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1.
JAMA ; 325(10): 942-951, 2021 03 09.
Artigo em Inglês | MEDLINE | ID: mdl-33687463

RESUMO

Importance: Cervical spondylotic myelopathy is the most common cause of spinal cord dysfunction worldwide. It remains unknown whether a ventral or dorsal surgical approach provides the best results. Objective: To determine whether a ventral surgical approach compared with a dorsal surgical approach for treatment of cervical spondylotic myelopathy improves patient-reported physical functioning at 1 year. Design, Setting, and Participants: Randomized clinical trial of patients aged 45 to 80 years with multilevel cervical spondylotic myelopathy enrolled at 15 large North American hospitals from April 1, 2014, to March 30, 2018; final follow-up was April 15, 2020. Interventions: Patients were randomized to undergo ventral surgery (n = 63) or dorsal surgery (n = 100). Ventral surgery involved anterior cervical disk removal and instrumented fusion. Dorsal surgery involved laminectomy with instrumented fusion or open-door laminoplasty. Type of dorsal surgery (fusion or laminoplasty) was at surgeon's discretion. Main Outcomes and Measures: The primary outcome was 1-year change in the Short Form 36 physical component summary (SF-36 PCS) score (range, 0 [worst] to 100 [best]; minimum clinically important difference = 5). Secondary outcomes included 1-year change in modified Japanese Orthopaedic Association scale score, complications, work status, sagittal vertical axis, health resource utilization, and 1- and 2-year changes in the Neck Disability Index and the EuroQol 5 Dimensions score. Results: Among 163 patients who were randomized (mean age, 62 years; 80 [49%] women), 155 (95%) completed the trial at 1 year (80% at 2 years). All patients had surgery, but 5 patients did not receive their allocated surgery (ventral: n = 1; dorsal: n = 4). One-year SF-36 PCS mean improvement was not significantly different between ventral surgery (5.9 points) and dorsal surgery (6.2 points) (estimated mean difference, 0.3; 95% CI, -2.6 to 3.1; P = .86). Of 7 prespecified secondary outcomes, 6 showed no significant difference. Rates of complications in the ventral and dorsal surgery groups, respectively, were 48% vs 24% (difference, 24%; 95% CI, 8.7%-38.5%; P = .002) and included dysphagia (41% vs 0%), new neurological deficit (2% vs 9%), reoperations (6% vs 4%), and readmissions within 30 days (0% vs 7%). Conclusions and Relevance: Among patients with cervical spondylotic myelopathy undergoing cervical spinal surgery, a ventral surgical approach did not significantly improve patient-reported physical functioning at 1 year compared with outcomes after a dorsal surgical approach. Trial Registration: ClinicalTrials.gov Identifier: NCT02076113.


Assuntos
Vértebras Cervicais/cirurgia , Laminectomia/métodos , Medidas de Resultados Relatados pelo Paciente , Doenças da Medula Espinal/cirurgia , Fusão Vertebral/métodos , Espondilose/cirurgia , Idoso , Idoso de 80 Anos ou mais , Vértebras Cervicais/diagnóstico por imagem , Seguimentos , Humanos , Imagem por Ressonância Magnética , Pessoa de Meia-Idade , Complicações Pós-Operatórias , Radiografia , Medula Espinal/diagnóstico por imagem , Resultado do Tratamento
2.
Medicine (Baltimore) ; 100(9): e24900, 2021 Mar 05.
Artigo em Inglês | MEDLINE | ID: mdl-33655951

RESUMO

OBJECTIVE: We designed and performed a network meta-analysis to compare the clinical outcomes among the 5 surgeries-anterior cervical corpectomy and fusion (ACCF), anterior controllable antedisplacement fusion (ACAF), laminoplasty (LP), laminectomy (LC), and posterior decompression with instrumented fusion (PDF)-for patients with cervical spondylosis related to the ossification of the posterior longitudinal ligament (OPLL). METHODS: Databases, including PubMed, EMBASE, Cochrane Library, Google Scholar, and Web of Science (firstly available-2019) were selected for literature search. We performed a network meta-analysis with the included studies. A Newcastle-Ottawa scale was employed to assess the study quality of the included studies. RESULTS: Total 23 studies with 1516 patients were included in our analysis. We found that ACCF achieved the most improvement in the Japanese Orthopaedic Association Scores and excellent and good recovery rate, ACAF achieved the best improvement of the improvement rate and lordosis. LP got the best operative time and blood loss. CONCLUSIONS: Our results suggested that both anterior (ACCF and ACAF) and posterior (LP, LC, and PDF) procedures have their strengths and weaknesses. Clinicians need to select the most appropriate surgery with a comprehensive consideration of the clinical condition of each patient with OPLL-related cervical spondylosis.


