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1.
Zhonghua Wai Ke Za Zhi ; 59(3): 216-221, 2021 Mar 01.
Artigo em Chinês | MEDLINE | ID: mdl-33685056

RESUMO

Objectives: To establish a geometric model of the atlantoaxial dislocation and basilar invagination reduction,and examine its value for clinical application. Methods: A retrospective analysis of 35 patients with atlantoaxial dislocation and basilar invagination admitted to the Department of Neurosurgery,First Affiliated Hospital of Chongqing Medical University from May 2018 to May 2020 was conducted.There were 5 males and 30 females,aged (48±15) years(range: 19 to 69 years). The geometric model of the atlantoaxial reduction was established based on the mid-sagittal section of the cervical spine. The relevant data were calculated according to the geometric model before operation,and the fusion cage of the corresponding height was placed into C1-2 facet joint of patient for quantitative reduction. The theoretical reset value, actual reset value, postoperative symptoms and complications were collected. The paired t-test was used to compare the difference between theoretical and actual reset value to verify the reliability of the geometric model. Results: The theoretical vertical reduction distance of all patients was (5.79±2.96) mm(range:1.52 to 10.96 mm),and the actual vertical reduction distance was (7.43±2.96)mm(range: 1.40 to 12.77 mm),and there was no statistical difference between them(t=-1.96,P=0.069).The theoretical reduction angle was (10.80±2.24)°(range: 7.09 to 14.86°), the actual reduction angle was (10.64±7.00)°(range: 3.50 to 20.50°),and there was no statistical difference between them (t=0.09, P=0.933). At 6 months follow-up, 35 patients achieved satisfactory atlanto-axial joint fusion, and the symptoms were relieved. No internal fixation system displacement, fracture, wound infection and other complications occurred. Conclusion: This geometric model can estimate the vertical reduction distance and the reduction angle of the axial before operation,and provide a reference for the height of the fusion cage so as to avoid under or over-reduction.


Assuntos
Articulação Atlantoaxial , Luxações Articulares , Modelos Biológicos , Doenças da Coluna Vertebral/cirurgia , Fusão Vertebral , Adulto , Idoso , Articulação Atlantoaxial/diagnóstico por imagem , Articulação Atlantoaxial/cirurgia , Vértebras Cervicais/diagnóstico por imagem , Vértebras Cervicais/cirurgia , Feminino , Humanos , Luxações Articulares/complicações , Luxações Articulares/diagnóstico por imagem , Luxações Articulares/cirurgia , Masculino , Pessoa de Meia-Idade , Reprodutibilidade dos Testes , Estudos Retrospectivos , Doenças da Coluna Vertebral/diagnóstico por imagem , Doenças da Coluna Vertebral/etiologia , Fusão Vertebral/instrumentação , Fusão Vertebral/métodos , Adulto Jovem
2.
Internist (Berl) ; 62(1): 34-46, 2021 Jan.
Artigo em Alemão | MEDLINE | ID: mdl-33355682

RESUMO

Back pain is a common reason for consulting a general practitioner. For 80% of patients, the back pain is nonspecific. Specific back pain has a determinable cause that needs to be rapidly identified. The diagnostic work-up to clarify spinal pain involves a detailed patient history taking into account the "red flags", a clinical examination and further stepwise diagnostics. In addition to laboratory diagnostics, structured morphological imaging is necessary. Causes of specific back pain include: fractures, infections, radiculopathy, tumors, axial spondylarthritis, as well as extravertebral causes. The diagnosis, treatment and continuous follow-up of the patient with specific back pain is interdisciplinary and requires close communication with the relevant specialists.


Assuntos
Dor nas Costas/etiologia , Exame Físico , Atenção Primária à Saúde/métodos , Doenças da Coluna Vertebral/diagnóstico por imagem , Dor nas Costas/diagnóstico , Dor nas Costas/terapia , Diagnóstico por Imagem/métodos , Humanos , Dor Lombar/etiologia , Anamnese , Fatores de Risco , Doenças da Coluna Vertebral/complicações , Doenças da Coluna Vertebral/terapia , Avaliação de Sintomas/métodos
3.
Cancer Radiother ; 25(1): 51-54, 2021 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-33376045

RESUMO

Bone location is uncommon in both sarcoidosis and in neck cancer (HNC). Diagnosis of a bone lesion is therefore challenging to distinguish its nature in a patient suffering from both diseases. We report the case of a 69-years-old woman referred for P16 positive HPV-HNC. Magnetic Resonance Imaging (MRI) showed T2 hypo-signal on iliac crest and spine. 18FDG-PET demonstrated radiotracer uptake on these locations suggesting bone metastasis. However, bone biopsy showed epithelioid granuloma without malignant cells compatible with sarcoidosis location. The diagnosis of both localized advanced HPV-HNC and systemic sarcoidosis (bone, central nervous system) were retained. The patient received corticosteroid regimen at 0.5mg/kg/day and Methotrexate for sarcoidosis and radiation and chemotherapy with platins for carcinoma. As granulomatous bone marrow infiltration may have an uptake on 18FDG-PET, bone sarcoidosis can mimic metastatic disease. In addition, MRI often fails to distinguish sarcoidosis lesions from metastatic lesion in bones. As no reliable imaging test can decipher both diseases, the description of our case reinforces the necessity to perform bone biopsy in a patient suffering from both conditions to expertise the nature of bone lesions.


