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1.
Neurosurg Focus ; 51(4): E6, 2021 10.
Artigo em Inglês | MEDLINE | ID: mdl-34598123

RESUMO

OBJECTIVE: Ankylosing spondylitis, the most common spondyloarthritis, fuses individual spinal vertebrae into long segments. The unique biomechanics of the ankylosed spine places patients at unusually high risk for unstable fractures secondary to low-impact mechanisms. These injuries are unique within the spine trauma population and necessitate thoughtful management. Therefore, the authors aimed to present a richly annotated data set of operative AS spine fractures with a significant portion of patients with simultaneous dual noncontiguous fractures. METHODS: Patients with ankylosing spondylitis with acute fractures who received operative management between 2012 and 2020 were reviewed. Demographic, admission, surgical, and outcome parameters were retrospectively collected and reviewed. RESULTS: In total, 29 patients were identified across 30 different admissions. At admission, the mean age was 71.7 ± 11.8 years. The mechanism of injury in 77% of the admissions was a ground-level fall; 30% also presented with polytrauma. Of admissions, 50% were patient transfers from outside hospitals, whereas the other half presented primarily to our emergency departments. Fifty percent of patients sustained a spinal cord injury, and 35 operative fractures were identified and treated in 32 surgeries. The majority of fractures clustered around the cervicothoracic (C4-T1, 48.6%) and thoracolumbar (T8-L3, 37.11%) junctions. Five patients (17.2%) had simultaneous dual noncontiguous operative fractures; these patients were more likely to have presented with a higher-energy mechanism of injury such as a bicycle or motor vehicle accident compared with patients with a single operative fracture (60% vs 8%, p = 0.024). On preoperative MRI, 56.3% of the fractures had epidural hematomas (EDHs); 25% were compressive of the underlying neural elements, which dictated the number of laminectomy levels performed (no EDH, 2.1 ± 2.36; noncompressive EDH, 2.1 ± 1.85; and compressive EDH, 7.4 ± 4 [p = 0.003]). The mean difference in instrumented levels was 8.7 ± 2.6 with a mean estimated blood loss (EBL) of 1183 ± 1779.5 mL. Patients on a regimen of antiplatelet therapy had a significantly higher EBL (2635.7 mL vs 759.4 mL, p = 0.015). Overall, patients had a mean hospital length of stay of 15.2 ± 18.5 days; 5 patients died during the same admission or after transfer to an outside hospital. Nine of 29 patients (31%) had died by the last follow-up (the mean follow-up was 596.3 ± 878.9 days). CONCLUSIONS: Patients with AS who have been found to have unstable spine fractures warrant a thorough diagnostic evaluation to identify secondary fractures as well as compressive EDHs. These patients experienced prolonged inpatient hospitalizations with significant morbidity and mortality.


Assuntos
Fraturas da Coluna Vertebral , Espondilite Anquilosante , Idoso , Idoso de 80 Anos ou mais , Vértebras Cervicais/lesões , Humanos , Pessoa de Meia-Idade , Estudos Retrospectivos , Fraturas da Coluna Vertebral/diagnóstico por imagem , Fraturas da Coluna Vertebral/cirurgia , Espondilite Anquilosante/complicações , Espondilite Anquilosante/diagnóstico por imagem , Espondilite Anquilosante/cirurgia , Vértebras Torácicas/lesões
2.
Neurosurg Focus ; 51(4): E2, 2021 10.
Artigo em Inglês | MEDLINE | ID: mdl-34598125

RESUMO

OBJECTIVE: Ankylosing spinal disorders (ASDs) such as ankylosing spondylitis (AS) and diffuse idiopathic skeletal hyperostosis (DISH) are complex diseases regarding diagnostics, treatment, and patient outcome, especially in trauma. Originating from rigid biomechanics and low bone quality in considerably comorbid patients, serious spinal injury requires thorough and immediate imaging and is frequently missed. The aim of this study was to evaluate patient characteristics as well as procedures in patients with ASD in order to identify the major particularities of treatment. METHODS: A total of 60 patients aged 78.5 ± 8.9 years were retrospectively included. Preoperative imaging as well as surgical treatment procedures and postoperative patient outcome were analyzed, including 30-day readmissions. RESULTS: CT imaging of the entire spine was performed within 24 hours after the initial trauma in 73.3% of patients. A delay in diagnostics (> 24 hours) occurred in 41.7% of patients transferred from primary care centers. At admission, 25.0% of patients had fracture-related neurological deficits (American Spinal Injury Association [ASIA] grades A and B in 4 patients, and ASIA grades C and D in 11 patients). A spinal epidural hematoma was found in 21.2% of patients and was symptomatic in 72.7% of those patients. Of the patients with fracture-related neurological deficits, 93.3% were operated on within 48 hours from symptom onset. One patient (1.7%) developed neurological deficits from diagnosis to surgery. Postoperatively, 18.3% of patients had surgical complications, and 76.7% of patients developed further medical issues, with pneumonia (38.3%), pulmonary decompensation (25.0%), and cardiac decompensation (20.0%) being the leading causes. The 30-day mortality rate was high at 10.0%. CONCLUSIONS: Treatment of patients with ASDs is complex. While surgical outcome is usually good, the multimorbid nature of these patients results in a high rate of major medical complications. If an ankylosing disease is suspected, MRI of the entire spine is mandatory. Upon diagnosis, treatment should be performed in centers capable of managing all aspects of the regular complications these patients will develop.