Assuntos
Descompressão Cirúrgica/métodos , Ligamentos Longitudinais/cirurgia , Metanálise em Rede , Ossificação do Ligamento Longitudinal Posterior/cirurgia , Cooperação do Paciente , Espondilose/cirurgia , Vértebras Cervicais , Humanos , Laminectomia/métodos , Laminoplastia/métodos , Ossificação do Ligamento Longitudinal Posterior/complicações , Fusão Vertebral/métodos , Espondilose/etiologia
3.
Medicine (Baltimore) ; 100(6): e24685, 2021 Feb 12.
Artigo em Inglês | MEDLINE | ID: mdl-33578600

RESUMO

ABSTRACT: Biportal endoscopic spine surgery (BESS) is extending its application to most kind of spine surgeries. Postoperative spinal epidural hematoma (POSEH) is one of the major concerns of this emerging technique. Through this study we aim to investigate the incidence of POSEH in BESS comparing to a conventional spine surgery (CSS).The patients who underwent a non-fusion decompressive spine surgery due to degenerative lumbar spinal stenosis (LSS) or herniated lumbar disc (HLD) or both between January 2015 and March 2019 were reviewed retrospectively. The incidence of clinical POSEH that demanded a revision surgery for hematoma evacuation was compared between CSS and BESS. As a second endpoint, the morphometric degree of POSEH was compared between the two groups. The maximal compression of cauda equina by POSEH was measured by 4 grade scale at the T2 axial image and the neurological state was evaluated by 5 grade scale. The indication of hematoma evacuation was more than hG3 with more than nG1. As a subgroup analysis, risk factors of POSEH in BESS were investigated.The 2 groups were homogenous in age, sex, number and level of operated segments. There was significant difference in the incidence of symptomatic POSEH as 2/142 (1.4%) in CSS and 8/95 (8.4%) in BESS (P = .016). The radiological thecal sac compression by hematoma was hG1 65 (61.3%), hG2 35 (33.0%), hG3 5 (4.7%), hG4 1 (0.9%) cases in CSS and hG1 33 (39.8%), hG2 25 (30.1%), hG3 22 (26.5%), hG4 3 cases (3.6%) in BESS. The difference was significant (P < .001). In BESS subgroup analysis, the risk factor of high grade POSEH was bilateral laminectomy (OR = 8.893, P = .023).The incidence of clinical and morphometric POSEH was higher in BESS. In BESS, POSEH developed more frequently in bilateral laminectomy than unilateral laminectomy.


Assuntos
Endoscopia/efeitos adversos , Hematoma Epidural Espinal/etiologia , Procedimentos Cirúrgicos Minimamente Invasivos/métodos , Estenose Espinal/cirurgia , Idoso , Estudos de Casos e Controles , Síndrome da Cauda Equina/diagnóstico por imagem , Síndrome da Cauda Equina/etiologia , Síndrome da Cauda Equina/cirurgia , Descompressão Cirúrgica/métodos , Feminino , Hematoma Epidural Espinal/diagnóstico por imagem , Hematoma Epidural Espinal/epidemiologia , Hematoma Epidural Espinal/cirurgia , Humanos , Incidência , Laminectomia/métodos , Vértebras Lombares/patologia , Imagem por Ressonância Magnética/métodos , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/epidemiologia , Radiologia/métodos , Estudos Retrospectivos , Fatores de Risco
4.
J Clin Neurosci ; 82(Pt A): 83-86, 2020 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-33317744

RESUMO

Intraoperative localization within the thoracic spine in the prone position may be particularly difficult on account of absence of common landmarks such as the sacrum or the C2 vertebra, thus increasing the potential for wrong-level surgery that may lead to patient morbidity and potential litigation. Some current localization methods involve implantation of markers that are invasive and serve to add to procedural expense while yet still failing to entirely eliminate errors. We describe a novel, non-invasive, and inexpensive technique for intraoperative localization of the thoracic spine in the prone position using an esophageal temperature probe. Following patient positioning, anteroposterior fluoroscopy is used to localize the radiopaque tip of the esophageal probe relative to the thoracic spine. After determining the probe tip's location, it becomes the counting reference for all subsequent intraoperative fluoroscopic localizations during surgery. As the probe tip is generally visible in the same fluoroscopic image as the surgical level, error from parallax created when moving the fluoroscopy machine from an anatomic landmark either above or below is avoided and a shorter fluoroscopy time is needed. Use of an esophageal temperature probe as a landmark in localizing spinal level may serve as a reliable and It offers a safe, reliable, and inexpensive technique for proper localization of thoracic spine levels.


Assuntos
Esofagoscópios , Fluoroscopia/métodos , Laminectomia/métodos , Coluna Vertebral/cirurgia , Vértebras Torácicas/cirurgia , Feminino , Humanos , Masculino , Posicionamento do Paciente , Decúbito Ventral , Estudo de Prova de Conceito
5.
Medicine (Baltimore) ; 99(45): e22355, 2020 Nov 06.
Artigo em Inglês | MEDLINE | ID: mdl-33157913

RESUMO

BACKGROUND: Most degenerative lumbar spinal stenosis (DLSS) patients primitively received the conservative treatment to control symptoms. In order to develop an optimal surgical treatment strategy, it is very significant to understand how the degenerative lumbar spondylolisthesis (DS) affects the effect of decompression in the DLSS. Thus, the aim of this current study was to explore whether the concomitant DS would affect the effect of decompression alone in the patients with DLSS. METHODS: The current study was carried out at our hospital and it was approved through our institutional review committee of General Hospital of Ningxia Medical University. During the period from January 2015 to December 2017, in our study, we identified consecutive patients who received the minimally invasive laminectomy to treat the DLSS. The inclusion criterion included radicular leg pain or neurogenic claudication with the neurological symptoms associated with DLSS syndrome, magnetic resonance imaging of the lumbar spine reveals at least 1 level of serious stenosis, the conservative treatment failed for at least 3 months, and patients agreed to provide the postoperative details. The major outcomes of this present research was Oswestry Disability Index. Secondary outcomes of this current study involved visual analog score, short form-36, surgical revision rate as well as complications. RESULTS: We assumed that previous DS possessed a negative effect on the postoperative results of the DLSS patients. TRIAL REGISTRATION: researchregistry5943.


