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1.
Praxis (Bern 1994) ; 109(2): 87-95, 2020 Feb.
Artigo em Alemão | MEDLINE | ID: mdl-32019459

RESUMO

Everyone Has Low Back Pain: Degenerative Lumbar Spinal Disorders and Their Treatment Options Abstract. Back pain is one of the most widespread diseases. Up to 84 % of people have low back pain at some point in their lives. Unspecific back pain is treated conservatively. As supportive measure, interventional pain therapy can be performed. Surgery for low back pain should be considered in selected cases only. However, accompanying neurological symptoms are frequent, such as radiation, i.e. sciatica. Typical etiologies are disc herniation or - increasingly frequent, and due to the aging population increasingly frequent - spinal canal stenosis. Surgery has a better prognosis in cases where conservative management failed. If severe neurological symptoms are present, surgery is indicated. Osteoporotic compression fractures cause acute back pain. The decision whether these patients should undergo kypho- or vertebroplasty should be based on guidelines.


Assuntos
Dor Lombar , Doenças da Coluna Vertebral , Estenose Espinal , Idoso , Humanos , Dor Lombar/etiologia , Dor Lombar/terapia , Vértebras Lombares , Prognóstico , Doenças da Coluna Vertebral/complicações , Doenças da Coluna Vertebral/terapia , Estenose Espinal/complicações , Estenose Espinal/terapia
2.
Instr Course Lect ; 69: 349-362, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32017737

RESUMO

Back pain and spinal deformity in the pediatric and adolescent patient population are common reasons for presentation to the orthopaedic surgeon, and although most conditions are benign and self-limiting, a standardized approach to the history and physical examination can identify concerning signs and symptoms as well as aid in determining the final diagnosis and a recommended treatment plan. The most common and concerning etiologies of back pain and spinal deformity will be reviewed, along with nonsurgical and surgical management of these conditions.


Assuntos
Exame Físico , Doenças da Coluna Vertebral , Coluna Vertebral , Adolescente , Criança , Humanos
3.
Medicine (Baltimore) ; 99(5): e19055, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-32000453

RESUMO

To investigate the outcomes and reliability of hybrid surgery (HS) versus anterior cervical discectomy and fusion (ACDF) for the treatment of multilevel cervical spondylosis and disc diseases.Hybrid surgery, combining cervical disc arthroplasty (CDA) with fusion, is a novel treatment to multilevel cervical degenerated disc disease in recent years. However, the effect and reliability of HS are still unclear compared with ACDF.To investigate the studies of HS versus ACDF in patients with multilevel cervical disease, electronic databases (Medline, Embase, Pubmed, Cochrane library, and Cochrane Central Register of Controlled Trials) were searched. Studies were included when they compared HS with ACDF and reported at least one of the following outcomes: functionality, neck pain, arm pain, cervical range of motion (ROM), quality of life, and incidence of complications. No language restrictions were used. Two authors independently assessed the methodological quality of included studies and extracted the relevant data.Seven clinical controlled trials were included in this study. Two trials were prospective and the other 5 were retrospective. The results of the meta-analysis indicated that HS achieved better recovery of NDI score (P = 0.038) and similar recovery of VAS score (P = 0.058) compared with ACDF at 2 years follow-up. Moreover, the total cervical ROM (C2-C7) after HS was preserved significantly more than the cervical ROM after ACDF (P = 0.000) at 2 years follow-up. Notably, the compensatory increase of the ROM of superior and inferior adjacent segments was significant in ACDF groups at 2-year follow-up (P < 0.01), compared with HS.The results demonstrate that HS provides equivalent outcomes and functional recovery for cervical disc diseases, and significantly better preservation of cervical ROM compared with ACDF in 2-year follow-up. This suggests the HS is an effective alternative invention for the treatment of multilevel cervical spondylosis to preserve cervical ROM and reduce the risk of adjacent disc degeneration. Nonetheless, more well-designed studies with large groups of patients are required to provide further evidence for the benefit and reliability of HS for the treatment of cervical disk diseases.


