Your browser doesn't support javascript.
loading
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 5.648
Filtrar
1.
BMJ Case Rep ; 14(1)2021 Jan 18.
Artigo em Inglês | MEDLINE | ID: mdl-33462042

RESUMO

Juvenile ossifying fibroma (JOF) is a rare benign fibro-osseous tumour occurring in craniofacial bones of children and young adults. An 8-year-old girl presented with low back pain since 10 months. Plain radiographs revealed a vertebra plana-like lesion of L3 vertebra. CT scan showed an osteolytic lesion with areas of ground-glass appearance interspersed with bone flecks involving the entire body, pedicles and laminae of L3 with well-circumscribed cortical margins. Biopsy was done-histopathological findings showed cellular fibrous stroma with bony trabeculae-which, on corroboration with clinical and radiological findings noted previously, confirmed the diagnosis of JOF. The patient underwent preoperative angioembolisation, curettage and posterior stabilisation. At follow-up of 15 months, the patient was asymptomatic-imaging revealed residual tumour in pedicles-which however did not progress radiologically. The case raises the importance of including this rare condition as a differential diagnosis in children and reports successful outcome with subtotal resection.


Assuntos
Fibroma Ossificante/diagnóstico , Fibroma Ossificante/cirurgia , Vértebras Lombares , Neoplasias da Coluna Vertebral/diagnóstico , Neoplasias da Coluna Vertebral/cirurgia , Criança , Feminino , Humanos
3.
Yonsei Med J ; 62(1): 59-67, 2021 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-33381935

RESUMO

PURPOSE: This study aimed to present our experiences with a precise surgical strategy for sacrectomy. MATERIALS AND METHODS: This study comprised a retrospective review of 16 patients (6 males and 10 females) who underwent sacrectomy from 2011 to 2019. The average age was 42.4 years old, and the mean follow-up period was 40.8 months. Clinical data, including age, sex, history, pathology, radiographs, surgical approaches, onset of recurrence, and prognosis, were analyzed. RESULTS: The main preoperative symptom was non-specific local pain. Nine patients (56%) complained of bladder and bowel symptoms. All patients required spinopelvic reconstruction after sacrectomy. Three patients, one high, one middle, and one hemi-sacrectomy, underwent spinopelvic reconstruction. The pathology findings of tumors varied (chordoma, n=7; nerve sheath tumor, n=4; giant cell tumor, n=3, etc.). Adjuvant radiotherapy was performed for 5 patients, chemotherapy for three, and combined chemoradiotherapy for another three. Six patients (38%) reported postoperative motor weakness, and newly postoperative bladder and bowel symptoms occurred in 5 patients. Three patients (12%) experienced recurrence and expired. CONCLUSION: In surgical resection of sacral tumors, the surgical approach depends on the size, location, extension, and pathology of the tumors. The recommended treatment option for sacral tumors is to remove as much of the tumor as possible. The level of root sacrifice is a predicting factor for postoperative neurologic functional impairment and the potential for morbidity. Pre-operative angiography and embolization are recommended to prevent excessive bleeding during surgery. Spinopelvic reconstruction must be considered following a total or high sacrectomy or sacroiliac joint removal.


Assuntos
Osteotomia , Sacro/cirurgia , Neoplasias da Coluna Vertebral/cirurgia , Adulto , Feminino , Humanos , Masculino , Osteotomia/efeitos adversos , Estudos Retrospectivos , Neoplasias da Coluna Vertebral/patologia , Neoplasias da Coluna Vertebral/fisiopatologia
4.
Medicine (Baltimore) ; 99(50): e23587, 2020 Dec 11.
Artigo em Inglês | MEDLINE | ID: mdl-33327321

