at the last follow-up. Treatment satisfaction was assessed according to the subjective evaluations of the patients.At the 12-month follow-up, 96.2% (52/54) and 90.3% (47/52) of group LIFP and HIFP belonged to good to excellent outcome categories, respectively, while 3.7% (2/54) and 9.6% (5/52) of group LIFP and HIFP belonged to fair respectively, neither group belonged to poor. Satisfaction rates of patients in group LIFP and group HIFP were 98.1% (53/54) and 92.3% (48/52), respectively. The patients' functional outcome grading and satisfaction rate in group LIFP were better than that in group HIFP. The VAS for low back and lower limb pain and the ODI improved significantly during the 12 months after surgery (all P < .001) in 2 groups. The VAS for low back and lower limb pain were no difference between two groups, however, the ODI of group LIFP was lower than that of group HIFP (P < .001). All patients achieved radiological fusion.The limited area decompression, intervertebral fusion, and pedicle screw fixation had a satisfactory effect on patients with DLSS with instability.


Assuntos
Descompressão Cirúrgica/métodos , Instabilidade Articular/cirurgia , Laminectomia/métodos , Vértebras Lombares , Parafusos Pediculares , Fusão Vertebral/métodos , Estenose Espinal/cirurgia , Feminino , Fluoroscopia , Seguimentos , Humanos , Instabilidade Articular/complicações , Instabilidade Articular/diagnóstico , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Estenose Espinal/complicações , Estenose Espinal/diagnóstico , Cirurgia Assistida por Computador/métodos , Fatores de Tempo , Resultado do Tratamento
3.
Medicine (Baltimore) ; 98(50): e18285, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31852104

RESUMO

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


Assuntos
Fraturas por Compressão/complicações , Hemangioma/complicações , Parto , Compressão da Medula Espinal/etiologia , Fraturas da Coluna Vertebral/complicações , Neoplasias da Coluna Vertebral/complicações , Vértebras Torácicas , Adulto , Descompressão Cirúrgica/métodos , Feminino , Fraturas por Compressão/diagnóstico , Fraturas por Compressão/cirurgia , Hemangioma/diagnóstico , Hemangioma/cirurgia , Humanos , Imagem por Ressonância Magnética , Tomografia Computadorizada com Tomografia por Emissão de Pósitrons , Compressão da Medula Espinal/diagnóstico , Compressão da Medula Espinal/cirurgia , Fraturas da Coluna Vertebral/diagnóstico , Fraturas da Coluna Vertebral/cirurgia , Neoplasias da Coluna Vertebral/diagnóstico , Neoplasias da Coluna Vertebral/cirurgia , Vertebroplastia/métodos
4.
Medicine (Baltimore) ; 98(41): e17553, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31593138

RESUMO

RATIONALE: Intraspinal anesthesia, the most common anesthesia type of orthopedic operation, is regarded as safe and simple. Despite of the rare incidence, puncture related complication of intraspinal anesthesia is catastrophic for spinal cord. Here we present an intradural hematoma case triggered by improper anesthesia puncture. The principal reason of this tragedy was rooted in the neglect of spine deformities diagnosis before anesthesia. To the best of our knowledge, there is no specific case report focusing on the intradural hematoma triggered by improper anesthesia puncture. PATIENT CONCERNS: Hereby a case of thoracolumbar spinal massive hematoma triggered by intraspinal anesthesia puncture was reported. The presenting complaint of the patient was little neurologic function improvement after surgery at 6-month follow-up. DIAGNOSES: Emergency MRI demonstrated that massive spindle-like intradural T2-weighted image hypointense signal masses from T12 to S2 badly compressed the dural sac ventrally, and his conus medullaris was at L3/4 intervertebral level with absence of L5 vertebral lamina. Hereby, the diagnoses were congenital spinal bifida, tethered cord syndrome, spine intradural hematoma, and paraplegia. INTERVENTIONS: Urgent surgical interventions including laminectomy, spinal canal exploration hematoma removal, and pedicle fixation were performed. The patient received both medication (mannitol, mecobalamin, and steroids) and rehabilitation (neuromuscular electric stimulation, hyperbaric oxygen). OUTCOMES: Postoperation, he had regained only hip and knee flexion at II grade strength. His neurologic function was unchanged until 3 weeks postoperation. Six-month follow-up showed just little neurologic function improvement, and the American Spinal Injury Association grade was C. LESSONS: By presenting an intradural hematoma case triggered by improper anesthesia puncture, we shared the treatment experience and discussed the potential mechanism of neurologic compromise. The principal reason for this tragedy is preanesthesia examination deficiency. Necessary radiology examinations must be performed to prevent misdiagnosis for spinal malformation.