Assuntos
Vértebras Cervicais/cirurgia , Discotomia/métodos , Doenças da Coluna Vertebral/cirurgia , Fusão Vertebral/métodos , Humanos , Degeneração do Disco Intervertebral/cirurgia , Deslocamento do Disco Intervertebral/cirurgia , Espondilose/cirurgia
4.
Radiologe ; 60(2): 132-137, 2020 Feb.
Artigo em Alemão | MEDLINE | ID: mdl-31915839

RESUMO

BACKGROUND: Spinal complaints affect a large proportion of the population and lead to numerous doctor visits. PURPOSE: The different techniques of CT-guided infiltration of spinal disorders, taking into account facet infiltration, periradicular infiltration and epidural flooding are demonstrated. MATERIALS AND METHODS: Discussion of basic work and expert recommendations as well as presentation of different treatment steps for everyday clinical practice. RESULTS: The CT-guided application of the different types of infiltration allows precise execution of the therapy. Both facet infiltration and periradicular infiltration and epidural flooding have their place depending on the clinical symptoms. The optimal combination of drugs to administer is still the subject of numerous studies and sometimes controversial discussions. CONCLUSION: An exact clinical and imaging evaluation of the pain symptoms in the back is the basic requirement for a targeted therapy.


Assuntos
Doenças da Coluna Vertebral , Tomografia Computadorizada por Raios X , Humanos , Doenças da Coluna Vertebral/diagnóstico por imagem , Doenças da Coluna Vertebral/terapia
5.
World Neurosurg ; 133: e789-e795, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31605849

RESUMO

BACKGROUND: Obesity has been shown to be associated with higher rates of complications after lumbar spine surgery. However, the evidence regarding the impact of body mass index (BMI) on outcomes following posterior cervical fusions (PCFs) remains limited. METHODS: The 2012-2017 American College of Surgeons National Surgical Quality Improvement Program database was queried using Current Procedural Terminology code 22600 to identify PCFs. Patients undergoing anterior cervical spine surgery and surgery for deformity, malignancy, or infection were excluded. Patients with missing data with regard to weight, height, and 30-day outcomes were excluded. BMI (kg/m2) was categorized into 4 groups: 1) <25.0, 2) 25.0-29.9, 3) 30.0-34.9, and 4) ≥35.0. Multivariate regression analyses were constructed to assess independent impact of BMI on 30-day outcomes while controlling for baseline clinical characteristics. RESULTS: Of 2786 patients with PCFs, 710 (25.5%) had BMI <25.0, 919 (33.0%) had BMI between 25.0 and 29.9, 655 (23.5%) had BMI between 30.0 and 34.9, and 502 (18.0%) had BMI ≥35.0. Following adjustment for baseline demographics and clinical characteristics, increased BMI was not associated with a higher risk of any adverse events, severe adverse events, minor adverse events, bleeding requiring transfusion, or readmissions within 30 days of surgery. BMI ≥35.0 versus BMI <25.0 was associated only with a higher risk of deep surgical site infections (odds ratio 4.61; P = 0.009). CONCLUSIONS: With the exception of a higher rate of deep surgical site infections seen in obese patients, increased BMI does not seem to have a major impact on 30-day outcomes following PCFs.


Assuntos
Índice de Massa Corporal , Vértebras Cervicais/cirurgia , Doenças da Coluna Vertebral/cirurgia , Fusão Vertebral/efeitos adversos , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Criança , Pré-Escolar , Bases de Dados Factuais , Feminino , Humanos , Lactente , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/etiologia , Estudos Retrospectivos , Fatores de Risco , Estados Unidos , Adulto Jovem
6.
World Neurosurg ; 133: 90-96, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31568901

RESUMO

BACKGROUND: Although adjacent segment disease (ASD) following anterior cervical fusion has been well described in the literature, there is relative paucity of data on this pathology after posterior cervical fusion. To our knowledge, there have been no reported cases of proximal ASD following posterior fusion to C2. CASE DESCRIPTION: We present 2 cases of proximal ASD presenting as retroodontoid pseudotumors following posterior fusion to C2, both in middle-aged females without history of rheumatologic disease. The first occurred in a patient with Klippel-Feil deformity 13 years after C2-6 posterior cervical fusion, the second in a patient 3 and a half years following revisional circumferential C2-T2 fusion. Both were successfully treated with proximal extension of laminectomy and fusion to the occiput, supplemented in the first patient by transdural decompression of retroodontoid mass. CONCLUSIONS: Proximal ASD can manifest as retroodontoid pseudotumor at variable time intervals following posterior fusion to C2. Clinicians must account for this possibility in their decision making.