RESUMO

RATIONALE: Angiosarcoma is a rare malignant tumors. The objective of this study is to report a patient who suffered from a progressive low back pain and left lower extremities radiation pain for about 8 months, After diagnoses, this was identified as an extremely rare case of primary multiple angiosarcoma of vertebra. PATIENT CONCERNS: A 54-year-old man with a history of 2-year hypertension and 8-year diabetes, both of which were well controlled by drug management. Lately, he suffered from a progressive low back pain and left lower extremities radiation pain for about 8 months. DIAGNOSES: Magnetic resonance imaging of lumbar showed a clear pathological fracture and primary multiple angiosarcoma of all vertebra. Postoperative pathology and High-throughput sequencing confirmed the diagnosis of primary multiple angiosarcoma of vertebra. INTERVENTIONS: The patient underwent minimally invasive pedicle screw fixation combined with bone cement augmentation for the purpose of stabilizing the damaged vertebrae. Following operation, he received both radiotherapy and chemotherapy for a period of time. OUTCOMES: The operation has achieved positive results in relieving pain and stabilizing the spine. No wound problem or operative complications occurred after operation. The patient reported an obvious remission of low back pain and was only capable to perform restricted physiological activities. A long-term palliative radiotherapy and chemotherapy were performed after operation. Unfortunately, the patient died 18 months later. CONCLUSION: This article emphasizes primary multiple angiosarcoma of vertebra. Despite being rare, it should be part of the differential when the patient manifested back pain and radiculopathy. We recommended the minimally invasive pedicle screw fixation for angiosarcoma of vertebra. Osteoplasty by bone cement augmentation was also an ideal choice for surgical treatment. It also advocates the use of specific targeted radiotherapy drugs based on gene analysis of tumors.


Assuntos
Fraturas Espontâneas/diagnóstico , Hemangiossarcoma/diagnóstico , Vértebras Lombares , Neoplasias Primárias Múltiplas/diagnóstico , Neoplasias da Coluna Vertebral/diagnóstico , Terapia Combinada , Fraturas Espontâneas/complicações , Fraturas Espontâneas/diagnóstico por imagem , Fraturas Espontâneas/cirurgia , Hemangiossarcoma/complicações , Hemangiossarcoma/diagnóstico por imagem , Hemangiossarcoma/cirurgia , Humanos , Dor Lombar/etiologia , Imagem por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Neoplasias Primárias Múltiplas/complicações , Neoplasias Primárias Múltiplas/diagnóstico por imagem , Neoplasias Primárias Múltiplas/cirurgia , Parafusos Pediculares , Neoplasias da Coluna Vertebral/complicações , Neoplasias da Coluna Vertebral/diagnóstico por imagem , Neoplasias da Coluna Vertebral/cirurgia
5.
Tech Vasc Interv Radiol ; 23(4): 100699, 2020 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-33308579

RESUMO

This article provides a step-by-step guide for minimally invasive percutaneous image-guided thermal ablation for treatment of vertebral metastases. Such interventions have proved safe and effective in management of selected patients with spinal metastases primarily to achieve pain palliation and local tumor control. Particular attention to patient selection guidelines, details of procedure techniques, thermal protection, adequacy of treatment, recognition and management of potential complications, and post-ablation imaging are essential for improved patient outcomes.


Assuntos
Dor nas Costas/cirurgia , Criocirurgia , Metastasectomia , Micro-Ondas/uso terapêutico , Manejo da Dor , Ablação por Radiofrequência , Radiografia Intervencionista , Neoplasias da Coluna Vertebral/cirurgia , Dor nas Costas/diagnóstico , Criocirurgia/efeitos adversos , Humanos , Metastasectomia/efeitos adversos , Micro-Ondas/efeitos adversos , Manejo da Dor/efeitos adversos , Complicações Pós-Operatórias/terapia , Ablação por Radiofrequência/efeitos adversos , Radiografia Intervencionista/efeitos adversos , Neoplasias da Coluna Vertebral/diagnóstico por imagem , Neoplasias da Coluna Vertebral/secundário , Resultado do Tratamento
6.
Kyobu Geka ; 73(10): 829-833, 2020 Sep.
Artigo em Japonês | MEDLINE | ID: mdl-33130774

RESUMO

While cases of surgical resection for primary lung cancers are increasing, lung cancer requiring vertebrectomy is rare. A high complication rate and recurrence rate have been reported after surgical resection for lung cancer with vertebral invasion. However, select patients who achieve complete resection after effective preoperative chemoradiotherapy show a better survival rate than others. Preoperative computed tomography and magnetic resonance imaging are necessary to consider surgical strategies and how to resect and reconstruct the vertebral body and chest wall with a clear margin before surgery. A 3-dimensional imaging or simulation model is useful for such ends. Several surgical approaches have been developed, such as the transmanubrial, posterior, posterolateral, or the combination thereof. Proper vertebrectomy( total, hemi, part of a vertebra, or only the transverse process of a vertebra) and reconstruction approaches should be decided in conjunction with orthopedic surgeons. While evidence is lacking, establishing proper surgical indications and developing effective strategies to achieve complete resection with a clear margin are the most critical points in lung cancer requiring vertebrectomy.