Assuntos
Anestesia/efeitos adversos , Hematoma/etiologia , Punções/efeitos adversos , Adulto , Descompressão Cirúrgica/métodos , Diagnóstico Diferencial , Hematoma/diagnóstico por imagem , Hematoma/patologia , Hematoma/cirurgia , Humanos , Doença Iatrogênica/epidemiologia , Injeções Espinhais , Laminectomia/métodos , Imagem por Ressonância Magnética/métodos , Masculino , Medula Espinal/irrigação sanguínea , Medula Espinal/patologia , Doenças da Medula Espinal/patologia , Coluna Vertebral/anormalidades , Coluna Vertebral/diagnóstico por imagem , Resultado do Tratamento
5.
Medicine (Baltimore) ; 98(39): e17144, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31574815

RESUMO

RATIONALE: Benign fibrous histiocytoma with pleural involvement in spinal region is a highly unusual disease with no standard curative managements yet. The objective of this study is to report an extremely rare case of a giant benign fibrous histiocytoma with pleural involvement in spinal region successfully operated by posterior spinal surgery. The management of these unique cases has yet to be well-documented. PATIENT CONCERNS: A 23-year-old man presented with a 2-month history of continuous and progressive back pain. A giant, expanding lesion of the T7 vertebral and paraspinal region with pleural involvement was identified. DIAGNOSES: Computed tomography scan and magnetic resonance imaging of spine showed expanding lesion of the T7 vertebral and paraspinal region involving the right thoracic cavity, which presented as a solid tumor. Postoperative pathology confirmed the diagnosis of thoracic benign fibrous histiocytoma. INTERVENTIONS: The patient underwent thoracic spinal canal decompression, complete tumor resection, pleural defect repair, and T4 to T10 internal fixation procedure via a posterior approach. OUTCOMES: The patient's symptom improved significantly after the surgery, and the postoperative period was uneventful at the 2-year follow-up visit. There were no complications associated with the operation during the follow-up period. LESSONS: In summary, the tumor's clinical features, imaging results, and pathological characteristics are unique. Combined efforts of specialists from orthopedics, thoracic surgery, neurosurgery, pathology, and medical oncology led to the successful diagnosis and management of this patient. Giant benign fibrous histiocytoma with pleural involvement in spinal region, although rare, should be part of the differential diagnosis when the patient presents with back pain and radiculopathy. We recommend the posterior or 1-stage anterior-posterior combined approach for complete resection of the giant thoracic benign fibrous histiocytoma when the tumor has caused severe symptoms or neurological deficits.


Assuntos
Descompressão Cirúrgica/métodos , Histiocitoma Fibroso Benigno/cirurgia , Neoplasias Pleurais/cirurgia , Neoplasias da Coluna Vertebral/cirurgia , Adulto , Histiocitoma Fibroso Benigno/patologia , Humanos , Masculino , Cavidade Pleural/patologia , Cavidade Pleural/cirurgia , Neoplasias Pleurais/patologia , Neoplasias da Coluna Vertebral/patologia , Vértebras Torácicas/patologia , Vértebras Torácicas/cirurgia
6.
Medicine (Baltimore) ; 98(43): e17610, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31651872

RESUMO

RATIONALE: Primary thoracic dumb-bell yolk sac tumor (YST) with both epidural and extraspinal extension is a rare disease with no standard curative managements yet. The objective of this study is to report a primary thoracic dumb-bell YST presenting with severe spinal cord compression successfully treated with posterior-only approach operation, followed by chemotherapy. The management of these unique cases has not been fully documented. PATIENT CONCERNS: A 26-mounth-old, previously healthy girl presented with progressive numbness and weakness of the lower extremities. Neurological examination revealed paralysis of both lower extremities, sensory disturbance below T-8 and bladder-bowel dysfunction. DIAGNOSIS: CT and MRI of spine showed a dumb-bell mass lesion with both epidural and extraspinal extension through enlarged intervertebral foramina and marked spinal cord compression at T7-T9. The AFP level was 13738 ng/ml. Preoperative puncture and Postoperative pathology confirmed the diagnosis of YST. INTERVENTIONS: By needle biopsy, we identified the pathological diagnosis is YST. Subsequently, the patient was treated with one-stage posterior-only approach operation, followed by 9 courses of chemotherapy based on cisplatin, bleomycin, etoposide. OUTCOMES: The patient has a complete neurologic recovery and remains recurrence free as of more than 2 years after the completion of operation. There were no other complications associated with the operation during the follow-up period. LESSONS: YST should be considered in the range of children with thoracic dumb-bell tumor presenting with spinal cord compression. Needle biopsy is valuable for preoperative diagnosis and design of the treatment strategy. If there is no evidence of CSF spread, metastasis or multiple diseases, it is effective to remove tumors as thoroughly as possible immediately, avoid further nerve injury and conduct enough chemotherapy. This case suggests that this treatment strategy is an effective option for primary YST with both epidural and extraspinal extension and severe spinal cord compression.