Assuntos
Vértebras Cervicais/cirurgia , Descompressão Cirúrgica/efeitos adversos , Cervicalgia/diagnóstico por imagem , Doenças da Coluna Vertebral/etiologia , Fusão Vertebral/efeitos adversos , Vértebras Cervicais/diagnóstico por imagem , Feminino , Humanos , Síndrome de Klippel-Feil/diagnóstico por imagem , Síndrome de Klippel-Feil/cirurgia , Imagem por Ressonância Magnética , Pessoa de Meia-Idade , Cervicalgia/cirurgia , Processo Odontoide/diagnóstico por imagem , Processo Odontoide/cirurgia , Doenças da Coluna Vertebral/diagnóstico por imagem , Doenças da Coluna Vertebral/cirurgia , Resultado do Tratamento
7.
World Neurosurg ; 133: e156-e164, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31476474

RESUMO

OBJECTIVE: To elucidate the correlation between changes in spinal/pelvic sagittal parameters and clinical treatment outcomes after oblique lumbar interbody fusion (OLIF). METHODS: Eighty-two patients with lumbar degenerative disease (LDD) treated by OLIF were retrospectively analyzed. The visual analog scale (VAS) score and Oswestry Disability Index (ODI) score were compared before and after surgery. Disk height (DH) and various spinal/pelvic sagittal parameters, including pelvic incidence (PI), pelvic tilt (PT), sacral slope (SS), lumbar lordosis (LL), and sagittal vertical axis (SVA), were measured preoperatively and at the last postoperative follow-up. The correlation between the changes in sagittal parameters before and after surgery and the clinical treatment outcomes were observed. RESULTS: ODI score, VAS score, and DH were significantly better at the last follow-up compared with before surgery. The change in PI was not statistically significant before and after surgery. PT significantly decreased and SS and LL significantly increased after surgery. Significant linear relationships were found for several independent variables (difference in DH before and after surgery, postoperative LL, difference in LL before and after surgery, PI-LL match status, and SVA status) and the dependent variable ODI. The difference in DH before and after surgery showed the strongest correlation. The percentages of PI-LL match were 37% before surgery and 66% after surgery. The percentage of the normal SVA was 9% before surgery and 62% after surgery. CONCLUSIONS: OLIF for treatment of LDD had significant clinical outcomes, effectively restored the spinal/pelvic sagittal balance, and helped to improve the patients' clinical conditions.


Assuntos
Vértebras Lombares/cirurgia , Ossos Pélvicos/diagnóstico por imagem , Fusão Vertebral/métodos , Coluna Vertebral/diagnóstico por imagem , Adulto , Idoso , Idoso de 80 Anos ou mais , Antropometria , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Ossos Pélvicos/patologia , Estudos Retrospectivos , Doenças da Coluna Vertebral/cirurgia , Coluna Vertebral/patologia , Resultado do Tratamento
8.
Artigo em Russo | MEDLINE | ID: mdl-31851168

RESUMO

AIM: To analyze clinical results of the surgical treatment of patients with isolated facet-syndrome of the lumbar spine using platelet-rich plasma (PRP) therapy for arcuate spine joints. MATERIAL AND METHODS: The study included 49 patients, aged 39.5 (34; 45), who, after provocative tests, were diagnosed with isolated facet syndrome and operated on from 2015 to 2018 using PRP therapy. A visual analogue pain scale (VAS), Oswestry questionnaire (ODI), Macnab subjective satisfaction scale, and the presence of complications were used to evaluate clinical efficacy. Dynamic evaluation was made on average 18 months after surgery. RESULTS AND CONCLUSION: PRP therapy is a highly effective method for treatment of patients with isolated facet syndrome caused by degenerative diseases of the facet joints. Clinical efficacy is confirmed by the persistent significant reduction of pain symptoms and restoration of functional status in the early and late postoperative periods with low risks of adverse outcomes.


