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1.
World Neurosurg ; 133: 29-33, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31526887

RESUMO

BACKGROUND: Spinal dural arteriovenous fistula (DAVF) typically has a single intradural drainage vein, abnormally connecting with the radiculomeningeal artery at the dura root sleeve. Multiple intradural draining veins are extremely rare. To date, only 1 case of spinal DAVF with multiple draining veins has been reported. CASE DESCRIPTION: A 62-year-old woman presented with a 2-year history of progressive weakness and numbness in her lower extremities. Spinal magnetic resonance imaging showed extensive edema of the cord and prominent vascular flow voids. Spinal angiography demonstrated a right L3 DAVF with supply from the left L3 lumbar artery. The feeding artery was also thought to give rise to the artery of Adamkiewicz. The spinal DAVF was surgically treated, and the artery of Adamkiewicz was retained. Her postoperative symptoms gradually improved. Eight months after the surgery, her symptoms gradually worsened. Repeat spinal angiography revealed a right L3 DAVF at the same location of the first fistula. In retrospect, the draining vein identified on the second angiography was mistakenly considered as the artery of Adamkiewicz at the first angiography. Therefore the initial fistula was drained through double draining veins, 1 of them mimicking the artery of Adamkiewicz. The fistula was coagulated and divided. Postoperatively, the patient's symptoms gradually improved. Three months after the second surgery, she was able to walk independently. CONCLUSIONS: Spinal DAVF is a rare disease, but clinicians should be cautious of possible multiple drainage veins in diagnosis and treatment.


Assuntos
Malformações Vasculares do Sistema Nervoso Central/diagnóstico por imagem , Dura-Máter/diagnóstico por imagem , Doenças da Medula Espinal/diagnóstico por imagem , Angiografia , Malformações Vasculares do Sistema Nervoso Central/cirurgia , Dura-Máter/irrigação sanguínea , Dura-Máter/cirurgia , Feminino , Humanos , Imagem por Ressonância Magnética , Pessoa de Meia-Idade , Doenças da Medula Espinal/cirurgia
2.
Neurology ; 93(23): e2133-e2143, 2019 12 03.
Artigo em Inglês | MEDLINE | ID: mdl-31719133

RESUMO

OBJECTIVE: To prospectively determine the potential of diffusion MRI (dMRI) of the cervical spinal cord and the corticospinal tracts in brain as surrogate outcome measure for progression of myelopathy in men with adrenoleukodystrophy, as better outcome measures to quantify progression of myelopathy would enable clinical trials with fewer patients and shorter follow-up. METHODS: Clinical assessment of myelopathy included Expanded Disability Status Scale (EDSS), Severity Scoring System for Progressive Myelopathy (SSPROM), Timed Up-and-Go, and 6-Minute Walk Test. Applied dMRI metrics included fractional anisotropy, mean diffusivity, axial diffusivity, and radial diffusivity. RESULTS: Data were available for 33 controls and 52 patients. First, cross-sectionally, differences between groups (controls vs patients; controls vs asymptomatic patients vs symptomatic patients) were statistically significant for fractional anisotropy, mean diffusivity, and radial diffusivity in spinal cord and brain corticospinal tracts (effect size 0.31-0.68). Correlations between dMRI metrics and clinical measures were moderate to strong (correlation coefficient 0.35-0.60). Second, longitudinally (n = 36), change on clinical measures was significant after 2-year follow-up for EDSS, SSPROM, and Timed Up-and-Go (p ≤ 0.021, effect size ≤0.14). Change on brain fractional anisotropy and radial diffusivity was slightly larger (p ≤ 0.002, effect sizes 0.16-0.28). In addition, a statistically significant change was detectable in asymptomatic patients using brain dMRI and not using the clinical measures. Change on clinical measures did not correlate to change on dMRI metrics. CONCLUSION: Although effect sizes were small, our prospective data illustrate the potential of dMRI as surrogate outcome measure for progression of myelopathy in men with adrenoleukodystrophy.