Assuntos
Doenças Ósseas/diagnóstico por imagem , Papillomavirus Humano 16 , Neoplasias Orofaríngeas/diagnóstico por imagem , Sarcoidose/diagnóstico por imagem , Corticosteroides/uso terapêutico , Idoso , Doenças Ósseas/tratamento farmacológico , Quimiorradioterapia/métodos , Feminino , Humanos , Ílio/diagnóstico por imagem , Imunossupressores/uso terapêutico , Imagem por Ressonância Magnética , Metotrexato/uso terapêutico , Neoplasias Orofaríngeas/terapia , Neoplasias Orofaríngeas/virologia , Sarcoidose/tratamento farmacológico , Doenças da Coluna Vertebral/diagnóstico por imagem
4.
Bone Joint J ; 103-B(1): 157-163, 2021 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-33380205

RESUMO

AIMS: This study, using a surgeon-maintained database, aimed to explore the risk factors for surgery-related complications in patients undergoing primary cervical spine surgery for degenerative diseases. METHODS: We studied 5,015 patients with degenerative cervical diseases who underwent primary cervical spine surgery from 2012 to 2018. We investigated the effects of diseases, surgical procedures, and patient demographics on surgery-related complications. As subcategories, the presence of cervical kyphosis ≥ 10°, the presence of ossification of the posterior longitudinal ligament (OPLL) with a canal-occupying ratio ≥ 50%, and foraminotomy were selected. The surgery-related complications examined were postoperative upper limb palsy (ULP) with a manual muscle test (MMT) grade of 0 to 2 or a reduction of two grade or more in the MMT, neurological deficit except ULP, dural tear, dural leakage, surgical-site infection (SSI), and postoperative haematoma. Multivariate logistic regression analysis was performed. RESULTS: The significant risk factors (p < 0.050) for ULP were OPLL (odds ratio (OR) 1.88, 95% confidence interval (CI) 1.29 to 2.75), foraminotomy (OR 5.38, 95% CI 3.28 to 8.82), old age (per ten years, OR 1.18, 95% CI 1.03 to 1.36), anterior spinal fusion (OR 2.85, 95% CI 1.53 to 5.34), and the number of operated levels (OR 1.25, 95% CI 1.11 to 1.40). OPLL was also a risk factor for neurological deficit except ULP (OR 5.84, 95% CI 2.80 to 12.8), dural tear (OR 1.94, 95% CI 1.11 to 3.39), and dural leakage (OR 3.15, 95% CI 1.48 to 6.68). Among OPLL patients, dural tear and dural leakage were frequently observed in those with a canal-occupying ratio ≥ 50%. Cervical rheumatoid arthritis (RA) was a risk factor for SSI (OR 10.1, 95% CI 2.66 to 38.4). CONCLUSION: The high risk of ULP, neurological deficit except ULP, dural tear, and dural leak should be acknowledged by clinicians and OPLL patients, especially in those patients with a canal-occupying ratio ≥ 50%. Foraminotomy and RA were dominant risk factors for ULP and SSI, respectively. An awareness of these risks may help surgeons to avoid surgery-related complications in these conditions. Cite this article: Bone Joint J 2021;103-B(1):157-163.


Assuntos
Vértebras Cervicais/cirurgia , Complicações Pós-Operatórias/epidemiologia , Doenças da Coluna Vertebral/cirurgia , Adulto , Idoso , Idoso de 80 Anos ou mais , Vértebras Cervicais/diagnóstico por imagem , Bases de Dados Factuais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Fatores de Risco , Doenças da Coluna Vertebral/diagnóstico por imagem
5.
Tech Vasc Interv Radiol ; 23(4): 100700, 2020 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-33308584

RESUMO

Degenerative lumbar spine disorder (DLSD) is a ubiquitously occurring event that may be induced or accelerated by multiple factors such as from overuse, trauma, genetic predisposition, nutrition deficiency, and others. While our understanding of this degenerative disorder is limited, in terms of prevention, the symptoms from DLSD can be significant and may lead to the reduction in the patient's quality of life and loss of work time. In the Global Burden of Disease Study, low back pain was ranked the highest of 291 different conditions, due to the number of years lost to disability, amounting to 83 million disability-adjusted life years lost in 2010. DLSD contains conditions involving disc degeneration, lumbar spinal stenosis, and spondylolisthesis, including symptoms ranging from low back pain to lower extremity radicular pain and weakness. In this issue, we will be discussing treatments for patients suffering with chronic low back pain from endplate disruption, utilizing basivertebral nerve radiofrequency ablation, also known as the INTRACEPT procedure. This issue will also cover minimally invasive lumbar decompression from lumbar spinal stenosis, due to contributory ligamentum flavum hypertrophy, utilizing the percutaneous image-guided lumbar decompression technique known as the MILD procedure.