Assuntos
Hiperostose Esquelética Difusa Idiopática , Fraturas da Coluna Vertebral , Espondilite Anquilosante , Humanos , Hiperostose Esquelética Difusa Idiopática/complicações , Hiperostose Esquelética Difusa Idiopática/diagnóstico por imagem , Hiperostose Esquelética Difusa Idiopática/cirurgia , Estudos Retrospectivos , Fraturas da Coluna Vertebral/complicações , Fraturas da Coluna Vertebral/diagnóstico por imagem , Fraturas da Coluna Vertebral/cirurgia , Coluna Vertebral , Espondilite Anquilosante/complicações , Espondilite Anquilosante/diagnóstico por imagem , Espondilite Anquilosante/cirurgia
4.
Neurosurg Focus ; 51(4): E4, 2021 10.
Artigo em Inglês | MEDLINE | ID: mdl-34598129

RESUMO

OBJECTIVE: The purpose of this retrospective cohort study was to analyze the early complications and mortality associated with multilevel spine surgery for unstable fractures in patients older than 80 years of age with ankylosing spondylitis and to compare the results with an age- and sex-matched cohort of patients with unstable osteoporotic fractures. METHODS: A retrospective review of the electronic medical records at a single institution was conducted between January 2014 and December 2019. Patient demographics, surgical characteristics, complications, hospital course, and 90-day mortality were collected. Comorbidities were stratified using the age-adjusted Charlson Comorbidity Index (CCI). RESULTS: Among 11,361 surgically treated patients, 22 patients with ankylosing spondylitis (AS group) and 24 patients with osteoporosis (OS group) were identified. The mean ages were 83.1 ± 3.1 years and 83.2 ± 2.6 years, respectively. A significant difference in the mean CCI score was found (7.6 vs 5.6; p < 0.001). Multilevel posterior fusion procedures were conducted in all patients, with 6.7 ± 1.4 fused levels in the AS group and 7.1 ± 1.1 levels fused in the OS group (p > 0.05). Major complications developed in 10 patients (45%) in the AS group compared with 4 patients (17%) in the OS group (p < 0.05). The 90-day mortality was 36% in the AS group compared with 0% in the OS group (p < 0.001). CONCLUSIONS: Patients older than 80 years of age with AS bear a high risk of adverse events after multilevel spinal fusion procedures. The high morbidity and 90-day mortality should be clearly discussed and carefully weighed against surgical treatment.


Assuntos
Osteoporose , Fraturas da Coluna Vertebral , Fusão Vertebral , Espondilite Anquilosante , Idoso de 80 Anos ou mais , Humanos , Osteoporose/complicações , Osteoporose/cirurgia , Estudos Retrospectivos , Fraturas da Coluna Vertebral/cirurgia , Fusão Vertebral/efeitos adversos , Espondilite Anquilosante/complicações , Espondilite Anquilosante/cirurgia , Resultado do Tratamento
5.
Neurosurg Focus ; 51(4): E8, 2021 10.
Artigo em Inglês | MEDLINE | ID: mdl-34598149

RESUMO

OBJECTIVE: The typical traumatic thoracolumbar (TL) fracture in patients with ankylosing spondylitis (AS) is a hyperextension injury involving all three spinal columns, which is associated with unfavorable outcomes. Although a consensus on the management of these highly unstable injuries is missing, minimally invasive surgery (MIS) has been progressively accepted as a treatment option, since it is related to lower morbidity and mortality rates. This study aimed to evaluate clinical and radiological outcomes after percutaneous instrumentation with cement augmentation for hyperextension TL fractures in patients with AS at a single institution. METHODS: This cohort study was completed retrospectively. Back pain was assessed at preoperative, postoperative, and final follow-up visits using the visual analog scale (VAS). Patient-reported outcomes via the Oswestry Disability Index (ODI) and the new mobility score (NMS) were obtained to assess disability and mobility during follow-up. Radiological outcomes included the Cobb angle, sagittal index (SI), union rate, and implant failure. Intra- and postoperative complications were recorded. RESULTS: A total of 22 patients met inclusion criteria. The mean patient age was 74.2 ± 7.3 years with a mean follow-up of 39.2 ± 17.4 months. The VAS score for back pain significantly improved over the follow-up period (from 8.4 ± 1.1 to 2.8 ± 0.8, p < 0.001). At the last follow-up, all patients had minor disability (mean ODI score 24.4 ± 6.1, p = 0.003) and self-sufficiency of mobility (mean NMS 7.5 ± 1.6, p = 0.02). The Cobb angle (5.2° ± 2.9° preoperatively to 4.4° ± 3.3° at follow-up) and SI (7.9° ± 4.2° to 8.8° ± 5.1°) were maintained at follow-up, showing no loss of segmental kyphosis. Bone union was observed in all patients. The overall complication rate was 9.1%, while the reoperation rate for implant failure was 4.5%. CONCLUSIONS: Percutaneous instrumentation with cement augmentation for traumatic hyperextension TL fractures in AS demonstrated good clinical and radiological outcomes, along with a high bone union level and low reoperation rate. Accordingly, MIS reduced the complication rate in the management of these injuries of the ankylosed spine.


