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2.
Radiologe ; 61(3): 251-257, 2021 Mar.
Artigo em Alemão | MEDLINE | ID: mdl-33570678

RESUMO

BACKGROUND: Inflammatory spinal cord diseases are difficult to differentiate based on magnetic resonance (MR) morphological properties. However, correct diagnosis is crucial for treatment and outcome. OBJECTIVES: What MR characteristics allow correct classification? MATERIALS AND METHODS: A literature search for articles published in PubMed about various forms of transverse myelitis was performed. RESULTS: The length of the lesions, the level and location in the cross-section, and the enhancement pattern gives good clues for the correct diagnosis. The most important characteristics have been summarized in a table. CONCLUSIONS: In most cases, it is not possible to make a conclusive diagnosis, because many diseases overlap.


Assuntos
Mielite Transversa , Doenças da Medula Espinal , Diagnóstico Diferencial , Humanos , Imagem por Ressonância Magnética , Mielite Transversa/diagnóstico por imagem , Medula Espinal/diagnóstico por imagem , Doenças da Medula Espinal/diagnóstico por imagem
3.
Lakartidningen ; 1182021 02 05.
Artigo em Sueco | MEDLINE | ID: mdl-33567096

RESUMO

Spinal cord infarction (SCI) causes acute spinal cord dysfunction with high morbidity. Without an inciting event such as a surgical procedure, a definitive diagnosis may be challenging. Thus, patients with a spontaneous (i e, non-traumatic, non-surgical) SCI are often misdiagnosed and the radiological distinction between SCI and other conditions with similar symptoms is more difficult than in cerebral infarction. Compared to cerebral infarction, SCI is rare and only accounts for approximately 1.2% of all strokes. SCI is usually localized to the anterior spinal artery area, causing the anterior spinal artery syndrome. Misdiagnosis may lead to unnecessary and possibly deleterious treatments as well as missed secondary stroke prevention. In this review, a typical case, an overview of the disease and newly proposed diagnostic criteria are presented.


Assuntos
Ataque Isquêmico Transitório , Doenças da Medula Espinal , Isquemia do Cordão Espinal , Humanos , Infarto/diagnóstico por imagem , Doenças da Medula Espinal/diagnóstico por imagem , Isquemia do Cordão Espinal/diagnóstico , Isquemia do Cordão Espinal/etiologia
4.
Clin Nucl Med ; 46(3): 266-269, 2021 03 01.
Artigo em Inglês | MEDLINE | ID: mdl-33443950

RESUMO

ABSTRACT: A 54-year-old woman was referred because of dizziness with fatigue for 2 months. MRI of the head and spinal cord revealed multiple ring or homogeneous enhancing nodules in the brain and spinal cord, concerning for metastases. FDG PET/CT showed multiple hypermetabolic nodules in the brain and spinal cord corresponding to the gadolinium-enhanced nodules and diffuse FDG uptake in the bilateral lower lobes of the lungs. Chest high-resolution CT showed diffuse, bilateral miliary opacities, most predominant in the lower lobes. The imaging findings and results of cerebrospinal fluid analysis were consistent with disseminated central nervous system tuberculomas with miliary pulmonary tuberculosis.


Assuntos
Fluordesoxiglucose F18 , Tomografia Computadorizada com Tomografia por Emissão de Pósitrons , Doenças da Medula Espinal/diagnóstico por imagem , Tuberculoma/diagnóstico por imagem , Encéfalo/patologia , Feminino , Humanos , Pessoa de Meia-Idade , Doenças da Medula Espinal/patologia , Tuberculoma/patologia
5.
Am Fam Physician ; 102(12): 740-750, 2020 12 15.
Artigo em Inglês | MEDLINE | ID: mdl-33320508

RESUMO

Degenerative cervical myelopathy encompasses a collection of pathologic conditions that result in progressive spinal cord dysfunction secondary to cord compression. Patients are typically male (3: 1 male-to-female ratio), and the average age of presentation is 64 years. The exact incidence is unclear because of differences in terminology and because radiographic findings can be present in asymptomatic individuals. Common examination findings include neck pain or stiffness, a wide-based ataxic gait, ascending paresthesia in the upper or lower extremities, lower extremity weakness, decreased hand dexterity, hyperreflexia, clonus, Babinski sign, and bowel or bladder dysfunction in severe disease. Definitive diagnosis requires correlation of physical examination findings with imaging findings. Magnetic resonance imaging of the cervical spine with and without contrast media is the preferred imaging modality. Cervical spine computed tomography, computed tomography myelography, and plain radiography are helpful in certain situations. Treatment depends on the presence and severity of symptoms. Surgery is recommended for patients with moderate to severe symptoms or rapidly progressive disease. Conservative treatments with monitoring for progression may be considered in patients with mild to moderate disease. The evidence for the effectiveness of conservative treatments is scarce and of low quality, and outcomes can vary with individual patients. Primary care physicians play a vital role in recognizing the typical presentation of degenerative cervical myelopathy, coordinating treatment as indicated, and managing comorbidities.


