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1.
Spine (Phila Pa 1976) ; 44(11): 801-808, 2019 Jun 01.
Artigo em Inglês | MEDLINE | ID: mdl-30475334

RESUMO

STUDY DESIGN: This study retrospectively analyzes prospectively collected data. OBJECTIVE: Here, we aim to determine the influence of preoperative and 12-month modified Japanese Orthopedic Association (mJOA) on satisfaction and understand the change in mJOA severity classification after surgical management of degenerative cervical myelopathy (DCM). SUMMARY OF BACKGROUND DATA: DCM is a progressive degenerative spine disease resulting from cervical cord compression. The natural progression of DCM is variable; some patients experience periods of stability, while others rapidly deteriorate following disease onset. The mJOA is commonly used to grade and categorize myelopathy symptoms, but its association with postoperative satisfaction has not been previously explored. METHODS: The quality and outcomes database (QOD) was queried for patients undergoing elective surgery for DCM. Patients were divided into mild (≥14), moderate (9 to 13), or severe (<9) categories on the mJOA scores. A McNemar-Bowker test was used to assess whether a significant proportion of patients changed mJOA category between preoperative and 12 months postoperative. A multivariable proportional odds ordinal logistic regression model was fitted with 12-month satisfaction as the outcome of interest. RESULTS: We identified 1963 patients who underwent elective surgery for DCM and completed 12-months follow-ups. Comparing mJOA severity level preoperatively and at 12 months revealed that 55% remained in the same category, 37% improved, and 7% moved to a worse category. After adjusting for baseline and surgery-specific variables, the 12-month mJOA category had the highest impact on patient satisfaction (P < 0.001). CONCLUSION: Patient satisfaction is an indispensable tool for measuring quality of care after spine surgery. In this sample, 12-month mJOA category, regardless of preop mJOA, was significantly correlated with satisfaction. Given these findings, it is important to advise patients of the probability that surgery will change their mJOA severity classification and the changes required to achieve postoperative satisfaction. LEVEL OF EVIDENCE: 3.


Assuntos
Vértebras Cervicais/cirurgia , Procedimentos Cirúrgicos Eletivos/psicologia , Satisfação do Paciente , Sociedades Médicas/classificação , Doenças da Medula Espinal/classificação , Doenças da Medula Espinal/cirurgia , Idoso , Procedimentos Cirúrgicos Eletivos/tendências , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Estudos Retrospectivos , Sociedades Médicas/tendências , Compressão da Medula Espinal/classificação , Compressão da Medula Espinal/cirurgia , Fatores de Tempo , Resultado do Tratamento
2.
Neuroradiology ; 60(10): 1035-1041, 2018 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-30109382

RESUMO

PURPOSE: Neurointerventional approaches have improved myelopathy in patients with spinal vascular lesions by providing effective management, particularly when surgical approaches are difficult. However, there have been challenges in describing and comparing recovery status during the post-treatment period. METHODS: We evaluated 43 patients with venous congestive myelopathy (VCM) using Aminoff-Logue Disability Scale for gait (AL-G) and micturition (AL-M) scores. These results were compared with our new PSMS grading system that evaluates four categories (grades 0-3): pain, sensory symptoms, motor deficit, and sphincter change. Simple linear regression was used to identify the association or trend among the scales. We also calculated an overall area under the receiver operating characteristic curve to compare the predictive ability of the PSMS system with that of the previous grading system (AL-G and AL-M). RESULTS: Compared with other grading system, the PSMS system was more sensitively correlated with patient status and the results were easy to compare with previous clinical statuses during follow-up. The PSMS system also measured pain, which is commonly associated with spinal dural arteriovenous fistula and not precisely evaluated by other grading system. CONCLUSIONS: The new PSMS grading system for patients with VCM correlated well with the previously used systems and included pain evaluation. This new grading system is an easy tool for the evaluation and comparison of outcomes before and after endovascular treatment.