Assuntos
Plasma Rico em Plaquetas , Doenças da Coluna Vertebral , Articulação Zigapofisária , Adulto , Humanos , Vértebras Lombares , Doenças da Coluna Vertebral/terapia , Síndrome , Resultado do Tratamento
9.
Rev Chilena Infectol ; 36(5): 656-662, 2019 Oct.
Artigo em Espanhol | MEDLINE | ID: mdl-31859808

RESUMO

Cryptococcosis is an infectious disease caused by a ubiquitous encapsulated yeast called Cryptococcus neoformans, it is usually associated with immunosuppressed patients. Osteomyelitis occurs in 5-10%, the spine involvement is one of the most reported. The purpose of this work is to present a case of isolated vertebral cryptococcosis and detail the results of a literature review. The treatment protocol is not yet established but it is recommended to start with aggressive intravenous therapy and continue with a suppressive treatment orally during a variable time. Surgical indication is considered in lesions that affect the spinal stability, deformity or neurological compromise and for local infectious control.


Assuntos
Criptococose/patologia , Osteomielite/microbiologia , Osteomielite/patologia , Doenças da Coluna Vertebral/microbiologia , Doenças da Coluna Vertebral/patologia , Idoso , Biópsia , Criptococose/diagnóstico por imagem , Cryptococcus/isolamento & purificação , Humanos , Imagem por Ressonância Magnética , Masculino , Osteomielite/diagnóstico por imagem , Doenças da Coluna Vertebral/diagnóstico por imagem , Tomografia Computadorizada por Raios X
10.
Lakartidningen ; 1162019 Nov 19.
Artigo em Sueco | MEDLINE | ID: mdl-31742654

RESUMO

Seventeen cases of infections in spinal structures were reported 2010-2017 to the Swedish Health and Social Care Inspectorate (IVO), a government agency responsible for supervising health care, for missed or delayed diagnosis. All patient records were scrutinized in order to find underlying causes and common factors. The delayed diagnoses were equally found among men and women and most frequent in in the age-group 65 to 79 years of age. The diagnostic delay most probably in many cases led to patient harm and avoidable sequelae, many with severe impairment for daily life. Several of the patients had a locus minoris resistentiae in the spine and in several cases the entry port of infections were cutaneous wounds, for example leg ulcers. The most important finding was that in the majority of cases the clinical investigation was inadequate and the clinical follow-up - while in hospital! - was inferior, without documentation of muscular weakness and sensory loss. In several cases a too passive management was found, when the losses eventually had become apparent, delaying surgical interventions.


Assuntos
Doenças da Coluna Vertebral , Idoso , Síndrome da Cauda Equina/complicações , Síndrome da Cauda Equina/diagnóstico , Síndrome da Cauda Equina/etiologia , Síndrome da Cauda Equina/terapia , Diagnóstico Tardio , Erros de Diagnóstico , Discite/complicações , Discite/diagnóstico , Discite/etiologia , Discite/terapia , Tratamento de Emergência , Feminino , Humanos , Masculino , Osteomielite/complicações , Osteomielite/diagnóstico , Osteomielite/etiologia , Osteomielite/terapia , Qualidade da Assistência à Saúde/normas , Doenças da Coluna Vertebral/complicações , Doenças da Coluna Vertebral/diagnóstico , Doenças da Coluna Vertebral/etiologia , Doenças da Coluna Vertebral/terapia , Estenose Espinal/complicações , Estenose Espinal/diagnóstico , Estenose Espinal/etiologia , Estenose Espinal/terapia , Espondilite/complicações , Espondilite/diagnóstico , Espondilite/etiologia , Espondilite/terapia , Vértebras Torácicas , Tempo para o Tratamento
11.
Spine (Phila Pa 1976) ; 44(21): E1248-E1255, 2019 Nov 01.
Artigo em Inglês | MEDLINE | ID: mdl-31634300

RESUMO

STUDY DESIGN: A case series of dual time-point F-fluoro-2-deoxy-D-glucose positron emission tomography/computed tomography (F-FDG PET/CT) for the diagnosis of spinal cord sarcoidosis. OBJECTIVE: The aim of this study was to illustrate three cases of spinal sarcoidosis with occult presentation and subsequent identification with the use of dual time-point F-FDG PET/CT. SUMMARY OF BACKGROUND DATA: Sarcoidosis of the spinal cord is very rare and when it occurs without systemic manifestations of disease can be a challenging diagnostic dilemma frequently resulting in the need for spinal cord biopsy in order to establish a diagnosis. METHODS: Case series presentation and report. RESULTS: This manuscript presents a case series experience of dual time-point F-FDG PET/CT for the diagnosis of spinal cord sarcoidosis. We review the cases of three patients who presented with myelopathy and underwent F-FDG DTPI as part of the evaluation for enhancing spinal cord lesions of unknown etiology for 2 years at a university-based cancer hospital. F-FDG DTPI was vital in making the diagnosis of sarcoidosis, and in two of the cases, the patients were able to avoid biopsy, thereby avoiding potential morbidity from an invasive procedure. CONCLUSION: F-FDG PET/CT imaging is a noninvasive imaging technique that can be crucial in the diagnosis of sarcoidosis of the spinal cord and help avoid unnecessary procedures. LEVEL OF EVIDENCE: 4.