Assuntos
Fraturas da Coluna Vertebral , Espondilite Anquilosante , Idoso , Idoso de 80 Anos ou mais , Estudos de Coortes , Fixação Interna de Fraturas , Humanos , Vértebras Lombares/diagnóstico por imagem , Vértebras Lombares/cirurgia , Estudos Retrospectivos , Fraturas da Coluna Vertebral/diagnóstico por imagem , Fraturas da Coluna Vertebral/cirurgia , Espondilite Anquilosante/complicações , Espondilite Anquilosante/diagnóstico por imagem , Espondilite Anquilosante/cirurgia , Vértebras Torácicas/diagnóstico por imagem , Vértebras Torácicas/lesões , Vértebras Torácicas/cirurgia , Resultado do Tratamento
6.
Neurosurg Focus ; 51(4): E9, 2021 10.
Artigo em Inglês | MEDLINE | ID: mdl-34598150

RESUMO

OBJECTIVE: Cervical fractures in patients with ankylosing spondylitis can have devastating neurological consequences. Currently, several surgical approaches are commonly used to treat these fractures: anterior, posterior, and anterior-posterior. The relative rarity of these fractures has limited the ability of surgeons to objectively determine the merits of each. The authors present an updated systematic review and meta-analysis investigating the utility of anterior surgical approaches relative to posterior and anterior-posterior approaches. METHODS: After a comprehensive literature search of the PubMed, Cochrane, and Embase databases, 7 clinical studies were included in the final qualitative and 6 in the final quantitative analyses. Of these studies, 6 compared anterior approaches with anterior-posterior and posterior approaches, while 1 investigated only an anterior approach. Odds ratios and 95% confidence intervals were calculated where appropriate. RESULTS: A meta-analysis of postoperative neurological improvement revealed no statistically significant differences in gross rates of neurological improvement between anterior and posterior approaches (OR 0.40, 95% CI 0.10-1.59; p = 0.19). However, when analyzing the mean change in neurological function, patients who underwent anterior approaches had a significantly lower mean change in postoperative neurological function relative to patients who underwent posterior approaches (mean difference [MD] -0.60, 95% CI -0.76 to -0.45; p < 0.00001). An identical trend was seen between anterior and anterior-posterior approaches; there were no statistically significant differences in gross rates of neurological improvement (OR 3.05, 95% CI 0.84-11.15; p = 0.09). However, patients who underwent anterior approaches experienced a lower mean change in neurological function relative to anterior-posterior approaches (MD -0.46, 95% CI -0.60 to -0.32; p < 0.00001). There were no significant differences in complication rates between anterior approaches, posterior approaches, or anterior-posterior approaches, although complication rates trended lower in patients who underwent anterior approaches. CONCLUSIONS: The results of this review and meta-analysis demonstrated the varying benefits of anterior approaches relative to posterior and anterior-posterior approaches in treatment of cervical fractures associated with ankylosing spondylitis. While reports demonstrated lower degrees of neurological improvement in anterior approaches, they may benefit patients with less-severe injuries if lower complication rates are desired.


Assuntos
Procedimentos Ortopédicos , Fraturas da Coluna Vertebral , Espondilite Anquilosante , Vértebras Cervicais/diagnóstico por imagem , Vértebras Cervicais/lesões , Vértebras Cervicais/cirurgia , Humanos , Fraturas da Coluna Vertebral/diagnóstico por imagem , Fraturas da Coluna Vertebral/cirurgia , Espondilite Anquilosante/complicações , Espondilite Anquilosante/cirurgia , Resultado do Tratamento
7.
Neurosurg Focus ; 51(4): E5, 2021 10.
Artigo em Inglês | MEDLINE | ID: mdl-34598124

RESUMO

OBJECTIVE: Ankylosing spondylitis (AS) is a chronic inflammatory disease affecting the sacroiliac joints and axial spine that is closely linked with human leukocyte antigen-B27. There appears to be an increased frequency of associated epidural hematomas in spine fractures in patients with AS. The objective was to review the incidence within the literature and a single-institution experience of the occurrence of epidural hematoma in the context of patients with AS requiring spine surgery. METHODS: Deep 6 AI software was used to search the entire database of patients at a single level I trauma center (since the advent of the institution's modern electronic health record system) to look at all patients with AS who underwent spinal surgery and who had a diagnosis of epidural hematoma. Additionally, a systemic literature review was performed of all papers evaluating the incidence of epidural hematoma in patients with spine fractures. RESULTS: A single-institution, retrospective review of records from 2009 to 2020 yielded a total of 164 patients with AS who underwent spine surgery. Of those patients, 17 (10.4%) had epidural hematomas on imaging, with the majority requiring surgical decompression. These spine fractures occurred close to the cervicothoracic or thoracolumbar junction. The patients ranged in age from 51 to 88 years, and there were 14 males and 3 females in the cohort. Eight patients were administered an antiplatelet and/or anticoagulant agent, and the rest were not. All patients required surgical stabilization, with 64.7% of patients also requiring decompressive laminectomies for evacuation of the hematoma and spinal cord decompression. Only 1 death was reported in the series. There was a tendency toward neurological improvement after surgical intervention. CONCLUSIONS: AS has been a well-described pathologic process that leads to an increased risk of three-column injury in spine fracture, with an increased incidence of symptomatic epidural hematoma compared with patients without AS. Early recognition of this entity is important to ensure that appropriate surgical management includes addressing compression of the neural elements in addition to surgical stabilization.


Assuntos
Hematoma Epidural Espinal , Fraturas da Coluna Vertebral , Espondilite Anquilosante , Idoso , Idoso de 80 Anos ou mais , Feminino , Hematoma Epidural Espinal/diagnóstico por imagem , Hematoma Epidural Espinal/epidemiologia , Hematoma Epidural Espinal/cirurgia , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Coluna Vertebral , Espondilite Anquilosante/complicações , Espondilite Anquilosante/diagnóstico por imagem , Espondilite Anquilosante/epidemiologia
8.
Am J Case Rep ; 22: e932760, 2021 Oct 12.
Artigo em Inglês | MEDLINE | ID: mdl-34637425