Assuntos
Doenças da Medula Espinal/classificação , Doenças da Medula Espinal/diagnóstico por imagem , Doenças Vasculares da Medula Espinal/diagnóstico por imagem , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Angiografia Digital , Malformações Vasculares do Sistema Nervoso Central/complicações , Avaliação da Deficiência , Progressão da Doença , Embolização Terapêutica/métodos , Feminino , Humanos , Imagem por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Medição da Dor , Índice de Gravidade de Doença , Doenças da Medula Espinal/fisiopatologia , Doenças Vasculares da Medula Espinal/classificação , Doenças Vasculares da Medula Espinal/fisiopatologia
3.
Neurology ; 90(1): e12-e21, 2018 01 02.
Artigo em Inglês | MEDLINE | ID: mdl-29196574

RESUMO

OBJECTIVE: To assess the predictive value of the initial clinical and paraclinical features in the differentiation of inflammatory myelopathies from other causes of myelopathy in patients with initial diagnosis of transverse myelitis (TM). METHODS: We analyzed the clinical presentation, spinal cord MRI, and CSF features in a cohort of 457 patients referred to a specialized myelopathy center with the presumptive diagnosis of TM. After evaluation, the myelopathies were classified as inflammatory, ischemic/stroke, arteriovenous malformations/fistulas, spondylotic, or other. A multivariable logistic regression model was used to determine characteristics associated with the final diagnosis and predictors that would improve classification accuracy. RESULTS: Out of 457 patients referred as TM, only 247 (54%) were confirmed as inflammatory; the remaining 46% were diagnosed as vascular (20%), spondylotic (8%), or other myelopathy (18%). Our predictive model identified the temporal profile of symptom presentation (hyperacute <6 hours, acute 6-48 hours, subacute 48 hours-21 days, chronic >21 days), initial motor examination, and MRI lesion distribution as characteristics that improve the correct classification rate of myelopathies from 67% to 87% (multinomial area under the curve increased from 0.32 to 0.67), compared to only considering CSF pleocytosis and MRI gadolinium enhancement. Of all predictors, the temporal profile of symptoms contributed the most to the increased discriminatory power. CONCLUSIONS: The temporal profile of symptoms serves as a clinical biomarker in the differential diagnosis of TM. The establishment of a definite diagnosis in TM requires a critical analysis of the MRI and CSF characteristics to rule out non-inflammatory causes of myelopathy. CLASSIFICATION OF EVIDENCE: This study provides Class IV evidence that for patients presenting with myelopathy, temporal profile of symptoms, initial motor examination, and MRI lesion distribution distinguish those with inflammatory myelopathies from those with other causes of myelopathy.


Assuntos
Doenças da Medula Espinal/diagnóstico , Adulto , Idoso , Biomarcadores/líquido cefalorraquidiano , Estudos de Coortes , Diagnóstico Diferencial , Progressão da Doença , Feminino , Humanos , Imagem por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Mielite Transversa/diagnóstico , Exame Neurológico , Estudos Retrospectivos , Medula Espinal/diagnóstico por imagem , Doenças da Medula Espinal/classificação , Fatores de Tempo
4.
Neurosurgery ; 81(1): 29-44, 2017 Jul 01.
Artigo em Inglês | MEDLINE | ID: mdl-28327939

RESUMO

BACKGROUND: The clinical significance of pathologies of the spinal dura is often unclear and their management controversial. OBJECTIVE: To classify spinal dural pathologies analogous to vascular aneurysms, present their symptoms and surgical results. METHODS: Among 1519 patients with spinal space-occupying lesions, 66 patients demonstrated dural pathologies. Neuroradiological and surgical features were reviewed and clinical data analyzed. RESULTS: Saccular dural diverticula (type I, n = 28) caused by defects of both dural layers, dissections between dural layers (type II, n = 29) due to defects of the inner layer, and dural ectasias (type III, n = 9) related to structural changes of the dura were distinguished. For all types, symptoms consisted of local pain followed by signs of radiculopathy or myelopathy, while one patient with dural ectasia presented a low-pressure syndrome and 10 patients with dural dissections additional spinal cord herniation. Type I and type II pathologies required occlusion of their dural defects via extradural (type I) or intradural (type II) approaches. For type III pathologies of the dural sac no surgery was recommended. Favorable results were obtained in all 14 patients with type I and 13 of 15 patients with type II pathologies undergoing surgery. CONCLUSION: The majority of dural pathologies involving root sleeves remain asymptomatic, while those of the dural sac commonly lead to pain and neurological symptoms. Type I and type II pathologies were treated with good long-term results occluding their dural defects, while ectasias of the dural sac (type III) were managed conservatively.


