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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
3.
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
4.
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
5.
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
6.
BMC Musculoskelet Disord ; 20(1): 418, 2019 Sep 11.
Artigo em Inglês | MEDLINE | ID: mdl-31506099

RESUMO

BACKGROUND: Resuming walking after lumbar surgery is a common focus of early post-operative rehabilitation, however there is no knowledge about whether increased walking is associated with better functional outcomes. This study aimed to determine whether time spent walking in the week after lumbar surgery, along with co-morbidities, pre-operative pain duration, pre-operative physical activity or function, or surgical variables predict substantial improvement in physical function six months after lumbar surgery. METHODS: A prospective cohort study design was utilized. Participants undergoing lumbar surgery (discectomy, decompression, fusion) were recruited between April and November 2016. Predictor variables were collected pre-operatively (age, sex, smoking status, obesity, diabetes, depression, anxiety, pre-operative pain duration, neurological deficit, physical activity levels, mobility restriction, function) and early post-operatively (post-operative walking time, surgical procedure, single/multi-level surgery). Outcome variables (physical function, back pain and leg pain severity) were measured pre-operatively and six-months post-operatively. Logistic regression analysis was used to establish prediction of substantial improvement in outcome at six months. RESULTS: Participants (N = 233; 50% female; age 61 (SD = 14) years) who walked more in the first post-operative week were more likely to have substantially improved function on the Oswestry Disability Questionnaire at six months (OR 1.18, 95%CI 1.02-1.37), as were participants with < 12 months pre-operative pain (OR 2.71, 95%CI 1.28-5.74), and those with lower pre-operative function (OR 4.02, 95%CI 2.33-6.93). Age < 65 years (OR 2.36, 95%CI 1.14-4.85), and < 12 months pre-operative pain (OR 3.52 95%CI 1.69-7.33) predicted substantial improvement on the SF-36 Physical Component Summary. There were no significant predictors for substantial improvement in either leg or back pain. CONCLUSIONS: Walking time in the week after lumbar surgery is one of several predictors of substantial improvement in function at six months. Further research is required to determine whether intervention designed to increase walking early after lumbar surgery results in improved longer-term recovery of function. TRIAL REGISTRATION: Australian New Zealand Clinical Trials Registry (ANZCTR), registration number 12616000747426 . Retrospectively registered on the 7th of June 2016.


Assuntos
Dor nas Costas/cirurgia , Discotomia/reabilitação , Deambulação Precoce/métodos , Recuperação de Função Fisiológica , Doenças da Coluna Vertebral/cirurgia , Idoso , Austrália , Dor nas Costas/diagnóstico , Dor nas Costas/etiologia , Avaliação da Deficiência , Feminino , Humanos , Modelos Logísticos , Estudos Longitudinais , Vértebras Lombares/fisiopatologia , Vértebras Lombares/cirurgia , Masculino , Pessoa de Meia-Idade , Medição da Dor , Período Pós-Operatório , Prognóstico , Estudos Prospectivos , Doenças da Coluna Vertebral/complicações , Doenças da Coluna Vertebral/fisiopatologia , Fatores de Tempo , Resultado do Tratamento , Caminhada
7.
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
8.
World Neurosurg ; 132: 173-176, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31491571

RESUMO

BACKGROUND: Epidermoid cysts of the spinal cord may rupture, resulting in keratin dissemination in the subarachnoid space, in the ventricles, and along the central canal of the spinal cord causing meningitis, myelopathic changes, or hydrocephalus. CASE DESCRIPTION: A 53-year-old woman with no past medical history presented with a 2-week history of headache located in the occipital region associated with neck pain. Brain magnetic resonance imaging demonstrated multiple fat droplets scattered throughout the subarachnoid and intraventricular spaces with significant edema of the right posterior temporoparietal lobes with trapping of the right temporal horn of the lateral ventricle and atrium. An intracranial lesion could not be observed in the study. The spinal region was suspected as the possible culprit, and spinal imaging showed a large cystic lesion at the level of the conus medullaris. The patient underwent neuronavigation endoscopic exploration of the right lateral ventricle with flushing of the keratin particles followed by a posterior lumbar decompression with resection of the epidermoid cyst. Pathology was consistent with an epidermoid cyst. Successful recovery with improvement in symptoms was quickly observed. CONCLUSIONS: When an epidermoid cyst is suspected but no intracranial lesion is found, the intraspinal area should be studied. Rupture of a spinal epidermoid cyst may cause meningitis and inflammation producing obstructive hydrocephalus. We present this rare entity and describe the diagnostic and surgical techniques used.