Assuntos
Neoplasias Pulmonares , Neoplasias da Coluna Vertebral , Humanos , Neoplasias Pulmonares/diagnóstico por imagem , Neoplasias Pulmonares/cirurgia , Recidiva Local de Neoplasia , Pneumonectomia , Neoplasias da Coluna Vertebral/diagnóstico por imagem , Neoplasias da Coluna Vertebral/cirurgia , Coluna Vertebral , Resultado do Tratamento
7.
Medicine (Baltimore) ; 99(44): e22937, 2020 Oct 30.
Artigo em Inglês | MEDLINE | ID: mdl-33126359

RESUMO

RATIONALE: Surgical treatment of spinal hepatocellular carcinoma metastasis after Liver transplantation (LT) is a clinical challenge. We herein report the clinical outcomes of the first case of a patient with T11 from hepatocellular carcinoma metastasis after systemic chemotherapy following LT combined with mesenteric resection and colectomy, who was successfully treated with En Bloc spondylectomy. PATIENT CONCERNS: The patient with HCC was a 40-year-old man, who had received LT combined with mesenteric resection and colectomy 15 months before. His main symptom was progressive back pain because of T11 metastasis. PET examinations showed a solitary metastasis at T11 without recurrence in the liver and metastasis in the other organs. DIAGNOSIS: The patient was diagnosed with the T11 vertebra HCC metastasis after LT combined with resection of HCC mesenteric metastasis and colon metastasis. INTERVENTIONS: Five cycles of systemic chemotherapy following LT were performed for preventing HCC metastases. However, the right abdominal wall metastasis was found 9 months after LT, followed by T11 metastases thereafter. Immediate resection of the right abdominal wall metastasis was achieved. En Bloc spondylectomy of T11 vertebra was chosen as a treatment for metastasis to T11. After T11 surgery, the patient showed obvious pain relief. However, At 3 months after T11 surgery, a grafted liver metastasis and multiple nodules metastasis in the greater omentum region were revealed with CT imaging, At 5 months after T11 surgery, multiple lung metastases were discovered by MRI. The patient was performed 5 cycles of chemotherapy, 3 times of infusion of iodine [131I] meximab and 3 times of TACE after T11 surgery. Multiple bone metastases were treated with radiotherapy. OUTCOMES: The patient died 29 months after LT combined with mesenteric resection and colectomy because of recurrence in the liver and metastasis in the lung. LESSONS: En Bloc spondylectomy may be a therapeutic choice for patients with progression after systemic chemotherapy for the solitary spinal metastases after LT combined with mesenteric resection and colectomy, which has a survival benefit without local recurrence at the surgical site. immunosuppressant after LT may result in worse immune function, which leads to HCC more prone to recurrence and bone metastasis.


Assuntos
Carcinoma Hepatocelular/patologia , Neoplasias do Colo/secundário , Neoplasias Hepáticas/patologia , Transplante de Fígado/efeitos adversos , Neoplasias Peritoneais/secundário , Neoplasias da Coluna Vertebral/secundário , Carcinoma Hepatocelular/diagnóstico por imagem , Carcinoma Hepatocelular/tratamento farmacológico , Colectomia , Neoplasias do Colo/diagnóstico por imagem , Neoplasias do Colo/cirurgia , Humanos , Neoplasias Hepáticas/diagnóstico por imagem , Neoplasias Hepáticas/tratamento farmacológico , Imagem por Ressonância Magnética , Masculino , Mesentério/cirurgia , Neoplasias Peritoneais/diagnóstico por imagem , Neoplasias Peritoneais/cirurgia , Tomografia Computadorizada com Tomografia por Emissão de Pósitrons , Radiografia , Neoplasias da Coluna Vertebral/diagnóstico por imagem , Neoplasias da Coluna Vertebral/cirurgia , Vértebras Torácicas
8.
Medicine (Baltimore) ; 99(42): e22604, 2020 Oct 16.
Artigo em Inglês | MEDLINE | ID: mdl-33080695