Assuntos
Vértebras Cervicais/diagnóstico por imagem , Vértebras Cervicais/patologia , Medicina de Família e Comunidade/métodos , Compressão da Medula Espinal/diagnóstico , Doenças da Medula Espinal/diagnóstico , Espondilose/diagnóstico , Diagnóstico Diferencial , Feminino , Humanos , Imagem por Ressonância Magnética , Masculino , Cervicalgia/etiologia , Compressão da Medula Espinal/diagnóstico por imagem , Doenças da Medula Espinal/diagnóstico por imagem , Espondilose/diagnóstico por imagem
6.
No Shinkei Geka ; 48(11): 1013-1019, 2020 Nov.
Artigo em Japonês | MEDLINE | ID: mdl-33199658

RESUMO

OBJECTIVE: We aimed to investigate the characteristics and operative results of elderly patients with cervical spondylotic myelopathy(aged ≧80 years)treated using the posterior approach. METHODS: Between April 2010 and December 2018, 21 patients aged ≧80 years(older group:8 men and 13 women;age range, 80-90 years)who underwent laminoplasty were reviewed and compared with 23 patients aged <80 years(younger group;13 men and 10 women;age range, 42-79 years)who underwent laminoplasty. The following data were obtained from chart reviews:age;sex;cervical canal stenosis level;time to operation;symptoms(e.g., gait disturbance);comorbidities(hypertension, diabetes mellitus, cancer, heart disease, ischemic cerebrovascular disease, and lumbar canal stenosis);antithrombotic drug use;cardiac, pulmonary, and renal functions;operative time;volume of blood loss during the operation;postoperative delirium;and follow-up period. Neurological deficits before and after the surgery were assessed using the neurosurgical cervical spine scale(NCSS). Data were statistically analyzed, and p-values <0.05 were considered statistically significant. RESULTS: The operative time, symptoms(hypertension), renal function, and preoperative NCSS score were significantly different between the older and younger groups. Meanwhile, most variables showed no significant differences between the groups. Although the preoperative NCSS score was lower in the older group, there was no significant difference in the degree of improvement in the NCSS score after surgery. CONCLUSIONS: The findings of this study suggest that we should not hesitate to perform surgery for cervical spondylotic myelopathy in elderly patients with favorable cardiorespiratory function.


Assuntos
Laminoplastia , Doenças da Medula Espinal , Espondilose , Idoso , Idoso de 80 Anos ou mais , Vértebras Cervicais/diagnóstico por imagem , Vértebras Cervicais/cirurgia , Feminino , Humanos , Masculino , Estudos Retrospectivos , Doenças da Medula Espinal/diagnóstico por imagem , Doenças da Medula Espinal/cirurgia , Espondilose/complicações , Espondilose/diagnóstico por imagem , Espondilose/cirurgia , Resultado do Tratamento
7.
Spinal Cord Ser Cases ; 6(1): 92, 2020 09 30.
Artigo em Inglês | MEDLINE | ID: mdl-32999271

RESUMO

INTRODUCTION: We observed individuals affected by spinal cord dysfunction (SCD) after coronavirus disease 2019 (COVID-19). The aim of our report is to provide our initial experience with individuals experiencing SCD after COVID-19 in a referral center in Northern Italy, from February 21 to July 15, 2020. CASE PRESENTATION: We report on three men with SCD after COVID-19. Case 1, aged 69 years, experienced T10 AIS B paraplegia upon awakening due to spinal cord ischemia from T8 to conus medullaris, besides diffuse thromboses, 27 days after the onset of COVID-19 symptoms. Case 2, aged 56 years, reported progressive cervicalgia 29 days after COVID-19 onset associated with C3 AIS C tetraplegia. Magnetic resonance imaging (MRI) revealed a C4-C6 spinal epidural abscess (SEA) requiring a C3-C4 left hemilaminectomy. Case 3, aged 48 years, reported backache together with lower limb muscle weakness on day 16 after being diagnosed with COVID-19. Exam revealed T2 AIS A paraplegia and an MRI showed a T1-T7 SEA. He underwent a T3-T4 laminectomy. Prior to SCD, all three individuals suffered from respiratory failure due to COVID-19, required mechanical ventilation, had cardiovascular risk factors, experienced lymphopenia, and received tocilizumab (TCZ). DISCUSSION: To our knowledge, this is the first report of SCD after COVID-19. Based on our experience, we did not observe a direct viral infection, but there were two different etiologies. In Case 1, the individual developed spinal cord ischemia, whereas in Cases 2 and 3 SEAs were likely related to the use of TCZ used to treat COVID-19.