Assuntos
Cisto Epidérmico/complicações , Hidrocefalia/etiologia , Hidrocefalia/cirurgia , Meningite/etiologia , Procedimentos Neurocirúrgicos/métodos , Doenças da Coluna Vertebral/complicações , Ventrículos Cerebrais/metabolismo , Ventrículos Cerebrais/patologia , Descompressão Cirúrgica , Endoscopia , Feminino , Humanos , Queratinas/metabolismo , Imagem por Ressonância Magnética , Pessoa de Meia-Idade , Neuronavegação , Ruptura , Espaço Subaracnóideo/metabolismo , Espaço Subaracnóideo/patologia , Resultado do Tratamento
9.
HNO ; 67(10): 801-814, 2019 Oct.
Artigo em Alemão | MEDLINE | ID: mdl-31485696

RESUMO

Dysphagia is a common symptom and can be indicative of a variety of heterogeneous diseases. "Classical" diseases of the head and neck region, such as acute tonsillitis, peritonsillar abscesses, diverticula, and benign or malignant tumors are common causes of dysphagia. However, it can also occur in the context of neurological diseases, e.g., as a result of stroke or as an age-related phenomenon (presbyphagia). Pathologies of the cervical spine can also be a cause of dysphagia. In this context, congenital or acquired diseases, inflammatory or degenerative processes, cervical spine surgery, and (malignant) masses of the cervical spine should be taken into account. Particular dysphagia with a positive history of previous operative interventions on the cervical spine or symptoms such as chronic back pain and trauma should give rise to consideration of a cervical spine-related cause.


Assuntos
Transtornos de Deglutição , Doenças da Coluna Vertebral , Vértebras Cervicais , Transtornos de Deglutição/diagnóstico , Transtornos de Deglutição/etiologia , Cabeça , Humanos , Pescoço , Doenças da Coluna Vertebral/complicações , Doenças da Coluna Vertebral/diagnóstico
10.
Medicina (Kaunas) ; 55(8)2019 Aug 07.
Artigo em Inglês | MEDLINE | ID: mdl-31394861

RESUMO

Background and Objectives: Spinal manipulations are interventions widely used by different healthcare professionals for the management of musculoskeletal (MSK) disorders. While previous theoretical principles focused predominantly on biomechanical accounts, recent models propose that the observed pain modulatory effects of this form of manual therapy may be the result of more complex mechanisms. It has been suggested that other phenomena like neurophysiological responses and the activation of the immune-endocrine system may explain variability in pain inhibition after the administration of spinal manipulative therapy (SMT). The aim of this paper is to provide an overview of the available evidence supporting the biological plausibility of high-velocity, low-amplitude thrust (HVLAT) on the immune-endocrine system. Materials and Methods: Narrative critical review. An electronic search on MEDLINE, ProQUEST, and Google Scholar followed by a hand and "snowballing" search were conducted to find relevant articles. Studies were included if they evaluated the effects of HVLAT on participants' biomarkers Results: The electronic search retrieved 13 relevant articles and two themes of discussion were developed. Nine studies investigated the effects of SMT on cortisol levels and five of them were conducted on symptomatic populations. Four studies examined the effects of SMT on the immune system and all of them were conducted on healthy individuals. Conclusions: Although spinal manipulations seem to trigger the activation of the neuroimmunoendocrine system, the evidence supporting a biological account for the application of HVLAT in clinical practice is mixed and conflicting. Further research on subjects with spinal MSK conditions with larger sample sizes are needed to obtain more insights about the biological effects of spinal manipulative therapy.