RESUMO

We examined the therapeutic effects of argon-helium cryoablation guided by computed tomography (CT) in the treatment of sacral chordoma.This is a retrospective study. CT-guided argon-helium cryoablation was used to treat 9 sacral chordoma patients at our centers between January 2016 and June 2019. We collected data on treatment response and success. Data from long-term follow-up of treatment outcomes were also assessed.All patients were treated successfully according to the indicated technical parameters. There were no reports of procedure-related complications from any of the patients. Complete response (CR) was also achieved in all patients. Six patients (66.7%) achieved initial CR after 1 treatment session and 3 patients (33.3%) achieved secondary CR after 2 treatment sessions. The chordoma-related symptoms improved significantly in all patients after treatment. The mean visual analogue scale score improved from 7.3 before treatment to 4.2 after treatment (P < .001). The mean function score improved from 3.2 before treatment to 1.4 after treatment (P < .001). The median length of follow-up for all patients was 33 months (range: 6-46 months). All patients were alive during the follow-up. Two (22.2%) patients experienced local recurrence (LR) at 6 and 9 months after treatment, respectively. These patients had revised treatment with trans-arterial embolism (n = 1) or repeat ablation (n = 1). The median progression-free survival was 36.8 months.Treatment of sacral chordoma with CT-guided argon-helium cryoablation is effective and offers a potentially beneficial therapeutic alternative for patients with the condition.


Assuntos
Cordoma/cirurgia , Criocirurgia , Radiografia Intervencionista , Sacro/cirurgia , Neoplasias da Coluna Vertebral/cirurgia , Adulto , Idoso , Cordoma/diagnóstico por imagem , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Sacro/diagnóstico por imagem , Neoplasias da Coluna Vertebral/diagnóstico por imagem , Tomografia Computadorizada por Raios X
9.
Anticancer Res ; 40(10): 5673-5678, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-32988892

RESUMO

BACKGROUND/AIM: We conducted a randomized controlled trial to investigate whether minimally access spine surgery (MASS) is less morbid than open surgery (OS) in patients with metastatic spinal cord compression (MSCC). PATIENTS AND METHODS: A total of 49 MSCC patients were included in the trial. The outcome measures were bleeding (L), operation time (min), re-operations and prolonged wound healing. RESULTS: The median age was 67 years (range=42-85 years) and 40% were men. The peri-operative blood loss in the MASS-group was significantly lower than that in the OS-group; 0.175L vs. 0.500L, (p=0.002). The median operation time for MASS was 142 min (range=72-203 min) vs. 103 (range=59-435 min) for OS (p=0.001). There was no significant difference between the two groups concerning revision surgery or delayed wound healing. CONCLUSION: The MASS technique in MSCC patients is associated with less blood loss, but a longer operation time when compared to the OS technique.


Assuntos
Procedimentos Cirúrgicos Minimamente Invasivos/métodos , Compressão da Medula Espinal/cirurgia , Disrafismo Espinal/cirurgia , Neoplasias da Coluna Vertebral/cirurgia , Adulto , Idoso , Idoso de 80 Anos ou mais , Perda Sanguínea Cirúrgica/fisiopatologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Procedimentos Cirúrgicos Minimamente Invasivos/efeitos adversos , Duração da Cirurgia , Avaliação de Resultados em Cuidados de Saúde , Reoperação/métodos , Compressão da Medula Espinal/sangue , Compressão da Medula Espinal/fisiopatologia , Disrafismo Espinal/sangue , Disrafismo Espinal/fisiopatologia , Neoplasias da Coluna Vertebral/sangue , Neoplasias da Coluna Vertebral/fisiopatologia , Neoplasias da Coluna Vertebral/secundário , Resultado do Tratamento
10.
Spine (Phila Pa 1976) ; 45(19): 1386-1394, 2020 Oct 01.
Artigo em Inglês | MEDLINE | ID: mdl-32756271