Assuntos
Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Descompressão Cirúrgica/métodos , Tumor do Seio Endodérmico/terapia , Laminectomia/métodos , Compressão da Medula Espinal/terapia , Neoplasias da Coluna Vertebral/terapia , Pré-Escolar , Tumor do Seio Endodérmico/complicações , Feminino , Humanos , Compressão da Medula Espinal/etiologia , Neoplasias da Coluna Vertebral/complicações , Vértebras Torácicas/patologia , Vértebras Torácicas/cirurgia , Resultado do Tratamento
7.
Zhonghua Wai Ke Za Zhi ; 57(10): 63-68, 2019 Oct 01.
Artigo em Chinês | MEDLINE | ID: mdl-31510735

RESUMO

Objective: To examine the effect of posterior reduction in atlantoaxial dislocation (AAD) associated with basilar invagination(BI) using Xuanwu occipital-cervical fusion system in single stage. Methods: Thirty-seven AAD accompanied with BI cases treated at Department of Neurosurgery, Xuanwu Hospital, Capital Medical Universiy and the Second Hospital of Hebei Medical University were retrospective analyzed. There were 15 males and 22 females with age of (42.3±12.3)years (range: 18-69 yars). All the cases had congenital osseous abnormalities, such as assimilation of atlas and abnormal cervical fusion. Anterior tissue was released through posterior route followed by cage implantation into facet joint and occipital-cervical fixation with cantilever technique. The clinical results were evaluated using Japanese Orthopedic Association scale(JOA) and the main radiological measurements including anterior atlantodental interval (ADI),the distance of odontoid tip above Chamberlain line,clivus-canal angle (CCA) and the length of syrinx were collected.The preoperative and postoperative JOA score and radiological measurements were compared by paired t-test. Results: The mean JOA score of the patients increased from 10.5 to 14.4 at the one-year follow-up(t=14.3,P=0.00).Complete reduction of AAD and BI was achieved in 34 patients.The mean clivus-canal angle improved from 118.0 degrees preoperative to 143.7 degrees postoperative(t=6.2,P=0.00). Shrinkage of the syrinx was observed 1 week after surgery in 24 patients, and 6 months in 31 patients. Twenty-eight patients achieved bone fusion 6 months after surgery. All the patients achieved bone fusion 12 months after surgery. One-side vertebral artery occlusion was diagnosed in 1 case postoperatively for transient dizziness, and relieved in 2 weeks. Two patients developed moderate neck pain after surgery, and relieved in 1 month. No implant failure, spacer subsidence or infection was observed. Conclusions: The treatment of AAD associated with BI using Xuanwu occipital-cervical fusion system from posterior approach in single stage is effective and safe. Cage implantation intraarticularly and fixation with cantilever technique achieve complete reduction in most cases.


Assuntos
Articulação Atlantoaxial/cirurgia , Descompressão Cirúrgica/métodos , Luxações Articulares/cirurgia , Platibasia/cirurgia , Fusão Vertebral/métodos , Adolescente , Adulto , Idoso , Vértebras Cervicais/anormalidades , Vértebras Cervicais/cirurgia , Descompressão Cirúrgica/instrumentação , Feminino , Humanos , Luxações Articulares/complicações , Masculino , Pessoa de Meia-Idade , Osso Occipital/anormalidades , Osso Occipital/cirurgia , Estudos Retrospectivos , Fusão Vertebral/instrumentação , Adulto Jovem
8.
Medicine (Baltimore) ; 98(35): e17021, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31464962

RESUMO

To describe the Tube in Tube interlaminar endoscopic decompression method and investigate its efficacy and safety in treating lumbar spinal stenosis (LSS).Utilizing the advantages of the micro-endoscopic decompression (MED) operation channel tube, we used a water-medium spinal endoscopy to perform trans-interlaminar canal decompression, that is, the "Tube in Tube" technique. A retrospective study was performed on 35 patients with LSS who were treated with the Tube in Tube technique. All patients were followed up to 12 months postoperatively. Visual analog scale (VAS), Japanese Orthopaedic Association (JOA) score, and Oswestry Disability Index (ODI) were collected preoperatively and at 3, 6, and 12 months postoperatively. Short-form (36) health survey (SF-36) score was used to examine the general health-related quality of life (HRQoL) of patients preoperatively and at 3 and 12 months postoperatively. Modified Macnab criteria were used to examine the clinical outcomes at 3 and 12 months post-surgery.The clinical outcomes were satisfactory, with an improvement in all scoring systems. The VAS, JOA, and ODI scores improved from 6.46 ±â€Š1.85, 12.03 ±â€Š4.96, and 42.17 ±â€Š12.22 preoperatively to 2.20 ±â€Š1.14, 21.40 ±â€Š5.86, and 13.14 ±â€Š7.52 at 12 months postoperatively, respectively (P < .001). The Macnab excellent or good rates reached 65.7% and 77.1% at the 3 and 12 months follow-ups. No severe complications occurred.The Tube in Tube technique had a positive clinical outcome in LSS patients and is safe, reliable, and efficacious. However, a larger number of cases and a multi-center research design will be needed further develop the technique.Level of Evidence: IV.