Assuntos
Fluordesoxiglucose F18 , Compostos Radiofarmacêuticos , Sarcoidose/diagnóstico por imagem , Doenças da Coluna Vertebral/diagnóstico por imagem , Adulto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Tomografia Computadorizada com Tomografia por Emissão de Pósitrons/métodos , Sarcoidose/patologia , Doenças da Medula Espinal/diagnóstico por imagem , Doenças da Medula Espinal/patologia , Doenças da Coluna Vertebral/patologia
12.
Medicine (Baltimore) ; 98(43): e17456, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31651848

RESUMO

INTRODUCTION: Calcification of ligamentum flavum (CLF) is an important cause of spinal stenosis and spinal cord compression. CLF does not usually induce immediate quadriparesis. Here we describe a rare case of immediate quadriparesis due to a large calcified mass containing liquids in the ligamentum flavum, which was easily confused with gout crystals. PATIENT CONCERNS: A 74-year-old Asian male felt progressive bilateral arm and leg weakness. On the fourth day, acute quadriparesis occurred. DIAGNOSIS: Coronal and sagittal computerized tomography (CT) and magnetic resonance imaging (MRI) showed a large circular mass in the left posterior part of the cervical 3/4 spinal canal, protruding into the canal, and occupying one-half of the spinal canal. INTERVENTIONS: Emergency laminectomy was performed at C3/4 level. The huge cyst was excised and 1 ml of white viscous liquid flowed out. OUTCOMES: After operation, CT and MRI showed a full laminectomy of C3/4 and complete decompression of the cervical spinal cord. Hematoxylin-eosin (HE) staining showed that large amounts of calcium was deposited around cystic tissues. Five-year follow-up after laminectomy showed good recovery. CONCLUSION: This case of immediate quadriparesis, caused by a large calcified mass containing fluid, is very rare. It should be at the earliest stage of calcification. Laminectomy is an effective treatment. This calcification was deceptive and was easily confused with gout crystals. It can help to understand the exact pathophysiology of CLF.


Assuntos
Calcinose/complicações , Vértebras Cervicais/patologia , Ligamento Amarelo/patologia , Quadriplegia/diagnóstico , Doenças da Coluna Vertebral/complicações , Idoso , Calcinose/patologia , Calcinose/cirurgia , Diagnóstico Diferencial , Humanos , Laminectomia/métodos , Masculino , Quadriplegia/etiologia , Quadriplegia/cirurgia , Doenças da Coluna Vertebral/patologia , Doenças da Coluna Vertebral/cirurgia , Resultado do Tratamento
13.
World Neurosurg ; 131: 391-398, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31658581

RESUMO

The anterior approach to lumbar spine fusion, termed anterior lumbar interbody fusion (ALIF), is becoming increasingly popular, with numerous recognized indications, well-defined advantages, and potential complications. From its first theoretical description in 1932 and the first operation published in 1933 to the more recently reported less invasive procedures, an anterior approach to the lumbar spine has many technical variations. Here we describe the evolution of the anterior approach to the lumbar spine, from a hugely invasive transperitoneal route to the current minimally invasive retroperitoneal approach. Many advantages have been advocated for the ALIF approach, and some issues about intraoperative and postoperative complications need to be evaluated in a more specific and homogeneous manner.