Assuntos
Sistema Endócrino/fisiologia , Sistema Imunitário/fisiologia , Manipulação da Coluna/efeitos adversos , Manipulação da Coluna/métodos , Sistema Endócrino/inervação , Sistema Endócrino/metabolismo , Humanos , Sistema Imunitário/inervação , Sistema Imunitário/metabolismo , Manejo da Dor/métodos , Manejo da Dor/normas , Doenças da Coluna Vertebral/complicações , Doenças da Coluna Vertebral/terapia , Resultado do Tratamento
11.
World Neurosurg ; 132: e463-e471, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31470148

RESUMO

BACKGROUND: Despite improved medical management, the incidence of spinal pathology remains high in patients with Parkinson disease (PD). Several studies have investigated lumbar spine surgery in this population, but data regarding costs and perioperative complications for patients undergoing cervical decompression/fusion on a nationwide scale are lacking. METHODS: Cases of cervical spinal decompression, fusion, or exploration in years 2008-2014 were collected via the Healthcare Cost and Utilization Project National Inpatient Sample. Demographics, complications, outcome, and total charges were compared in patients with and without PD (NPD). Confounding variables were identified for multivariate analysis. RESULTS: Data were available for 195,341 cervical spine cases, of which PD was prevalent in 779 cases (0.4%). Cases with PD experienced greater overall complication rates (12.5 vs. 7.6%; P < 0.001). Multivariate analysis revealed longer lengths of stay for the PD cohort (mean = 1.21 days longer; P < 0.001) and decreased routine discharge (odds ratio = 0.308; P < 0.001). There was no significant difference in mean total charges between PD and NPD (-$1532; P = 0.337). Mortality rates did not significantly differ for either group. CONCLUSIONS: Although patients with PD experience greater complication rates and non-home discharges following cervical spine surgery compared with NPD patients, the overall clinical impact of these results may be minimal relative to surgery at other spinal levels in this population.


Assuntos
Vértebras Cervicais/cirurgia , Descompressão Cirúrgica/efeitos adversos , Doença de Parkinson , Complicações Pós-Operatórias/epidemiologia , Fusão Vertebral/efeitos adversos , Idoso , Feminino , Humanos , Incidência , Pacientes Internados , Tempo de Internação , Masculino , Pessoa de Meia-Idade , Doença de Parkinson/complicações , Estudos Retrospectivos , Doenças da Coluna Vertebral/complicações , Doenças da Coluna Vertebral/cirurgia
12.
World Neurosurg ; 131: 120-125, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31400526

RESUMO

BACKGROUND: A noninvasive approach for basilar invagination (BI) and moreover, cervical traction to reduce odontoid invagination, has not been thoroughly described in the literature. We report a case of BI with Arnold-Chiari malformation in which preoperative reduction using Gardner well cervical traction was attempted and the patient developed central hypoventilation syndrome. CASE DESCRIPTION: A 15-year-old boy presented with a 6-month history of progressive cervical myelopathy signs and symptoms, modified Japanese orthopedic association score 12 of 18. Radiology showed type A BI with occipitalization of atlas and a posterior arch defect of axis. A preoperative closed cervical traction followed by occipitocervical fusion via a posterior-only approach was planned. The patient developed 3 episodes of apnea on sleeping when on traction. Labeled as central hypoventilation, he was operated by foramen magnum decompression and occipitocervical fusion. CONCLUSIONS: Cervical traction followed by posterior fixation is an effective way to manage basilar invagination with Arnold-Chiari malformation and assimilated C1. However, patients should be monitored closely for respiratory dysfunction.


Assuntos
Malformação de Arnold-Chiari/cirurgia , Articulação Atlantoccipital/cirurgia , Apneia do Sono Tipo Central/etiologia , Doenças da Coluna Vertebral/cirurgia , Tração/efeitos adversos , Adolescente , Malformação de Arnold-Chiari/complicações , Malformação de Arnold-Chiari/diagnóstico por imagem , Articulação Atlantoccipital/diagnóstico por imagem , Descompressão Cirúrgica/métodos , Humanos , Masculino , Doenças da Coluna Vertebral/complicações , Doenças da Coluna Vertebral/diagnóstico por imagem , Fusão Vertebral/métodos
13.
World Neurosurg ; 131: e170-e175, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31330334