Assuntos
Laminectomia/métodos , Vértebras Lombares/cirurgia , Estenose Espinal/cirurgia , Espondilolistese/complicações , Idoso , Avaliação da Deficiência , Feminino , Humanos , Vértebras Lombares/diagnóstico por imagem , Imagem por Ressonância Magnética , Masculino , Complicações Pós-Operatórias , Reoperação/estatística & dados numéricos , Projetos de Pesquisa , Estudos Retrospectivos , Estenose Espinal/diagnóstico por imagem , Espondilolistese/diagnóstico por imagem , Escala Visual Analógica
6.
Medicine (Baltimore) ; 99(43): e22792, 2020 Oct 23.
Artigo em Inglês | MEDLINE | ID: mdl-33120796

RESUMO

RATIONALE: We report a case of Schmorl node induced multiple radiculopathy. PATIENT CONCERNS: A 70-year-old female patient complained of lower back pain in the left leg accompanied by numbness and weakness. DIAGNOSIS: Radiographs showed obvious osteoporosis in the lumbar vertebrae. Computed tomography demonstrated a hole in the upper posterior half of the L2 vertebral body. Magnetic resonance imaging of the lumbar spine revealed a herniated disc involving a protrusion at the posterior wall of the L2 vertebral body, which was present in the left lateral and dorsal epidural spaces. There was significant lumbar stenosis at the L2 vertebral body secondary to dural sac compression due to the mass. INTERVENTION: Left-sided hemilaminectomy was performed at L2 with screw fixation at L1-3. Intraoperatively, the severely ruptured disc compression in the dural sac and nerve root was removed. OUTCOMES: The patient's leg pain was immediately resolved, and her back pain was reduced. The patient recovered normal motor function at 20 days after surgery. LESSONS: A Schmorl node can progress and break through the lumbar vertebral body, resulting in nerve compression. A large proximal herniated mass can cause distal multiple radiculopathy. Therefore, this special case of Schmorl node with multiple radiculopathy should be treated by removing the proximal herniated nucleus pulposus from the vertebral body.


Assuntos
Deslocamento do Disco Intervertebral/complicações , Vértebras Lombares/patologia , Radiculopatia/etiologia , Idoso , Constrição Patológica , Feminino , Humanos , Deslocamento do Disco Intervertebral/cirurgia , Laminectomia/métodos , Dor Lombar , Vértebras Lombares/cirurgia , Osteoporose/complicações
7.
Neurocirugía (Soc. Luso-Esp. Neurocir.) ; 31(5): 249-252, sept.-oct. 2020. ilus
Artigo em Espanhol | IBECS | ID: ibc-195157

RESUMO

La flegmasía cerúlea dolens es un estado muy infrecuente, secundario a trombosis venosa profunda, de origen multietiológico, que afecta usualmente a las extremidades inferiores. Se presenta con dolor en miembro inferior y edema rápidamente progresivo que puede comprometer la perfusión de la extremidad, pudiendo llevar a gangrena, amputación e incluso a la muerte. Se presenta un caso de flegmasía extremadamente raro secundario a trombosis venosa profunda masiva del eje iliofemoral izquierdo provocado por un hematoma crónico compresivo de origen traumático por cizallamiento del tornillo de S1 en una paciente intervenida hacia 3 meses de hernia discal lumbar mediante artrodesis e instrumentación vertebral L5-S1. Este artículo muestra la necesidad de realizar un escrupuloso escrutinio de los tornillos tanto intra como postoperatoriamente cuando nos encontramos cerca de los grandes vasos


Phlegmasia cerulea dolens is a very infrequent condition secondary to a deep venous thrombosis of multietiological origin usually affecting the lower extremities. It presents with pain and edema in the lower limb rapidly progressive that can compromise the perfusion of the limb, being able to cause gangrene, amputation and even death. We present an extremely rare case of a phlegmasia secondary to a massive deep venous tombosis of the left iliofemoral axis caused by chronic compressive hematoma of a traumatic origin due to a S1 screw shearing in a patient operated three months ago of a lumbar herniated disc through a L5-S1 fussion. This article shows the need to perform a scrupulously scrutinize of the screws both intra and postoperatively when we are close to the great vessels


Assuntos
Humanos , Feminino , Pessoa de Meia-Idade , Tromboflebite/terapia , Trombose Venosa/complicações , Laminectomia/métodos , Trombofilia/fisiopatologia , Heparina de Baixo Peso Molecular/uso terapêutico , Extremidade Inferior/patologia , Extremidade Inferior/cirurgia , Trombose Venosa/diagnóstico por imagem , Anticoagulantes/uso terapêutico , Meias de Compressão
8.
Spine (Phila Pa 1976) ; 45(14): E871-E877, 2020 Jul 15.
Artigo em Inglês | MEDLINE | ID: mdl-32609470