Assuntos
Betacoronavirus , Infecções por Coronavirus/diagnóstico por imagem , Pneumonia Viral/diagnóstico por imagem , Doenças da Medula Espinal/diagnóstico por imagem , Medula Espinal/diagnóstico por imagem , Idoso , Infecções por Coronavirus/complicações , Infecções por Coronavirus/cirurgia , Humanos , Laminectomia , Masculino , Pessoa de Meia-Idade , Pandemias , Pneumonia Viral/complicações , Pneumonia Viral/cirurgia , Medula Espinal/cirurgia , Doenças da Medula Espinal/etiologia , Doenças da Medula Espinal/cirurgia
8.
Rinsho Shinkeigaku ; 60(10): 699-705, 2020 Oct 24.
Artigo em Japonês | MEDLINE | ID: mdl-32893247

RESUMO

A 75-year-old woman developed low back pain, weakness of the lower extremities, and urinary retention. On day 7 after the onset of symptoms, she was brought to the emergency department of our hospital by an ambulance because of progressive weakness of both lower extremities. Spine MRI showed longitudinally extensive spinal cord lesion (LESCL) at the Th8-Th11 spinal cord level and flow voids around the lesions. Lumbar puncture revealed a normal opening pressure, yellowish appearance, pleocytosis with polymorphonuclear predominance, and decreased cerebrospinal fluid (CSF) glucose levels. Based on the rapidly progressing myelopathy, LESCL, and CSF findings, we initially diagnosed the patient with myelitis and administered acyclovir and high-dose intravenous immunoglobulin on day 7. Spine MRI with gadolinium-enhancement showed longitudinally extending flow voids of the thoracic cord, and digital subtraction arteriogram (DSA) revealed arteriovenous shunt on the dura with dilated and tortuous intradural veins. We finally diagnosed her with spinal dural arteriovenous fistula (SDAVF). Cases of SDAVF might be initially misdiagnosed as myelitis because of showing rapid progressive myelopathy, pleocytosis with polymorphonuclear predominance, and decreased CSF glucose levels. Lumbar puncture and steroid administration for the cases of SDAVF could aggravate the patient's neurological symptoms. Therefore, lumbar puncture and initiation of immunotherapy should be avoided until SDAVF is completely excluded in patients with suspected myelitis on spine MRI without gadolinium-enhancement, even if their neurological symptoms progress rapidly.


Assuntos
Malformações Vasculares do Sistema Nervoso Central/complicações , Malformações Vasculares do Sistema Nervoso Central/diagnóstico , Glucose/líquido cefalorraquidiano , Leucocitose/diagnóstico por imagem , Leucocitose/etiologia , Neutrófilos/patologia , Doenças da Medula Espinal/diagnóstico por imagem , Doenças da Medula Espinal/etiologia , Medula Espinal/diagnóstico por imagem , Angiografia Digital , Biomarcadores/líquido cefalorraquidiano , Malformações Vasculares do Sistema Nervoso Central/patologia , Malformações Vasculares do Sistema Nervoso Central/terapia , Progressão da Doença , Embolização Terapêutica/métodos , Feminino , Humanos , Imagem por Ressonância Magnética , Vértebras Torácicas , Resultado do Tratamento
9.
Medicine (Baltimore) ; 99(33): e20955, 2020 Aug 14.
Artigo em Inglês | MEDLINE | ID: mdl-32871974