Assuntos
Cistos/classificação , Cistos/patologia , Dura-Máter/patologia , Doenças da Medula Espinal/classificação , Doenças da Medula Espinal/patologia , Adolescente , Adulto , Idoso , Criança , Estudos de Coortes , Cistos/cirurgia , Dilatação Patológica , Dura-Máter/diagnóstico por imagem , Dura-Máter/cirurgia , Feminino , Humanos , Imagem por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Radiculopatia/diagnóstico por imagem , Radiculopatia/etiologia , Radiculopatia/cirurgia , Doenças da Medula Espinal/cirurgia , Adulto Jovem
5.
IEEE J Biomed Health Inform ; 20(1): 91-9, 2016 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-25423659

RESUMO

Predicting the functional outcomes of spinal cord disorder patients after medical treatments, such as a surgical operation, has always been of great interest. Accurate posttreatment prediction is especially beneficial for clinicians, patients, care givers, and therapists. This paper introduces a prediction method for postoperative functional outcomes by a novel use of Gaussian process regression. The proposed method specifically considers the restricted value range of the target variables by modeling the Gaussian process based on a truncated Normal distribution, which significantly improves the prediction results. The prediction has been made in assistance with target tracking examinations using a highly portable and inexpensive handgrip device, which greatly contributes to the prediction performance. The proposed method has been validated through a dataset collected from a clinical cohort pilot involving 15 patients with cervical spinal cord disorder. The results show that the proposed method can accurately predict postoperative functional outcomes, Oswestry disability index and target tracking scores, based on the patient's preoperative information with a mean absolute error of 0.079 and 0.014 (out of 1.0), respectively.


Assuntos
Doenças da Medula Espinal/classificação , Doenças da Medula Espinal/fisiopatologia , Idoso , Algoritmos , Estudos de Coortes , Força da Mão/fisiologia , Humanos , Aplicações da Informática Médica , Pessoa de Meia-Idade , Distribuição Normal , Doenças da Medula Espinal/terapia , Resultado do Tratamento
6.
Spine (Phila Pa 1976) ; 40(21): 1653-9, 2015 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-26502097

RESUMO

STUDY DESIGN: Analysis of the prospective AOSpine CSM-International and North America datasets and survey of AO Spine International. OBJECTIVE: This study aims to define the minimum clinically important difference (MCID) of the modified Japanese Orthopaedic Association (mJOA) in patients with degenerative cervical myelopathy (DCM). SUMMARY OF BACKGROUND DATA: The mJOA is the most frequently used clinician-administered tool to assess functional status in patients with DCM. By defining its MCID, clinicians can better evaluate treatment outcomes for this condition. METHODS: Three methods were used to determine the MCID of the mJOA: (1) distribution-based, (2) anchor-based and receiver operating characteristic (ROC) analysis, and (3) professional opinion. Distribution-based methods were used to estimate the MCID by computing the half standard deviation and standard error of measurement. Using anchor-based methods, mJOA at 12 months after surgery was compared between patients who were "slightly improved" on the Neck Disability Index (NDI) and those who were "unchanged." ROC analysis was performed to compute a discrete integer value for the MCID that yielded the smallest difference between sensitivity and specificity. We repeated anchor-based methods for patients with mild (mJOA: 15-17), moderate (mJOA: 12-14), and severe disease (mJOA <12). RESULTS: The half standard deviation of the baseline mJOA was 1.36 and the standard error of measurement was 1.21. The difference in mJOA between patients who "slightly improved" on the NDI and "unchanged" patients was 1.11. ROC analysis yielded a value of 2 for the MCID. The survey of 416 spine professionals confirmed these estimates: the mean response was 1.65 ±â€Š0.66. The MCID significantly varied depending on myelopathy severity: ROC analysis yielded a threshold of 1 for mild, 2 for moderate, and 3 for severe patients. CONCLUSION: The MCID of the mJOA is estimated to be between 1 and 2 points and varies with myelopathy severity. This knowledge will enable clinicians to identify meaningful functional improvements in DCM patients. LEVEL OF EVIDENCE: N/A.