Assuntos
Dor Crônica/cirurgia , Descompressão Cirúrgica , Dor Lombar/cirurgia , Vértebras Lombares/cirurgia , Manejo da Dor , Ablação por Radiofrequência , Radiografia Intervencionista , Doenças da Coluna Vertebral/cirurgia , Dor Crônica/diagnóstico , Dor Crônica/fisiopatologia , Descompressão Cirúrgica/efeitos adversos , Humanos , Dor Lombar/diagnóstico , Dor Lombar/fisiopatologia , Vértebras Lombares/diagnóstico por imagem , Vértebras Lombares/fisiopatologia , Manejo da Dor/efeitos adversos , Ablação por Radiofrequência/efeitos adversos , Radiografia Intervencionista/efeitos adversos , Doenças da Coluna Vertebral/diagnóstico por imagem , Doenças da Coluna Vertebral/fisiopatologia , Resultado do Tratamento
7.
BMC Infect Dis ; 20(1): 724, 2020 Oct 02.
Artigo em Inglês | MEDLINE | ID: mdl-33008310

RESUMO

BACKGROUND: Spinal neuroschistosomiasis (SN) is one of the most severe clinical presentations of schistosomiasis infection and an ectopic form of the disease caused by any species of Schistosoma. In Brazil, all cases of this clinical manifestation are related to Schistosoma mansoni, the only species present in the country. Although many cases have been reported in various endemic areas in Brazil, this is the first time in the literature that SN is described in two brothers. CASE PRESENTATION: Two cases of SN were accidentally diagnosed during an epidemiological survey in an urban area endemic for schistosomiasis transmission. Both patients complained of low back pain and muscle weakness in the lower limbs. Sphincter dysfunction and various degrees of paresthesia were also reported. The patients' disease was classified as hepato-intestinal stage schistosomiasis mansoni at the onset of the chronic form. A positive parasitological stool test for S. mansoni, clinical evidence of myeloradicular damage and exclusion of other causes of damage were the basic criteria for diagnosis. After treatment with praziquantel and corticosteroid, the patients presented an improvement in symptoms, although some complaints persisted. CONCLUSIONS: It is important to consider SN when patients come from areas endemic for transmission of schistosomiasis mansoni. Clinical physicians and neurologists should consider this diagnostic hypothesis, because recovery from neurological injuries is directly related to early treatment. As, described here in two brothers, a genetic predisposition may be related to neurological involvement. Primary care physicians should thus try to evaluate family members and close relatives in order to arrive at prompt schistosomiasis diagnosis in asymptomatic individuals and propose treatment in an attempt to avoid progression to SN.


Assuntos
Neuroesquistossomose/diagnóstico por imagem , Schistosoma mansoni , Esquistossomose mansoni/diagnóstico por imagem , Doenças da Coluna Vertebral/diagnóstico por imagem , Adulto , Animais , Brasil/epidemiologia , Progressão da Doença , Família , Humanos , Masculino , Debilidade Muscular , Neuroesquistossomose/fisiopatologia , Irmãos , Doenças da Coluna Vertebral/fisiopatologia
8.
Medicine (Baltimore) ; 99(43): e22443, 2020 Oct 23.
Artigo em Inglês | MEDLINE | ID: mdl-33120739

RESUMO

The objectives of this study were to describe the prevalence and characteristics of radiographic lesions of the hands, and calcifications of the spine on computer tomography scans (CT-scans), and to investigate the relationships between radiographic and CT-scan abnormalities and clinical features in a population of patients with systemic sclerosis (SSc).Subjects underwent X-ray examination of the hands, and thoracic or thoraco-abdominal and pelvic CT scan or lumbar CT scan in the year. Structural lesions on hand X ray was scored and spinal calcifications were evaluated in the anterior, intracanal and posterior segments. Intra and inter-reliability was tested for radiography and CT- scan. Prognostic factors considered were interstitial pulmonary lesions on the CT scan, pulmonary arterial hypertension (PAH) and death.This study involved 77 SSc patients, 58 (75%) with limited cutaneous SSc (lcSSc) and 19 (25%) with diffuse SSc (dSSc). The prevalences of radiographic lesions of the hand were 28.6% for periarticular calcifications and 26% for calcinosis. On CT scan, 64 (83%) patients exhibited at least 1 calcification. Spine calcifications were depicted in 80.5%, 27.3%, and 35.1% at the anterior, intracanal and posterior segments respectively. Calcifications were mainly localized on thoracic spine. Inter reader reliabilities were good for hands and moderate for spine respectively. Spine calcifications and periarticular calcifications in the hands were associated (P = .012). Calcinosis in the hands was related to PAH (P = .02). Posterior calcification segment and foraminal calcifications were associated with interstitial lung disease (ILD) (P = .029) and death (P = .001).More than 80% of systemic sclerosis patients presented spine calcifications. A significant association between hands and spinal calcifications were confirmed and some localization in the posterior segment considered as a bad prognostic factor.


Assuntos
Calcinose/diagnóstico por imagem , Ossos da Mão/diagnóstico por imagem , Escleroderma Sistêmico/complicações , Doenças da Coluna Vertebral/diagnóstico por imagem , Coluna Vertebral/diagnóstico por imagem , Fatores Etários , Feminino , Humanos , Hipertensão Pulmonar/complicações , Doenças Pulmonares Intersticiais/complicações , Masculino , Pessoa de Meia-Idade , Prognóstico , Radiografia , Reprodutibilidade dos Testes , Estudos Retrospectivos , Escleroderma Sistêmico/mortalidade , Tomografia Computadorizada por Raios X
9.
Med. clín (Ed. impr.) ; 155(8): 335-339, oct. 2020. graf, tab
Artigo em Inglês | IBECS | ID: ibc-197036

