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1.
Medicine (Baltimore) ; 100(9): e24973, 2021 Mar 05.
Artigo em Inglês | MEDLINE | ID: mdl-33655965

RESUMO

RATIONALE: An abdominal pseudohernia is a protrusion of the abdominal wall that there is no actual muscular disruption. This report presents a case in which abdominal muscle activities were accurately and quantitatively measured using ultrasonography (US) and surface electromyography in a patient with abdominal pseudohernia. PATIENT CONCERNS: A 62-year-old man presented with a marked protrusion on the left abdomen with increasing abdominal pressure. DIAGNOSES: First, the thickness of the abdominal muscle was measured with US while the patient constantly blew the positive expiratory pressure device. When the force was applied to the abdomen, the mean thickness of the muscle layer on the lesion site was found to be thinner. Second, the activities of the abdominal muscles were measured using surface electromyography by attaching electrodes to 8 channels at the same time. When the same pressure was applied on both sides of the abdomen, more recruitment occurred to compensate for muscle weakness at the lesion site. Through the previous 2 tests, the decrease in muscle activity in the lesion area could be quantitatively evaluated. Third, the denervation of the muscle was confirmed using US-guided needle electromyography. INTERVENTIONS: The patient in this case was wearing an abdominal binder. In addition, he had been training his abdominal muscles through McGill exercise and breathing exercises such as with a positive expiratory pressure device. OUTCOMES: The patient was able to understand his symptoms. A follow-up test will be performed to see if there is any improvement. LESSONS: By using these outstanding assessment methods, proper diagnosis and rehabilitation treatment strategies can be developed.


Assuntos
Músculos Abdominais/diagnóstico por imagem , Eletromiografia/métodos , Fraturas por Compressão/complicações , Hérnia Abdominal/diagnóstico , Vértebras Lombares/lesões , Fraturas da Coluna Vertebral/complicações , Vértebras Torácicas/lesões , Ultrassonografia/métodos , Músculos Abdominais/fisiopatologia , Fraturas por Compressão/diagnóstico , Hérnia Abdominal/etiologia , Humanos , Masculino , Pessoa de Meia-Idade , Fraturas da Coluna Vertebral/diagnóstico
2.
Medicine (Baltimore) ; 100(10): e25056, 2021 Mar 12.
Artigo em Inglês | MEDLINE | ID: mdl-33725892

RESUMO

ABSTRACT: Sacral fracture is the most frequent posterior injury among unstable pelvic ring fractures and is prone to massive hemorrhage and hemodynamic instability. Contrast extravasation (CE) on computed tomography (CT) is widely used as an indicator of significant arterial bleeding. However, while CE is effective to detect significant arterial bleeding but negative result cannot completely rule out massive bleeding. Therefore, additional factors help to compensate CE for the prediction of early hemodynamically unstable condition.We evaluated the risk factors that predict CE on enhanced computed CT in patients with sacral fractures. Patients were classified into 2 groups: CE positive on enhanced CT of the pelvis [CE(+)] and CE negative [CE(-)]. We compared age, sex, injury severity score (ISS), systolic blood pressure (sBP), type of sacral fracture based on Denis classification, platelet (PLT), base excess, lactate, prothrombin time-international normalized ratio, hemoglobin (Hb), activated partial thromboplastin time, D-dimer, and fibrinogen between the 2 groups.A total of 82 patients were treated for sacral fracture, of whom 69 patients were enrolled. There were 17 patients (10 men and 7 women) in CE(+) and 52 patients (28 men and 24 women) in CE(-). Age, ISS, and blood transfusion within 24 hours were significantly higher in the CE(+) group than in the CE(-) group (P = .023, P < .001, P < .001). sBP, Hb, PLT, fibrinogen were significantly lower in the CE(+) group than in the CE(-) group (P < .001, P < .001, P < .001, P < .001). D-dimer and lactate were higher in the CE(+) group than in the CE(-) group (P = .036, P < .001) with significant differences. On multivariate analysis, the level of fibrinogen was an independent predictor of CE(+). The area under the curve value for fibrinogen was 0.88, and the optimal cut-off value for prediction was 199 mg/dL.The fibrinogen levels on admission can predict contrast extravasation on enhanced CT in patients with sacral fractures. The optimal cut-off value of fibrinogen for CE(+) prediction in sacral fracture was 199 mg/dL. The use of fibrinogen to predict CE(+) could lead to prompt and effective treatment of active arterial hemorrhage in sacral fracture.


Assuntos
Extravasamento de Materiais Terapêuticos e Diagnósticos/etiologia , Fibrinogênio/análise , Hemorragia/diagnóstico , Sacro/lesões , Fraturas da Coluna Vertebral/complicações , Adulto , Idoso , Idoso de 80 Anos ou mais , Biomarcadores/sangue , Meios de Contraste/administração & dosagem , Estudos de Viabilidade , Feminino , Hemorragia/sangue , Hemorragia/etiologia , Humanos , Escala de Gravidade do Ferimento , Masculino , Pessoa de Meia-Idade , Estudos Observacionais como Assunto , Admissão do Paciente , Prognóstico , Curva ROC , Valores de Referência , Estudos Retrospectivos , Sacro/irrigação sanguínea , Sacro/diagnóstico por imagem , Fraturas da Coluna Vertebral/sangue , Fraturas da Coluna Vertebral/diagnóstico , Tomografia Computadorizada por Raios X
3.
Medicine (Baltimore) ; 100(2): e24096, 2021 Jan 15.
Artigo em Inglês | MEDLINE | ID: mdl-33466175

RESUMO

RATIONALE: We report the first case of the management of spinal cord transection due to thoracolumbar fracture-dislocation in human beings. There are several case reports of cord transection, but only radiological findings have been reported; we report intraoperative findings and management. PATIENT CONCERNS: A 53-year-old man presented to the hospital after falling. He had no motor power or sensation below T10 (below the umbilicus area) dermatome level. American Spinal Injury Association (ASIA) impairment scale was grade A. Magnetic resonance imaging and computed tomography demonstrated a fracture and translation of the vertebral body at the T11-T12 level and anterior displacement of T11 on T12, with complete disruption of the spinal cord. DIAGNOSIS: Complete spinal cord resection due to T11-T12 fracture-dislocation. INTERVENTIONS: We performed spinal fusion with pedicle screw instrumentation (T10-L1) and autobone graft and decompression and repaired the dural sac to prevent cerebrospinal fluid leakage. There was no neurological recovery either immediately or 4 years post-operation at follow-up. CONCLUSION: To the best of our knowledge, this report is the first on the intraoperative finding and management of the complete transection of the spinal cord in thoracolumbar spine injury. Perfect fusion is required to facilitate rehabilitation and daily living, prevent neurogenesis, and prevent unnecessary pain such as phantom pain.