Assuntos
Descompressão Cirúrgica/métodos , Vértebras Lombares/cirurgia , Estenose Espinal/cirurgia , Idoso , Idoso de 80 Anos ou mais , Endoscopia , Feminino , Nível de Saúde , Humanos , Masculino , Pessoa de Meia-Idade , Medição da Dor , Qualidade de Vida , Estudos Retrospectivos
9.
J Clin Neurosci ; 68: 218-223, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31331749

RESUMO

Metastatic disease to the vertebral column can cause spinal instability, neurological deterioration and pain. The present study was designed to provide insight into the cohort undergoing vertebrectomy for metastatic disease to the spinal column, assessing the associated morbidity, functional outcomes and survival. A retrospective review of 141 consecutive vertebrectomies for metastatic disease was undertaken. The procedures were performed between 2006 and 2016 at a single institution. Medical records were reviewed and data was obtained regarding primary malignancy, presenting symptoms, pre-operative chemotherapy or radiotherapy, Spinal Instability Neoplastic Score, neurological function, operative approach and duration, blood loss, transfusion requirement, complications, survival, delayed neurological deterioration and construct failure. Long-term follow-up data was available for 123 patients. Forty-two patients were alive at the time of review with a mean survival of 464 days. Post-operative neurological function was preserved or improved in 96.5% of patients. Five patients suffered a neurological deterioration post-operatively. The major complication rate was 19.8% with the most frequent complication being wound infection or dehiscence requiring revision. There were four inpatient deaths. Mean operative time was 240 min. Mean blood loss was 1490 mls. When assessing results by age, no significant difference with respect to complications, neurological outcomes or survival was demonstrated in patients over age 65. There was a significant reduction in survival and higher complication rates in patients who were non-ambulatory following vertebrectomy. Vertebrectomy is a safe and effective means of providing circumferential neural decompression and stabilization with an acceptable complication rate in patients with vertebral metastases, irrespective of age.


Assuntos
Procedimentos Neurocirúrgicos/métodos , Complicações Pós-Operatórias/epidemiologia , Neoplasias da Coluna Vertebral/secundário , Neoplasias da Coluna Vertebral/cirurgia , Coluna Vertebral/cirurgia , Adulto , Idoso , Estudos de Coortes , Descompressão Cirúrgica/efeitos adversos , Descompressão Cirúrgica/métodos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Procedimentos Neurocirúrgicos/efeitos adversos , Complicações Pós-Operatórias/etiologia , Estudos Retrospectivos
10.
Khirurgiia (Mosk) ; (6): 94-100, 2019.
Artigo em Russo | MEDLINE | ID: mdl-31317947

RESUMO

Carpal tunnel syndrome (CTS) requires special attention due to its different reasons and course. Knowledge about the variability of median nerve (MN) topography in carpal canal region, features of diagnosis and treatment extends outlooks on this pathology. Aggregating rare clinical cases from the Medline and Pubmed databases is useful to form personified approach. There are 3 types of topographic variations which should be considered to prevent false-positive diagnosis of pathology: recurrent branch location, early bi- and trifurcations of MN, anastomoses. Since acute CTS is treated only by surgery, every surgical approach is aimed at minimally invasiveness and fast recovery. Endoscopic decompression (ED) is more favorable regarding these aspects. However, this method cannot be considered as perfect due to available data about incomplete decompression and certain incidence of recurrences. The last ones are absent after microsurgical decompression as a rule. It can be concluded that only individual approach is advisable for complete release of CTS without iatrogenic damage and recurrences.


Assuntos
Síndrome do Túnel Carpal/diagnóstico , Síndrome do Túnel Carpal/cirurgia , Nervo Mediano/cirurgia , Procedimentos Neurocirúrgicos/métodos , Doença Aguda , Síndrome do Túnel Carpal/etiologia , Descompressão Cirúrgica/efeitos adversos , Descompressão Cirúrgica/métodos , Humanos , Doença Iatrogênica/prevenção & controle , Nervo Mediano/anatomia & histologia , Nervo Mediano/patologia , Microcirurgia , Procedimentos Cirúrgicos Minimamente Invasivos , Procedimentos Neurocirúrgicos/efeitos adversos , Recidiva
11.
J Clin Neurosci ; 68: 312-316, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31337582