RESUMO

INTRODUCTION/OBJECTIVES: To describe the clinical, radiological and microbiological characteristics of vertebral osteomyelitis patients, analysing the factors that played a role on their outcome. PATIENTS AND METHODS: Single-centre retrospective observational study including patients diagnosed with vertebral osteomyelitis, based on the combination of clinical presentation with either a definitive bacteriological diagnosis and/or imaging studies. RESULTS: 116 adult patients were included with a mean age of 62.75 (14.98) years. Males predominated (68.10%). Eighteen patients (15.51%) were immunosuppressed. The most frequent symptom was back pain (99.14%) followed by fever, which was detected in 45 patients (38.79%). Puncture-aspiration or biopsy was performed in 84 patients (72.10%) and its culture was positive in 48 samples (57.14%). Gram positive species predominated (73.86%) on cultures, followed by Gram negative (12.5%), mycobacteria (10.23%) and fungi (3.41%). No microorganism was identified in 28 patients (24.14%). On imaging, most of the patients (92.24%) had paravertebral or epidural abscess. 63 cases (54.31%) showed vertebral destruction and 39 (33.62%) cord compression. Twenty-two patients (18.97%) required further surgical procedures and 13 (11.21%) died. CONCLUSIONS: The average patient is middle aged (often male) with a history of subacute back pain, sometimes presenting fever and/or neurological damage on diagnosis. Acute phase reactants are frequently raised. Diabetes mellitus, endocarditis and immunosuppressed patients may have the worst chance of a good outcome, therefore these patients should be more carefully managed (always try to obtain an imaging-guided biopsy, correct antibiotic treatment, and a functional and clinical follow-up)


INTRODUCCIÓN/OBJETIVOS: Describir las características clínicas, radiológicas y microbiológicas de pacientes con osteomielitis vertebral en nuestro centro, analizando qué variables tuvieron influencia pronóstica. MATERIAL Y MÉTODOS: Se llevó a cabo un estudio observacional, unicéntrico y retrospectivo incluyendo pacientes adultos diagnosticados de osteomielitis vertebral sobre la base de la combinación de las manifestaciones clínicas con un diagnóstico microbiológico y/o radiológico compatible. RESULTADOS: Se incluyeron un total de 116 pacientes con una media de edad de 62,75 (14,98) años, predominando el género masculino (68,10%). Dieciocho de ellos (15,51%) estaban inmunosuprimidos. El síntoma más frecuente fue el dolor lumbar (99,14%) seguido de la fiebre, detectada en 45 pacientes (38,79%). Se realizó punción-biopsia en 84 pacientes (72,10%) con positividad en el cultivo en 48 muestras (57,14%) donde predominó el crecimiento de Gram positivos (73,86%) seguido de Gram negativos (12,5%), micobacterias (10,23%) y hongos (3,41%). En 28 pacientes (24,14%) no se pudo identificar el agente causal. En el estudio de resonancia magnética, la mayoría de los pacientes tenían abscesificación paravertebral o epidural (92,24%); 63 pacientes (54,31%) tenían hallazgos compatibles con destrucción vertebral y 39 (33,62%), compresión medular. En 22 casos (18,97%) se requirió un abordaje quirúrgico posterior. Trece pacientes (11,21%) fallecieron a causa de la infección o de sus complicaciones. CONCLUSIONES: El paciente promedio es un varón de edad media, con historia de dolor lumbar de curso subagudo e insidioso, con presencia inconstante de fiebre, presente en menos de la mitad de los casos. Con relativa frecuencia se ha detectado una exploración neurológica patológica en la presentación clínica. Los reactantes de fase aguda estaban elevados en la mayoría de los pacientes. Los casos en los que exista comorbilidad (sobre todo diabetes mellitus o inmunosupresión), así como la concomitancia con endocarditis, debe de implicar un manejo más cauto


Assuntos
Humanos , Masculino , Adolescente , Adulto Jovem , Adulto , Pessoa de Meia-Idade , Idoso , Idoso de 80 Anos ou mais , Osteomielite/diagnóstico por imagem , Osteomielite/microbiologia , Dor Lombar/etiologia , Osteomielite/patologia , Doenças da Coluna Vertebral/diagnóstico por imagem , Doenças da Coluna Vertebral/patologia , Estudos Retrospectivos , Punção Espinal/métodos , Infecções/complicações , Tomografia Computadorizada com Tomografia por Emissão de Pósitrons
10.
AJR Am J Roentgenol ; 215(3): 534-544, 2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-32755228

RESUMO

OBJECTIVE. The purpose of this article is to provide a review of the imaging of spine fixation hardware. CONCLUSION. As the prevalence of neck and back pain continues to increase, so does the number of surgical procedures used to treat such pain. Accordingly, new techniques and hardware designs are used, and the hardware will be seen on postoperative imaging. It is critical that radiologists understand the appropriate imaging modalities for the assessment of spine fixation hardware, recognize the normal imaging appearance of such hardware, and be able to detect hardware-related complications.