Assuntos
Fratura-Luxação/cirurgia , Traumatismos da Medula Espinal/cirurgia , Fraturas da Coluna Vertebral/cirurgia , Fusão Vertebral/métodos , Vértebras Torácicas/lesões , Fratura-Luxação/complicações , Humanos , Achados Incidentais , Período Intraoperatório , Masculino , Pessoa de Meia-Idade , Parafusos Pediculares , Traumatismos da Medula Espinal/diagnóstico , Fraturas da Coluna Vertebral/complicações , Vértebras Torácicas/cirurgia
4.
Medicine (Baltimore) ; 100(2): e24088, 2021 Jan 15.
Artigo em Inglês | MEDLINE | ID: mdl-33466170

RESUMO

RATIONALE: Takotsubo syndrome (TTS) is characterized by recovery of wall motion abnormalities and acute left ventricular dysfunction, which are often caused by acute physical or emotional stressors. It is rarely reported that TTS can be precipitated by change in position in the patient in the operating room. We report a case of a patient with a thoracic vertebral fracture who presented with TTS precipitated by changing from a supine to a prone position before percutaneous kyphoplasty (PKP) under local anesthesia. PATIENT CONCERNS: A 76-year-old man who was diagnosed with a fracture in a thoracic vertebra was sent to the operating room to undergo PKP under local anesthesia. Approximately 5 minutes after changing from a supine to a prone position, which is necessary for PKP, the patient experienced chest pain, headache, and sweating. DIAGNOSIS: A fracture in a thoracic vertebra; TTS. INTERVENTIONS: As a result of 12-lead electrocardiography, echocardiography, left ventriculogram, and cardiac catheterization, the diagnosis of TTS was retained, and supportive therapy was initiated. OUTCOMES: Two hours later, the patient's symptoms mitigated significantly and the ST segment returned to baseline. Four days later, echocardiography showed normal systolic function without wall motion abnormalities and the patient returned to the orthopedics ward for further treatment. LESSONS: It is necessary for anesthetists to recognize TTS which is life-threatening during monitored anesthetic care (MAC). We highlight the importance of being alerted to the possibility of TTS when managing patients with thoracic vertebral fractures undergoing surgery under local anesthesia.


Assuntos
Posicionamento do Paciente/efeitos adversos , Fraturas da Coluna Vertebral/complicações , Cardiomiopatia de Takotsubo/etiologia , Vértebras Torácicas/lesões , Idoso , Humanos , Cifoplastia , Masculino , Fraturas da Coluna Vertebral/fisiopatologia , Fraturas da Coluna Vertebral/cirurgia , Vértebras Torácicas/fisiopatologia
5.
PLoS One ; 15(10): e0240084, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33052943

RESUMO

This study aimed to investigate the diagnostic performance of chest computed tomography (CT) for opportunistic screening and longitudinal follow-up of osteoporosis in breast cancer patients, compared to dual-energy X-ray absorptiometry (DXA). The association between L1 vertebral attenuation on chest CT and incidental fracture was also evaluated. We retrospectively reviewed 414 consecutive breast cancer patients who underwent both non-enhanced chest CT and DXA within a 3-month interval and had at least two DXA and two chest CT examinations over more than 1 year. The attenuation value of the L1 trabecular bone was measured on an axial CT image and compared to the corresponding DXA T-score. The diagnostic performance of L1 vertebral attenuation on CT for osteoporosis was calculated at different thresholds (90 HU, 100 HU, 110 HU), and the correlation between L1 vertebral attenuation values and DXA T-scores was statistically analyzed. Overall fracture-free survival was estimated and compared with the threshold of 90 HU on CT and -2.5 T-score on DXA. Of 414 patients (median age, 53.0 years), 88 (21.3%) had either vertebral or non-vertebral fractures. The median follow-up duration between initial and final DXA was 902.9 days. There was a moderate correlation between L1 vertebral attenuation value and DXA T-score (ρ = 0.684, CI 0.653-0.712). Fracture-free survival was significantly lower in patients with attenuation values ≤90 HU on CT and T-scores ≤-2.5 on DXA (P < .001). Multivariate analysis revealed that attenuation values ≤90 HU on CT (P < .001), T-scores ≤-2.5 on DXA (P = .003), and age ≥65 years (P = .03) were independent significant prognostic factors associated with overall fracture-free survival. The sensitivities and specificities of L1 attenuation value were 54.9% and 85.8% at 90-HU threshold, 74.0% and78.4% at 100-HU threshold, and 83.9% and 70.1% at 110-HU threshold, respectively. In conclusion, CT can be used for predicting osteoporosis and discriminating incidental fracture risk in breast cancer patients.