RESUMO

INTRODUCTION: The lateral transpsoas approach (LTPA) has gained popularity in thoracolumbar spine surgery procedures; however, there is an insufficient amount of data pertaining to motor and sensory complications that arise when a corpectomy is performed through the LTPA approach. METHODS: Patients who underwent a corpectomy through a LTPA at a single institution between 2006 and 2016 were analyzed. Demographics, neurological outcomes, and complications were recorded. The minimum follow-up was 6 months. Univariate analysis was performed to compare demographics, surgical characteristics, complications, and outcome scores. To compare categorical variables, the χ2 test was used. For continuous outcomes, simple linear regression was used. Statistical significance was set at P < 0.05. RESULTS: A total of 166 patients were included. The patients were divided into 2 groups; LTPA without corpectomy (n = 112) versus LTPA with corpectomy (n = 54). Patients without corpectomy showed a significantly lower rate of postoperative infections compared with patients with corpectomy (3.6% vs. 22.2%; P < 0.000). A higher percentage of postoperative complications was found in patients with corpectomy (31.5% vs. 13.4%; P = 0.006). The rate of neurologic complications at the 6-month follow-up and the reoperation rate (22.7% vs. 32.4%; P = 0.256) were higher in the corpectomy group (8.9% vs. 7.4%; P = 0.741), no significant difference was found between the groups. CONCLUSION: Patients who underwent an LTPA corpectomy have a higher risk to suffer from postoperative complications. The results at the 6-month follow-up did not significantly differ between the groups.


Assuntos
Vértebras Lombares/cirurgia , Procedimentos Neurocirúrgicos/métodos , Doenças da Coluna Vertebral/cirurgia , Fusão Vertebral/métodos , Vértebras Torácicas/cirurgia , Idoso , Feminino , Humanos , Dor Lombar/etiologia , Dor Lombar/cirurgia , Plexo Lombossacral/lesões , Masculino , Pessoa de Meia-Idade , Procedimentos Cirúrgicos Minimamente Invasivos , Complicações Pós-Operatórias/epidemiologia , Músculos Psoas , Radiculopatia/etiologia , Radiculopatia/cirurgia , Estudos Retrospectivos , Doenças da Coluna Vertebral/complicações , Fraturas da Coluna Vertebral/cirurgia , Neoplasias da Coluna Vertebral/cirurgia , Resultado do Tratamento
14.
Biomed Res Int ; 2019: 6286258, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31236410

RESUMO

How to decrease intraoperative bleeding, shorten surgical time, and increase safety in spinal surgery is an important issue. Ultrasonic bone removers and FloSeal have been proven to increase safety, reduce the surgical duration, and decrease intraoperative bleeding in skull base surgery. Therefore, we aimed to compare the surgical duration, blood loss, and complications during spinal surgery with or without the use of FloSeal and an ultrasonic bone scalpel. Therefore, we retrospectively reviewed 293 patients who underwent thoracolumbar spinal surgery with decompression and instrumented fusion performed by a single surgeon. We divided these patients into three groups, including nonuse of FloSeal nor a bone scalpel (group A), use of FloSeal only (group B), and use of FloSeal and a bone scalpel (group C) intraoperatively after pairing in terms of age, sex, and surgical level. The surgical duration, blood loss, and occurrence of complications were all recorded. The mean surgical duration in group A was 160 mins, in group B it was 167 mins, and in group C it was 134 mins. The mean blood loss was 700 ml in group A, 682 ml in group B, and 383 ml in group C. Six patients sustained intraoperative dura injuries in total, 3 in group A, 2 in group B, and 1 in group C. No postoperative neurologic defects or occurrences of hematoma were recorded. According to our results, we concluded that combined use of FloSeal and bone scalpels is recommended during primary thoracolumbar spinal surgery to reduce the intraoperative blood loss and shorten the surgical duration.