RESUMO

STUDY DESIGN: Case series. OBJECTIVE: For each of the most frequent clinical scenarios, the authors reached a consensus on how should be timing and indications be optimized to reduce risk while maintaining the expected outcomes under the Covid-19 pandemics. SUMMARY OF BACKGROUND DATA: The organization of health care has been changed by the Covid-19 pandemic with a direct impact on Spine Oncology Surgery. Emergency surgery is still a priority, but in case of spinal tumors it should be better defined which conditions require emergency treatment. METHODS: An expert panel with general spine surgeons, oncological spine surgeons, and radiation oncologists was formed to analyze the most frequent scenarios in spinal musculoskeletal oncology during Covid-19 pandemics. RESULTS: Spine metastases can be found incidentally during follow-up or can clinically occur by increasing pain, pathologic fracture, and/or neurological symptoms. Primary spine tumors are much more rare and very rarely present with acute onset. The first step is to suspect this rare condition, to avoid to treat a primary tumor as it were a metastasis. Most complex surgery, like en bloc resection, associated with high morbidity and mortality rate for the treatment of low grade malignancy like chordoma or chondrosarcomas, if intensive care unit availability is reduced, can be best delayed some weeks, as not impacting on prognosis, due to the slow growth rate of these conditions. The currently accepted protocols for Ewing sarcoma (ES) and osteogenic sarcoma must be performed for local and systemic disease control. For ES, after the first courses of chemotherapy, radiotherapy can be selected instead of surgery, during Covid-19, to the end of the full course of chemotherapy. In immunocompromised patients, (treated by chemotherapy), it is necessary to avoid contact with affected or exposed people. CONCLUSION: Even more than during normal times, a multidisciplinary approach is mandatory to share the decision to modify a treatment strategy. LEVEL OF EVIDENCE: 5.


Assuntos
Betacoronavirus , Infecções por Coronavirus/cirurgia , Oncologia/normas , Pandemias , Pneumonia Viral/cirurgia , Neoplasias da Coluna Vertebral/cirurgia , Cirurgiões/normas , Adulto , Tomada de Decisão Clínica/métodos , Infecções por Coronavirus/diagnóstico por imagem , Infecções por Coronavirus/epidemiologia , Feminino , Humanos , Masculino , Oncologia/métodos , Pessoa de Meia-Idade , Pandemias/prevenção & controle , Equipe de Assistência ao Paciente/normas , Pneumonia Viral/diagnóstico por imagem , Pneumonia Viral/epidemiologia , Prognóstico , Procedimentos Cirúrgicos Reconstrutivos/métodos , Procedimentos Cirúrgicos Reconstrutivos/normas , Neoplasias da Coluna Vertebral/diagnóstico por imagem , Neoplasias da Coluna Vertebral/epidemiologia , Cirurgiões/psicologia
11.
Niger J Clin Pract ; 23(8): 1167-1171, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-32788497

RESUMO

Background: Spine tumors could affect the bony elements and/or its neural contents. Clinical manifestations are underlined by their biological behaviors. Aim: This study aims to identify the pattern of presentation and surgical management of spine tumors in southeast Nigeria over a 10-year period. Patients and Methods: A retrospective analysis of patients who were managed surgically for the spine and spinal cord neoplastic lesions over a 10-year period. All patients had pre-and post-operative magnetic resonance imaging (MRI) and histological diagnosis. Relevant clinical, radiological, and histological data were extracted and analyzed using Statistical Package for the Social Sciences (SPSS) for windows version 21. Results: Four hundred and seventy-two spine procedures performed within the study period, 39 cases of histologically proven primary spinal cord tumors (PSCT) and non-PSCT were identified. These represented 8.3% of spine procedures. Seventeen were PSCT (3.6% of spine procedures), while 22 (4.7%) had non-PSCT, mean age for the PSCT group was 45 yrs and non-PSCT 59.5 years. A total of 56.5% of tumors are involved in the thoracic region, 43.7% in the cervical region. PSCT was likely to affect the cervical spine; while bony spine tumors, thoracic spine [odds ratio (OR) 4.9, P value 0.019]. A total of 84.6% of non-PSCT affected the bony spine, mainly the vertebral body. The histological result showed metastatic adenocarcinoma to be the most common tumor (33.3%). PSCT was likely to be benign than non-PSCT (P value < 0.00001). Gross total resection (GTR) was done in 100% of PSCT, and 50% in non-PSCT. Thirteen (40.6%) patients improved and 11 (34.4%) patients remained the same. Conclusions: Metastatic adenocarcinoma was the most common tumor of the spine. There was restricted ability at a GTR for non-PSCT compared to PSCT. Grossly 75% had improved/same neurological status, as such adjudged as a good outcome.