Assuntos
Neoplasias da Mama/patologia , Osteoporose/diagnóstico , Tórax/diagnóstico por imagem , Tomografia Computadorizada por Raios X , Absorciometria de Fóton , Neoplasias da Mama/complicações , Neoplasias da Mama/mortalidade , Feminino , Humanos , Estimativa de Kaplan-Meier , Estudos Longitudinais , Pessoa de Meia-Idade , Osteoporose/complicações , Prognóstico , Modelos de Riscos Proporcionais , Estudos Retrospectivos , Risco , Fraturas da Coluna Vertebral/complicações , Fraturas da Coluna Vertebral/diagnóstico
6.
J Vasc Interv Radiol ; 31(10): 1683-1689.e1, 2020 10.
Artigo em Inglês | MEDLINE | ID: mdl-32921566

RESUMO

PURPOSE: To assess the safety and efficacy of multilevel thoracolumbar vertebroplasty in the simultaneous treatment of ≥ 6 painful pathologic compression fractures. MATERIALS AND METHODS: Retrospective review was conducted of 50 consecutive patients treated with vertebroplasty for ≥ 6 pathologic compression fractures in a single session for pain palliation at a tertiary single cancer center from 2015 to 2019. Outcomes measured included procedural safety according to Common Terminology Criteria for Adverse Events (CTCAE), change in 4-week postprocedure back pain by numeric rating scale (NRS), comparison of daily opioid medication consumption, and development of skeletal-related events. RESULTS: A total of 397 pathologic compression fractures were treated during 50 sessions (mean, 7.9 per patient ± 1.5). Mean procedure duration was 162 minutes ± 35, mean postoperative hospitalization duration was 1.6 days ± 0.9, and mean follow-up duration was 401 days ± 297. Seven complications were recorded, including 1 case of symptomatic polymethyl methacrylate pulmonary embolism. No major complications (CTCAE grade 4/5) were reported. NRS pain score was significantly decreased (5.0 ± 1.8 vs 1.7 ± 1.4; P < .0001), with a mean score decrease of 3.3 points (66%). Opioid agent use decreased significantly (76 mg/24 h ± 42 vs 45 mg/24 h ± 37; P = .0003), with a mean decrease of 30 mg/24 h (39%). Skeletal-related events occurred in 7 patients (14%). CONCLUSIONS: Multilevel vertebroplasty for ≥ 6 pathologic compression fractures is safe and provides significant palliative benefit when performed simultaneously.


Assuntos
Dor nas Costas/prevenção & controle , Fraturas por Compressão/terapia , Fraturas Múltiplas/terapia , Fraturas Espontâneas/terapia , Vértebras Lombares/lesões , Cuidados Paliativos , Fraturas da Coluna Vertebral/terapia , Vértebras Torácicas/lesões , Vertebroplastia , Idoso , Dor nas Costas/diagnóstico , Dor nas Costas/etiologia , Feminino , Fraturas por Compressão/complicações , Fraturas por Compressão/diagnóstico por imagem , Fraturas Múltiplas/complicações , Fraturas Múltiplas/diagnóstico por imagem , Fraturas Espontâneas/complicações , Fraturas Espontâneas/diagnóstico por imagem , Humanos , Vértebras Lombares/diagnóstico por imagem , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Fraturas da Coluna Vertebral/complicações , Fraturas da Coluna Vertebral/diagnóstico por imagem , Vértebras Torácicas/diagnóstico por imagem , Resultado do Tratamento , Vertebroplastia/efeitos adversos
7.
AJR Am J Roentgenol ; 215(4): 970-977, 2020 10.
Artigo em Inglês | MEDLINE | ID: mdl-32809864

RESUMO

OBJECTIVE. The purpose of this study was to evaluate whether CT features can predict bone marrow edema (BME) on MRI and fracture age in vertebral fragility fractures. MATERIALS AND METHODS. A total of 189 thoracolumbar compression fractures in 103 patients (14 men, 89 women; mean age, 76 years) imaged with both spine CT and MRI were retrospectively included. The presence and extent of BME were assessed on MRI to divide fractures into those with and without BME. The group with BME was then classified for subgroup analysis into fractures with extensive BME (comprising 50% or more of the vertebral body) and those with BME comprising less than 50% of the vertebral body. On CT, five features (presence of cortical or endplate fracture line, presence of trabecular fracture line, presence of condensation band, change in trabecular attenuation, and width of paravertebral soft-tissue change) were analyzed. RESULTS. All five CT findings were predominantly seen in fractures with BME (p < 0.001). Elevated trabecular attenuation, presence of a cortical or endplate fracture line, and paravertebral soft-tissue width showed excellent diagnostic indication for fractures with BME (ROC AUCs: 0.990, 0.976, and 0.950, respectively). In the subgroup with extensive BME, paravertebral soft-tissue width was significantly higher, whereas the change in trabecular attenuation was lower compared with those with BME comprising less than 50% of the vertebral body (p < 0.001). When BME was present, fracture age was not significantly different between the two subgroups, and only greater trabecular attenuation elevation was predictive of older fracture age on linear mixed model analyses (p < 0.001). Interobserver agreement was good for the trabecular fracture line factor and excellent for all other factors. CONCLUSION. CT features accurately correlate with the presence and extent of BME in vertebral fragility fractures. Elevation of trabecular attenuation was the only significant image predictor of fracture age.


Assuntos
Doenças da Medula Óssea/diagnóstico por imagem , Edema/diagnóstico por imagem , Fraturas por Compressão/diagnóstico por imagem , Tomografia Computadorizada Multidetectores , Fraturas da Coluna Vertebral/diagnóstico por imagem , Idoso , Idoso de 80 Anos ou mais , Doenças da Medula Óssea/etiologia , Edema/etiologia , Feminino , Fraturas por Compressão/complicações , Humanos , Vértebras Lombares/lesões , Imagem por Ressonância Magnética , Masculino , Valor Preditivo dos Testes , Estudos Retrospectivos , Sensibilidade e Especificidade , Fraturas da Coluna Vertebral/complicações , Vértebras Torácicas/lesões
8.
Medicine (Baltimore) ; 99(27): e20479, 2020 Jul 02.
Artigo em Inglês | MEDLINE | ID: mdl-32629631

RESUMO

The aim of the present study was to evaluate the clinical effect of percutaneous vertebroplasty (PVP) in the treatment of old osteoporotic vertebral compression fracture (OVCF) pain.A retrospective study was conducted on the clinical and imaging data of 31 patients with old OVCF treated by PVP from June 2010 to September 2011. Clinical efficacy was evaluated by the visual analog scale (VAS) scores, the oswestry disability index (ODI), the Cobb angle, and vertebral kyphotic angle at pre-operation and post-operation 3 days, 3 months, and 12 months.The VAS scores and ODI scores of 3 day, 3 month, and 12 month after PVP were significantly improved compared with those before operation (P < .05), but the Cobb angle and vertebral kyphosis angle were not significantly improved compared with those before operation (P > .05).PVP can effectively relieve the pain caused by old OVCF, and the motor ability of the patients is improved obviously. However, the recovery of Cobb angle and vertebral kyphosis angle was not obvious.