RESUMO

BACKGROUND The presence of fat droplets within the subarachnoid space is an uncommon finding, which is almost exclusively associated with a ruptured dermoid cyst. In a trauma setting, transthecal migration of fat droplets is an extremely rare occurrence. We present 2 case reports of intracranial transthecal migration of fatty bone marrow after sacral fractures. CASE REPORT Both patients presented to the Emergency Department (ED) after falls from a standing height. The first patient, an 84-year-old woman, suffered a stable sacral fracture extending into a large meningeal cyst within the right S2 foramen. Her initial neurological assessment and computed tomography (CT) of the head were unremarkable. As the fracture did not require surgical treatment, she was discharged home and prescribed bed rest, analgesics, and venous thromboembolism prophylaxis. Three days after the injury, she was readmitted to the ED with a mild headache, dizziness, and an episode of nausea and vomiting. A follow-up head CT revealed fat droplets in the subarachnoid space and lateral ventricles. After successful symptomatic treatment, she was discharged home in good general condition. The second patient, a 60-year-old man, underwent a head CT for a scalp hematoma, which revealed fat droplets in the 3rd ventricle and right lateral ventricle. The pelvic CT revealed a large sacral meningeal cyst with microfractures in its wall. He was discharged home on the same day and prescribed bed rest and analgesics. CONCLUSIONS The detection of intracranial intrathecal fat droplets in association with a specific trauma mechanism should initiate the search for a sacral fracture.


Assuntos
Lesões do Pescoço , Fraturas da Coluna Vertebral , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Ruptura , Sacro/diagnóstico por imagem , Sacro/lesões , Tomografia Computadorizada por Raios X
9.
JNMA J Nepal Med Assoc ; 59(236): 402-405, 2021 Apr 30.
Artigo em Inglês | MEDLINE | ID: mdl-34508540

RESUMO

Burst fracture of C5 with traumatic anterior spondyloptosis of C6 and posterior spondylolisthesis of C4 vertebra is an exceedingly rare high energy injury. Treatment includes decompression, reduction, stabilization, and fusion via anterior or posterior or combined anterior-posterior approach with or without prior traction. We report this rare subaxial cervical spine injury associated with quadriplegia managed with combined anterior and posterior instrumented fusion. A multidisciplinary approach with preoperative assessment and planning is crucial in managing cervical spine injury. Immediate postoperative critical care support, rehabilitation, and dedicated nursing care are required for a favorable outcome in traumatic quadriplegia.


Assuntos
Fraturas da Coluna Vertebral , Espondilolistese , Vértebras Cervicais/diagnóstico por imagem , Vértebras Cervicais/lesões , Vértebras Cervicais/cirurgia , Humanos , Fraturas da Coluna Vertebral/complicações , Fraturas da Coluna Vertebral/diagnóstico por imagem , Fraturas da Coluna Vertebral/cirurgia , Espondilolistese/cirurgia
10.
BMC Musculoskelet Disord ; 22(1): 757, 2021 Sep 04.
Artigo em Inglês | MEDLINE | ID: mdl-34481480

RESUMO

BACKGROUND: The prevention of self-harm is an international public health priority. It is vital to identify at-risk populations, particularly as self-harm is a risk factor for suicide. This study aims to examine the risk of self-harm in people with vertebral fractures. METHODS: Retrospective cohort study. Patients with vertebral fracture were identified within the Clinical Practice Research Datalink and matched to patients without fracture by sex and age. Incident self-harm was defined by primary care record codes following vertebral fracture. Overall incidence rates (per 10,000 person-years (PY)) were reported. Cox regression analysis determined risk (hazard ratios (HR), 95 % confidence interval (CI)) of self-harm compared to the matched unexposed cohort. Initial crude analysis was subsequently adjusted and stratified by median age and sex. RESULTS: The number of cases of vertebral fracture was 16,293, with a matched unexposed cohort of the same size. Patients were predominantly female (70.1 %), median age was 76.3 years. Overall incidence of self-harm in the cohort with vertebral fracture was 12.2 (10.1, 14.8) /10,000 PY. There was an initial crude association between vertebral fracture and self-harm, which remained after adjustment (HR 2.4 (95 %CI 1.5, 3.6). Greatest risk of self-harm was found in those with vertebral fractures who were aged below 76.3 years (3.2(1.8, 5.7)) and male (3.9(1.8, 8.5)). CONCLUSIONS: Primary care patients with vertebral fracture are at increased risk of self-harm compared to people without these fractures. Male patients aged below 76 years of age appear to be at greatest risk of self-harm. Clinicians need to be aware of the potential for self-harm in this patient group.


Assuntos
Comportamento Autodestrutivo , Fraturas da Coluna Vertebral , Idoso , Estudos de Coortes , Feminino , Humanos , Incidência , Masculino , Estudos Retrospectivos , Fatores de Risco , Comportamento Autodestrutivo/diagnóstico , Comportamento Autodestrutivo/epidemiologia , Fraturas da Coluna Vertebral/epidemiologia
11.
BMJ Open ; 11(9): e045854, 2021 09 06.
Artigo em Inglês | MEDLINE | ID: mdl-34489267

RESUMO

INTRODUCTION: Multiple myeloma (MM) is a plasma cell cancer where about 1/3 of the patients present with pathological fractures at the time of diagnosis. Despite treatment, the majority of the patients will develop additional fractures. Because survival and prognosis has improved significantly over the last two decades for patients with MM, there is an increased need to focus on optimal fracture treatment. Traditionally, fracture pain is treated conservatively with opioids, bisphosphonates, bracing and radiation therapy. Vertebral augmentation has been used for the last three decades as a minimally invasive treatment option for vertebral compression fractures, but the evidence base for the efficacy is weak. We describe a trial assessing the impact of vertebroplasty on clinical outcome in the treatment of patients with MM with painful vertebral fractures. METHODS: 100 patients with MM with painful vertebral fractures will be randomised in a prospective, single-blinded, multicentre, clinical trial where patients are randomised to either usual care or usual care supplemented with vertebroplasty with a possibility of crossover 4 weeks after randomisation. The primary outcome will be change in Oswestry Disability Index at 4 weeks. ANALYSIS: Primary and secondary outcomes are assessed at baseline and at 4, 8, 26 and 52 weeks. Categorical data will be presented by means of frequencies and related percentages; continuous data will be displayed by means of descriptive statistics. ETHICS AND DISSEMINATION: The study has been evaluated by the Regional Committees on Health Research for Southern Denmark (S-20200075) and notified and approved by the Region of Southern Denmark and listed in the internal record, journal no. 20/22355. All participants provide consent. The protocol will follow the SPIRIT (Standard Protocol Items for Randomized Trials) statement. The Danish Myeloma Patient Organization supports the study. Findings will be disseminated in peer-reviewed publications and presented at national and international conferences. TRIAL REGISTRATION NUMBER: NCT04533217.