Assuntos
Doenças da Medula Espinal/classificação , Doenças da Medula Espinal/epidemiologia , Idoso , Medula Cervical/fisiopatologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Curva ROC , Índice de Gravidade de Doença , Doenças da Medula Espinal/fisiopatologia
7.
Neurocirugia (Astur) ; 26(5): 234-40, 2015.
Artigo em Espanhol | MEDLINE | ID: mdl-25843209

RESUMO

The prevalence of arachnoid cysts in children is 1-3%. They are more frequent in boys. They can be located intracranially or in the spine. Intracranial cysts are classified as supratentorial, infratentorial, and supra-infratentorial (tentorial notch). Supratentorial are divided into middle cranial fossa, convexity, inter-hemisferic, sellar region, and intraventricular. Infratentorial are classified into supracerebellar, infracerebellar, hemispheric, clivus, and cerebellopontine angle. Finally spinal arachnoid cysts are classified taking into account whether they are extra- or intradural, and nerve root involvement.


Assuntos
Cistos Aracnóideos/classificação , Cistos Aracnóideos/epidemiologia , Encéfalo/patologia , Ângulo Cerebelopontino/patologia , Criança , Fossa Craniana Posterior/patologia , Humanos , Doenças da Medula Espinal/classificação , Doenças da Medula Espinal/epidemiologia
8.
J Magn Reson Imaging ; 41(6): 1682-8, 2015 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-25044870

RESUMO

PURPOSE: To investigate the use of a newly designed machine learning-based classifier in the automatic identification of myelopathic levels in cervical spondylotic myelopathy (CSM). MATERIALS AND METHODS: In all, 58 normal volunteers and 16 subjects with CSM were recruited for diffusion tensor imaging (DTI) acquisition. The eigenvalues were extracted as the selected features from DTI images. Three classifiers, naive Bayesian, support vector machine, and support tensor machine, and fractional anisotropy (FA) were employed to identify myelopathic levels. The results were compared with clinical level diagnosis results and accuracy, sensitivity, and specificity were calculated to evaluate the performance of the developed classifiers. RESULTS: The accuracy by support tensor machine was the highest (93.62%) among the three classifiers. The support tensor machine also showed excellent capacity to identify true positives (sensitivity: 84.62%) and true negatives (specificity: 97.06%). The accuracy by FA value was the lowest (76%) in all the methods. CONCLUSION: The classifiers-based method using eigenvalues had a better performance in identifying the levels of CSM than the diagnosis using FA values. The support tensor machine was the best among three classifiers.


Assuntos
Vértebras Cervicais , Imagem de Tensor de Difusão/métodos , Doenças da Medula Espinal/classificação , Espondilose/classificação , Adulto , Idoso , Idoso de 80 Anos ou mais , Anisotropia , Teorema de Bayes , Estudos de Casos e Controles , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Sensibilidade e Especificidade , Máquina de Vetores de Suporte
10.
Rev. neurol. (Ed. impr.) ; 57(supl.1): s129-s138, 6 sept., 2013. tab
Artigo em Espanhol | IBECS | ID: ibc-149014

RESUMO

El término ‘mielopatías agudas’ se refiere a una disfunción de la médula espinal y representa un grupo heterogéneo de trastornos con distintas etiologías y características clínicas (imaginológicas y de pronóstico). El objetivo de esta revisión es tratar las mielopatías agudas no traumáticas. La mielopatía aguda puede deberse a varias causas, como agentes infecciosos o procesos inflamatorios, compresión y lesiones vasculares, entre otros. La presentación clínica es a menudo dramática con tetraparesia o paraparesia, alteraciones sensitivas y disfunción de la vejiga o del intestino. La historia y el examen físico se utilizan para localizar la lesión o el nivel específico de la médula, que puede guiar la solicitud de la imagen. La primera prioridad es descartar una lesión compresiva. Si se sospecha una mielopatía, debe obtenerse tan pronto como sea posible una resonancia magnética medular con gadolinio. Si no hay ninguna lesión estructural, entonces la presencia o ausencia de inflamación de la médula espinal debe documentarse con una punción lumbar. La ausencia de pleocitosis daría lugar a la consideración de causas no inflamatorias como malformaciones arteriovenosas, embolia fibrocartilaginosa o posiblemente el inicio de una mielopatía inflamatoria. En presencia de un proceso inflamatorio (realce con gadolinio, pleocitosis o elevado índice de inmunoglobulina en el líquido cefalorraquídeo), se deberá determinar si hay una inflamación o una causa infecciosa. Se tienen que considerar hongos, bacterias, parásitos y virus, así como enfermedades autoinmunes e inflamatorias que involucran al sistema nervioso central (AU)