RESUMO

STUDY DESIGN: Retrospective study. OBJECTIVE: To evaluate the outcomes and safety of endoscopic laminectomy for central lumbar canal spinal stenosis. SUMMARY OF BACKGROUND DATA: .: Spinal endoscopy is mostly used in the treatment of lumbar disc herniation, while endoscopic laminectomy for lumbar spinal stenosis is rarely reported. METHODS: From January 2016 to June 2017, 38 patients with central lumbar canal spinal stenosis were treated with endoscopic laminectomy. Clinical symptoms were evaluated at 1, 3, 6, and 12 months and the last follow-up after surgery. Functional outcomes were assessed by using the Japanese Orthopedic Association Scores (JOA) and Oswestry Disability Index (ODI). The decompression effect was assessed by using the dural sac cross-sectional area (DSCA). Lumbar stability was evaluated using lumbar range of motion (ROM), ventral intervertebral space height (VH), and dorsal intervertebral space height (DH). RESULTS: The mean age of the cases was 60.8 years, the mean operation time was 66.3 minutes, the blood loss was 38.8 mL, and the length of incision was 19.6 mm. The mean time in bed was 22.3 hours, and the mean hospital stay was 8.8 days. JOA scores were improved from 10.9 to 24.1 (P < 0.05), ODI scores were improved from 79.0 to 27.9 (P < 0.05), DSCA was improved from 55.7 to 109.5 mm (P < 0.05), ROM scores were improved from 5.6° to 5.7° (P < 0.05), and DH scores were reduced from 6.6 to 6.5 mm (P < 0.05). There was no significant difference in VH before and after operation (P > 0.05). There were no serious complications during the follow-ups. CONCLUSION: Endoscopic laminectomy had the advantage of a wider view, which was effective, safe, and less invasive for lumbar spinal stenosis. LEVEL OF EVIDENCE: 5.


Assuntos
Endoscopia , Laminectomia , Vértebras Lombares/cirurgia , Estenose Espinal/cirurgia , Perda Sanguínea Cirúrgica , Endoscopia/efeitos adversos , Endoscopia/métodos , Endoscopia/estatística & dados numéricos , Humanos , Laminectomia/efeitos adversos , Laminectomia/métodos , Laminectomia/estatística & dados numéricos , Tempo de Internação , Pessoa de Meia-Idade , Complicações Pós-Operatórias , Estudos Retrospectivos , Resultado do Tratamento
9.
Rev. esp. anestesiol. reanim ; 67(6): 347-350, jun.-jul. 2020. ilus
Artigo em Espanhol | IBECS | ID: ibc-199526

RESUMO

El glioblastoma espinal primario (GBM) es una entidad clínicamente rara, con progresión rápida y resultado inevitable, a pesar de su manejo intensivo. En una mujer embarazada, esta neoplasia es particularmente grave, ya que los beneficios potenciales para la madre que ofrece el tratamiento estándar para GBM deben sopesarse frente a los riesgos para el feto. Existen pocas directrices en la literatura sobre cómo manejar a las pacientes embarazadas con tumores neuroaxiales malignos y, en opinión de los autores, no se han publicado informes hasta la fecha sobre este neoplasma específico en dicha población. Este caso clínico describe el manejo de una paciente embarazada con GBM no diagnosticado previamente, con rápida progresión intramedular, a la que se realizó cesárea electiva para permitir el inicio de tratamiento oncológico. Debatimos los dilemas a los que se enfrentan los anestesistas, con esperanza de aportar directrices ante las futuras decisiones y de optimizar los resultados


Primary spinal glioblastoma (GBM) is a clinically rare entity with rapid progression and a dismal outcome despite aggressive treatment. In a pregnant woman, this malignancy is particularly dramatic because the potential benefits to the mother offered by standard GBM treatment must be balanced against the risks to the fetus. There is little guidance in the literature on how to manage pregnant patients with malignant neuraxial tumours and, to the authors' knowledge, no reports have been published so far regarding this specific neoplasm in such population. This case report describes the management of a pregnant patient with a previously undiagnosed and rapidly progressive intramedullary GBM submitted to an elective caesarean delivery to allow subsequent onset of oncological treatment. Dilemmas faced by anaesthetists are discussed in hope to provide guidance for future decisions and optimize outcomes


Assuntos
Humanos , Feminino , Gravidez , Adulto , Glioblastoma/cirurgia , Cesárea/métodos , Anestesia/métodos , Anestésicos/administração & dosagem , Neoplasias da Medula Espinal/cirurgia , Laminectomia/métodos , Complicações Neoplásicas na Gravidez/cirurgia , Anestesia Obstétrica/métodos , Neoplasias da Medula Espinal/complicações
10.
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
11.
World Neurosurg ; 140: 347-352, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32434012

RESUMO

BACKGROUND: Intraspinal extradural ventral cysts in the lumbar spine can cause back pain and neurological deficits of the lower extremities. For the resection of this type of space-occupying lesion, the transdural approach has not been reported in the literature. CASE DESCRIPTION: A 66-year-old man presented, suffering from progressive radiation pain of his bilateral lower extremities. Imaging examination revealed a cystic lesion in ventral side of lumbar spinal canal. We conducted the excision of the cyst with the transdural approach. The symptoms of the patient disappeared immediately after the operation and recurrence of the symptoms has not been observed in the 3-month follow-up. CONCLUSIONS: This operation approach is safe and effective. Compared with the previous surgical approach reported in the literature, by this approach surgeons could achieve less injury, shorter operation time, and the same surgical outcomes in the short term. Therefore, we would like to present this approach to provide an alternative to deal with similar lesions.