Assuntos
Vértebras Lombares/cirurgia , Doenças da Coluna Vertebral/cirurgia , Fusão Vertebral/métodos , História do Século XX , Humanos , Laparoscopia/história , Laparoscopia/métodos , Laparoscopia/tendências , Ilustração Médica , Doenças da Coluna Vertebral/história , Fusão Vertebral/história , Fusão Vertebral/tendências
15.
Rev Cardiovasc Med ; 20(3): 179-186, 2019 Sep 30.
Artigo em Inglês | MEDLINE | ID: mdl-31601092

RESUMO

Cerebral autosomal recessive arteriopathy with subcortical infarcts and leukoencephalopathyis a rare form of inherited cerebral small vessel disease associated with mutations in the high-temperature requirement serine peptidase A1 gene. As of now, only about 50 cases have been reported. In 2012, our group reported a family with a novel mutant of the high-temperature requirement serine peptidase A1 gene in China for the first time. To further explore the molecular pathogenesis of cerebral autosomal recessive arteriopathy with subcortical infarcts and leukoencephalopathy, a recombination mouse model expressed human high-temperature requirement serine peptidase A1 gene mutant identified by our group was generated using the Donor & Clustered Regularly Interspaced Short Palindromic Repeats/Cas9 system and termed the Mut-high-temperature requirement serine peptidase A1 geneL364P mouse model. Results show that Mut-high-temperature requirement serine peptidase A1 geneL364P mice present similar pathological characteristics to patients with cerebral autosomal recessive arteriopathy with subcortical infarcts and leukoencephalopathy, suggesting that the Mut-high-temperature requirement serine peptidase A1 geneL364P mouse model was generated successfully. Moreover, apoptosis was induced in mouse brain vascular smooth muscle cells derived from Mut-high-temperature requirement serine peptidase A1 geneL364P mice. In summary, the cerebral autosomal recessive arteriopathy with subcortical infarcts and leukoencephalopathy mouse model described in this study will be beneficial to demonstrate the pathological mechanism of cerebral autosomal recessive arteriopathy with subcortical infarcts and leukoencephalopathy and provide new therapeutic targets for clinical treatment.


Assuntos
Alopecia/genética , Encéfalo/irrigação sanguínea , Infarto Cerebral/genética , Serina Peptidase 1 de Requerimento de Alta Temperatura A/genética , Leucoencefalopatias/genética , Mutação , Doenças da Coluna Vertebral/genética , Alopecia/enzimologia , Alopecia/patologia , Animais , Apoptose , Células Cultivadas , Infarto Cerebral/enzimologia , Infarto Cerebral/patologia , Predisposição Genética para Doença , Serina Peptidase 1 de Requerimento de Alta Temperatura A/metabolismo , Leucoencefalopatias/enzimologia , Leucoencefalopatias/patologia , Camundongos Endogâmicos C57BL , Camundongos Transgênicos , Músculo Liso Vascular/enzimologia , Músculo Liso Vascular/patologia , Miócitos de Músculo Liso/enzimologia , Miócitos de Músculo Liso/patologia , Fenótipo , Doenças da Coluna Vertebral/enzimologia , Doenças da Coluna Vertebral/patologia
16.
Medicine (Baltimore) ; 98(41): e17344, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31593083

RESUMO

RATIONALE: The meningovertebral ligaments are a group of tissues that connect the dura and the vertebral bone. Abnormal fibrous ligaments in the canal space, which are essentially different from these ligaments, have been identified and their presence very rarely results in spinal disorder. PATIENT CONCERNS: A 20-year-old Mongolian woman had developed persistent headache at 15 years of age. She then became unable to run fast when she was 19 years old and had progressively declining ability to move. She complained of back pain and unstable gait 6 months prior to presentation. Physical examination revealed exaggerated deep tendon reflexes in the lower extremities and decreased proximal leg muscle strength bilaterally. DIAGNOSES: Magnetic resonance imaging (MRI) revealed abnormal bands compressing the spinal cord at the T10/11 level, with large epidural lipomatosis dorsal to the dural tube. INTERVENTION: To decompress the cord, posterior laminectomy for T3-L3 and removal of the heterotopic ligaments were performed with T8-L1 posterior fusion. OUTCOMES: Sufficient decompression of the cord was noted on postoperative MRI at the affected segments. The patient could subsequently walk without a cane and headache resolved immediately after the operation. LESSONS: The presence of an aberrant epidural band is a rare pathologic state that often coexists with a surrounding lipomatosis and can lead to spinal cord compression. Removal of the band is a promising treatment for myelopathy caused by the compressive lesion.