RESUMO

We conducted a retrospective study to compare the clinical and radiological results of anterior cervical discectomy and fusion (ACDF) and posterior laminoplasty for two-level localized ossification of the posterior longitudinal ligament (OPLL).ACDF and posterior laminoplasty are performed for localized OPLL at the disc and vertebral body levels, respectively.Eighty six patients with two-level localized OPLL who underwent surgery from January 2011 to December 2016 were retrospectively investigated (41, ACDF group; 45, laminoplasty group). Clinical outcomes were reviewed, and radiologic results such as occupying ratio (OR), space available in the spinal cord, cranial and caudal OPLL-to-disc distance (ODD)/posterior body height (PBH) ratios, segmental angle, C2-C7 Cobb angle, T1 slope, C2-C7 sagittal vertical axis (SVA), and range of motion were investigated.Patients were followed-up for an average of 42.7 ±â€Š10.5 months. Clinical outcomes, postoperative OR, and space available in the spinal cord were significantly improved at the final follow-up in both groups. Preoperatively, the OR and cranial and caudal ODD/PBH ratios were not significantly different between the groups. Compared to pre-operative values, differences in the segmental and C2-C7 Cobb angles at the final follow-up were statistically significant for the ACDF group (P < .05). The mean operative time, bleeding volume, and the duration of hospitalization were significantly lower in the ACDF group than in the laminoplasty group (P < .05). Complications occurred in 1 ACDF case and in 5 laminoplasty cases.Both ACDF and laminoplasty provided satisfactory clinical and radiologic outcomes for two-level localized OPLL. However, ACDF was associated with a lower operation time, bleeding loss, duration of hospitalization, and complications.


Assuntos
Discotomia , Laminoplastia , Ossificação do Ligamento Longitudinal Posterior/cirurgia , Doenças da Medula Espinal/etiologia , Doenças da Medula Espinal/cirurgia , Fusão Vertebral , Adulto , Idoso , Perda Sanguínea Cirúrgica , Vértebras Cervicais/diagnóstico por imagem , Vértebras Cervicais/cirurgia , Feminino , Humanos , Laminoplastia/métodos , Tempo de Internação , Ligamentos Longitudinais/diagnóstico por imagem , Ligamentos Longitudinais/cirurgia , Masculino , Pessoa de Meia-Idade , Duração da Cirurgia , Ossificação do Ligamento Longitudinal Posterior/complicações , Ossificação do Ligamento Longitudinal Posterior/diagnóstico por imagem , Complicações Pós-Operatórias , Amplitude de Movimento Articular , Estudos Retrospectivos , Doenças da Medula Espinal/diagnóstico por imagem , Fusão Vertebral/métodos , Resultado do Tratamento
10.
Pediatrics ; 146(3)2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-32859736

RESUMO

Arteriovenous malformations (AVMs) have recently been reported to have a high incidence of somatic KRAS mutations suggesting potential for treatment with mitogen-activated protein kinase inhibitors. In this case report, we describe genotype-targeted treatment of a KRAS mutant metameric AVM in a patient with Cobb syndrome using the mitogen-activated protein kinase inhibitor trametinib. Therapeutic response was monitored with phase-contrast magnetic resonance angiography to quantify AVM arterial inflow as an imaging biomarker. Treatment with trametinib resulted in a substantial decrease in blood flow to the AVM, with a >75% reduction in arterial inflow after 6 months of trametinib therapy.


Assuntos
Malformações Arteriovenosas/tratamento farmacológico , Genótipo , Inibidores de Proteínas Quinases/administração & dosagem , Proteínas Proto-Oncogênicas p21(ras)/genética , Piridonas/administração & dosagem , Pirimidinonas/administração & dosagem , Doenças da Medula Espinal/tratamento farmacológico , Adolescente , Sequência de Aminoácidos , Malformações Arteriovenosas/diagnóstico por imagem , Malformações Arteriovenosas/genética , Sistemas de Liberação de Medicamentos/métodos , Humanos , Masculino , Proteínas Proto-Oncogênicas p21(ras)/antagonistas & inibidores , Doenças da Medula Espinal/diagnóstico por imagem , Doenças da Medula Espinal/genética , Síndrome , Resultado do Tratamento
12.
J Clin Neurosci ; 78: 433-438, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-32600974

RESUMO

Extradural spinal meningeal cysts are rare lesions in the adult spine and are an uncommon cause of neurologic deficits. We present the case of an adult who presented with myelopathic symptoms related to a dorsally based extradural thoracic meningeal cyst in the absence of any defect in the posterior spinal elements and no history of spinal dysraphism or trauma. We also performed a review of the literature to evaluate the surgical techniques for extradural meningeal cysts. Most thoracic cysts are intradural arachnoid cysts, yet this lesion is an extradural meningeal cyst, not an intradural arachnoid cyst. Because of the rarity of this lesion, its anatomic characterization can be difficult to conceptualize. An artist's illustration helps illustrate the anatomic characteristics of this cyst and our surgical management.