Assuntos
Cistos do Sistema Nervoso Central/cirurgia , Vértebras Lombares/cirurgia , Idoso , Descompressão Cirúrgica/métodos , Humanos , Laminectomia/métodos , Masculino , Resultado do Tratamento
12.
J Clin Neurosci ; 77: 62-66, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32409209

RESUMO

OBJECTIVE: Space-occupying spinal meningiomas (SM), commonly diagnosed due to gradual neurological deterioration, are treated surgically by decompression and tumor resection. In this series of patients with surgically treated SM, we determined individual predictors of functional outcome in the context of intraoperative neuromonitoring (IOM). METHODS: This retrospective study included 45 patients (39 women, 6 men; mean age 63 years). We reviewed pre- and postoperative charts, surgical reports, radiographic data for demographics, use of IOM, duration of symptoms, histopathology, co-morbidities, radiographic extension, surgical strategy, neurological performance (Japanese Orthopedic Association Score [JOA score]. Median follow-up was 34 months (12-190 months). RESULTS: Most frequent surgical approaches were laminectomy (71.1%, n = 32) and hemi-laminectomy (28.9%, n = 13). Predominant SM site was the thoracic spine (55.6%, n = 25). Most common symptoms were sensory deficits (77.8%, n = 35), gait disorders (55.6%, n = 25), motor deficits (42.2%, n = 19), and radiating pain (37.8%, n = 17). Simpson grade 1 resection was achieved in 6 patients, most common type of resection was Simpson grade 2 in 36 patients. During follow-up, 80.0% of patients had fully recovered sensory deficits (p < 0.001), 76.0% of patients with preoperative gait disorders had been asymptomatic (p < 0.001), and motor deficits in 12/19 (63.1%). Pain had decreased significantly from admission to follow-up (p = 0.001). IOM was used in 20 (44.4%) patients. Postoperatively, 6(13.3%) patients had developed a new neurological deficit, 4 of them operated without IOM. CONCLUSION: Resection of SM with IOM showed good recovery, excellent functional results with low surgical morbidity.


Assuntos
Descompressão Cirúrgica/tendências , Laminectomia/tendências , Neoplasias Meníngeas/cirurgia , Meningioma/cirurgia , Recuperação de Função Fisiológica , Adulto , Idoso , Idoso de 80 Anos ou mais , Descompressão Cirúrgica/métodos , Feminino , Seguimentos , Humanos , Laminectomia/métodos , Masculino , Neoplasias Meníngeas/diagnóstico , Meningioma/diagnóstico , Pessoa de Meia-Idade , Procedimentos Neurocirúrgicos/métodos , Procedimentos Neurocirúrgicos/tendências , Recuperação de Função Fisiológica/fisiologia , Estudos Retrospectivos , Resultado do Tratamento
13.
J Clin Neurosci ; 75: 11-18, 2020 May.
Artigo em Inglês | MEDLINE | ID: mdl-32249177

RESUMO

BACKGROUND: Thoracolumbar burst fractures (TLBFs) are the most common spinal trauma; however, their appropriate management has not yet been determined. In this study, we aimed to compare the clinical and radiological results of percutaneous pedicle screw fixation (PPSF) following posterior decompression technique versus anterior corpectomy and fusion technique for the treatment of TLBFs. METHODS: A total of 46 patients (2002-2015) with TLBFs were included in this study. The inclusion criteria were a single-level Magerl type A3 burst fracture of the thoracolumbar junctional spine (T12-L2). The patients were divided into two groups; Group A (22 patients) underwent anterior corpectomy and fusion, and Group B (24 patients) underwent PPSF after posterior decompression. Anterior corpectomy and fusion surgery were performed in 22 cases before April 2009, and PPSF following posterior decompression technique was used in 24 cases since then. For radiological assessment, the kyphosis angle was measured preoperatively, early postoperatively, and at the last follow-up using the Cobb angle. Mean correction of the Cobb angle after surgery, and loss of correction between the immediate postoperative and final Cobb angle were calculated accordingly. All neurological deficits were identified in the initial evaluation and graded using the American Spinal Injury Association(ASIA) grading system. Perioperative parameters including operation time, amount of blood loss, and mean hospital stay were also evaluated. RESULTS: The patients comprised 17 males and 5 females in Group A and 13 males and 11 females in Group B. In terms of the involved levels, there were three cases of T12, twelve L1, and seven L2 in Group A and one case of T12, thirteen L1, and ten L2 in Group B. The mean follow-up duration was 44.9 months in Group A and 14.7 months in Group B. The kyphotic angle was significantly corrected after surgery by 6.4° in Group A (p = 0.001) and 9.2° in Group B (p < 0.001). Among patients with neurological deficit, 11 of 15 in Group A and 20 of 23 in Group B demonstrated improvement by at least one ASIA grade at the final observation. However, there was no significant difference in neurological improvement between the two groups (p = 0.13). Mean operation time was significantly shorter (p < 0.001) and mean blood loss was significantly less (p < 0.001) in Group B than in Group A. Mean hospital stay was also significantly shorter in Group B (p < 0.001). CONCLUSIONS: Spinal canal decompression through small laminectomy followed by PPSF in the treatment of TLBFs with neurological deficits offers excellent clinical and radiological improvement as well as biomechanical stability. Furthermore, this can be a safe and effective surgical option with the advantage of less invasiveness in the treatment of TLBFs.


Assuntos
Fixação Interna de Fraturas/métodos , Fraturas por Compressão/cirurgia , Fraturas da Coluna Vertebral/cirurgia , Fusão Vertebral/métodos , Adulto , Idoso , Descompressão Cirúrgica/métodos , Feminino , Humanos , Laminectomia/métodos , Vértebras Lombares/cirurgia , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Vértebras Torácicas/cirurgia
14.
Spine (Phila Pa 1976) ; 45(8): E465-E476, 2020 Apr 15.
Artigo em Inglês | MEDLINE | ID: mdl-32224807