Assuntos
Perda Sanguínea Cirúrgica/prevenção & controle , Doenças da Coluna Vertebral/cirurgia , Coluna Vertebral/cirurgia , Adulto , Idoso , Idoso de 80 Anos ou mais , Perda Sanguínea Cirúrgica/fisiopatologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Doenças da Coluna Vertebral/complicações , Doenças da Coluna Vertebral/patologia , Coluna Vertebral/irrigação sanguínea , Instrumentos Cirúrgicos , Resultado do Tratamento , Ultrassom
15.
Curr Opin Anaesthesiol ; 32(5): 609-615, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31192792

RESUMO

PURPOSE OF REVIEW: Frailty and sarcopenia represent a state of increased fragility and decreased reserve, and both have been associated with worse outcomes after surgery. The present review focuses on the definitions and measurement tools used to assess frailty and sarcopenia in patients with spinal disorder, and the relationships between frailty, sarcopenia, and postoperative outcomes in patients undergoing complex spine surgery. RECENT FINDINGS: Complex spine surgery is associated with a high rate of adverse events when using a validated, prospective data collection system. Recent studies have demonstrated that patients with spine surgery with frailty and sarcopenia have a higher risk of adverse events, although this relationship varies depending on the measurement tool and specific population studied. Both general and specific frailty assessment tools have been used in the spine surgery population, however the optimal tool is not known. Spinal disorders such as lumbar stenosis contribute to the frailty phenotype, and may be reversible with surgery. SUMMARY: Frailty and sarcopenia are increasingly recognized as important predictors of adverse outcomes after complex spine surgery. The optimal tool to measure frailty and sarcopenia in patients with spinal disorders remains unclear, and the role of surgery as an intervention to reverse frailty requires further investigation.


Assuntos
Fragilidade/diagnóstico , Procedimentos Neurocirúrgicos/efeitos adversos , Complicações Pós-Operatórias/prevenção & controle , Cuidados Pré-Operatórios/métodos , Sarcopenia/diagnóstico , Doenças da Coluna Vertebral/cirurgia , Fragilidade/etiologia , Fragilidade/fisiopatologia , Humanos , Procedimentos Neurocirúrgicos/métodos , Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/fisiopatologia , Fatores de Risco , Sarcopenia/etiologia , Sarcopenia/fisiopatologia , Doenças da Coluna Vertebral/complicações , Resultado do Tratamento
16.
Bone Joint J ; 101-B(6_Supple_B): 37-44, 2019 06.
Artigo em Inglês | MEDLINE | ID: mdl-31146559

RESUMO

AIMS: Patients may present with concurrent symptomatic osteoarthritis (OA) of the hip and degenerative disorders of the lumbar spine, with surgical treatment being indicated for both. Whether arthroplasty of the hip or spinal surgery should be performed first remains uncertain. MATERIALS AND METHODS: Clinical scenarios were devised for a survey asking the preferred order of surgery and the rationale for this decision for five fictional patients with both OA of the hip and degenerative lumbar disorders. These were symptomatic OA of the hip and: 1) lumbar spinal stenosis with neurological claudication; 2) lumbar degenerative spondylolisthesis with leg pain; 3) lumbar disc herniation with leg weakness; 4) lumbar scoliosis with back pain; and 5) thoracolumbar disc herniation with myelopathy. This survey was sent to 110 members of The Hip Society and 101 members of the Scoliosis Research Society. The choices of the surgeons were compared among scenarios and between surgical specialties using the chi-squared test. The free-text comments were analyzed using text-mining. RESULTS: Responses were received from 51 hip surgeons (46%) and 37 spine surgeons (37%). The percentages of hip surgeons recommending 'hip first' differed significantly among scenarios: 59% for scenario 1; 73% for scenario 2; 47% for scenario 3; 47% for scenario 4; and 10% for scenario 5 (p < 0.001). The percentages of spine surgeons recommending 'hip first' were 49% for scenario 1; 70% for scenario 2; 19% for scenario 3; 78% for scenario 4; and 0% for scenario 5. There were significant differences between the groups for scenarios 3 (more hip surgeons recommended 'hip first'; p = 0.012) and 4 (more hip surgeons recommended 'spine first'; p = 0.006). CONCLUSION: In patients with coexistent OA of the hip and degenerative disorders of the spine, the question of 'hip or spinal surgery first' elicits relatively consistent answers in some clinical scenarios, but remains controversial in others, even for experienced surgeons. The nature of neurological symptoms can influence surgeons' decision-making. Cite this article: Bone Joint J 2019;101-B(6 Supple B):37-44.