Assuntos
Cistos Aracnóideos/complicações , Doenças da Medula Espinal/etiologia , Adulto , Cistos Aracnóideos/cirurgia , Humanos , Imagem por Ressonância Magnética , Cisto Mediastínico/complicações , Doenças da Medula Espinal/diagnóstico por imagem , Doenças da Medula Espinal/cirurgia , Disrafismo Espinal , Coluna Vertebral/patologia
13.
Spine (Phila Pa 1976) ; 45(15): E909-E916, 2020 Aug 01.
Artigo em Inglês | MEDLINE | ID: mdl-32675602

RESUMO

STUDY DESIGN: Retrospective cohort study. OBJECTIVE: The objective of this study was to elucidate the rate and causes of reoperation for late neurological deterioration after cervical laminoplasty by comparing cases of cervical spondylotic myelopathy (CSM) with those of ossification of the posterior longitudinal ligament (OPLL). SUMMARY OF BACKGROUND DATA: Although the long-term surgical outcomes of cervical laminoplasty in patients with CSM or OPLL are satisfactory, reoperation is sometimes required for late neurological deterioration after laminoplasty. However, limited information is available about long-term follow-up in such cases. METHODS: This retrospective cohort study included 623 patients who underwent cervical laminoplasty for cervical myelopathy (average follow-up duration, 6.1 [range, 2-15] years). The rate of reoperations for late neurological deterioration (>6 mo after the initial surgery) was investigated. RESULTS: Primary diagnoses were CSM and OPLL in 522 (83.8%) and 101 (16.2%) patients, respectively. During the follow-up period, 10 (1.6%) patients required reoperation: 7 (1.3%) in the CSM group and 3 (3.0%) in the OPLL group. No significant difference was found between the CSM and OPLL groups regarding patients requiring reoperation (P = 0.26). The mean elapsed time between primary surgery and reoperation was 4.7 ±â€Š3.2 and 10.0 ±â€Š5.7 years in the CSM and OPLL groups, respectively. The predicted risk percentages of reoperation at 10 years after primary surgery were 2.9% and 1.0% in the CSM and OPLL group, respectively. The causes of reoperation for CSM were C5 palsy in five, severe radiculopathy in one, and restenosis due to instability after laminoplasty in one case; the cause of reoperation for OPLL was enlargement of ossification in all three cases. CONCLUSION: Although the clinical outcomes of laminoplasty were favorable in most patients, reoperation for late neurological deterioration was required in approximately 1.0% to 3.0% of CSM and OPLL cases within 10 years after laminoplasty. LEVEL OF EVIDENCE: 4.


Assuntos
Vértebras Cervicais/cirurgia , Laminoplastia/efeitos adversos , Ossificação do Ligamento Longitudinal Posterior/cirurgia , Reoperação/métodos , Doenças da Medula Espinal/cirurgia , Espondilose/cirurgia , Adulto , Idoso , Vértebras Cervicais/diagnóstico por imagem , Estudos de Coortes , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Ossificação do Ligamento Longitudinal Posterior/diagnóstico por imagem , Complicações Pós-Operatórias/diagnóstico por imagem , Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/cirurgia , Estudos Retrospectivos , Doenças da Medula Espinal/diagnóstico por imagem , Espondilose/diagnóstico por imagem , Resultado do Tratamento
14.
J Stroke Cerebrovasc Dis ; 29(8): 105007, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-32689639

RESUMO

Neuromyelitis optica spectrum disorder (NMOSD) is an immune-mediated disorder. It often develops acute myelopathy due to longitudinally extensive transverse myelitis (LETM), although other disorders can cause an LETM-like lesion. Here, we report a 76-year-old patient presenting with acute-onset, progressive myelopathy, which proved to be caused by an intracranial dural arteriovenus fistula (dAVF). Magnetic resonance imaging (MRI) revealed a longitudinally extensive spinal cord lesion, which was further extended rostrally to the medulla. Although cord surface flow voids were absent on T2-weighted MRI, abnormally congested peri-spinal veins showed up with gadolinium contrast. Angiography confirmed dAVF in the posterior fossa, which drained into the peri-spinal veins. Intracranial dAVF should be considered as a differential diagnosis of NMOSD, because it is not immunologically but is surgically treatable.


Assuntos
Angiografia Digital , Malformações Vasculares do Sistema Nervoso Central/diagnóstico por imagem , Imagem por Ressonância Magnética , Neuromielite Óptica/diagnóstico por imagem , Doenças da Medula Espinal/diagnóstico por imagem , Medula Espinal/diagnóstico por imagem , Idoso , Malformações Vasculares do Sistema Nervoso Central/complicações , Malformações Vasculares do Sistema Nervoso Central/terapia , Diagnóstico Diferencial , Embolização Terapêutica , Humanos , Malformações Arteriovenosas Intracranianas , Masculino , Valor Preditivo dos Testes , Doenças da Medula Espinal/etiologia , Doenças da Medula Espinal/terapia , Resultado do Tratamento , Procedimentos Cirúrgicos Vasculares
15.
Rev. neurol. (Ed. impr.) ; 71(1): 26-30, 1 jul., 2020. ilus
Artigo em Espanhol | IBECS | ID: ibc-195441