The term ‘acute myelopathies’ –referred to a spinal cord dysfunction– represent a heterogeneous group of disorders with distinct etiologies, clinical and radiologic features, and prognoses. The objective of this review is to discuss the non-traumatic acute myelopathies. Acute myelopathy can be due to several causes as infective agents or inflammatory processes, such as in acute myelitis, compressive lesions, vascular lesions, etc. The clinical presentation is often dramatic with tetraparesis or paraparesis, sensory disturbances and bladder and/or bowel dysfunction. History and physical examination are used to localize the lesion to the root or specific level of the cord, which can guide imaging. Different syndromes are recognized: complete transverse lesion, central grey matter syndrome, anterior horn syndrome, anterior spinal artery syndrome, etc). The first priority is to rule out a compressive lesion. If a myelopathy is suspected, a gadolinium-enhanced MRI of the spinal cord should be obtained as soon as possible. If there is no structural lesion such as epidural blood or a spinal mass, then the presence or absence of spinal cord inflammation should be documented with a lumbar puncture. The absence of pleocytosis would lead to consideration of non inflammatory causes of myelopathy such as arteriovenous malformations, fibrocartilaginous embolism, or possibly early inflammatory myelopathy. In the presence of an inflammatory process (defined by gadolinium enhancement, cerebrospinal fluid pleocytosis, or elevated cerebrospinal fluid immunoglobulin index), one should determine whether there is an inflammatory or an infectious cause. Different virus, bacterias, parasites and fungi have to be considered as autoimmune and inflammatory diseases that involve the central nervous system (AU)


Assuntos
Humanos , Criança , Adolescente , Doenças da Medula Espinal/complicações , Doenças da Medula Espinal/diagnóstico , Doenças da Medula Espinal/etiologia , Doenças da Medula Espinal/terapia , Doenças da Medula Espinal/classificação , Compressão da Medula Espinal/diagnóstico , Compressão da Medula Espinal/etiologia , Neoplasias da Medula Espinal/complicações , Neoplasias da Medula Espinal/diagnóstico , Medula Espinal/irrigação sanguínea , Doença Aguda , Diagnóstico Diferencial , Isquemia/diagnóstico , Isquemia/etiologia , Mielite/diagnóstico , Mielite/etiologia , Dor/etiologia , Neuroimagem , Doenças Desmielinizantes/diagnóstico , Transtornos das Sensações/etiologia , Quadriplegia/etiologia , Mielite Transversa/diagnóstico , Doenças Autoimunes do Sistema Nervoso/diagnóstico , Abscesso Epidural/diagnóstico , Transtornos Neurológicos da Marcha/etiologia
11.
Rev Neurol ; 57 Suppl 1: S129-38, 2013 Sep 06.
Artigo em Espanhol | MEDLINE | ID: mdl-23897140

RESUMO

The term 'acute myelopathies'--referred to a spinal cord dysfunction--represent a heterogeneous group of disorders with distinct etiologies, clinical and radiologic features, and prognoses. The objective of this review is to discuss the non-traumatic acute myelopathies. Acute myelopathy can be due to several causes as infective agents or inflammatory processes, such as in acute myelitis, compressive lesions, vascular lesions, etc. The clinical presentation is often dramatic with tetraparesis or paraparesis, sensory disturbances and bladder and/or bowel dysfunction. History and physical examination are used to localize the lesion to the root or specific level of the cord, which can guide imaging. Different syndromes are recognized: complete transverse lesion, central grey matter syndrome, anterior horn syndrome, anterior spinal artery syndrome, etc). The first priority is to rule out a compressive lesion. If a myelopathy is suspected, a gadolinium-enhanced MRI of the spinal cord should be obtained as soon as possible. If there is no structural lesion such as epidural blood or a spinal mass, then the presence or absence of spinal cord inflammation should be documented with a lumbar puncture. The absence of pleocytosis would lead to consideration of non inflammatory causes of myelopathy such as arteriovenous malformations, fibrocartilaginous embolism, or possibly early inflammatory myelopathy. In the presence of an inflammatory process (defined by gadolinium enhancement, cerebrospinal fluid pleocytosis, or elevated cerebrospinal fluid immunoglobulin index), one should determine whether there is an inflammatory or an infectious cause. Different virus, bacterias, parasites and fungi have to be considered as autoimmune and inflammatory diseases that involve the central nervous system.