Assuntos
Fraturas por Compressão/complicações , Fraturas por Osteoporose/complicações , Dor Intratável/cirurgia , Fraturas da Coluna Vertebral/complicações , Vertebroplastia/métodos , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Dor Intratável/etiologia , Estudos Retrospectivos , Resultado do Tratamento , Vertebroplastia/estatística & dados numéricos
9.
Pain Res Manag ; 2020: 4145096, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32566060

RESUMO

Purpose: We aimed to present our experience in anchoring technique and evaluate the efficacy and safety of unilateral percutaneous vertebroplasty in patients with neurologically intact Kümmell's disease. Methods: From January 2014 to December 2017, 29 patients (17 males and 12 females) with neurologically intact Kümmell's disease were operated on using anchoring technique in unilateral percutaneous vertebroplasty (PVP). Ages of the enrolled patients ranged from 67 to 81 years (mean 73.8 years). Clinical efficacy was evaluated by back pain visual analogue scale (BP-VAS) score, Oswestry disability index (ODI) score, as well as the height of anterior border and the kyphotic angle of the involved vertebral body on a standing lateral radiograph. The safety of PVP was assessed by surgical-related complications, including bone cement leakage and neurological deficit. Results: All 29 patients underwent the PVP procedure successfully. The mean operation time was 35 ± 12 min. And all patients were able to walk/ambulate with a thoracolumbar brace after 12 to 24 hours, staying in bed postoperatively. Significantly statistical differences were observed in both BP-VAS and ODI scores at each time point of follow-up when compared with the preoperative condition (P < 0.05). Besides, statistically significant improvement in radiographic measurements such as kyphotic angle and the height of the anterior border of the involved vertebral body between the preoperative and postoperative assessments was also observed (P < 0.05) and asymptomatic leakage of cement occurred in 7 of 29 cases (24.1%). Conclusions: We considered that the anchoring technique in unilateral PVP could provide an effective and safe alternative for neurologically intact Kümmell's disease.


Assuntos
Procedimentos Cirúrgicos Minimamente Invasivos/métodos , Fraturas por Osteoporose/cirurgia , Fraturas da Coluna Vertebral/cirurgia , Vertebroplastia/métodos , Idoso , Idoso de 80 Anos ou mais , Cimentos para Ossos , Feminino , Fraturas por Compressão/cirurgia , Humanos , Masculino , Fraturas da Coluna Vertebral/complicações
10.
Pain Physician ; 23(3): 315-324, 2020 06.
Artigo em Inglês | MEDLINE | ID: mdl-32517398

RESUMO

BACKGROUND: Vertebral cement augmentation is a commonly used procedure in patients with vertebral body compression fractures from primary or secondary osteoporosis, metastatic disease, or trauma. Many of these patients present with radiculopathy as a presenting symptom, and can experience symptomatic relief following the procedure. OBJECTIVES: To determine the incidence of preprocedural radiculopathy in patients with vertebral body compression fractures presenting for cement augmentation, and present their postoperative outcomes. STUDY DESIGN: Retrospective cohort study. SETTING: Interventional pain practice in a tertiary care university hospital. METHODS: In this cohort study, all patients who underwent kyphoplasty (KP) or vertebroplasty (VP) procedures in a 7-year period within our practice were evaluated through a search of the electronic medical records. The primary endpoint was to evaluate the prevalence of noncompressive preprocedural radiculopathy in our patients. Evaluation of each patient's relative improvement following the procedure, respective to the initial presence or absence of radicular symptoms (including and above T10, above and below T10, and below T10) was included as a secondary endpoint. Additional subanalysis was performed with respect to patients demographics, fracture location, and primary indication for the procedure (osteoporosis, trauma, etc.). RESULTS: A total of 302 procedures were performed during this time period, encompassing 544 total vertebral body levels. After exclusion criteria were applied to this cohort, 31.6% of patients demonstrated radiculopathy prior to the procedure that could not be explained by nerve impingement. Nearly half of patients demonstrated an optimal clinical outcome (48.5% nearly complete/complete resolution of symptoms, 40.1% partial resolution of symptoms, 11.4% little to no resolution of symptoms). Patients with fractures above T10 were more likely to see complete resolution, whereas patients with fractures above and below T10 were likely to not see any resolution. Men and women without initial radiculopathy symptoms were more likely to see little to no resolution, regardless of fracture location. LIMITATIONS: This retrospective study used an electronic chart review of clinicians' notes to determine the presence of radiculopathy and their relative improvement following the procedure. CONCLUSIONS: Preprocedural radiculopathy is a common symptom of patients presenting for the evaluation of VP or KP. The presence of radiculopathy in the absence of nerve impingement may be an important marker for those patients who may experience greater benefit from the procedure. KEY WORDS: Radiculopathy, kyphoplasty, vertebroplasty, osteoporosis, compression fracture, spine, cement augmentation.