Assuntos
Adrenoleucodistrofia/diagnóstico por imagem , Adrenoleucodistrofia/patologia , Neuroimagem/métodos , Doenças da Medula Espinal/diagnóstico por imagem , Doenças da Medula Espinal/patologia , Adolescente , Adrenoleucodistrofia/complicações , Adulto , Idoso , Imagem de Difusão por Ressonância Magnética/métodos , Progressão da Doença , Humanos , Interpretação de Imagem Assistida por Computador/métodos , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Tratos Piramidais/diagnóstico por imagem , Tratos Piramidais/patologia , Doenças da Medula Espinal/etiologia , Adulto Jovem
3.
Spine (Phila Pa 1976) ; 44(21): E1248-E1255, 2019 Nov 01.
Artigo em Inglês | MEDLINE | ID: mdl-31634300

RESUMO

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


Assuntos
Fluordesoxiglucose F18 , Compostos Radiofarmacêuticos , Sarcoidose/diagnóstico por imagem , Doenças da Coluna Vertebral/diagnóstico por imagem , Adulto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Tomografia Computadorizada com Tomografia por Emissão de Pósitrons/métodos , Sarcoidose/patologia , Doenças da Medula Espinal/diagnóstico por imagem , Doenças da Medula Espinal/patologia , Doenças da Coluna Vertebral/patologia
6.
Isr Med Assoc J ; 21(8): 542-545, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31474017

RESUMO

BACKGROUND: Spinal manipulation therapy (SMT) is commonly used as an effective therapeutic modality for a range of cervical symptoms. However, in rare cases, cervical manipulation may be associated with complications. In this review we present a series of cases with cervical spine injury and myelopathy following therapeutic manipulation of the neck, and examine their clinical course and neurological outcome. We conducted a search for patients who developed neurological symptoms due to cervical spinal cord injury following neck SMT in the database of a spinal unit in a tertiary hospital between the years 2008 and 2018. Patients were assessed for the clinical course and deterioration, type of manipulation used and subsequent management. A total of four patients were identified, two men and two women, aged 32-66 years. In three patients neurological deterioration appeared after chiropractic adjustment and in one patient after tuina therapy. Three patients were managed with anterior cervical discectomy and fusion while one patient declined surgical treatment. Assessment for subjective and objective evidence of cervical myelopathy should be performed prior to cervical manipulation, and suspected myelopathic patients should be sent for further workup by a specialist familiar with cervical myelopathy (such as a neurologist, a neurosurgeon or orthopedic surgeon who specializes in spinal surgery). Nevertheless, manipulation therapy remains an important and generally safe treatment modality for a variety of cervical complaints. This review does not intend to discard the role of SMT as a significant part in the management of patients with neck related symptoms, rather it is meant to draw attention to the need for careful clinical and imaging investigation before treatment.


Assuntos
Manipulações Musculoesqueléticas/efeitos adversos , Doenças da Medula Espinal/diagnóstico por imagem , Doenças da Medula Espinal/etiologia , Doença Aguda , Adulto , Idoso , Vértebras Cervicais/diagnóstico por imagem , Vértebras Cervicais/cirurgia , Discotomia/métodos , Feminino , Humanos , Imagem por Ressonância Magnética/métodos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Doenças da Medula Espinal/cirurgia
7.
J Vet Intern Med ; 33(5): 2312-2318, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31490026

RESUMO

BACKGROUND: Transcranial magnetic stimulation (TMS) and recording of magnetic motor evoked potentials (MMEP) can detect neurological dysfunction in horses but cutoff values based on confirmed spinal cord dysfunction are lacking. OBJECTIVES: To determine latency time cutoff for neurological dysfunction. ANIMALS: Five control horses and 17 horses with proprioceptive ataxia. METHODS: Case-control study with receiver operating characteristic curve analysis, based on diagnostic imaging, TMS, and histopathological findings. Horses were included if all 3 examinations were performed. RESULTS: Diagnostic imaging and histopathology did not show abnormalities in the control group but confirmed spinal cord compression in 14 of 17 ataxic horses. In the remaining 3 horses, histopathological lesions were mild to severe, but diagnostic imaging did not confirm spinal cord compression. In control horses, latency time values of thoracic and pelvic limbs were significantly lower than in ataxic horses (20 ± 1 vs 34 ± 16 milliseconds, P = .05; and 39 ± 1 vs 78 ± 26 milliseconds, P = .004). Optimal cutoff values to detect spinal cord dysfunction were 22 milliseconds (sensitivity [95% CI interval], 88% [73%-100%]; specificity, 100% [100%-100%]) in thoracic and 40 milliseconds (sensitivity, 94% [83%-100%]; specificity, 100% [100%-100%]) in pelvic limbs. To detect spinal cord dysfunction caused by compression, the optimal cutoff for thoracic limbs remained 22 milliseconds, while it increased to 43 milliseconds in pelvic limbs (sensitivity, 100% [100%-100%]; specificity, 100% [100%-100%] for thoracic and pelvic limbs). CONCLUSIONS AND CLINICAL IMPORTANCE: Magnetic motor evoked potential analysis using these cutoff values is a promising diagnostic tool for spinal cord dysfunction diagnosis in horses.