Assuntos
Coristoma/cirurgia , Ligamentos , Doenças da Medula Espinal/cirurgia , Doenças da Coluna Vertebral/cirurgia , Coristoma/complicações , Espaço Epidural/cirurgia , Feminino , Humanos , Doenças da Medula Espinal/etiologia , Doenças da Coluna Vertebral/complicações , Vértebras Torácicas/cirurgia , Adulto Jovem
17.
Fa Yi Xue Za Zhi ; 35(4): 437-439, 2019 Aug.
Artigo em Inglês, Chinês | MEDLINE | ID: mdl-31532153

RESUMO

Abstract: Objective To provide a reference for the assessment of the disability grade of Kümmell's disease cases, through the analysis of the basic situation, the disability grade and the causality of Kümmell's disease cases. Methods Data of appraised individuals in 8 cases of Kümmell's disease from traffic accident spinal injury cases accepted by the Institute from 2015 to 2017 were collected, and the basic situation, vertebral fracture sites and disability grades of the appraised individuals were analyzed. Results Among 8 cases of appraised individuals, there were 2 males and 6 females, the oldest 75 years and the youngest 50 years, with an average age of 62.5 years, all of whom suffered from single vertebral fracture. Among them, 1 patient had thoracic 11 vertebra fracture, 3 thoracic 12 vertebra fracture, 2 lumbar 1 vertebra fracture, 1 lumbar 2 vertebra fracture, and 1 lumbar 4 vertebra fracture, all of whom were assessed as grade 10 disability. Conclusion In the assessment of disability grade of vertebral fracture, dynamic observation of the vertebral fracture and its recovery should be made based on imaging data. If it is suspected that there is Kümmell's disease, it should be differentiated from other diseases. Also, the disability grade will be assessed according to the corresponding standards when the morphology of the injured vertebral body is relatively stable.


Assuntos
Acidentes de Trânsito , Avaliação da Deficiência , Doenças da Coluna Vertebral/patologia , Fraturas da Coluna Vertebral/patologia , Idoso , Feminino , Medicina Legal , Humanos , Vértebras Lombares , Masculino , Pessoa de Meia-Idade , Doenças da Coluna Vertebral/diagnóstico , Doenças da Coluna Vertebral/etiologia , Fraturas da Coluna Vertebral/diagnóstico , Vértebras Torácicas
18.
Spine (Phila Pa 1976) ; 44(19): E1159-E1160, 2019 Oct 01.
Artigo em Inglês | MEDLINE | ID: mdl-31524840

RESUMO

: Johann Peter Frank (1745-1821) is generally known as one of the founders of the modern Hygiene and Public Health. It is less known his contribution in investigating the pathogenesis of spinal disorders. In his "De Vertebralis Columnae in Morbis Dignitate" (1791), Frank first proposed to use the Latin term "rhachialgia" (back pain) to indicate all the painful states of spine. He focused on the "plethora spinali" in the vessels of the spinal cord and its membrane, sustaining that blood congestion was the origin of all the spinal disorders. He also believed that the excess of blood was able to generate a "diffuse inflammation" of vertebral and medullary structures. The innovative concepts developed by Johann Peter Frank demonstrated that he could be worthily considered as a pioneer in the study of spinal disorders.Level of Evidence: 5.


Assuntos
Dor nas Costas , Médicos/história , Doenças da Coluna Vertebral , Dor nas Costas/etiologia , Dor nas Costas/história , Dor nas Costas/patologia , Dor nas Costas/fisiopatologia , Alemanha , História do Século XVIII , História do Século XIX , Humanos , Saúde Pública/história , Doenças da Coluna Vertebral/etiologia , Doenças da Coluna Vertebral/história , Doenças da Coluna Vertebral/patologia , Doenças da Coluna Vertebral/fisiopatologia
19.
World Neurosurg ; 132: 309-313, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31525482