RESUMO

INTRODUCCIÓN: La hernia medular idiopática es una patología infrecuente que cursa clínicamente con una mielopatía progresiva, la mayoría de las ocasiones en forma de síndrome de Brown-Séquard. Su base anatómica es un defecto dural por el que se incarcera progresivamente una porción del cordón medular anterior. La resonancia magnética y la mielotomografía demuestran un acodamiento medular en «tienda de campaña» hacia la cara anterior del estuche dural, a nivel dorsal medio fundamentalmente. Caso clínico. Varón de 37 años, diagnosticado de hernia medular idiopática e intervenido quirúrgicamente mediante una técnica propia; se demuestra su correlación neurorradiológica, anatomoquirúrgica y evolutiva. CONCLUSIÓN: El tratamiento debe ser individualizado, pues no existe una técnica quirúrgica universalmente establecida


INTRODUCTION: Idiopathic medullary herniation is an infrequent disease, which shows up in clinical form as a progressive mielopathy, most commonly known as the Brown-Séquard syndrome. Its anatomical base is a dural defect where a portion of anterior spinal cord gets progressively incarcerated. The MRI and myelo-CT scan show a bending of the spinal cord in the form of a «bell tent» towards the anterior dural sheath at the mid-dorsal portion mainly. CASE REPORT: A 37 year old male, who was diagnosed of idiopathic medullary herniation and surgically treated by our own developed technique, reporting its neuroradiological, anatomo-surgical and clinical correlation. CONCLUSION. Treatment should be individualized, as no standard surgical technique has been established up to the present


Assuntos
Humanos , Masculino , Adulto , Síndrome de Brown-Séquard/etiologia , Progressão da Doença , Hérnia , Doenças da Medula Espinal/diagnóstico por imagem , Herniorrafia/métodos , Doenças da Medula Espinal/cirurgia , Síndrome de Brown-Séquard/fisiopatologia , Síndrome de Brown-Séquard/cirurgia
16.
Spine (Phila Pa 1976) ; 45(10): 641-648, 2020 May 15.
Artigo em Inglês | MEDLINE | ID: mdl-32358304

RESUMO

STUDY DESIGN: A prospective cohort study. OBJECTIVE: This study aimed to investigate the relationship between preoperative cervical sagittal alignment and postoperative kyphosis in patients with cervical spondylotic myelopathy (CSM) and to determine the cut-off angle for predicting the postlaminoplasty kyphosis. SUMMARY OF BACKGROUND DATA: There have been several reports describing a cervical kyphosis after laminoplasty. However, there has been no study on the cut-off angle for predicting the postoperative kyphosis in a large series of patients with CSM. METHODS: A total of 1025 consecutive patients with CSM (642 men and 383 women; mean age, 64.4 yr; range, 23-93 yrs) who underwent laminoplasty were included. The average follow-up period was 30.0 months. Radiography was performed before the surgery and at final follow-up. The cervical alignment with neutral view was measured by using the Cobb method. An alignment of C2-7 lordotic angle more than 0° was defined as lordosis and C2-7 lordotic angle less than 0° was defined as kyphosis. The incidence of postoperative kyphosis was evaluated on lateral radiographs. RESULTS: In all patients, the mean C2-7 alignment in the neutral position was 11.5° lordotic before surgery and 14.2° lordotic at final follow-up. In the patient without preoperative kyphotic alignment, receiver operating characteristic curve of preoperative C2-7 lordotic angle showed 7° as a predictor for the postlaminoplasty kyphosis (area under the curve  = 0.75, P < 0.0001). Among the preoperatively 720 patients with lordosis more than 7°, postoperative kyphosis was observed in 20 patients (2.8%), whereas in the preoperatively 191 patients with lordosis less than 7°, postoperative kyphosis was seen in 28 patients (14.7%). CONCLUSION: The cut-off value of preoperative C2-7 lordotic angle for predicting the postlaminoplasty kyphosis was 7° in CSM patient without preoperative kyphotic alignment. LEVEL OF EVIDENCE: 3.