Assuntos
Vértebras Lombares/cirurgia , Osteoartrite do Quadril/cirurgia , Doenças da Coluna Vertebral/cirurgia , Competência Clínica/normas , Tomada de Decisão Clínica , Humanos , Cirurgiões Ortopédicos/normas , Cirurgiões Ortopédicos/estatística & dados numéricos , Osteoartrite do Quadril/complicações , Padrões de Prática Médica/estatística & dados numéricos , Características de Residência , Doenças da Coluna Vertebral/complicações , Estados Unidos
17.
Neuroradiology ; 61(8): 881-889, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31101947

RESUMO

PURPOSE: To analyze the causes of pain, imaging characteristics, and therapeutic effect of spinal injection in patients with extreme low back pain or sciatica. METHODS: We analyzed 381 consecutive patients with extreme low back pain or sciatica visiting our spinal intervention center between January and December 2017. Clinical and imaging characteristics were analyzed. The treatment response, defined as a numerical pain rating scale decrease of ≥ 30%, was measured. Fisher's exact test was performed to identify the association between the injection response and subsequent lumbar surgery rate. RESULTS: The most frequent cause of pain was spinal stenosis, followed by herniated intervertebral disc, facet osteoarthritis, and osteoporotic compression fracture. A herniated intervertebral disc was the most common disorder in patients < 50 years of age, while spinal stenosis was the most common in patients ≥ 50 years of age. Women comprised 66.4% of the study population. The majority of lumbar pathologies occurred below L3/4. Spinal injection was found to be effective in 44.2% of cases. Those who responded to the injection showed a significantly lower rate of lumbar surgery within 6 months (P = 0.004). CONCLUSIONS: Those with extreme low back pain or sciatica had clinical and imaging characteristics similar to those with typical low back pain referred for spinal injection. Spinal injection could be an effective method of pain control for patients with extreme low back pain or sciatica.


Assuntos
Injeções Espinhais , Dor Lombar/diagnóstico por imagem , Vértebras Lombares , Imagem por Ressonância Magnética , Ciática/diagnóstico por imagem , Doenças da Coluna Vertebral/diagnóstico por imagem , Adulto , Idoso , Anestésicos Locais/administração & dosagem , Dexametasona/administração & dosagem , Feminino , Glucocorticoides/administração & dosagem , Humanos , Dor Lombar/tratamento farmacológico , Dor Lombar/etiologia , Masculino , Pessoa de Meia-Idade , Medição da Dor , Estudos Retrospectivos , Ropivacaina/administração & dosagem , Ciática/tratamento farmacológico , Ciática/etiologia , Doenças da Coluna Vertebral/complicações
18.
J Dermatol ; 46(6): 526-530, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31106878

RESUMO

Scalp dysesthesia may be underrecognized but is an important condition which requires special management strategies. Through our case series of four patients, we have noted that patients were frequently misdiagnosed with seborrheic dermatitis and failed standard treatment. However, patients did benefit from low doses of oral pregabalin and a topical compound of amitriptyline, lidocaine and ketamine. Oral antihistamines and topical corticosteroids did not work sufficiently on their own but added value when used in conjunction with analgesic agents. Our experience and published work also suggest the association of cervical spinal changes, psychiatric disorders, and other environmental and habitual factors.


Assuntos
Analgésicos/administração & dosagem , Glucocorticoides/administração & dosagem , Antagonistas dos Receptores Histamínicos/administração & dosagem , Parestesia/diagnóstico , Administração Cutânea , Administração Oral , Idoso , Vértebras Cervicais , Dermatite Seborreica/diagnóstico , Erros de Diagnóstico , Exposição Ambiental/efeitos adversos , Feminino , Humanos , Transtornos Mentais/complicações , Pessoa de Meia-Idade , Parestesia/tratamento farmacológico , Parestesia/etiologia , Parestesia/psicologia , Couro Cabeludo , Dermatoses do Couro Cabeludo/diagnóstico , Doenças da Coluna Vertebral/complicações , Resultado do Tratamento
19.
World Neurosurg ; 129: e311-e316, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31132486