RESUMO

STUDY DESIGN: Retrospective cohort. OBJECTIVE: To describe our technique for and evaluate the time demand, radiation exposure and outcomes of skin-anchored intraoperative three-dimensional navigation (ION) in minimally invasive (MIS) lumbar surgery, and to compare these parameters to 2D fluoroscopy for MI-TLIF. SUMMARY OF BACKGROUND DATA: Limited visualization of anatomic landmarks and narrow access corridor in MIS procedures result in greater reliance on image guidance. Although two-dimensional fluoroscopy has historically been used, ION is gaining traction. METHODS: Patients who underwent MIS lumbar microdiscectomy, laminectomy, or MI-TLIF using skin-anchored ION and MI-TLIF by the same surgeon using 2D fluoroscopy were selected. Operative variables, radiation exposure, and short-term outcomes of all procedures were summarized. Time-demand and radiation exposure of fluoroscopy and ION for MI-TLIF were compared. RESULTS: Of the 326 patients included, 232 were in the ION cohort (92 microdiscectomies, 65 laminectomies, and 75 MI-TLIFs) and 94 in the MI-TLIF using 2D fluoroscopy cohort. Time for ION setup and image acquisition was a median of 22 to 24 minutes. Total fluoroscopy time was a median of 10 seconds for microdiscectomy, 9 for laminectomy, and 26 for MI-TLIF. Radiation dose was a median of 15.2 mGy for microdiscectomy, 16.6 for laminectomy, and 44.6 for MI-TLIF, of this, 93%, 95%, and 37% for microdiscectomy, laminectomy, and MI-TLIF, respectively were for ION image acquisition, with the rest attributable to the procedure. There were no wrong-level surgeries. Compared with fluoroscopy, ION for MI-TLIF resulted in lower operative times (92 vs. 108 min, P < 0.0001), fluoroscopy time (26 vs. 144 s, P < 0.0001), and radiation dose (44.6 vs. 63.1 mGy, P = 0.002), with equivalent time-demand and length of stay. ION lowered the radiation dose by 29% for patients and 55% for operating room personnel. CONCLUSION: Skin-anchored ION does not increase time-demand compared with fluoroscopy, is feasible, safe and accurate, and results in low radiation exposure. LEVEL OF EVIDENCE: 3.


Assuntos
Imageamento Tridimensional/métodos , Monitorização Neurofisiológica Intraoperatória/métodos , Vértebras Lombares/cirurgia , Procedimentos Cirúrgicos Minimamente Invasivos/métodos , Duração da Cirurgia , Exposição à Radiação , Adulto , Idoso , Estudos de Coortes , Discotomia/efeitos adversos , Discotomia/métodos , Feminino , Fluoroscopia/efeitos adversos , Fluoroscopia/métodos , Humanos , Imageamento Tridimensional/efeitos adversos , Monitorização Neurofisiológica Intraoperatória/efeitos adversos , Laminectomia/efeitos adversos , Laminectomia/métodos , Vértebras Lombares/diagnóstico por imagem , Masculino , Pessoa de Meia-Idade , Procedimentos Cirúrgicos Minimamente Invasivos/efeitos adversos , Neuronavegação/efeitos adversos , Neuronavegação/métodos , Estudos Prospectivos , Exposição à Radiação/efeitos adversos , Estudos Retrospectivos , Pele/diagnóstico por imagem , Fusão Vertebral/efeitos adversos , Fusão Vertebral/métodos
15.
Neurocirugía (Soc. Luso-Esp. Neurocir.) ; 31(2): 64-75, mar.-abr. 2020. ilus, tab
Artigo em Espanhol | IBECS | ID: ibc-190374

RESUMO

OBJETIVO: Evaluar la efectividad y seguridad del polvo de vancomicina tópico como profilaxis de infección de herida quirúrgica (IHQ) en cirugía de columna electiva por abordaje posterior. MATERIAL Y MÉTODOS: Estudio unicéntrico cuasiexperimental de comparación pre- y postintervención. El grupo postintervención recibió profilaxis antibiótica estándar preoperatoria junto a 1g de polvo de vancomicina en el lecho quirúrgico antes del cierre de la herida. El grupo preintervención solo recibió la profilaxis intravenosa. RESULTADOS: Participaron 150 pacientes en cada grupo. Ocurrieron 12 infecciones (7 superficiales, 5 profundas) en el grupo postintervención y 16 infecciones (7 superficiales, 9 profundas) en el grupo preintervención. El riesgo de IHQ profunda se redujo del 6% al 3,3% (OR 0,54; IC 95% 0,17-1,65; p = 0,411) con el tratamiento. El porcentaje de IHQ profunda por gramnegativos-positivos fue del 80-20% en el grupo tratado con vancomicina y del 33-67% en los no tratados (p = 0,265). No se produjeron efectos adversos locales ni sistémicos por el tratamiento. CONCLUSIÓN: La profilaxis con polvo de vancomicina en cirugía electiva de columna por abordaje posterior no redujo de forma significativa la incidencia de IHQ superficial o profunda. Se constató una tendencia al aumento de IHQ profunda por microorganismos gramnegativos en los tratados con vancomicina


OBJECTIVE: To assess the effectiveness and safety of vancomycin powder as surgical site infection (SSI) prophylaxis in posterior bilateral elective spinal surgery. MATERIALS AND METHODS: Single-center quasi-experimental pre and postintervention comparative cohort study. The post-intervention group received standard intravenous antibiotic prophylaxis plus 1g of vancomycin powder into the surgical field before wound closure, and the pre-intervention group only the intravenous prophylaxis. RESULTS: 150 patients were included in each group. Twelve SSI (7 superficial and 5 deep) occurred in the post-intervention group and 16 SSI (7 superficial and 9 deep) in the pre-intervention group. The risk of deep SSI decreased from 6.0% to 3.3% (OR 0,54, 95%CI 0.17-1.65, p = 0.411) with vancomycin powder. The percentage of deep SSI due to gram negative-positive germs were 80%-20% and 33%-67% for the post- and pre-intervention groups, respectively (p = 0.265). No local or systemic adverse effects occurred attributable to vancomycin powder. CONCLUSIÓN: In posterior elective spinal surgery, prophylaxis with vancomycin powder did not result in a significantly reduced incidence of superficial and deep SSI. There was a trend towards a higher incidence of deep SSI caused by gram negative microorganisms among those treated with vancomycin