RESUMO

PURPOSE: The recovery rate of Japanese Orthopedic Association (JOA) score with K-line (-) cervical ossification of the posterior longitudinal ligament (OPLL) for posterior decompression with in-situ fusion (PDF) tends to be lower than that of anterior decompression with fusion (ADF). However, ADF is a technically demanding operation and has ADF-specific complications. This prospective report introduced a novel concept of PDF with selective lordotic correction as well as prophylactic foraminal decompression. METHODS: Six consecutive patients (four men and two women; mean age, 61.8 years) were included. PDF was performed, attempting to create cervical lordosis to acquire a posterior shift of the spinal cord, while preventing postoperative C5 palsy by prophylactic facetectomy and selective lordotic correction. RESULTS: The mean recovery rate of JOA score at the final follow-up was 70.9 ±â€¯20.3%. The mean C2-C7 angle preoperatively and at final follow-up was 5.5 ±â€¯3.9° and 12.2 ±â€¯4.8°, respectively. No symptomatic nerve root palsy, except one case with transient C7 root iatrogenic palsy, was found. CONCLUSIONS: A novel concept of PDF with selective lordotic correction obtained recovery rates of JOA scores comparable to those of ADF. We believe that this method can improve PDF outcomes in patients with K-line (-) OPLL.


Assuntos
Descompressão Cirúrgica/métodos , Procedimentos Neurocirúrgicos/métodos , Ossificação do Ligamento Longitudinal Posterior/cirurgia , Fusão Vertebral/métodos , Adulto , Idoso , Vértebras Cervicais/cirurgia , Feminino , Humanos , Lordose/etiologia , Lordose/cirurgia , Masculino , Pessoa de Meia-Idade , Ossificação do Ligamento Longitudinal Posterior/complicações , Estudos Prospectivos , Estudos Retrospectivos , Resultado do Tratamento
12.
J Craniofac Surg ; 30(7): e658-e661, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31261346

RESUMO

INTRODUCTION: Odontogenic cysts are defined as those cysts that arise from odontogenic epithelium and occur in the tooth-bearing regions of the jaws. Cystectomy, marsupialization, or decompression of odontogenic cyst are the most common treatments proposed for this pathology. The aim of this study is to retrospectively evaluate the result of decompression based on the volumetric reduction of the cystic cavity and new bone formation by cone beam computerized tomography (CBCT). METHODS: The 16 patients affected by a large odontogenic mandibular cyst were enrolled in the study. All the patients underwent a surgical decompression of the cyst followed by the enucleation after a follow-up ranging from 6 to 9 months according to the volume's reduction and new bone formation. All the patients were evaluated with a CBCT before and after the surgical decompression to measure and analyze the percentage of reduction of the cystic volume before proceeding with the enucleation. RESULTS: The decompression of the cyst showed a reduction of the cystic volume ranging from 38.2% to 54.4% proportionally to the treatment duration. The highest percentage of volume reduction observed was 54.4% in 1 patient followed-up for 9 months, before the surgical enucleation. CONCLUSION: In our experience, the decompression seems to be the most suitable technique for the primary treatment of large odontogenic cyst of the jaws followed by the enucleation after 6 to 9 months. The CBCT is an objective method to evaluate the cystic volume reduction after the decompression and helps the surgeon with the surgical planning.


Assuntos
Mandíbula/cirurgia , Cistos Odontogênicos/cirurgia , Zigoma/cirurgia , Adolescente , Adulto , Idoso , Tomografia Computadorizada de Feixe Cônico , Descompressão Cirúrgica/métodos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Procedimentos Neurocirúrgicos , Procedimentos Cirúrgicos Reconstrutivos , Estudos Retrospectivos , Adulto Jovem
13.
Bone Joint J ; 101-B(7): 872-879, 2019 07.
Artigo em Inglês | MEDLINE | ID: mdl-31256678

RESUMO

AIMS: The aim of this study was to explore the prognostic factors for postoperative neurological recovery and survival in patients with complete paralysis due to neoplastic epidural spinal cord compression. PATIENTS AND METHODS: The medical records of 135 patients with complete paralysis due to neoplastic cord compression were retrospectively reviewed. Potential factors including the timing of surgery, muscular tone, and tumour characteristics were analyzed in relation to neurological recovery using logistical regression analysis. The association between neurological recovery and survival was analyzed using a Cox model. A nomogram was formulated to predict recovery. RESULTS: A total of 52 patients (38.5%) achieved American Spinal Injury Association Impairment Scale (AIS) D or E recovery postoperatively. The timing of surgery (p = 0.003) was found to be significant in univariate analysis. In multivariate analysis, surgery within one week was associated with better neurological recovery than surgery within three weeks (p = 0.002), with a trend towards being associated with a better neurological recovery than surgery within one to two weeks (p = 0.597) and two to three weeks (p = 0.055). Age (p = 0.039) and muscle tone (p = 0.018) were also significant predictors. In Cox regression analysis, good neurological recovery (p = 0.004), benign tumours (p = 0.039), and primary tumours (p = 0.005) were associated with longer survival. Calibration graphs showed that the nomogram did well with an ideal model. The bootstrap-corrected C-index for neurological recovery was 0.72. CONCLUSION: In patients with complete paralysis due to neoplastic spinal cord compression, whose treatment is delayed for more than 48 hours from the onset of symptoms, surgery within one week is still beneficial. Surgery undertaken at this time may still offer neurological recovery and longer survival. The identification of the association between these factors and neurological recovery may help guide treatment for these patients. Cite this article: Bone Joint J 2019;101-B:872-879.