Assuntos
Adenocarcinoma/cirurgia , Neoplasias da Medula Espinal/diagnóstico , Neoplasias da Medula Espinal/cirurgia , Neoplasias da Coluna Vertebral/diagnóstico , Neoplasias da Coluna Vertebral/cirurgia , Coluna Vertebral/diagnóstico por imagem , Adenocarcinoma/patologia , Adolescente , Adulto , Vértebras Cervicais/cirurgia , Feminino , Humanos , Imagem por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Metástase Neoplásica/patologia , Procedimentos Neurocirúrgicos/métodos , Nigéria , Estudos Retrospectivos , Doenças da Medula Espinal , Neoplasias da Medula Espinal/patologia , Neoplasias da Coluna Vertebral/patologia , Resultado do Tratamento , Adulto Jovem
12.
J Clin Neurosci ; 78: 73-78, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-32600973

RESUMO

Breast cancer spinal metastases (BCSM) are common and require proper treatment that leads to an improvement of the quality of life and contributes to the quod vitam prognosis. Surgical treatment is often required for intractable pain, spinal cord compression or spinal instability. The aim of this retrospective study is to identify which prognostic factors could affect postoperative overall survival in patients affected by BCSM. We report a retrospective cohort study of patients with BCSM, surgically treated from September 2009 to May 2018. Demographic and clinical data were collected. Kaplan-Meier method was used to estimate overall survival, and the log-rank test was used to compare survival curves. A total of 77 patients were studied. The median age at the time of surgery was 54 years. The median follow-up was 49 months. The 3-year and 5-year overall survival rates were 61% (95%CI: 47.5-72.1) and 43.3% (95%CI: 28.8-57.1). Metastatic bone disease (p = 0.0196), preoperative neurological impairment (p = 0.0029), Karnofsky status <70 (p = 0.0241) reduce survival. With multivariate analysis, the effect of Karnofsky score loses statistical significance. The presence of concurrent bone metastases and a preoperative neurological deficit are independent prognostic factors. Therapeutic choices are based on a multidisciplinary assessment that takes into consideration several factors, including an accurate study of prognostic factors.


Assuntos
Neoplasias da Mama , Neoplasias da Coluna Vertebral/mortalidade , Neoplasias da Coluna Vertebral/secundário , Neoplasias da Coluna Vertebral/cirurgia , Adulto , Idoso , Feminino , Humanos , Avaliação de Estado de Karnofsky , Masculino , Pessoa de Meia-Idade , Dor Intratável/cirurgia , Prognóstico , Qualidade de Vida , Estudos Retrospectivos , Compressão da Medula Espinal/cirurgia , Neoplasias da Coluna Vertebral/diagnóstico , Coluna Vertebral/cirurgia , Taxa de Sobrevida
13.
Turk Neurosurg ; 30(4): 632-635, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32672344

RESUMO

Spinal meningiomas are rare in the lumbosacral region. The best solution is complete tumor resection. However, how to preserve the patient?s rectum/bladder function after en bloc resection is still a considerable challenge, even without spinopelvic reconstruction. The use of the three-dimensional (3D) printing technique may simplify it. The final step after restoration is the establishment of rigid fixation. The purpose of this article was to present a case of lumbosacral meningiomas treated by en bloc resection, 3D-printed prosthesis reconstruction, and fixation with pedicle screws and cortical bone trajectory screws. A 35-year-old woman has suffered from lumbosacral and two legs pain for two months. During the previous month, she limped, and her strength was 4/5 in both legs. Magnetic resonance imaging (MRI) revealed space-occupying lesions from the lumbar 5 (L5) to sacral 3 (S3) vertebral bodies. The previous biopsy confirmed the lesions were spinal meningiomas. The patient underwent an en bloc resection followed by 3D-printed prosthesis reconstruction and internal fixation with a novel technique. The surgery was successful, and the patient recovered well postoperatively according to follow-up examination. En bloc resection of L5-S3 meningiomas without rectum/bladder function sacrifice is a feasible procedure, and 3D-printed prosthesis provides an alternative method for the reconstruction of the spinopelvic ring. The rigid fixation construct using the novel four-rod technique could develop strong bony fusion.


Assuntos
Fixadores Internos , Região Lombossacral/cirurgia , Neoplasias Meníngeas/cirurgia , Meningioma/cirurgia , Impressão Tridimensional , Neoplasias da Coluna Vertebral/cirurgia , Adulto , Prótese Ancorada no Osso , Feminino , Humanos , Região Lombossacral/diagnóstico por imagem , Imagem por Ressonância Magnética/métodos , Neoplasias Meníngeas/diagnóstico por imagem , Meningioma/diagnóstico por imagem , Reto/diagnóstico por imagem , Reto/patologia , Neoplasias da Coluna Vertebral/diagnóstico por imagem , Bexiga Urinária/diagnóstico por imagem
14.
J Clin Neurosci ; 78: 67-72, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-32620473