Assuntos
Vértebras Cervicais/diagnóstico por imagem , Cifose/diagnóstico por imagem , Laminoplastia/tendências , Cuidados Pré-Operatórios/normas , Doenças da Medula Espinal/diagnóstico por imagem , Espondilose/diagnóstico por imagem , Adulto , Idoso , Idoso de 80 Anos ou mais , Vértebras Cervicais/cirurgia , Feminino , Seguimentos , Humanos , Cifose/cirurgia , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Cuidados Pré-Operatórios/métodos , Estudos Prospectivos , Doenças da Medula Espinal/cirurgia , Espondilose/cirurgia , Adulto Jovem
17.
J Clin Neurosci ; 77: 25-30, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32451215

RESUMO

Spinal dural arteriovenous fistula (dAVF) is an extremely rare vascular entity that is usually misdiagnosed. We sought to determine the long-term clinical outcomes of patients undergoing microsurgical treatment for delayed diagnosis of spinal dAVF. This retrospective study identified patients with delayed diagnosed spinal dAVF at our institution from 2009 to 2018. Patients' data, including demographics, imaging, and follow-up data, were evaluated. This cohort included 65 consecutive patients with 68 dAVFs and a male-to-female ratio of 4:1 and a mean age of 53.5 ± 13.7 years. The presenting symptoms consisted of limb weakness (n = 42, 64.6%), paraparesis (n = 34, 52.3%), sphincter disturbances (n = 8, 12.3%), and pain (n = 13, 20.0%). The proportion of patients with each symptom significantly increased and patients experienced increased disability when the diagnosis was finalized. The mean length of delay of diagnosis was 20.7 ± 30.0 months. Surgery resulted in complete occlusion of the fistula on the first attempt in all patients. Three patients developed recurrent fistulas, and three died in the follow-up period. Improved motor function was achieved in 38 patients (59.5%). Other symptoms, such as sensory disorders, sphincter dysfunction, and pain, improved by 37.3%, 32.3%, and 66.7%, respectively. Patients with spinal dAVF usually exhibit progressive ascending myelopathy and often remain misdiagnosed for months to years. Some patients' increased disability cannot be reversed through surgery.


Assuntos
Malformações Vasculares do Sistema Nervoso Central/diagnóstico por imagem , Malformações Vasculares do Sistema Nervoso Central/cirurgia , Diagnóstico Tardio/tendências , Medula Espinal/diagnóstico por imagem , Medula Espinal/cirurgia , Adulto , Idoso , Idoso de 80 Anos ou mais , Estudos de Coortes , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Dor/diagnóstico por imagem , Dor/cirurgia , Paraparesia/diagnóstico por imagem , Paraparesia/cirurgia , Estudos Retrospectivos , Doenças da Medula Espinal/diagnóstico por imagem , Doenças da Medula Espinal/cirurgia , Resultado do Tratamento
18.
BMC Neurol ; 20(1): 185, 2020 May 13.
Artigo em Inglês | MEDLINE | ID: mdl-32404188

RESUMO

BACKGROUND: To explore the feasibility of the metrics of diffusion kurtosis imaging (DKI) for investigations of the microstructural changes of spinal cord injury in patients with degenerative cervical myelopathy (DCM) and the correlation between Japan Orthopaedic Association (JOA) scores and DKI metrics. METHODS: Fifty-seven patients with DCM and 38 healthy volunteers underwent 3.0 T magnetic resonance (MR) imaging with routine MRI sequences and DKI from echo-planar imaging sequence. Based on the JOA score, DCM patients were divided into four subgroups. DKI metrics of the DCM group and control group were obtained and compared, separately for the white matter (WM) and the gray matter (GM). RESULTS: The FA values in WM were significantly lower (P = 0.020) in the DCM group than in the control group. The MK values in GM were lower (P = 0.011) in the DCM group than in the control group. The MD values in WM were significantly higher (P = 0.010) in the DCM group than in the control group. In GM, the JOA score was positively correlated with the MK values (r = 0.768, P < 0.05). In the WM, the JOA score was positively correlated with the FA values (r = 0.612, P < 0.05). CONCLUSION: DKI provides quantitive evaluation to the characters of microstructure of the spinal cord damage in patients with DCM compared to conventional MR. MK values can reflect microstructural abnormalities of gray matter of the cervical spinal cord and provide more information beyond that obtained with routine diffusion metrics. In addition, MK values of GM and FA values of WM may as a be highly sensitive biomarker for the degree of cervical spinal cord damage.