Assuntos
Descompressão Cirúrgica/métodos , Neoplasias Epidurais/complicações , Procedimentos Neurocirúrgicos/métodos , Paralisia/cirurgia , Compressão da Medula Espinal/cirurgia , Tempo para o Tratamento , Adulto , Feminino , Seguimentos , Humanos , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Paralisia/etiologia , Paralisia/mortalidade , Modelos de Riscos Proporcionais , Recuperação de Função Fisiológica , Estudos Retrospectivos , Compressão da Medula Espinal/etiologia , Compressão da Medula Espinal/mortalidade , Coluna Vertebral/cirurgia , Resultado do Tratamento
14.
Orthopade ; 48(10): 831-836, 2019 Oct.
Artigo em Alemão | MEDLINE | ID: mdl-31297556

RESUMO

INTRODUCTION: In the treatment of lumbar spinal stenosis, interspinous spacers can be used in a tissue and time sparing technique. Relief of low back pain might be achieved by stress reduction of facet joints and limitation of segmental mobility. AIM: Presentation of dynamic stabilization by means of an interspinous spacer with and without decompression and to compare it with the outcome of decompression and fusion. MATERIAL AND METHODS: As part of a PubMed search, randomized controlled trials (RCTs) and non-RCTs from high-quality controlled clinical trials were selected and contrasted with our own experience. RESULTS: The current literature was evaluated, which assesses interspinous spacers with and without decompression in comparison with the "gold standard", the microsurgical interlaminar decompression. CONCLUSION: Published data indicate that the use of interspinous spacers with or without decompression for the treatment of lumbar spinal stenosis is not less effective than stand-alone decompression. The reoperation rate can only be proven for implants without decompression on the basis of Level I studies. However, as a link between decompression alone and fusion, it cannot yet provide a scientifically clear solution.


Assuntos
Descompressão Cirúrgica/métodos , Fixadores Internos , Vértebras Lombares/cirurgia , Implantação de Prótese/métodos , Fusão Vertebral/métodos , Estenose Espinal/cirurgia , Descompressão Cirúrgica/instrumentação , Humanos , Fixadores Internos/efeitos adversos , Próteses e Implantes , Reoperação , Estenose Espinal/fisiopatologia , Resultado do Tratamento
15.
Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi ; 33(7): 831-836, 2019 Jul 15.
Artigo em Chinês | MEDLINE | ID: mdl-31297999

RESUMO

Objective: To summarize the efficacy of percutaneous endoscopic transforaminal unilateral decompression for the treatment of lumbar spinal stenosis, and to investigate the incidence and possible reasons for lower extremity symptoms of non-surgical side after surgery. Methods: The clinical data of 46 patients who underwent percutaneous endoscopic transforaminal unilateral decompression for lumbar lateral recess stenosis between February 2016 and March 2018 were retrospectively analysed. There were 22 males and 24 females with an average age of 56.9 years (range, 21-90 years). The disease duration was 6 months to 12 years (mean, 4.8 years). There were 37 cases of single-segment lumbar lateral recess stenosis and 9 cases of multi-segment stenosis. All patients underwent single-segment surgery, including 2 cases of L 3, 4, 35 cases of L 4, 5, and 9 cases of L 5, S 1. For patients with multi-segment lumbar lateral recess stenosis, the single segment consistent with radicular symptom was selected for surgery. The visual analogue scale (VAS) scores of low back pain and sciatica and Oswestry disability index (ODI) scores were recorded preoperatively and at last follow-up to evaluate the relief of symptoms. Postoperative symptoms on non-surgical side of lower extremity including new or aggravated radiation pain and numbness were recorded. The surgical effectiveness was evaluated according to modified MacNab score at last follow-up. Results: All the 46 patients underwent successful operations without postoperative complications such as wound infection, permanent nerve root injury, and deep vein thrombosis. The patients were followed up 12-37 months (mean, 23.8 months). Four patients suffered from radioactive pain and numbness for the non-surgical side of lower extremities at 1-3 months postoperatively, and the symptoms were improved after conservative treatment without revision surgery. VAS scores of low back pain and sciatica and the ODI scores were significantly improved at last follow-up when compared with preoperative ones ( P<0.01). According to the criteria of modified MacNab scores, 25 cases were excellent, 17 cases were good, 3 cases were fair, and 1 case was poor. The excellent and good rate was 91.3%. Conclusion: Percutaneous endoscopic transforaminal unilateral decompression for lumbar spinal stenosis would be able to relieve pain effectively and achieve good results. Lower extremity symptoms of non-surgical side may be observed postoperatively. Although the symptoms can be relieved by conservative treatment, further investigation should be carried out for the long-term result of those cases.