Assuntos
Fraturas por Compressão , Mieloma Múltiplo , Fraturas da Coluna Vertebral , Vertebroplastia , Fraturas por Compressão/etiologia , Fraturas por Compressão/cirurgia , Humanos , Estudos Multicêntricos como Assunto , Mieloma Múltiplo/complicações , Estudos Prospectivos , Ensaios Clínicos Controlados Aleatórios como Assunto , Método Simples-Cego , Fraturas da Coluna Vertebral/cirurgia , Resultado do Tratamento
12.
BMC Musculoskelet Disord ; 22(1): 805, 2021 Sep 18.
Artigo em Inglês | MEDLINE | ID: mdl-34537042

RESUMO

BACKGROUND: The impact of intravertebral cleft (IVC) on cement leakage in percutaneous vertebroplasty (PVP) for osteoporotic vertebral compression fractures (OVCFs) has been discussed. However, the results were conflicting, as the study population and cement leakage classification were heterogeneous. The aim of the study was to evaluate the impact of IVC on the incidence of leakage through vein, leakage through cortex as well as general leakage in PVP for OVCFs. METHODS: All patients with OVCFs who underwent PVP between January 2016 and June 2019 at our institution were retrospectively reviewed. Patients were eligible for this case-control study if they were diagnosed as single level fracture in spine. After inclusive and exclusive criteria were met, a total of 139 patients with IVC were enrolled as the study group. Non-IVC controls were matched in a 1:1 ratio in age (within 3 years), sex and fracture severity with patients in study group. Cement leakage were classified into four types [type B (through basivertebral vein), type S (through segmental vein), type-C (through a cortical defect), and type D (intradiscal leakage)], furtherly into two types [venous type (type-B or/and type S) and cortical type (type-C or/and type-D)]. A general leakage rate and a specific leakage rate per each type were compared between both groups. RESULTS: Each group included 139 patients. Groups were homogenous for age, sex, fracture severity, fracture location, fracture type, cement volume, puncture approach and property of cement. Compared with control group, IVC group had a significantly lower rate of type-B (20.9% vs. 31.7%, P = 0.041), type-S (24.5% vs. 52.5%, P = 0.000), and venous type leakage (37.4% vs. 67.6%, P = 0.000), a significantly higher rate of type-C (25.9% vs. 12.2%, P = 0.004), type-D (16.5% vs. 6.5%, P = 0.009), and cortical type leakage (40.3% vs. 16.5%, P = 0.000), no significant difference on the rate of general leakage (67.6% vs. 76.3%, P = 0.109). CONCLUSION: IVC decreased the risk of cement leakage through vein and increased the risk of cement leakage through cortex. However, it had no significant effect on the occurrence of general leakage.


Assuntos
Fraturas por Compressão , Fraturas por Osteoporose , Fraturas da Coluna Vertebral , Vertebroplastia , Cimentos Ósseos/uso terapêutico , Estudos de Casos e Controles , Pré-Escolar , Fraturas por Compressão/diagnóstico por imagem , Fraturas por Compressão/epidemiologia , Fraturas por Compressão/cirurgia , Humanos , Fraturas por Osteoporose/diagnóstico por imagem , Fraturas por Osteoporose/epidemiologia , Fraturas por Osteoporose/cirurgia , Estudos Retrospectivos , Fatores de Risco , Fraturas da Coluna Vertebral/diagnóstico por imagem , Fraturas da Coluna Vertebral/epidemiologia , Fraturas da Coluna Vertebral/cirurgia , Resultado do Tratamento , Vertebroplastia/efeitos adversos
13.
Niger J Clin Pract ; 24(9): 1360-1365, 2021 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-34531350

RESUMO

Objective: This study aims to evaluate the clinical efficacy of percutaneous pedicle screw fixation (PPSF) combined with percutaneous vertebroplasty (PVP) for the treatment of the thoracolumbar vertebral compression fracture (VCF) without neurologic deficits. Materials and Methods: This was a prospective observational study. Between January 2015 and December 2018, 62 patients who had suffered from traumatic thoracolumbar (VCF) burst fractures without neurologic deficits were included in this study. The patients were divided into two groups as follows: patients who underwent PPSF combined with PVP (PPSF-PVP Group; n = 24) and patients who underwent only PPSF (PPSF Group; n = 38). The patients were (PPSF and PPSF-PVP Group) followed up for more than 9 months. The kyphotic angle, compression ratio, and visual analog scale (VAS) score for back pain were analyzed and compared between the two groups. Results: The patients were followed up for an average of 9.1 months. Hospital stay significantly decreased in PPSF-PVP Group (P < 0.001). The median VAS score significantly decreased after the surgery in both the groups (P < 0.005), and mean VAS scores in PPSF-PVP Group were significantly lower than those in PPSF Group. No significant (P > 0.005) changes in local kyphosis and the vertebral body height gains obtained at the end of the follow-up period in PPSF-PVP Group. However, local kyphosis increased significantly (P < 0.005) and the central and anterior vertebral body height decreased significantly (P < 0.005) when compared with the PPSF-PVP Group. Conclusion: PPSF combined with PVP procedure is a good choice for the treatment of traumatic thoracolumbar VCF; however, due to the lack of long-term follow-up data, concern still exists regarding the effects of pedicle screw procedure after PVP.