Assuntos
Cimentos para Ossos/uso terapêutico , Fraturas por Compressão/complicações , Radiculopatia/epidemiologia , Radiculopatia/etiologia , Radiculopatia/cirurgia , Fraturas da Coluna Vertebral/complicações , Idoso , Estudos de Coortes , Feminino , Fraturas por Compressão/cirurgia , Humanos , Cifoplastia/métodos , Masculino , Pessoa de Meia-Idade , Prevalência , Estudos Retrospectivos , Fraturas da Coluna Vertebral/cirurgia , Resultado do Tratamento , Vertebroplastia/métodos
11.
Medicine (Baltimore) ; 99(21): e20276, 2020 May 22.
Artigo em Inglês | MEDLINE | ID: mdl-32481306

RESUMO

RATIONALE: The most common fractures of the spine are associated with the thoracolumbar junction (T10-L2). And burst fractures make up 15% of all traumatic thoracolumbar fractures, which are often accompanied by neurological deficits and require open surgeries. Common surgeries include either anterior, posterior or a combination of these approaches. Here, we report the first attempt to treat thoracolumbar burst fracture (TLBF) with severe neurologic deficits by percutaneous pedicle screw fixation (PPSF) and transforaminal endoscopic spinal canal decompression (TESCD). PATIENT CONCERNS: A 46-year-old Chinese woman suffered from severe lower back pain with grade 0 muscle strength of lower limbs, without any sensory function below the injury level, with an inability to urinate or defecate after a motor vehicle accident. Imaging studies confirmed that she had Magerl type A 3.2 L1 burst fracture. DIAGNOSES: Burst fracture at L1. INTERVENTIONS: The patient underwent PPSF at the level of T12 to L2, but her neurological function did not fully recover after the operation. One week after the injury, we performed TESCD on her. OUTCOMES: There was an immediate improvement in her neurological function in just 1 day after 2-stage operation. During the 6-month follow-up period, her neurological functions gradually recovered, and she was able to defecate and urinate. At the last follow-up visit, her spinal cord function was assessed to be at Frankel grade D. LESSONS: PPSF plus TESCD can achieve complete spinal cord decompression, promote neurological recovery, and is therefore an effective method for the treating lumbar burst fractures with severe neurologic deficits.


Assuntos
Endoscopia/métodos , Fixação Interna de Fraturas/métodos , Dor Lombar/etiologia , Vértebras Lombares/lesões , Parafusos Pediculares , Fraturas da Coluna Vertebral/cirurgia , Vértebras Torácicas/lesões , Descompressão Cirúrgica/métodos , Feminino , Fraturas por Compressão/complicações , Fraturas por Compressão/diagnóstico , Fraturas por Compressão/cirurgia , Humanos , Laminectomia/métodos , Dor Lombar/diagnóstico , Dor Lombar/cirurgia , Imagem por Ressonância Magnética , Pessoa de Meia-Idade , Fraturas da Coluna Vertebral/complicações , Fraturas da Coluna Vertebral/diagnóstico , Tomografia Computadorizada por Raios X
12.
Scand J Trauma Resusc Emerg Med ; 28(1): 42, 2020 May 24.
Artigo em Inglês | MEDLINE | ID: mdl-32448190

RESUMO

BACKGROUND: Major trauma often comprises fractures of the thoracolumbar spine and these are often accompanied by relevant thoracic trauma. Major complications can be ascribed to substantial simultaneous trauma to the chest and concomitant immobilization due to spinal instability, pain or neurological dysfunction, impairing the respiratory system individually and together. Thus, we proposed that an early stabilization of thoracolumbar spine fractures will result in significant benefits regarding respiratory organ function, multiple organ failure and length of ICU / hospital stay. METHODS: Patients documented in the TraumaRegister DGU®, aged ≥16 years, ISS ≥ 16, AISThorax ≥ 3 with a concomitant thoracic and / or lumbar spine injury severity (AISSpine) ≥ 3 were analyzed. Penetrating injuries and severe injuries to head, abdomen or extremities (AIS ≥ 3) led to patient exclusion. Groups with fractures of the lumbar (LS) or thoracic spine (TS) were formed according to the severity of spinal trauma (AISspine): AISLS = 3, AISLS = 4-5, AISTS = 3 and AISTS = 4-5, respectively. RESULTS: 1740 patients remained for analysis, with 1338 (76.9%) undergoing spinal surgery within their hospital stay. 976 (72.9%) had spine surgery within the first 72 h, 362 (27.1%) later on. Patients with injuries to the thoracic spine (AISTS = 3) or lumbar spine (AISLS = 3) significantly benefit from early surgical intervention concerning ventilation time (AISLS = 3 only), ARDS, multiple organ failure, sepsis rate (AISTS = 3 only), length of stay in the intensive care unit and length of hospital stay. In multiple injured patients with at least severe thoracic spine trauma (AISTS ≥ 4) early surgery showed a significantly shorter ventilation time, decreased sepsis rate as well as shorter time spend in the ICU and in hospital. CONCLUSIONS: Multiply injured patients with at least serious thoracic trauma (AISThorax ≥ 3) and accompanying spine trauma can significantly benefit from early spine stabilization within the first 72 h after hospital admission. Based on the presented data, primary spine surgery within 72 h for fracture stabilization in multiply injured patients with leading thoracic trauma, especially in patients suffering from fractures of the thoracic spine, seems to be beneficial.