Assuntos
Dor nas Costas/diagnóstico por imagem , Dor nas Costas/cirurgia , Cervicalgia/diagnóstico por imagem , Cervicalgia/cirurgia , Dispositivos de Fixação Ortopédica , Doenças da Coluna Vertebral/diagnóstico por imagem , Doenças da Coluna Vertebral/cirurgia , Humanos
11.
Emerg Radiol ; 27(6): 731-735, 2020 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-32696116

RESUMO

PURPOSE: To evaluate the prevalence and features of lung apical findings on neck and cervical spine CTs performed in patients with COVID-19. METHODS: This was a retrospective, IRB-approved study performed at a large academic hospital in the USA. Between March 3, 2020, and May 6, 2020, 641 patients with COVID-19 infection diagnosed by RT-PCR received medical care at our institution. A small cohort of patients with COVID-19 infection underwent neck or cervical spine CT imaging for indications including stroke, trauma, and neck pain. The lung apices included in the field of view on these CT scans were reviewed for the presence of findings suspicious for COVID-19 pneumonia, including ground-glass opacities, consolidation, or crazy-paving pattern. The type and frequency of these findings were recorded and correlated with clinical information including age, gender, and symptoms. RESULTS: Thirty-four patients had neck or spine CTs performed before or concurrently with a chest CT. Of this group, 17 (50%) had unknown COVID-19 status at the time of neck or spine imaging and 10 (59%) of their CT studies had findings in the lung apices consistent with COVID-19 pneumonia. CONCLUSION: Lung apical findings on cervical spine or neck CTs consistent with COVID-19 infection are common and may be encountered on neuroimaging performed for non-respiratory indications. For these patients, the emergency radiologist may be the first physician to suspect underlying COVID-19 infection.


Assuntos
Infecções por Coronavirus/diagnóstico por imagem , Pneumonia Viral/diagnóstico por imagem , Tomografia Computadorizada por Raios X/métodos , Adulto , Idoso , Idoso de 80 Anos ou mais , Betacoronavirus , Boston , Angiografia por Tomografia Computadorizada , Meios de Contraste , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Lesões do Pescoço/diagnóstico por imagem , Cervicalgia/diagnóstico por imagem , Pandemias , Estudos Retrospectivos , Doenças da Coluna Vertebral/diagnóstico por imagem , Acidente Vascular Cerebral/diagnóstico por imagem
13.
Rev. esp. cir. ortop. traumatol. (Ed. impr.) ; 64(3): 177-184, mayo-jun. 2020. tab, graf
Artigo em Espanhol | IBECS | ID: ibc-196338

RESUMO

ANTECEDENTES Y OBJETIVO: Hoy por hoy el dolor lumbar sigue constituyendo una entidad patológica de alta incidencia en la población occidental. No hemos encontrado en la literatura datos que evalúen si con una exploración física correcta y una valoración de las radiologías simples de la columna vertebral se puede diagnosticar a los pacientes con una alta probabilidad de ser candidatos a cirugía de columna lumbar, disminuyendo así la carga asistencial y el consumo de recursos que esta patología supone. El objetivo del estudio es desarrollar una calculadora de fácil manejo que permita derivar a las consultas de Cirugía del Raquis solo a los pacientes con elevada probabilidad de recibir tratamiento quirúrgico. MATERIALES Y MÉTODOS: Estudio observacional y retrospectivo que incluyó a todos los pacientes mayores de edad del Área Sanitaria de Talavera de la Reina (Toledo) con diagnóstico clínico y/o radiológico de patología lumbar degenerativa derivados, por otros especialistas durante un año natural, a la unidad de Cirugía de Columna para valorar la indicación de cirugía tras tratamiento conservador infructuoso. Todos los pacientes fueron evaluados bajo un mismo protocolo con un seguimiento de 6años, al final de los cuales se controló quiénes fueron intervenidos sobre la columna lumbar. RESULTADOS: Se estudiaron un total de 201 pacientes, y al final de los 6años de seguimiento se intervinieron un total de 77 pacientes. Se encontró una concordancia del 70% entre la indicación de tratamiento quirúrgico y el tratamiento recibido al final del seguimiento, por lo que se realizó una regresión logística tratando de hacer una predicción de los pacientes que se pueden derivar a las unidades de Cirugía del Raquis, y a partir de ahí se generó una calculadora, que incluía la variable radiología simple como ítem imprescindible, y que mostró como estadísticamente significativo (p < 0,05): la edad, los signos de no organicidad de Waddell, el signo de Lassegue y la valoración de la radiología simple. A partir de la obtención de esta herramienta, se realizó el cálculo de probabilidad de ser intervenido a todos los pacientes a los que se propuso tratamiento quirúrgico, obteniéndose como punto de corte, al emplear la calculadora, unos resultados por encima del 62%. CONCLUSIONES: El empleo de la calculadora diseñada predice la posibilidad de ser candidato a tratamiento quirúrgico con un 70% de fiabilidad, así que los pacientes con un resultado en la calculadora superior al 62% deben ser derivados a consultas de Cirugía del Raquis para valoración por un especialista