Assuntos
Humanos , Masculino , Feminino , Pessoa de Meia-Idade , Idoso , Idoso de 80 Anos ou mais , Antibioticoprofilaxia/métodos , Infecção da Ferida Cirúrgica/prevenção & controle , Vancomicina/uso terapêutico , Resultado do Tratamento , Coluna Vertebral/cirurgia , Infecção da Ferida Cirúrgica/tratamento farmacológico , Administração Tópica , Estudos de Coortes , Estudos Retrospectivos , Sucção/métodos , Laminectomia/métodos , Fatores de Risco , Vancomicina/efeitos adversos
16.
Vet J ; 256: 105435, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-32113586

RESUMO

Degenerative lumbosacral stenosis in dogs frequently involves L7-S1 foraminal stenosis and L7 nerve root compression. Surgical techniques to decompress the L7 nerve root include foraminotomy and intervertebral distraction. The objective of this study was to compare the effect of foraminotomy and intervertebral distraction on the total, cranial, and caudal compartmental volumes of the L7-S1 intervertebral neurovascular foramen (NF). CT images were obtained from eight canine lumbosacral (L5-CD1) specimens in the following sequential conditions: native spine (1), after dorsal laminectomy and partial discectomy of L7-S1 (2), after L7-S1 foraminotomy (3), after distraction with an interbody cage between L7 and S1 (4), after cage distraction stabilized with pedicle screw-rod fixation in neutral (5) and flexed position (6). The volume of the complete NF and its cranial and caudal subcompartments were calculated using the CT images and statistically compared between conditions. P < 0.05 was considered statistically significant. The volume of the complete NF was significantly increased after foraminotomy (mean ± standard deviation (146.8 ± 26.5%, P < 0.01) and after distraction (Condition 4, 121.0 ± 19.1%; Condition 5, 116.6 ± 29.3 %; Condition 6, 119.0 ± 21.8 %; P = 0.01) with no difference between the distraction conditions. Foraminotomy induced a significantly larger increase in total NF volume compared to distraction. Foraminotomy, but not distraction, induced a significant increase in volume of the cranial subcompartment (158.2 ± 33.2 %; P < 0.01). Foraminotomy is more effective in increasing the foraminal volume and especially the cranial subcompartment, which is where the L7 nerve root traverses the NF. Hence, foraminotomy may be more effective in decompressing the L7 nerve root.


Assuntos
Descompressão Cirúrgica/veterinária , Doenças do Cão/cirurgia , Foraminotomia/veterinária , Estenose Espinal/veterinária , Animais , Descompressão Cirúrgica/métodos , Discotomia/métodos , Discotomia/veterinária , Doenças do Cão/diagnóstico por imagem , Cães , Foraminotomia/métodos , Laminectomia/métodos , Laminectomia/veterinária , Vértebras Lombares/cirurgia , Região Lombossacral/diagnóstico por imagem , Região Lombossacral/cirurgia , Estenose Espinal/cirurgia , Tomografia Computadorizada por Raios X/veterinária
17.
Medicine (Baltimore) ; 99(10): e19348, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-32150074

RESUMO

RATIONALE: A patient presented the abdominal wall protrusion due to tophaceous gout of the spine. Similar cases were not reported in the literature. This study aimed to report a case of tophaceous gout of the spine with abdominal wall protrusion. PATIENT CONCERNS: A 38-year-old male patient had a 10-year history of gout and hyperuricemia. He complained of back pain and abdominal wall protrusion. DIAGNOSES: The patient was diagnosed with tophaceous gout of the spine with abdominal wall weakness caused by T11 nerve root compression. INTERVENTIONS: A semi-lamina decompression was performed at T11-T12. The pathological examination of the specimen demonstrated tophaceous gout of the spine. OUTCOMES: After the surgery, the patient's back pain was completely relieved and the abdominal wall weakness significant improved. LESSONS: This case highlighted that axial gout could mimic thoracic disk herniation clinically. The abdominal wall weakness might also be due to single T11 nerve compression by the tophaceous gout of the spine. In patients with a history of gout, axial gout should be considered as one of the differential diagnoses.


Assuntos
Parede Abdominal/anormalidades , Gota/cirurgia , Vértebras Torácicas/cirurgia , Parede Abdominal/cirurgia , Humanos , Hiperuricemia/complicações , Hiperuricemia/cirurgia , Laminectomia/métodos , Compressão da Medula Espinal/cirurgia
18.
World Neurosurg ; 138: 231-241, 2020 06.
Artigo em Inglês | MEDLINE | ID: mdl-32169619

RESUMO

BACKGROUND: Filum terminale arteriovenous fistulas (FTAVFs) are rare, and the pathogenesis of these fistulas remains unclear. They may be either congenital or acquired in origin. The authors report 3 cases of FTAVFs in association with severe spinal canal stenosis. The authors also review literature of FTAVFs associated with spinal canal stenosis. CASE DESCRIPTION: All 3 cases harboring FTAVFs manifested with progressive myelopathy and bowel/bladder dysfunction following long history of back pain, sciatica, and/or intermittent claudication. The fistulas were located around or at the level of spinal canal stenosis and supplied by the anterior spinal and/or lateral sacral arteries with cranial drainage from the dilated vein of the filum terminale to the perimedullary veins. The first and third cases were treated concomitantly by performing instrumented fusion with decompressive laminectomy along with occlusion of the fistula with good results. The second case was unsuccessfully treated by endovascular treatment through the lateral sacral artery and denied further surgical treatment. CONCLUSIONS: Our 3 case reports may provide additional evidence supporting an acquired etiology of FTAVFs, probably secondary to the severe central canal stenosis. From our review, the level of the fistulas in most patients is correlated with the level of spinal canal stenosis. The authors preferred the concomitant surgical treatment by performing decompressive laminectomy and obliteration of the fistula in the same surgical session.