Assuntos
Medula Cervical/diagnóstico por imagem , Imagem Ecoplanar/métodos , Neuroimagem/métodos , Doenças da Medula Espinal/diagnóstico por imagem , Adulto , Medula Cervical/patologia , Feminino , Substância Cinzenta/diagnóstico por imagem , Substância Cinzenta/patologia , Humanos , Japão , Imagem por Ressonância Magnética/métodos , Masculino , Pessoa de Meia-Idade , Doenças da Medula Espinal/patologia , Substância Branca/diagnóstico por imagem , Substância Branca/patologia
19.
J Clin Neurosci ; 78: 252-258, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-32340846

RESUMO

OBJECTIVE: In this randomized, single blind and controlled study, the feasibility and precision of 3-dimensional printing templates for cervical lateral mass screw insertion was evaluated. METHODS: A total of 6 patients (72 screws), who were diagnosed with cervical spondylotic myelopathy (CSM) and developmental cervical spinal stenosis, were randomly divided into A and B two groups. All subjects underwent modified posterior surgery with using cervical lateral mass screws insertion (C4-C6). Group A underwent surgeries with screw insertion assisted by the guidance of 3-dimensional printing templates and Group B underwent surgeries with screw insertion by freehand. The criteria of the accuracy of screw placement were set as the main evaluation indicators. RESULTS: There was no significant difference between the 2 groups in age, improvement rate of JOA, operation time and blood loss. According to Bayard's criteria, 32 screws (88.9%) were described as "acceptable" in group A and 22 screws (61.1%) were described as "acceptable" in Group B (P < 0.05). Based on our criteria, the "excellent and good" rate of screws was 83.3% in group A and 47.2% in Group B, respectively (P < 0.05). The precision of screws' location in Group A was superior to that in Group B. CONCLUSIONS: 3-Dimensional printing screw insertion templates may achieve (1) comprehensive visualization of the cervical vertebrae and lateral mass and the individual surgical planning using the 3-dimensional model preoperatively. (2) increasing the accuracy of cervical lateral mass screw insertion.


Assuntos
Parafusos Ósseos/normas , Vértebras Cervicais/cirurgia , Impressão Tridimensional/normas , Doenças da Medula Espinal/cirurgia , Fusão Vertebral/normas , Adulto , Idoso , Vértebras Cervicais/diagnóstico por imagem , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Duração da Cirurgia , Estudos Prospectivos , Método Simples-Cego , Doenças da Medula Espinal/diagnóstico por imagem , Fusão Vertebral/métodos
20.
World Neurosurg ; 138: 504-511.e8, 2020 06.
Artigo em Inglês | MEDLINE | ID: mdl-32224269

RESUMO

OBJECTIVE: Spinal involvement in neurocysticercosis is rare and can lead to debilitating injury if not diagnosed and treated early. We aim to provide the reader with a thorough analysis of the best available evidence regarding patient characteristics, optimal treatment modality, and outcomes in cases of spinal neurocysticercosis. METHODS: A systematic review of the literature using PubMed, Google Scholar, and Web of Science electronic databases was made according to the PRISMA guidelines. An illustrative case of intramedullary-cervical spinal disease is also presented for illustrative purposes. RESULTS: A total of 46 reports of 103 patients fitting the screening criteria were identified. Isolated spinal involvement was seen in 46.15% of patients. Most infections (76.92%) had an intradural extramedullary localization, with 43.27% of cases involving >1 spinal cord level. The most common presenting symptoms were motor deficits (77.88%), pain syndromes (64.42%), and sensory deficits (53.85%). Combined surgical resection and pharmacologic therapy was the most frequently used treatment modality (49.04%) and had the highest proportion of patients reporting symptomatic improvement at follow-up (78.43%). Combination therapy had a significantly higher rate of neurologic recovery compared with surgery alone (P = 0.004) or medical treatment (P = 0.035). CONCLUSIONS: Spinal involvement in neurocysticercosis should be considered in patients from or who traveled to endemic areas presenting with ring-enhancing lesions. Combined treatment with surgery followed by cysticidal and steroid medication seems to be superior to surgery or medical treatment in isolation and seems to provide the highest chances of recovery.


Assuntos
Corticosteroides/uso terapêutico , Albendazol/uso terapêutico , Anticestoides/uso terapêutico , Neurocisticercose/terapia , Procedimentos Neurocirúrgicos , Doenças da Medula Espinal/terapia , Adulto , Idoso , Animais , Terapia Combinada , Humanos , Hidrocefalia/etiologia , Laminectomia , Imagem por Ressonância Magnética , Pessoa de Meia-Idade , Debilidade Muscular/etiologia , Neurocisticercose/complicações , Neurocisticercose/diagnóstico por imagem , Neurocisticercose/fisiopatologia , Dor/etiologia , Recuperação de Função Fisiológica , Distúrbios Somatossensoriais/etiologia , Doenças da Medula Espinal/complicações , Doenças da Medula Espinal/diagnóstico por imagem , Doenças da Medula Espinal/fisiopatologia , Taenia solium , Resultado do Tratamento , Adulto Jovem
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