Assuntos
Doenças da Medula Espinal/etiologia , Doença Aguda , Adolescente , Doenças Autoimunes do Sistema Nervoso/diagnóstico , Criança , Doenças Desmielinizantes/diagnóstico , Diagnóstico Diferencial , Abscesso Epidural/diagnóstico , Transtornos Neurológicos da Marcha/etiologia , Humanos , Isquemia/diagnóstico , Isquemia/etiologia , Mielite/diagnóstico , Mielite/etiologia , Mielite Transversa/diagnóstico , Neuroimagem , Dor/etiologia , Quadriplegia/etiologia , Transtornos das Sensações/etiologia , Medula Espinal/irrigação sanguínea , Compressão da Medula Espinal/diagnóstico , Compressão da Medula Espinal/etiologia , Doenças da Medula Espinal/classificação , Doenças da Medula Espinal/complicações , Doenças da Medula Espinal/diagnóstico , Doenças da Medula Espinal/terapia , Neoplasias da Medula Espinal/complicações , Neoplasias da Medula Espinal/diagnóstico
12.
Neurology ; 77(13): 1235-40, 2011 Sep 27.
Artigo em Inglês | MEDLINE | ID: mdl-21917768

RESUMO

OBJECTIVE: Spinal digital subtraction angiography (SpDSA) continues to be the imaging gold standard for the evaluation of spinal cord vascular disorders. The safety of this procedure has a poor historical reputation and there are few current reports on complication rates. We hypothesized that modern SpDSA can be performed with an acceptably low risk of iatrogenic complications. METHODS: In this retrospective series, we reviewed 302 consecutive spinal angiograms performed during a 10-year period at our institution for the frequency of intraprocedural and postprocedural neurologic, non-neurologic, and local complications. Indications for SpDSA, prior noninvasive imaging findings, and angiographic diagnoses for each case were assessed to evaluate the diagnostic contribution of the procedure. RESULTS: There were no intraprocedural or postprocedural neurologic complications in the studied cohort. Systemic complications occurred in 2 cases (0.7%), in the form of back spasms in one patient and pulmonary edema in the other. Both recovered promptly and were discharged at baseline status. Access-site complications included 3 groin hematomas (1.0%), all managed conservatively. MRI findings showed 51% sensitivity and 83% specificity for spinal vascular malformations. A total of 31% of patients with the preangiographic diagnosis of transverse myelitis were found to have a vascular malformation. CONCLUSION: SpDSA carries very low risks of neurologic and systemic complications, while offering a gold-standard level of diagnostic confidence for the evaluation of the normal and pathologic vasculature of the spinal cord.


Assuntos
Angiografia Digital/efeitos adversos , Doenças da Medula Espinal/diagnóstico , Medula Espinal/diagnóstico por imagem , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Angiografia Digital/estatística & dados numéricos , Malformações Vasculares do Sistema Nervoso Central/complicações , Malformações Vasculares do Sistema Nervoso Central/diagnóstico por imagem , Criança , Pré-Escolar , Feminino , Humanos , Lactente , Estudos Longitudinais , Imagem por Ressonância Magnética/métodos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Medula Espinal/patologia , Doenças da Medula Espinal/classificação , Artéria Vertebral/diagnóstico por imagem , Artéria Vertebral/patologia , Adulto Jovem
14.
Neurosurgery ; 69(1): 103-11; discussion 111, 2011 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-21368688