Assuntos
Fraturas por Compressão , Parafusos Pediculares , Fraturas da Coluna Vertebral , Vertebroplastia , Fixação Interna de Fraturas , Fraturas por Compressão/cirurgia , Humanos , Vértebras Lombares/diagnóstico por imagem , Vértebras Lombares/cirurgia , Fraturas da Coluna Vertebral/cirurgia , Vértebras Torácicas/lesões , Vértebras Torácicas/cirurgia , Resultado do Tratamento
14.
Medicine (Baltimore) ; 100(35): e27135, 2021 Sep 03.
Artigo em Inglês | MEDLINE | ID: mdl-34477163

RESUMO

RATIONALE: We present the first case of a patient with severe aortic stenosis who developed anaphylactic shock and was successfully treated with adrenaline and landiolol, a highly selective ß1-receptor blocker, to prevent disruption of the myocardial oxygen supply-demand balance caused by tachycardia. PATIENT CONCERNS: An 86-year-old woman was scheduled for simultaneous anterior-posterior fixation for a burst fracture of the 12th thoracic vertebra; 200 mg sugammadex, a neuromuscular blocking agent antagonist, was administered postoperatively, and she was extubated without complications. However, 6 min after extubation, her blood pressure decreased abruptly to 55/29 mm Hg, and her heart rate increased to 78 bpm. Then, we intervened with fluid loading, an increased dose of noradrenaline, and phenylephrine administration. However, her blood pressure did not increase. DIAGNOSES: A general observation revealed urticaria on the lower leg; thus, we suspected anaphylactic shock due to sugammadex administration. INTERVENTIONS: We carefully administered 2 doses of 0.05 mg adrenaline and simultaneously administered landiolol at 60 µg/kg/min to suppress adrenaline-induced tachycardia. Adrenaline administration resulted in a rapid increase in blood pressure to 103/66 mm Hg and a maximum heart rate of 100 bpm, suppressing excessive tachycardia. OUTCOMES: The patient's general condition was stable after the intervention, and circulatory agonists could be discontinued the following day. She was discharged from the intensive care unit on the fourth postoperative day. LESSONS: Landiolol may help control the heart rate of patients with aortic stenosis and anaphylactic shock. The combined use of landiolol and adrenaline may improve patient outcomes; however, their efficacy and risks must be evaluated by studying additional cases.


Assuntos
Agonistas Adrenérgicos beta/uso terapêutico , Antagonistas Adrenérgicos beta/uso terapêutico , Anafilaxia/induzido quimicamente , Epinefrina/uso terapêutico , Morfolinas/uso terapêutico , Sugammadex/efeitos adversos , Ureia/análogos & derivados , Idoso de 80 Anos ou mais , Anafilaxia/tratamento farmacológico , Estenose da Valva Aórtica/complicações , Estenose da Valva Aórtica/diagnóstico por imagem , Ecocardiografia , Feminino , Humanos , Complicações Pós-Operatórias/induzido quimicamente , Complicações Pós-Operatórias/tratamento farmacológico , Rocurônio/antagonistas & inibidores , Fraturas da Coluna Vertebral/complicações , Fraturas da Coluna Vertebral/cirurgia , Ureia/uso terapêutico
15.
Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi ; 35(9): 1155-1160, 2021 Sep 15.
Artigo em Chinês | MEDLINE | ID: mdl-34523281

RESUMO

Objective: To investigate the effectiveness of synchronous unilateral percutaneous kyphoplasty (PKP) in the treatment of double noncontiguous thoracolumbar osteoporotic vertebral compression fracture (OVCF). Methods: Between December 2018 and September 2020, 27 patients with double noncontiguous thoracolumbar OVCF were treated by synchronous unilateral PKP. There were 11 males and 16 females, with an average age of 75.4 years (range, 66-92 years). The fractures were caused by falls in 22 cases and sprains in 5 cases. The time from injury to hospital admission was 0.5-7.0 days, with an average of 2.1 days. The fractured vertebrae located at T 9 in 2 cases, T 10 in 3 cases, T 11 in 10 cases, T 12 in 15 cases, L 1 in 12 cases, L 2 in 6 cases, L 3 in 4 cases, and L 4 in 2 cases. The volume of bone cement injected into each vertebral body, operation time, and intraoperative fluoroscopy times were recorded. Anteroposterior and lateral X-ray films of thoracolumbar spine were taken to observe the anterior height of the injured vertebra, the Cobb angle of kyphosis, and the diffusion and good distribution rate of bone cement in the thoracolumbar spine. Visual analogue scale (VAS) score and Oswestry disability index (ODI) were used to evaluate the pain and functional improvement. Results: All operations completed successfully. The operation time was 34-70 minutes, with an average of 45.4 minutes. The intraoperative fluoroscopy was 21- 60 times, with an average of 38.6 times. The volume of bone cement injected into each vertebral body was 2-9 mL, with an average of 4.3 mL. All patients were followed up 6-21 months, with an average of 11.3 months. X-ray film reexamination showed that the anterior height of the injured vertebra and Cobb angle at each time point after operation were significantly improved than those before operation ( P<0.05), and there was no significant difference between different time points after operation ( P>0.05). The distribution of bone cement was excellent in 40 vertebral bodies, good in 13 vertebral bodies, and poor in 1 vertebral body, and the excellent and good rate was 98.1% (53/54). The pain of all patients significantly relieved or disappeared, and the function improved. The VAS score and ODI at each time point after operation were significantly lower than those before operation ( P<0.05), and there was no significant difference between different time points after operation ( P>0.05). Conclusion: For the double noncontiguous thoracolumbar OVCF, the synchronous unilateral PKP has the advantages of simple puncture, less trauma, less intraoperative fluoroscopy, shorter operation time, satisfactory distribution of bone cement, etc. It can restore the height of the vertebral body, correct the kyphotic angle, significantly alleviate the pain, and improve the function.