RESUMO

Our objective is to describe the surgical management and outcomes following surgical intervention for aggressive spine hemangiomas. Patients from 2005 to 2018 with an aggressive hemangioma of the cervical, thoracic, lumbar spine and sacrum treated surgically at a tertiary referral academic medical center were included in this study. The hospital pathology department database was used to identify patients with a diagnosis of aggressive hemangioma. Patient demographics, medical history, operative procedure, adjunct treatment, early and late complications, and recurrence were analyzed using the Fischer exact test with significance set at p < 0.05 Ten patients met inclusion criteria for the study. The average follow up was 11 months. Eight out of ten patients had aggressive hemangioma of the thoracic spine. Seven of the ten patients presented with back or leg pain. The most common surgery was laminectomy at the site of the lesion (70%). 40% of patients underwent a spinal fusion, with two of these patients receiving concurrent intra-operative vertebroplasty. Three patients underwent post-operative radiation therapy. Five complications were noted among three individuals. There were three perioperative complications, deep venous thrombosis, renal insufficiency, one surgical site infection, and two postoperative complications, both revisions. There were no recurrences. Surgical intervention for aggressive spine hemangiomas is an effective treatment with relatively low complication and recurrence rates.


Assuntos
Hemangioma/cirurgia , Neoplasias da Coluna Vertebral/cirurgia , Adulto , Feminino , Humanos , Laminectomia , Masculino , Pessoa de Meia-Idade , Recidiva Local de Neoplasia/cirurgia , Dor , Fusão Vertebral , Coluna Vertebral/cirurgia , Resultado do Tratamento , Vertebroplastia
15.
Medicine (Baltimore) ; 99(25): e20430, 2020 Jun 19.
Artigo em Inglês | MEDLINE | ID: mdl-32569166

RESUMO

To compare the efficacy and safety of kyphoplasty (KP) in the treatment of occult metastatic vertebral tumors (OMVT) and non-occult metastatic vertebral tumors (MVT).From January 2013 to December 2017, 65 cases of occult metastatic vertebral tumors and 82 cases of metastatic vertebral tumors were selected and divided into 2 groups. After KP, they were followed up by a year of outpatient visits and telephone calls. The visual analogue scale (VAS) and Oswestry disability index (ODI) scores, the amount of bone cement injected, the change of vertebral height and the incidence of complications were recorded, compared and analyzed by SPSS software. t test was used to compare the differences between the same group of patients at different times and between the 2 groups of patients.In the OMVT group, the operation time was 24.52 ±â€Š4.24 minutes, the fluoroscopy time was 10.18 ±â€Š1.53 minutes and the volume of bone cement was 3.62 ±â€Š0.93 ml. The VAS score decreased from 7.26 ±â€Š01.08 preoperatively to 2.77 ±â€Š0.93 postoperatively (P < .01). The ODI score decreased from 64.89 ±â€Š9.05 preoperatively to 25.82 ±â€Š4.63 postoperatively (P < .01). In the MVT group, the operation time was 26.63 ±â€Š4.61 minutes, the fluoroscopy time was 11.04 ±â€Š2.15 minutes and the volume of bone cement was 4.09 ±â€Š1.10 ml. The VAS score decreased from 7.73 ±â€Š0.94 preoperatively to 3.22 ±â€Š0.80 postoperatively (P < .01). The ODI score decreased from 69.20 ±â€Š7.14 preoperatively to 28.02 ±â€Š4.40 postoperatively (P < .01). The vertebral height of MVT patients was significantly improved after operation (P < .01), but there was no difference in OMVT patients (P > .05).Occult metastatic vertebral tumors can be detected by Magnetic Resonance Imaging (MRI), and KP may be more effective and safer in the treatment of OMVT.


Assuntos
Doenças Assintomáticas/terapia , Cifoplastia/estatística & dados numéricos , Neoplasias da Coluna Vertebral/diagnóstico por imagem , Neoplasias da Coluna Vertebral/cirurgia , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Imagem por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Neoplasias da Coluna Vertebral/secundário
16.
Tech Vasc Interv Radiol ; 23(2): 100677, 2020 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-32591193

RESUMO

Percutaneous thermal ablation has proven to be safe and effective in the management of patients with spinal tumors. Such treatment is currently proposed following the decision of a multidisciplinary tumor board to patients with small painful benign tumors such as osteoid osteoma or osteoblastoma, as well as carefully selected patients presenting with spinal metastases. In both scenarios, in order to provide a clinically effective procedure, ablation is often tailored to the specific patients' clinical needs and features of the target tumor. In this review, we present the most common clinical contexts in which spine ablation may be proposed. We scrutinize technical aspects and challenges that may be encountered during the procedure, as well as offering insight on follow-up and expected outcomes.