BACKGROUND AND AIM: Low-back pain remains a common pathological entity in the Western population. We have found no data in the literature that assess whether, with correct physical examination and evaluation of simple x-rays of the spine, it is possible to diagnose patients who are highly likely to be candidates for lumbar spine surgery and thus reduce the care burden and resource consumption that this disorder entails. The aim of the study was to develop a user-friendly calculator that allows only patients who are strong candidates for surgical treatment to be referred for spinal surgery consultation. MATERIAL AND METHOD: An observational and retrospective study that included all adult patients from the healthcare area of Talavera de la Reina (Toledo, Spain) with a clinical and/or radiological diagnosis of degenerative lumbar spine disease referred by other specialists over one calendar year to the spinal surgery unit to assess whether surgery was indicated after unsuccessful conservative treatment. All the patients were assessed under the same protocol with a follow-up of 6years, at the end of which we performed a check of those who had undergone lumber spine surgery. RESULTS: A total of 201 patients were studied and at the end of the 6-year follow-up, a total of 77 patients had been operated. Concordance of 70% was found between the indication for surgical treatment and the treatment received at the end of the follow-up. Therefore a logistic regression was performed in an attempt to predict the patients that could be referred to the spinal surgery units and from that a calculator was generated, which included the plain x-ray variable as an essential item, and which showed as statistically significant (P<.05): age, Waddell's non-organic signs, Lasegue's sign and plain x-ray assessment. Once this tool had been obtained, the likelihood of undergoing surgery was calculated for all patients who were proposed surgical treatment, obtaining results above 62% as the cut-off point when using the calculator. CONCLUSIONS: The use of the calculator predicts the possibility of being a candidate for surgical treatment with 70% reliability. Therefore, patients with a result in the calculator of above 62% should be referred for spinal surgery consultation for assessment by a specialist


Assuntos
Humanos , Masculino , Feminino , Pessoa de Meia-Idade , Equipamentos e Provisões , Seleção de Pacientes , Doenças da Coluna Vertebral/cirurgia , Dor Lombar/cirurgia , Doenças da Coluna Vertebral/diagnóstico por imagem , Estudos Retrospectivos , Encaminhamento e Consulta , Radiografia , Análise de Regressão
14.
Stroke ; 51(6): 1750-1757, 2020 06.
Artigo em Inglês | MEDLINE | ID: mdl-32397933

RESUMO

Background and Purpose- Distribution patterns of iron deposition in deep gray matter and their association with clinical characteristics in cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy (CADASIL) remain unclear. We aimed to evaluate iron deposition in deep gray matter in patients with CADASIL using 7.0-T susceptibility-weighted imaging and mapping and to explore its correlations with clinical characteristics. Methods- Thirty-nine patients with CADASIL, confirmed via genetic analysis or skin biopsy, were enrolled. We examined patients using the Mini-Mental State Examination, modified Rankin Scale, and brain 7.0-T magnetic resonance imaging and obtained magnetic resonance imaging lesion loads, small vessel disease scores, and susceptibility mapping. The following regions of interest were selected: caudate nucleus, putamen, globus pallidus, thalamus, substantia nigra, and red nucleus. The quantitative differences in the susceptibility of deep gray matter between the CADASIL and control groups and the correlations between deep gray matter susceptibility and clinical characteristics were identified. Results- Compared with the control group, the CADASIL group showed significantly increased susceptibility of caudate nucleus, putamen, thalamus, substantia nigra, and red nucleus. The susceptibility of deep gray matter in basal ganglia region, including caudate nucleus, putamen, and thalamus, significantly increased with age or disease duration and positively correlated with small vessel disease scores in patients with CADASIL. Moreover, the susceptibility of thalamus positively correlated with modified Rankin Scale scores after adjusting for age and disease duration and that of putamen negatively correlated with Mini-Mental State Examination scores in patients with CADASIL after adjusting for age. Conclusions- Our findings indicate an association between abnormal iron deposition in deep gray matter of patients with CADASIL and their clinical characteristics. Therefore, excess iron deposition in deep gray matter, as indicated by 7.0-T susceptibility-weighted imaging and mapping, might not only be a novel magnetic resonance imaging feature but also a potential biomarker for CADASIL severity.


Assuntos
Alopecia/diagnóstico por imagem , Alopecia/metabolismo , Infarto Cerebral/diagnóstico por imagem , Infarto Cerebral/metabolismo , Substância Cinzenta , Ferro/metabolismo , Leucoencefalopatias/diagnóstico por imagem , Leucoencefalopatias/metabolismo , Imagem por Ressonância Magnética , Doenças da Coluna Vertebral/diagnóstico por imagem , Doenças da Coluna Vertebral/metabolismo , Adulto , Alopecia/genética , Infarto Cerebral/genética , Feminino , Substância Cinzenta/diagnóstico por imagem , Substância Cinzenta/metabolismo , Humanos , Leucoencefalopatias/genética , Masculino , Pessoa de Meia-Idade , Doenças da Coluna Vertebral/genética
15.
Radiology ; 296(3): E173-E179, 2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-32391741