Assuntos
Fraturas por Compressão , Cifoplastia , Fraturas por Osteoporose , Fraturas da Coluna Vertebral , Idoso , Cimentos Ósseos , Feminino , Fraturas por Compressão/diagnóstico por imagem , Fraturas por Compressão/cirurgia , Humanos , Masculino , Fraturas por Osteoporose/cirurgia , Estudos Retrospectivos , Fraturas da Coluna Vertebral/cirurgia , Punção Espinal , Resultado do Tratamento
16.
Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi ; 35(9): 1161-1166, 2021 Sep 15.
Artigo em Chinês | MEDLINE | ID: mdl-34523282

RESUMO

Objective: To compare the refracture risk between sandwich vertebrae and ordinary adjacent vertebrae, and to explore the risk factors related to refracture. Methods: Retrospective analysis was performed on the data of patients who received percutaneous vertebral augmentation (PVA) and formed sandwich vertebrae between April 2015 and October 2019. Of them, 115 patients were enrolled in the study. There were 27 males and 88 females with an average age of 73.9 years (range, 53-89 years). Univariate analysis was performed to analyzed the patients' general data, vertebral augmentation related indexes, and sandwich vertebrae related indexes. Survival analysis was performed for all untreated vertebrae at T 4-L 5 of the included patients at the vertebra-specific level, and risk curves of refracture probability of untreated vertebrae between sandwich vertebrae and ordinary adjacent vertebrae were compared. Cox's proportional hazards regression model was used to analyze risk factors for refracture. Results: The 115 patients were followed up 12.6-65.9 months (mean, 36.2 months). Thirty-seven refractures involving 51 vertebral bodies occurred in 31 patients. The refracture rate of 27.0% (31/115) in patients with sandwich vertebrae was significantly higher than that of 15.2% (187/1228) in all patients who received PVA during the same period ( χ 2=10.638, P=0.001). Univariate analysis results showed that there was a significant difference in the number of augmented vertebrae between patients with and without refractures ( Z=0.870, P=0.004). However, there was no significant difference in gender, age, body mass index, whether had clear causes of fracture, whether had dual energy X-ray absorptiometry testing, whether the sandwich vertebra generated through the same PVA, puncture method, method of PVA, number of PVA procedures, number of vertebrae with old fracture, whether complicated with spinal deformity, bone cement distribution, and kyphosis angle of sandwich vertebral area ( P>0.05). Among the 1 293 untreated vertebrae, there were 136 sandwich vertebrae and 286 ordinary adjacent vertebrae. The refracture rate of sandwich vertebrae was 11.3% which was higher than that of ordinary adjacent vertebrae (6.3%)( χ 2=4.668, P=0.031). The 1- and 5-year fracture-free probabilities were 0.90 and 0.87 for the sandwich vertebrae, and 0.95 and 0.93 for the ordinary adjacent vertebrae, respectively. There was a significant difference between the two risk curves of refracture ( χ 2=4.823, P=0.028). Cox's proportional hazards regression model analysis results showed that the sandwich vertebrae, thoracolumbar location, the number of the augmented vertebrae, and the unilateral puncture were significant risk factors for refracture ( P<0.05). Conclusion: The sandwich vertebrae has a higher risk of refracture when compared with the ordinary adjacent vertebrae, and its 1- and 5-year fracture-free probabilities are lower than those of the ordinary adjacent vertebrae. However, the 5-year fracture-free probability of sandwich vertebrae is still 0.87, so prophylactic enhancement is not recommended for all sandwich vertebrae. In addition, the sandwich vertebrae, thoracolumbar location, the number of the augmented vertebrae, and the unilateral puncture were important risk factors for refracture.


Assuntos
Fraturas por Compressão , Fraturas por Osteoporose , Fraturas da Coluna Vertebral , Vertebroplastia , Idoso , Cimentos Ósseos , Feminino , Humanos , Masculino , Estudos Retrospectivos , Fatores de Risco , Coluna Vertebral
17.
J Int Med Res ; 49(9): 3000605211046115, 2021 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-34551614

RESUMO

Percutaneous vertebroplasty (PVP) was first reported in 1987 for treating vertebral hemangiomas. PVP is also an effective treatment for osteoporotic vertebral compression fracture that mainly involves a percutaneous injection of polymethylmethacrylate. Severe complications of PVP have been reported in recent years. However, to the best of our knowledge, cement-associated thrombotic embolism in the inferior vena cava and bilateral iliac veins after PVP has rarely been reported. We experienced a patient with cement-associated thrombotic embolism in the inferior vena cava and bilateral iliac veins after PVP. Fortunately, after conservative therapy, we achieved a satisfactory result. Unfortunately, we could not explain the cause of the cement leakage and formation of the thrombotic embolism. We believe that surgeons should have a better understanding of the fracture pattern and anatomy of the vertebral venous net system. They should also perform meticulous imaging monitoring with slower pushing of the cement to minimize the risks during the PVP. This case report highlights a rare, but potentially life-threatening, complication of PVP. Surgeons need to be aware of the possibility of cement leakage and the formation of cement-associated thrombotic embolism so that they are much more vigilant when performing PVP.