RESUMO

BACKGROUND: Considerable attention has focused on concerns of increased complications with recombinant human bone morphogenetic protein-2 (rhBMP-2) use for anterior cervical fusion, but few reports have assessed its use for posterior cervical fusions. OBJECTIVE: To assess the safety, efficacy, and dosing of rhBMP-2 as an adjunct for instrumented posterior cervical arthrodesis. METHODS: All patients treated by the senior author with posterior cervical or cervicothoracic instrumented fusion using rhBMP-2 from 2003 to 2008 with a minimum of 2 years of follow-up were included. Diagnosis, levels fused, rhBMP-2 dose, complications, and fusion were assessed. RESULTS: Fifty-three patients with a mean age of 55.7 years (range, 2-89 years) and an average follow-up of 40 months (range, 25-80 months) met inclusion criteria. Surgical indications included basilar invagination (n = 6), fracture (n = 6), atlantoaxial instability (n = 16), kyphosis/kyphoscoliosis (n = 22), osteomyelitis (n = 1), spondylolisthesis (n = 1), and cyst (n = 1). Fifteen patients had confirmed rheumatoid disease. The average rhBMP-2 dose was 1.8 mg per level, with a total of 282 levels treated (average, 5.3 levels; SD, 2.8 levels). Among 53 patients, only 2 complications (3.8%) were identified: a superficial wound infection and an adjacent-level degeneration. No cases of dysphagia or neck swelling requiring treatment were identified. At the last follow-up, all patients had achieved fusion. CONCLUSION: Despite many of the patients in the present series having complex pathology and/or rheumatoid arthritis, a 100% fusion rate was achieved. Collectively, these data suggest that use of rhBMP-2 as an adjunct for posterior cervical fusion is safe and effective at an average dose of 1.8 mg per level.


Assuntos
Proteína Morfogenética Óssea 2/uso terapêutico , Doenças da Medula Espinal/tratamento farmacológico , Doenças da Medula Espinal/cirurgia , Fusão Vertebral/métodos , Fator de Crescimento Transformador beta/uso terapêutico , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Vértebras Cervicais/efeitos dos fármacos , Vértebras Cervicais/cirurgia , Criança , Pré-Escolar , Feminino , Humanos , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Proteínas Recombinantes/uso terapêutico , Estudos Retrospectivos , Doenças da Medula Espinal/classificação , Tomografia Computadorizada por Raios X , Resultado do Tratamento , Adulto Jovem
18.
Salud(i)ciencia (Impresa) ; 17(4): 334-337, mar. 2010.
Artigo em Português | LILACS | ID: lil-583676

RESUMO

Mielopatias agudas são emergências neurológicas. Por serem pouco comuns, muitas vezes há dificuldade no diagnóstico e atraso no início do tratamento destes pacientes. Através de revisão de literatura, descrevemos as características das principais causas de mielopatias não compressivas: 1) mielopatias inflamatórias (doenças desmielinizantes, auto-imunes e para-infecciosas); 2) pós radiação tardia, 3) por alterações vasculares e 4) por deficiência de vitamina B12. Um algoritmo para auxílio na abordagem destes pacientes e posterior investigação etiológica é apresentado.


Assuntos
Compressão da Medula Espinal/classificação , Compressão da Medula Espinal/diagnóstico , Compressão da Medula Espinal/etiologia , Doenças da Medula Espinal/classificação , Doenças da Medula Espinal/diagnóstico , Doenças da Medula Espinal/terapia
19.
Salud(i)ciencia (Impresa) ; 17(4): 334-337, mar. 2010.
Artigo em Português | BINACIS | ID: bin-125304

RESUMO

Mielopatias agudas sÒo emergÛncias neurológicas. Por serem pouco comuns, muitas vezes há dificuldade no diagnóstico e atraso no início do tratamento destes pacientes. Através de revisÒo de literatura, descrevemos as características das principais causas de mielopatias nÒo compressivas: 1) mielopatias inflamatórias (doenþas desmielinizantes, auto-imunes e para-infecciosas); 2) pós radiaþÒo tardia, 3) por alteraþ§es vasculares e 4) por deficiÛncia de vitamina B12. Um algoritmo para auxílio na abordagem destes pacientes e posterior investigaþÒo etiológica é apresentado.(AU)


Assuntos
Doenças da Medula Espinal/diagnóstico , Doenças da Medula Espinal/terapia , Doenças da Medula Espinal/classificação , Compressão da Medula Espinal/classificação , Compressão da Medula Espinal/diagnóstico , Compressão da Medula Espinal/etiologia
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