RESUMO

Background Atypical manifestations of coronavirus disease 2019 (COVID-19) are being encountered as the pandemic unfolds, leading to non-chest CT scans that may uncover unsuspected pulmonary disease. Purpose To investigate patients with primary nonrespiratory symptoms who underwent CT of the abdomen or pelvis or CT of the cervical spine or neck with unsuspected findings highly suspicious for pulmonary COVID-19. Materials and Methods This retrospective study from March 10, 2020, to April 6, 2020, involved three institutions, two in a region considered a hot spot (area of high prevalence) for COVID-19. Patients without known COVID-19 were included who presented to the emergency department (ED) with primary nonrespiratory (gastrointestinal or neurologic) symptoms, had lung parenchymal findings suspicious for COVID-19 at non-chest CT but not concurrent chest CT, and underwent COVID-19 testing in the ED. Group 1 patients had reverse transcription polymerase chain reaction (RT-PCR) results obtained before CT scan reading (COVID-19 suspected on presentation); group 2 had RT-PCR results obtained after CT scans were read (COVID-19 not suspected). Presentation and imaging findings were compared, and outcomes were evaluated. Descriptive statistics and Fisher exact tests were used for analysis. Results Group 1 comprised 62 patients (31 men, 31 women; mean age, 67 years ±17 [standard deviation]), and group 2 comprised 57 patients (28 men, 29 women; mean age, 63 years ± 16). Cough and fever were more common in group 1 (37 of 62 [60%] and 29 of 62 [47%], respectively) than in group 2 (nine of 57 [16%] and 12 of 57 [21%], respectively), with no significant difference in the remaining symptoms. There were 101 CT scans of the abdomen or pelvis and 18 CT scans of the cervical spine or neck. In group 1, non-chest CT findings provided the initial evidence of COVID-19-related pneumonia in 32 of 62 (52%) patients. In group 2, the evidence was found in 44 of 57 (77%) patients. Overall, the most common CT findings were ground-glass opacity (114 of 119, 96%) and consolidation (47 of 119, 40%). Major interventions (vasopressor medication or intubation) were required for 29 of 119 (24%) patients, and 27 of 119 (23%) died. Patients who underwent CT of the cervical spine or neck had worse outcomes than those who underwent abdominal or pelvic CT (P = .01). Conclusion In a substantial percentage of patients with primary nonrespiratory symptoms who underwent non-chest CT, CT provided evidence of coronavirus disease 2019-related pneumonia. © RSNA, 2020.


Assuntos
Infecções por Coronavirus , Pulmão , Pandemias , Pneumonia Viral , Tomografia Computadorizada por Raios X/estatística & dados numéricos , Idoso , Idoso de 80 Anos ou mais , Betacoronavirus , Infecções por Coronavirus/diagnóstico por imagem , Infecções por Coronavirus/patologia , Infecções por Coronavirus/terapia , Serviço Hospitalar de Emergência , Feminino , Gastroenteropatias/diagnóstico por imagem , Humanos , Achados Incidentais , Pulmão/diagnóstico por imagem , Pulmão/patologia , Masculino , Pessoa de Meia-Idade , Pneumonia Viral/diagnóstico por imagem , Pneumonia Viral/patologia , Pneumonia Viral/terapia , Radiografia Abdominal/estatística & dados numéricos , Estudos Retrospectivos , Doenças da Coluna Vertebral/diagnóstico por imagem , Coluna Vertebral/diagnóstico por imagem
17.
World Neurosurg ; 139: 163-168, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-32305612

RESUMO

BACKGROUND: Aneurysmal bone cysts (ABCs) comprise 1%-2% of all bone tumors. ABCs involving the upper cervical spine in pediatric patients complicate intervention because of an immature skeleton and nearby neurovascular elements. Treatment often consists of surgical intervention with preoperative embolization to mitigate blood loss. During selective arterial embolization, it is important to be aware of extracranial-intracranial anastomoses from tumor feeding vessels. We describe a C2 vertebrae ABC that had multiple tumor arteries anastomosing with bilateral vertebral arteries. CASE DESCRIPTION: A 3-year-old healthy girl presented with 1 month of progressive neck pain and palpable posterior neck mass. Imaging was most consistent with an ABC of the C2 vertebra. Preoperative embolization was planned. Angiography demonstrated tumor arterial supply anastomosing with the left and right vertebral artery stemming from the ascending and deep cervical artery branches. Tumor embolization was therefore carried out using coils and larger embolization particles to decrease ischemic stroke risk. Follow-up angiography showed successful tumor embolization with no vertebrobasilar complications. Surgical excision was uncomplicated and the patient's cervical spine has remained stable without fusion. CONCLUSIONS: Preoperative embolization for ABC resection is common, but thorough angiography must be done to rule out dangerous extracranial-intracranial anastomoses. This case demonstrated 2 key anastomoses with the vertebral artery that if not recognized, could lead to disastrous consequences. Comprehensive angiographic evaluation is necessary because previous reports have described ischemic complications from embolization because of unrecognized vertebrobasilar anastomoses. If any angiographic evidence is seen, then larger particle size, coil embolization, or abandoning the case should be considered.


Assuntos
Vértebra Cervical Áxis , Cistos Ósseos Aneurismáticos/irrigação sanguínea , Embolização Terapêutica/métodos , Procedimentos Neurocirúrgicos/métodos , Doenças da Coluna Vertebral/terapia , Artéria Vertebral/diagnóstico por imagem , Cistos Ósseos Aneurismáticos/diagnóstico por imagem , Cistos Ósseos Aneurismáticos/terapia , Angiografia Cerebral , Vértebras Cervicais , Pré-Escolar , Feminino , Humanos , Imageamento Tridimensional , Imagem por Ressonância Magnética , Doenças da Coluna Vertebral/diagnóstico por imagem
18.
Neurosurgery ; 86(6): E544-E550, 2020 06 01.
Artigo em Inglês | MEDLINE | ID: mdl-32315427