Assuntos
Descompressão Cirúrgica , Estenose Espinal , Adulto , Idoso , Idoso de 80 Anos ou mais , Descompressão Cirúrgica/métodos , Feminino , Humanos , Extremidade Inferior , Vértebras Lombares , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Estenose Espinal/cirurgia , Adulto Jovem
16.
Dis Colon Rectum ; 62(8): 1014-1019, 2019 08.
Artigo em Inglês | MEDLINE | ID: mdl-31283595

RESUMO

BACKGROUND: A restorative proctocolectomy with an IPAA is the surgical treatment of choice for medically refractory ulcerative colitis. Until now, a pouch volvulus has been considered a rare complication, only described in case reports and small case series. The aim of this technical note was to develop a standardized approach to allow a minimally invasive treatment. TECHNIQUE: First, an endoscopic decompression of the pouch is attempted. Subsequently, an exploratory laparoscopy is performed. If the endoscopic decompression was successful, a complete laparoscopic reduction is feasible. Once the integrity of the pouch is confirmed, a bilateral pouchopexy is performed, using multifilament interrupted sutures. Finally, the pouch patency is tested by pouchoscopy. RESULTS: Between December 2010 and December 2018, 151 minimally invasive restorative proctocolectomies with an IPAA were performed. Eighty-nine IPAAs were constructed with the mesentery positioned anteriorly, 35 posteriorly, and 27 on the right side. Three patients were diagnosed with an IPAA volvulus. All 3 of the patients were in the anterior group (3.4%) compared with 0 patients in the nonanterior group. One patient (33%) was treated laparoscopically, after a successful endoscopic reduction. In the other 2 cases, conversion to a laparotomy was needed because an endoscopic decompression could not be achieved. CONCLUSION: An endoscopic decompression was required to allow a laparoscopic treatment, and a bilateral pouchopexy was needed to avoid recurrence. This standardized approach might be a good treatment option, and we are awaiting additional follow-up to determine its long-term durability. In addition to the already described risk factors (minimally invasive technique, female sex, and low BMI), an anterior positioning of the pouch mesentery might be a potential risk factor as well for pouch volvulus. However, these observations should be carefully interpreted, considering the small number of cases.


Assuntos
Colite Ulcerativa/cirurgia , Descompressão Cirúrgica/métodos , Volvo Intestinal/cirurgia , Laparoscopia/métodos , Complicações Pós-Operatórias/cirurgia , Proctocolectomia Restauradora/efeitos adversos , Adulto , Feminino , Seguimentos , Humanos , Volvo Intestinal/etiologia , Pessoa de Meia-Idade , Complicações Pós-Operatórias/etiologia , Estudos Retrospectivos
17.
J Clin Neurosci ; 67: 226-230, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31281086

RESUMO

Benign intracranial cystic lesions of the thalamus are an uncommon clinical entity rarely requiring operative decompression. In combination with cyst fenestration, cerebrospinal fluid (CSF) flow diversion or fenestrated stent placement may be performed at the time of surgery. We describe a method of treatment of these cysts using endoscopic cyst fenestration with fenestrated transventricular stent placement. Three patients with benign cystic lesions were treated with stereotactic-guided, endoscopic fenestration and fenestrated stent placement. All 3 had radiographic and clinical improvement. There were no complications. Endoscopic fenestration and transventricular fenestrated stent placement is a minimally invasive, effective, and safe method to decompress benign, symptomatic cystic lesions of the thalamus.


Assuntos
Cistos do Sistema Nervoso Central/cirurgia , Neuroendoscopia/métodos , Técnicas Estereotáxicas , Tálamo/cirurgia , Adulto , Descompressão Cirúrgica/métodos , Feminino , Humanos , Lactente , Masculino , Pessoa de Meia-Idade , Stents , Resultado do Tratamento
18.
Medicine (Baltimore) ; 98(28): e16475, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31305482

RESUMO

Afferent loop obstruction is an uncommon complication associated with Billroth-II distal gastrectomy. Inappropriate treatment may result in life-threatening events as perforation and peritonitis. For the benign afferent loop obstruction, Braun or Roux-en-Y reconstruction has been reported as the choice. However, the edematous afferent loop may result in anastomotic fistula. In this study, a less invasive technique was described for treatment of benign afferent loop obstruction. The aim of this study was to investigate the effectiveness and safety of endoscopic nasogastric tube insertion for treatment of benign afferent loop obstruction.We conducted a retrospective review of the data of 2548 gastric cancer patients who underwent distal gastrectomy from January 2002 to January 2018. Patients who developed benign afferent loop obstruction were treated by this procedure. Outcomes were recorded. Follow-up was scheduled at 3, 6, and 12 months after the treatment.Twenty-six patients (1.0%) developed afferent loop obstruction. The median age, consisting of 19 men and 7 women, was 60 years (range 36-69 years). Of these 26 patients, 23 underwent the endoscopic treatment. The obstructive symptoms had a rapid relief in all the 23 patients. No one died due to this procedure. However, 2 patients underwent surgical treatment due to intestinal obstruction because of adhesion at >4 and 7 months after the endoscopic drainage, respectively.Endoscopic nasogastric tube insertion is an effective and safe procedure for treatment of benign afferent loop obstruction. In addition, it could be considered as the first step in treatment, especially in high-surgical-risk patients.