Assuntos
Embolia , Fraturas por Compressão , Fraturas por Osteoporose , Fraturas da Coluna Vertebral , Vertebroplastia , Cimentos Ósseos/efeitos adversos , Humanos , Veia Ilíaca/diagnóstico por imagem , Resultado do Tratamento , Veia Cava Inferior/diagnóstico por imagem , Vertebroplastia/efeitos adversos
18.
BMJ Case Rep ; 14(9)2021 Sep 29.
Artigo em Inglês | MEDLINE | ID: mdl-34588199

RESUMO

A 67-year-old man who had been pinned between a basket crane and a tree complained of severe pain in his lower back and a decreased appetite. Laparotomy after decompressing the gastrointestinal tract revealed incarceration of an ileal loop within a fractured third lumbar vertebra. The damaged bowel was resected, and an end-to-end anastomosis was performed. Once the patient's condition had stabilised, posterior lumbar fixation was performed. There were no abdominal complications or lower limb neurological deficits during the follow-up period. Enhanced CT and MRI had been helpful in making the diagnoses. Histopathological examination revealed the aetiology of the traumatic incarceration: the intestine had been pinched as the disc space closed, and the body attempted to return to its original state by exerting countertraction.


Assuntos
Fraturas da Coluna Vertebral , Idoso , Fixação Interna de Fraturas , Humanos , Hérnia Interna , Vértebras Lombares/diagnóstico por imagem , Vértebras Lombares/lesões , Vértebras Lombares/cirurgia , Masculino , Fraturas da Coluna Vertebral/complicações , Fraturas da Coluna Vertebral/diagnóstico por imagem , Corpo Vertebral
19.
Comput Biol Med ; 137: 104833, 2021 10.
Artigo em Inglês | MEDLINE | ID: mdl-34534795

RESUMO

Osteoporosis-related vertebral compression fracture can occur under normal physiological activities. Bone metastasis is another source of vertebral fracture. Different loading rates, either high-energy traumas such as falls or low-energy traumas under normal physiological activities, can result in different fracture outcomes. The aim of the current study was to develop a quantitative computed tomography-based finite element analysis (QCT/FEA) technique for single vertebral bodies to predict fracture strength of three-level spine segments. Developed QCT/FEA technique was also used to characterize vertebral elastic moduli at two loading rates of 5 mm/min, representing a physiologic loading condition, and 12000 mm/min, representing a high-energy trauma. To this end, a cohort of human spine segments divided into three groups of intact, defect, and augmented were mechanically tested to fracture; then, experimental stiffness and fracture strength values were measured. Outcomes of this study showed no significant difference between the elastic modulus equations at the two testing speeds. Areal bone mineral density measured by dual x-ray absorptiometry (DXA/BMD) explained only 53% variability (R2 = 0.53) in fracture strength outcomes. However, QCT/FEA could explain 70% of the variability (R2 = 0.70) in experimentally measured fracture strength values. Adding disk degeneration grading, testing speed, and sex to QCT/FEA-estimated fracture strength values further increased the performance of our statistical model by 14% (adjusted R2 of 0.84 between the prediction and experimental fracture forces). In summary, our results indicated that a single-vertebra model, which is computationally less expensive and more time efficient, is capable of estimating fracture outcomes with acceptable performance (range: 70-84%).


Assuntos
Fraturas por Compressão , Fraturas da Coluna Vertebral , Absorciometria de Fóton , Densidade Óssea , Análise de Elementos Finitos , Fraturas por Compressão/diagnóstico por imagem , Humanos , Fraturas da Coluna Vertebral/diagnóstico por imagem , Coluna Vertebral
20.
Acta Biomed ; 92(S5): e2021402, 2021 09 10.
Artigo em Inglês | MEDLINE | ID: mdl-34505841

RESUMO

BACKGROUND AND AIM: To establish an optimal timing for vertebroplasty in order to obtain a clinically important pain reduction and improving quality of live in patients with osteoporotic or traumatic vertebral fractures. METHODS: This study includes 22 vertebroplasty procedures performed from October 2018 to July 2020 in 21 patients with traumatic or osteoporotic vertebral fractures (19 female, two men; age between 53 and 89 years). All treatments were executed under fluoroscopic guidance using 11 or 13 G needle through transpedicular or costovertebral unilateral approach. Each patient underwent conscious sedation, continuously monitored by an anesthesiologist. Preoperative MRI images, obtained by 3T or 1.5T MRI scanner, always showed bone marrow edema. The VAS scale and Roland Morris disability questionnaire (RMdq) were administered to patients before and after the treatment to evaluate pain and life quality. RESULTS: 7 patients were treated in the first month after the injury, one was treated twice; 8 patients in the second month, 6 in the third. We observed a reduction of: 5.5 points in the vas scale, 10.3 in the RMdq in the first month; 5.6 points vas, 11.6 points RMdq in the second month; 4 points vas and 9.75 points RMdq in the third month. CONCLUSIONS: This study demostrated that, in our preliminary experience, vertebroplasty has the best outcome if performed at 2 months from injury.


Assuntos
Fraturas por Compressão , Fraturas por Osteoporose , Fraturas da Coluna Vertebral , Vertebroplastia , Idoso , Idoso de 80 Anos ou mais , Feminino , Fraturas por Compressão/diagnóstico por imagem , Fraturas por Compressão/cirurgia , Humanos , Masculino , Pessoa de Meia-Idade , Fraturas por Osteoporose/diagnóstico por imagem , Fraturas por Osteoporose/cirurgia , Medição da Dor , Estudos Retrospectivos , Fraturas da Coluna Vertebral/diagnóstico por imagem , Fraturas da Coluna Vertebral/cirurgia , Resultado do Tratamento
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