Assuntos
Potencial Evocado Motor , Doenças dos Cavalos/fisiopatologia , Doenças da Medula Espinal/veterinária , Estimulação Magnética Transcraniana/veterinária , Animais , Ataxia/diagnóstico por imagem , Ataxia/fisiopatologia , Ataxia/veterinária , Estudos de Casos e Controles , Feminino , Doenças dos Cavalos/diagnóstico por imagem , Cavalos , Masculino , Medula Espinal/diagnóstico por imagem , Medula Espinal/fisiopatologia , Compressão da Medula Espinal/diagnóstico por imagem , Compressão da Medula Espinal/fisiopatologia , Compressão da Medula Espinal/veterinária , Doenças da Medula Espinal/diagnóstico por imagem , Doenças da Medula Espinal/fisiopatologia
8.
Rev. Hosp. Ital. B. Aires (2004) ; 39(3): 94-97, sept. 2019. ilus.
Artigo em Espanhol | LILACS | ID: biblio-1048277

RESUMO

Las fístulas arteriovenosas durales medulares son malformaciones vasculares adquiridas que constituyen una causa muy infrecuente de mielopatía progresiva (5-10 casos por millón de habitantes por año). La resonancia magnética es el estudio por imágenes de elección para su diagnóstico. A continuación presentamos el caso de una paciente femenina de 89 años, que consultó a la guardia de nuestra institución por un cuadro de paraparesia moderada asociada a parestesias e incontinencia urinaria posterior a esfuerzo físico. Se le diagnosticó una fístula arteriovenosa dural medular como causante de su cuadro. (AU)


Spinal dural arteriovenous fistulas (SDAVF) are acquired spinal vascular malformations and a rare cause of progressive myelopathy (5-10 new cases per year and per 1 million inhabitants). Magnetic resonance imaging is the diagnosis modality of choice. We present a case of a 89-year-old female patient who consulted the emergency department of our institution because of paraparesis and lower extremities paresthesias associated with urinary incontinence post physical effort. With the final diagnosis of spinal dural arteriovenous fistula, as a cause of the clinical symptoms. (AU)


Assuntos
Humanos , Masculino , Feminino , Pessoa de Meia-Idade , Idoso de 80 Anos ou mais , Fístula Arteriovenosa/diagnóstico por imagem , Dura-Máter/anormalidades , Parestesia , Fibrilação Atrial/complicações , Doenças da Medula Espinal/diagnóstico por imagem , Tabagismo/complicações , Incontinência Urinária , Fístula Arteriovenosa/etiologia , Fístula Arteriovenosa/epidemiologia , Dor Lombar/complicações , Aneurisma da Aorta Abdominal/complicações , Paraparesia , Incontinência Fecal , Hipertensão/complicações , Hipestesia , Disfunção Erétil , Anticoagulantes/uso terapêutico
10.
Rev. med. Rosario ; 85(2): 72-76, mayo-ago. 2019. ilus
Artigo em Espanhol | LILACS | ID: biblio-1053263

RESUMO

Las enfermedades de la moto neurona inferior constituyen un grupo heterogéneo de entidades con pronósticos diferentes. El signo radiológico "ojos de serpiente" hace referencia a la hiperintensidad bilateral en el asta anterior de la médula espinal en los cortes axiales de las imágenes por resonancia magnética, generalmente asociada a afecciones como infartos espinales, amiotrofia espondilótica, enfermedad de Hirayama y esclerosis lateral amiotrófica. Se ha descripto recientemente un reducido número de casos de enfermedad de moto neurona inferior asociada a "ojos de serpiente" con características clínicas y pronóstico distintivos. Presentamos dos casos de enfermedad de moto neurona inferior asociada al signo "ojos de serpiente" en pacientes jóvenes. El curso clínico fue progresivo con períodos prolongados de estabilidad clínica y ausencia de compromiso de moto neurona superior durante la evolución. Los pacientes presentaron debilidad segmentaria y asimétrica de miembros superiores con predominio distal en el primer caso y proximal en el segundo. Los casos presentados se corresponden en gran parte con lo comunicado en la literatura, dando apoyo a la existencia de una nueva entidad con pronóstico relativamente benigno denominada enfermedad de moto neurona inferior esporádica con signo de ojos de serpiente en las imágenes por resonancia magnética y cuya identificación debiera obviar tratamientos innecesarios (AU)