Assuntos
Traumatismo Múltiplo/terapia , Fraturas da Coluna Vertebral/terapia , Traumatismos Torácicos/terapia , Adulto , Idoso , Cuidados Críticos , Feminino , Humanos , Escala de Gravidade do Ferimento , Tempo de Internação , Vértebras Lombares/lesões , Masculino , Pessoa de Meia-Idade , Traumatismo Múltiplo/complicações , Sistema de Registros , Fraturas da Coluna Vertebral/complicações , Traumatismos Torácicos/complicações , Vértebras Torácicas/lesões , Tempo para o Tratamento
13.
BMC Neurol ; 20(1): 162, 2020 Apr 29.
Artigo em Inglês | MEDLINE | ID: mdl-32349710

RESUMO

BACKGROUND: Spinal cerebrospinal fluid (CSF) leak can lead to intracranial hypotension and is an important differential diagnosis to consider in patients with sudden-onset chronic daily headaches. Pars interarticularis (PI) fracture is a potential rare cause of suspected spinal CSF leak. METHODS: This is a retrospective case series of 6 patients with suspected spinal CSF leak evaluated between January 2016 and September 2019. All patients received a magnetic resonance imaging (MRI) of the brain with and without gadolinium, MRI whole spine and full spine computed tomography (CT) myelogram. Targeted epidural patches with fibrin sealant were performed. Treatment response at return visit (3 months post-patch) was documented. RESULTS: Six patients (4 females, 2 males) were diagnosed with a suspected spinal CSF leak and PI fracture. Mean age at the time of headache onset was 39 years old, and a range from 32 to 50 years old. Mean time to targeted epidural patches with fibrin sealant was 4.5 years. All 6 patients had PI fractures identified on CT myelogram and received targeted epidural patches with fibrin sealant at the site of the PI fracture. All patients had significant improvement in their headache intensity. CONCLUSION: Our study highlights: 1) the importance of PI fracture as a possible culprit of suspected spinal CSF leak in patients with intracranial hypotension; 2) the added benefit of CT imaging for detecting bony abnormalities such as fractures in patients with intracranial hypotension; and 3) the successful treatment of suspected spinal CSF leak when targeting the fracture site.


Assuntos
Vazamento de Líquido Cefalorraquidiano/diagnóstico por imagem , Fraturas da Coluna Vertebral/diagnóstico por imagem , Adulto , Vazamento de Líquido Cefalorraquidiano/complicações , Feminino , Adesivo Tecidual de Fibrina/uso terapêutico , Gadolínio , Cefaleia/complicações , Cefaleia/tratamento farmacológico , Humanos , Imagem por Ressonância Magnética/métodos , Masculino , Pessoa de Meia-Idade , Mielografia , Estudos Retrospectivos , Fraturas da Coluna Vertebral/complicações , Fraturas da Coluna Vertebral/tratamento farmacológico , Tomografia Computadorizada por Raios X , Adulto Jovem
14.
Am J Med ; 133(10): 1135-1142, 2020 10.
Artigo em Inglês | MEDLINE | ID: mdl-32442508

RESUMO

Chest pain is a common presenting complaint in the primary care setting. Imaging plays a key role in the evaluation of the multiple organ systems that can be responsible for chest pain. With numerous imaging modalities available, determination of the most appropriate test and interpretation of the findings can be a challenge for the clinician. In this 2-part series, we offer resources to guide primary care physicians in the selection of imaging studies and present the imaging findings of various causes of nonemergent chest pain. In Part 2, we focus on the radiologic appearance of common noncardiac sources of chest pain, including gastrointestinal, pulmonary, and musculoskeletal etiologies.


Assuntos
Dor no Peito/etiologia , Transtornos da Motilidade Esofágica/diagnóstico por imagem , Hérnia Hiatal/diagnóstico por imagem , Doenças Musculoesqueléticas/diagnóstico por imagem , Atenção Primária à Saúde , Doenças Respiratórias/diagnóstico por imagem , Transtornos da Motilidade Esofágica/complicações , Fraturas por Compressão/complicações , Fraturas por Compressão/diagnóstico por imagem , Refluxo Gastroesofágico/complicações , Refluxo Gastroesofágico/diagnóstico por imagem , Hérnia Hiatal/complicações , Humanos , Imagem por Ressonância Magnética , Doenças Musculoesqueléticas/complicações , Derrame Pleural/complicações , Derrame Pleural/diagnóstico por imagem , Pneumonia/complicações , Pneumonia/diagnóstico por imagem , Pneumotórax/complicações , Pneumotórax/diagnóstico por imagem , Radiografia Torácica , Doenças Respiratórias/complicações , Fraturas das Costelas/complicações , Fraturas das Costelas/diagnóstico por imagem , Fraturas da Coluna Vertebral/complicações , Fraturas da Coluna Vertebral/diagnóstico por imagem , Parede Torácica/diagnóstico por imagem , Síndrome de Tietze/complicações , Síndrome de Tietze/diagnóstico por imagem , Tomografia Computadorizada por Raios X
15.
J Surg Res ; 253: 100-104, 2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-32339786

RESUMO

BACKGROUND: Osteopenia is common in the elderly, increasing their risk of sustaining cervical fractures after ground level falls (GLFs). We sought to examine the incidence of blunt cerebrovascular injury (BCVI) and subsequent stroke in elderly GLF patients as compared with other higher injury mechanisms. MATERIALS AND METHODS: The Trauma Quality Improvement Program database (2011-2016) was used to identify blunt trauma patients with isolated (other body region abbreviated injury scale <3) cervical spine (C1-C7) fractures. Patients were stratified into three groups: nonelderly patients (<65) with all mechanisms of injury, elderly patients (≥65) with GLF, and elderly patients with all other mechanism of injury. Multivariable logistic regression was used to determine predictors for BCVI, stroke, spinal cord injury, and acute kidney injury. RESULTS: Seventeen thousand six hundred twenty-eight patients with cervical spine injuries were identified. BCVI was highest in the <65 group (0.8%) and lowest in elderly patients with GLF (0.3%, P = 0.001). When controlling for other factors, elderly patients with GLF were less likely to sustain BCVI (adjusted odds ratio: 0.46, P = 0.03) but had comparable rates of stroke attributable to BCVI (18.2% versus 6.5%, P = 0.184) and comparable rate of acute kidney injury compared with elderly patients with other mechanism of injury. CONCLUSIONS: In elderly patients with isolated cervical spine fracture after GLF, BCVI occurs less frequently but is associated with a comparable rate of stroke as compared with other mechanisms. Low injury mechanism should not preclude BCVI screening in the presence of cervical spine fractures.