RESUMO

INTRODUCTION: Rosai-Dorfman disease (RDD) is a rare disease that can be triggered by either viral or bacterial infection. Several parts of the body can be involved, from the central nervous system to the pelvic regions had been reported. At present, there is a serious lack of guidelines as to how to treat cases of RDD involving the spine. Current trends show that surgery remains the first method of choice to cure this disease, but in refractory or recurrent RDD, repeat surgery cannot guarantee total resection. Under such circumstances, adjuvant therapy can be very useful. Here, we share our experience of treating recurrent spinal RDD. CASE DESCRIPTION: Our patient was a 32-year-old male patient with hepatitis B virus infection. He suffered from lower back pain with lower limb weakness after being hit by a metal pipe. Laminectomy of T11-12 was performed to decompress the spinal cord. The final pathological results demonstrated chronic inflammation. After surgery, the lower limbs improved and the patient recovered quite well. However, he returned 3 years later with the same complaints and was diagnosed with RDD. Durectomy was performed and repaired with an artificial dura. Thalidomide therapy was initiated. Currently, 9 years later, the patient has not experienced recurrence or any form of neurological deficit. CONCLUSIONS: RDD is a rare disease and can be misdiagnosed easily. Although it may resolve spontaneously, recurrence is possible. Hence, extensive follow-up is necessary. Surgery remained the first choice of surgery, however, when encountered recurrent or nonresectable RDD, adjuvant therapy such as corticosteroids, thalidomide, and radiotherapy could help. In this article, we shared our experience using thalidomide in treating nonresectable RDD.


Assuntos
Histiocitose Sinusal/terapia , Imunossupressores/uso terapêutico , Doenças da Coluna Vertebral/terapia , Talidomida/uso terapêutico , Vértebras Torácicas/cirurgia , Adulto , Histiocitose Sinusal/complicações , Histiocitose Sinusal/diagnóstico por imagem , Histiocitose Sinusal/patologia , Humanos , Dor Lombar/etiologia , Extremidade Inferior , Masculino , Debilidade Muscular/etiologia , Recidiva , Doenças da Coluna Vertebral/complicações , Doenças da Coluna Vertebral/diagnóstico por imagem , Doenças da Coluna Vertebral/patologia
20.
Acta Ortop Mex ; 33(1): 13-17, 2019.
Artigo em Espanhol | MEDLINE | ID: mdl-31480120

RESUMO

OBJECTIVE: To evaluate functional and radiographic results in patients with diagnosis of degenerative disease of the lumbar column subject to treatment with transpedicular fixing plus the application of system S14 (B-FUS), and to evaluate the disease development of adjacent disk associated with the method of selected treatment. MATERIAL AND METHODS: A transversal descriptive retrospective study in which a total of 32 patients with diagnosis of the degenerative pathology of the column lumbar was included, including 12 patients with lumbar degenerative discopathy (37.50%), 11 patients intervertebral lumbar instability (34.38%), seven with narrow lumbar channel (21.88%) and two patients with adjacent discreet disorder disease (6.25%). Of the sample of 32 patients, 17 belong to the male gender and 15 to the female gender; the middle age of the group was 52 years old with a range of age (26-80 years). Patients operated in the period of January 2015 to December 2016 were included. The procedures were assigned and carry out randomly by two specialist surgeons in column with standardization of surgical technique. clinical and radiographic monitoring was performed by the external consultation of column surgery in the two weeks and after a monthly period during a period of at least nine months, presenting a monitoring range between nine and 33 months, with clinical and radiographic valuation. RESULTS: 17 belonged to male gender and 15 to female gender; the average age was 52 years with a range of 26-80 years. To the 32 patients was performed an assessment of pain prior to surgery (eva) with an average of 7.6 Points and a post-surgical assessment of 1.2 Points on average, having a significant decrease, the qualitative radiographic evaluation by surgeons without development of adjacent disk disease in none of the cases even in those that were valued above 20 months after surgery. Complications: 1 rupture of transpedicular screw post-traumatic (3.1%), 1 Surgical reoperation by discopathy of l3-l4 (3.1%) and 3 cases of wound infection that remitted with antibiotic use (10%), the total complications corresponded to (15.6%) and none is associated with the disease of the adjacent disk. CONCLUSIONS: The s14 system (b-fus) in our series of cases as a treatment for degenerative lumbar spine disease has proven to be an effective therapeutic option by reducing the risk of disease development of the adjacent disk.


Assuntos
Instabilidade Articular , Doenças da Coluna Vertebral , Fusão Vertebral , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Vértebras Lombares , Masculino , Pessoa de Meia-Idade , Proteína FUS de Ligação a RNA , Reoperação , Estudos Retrospectivos , Fusão Vertebral/métodos , Resultado do Tratamento
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