Assuntos
Fístula Arteriovenosa/complicações , Fístula Arteriovenosa/terapia , Doenças do Sistema Nervoso Periférico/complicações , Doenças do Sistema Nervoso Periférico/terapia , Estenose Espinal/complicações , Estenose Espinal/terapia , Idoso , Cauda Equina/patologia , Cauda Equina/cirurgia , Descompressão Cirúrgica/métodos , Embolização Terapêutica/métodos , Procedimentos Endovasculares/métodos , Feminino , Humanos , Laminectomia/métodos , Região Lombossacral , Masculino , Pessoa de Meia-Idade , Fusão Vertebral/métodos
19.
World Neurosurg ; 137: 367-371, 2020 05.
Artigo em Inglês | MEDLINE | ID: mdl-32084619

RESUMO

BACKGROUND: The distal extent of the spinal cord is most often at the level of the L1 or L2 vertebral body. In rare cases, a low-lying cord extends more distally. In this scenario, pathology that normally causes radiculopathy may cause myelopathy due to compression of the cord rather than nerve roots of the cauda equina. CASE DESCRIPTION: A 40-year-old man presented with progressive leg pain, sensory changes, hyperreflexia, and gait disturbance 1 month after a fall. The patient was myelopathic and had central L1/2 and L2/3 disk herniations. After unsuccessful unilateral laminotomy bilateral decompression, it was decided that an endoscopic diskectomy would be the best technique to remove the disk herniation without trauma to the cord or destabilizing the spine to require fusion. A percutaneous endoscopic lumbar diskectomy at L1/2 was performed under local anesthesia. The patient's leg pain, sensory changes, hyperreflexia, and gait disturbance resolved after surgery, and he was doing well at 6 months' follow-up. CONCLUSIONS: In patients with spina bifida occulta who present with myelopathy, lumbar disk herniation should be considered if the patient has a low-lying cord. This is the first report of percutaneous endoscopic lumbar diskectomy for lumbar disk herniation in the presence of a low-lying spinal cord. We have demonstrated that this approach can treat this condition effectively and safely.


Assuntos
Discotomia/métodos , Deslocamento do Disco Intervertebral/cirurgia , Vértebras Lombares , Espinha Bífida Oculta/complicações , Compressão da Medula Espinal/cirurgia , Adulto , Descompressão Cirúrgica/métodos , Progressão da Doença , Humanos , Deslocamento do Disco Intervertebral/complicações , Deslocamento do Disco Intervertebral/diagnóstico por imagem , Laminectomia/métodos , Imagem por Ressonância Magnética , Masculino , Defeitos do Tubo Neural/complicações , Compressão da Medula Espinal/diagnóstico por imagem , Compressão da Medula Espinal/etiologia
20.
Acta Neurochir (Wien) ; 162(4): 929-936, 2020 04.
Artigo em Inglês | MEDLINE | ID: mdl-32086604

RESUMO

PURPOSE: Facet cysts develop due to degeneration of the zygapophyseal joints and can lead to radiculopathy and neurogenic claudication. Various surgical options are available for facet cyst excision. The aim was to facilitate surgical treatment of lumbar facet cysts based on a new classification. METHODS: We retrospectively analyzed all patients of the last 10 years in whom a facet cyst was surgically removed (ipsilateral laminotomy, contralateral laminotomy, and segmental fusion). Several radiological parameters were analyzed and correlated with the patients' outcome (residual symptoms, perioperative complications, need for re-operation, need for secondary fusion, facet cyst recurrence). RESULTS: One hundred eleven patients (55 women; median age 64 years) could be identified. Thirty-three (48%) of 69 cases, for which MRI data were available, were classified as medial facet cyst (compressing the spinal canal), 6 facet cysts were localized intraforaminal (9%) and 30 cases (43%) mediolateral (combination of both). The contralateral approach had the lowest rate for revision surgery (7.5%, p = .038) and the lowest prevalence of residual complaints (7.5%, p = .109). A spondylolisthesis and a higher/steeper angle of the facet joints were associated with poorer patient outcome. CONCLUSIONS: Lateral facet joint cysts are best resected by a contralateral approach offering the best outcome while medial cysts are suitable for removal by an ipsilateral laminotomy. The approach of mediolateral cysts can be determined by the width of the lamina and the angle of the joint. Segmental fusion should be considered in cases with detected spondylolisthesis and/or steep facet joints.


Assuntos
Laminectomia/métodos , Complicações Pós-Operatórias/epidemiologia , Cisto Sinovial/classificação , Articulação Zigapofisária/cirurgia , Adulto , Idoso , Feminino , Humanos , Laminectomia/efeitos adversos , Imagem por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Radiografia , Cisto Sinovial/diagnóstico por imagem , Cisto Sinovial/patologia , Cisto Sinovial/cirurgia
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