Lower motor neuron diseases are a heterogeneous group of entities with different prognosis. The "snake eyes" sign refers to bilateral hyper intensity of the anterior horns on axial magnetic resonance imaging of the spinal cord. It has been associated with ischemia, cervical spondylosis, Hirayama disease, and amyotrophic lateral sclerosis. Recently, a small number of cases of lower motor neuron disease associated with the "snake eyes" sign have been described as having distinctive clinical manifestations and prognosis. Two young patients with "snake eyes" sign associated with lower motor neuron disease had a progressive initial course followed by a stabilization of symptoms without involvement of upper motor neuron. They presented with asymmetric segmental arm weakness with distal predominance in the first a case and proximal predominance in the second. These cases match with those reported in the literature giving support to lower motor neuron disease with "snake eyes" as a pathological entity with a relatively good prognosis. This diagnosis should avoid unnecessary treatments (AU)


Assuntos
Humanos , Masculino , Feminino , Adulto , Espectroscopia de Ressonância Magnética , Doença dos Neurônios Motores/diagnóstico por imagem , Doenças da Medula Espinal/diagnóstico por imagem , Atrofia Muscular Espinal , Diagnóstico Diferencial , Esclerose Amiotrófica Lateral
11.
Turk Neurosurg ; 29(4): 584-593, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31270797

RESUMO

AIM: To compare outcomes and complications in patients with thoracic disc herniation (TDH) undergoing surgery with either the posterior or anterior approach. MATERIAL AND METHODS: A total of 86 patients, with 98 symptomatic TDHs, who underwent surgery in a single institution between 2007 and 2016, were included. Overall, 68 patients were in the anterior and 18 were in the posterior group. Ten patients underwent multilevel TDH surgery. RESULTS: The groups were similar in age, sex, body mass index, and clinical symptoms. In the anterior group, 4 patients (5.9%) had major complications, and 26 (38.2%) had minor complications. In the posterior group, 6 patients (33.3%) had major complications, and 4 (22.2%) had minor complications. Visual analog scores at the final follow-up improved in both groups as compared to baseline preoperative scores (p > 0.05). The rate of neurological improvement in patients with myelopathy was significantly higher in the anterior group (43/50) than in the posterior group (8/14) (p < 0.05). CONCLUSION: The current study showed that higher rates of major complications in central and calcified paracentral TDHs are associated with posterior approaches when compared to anterior approaches. In addition, anterior approaches had superior neurological recovery and clinical outcomes. Therefore, we recommend the anterior approach for the treatment of calcified and/or non-calcified central and calcified paracentral TDH, while reserving posterior approaches for small non-calcified paracentral disc herniations.


Assuntos
Gerenciamento Clínico , Discotomia/métodos , Deslocamento do Disco Intervertebral/diagnóstico por imagem , Deslocamento do Disco Intervertebral/cirurgia , Vértebras Torácicas/diagnóstico por imagem , Vértebras Torácicas/cirurgia , Adulto , Idoso , Idoso de 80 Anos ou mais , Discotomia/efeitos adversos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Estudos Retrospectivos , Doenças da Medula Espinal/diagnóstico por imagem , Doenças da Medula Espinal/cirurgia , Resultado do Tratamento , Adulto Jovem
12.
Spine (Phila Pa 1976) ; 44(20): 1403-1411, 2019 Oct 15.
Artigo em Inglês | MEDLINE | ID: mdl-31261277