RESUMO

BACKGROUND: Posterior cervical fusion (PCF) is performed to treat cervical myelopathy, radiculopathy, and/or deformity. Constructs ending at the cervicothoracic junction (CTJ) may lead to higher rates of adjacent segment disease, and much debate exists regarding crossing the CTJ due to paucity of data in the literature. OBJECTIVE: To determine whether extension of PCF constructs across the CTJ decreases incidence of adjacent segment disease and need for revision surgery. METHODS: A single-center retrospective case series of patients undergoing multilevel PCFs since 2011 with at least 6-mo follow-up was conducted. Outcomes were analyzed and compared based on caudal extent of instrumentation via multivariate regression. RESULTS: A total of 149 patients underwent PCF, with a mean follow-up of 18.9 mo. A total of 15 (10.1%) revisions were performed, 7 (4.7%) of which were related to the construct. Five (8.3%) revisions were performed for constructs ending at C6, 1 (5.3%) at C7, 1 (2.6%) at T1, and none (0%) at T2 (P = .035). Mean procedure duration was 215 min at C6, 214 min at C7, 239 min at T1, and 343 min at T2 (P = .001). Mean estimated blood loss was 224 mL at C6, 178 mL at C7, 308 mL at T1, and 575 mL at T2 (P = .001). There was no difference in length of stay, disposition, surgical site infection, or radiographic parameters. CONCLUSION: Extension of PCFs across the CTJ leads to lower early revision rates, but also to increased procedure duration and estimated blood loss. As such, decisions regarding caudal extent of instrumentation must weigh the risk of pseudarthrosis against that of longer procedures with higher blood loss.


Assuntos
Vértebras Cervicais/cirurgia , Descompressão Cirúrgica/métodos , Doenças da Coluna Vertebral/cirurgia , Fusão Vertebral/métodos , Vértebras Torácicas/cirurgia , Adulto , Idoso , Vértebras Cervicais/diagnóstico por imagem , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Doenças da Coluna Vertebral/diagnóstico por imagem , Vértebras Torácicas/diagnóstico por imagem
19.
Radiology ; 295(2): 390-396, 2020 05.
Artigo em Inglês | MEDLINE | ID: mdl-32125257

RESUMO

Background Spinal digital subtraction angiography (DSA) exposes patients and operators to substantial amounts of radiation. Antiscatter grid (ASG) removal is used to decrease radiation exposure but may reduce image quality. Purpose To determine whether ASG removal during spinal DSA in adults reduces radiation dose while maintaining diagnostic image quality and whether dose reduction is related to body mass index (BMI). Materials and Methods This Health Insurance Portability and Accountability Act-compliant prospective study included adults undergoing spinal DSA between January and December 2016. Each procedure included an additional angiographic acquisition performed twice, once with and once without ASG, either documenting the artery of Adamkiewicz (no pathology group) or the condition leading to the procedure (pathology group). Dose differences between study acquisitions and the influence of BMI were evaluated via paired t test. Two neurointerventionalists blinded to acquisition protocols were asked to independently evaluate a sample of 40 study acquisitions (20 with ASG, 20 without ASG) from 20 randomly selected participants to (a) rate image quality, (b) categorize findings, and (c) determine whether images had been obtained with or without ASG. Percentage agreement on image quality, findings categorization, and ability to correctly identify the acquisition protocol was calculated for both readers. Results Fifty-three participants (mean age ± standard deviation, 51 years ± 15.2; 32 men) were evaluated. ASG removal reduced the mean dose per acquisition by approximately 33% (mean dose-area product and air kerma decreased from 202 to 135.6 µGy/m2 and from 35.3 to 24 mGy, respectively; P < .001) independently of BMI (P = .3). Both readers evaluated all images (40 of 40) as being of diagnostic quality and correctly categorized findings in 19 of 20 (95%) cases. Overall percentage agreement for correct protocol identification was 60% (12 of 20) for grid-in and 45% (nine of 20) for grid-out images. Conclusion Antiscatter grid removal during spinal digital subtraction angiography decreased participants' radiation exposure while preserving diagnostic image quality. © RSNA, 2020.


Assuntos
Angiografia Digital/instrumentação , Proteção Radiológica/métodos , Intensificação de Imagem Radiográfica/instrumentação , Doenças da Coluna Vertebral/diagnóstico por imagem , Adulto , Idoso , Idoso de 80 Anos ou mais , Artefatos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Doses de Radiação , Exposição à Radiação , Espalhamento de Radiação
20.
Radiol Med ; 125(7): 654-667, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32088810

RESUMO

The involvement of the cervical spine in musculoskeletal diseases can be crucial in terms of prognosis and morbidity. Early diagnosis of possible involvement of the craniocervical junction is essential to avoid the onset of neurological complications with poor prognosis. Among inflammatory diseases, rheumatoid arthritis affects the cervical spine frequently (in about 25% of patients). Atlantoaxial inflammatory changes are also detectable in spondyloarthritis. The involvement of the cervical spine in diffuse idiopathic skeletal hyperostosis is recognized as the cause of various clinical manifestations that may involve the pharynx, larynx and esophagus. The cervical spine may be specifically frequently implicated in crystal-associated arthropathies. Spinal cord infections are infrequent diseases that account for 3-4% of all spine infections. This pictorial review attempts to provide insights to interpret the radiological appearances of the craniocervical junction on conventional radiography, computed tomography and magnetic resonance imaging in relation to various musculoskeletal disease processes.


Assuntos
Articulação Atlantoccipital , Vértebras Cervicais , Doenças Musculoesqueléticas/complicações , Doenças da Medula Espinal/diagnóstico por imagem , Doenças da Medula Espinal/etiologia , Doenças da Coluna Vertebral/diagnóstico por imagem , Doenças da Coluna Vertebral/etiologia , Diagnóstico Precoce , Humanos
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