RESUMO

OBJECTIVE: Previous studies have identified the impact of affective disorders on preoperative and postoperative perception of pain. However, there is a scarcity of data identifying the impact of affective disorders on postdischarge narcotic refills. The aim of this study was to determine whether patients with affective disorders have more narcotic refills after complex spinal fusion for deformity correction. METHODS: The medical records of 121 adult (≥18 years old) spine deformity patients undergoing elective, primary complex spinal fusion (≥5 level) for deformity correction at a major academic institution from 2010 to 2015 were reviewed. Patient demographics, comorbidities, intraoperative and postoperative complication rates, baseline and postoperative patient-reported pain scores, ambulatory status, and narcotic refills were collected for each patient. The primary outcome was the rate of 6-week and 3-month narcotic refills. RESULTS: Of the 121 patients, 43 (35.5%) had a clinical diagnosis of anxiety or depression (affective disorder) (AD n = 43; No-AD n = 78). Preoperative narcotic use was significantly higher in the AD cohort (AD 65.9% vs. No-AD 37.7%, P = 0.0035). The AD cohort had significantly higher pain scores at baseline (AD 6.5 ± 2.9 vs. No-AD 4.7 ± 3.1, P = 0.004) and at the first postoperative pain score reported (AD 6.7 ± 2.6 vs. No-AD 5.6 ± 2.9, P = 0.049). However, there were no significant differences in narcotic refills at 6 weeks (AD 34.9% vs. No-AD 25.6%, P = 0.283) and 3 months (AD 23.8% vs. No-AD 17.4%, P = 0.411) after discharge between the cohorts. CONCLUSIONS: Our study suggests that whereas spinal deformity patients with affective disorders may have a higher baseline perception of pain and narcotic use, the impact of affective disorders on narcotic refills at 6 weeks and 3 months may be minimal after complex spinal fusion.


Assuntos
Transtornos do Humor/complicações , Entorpecentes/uso terapêutico , Dor Pós-Operatória/tratamento farmacológico , Doenças da Coluna Vertebral/cirurgia , Fusão Vertebral/efeitos adversos , Adulto , Prescrições de Medicamentos , Procedimentos Cirúrgicos Eletivos/efeitos adversos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Entorpecentes/administração & dosagem , Percepção da Dor/efeitos dos fármacos , Dor Pós-Operatória/complicações , Estudos Retrospectivos , Doenças da Coluna Vertebral/complicações , Coluna Vertebral/cirurgia
20.
Dan Med J ; 66(5)2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-31066352

RESUMO

INTRODUCTION: A venous thromboembolism (VTE), i.e. deep vein thrombosis (DVT) or pulmonary embolism (PE), is a potentially lethal complication to surgical procedures. The aim of this study was to evaluate the incidence of symptomatic VTEs in a large consecutive Danish cohort treated surgically for degenerative spinal disease. METHODS: This was a retrospective, consecutive, one-centre cohort study of patients treated surgically for either cervical or lumbar degenerative disease. According to the local treatment protocol, patients with an increased risk of VTE received rivaroxaban as thrombosis prophylaxis. VTE events within six months from the surgical procedure were identified via the Danish National Patient Register and confirmed by patient chart review. RESULTS: A total of 6,145 surgical procedures were included - 808 cervical and 5,337 lumbar procedures. Twelve patients (0.2%) were examined on suspicion of symptomatic VTE, ten for DVT and two for PE. VTE was confirmed in eight patients (0.1%), seven DVT and one PE. One patient died within six months, producing a mortality rate of 0.01%. CONCLUSIONS: VTEs are an uncommon but potentially lethal complication in patients who undergo surgery for a degenerative spinal disease. Incidence and mortality were low in a consecutive cohort where rivaroxaban was used as thrombosis prophylaxis in patients with an increased preoperative risk of VTE. FUNDING: none. TRIAL REGISTRATION: not relevant.


Assuntos
Complicações Pós-Operatórias/epidemiologia , Doenças da Coluna Vertebral/cirurgia , Tromboembolia Venosa/epidemiologia , Trombose Venosa/epidemiologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Anticoagulantes/uso terapêutico , Feminino , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Embolia Pulmonar/epidemiologia , Estudos Retrospectivos , Doenças da Coluna Vertebral/complicações
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