RESUMO

STUDY DESIGN: A nonrandomized, prospective, and single-center clinical trial. OBJECTIVE: The aim of this study was to investigate the clinical and radiographic efficacy of ProDisc Vivo cervical total disc replacement (cTDR) in patients with clinical and radiographic documented cervical spondylotic myelopathy (CSM), due to degenerative changes at the index level. SUMMARY OF BACKGROUND DATA: Decompression and fusion is still the gold standard in patients with cervical myelopathy. Very limited data are available regarding the application of cTDR in patients with clinical and radiological documented CSM in context of clinical and radiographic outcomes. METHODS: Clinical outcome scores included the Neck Disability Index (NDI), Visual Analogue Scale (VAS), arm and neck pain self-assessment questionnaires as well as the Nurick grade and the Japanese Orthopaedic Association (JOA) score. The radiological outcome included the range of motion (ROM), the segmental and global (C2-C7) lordosis, and the occurrence of heterotopic ossifications. RESULTS: Eighteen consecutive patients (10 males, 8 females) with documented clinical and radiological signs of myelopathy were included in this investigation. The study population had a mean age of 52.4 years and a follow-up period of 20.3 months in average (range 3-48 months). The mean range ROM of the index level stayed consistent with 6.8° preoperatively and 7.2° (P = 0.578) at the last follow-up; the global lordosis in neutral position changed from 3.5° to 14.2° significantly (P = 0.005) in mean. The JOA score improved from 11.3 to 16.6 (P < 0.001) as well as the NDI 36.7 to 10.3 (P < 0.001) and the VAS score from 5.7/6.1 (arm/neck) to 1.3/2.0 (P < 0.001/P < 0.001). The mean Nurick grade was 1.33 preoperatively and dropped down in all cases to Nurick grade of 0 (P < 0.001). CONCLUSION: cTDR (with ProDisc Vivio) in patients with CSM yielded good clinical and radiographic outcomes and found as a reliable, safe, and motion-preserving surgical treatment option, although its indication is very limited due to numerous exclusion criteria. LEVEL OF EVIDENCE: 4.


Assuntos
Vértebras Cervicais/diagnóstico por imagem , Degeneração do Disco Intervertebral/diagnóstico por imagem , Doenças da Medula Espinal/diagnóstico por imagem , Espondilose/diagnóstico por imagem , Substituição Total de Disco/tendências , Adulto , Idoso , Vértebras Cervicais/cirurgia , Feminino , Seguimentos , Humanos , Degeneração do Disco Intervertebral/cirurgia , Masculino , Pessoa de Meia-Idade , Cervicalgia/diagnóstico por imagem , Cervicalgia/cirurgia , Estudos Prospectivos , Doenças da Medula Espinal/cirurgia , Espondilose/cirurgia , Substituição Total de Disco/métodos , Resultado do Tratamento
13.
World Neurosurg ; 130: e687-e693, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31279919

RESUMO

OBJECTIVE: To assess whether preoperative T1 slope and cervical lordosis mismatching affect the surgical outcomes of patients with cervical spondylotic myelopathy (CSM) after laminoplasty. METHODS: A total of 85 patients with CSM who underwent unilateral open-door laminoplasty between January 2013 and May 2017 were retrospectively reviewed. Based on preoperative T1 slope and C2-C7 lordosis matching, the patients were divided into 2 groups: the match group and the mismatch group. The T1 slope minus C2-C7 lordosis (T1S-CL) <20° was defined as matching. Radiographic parameters included T1 slope, C2-C7 lordosis, C2-C7 sagittal vertical axis (SVA), and T1S-CL. Clinical outcomes were based on the Neck Disability Index (NDI) and Japanese Orthopedic Association (JOA) scores. RESULTS: The preoperative T1S-CL had significant correlation with T1 slope (r = 0.283), C2-C7 lordosis (r = -0.611), and C2-C7 SVA (r = 0.331). At the final follow-up, patients in the mismatch group had a higher incidence of postoperative cervical kyphosis (P = 0.007) and C2-C7 SVA >40 mm (P = 0.043). The mismatch group also had greater △C2-C7 lordosis (P = 0.028), △C2-C7 SVA (P = 0.042), and △T1S-CL (P = 0.044). Comparison of clinical outcomes revealed that patients in the match group had better NDI and JOA recovery (P < 0.05). CONCLUSIONS: T1S-CL is a clinically relevant parameter for surgical decision making because patients with T1S-CL mismatching are more likely to have postoperative kyphotic alignment changes and cervical sagittal imbalance. Laminoplasty might not be a suitable option for patients with T1S-CL mismatching.


Assuntos
Vértebras Cervicais/diagnóstico por imagem , Laminoplastia/tendências , Lordose/diagnóstico por imagem , Cuidados Pré-Operatórios/métodos , Espondilose/diagnóstico por imagem , Adulto , Idoso , Vértebras Cervicais/cirurgia , Feminino , Seguimentos , Humanos , Laminoplastia/métodos , Lordose/cirurgia , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Doenças da Medula Espinal/diagnóstico por imagem , Doenças da Medula Espinal/cirurgia , Espondilose/cirurgia , Resultado do Tratamento
14.
No Shinkei Geka ; 47(7): 795-798, 2019 Jul.
Artigo em Japonês | MEDLINE | ID: mdl-31358699

RESUMO

A 35-year-old man with neurofibromatosis type I presented with right arm weakness and gait disturbance that had developed gradually. MR imaging revealed bilateral intra-and extradural tumors at the C1-2 level. Although the adjacent spinal cord was narrowed, there was no evident contact between the tumors and the spinal cord. Computed tomography myelography revealed that the tumors compressed the cord only during neck rotation. The tumors were resected to make an abundant subdural space around the affected cord. The patient's neurological symptoms improved postoperatively. Because contact between the masses and spinal cord only occurred upon neck rotation, we believe it is important to consider the possibility of intermittent compression, termed dynamic rotational canal stenosis, in patients with masses at the C1-2 level, even when such masses are not seen to be in contact with the cervical cord on routine radiological examination.