Assuntos
Acidentes por Quedas , Traumatismo Cerebrovascular/epidemiologia , Vértebras Cervicais/lesões , Traumatismos Cranianos Fechados/epidemiologia , Fraturas da Coluna Vertebral/complicações , Acidente Vascular Cerebral/epidemiologia , Adulto , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Traumatismo Cerebrovascular/etiologia , Feminino , Traumatismos Cranianos Fechados/etiologia , Humanos , Incidência , Escala de Gravidade do Ferimento , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Fatores de Risco , Acidente Vascular Cerebral/etiologia , Centros de Traumatologia/estatística & dados numéricos , Estados Unidos/epidemiologia , Adulto Jovem
16.
Clin Ter ; 171(3): e240-e244, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32323713

RESUMO

Postural instability and increased risk of falls are relevant problems in patients with fragility vertebral fractures (VFs). The inter-relationship between flexed posture (FP), VFs and altered balance control is complex and only partially elucidated. The purpose of the study is to identify key factors of balance impairment in osteoporotic patients with VFs. In particular, we focused on the role of FP, number and severity of VFs and their relationships with clinical and static balance instrumental measures. Secondary aim of the study is to investigate possible correlations of stabilometric parameters with clinical and functional outcome measures. The results showed no significant correlations between static balance parameters and FP, number and severity of VFs. Stabilometry measures weakly correlate with age, 20 meters Walking Test and Barthel Index. Further studies are required to improve our understanding of the mechanisms underlying balance impairment in patients with VFs with the aim of identifying early clinical and instrumental markers of poor balance and fall's risk.


Assuntos
Fraturas da Coluna Vertebral/fisiopatologia , Acidentes por Quedas/prevenção & controle , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Equilíbrio Postural , Estudos Retrospectivos , Medição de Risco , Fraturas da Coluna Vertebral/complicações
17.
Technol Cancer Res Treat ; 19: 1533033820904447, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32336255

RESUMO

Stereotactic body radiation therapy in patients with spine metastases maximizes local tumor control and preserves neurologic function. A novel approach could be the use of stereotactic body radiation therapy with simultaneous integrated boost delivering modality. The aim of the present study is to report our experience in the treatment of spine metastases using a frameless radiosurgery system delivering stereotactic body radiation therapy-simultaneous integrated boost technique. The primary endpoints were the pain control and the time to local progression; the secondary ones were the overall survival and toxicity. A total of 20 patients with spine metastases and 22 metastatic sites were treated in our center with stereotactic body radiation therapy-simultaneous integrated boost between December 2007 and July 2018. Stereotactic body radiation therapy-simultaneous integrated boost treatments were delivered doses of 8 to 10 Gy in 1 fraction to isodose line of 50%. The median follow-up was 35 months (range: 12-110). The median time to local progression for all patients was not reached and the actuarial 1-, 2-, and 3-years local free progression rate was 86.36%. In 17 of 20 patients, a complete pain remission was observed and 3 of 20 patients had a partial pain remission (complete pain remission + partial pain remission: 100%). The median overall survival was 38 months (range 12-83). None of the patients experienced neither radiation adverse events (grade 1-4) nor reported pain flair reaction. None of the patients included in our series experienced vertebral compression fracture. Spine radiosurgery with stereotactic body radiation therapy-simultaneous integrated boost is safe. The use of this modality in spine metastases patients provides an excellent local control.


Assuntos
Fraturas por Compressão/complicações , Manejo da Dor/métodos , Radiocirurgia/métodos , Fraturas da Coluna Vertebral/complicações , Neoplasias da Coluna Vertebral/secundário , Neoplasias da Coluna Vertebral/cirurgia , Adulto , Idoso , Idoso de 80 Anos ou mais , Fracionamento da Dose de Radiação , Feminino , Fraturas por Compressão/patologia , Humanos , Masculino , Pessoa de Meia-Idade , Doses de Radiação , Estudos Retrospectivos , Fraturas da Coluna Vertebral/patologia , Neoplasias da Coluna Vertebral/mortalidade , Taxa de Sobrevida , Resultado do Tratamento
18.
Artigo em Inglês | MEDLINE | ID: mdl-32131965

RESUMO

PURPOSE OF THE STUDY In this randomized prospective study, we monitored and compared perioperative changes in skeletal muscle enzymes blood levels in open and mini-invasive stabilization of thoracolumbar spine fractures. The established hypothesis was to confirm higher blood levels of muscle enzymes in open stabilization. MATERIAL AND METHODS This study included 38 patients with the mean age of 46.4 years. 19 injuries were managed in an open procedure and 19 procedures were mini-invasive. Venous blood was taken intermittently at short intervals to determine the levels of skeletal muscle enzymes. The catalytic concentration of creatine kinase was determined via an enzymatic UV-test, and the concentration of myoglobin via electro-chemiluminescent immunoassay. Enzyme levels were processed statistically. The Wilcoxon test was used. RESULTS The median increase in the values of both enzymes is higher in the mini-invasive method than in the open method in both the surgery phase for the injury and in the extraction phase. The median increase in the values of both enzymes is higher in both methods for the primary procedure phase compared to the extraction phase. All results are statistically significant at p of <0.05. All tests were calculated using the MATLAB Statistics Toolbox. DISCUSSION A very surprising finding, when testing the hypothesis of the levels increasing mainly in open stabilization, was confirming the opposite. Both enzymes were higher in the mini-invasive approach to stabilising the spine after the injury, but also after the extraction. This contradicts the available literature. However, this can be explained by the methodology of enzyme levels determination in the previously published studies. We believe that this phenomenon can be partially caused by an iatrogenic mini-compartment of muscles in the postoperative period, absence of wound drainage, but also by higher muscle contusion when inserting bolts through the tubes via small incisions, when the tubes penetrate to the entry points relatively violently and the muscles in this area are affected more than in the classical skeletization. CONCLUSIONS Analysis of biochemical changes in open and mini-invasive surgery did not confirm the hypothesis that levels of creatine kinase and myoglobin enzymes increase especially in open stabilization. On the contrary, they were statistically significantly higher in mini-invasive procedures. Key words: creatine kinase, myoglobin, muscle enzymes, spine fracture, spine surgery, miniinvasive surgery.