Assuntos
Síndrome da Alça Aferente/terapia , Endoscopia Gastrointestinal , Gastrectomia , Intubação Gastrointestinal , Complicações Pós-Operatórias/terapia , Neoplasias Gástricas/cirurgia , Adulto , Idoso , Descompressão Cirúrgica/métodos , Endoscopia Gastrointestinal/métodos , Seguimentos , Humanos , Intubação Gastrointestinal/métodos , Pessoa de Meia-Idade , Cirurgia Endoscópica por Orifício Natural/métodos , Estudos Retrospectivos , Resultado do Tratamento
19.
Plast Reconstr Surg ; 144(1): 98e-101e, 2019 07.
Artigo em Inglês | MEDLINE | ID: mdl-31246831

RESUMO

Surgical treatment of migraine headaches involves avulsion or decompression of the affected peripheral nerves. One of the sites targeted is site II, the zygomaticotemporal branch of the trigeminal nerve. Although traditionally the procedure involved either an endoscopic or transpalpebral approach to access the nerve, both methods involve general anesthesia in an operating room. The senior authors developed a new technique to directly access the nerve by means of a transverse lateral canthal extension incision that can be performed under local anesthesia in an office setting. A cadaver dissection to assess safety and anatomical variability was performed with visualization and complete avulsion of the zygomaticotemporal branch of the trigeminal nerve in all cases, with no injury to surrounding structures. An office-based procedure for zygomaticotemporal branch of the trigeminal nerve compression can help reduce the risks and costs associated with a general anesthetic and can be used for patients with isolated migraines localized to the zygomaticotemporal branch of the trigeminal nerve or recurrent secondary triggers to that area. CLINICAL QUESTION/LEVEL OF EVIDENCE:: Therapeutic, V.


Assuntos
Descompressão Cirúrgica/métodos , Aparelho Lacrimal/cirurgia , Transtornos de Enxaqueca/cirurgia , Procedimentos Neurocirúrgicos/métodos , Nervo Trigêmeo/cirurgia , Cadáver , Feminino , Humanos , Masculino
20.
Pediatr Cardiol ; 40(6): 1266-1274, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31250046

RESUMO

Left heart distension during venoarterial extracorporeal membrane oxygenation (VA ECMO) often necessitates decompression to facilitate myocardial recovery and prevent life-threatening complications. The objectives of this study were to compare clinical outcomes between patients who did and did not undergo left atrial (LA) decompression, quantify decompression efficacy, and identify risk factors for development of left heart distension. This was a single-center retrospective case-control study. Pediatric VA ECMO patients who underwent LA decompression from June 2004 to March 2016 were identified, and a control cohort of VA ECMO patients who did not undergo LA decompression were matched based on diagnosis, extracorporeal cardiopulmonary resuscitation, and age. Among 194 VA ECMO cases, 21 (11%) underwent LA decompression. Compared to the control cohort, patients with decompression had longer hospital length of stay (60 ± 55 vs. 27 ± 23 days, p = 0.012), but similar in-hospital mortality (29% vs. 38%, p = 0.513). Decompression successfully decreased mean LA pressure (24 ± 11 to 14 ± 4 mmHg, p = 0.022) and LA:RA pressure gradient (10 ± 7 to 0 ± 1 mmHg, p = 0.011). No significant differences in early quantitative measures of cardiac function were observed between cases and controls to identify risk factors for left heart distension. Despite higher qualitative risk for impaired cardiac recovery, patients who underwent LA decompression had comparable outcomes to those who did not. Given that traditional quantitative measures of cardiac function are insufficient to predict development of eventual left heart distension, a combination of clinical history, radiographic findings, hemodynamic monitoring, and laboratory markers should be used during the evaluation and management of these patients.


Assuntos
Descompressão Cirúrgica/métodos , Oxigenação por Membrana Extracorpórea/efeitos adversos , Átrios do Coração/cirurgia , Disfunção Ventricular Esquerda/etiologia , Disfunção Ventricular Esquerda/cirurgia , Adolescente , Estudos de Casos e Controles , Criança , Pré-Escolar , Descompressão Cirúrgica/mortalidade , Feminino , Átrios do Coração/patologia , Mortalidade Hospitalar , Humanos , Lactente , Tempo de Internação/estatística & dados numéricos , Masculino , Estudos Retrospectivos , Fatores de Risco
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