Assuntos
Neurofibromatose 1/complicações , Compressão da Medula Espinal , Doenças da Medula Espinal , Adulto , Vértebras Cervicais , Humanos , Imagem por Ressonância Magnética , Masculino , Mielografia , Pescoço , Rotação , Compressão da Medula Espinal/complicações , Compressão da Medula Espinal/diagnóstico por imagem , Doenças da Medula Espinal/diagnóstico por imagem , Doenças da Medula Espinal/etiologia
15.
J Orthop Surg Res ; 14(1): 224, 2019 Jul 18.
Artigo em Inglês | MEDLINE | ID: mdl-31319870

RESUMO

OBJECTIVE: Increased signal intensity (ISI) on T2-weighted magnetic resonance imaging (MRI) often indicates severe compression in patients with cervical myelopathy (CM). The optimal surgical approach for CM patients with ISI on T2-weighted MRI remains unclear. This meta-analysis aims to compare the clinical outcomes between anterior and posterior approaches for the treatment of these patients. METHODS: MEDLINE, EMBASE, Web of Science, and Chinese National Knowledge Infrastructure (CNKI) were searched for relevant studies through January 2019. Statistical comparisons were made when appropriate. RESULTS: A total of 9 studies (748 participants) out of 1066 citations were included in this study. All of the selected studies were high quality, as indicated by the Newcastle-Ottawa scale and the Cochrane Collaboration tool for assessing the risk of bias. Clinical outcomes were compared between anterior and posterior approaches in 4 studies (237 participants). The preoperative Japanese Orthopedic Association (JOA) score was similar between the two groups [P = 0.98, weighted mean difference (WMD) = 0.01 (- 0.58, 0.59)]. The postoperative JOA score [P < 0.05, WMD = 0.68 (0.06, 1.30)] and recovery rates [P < 0.01, WMD = 0.12 (0.06, 0.17)] were significantly higher in the anterior group than in the posterior group. CONCLUSION: The anterior approach was associated with better postoperative neural function than the posterior approach in CM patients with ISI on T2-weighted MRI.


Assuntos
Vértebras Cervicais/diagnóstico por imagem , Vértebras Cervicais/cirurgia , Imagem por Ressonância Magnética/métodos , Procedimentos Ortopédicos/métodos , Doenças da Medula Espinal/diagnóstico por imagem , Doenças da Medula Espinal/cirurgia , Humanos , Estudos Prospectivos , Ensaios Clínicos Controlados Aleatórios como Assunto/métodos , Estudos Retrospectivos , Resultado do Tratamento
16.
World Neurosurg ; 130: 42-49, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31254689

RESUMO

BACKGROUND: Fistulas of the filum terminale are rare lesions that result from a fistulous connection between the artery and vein of the filum terminale. These lesions often present as progressive thoracic myelopathy secondary to venous hypertension that is transmitted to the coronal venous plexus of the spinal cord. Frequently, filum fistulas will be associated with lumbar stenosis and likely form as a result of chronic inflammation and compression. However, owing to the relative rarity of filum fistulas and the commonality of lumbar stenosis, the presence of a filum fistula could be overlooked or misdiagnosed. CASE DESCRIPTION: We have presented the case of a 62-year-old man with severe lumbar stenosis who had presented with progressive thoracic myelopathy. The evaluation, including spinal angiography, identified a low-flow arteriovenous fistula within the filum terminale that was successfully treated with microsurgical obliteration. The patient tolerated the procedure well, with good functional recovery within 1 month. CONCLUSION: Just as was the case with our patient, these lesions demonstrate a high association with lumbar stenosis and tethered or tight cord syndrome. We reviewed the clinical presentation, imaging findings, surgical management, and possible mechanisms of development for these rarely encountered fistulas.