Assuntos
Creatina Quinase , Doenças Musculares , Mioglobina , Fraturas da Coluna Vertebral , Creatina Quinase/metabolismo , Humanos , Vértebras Lombares , Pessoa de Meia-Idade , Procedimentos Cirúrgicos Minimamente Invasivos , Doenças Musculares/diagnóstico , Doenças Musculares/etiologia , Mioglobina/metabolismo , Estudos Prospectivos , Fraturas da Coluna Vertebral/complicações , Fraturas da Coluna Vertebral/cirurgia , Vértebras Torácicas
19.
Acta Chir Orthop Traumatol Cech ; 87(1): 52-57, 2020.
Artigo em Tcheco | MEDLINE | ID: mdl-32131972

RESUMO

Hemicorporectomy or translumbar amputation is an extensive surgical procedure consisting in removing the lower portion of the body. Thakur et al. found a total of 71 hemicorporectomies described in literature before 2017. In the form of a case study we present the case of our patient with terminal pelvic osteomyelitis, in whom hemicorporectomy was subsequently performed, namely from the spine surgery perspective. The man, 19 years old, was exposed to high-voltage electricity and fell down from a height of 4 meters. He suffered an instable comminuted fracture of T10 (AO A3.3.) with paraplegia (Frankel A) and multiple third-degree burns affecting 25% of his total body surface area. Subsequently, the patient underwent a total of 16 surgical procedures performed by medical experts in various specialties (orthopaedic surgery, general surgery, plastic surgery, urology, vascular surgery), but in spite of that the extensive pelvic osteomyelitis has not been successfully managed. At first, urine and stool diversion were performed. After 3 weeks, i.e. 18 months after the injury, the removal of the lower portion of the body was scheduled. The hemicorporectomy was divided into 4 stages. The surgery started by posterior transecting the spine at L4-L5 segment with nerve root and dural sac ligation and treating the bleeding venous plexus in the spinal canal. After turning the patient to the supine position, the second stage of the operation followed, consisting in transecting large vessels and harvesting a musculocutaneous flap from the right thigh. During the third stage of the surgery the separation of the L4-L5 motion segment was completed by the transaction of the anterior longitudinal ligament and m. psoas major, subsequently followed by the amputation of the lower portion of the body. During the last stage of the surgery, the wound was closed by musculocutaneous flap from the fight thigh with preserved a. femoralis. The patient was discharged to home in a generally good condition 127 days after the amputation of the lower portion of the body. Now, 1 year after the surgery, the patient enjoys good physical as well as mental health. Hemicorporectomy is an extensive surgical technique, which can despite multiple complications be offered to patients with otherwise unmanageable condition. Terminal pelvic osteomyelitis is currently the most frequent diagnostic indication and the resulting condition makes possible a long-term survival of the patient in a satisfactory condition. The spinal surgeon is an irreplaceable member of the multidisciplinary team performing the surgical procedure, the primary treatment of the spinal column considerably limits blood losses. Key words: hemicorporectomy, en bloc sacrectomy, terminal pelvic osteomyelitis, sacral tumors.


Assuntos
Procedimentos Ortopédicos , Osteomielite , Procedimentos Cirúrgicos Reconstrutivos , Adulto , Amputação , Humanos , Masculino , Osteomielite/cirurgia , Pelve , Fraturas da Coluna Vertebral/complicações , Adulto Jovem
20.
World Neurosurg ; 138: e354-e360, 2020 06.
Artigo em Inglês | MEDLINE | ID: mdl-32142946

RESUMO

OBJECTIVE: The aim to evaluate central sarcopenia, as measured by psoas cross-sectional area on admission imaging, is associated with outcomes in patients with vertebral compression fractures (VCFs) treated with percutaneous vertebral augmentation treatment. METHODS: We evaluated the records of patients aged >60 years treated with vertebroplasty or kyphoplasty between 2009 and 2018 for osteoporotic VCFs. The Social Security Death Index was used to determine death. We used the psoas:lumbar vertebral index (PLVI), calculated using the cross-sectional area of the L4 vertebral body and the left and right psoas muscles, to assess for sarcopenia. A multivariate Cox algorithm was applied to recognize factors independently associated with survival. RESULTS: A total of 103 patients were included with an average age of 72.3 years. During the study period, 22 (21.4%) patients were deceased, whereas 81 (78.6%) were alive. The survival rates at 1 month, 6 months, and 1 year after surgery were 99%, 94.1%, and 88.4%, respectively. PLVI measurements ranged from 0.24-1.19 with a mean of 0.59 ± 0.17 and a median of 0.603. A total of 51 patients with a median value of 0.603 were defined as low PLVI group, and 52 patients with a median value of ≥0.603 were defined as the high PLVI group. PLVI was significantly low in patients who died. Age, American Society of Anesthesiologists score, and PLVI value were independently associated with a poor overall survival. CONCLUSIONS: There is a significant correlation between sarcopenia and postoperative mortality after vertebral augmentation procedure in patients with VCFs.


Assuntos
Fraturas por Osteoporose/complicações , Fraturas por Osteoporose/cirurgia , Sarcopenia/complicações , Fraturas da Coluna Vertebral/complicações , Fraturas da Coluna Vertebral/cirurgia , Idoso , Idoso de 80 Anos ou mais , Feminino , Fraturas por Compressão/complicações , Fraturas por Compressão/mortalidade , Fraturas por Compressão/cirurgia , Humanos , Masculino , Pessoa de Meia-Idade , Procedimentos Cirúrgicos Minimamente Invasivos/métodos , Fraturas por Osteoporose/mortalidade , Estudos Retrospectivos , Fatores de Risco , Fraturas da Coluna Vertebral/mortalidade , Resultado do Tratamento , Vertebroplastia/métodos
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