Assuntos
Fístula Arteriovenosa/diagnóstico por imagem , Fístula Arteriovenosa/cirurgia , Cauda Equina/diagnóstico por imagem , Cauda Equina/cirurgia , Doenças da Medula Espinal/diagnóstico por imagem , Doenças da Medula Espinal/cirurgia , Humanos , Masculino , Pessoa de Meia-Idade , Doenças do Sistema Nervoso Periférico/diagnóstico por imagem , Doenças do Sistema Nervoso Periférico/cirurgia , Vértebras Torácicas/diagnóstico por imagem , Vértebras Torácicas/cirurgia
17.
BMC Vet Res ; 15(1): 182, 2019 May 31.
Artigo em Inglês | MEDLINE | ID: mdl-31151444

RESUMO

BACKGROUND: A retrospective case series study was undertaken to describe the magnetic resonance imaging (MRI) findings in Pug dogs with thoracolumbar myelopathy and concurrent caudal articular process (CAP) dysplasia. Electronic clinical records were searched for Pug dogs who underwent MRI for the investigation of a T3-L3 spinal cord segment disease with subsequent confirmation of CAP dysplasia with computed tomography between January 2013 and June 2017. Clinical parameters age, gender, neuter status, body weight, urinary or faecal incontinence, severity and duration of clinical signs were recorded. MRI abnormalities were described. Univariable non-parametric tests investigated the association between the clinical parameters and evidence of extra- or intra-dural spinal cord compression on MRI. RESULTS: 18 Pug dogs were included. The median age was 106 months with median duration of clinical signs 5 months. All presented with variable severity of spastic paraparesis and ataxia; 50% suffered urinary/faecal incontinence. In all cases, MRI revealed a focal increase in T2-weighted signal intensity within the spinal cord at an intervertebral level where bilateral CAP dysplasia was present; this was bilateral aplasia in all but one case, which had one aplastic and one severely hypoplastic CAP. MRI lesions were associated with spinal cord compression in all but one case; intervertebral disc protrusion resulted in extra-dural compression in 10 (56%) cases; intra-dural compression was associated with a suspected arachnoid diverticulum in 4 (22%) cases and suspected pia-arachnoid fibrosis in 3 cases (17%). There was no association between clinical parameters and a diagnosis of intra-dural vs extra-dural compression. CAP dysplasia occurred at multiple levels in the T10-13 region with bilateral aplasia at T11-12 most often associated with corresponding spinal cord lesions on MRI. CONCLUSIONS: All Pugs dogs in this study were presented for chronic progressive ambulatory paraparesis; incontinence was commonly reported. Although intervertebral disc disease was the most common radiologic diagnosis, intra-dural compression associated with arachnoid diverticulae/fibrosis was also common. Bilateral CAP aplasia was present in all but one Pug dog at the level of MRI detectable spinal cord lesions. A causal relationship between CAP dysplasia and causes of thoracolumbar myelopathy is speculated but is not confirmed by this study.


Assuntos
Doenças do Desenvolvimento Ósseo/veterinária , Doenças do Cão/diagnóstico por imagem , Doenças da Medula Espinal/veterinária , Animais , Doenças do Desenvolvimento Ósseo/diagnóstico por imagem , Cães , Feminino , Degeneração do Disco Intervertebral/diagnóstico por imagem , Degeneração do Disco Intervertebral/veterinária , Deslocamento do Disco Intervertebral/diagnóstico por imagem , Deslocamento do Disco Intervertebral/veterinária , Imagem por Ressonância Magnética/veterinária , Masculino , Paraparesia Espástica/veterinária , Estudos Retrospectivos , Compressão da Medula Espinal/diagnóstico por imagem , Compressão da Medula Espinal/veterinária , Doenças da Medula Espinal/diagnóstico por imagem , Vértebras Torácicas/diagnóstico por imagem
18.
Spine (Phila Pa 1976) ; 44(22): 1606-1612, 2019 Nov 15.
Artigo em Inglês | MEDLINE | ID: mdl-31205181

RESUMO

STUDY DESIGN: Prospective Cohort OBJECTIVE.: The aim of this study was to evaluate which demographic, clinical, or radiographic factors are associated with selection for surgical intervention in patients with mild cervical spondylotic myelopathy (CSM). SUMMARY OF BACKGROUND DATA: Surgery has not been shown superior to best conservative management in mild CSM comparative studies; trials of conservative management represent an acceptable alternative to surgical decompression. It is unknown what patients benefit from surgery. METHODS: This is a prospective study of patients with mild CSM, defined as modified Japanese Orthopaedic Association Score (mJOA) ≥15. Patients were recruited from seven sites contributing to the Canadian Spine Outcomes Research Network. Demographic, clinical, radiographic and health related quality of life data were collected on all patients at baseline. Multivariate logistic regression modeling was used to identify factors associated with surgical intervention. RESULTS: There were 122 patients enrolled, 105 (86.0%) were treated surgically, and 17 (14.0%) were treated nonoperatively. Overall mean age was 54.8 years (SD 12.6) with 80 (65.5%) males. Bivariate analysis revealed no statistically significant differences between surgical and nonoperative groups with respect to age, sex, BMI, smoking status, number of comorbidities and duration of symptoms; mJOA scores were significantly higher in the nonoperative group (16.8 [SD 0.99] vs. 15.9 [SD 0.89], P < 0.001). There was a statistically significant difference in Neck Disability Index, SF12 Physical Component, SF12 Mental Component Score, EQ5D, and PHQ-9 scores between groups; those treated surgically had worse baseline questionnaire scores (P < 0.05). There was no difference in radiographic parameters between groups. Multivariable analysis revealed that lower quality of life scores on EQ5D were associated with selection for surgical management (P < 0.018). CONCLUSION: Patients treated surgically for mild cervical myelopathy did not differ from those treated nonoperatively with respect to baseline demographic or radiographic parameters. Patients with worse EQ5D scores had higher odds of surgical intervention. LEVEL OF EVIDENCE: 3.


Assuntos
Vértebras Cervicais , Doenças da Medula Espinal , Adulto , Idoso , Vértebras Cervicais/diagnóstico por imagem , Vértebras Cervicais/cirurgia , Tratamento Conservador/estatística & dados numéricos , Descompressão Cirúrgica/estatística & dados numéricos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Qualidade de Vida , Doenças da Medula Espinal/diagnóstico por imagem , Doenças da Medula Espinal/epidemiologia , Doenças da Medula Espinal/terapia , Resultado do Tratamento
20.
World Neurosurg ; 128: 143-148, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31042601

RESUMO

BACKGROUND: Subacute posttraumatic ascending myelopathy (SPAM) involves the rise in high signal intensity on T2-weighted images ≥4 vertebral segments above the initial injured site, and it usually occurs within the first few weeks after the injury. The pathophysiologic mechanisms of traumatic spinal cord damage are not clearly understood; however, there are some pathophysiologic processes such as arterial thrombosis, venous thrombosis, congestive ischemia, inflammatory or autoimmune reaction, and infection in the form of meningitis or myelitis that could lead to SPAM. CASE DESCRIPTION: We present a case of T7 fracture because of left shoulder gunshot injury and ascending myelopathy up to the C2 vertebra level, which occurred 1 week after the gunshot injury, without pretraumatic cervical injury or syringomyelia. Although control magnetic resonance imaging findings showed the second rise in the high signal intensity level of the spinal cord, T2-weighted signal intensity and cord edema decreased and the patient showed neurologic improvement. CONCLUSIONS: This was the first case in the literature that showed rise 2 times in high signal intensity level in the spinal cord because of gunshot injury. Inflammatory reactions and secondary injury processes might have led to neurologic deterioration and ascending myelopathy in our case; therefore, the patient may have shown neurologic improvement after methylprednisolone therapy because of its anti-inflammatory and antiedema effects. There is no clear evidence whether neurologic improvement is associated with steroid therapy or it is because of the natural course of SPAM.


Assuntos
Paraplegia/fisiopatologia , Doenças da Medula Espinal/fisiopatologia , Traumatismos da Medula Espinal/fisiopatologia , Fraturas da Coluna Vertebral/diagnóstico por imagem , Vértebras Torácicas/diagnóstico por imagem , Ferimentos por Arma de Fogo/diagnóstico por imagem , Adulto , Progressão da Doença , Humanos , Laminectomia , Imagem por Ressonância Magnética , Masculino , Paraplegia/etiologia , Doenças da Medula Espinal/diagnóstico por imagem , Doenças da Medula Espinal/etiologia , Traumatismos da Medula Espinal/diagnóstico por imagem , Traumatismos da Medula Espinal/etiologia , Fraturas da Coluna Vertebral/complicações , Fraturas da Coluna Vertebral/cirurgia , Vértebras Torácicas/lesões , Vértebras Torácicas/cirurgia , Ferimentos por Arma de Fogo/complicações , Ferimentos por Arma de Fogo/cirurgia
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