Assuntos
Criocirurgia , Ablação por Radiofrequência , Neoplasias da Coluna Vertebral/cirurgia , Vertebroplastia , Tomada de Decisão Clínica , Criocirurgia/efeitos adversos , Criocirurgia/instrumentação , Humanos , Seleção de Pacientes , Complicações Pós-Operatórias/terapia , Ablação por Radiofrequência/efeitos adversos , Ablação por Radiofrequência/instrumentação , Fatores de Risco , Neoplasias da Coluna Vertebral/diagnóstico por imagem , Neoplasias da Coluna Vertebral/patologia , Resultado do Tratamento , Vertebroplastia/efeitos adversos , Vertebroplastia/instrumentação
17.
Turk Neurosurg ; 30(4): 588-594, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32530483

RESUMO

AIM: To elucidate the characteristics of kyphoplasty in correlation with spinal metastasis. MATERIAL AND METHODS: Data of patients treated by kyphoplasty between January 2017 and December 2019 were reviewed retrospectively. Preoperative prophylactic antibiotics and low-molecular-weight heparin injections were performed. Postoperative follow-up was conducted at least 24 hours after the procedure. All patients were treated under sedoanalgesia. Bone biopsies were collected from all patients. RESULTS: One hundred ninety-nine vertebra fractures were treated in 130 patients. The mean age of the patients was 65.27 ± 8.79 years (18?90 years) and 66 patients were male (50.7%). Forty-five patients had osteoporosis, six patients showed malignancy, and osteomyelitis was found in three patients, while the others? presentations were secondary to trauma. Most commonly, the L1 (n=59), Th12 (n=45), and L2 (n=34) levels were found to develop vertebral fractures. Forty patients had multiple levels of vertebral fracture, with a higher rate of osteoporosis (n=24; 60%). Three patients showed undiagnosed oncologic disease with an initial diagnosis of acute fracture following minor trauma, while the primary oncologic diagnosis was established by bone biopsy taken during the routine procedure in each procedure (e.g., plasmacytoma, lymphoma, adenocarcinoma of the lung). None of the patients developed an infection due to kyphoplasty, permanent neuromotor deficit, or mortality. The mean postoperative hospital length of stay was 1.6 days. CONCLUSION: Bone biopsy should be performed to diagnose early spinal metastases. Although an accurate bone biopsy may not be obtained from some patients, particularly from those with osteoporosis, performing bone biopsy during the procedure does not cause time loss or any other complications, and protects the surgeon from possible medicolegal problems.


Assuntos
Detecção Precoce de Câncer/métodos , Cifoplastia/métodos , Fraturas da Coluna Vertebral/diagnóstico por imagem , Fraturas da Coluna Vertebral/cirurgia , Neoplasias da Coluna Vertebral/diagnóstico por imagem , Neoplasias da Coluna Vertebral/cirurgia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Fraturas por Compressão/cirurgia , Humanos , Cifoplastia/efeitos adversos , Vértebras Lombares/diagnóstico por imagem , Vértebras Lombares/lesões , Vértebras Lombares/cirurgia , Masculino , Pessoa de Meia-Idade , Osteomielite/complicações , Osteomielite/cirurgia , Osteoporose/complicações , Osteoporose/cirurgia , Estudos Retrospectivos , Vértebras Torácicas/diagnóstico por imagem , Vértebras Torácicas/lesões , Vértebras Torácicas/cirurgia , Resultado do Tratamento , Vertebroplastia/métodos , Adulto Jovem
18.
J Clin Neurosci ; 78: 128-134, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-32507710

RESUMO

Spinal solitary fibrous tumor/hemangiopericytoma (SFT/HPC) is a rare mesenchymal malignancy. Radiographically, SFT/HPCs have a mutable appearance, with irregular borders, heterogeneous contrast enhancement, and variable but frequently hypointense T2 signal. We report a series of 5 neurosurgically managed spinal SFT/HPCs treated at our institution, with particular attention to 3 lesions demonstrating marked T2-hypointensity and differential diagnosis for the unusual finding of a "T2 dark" spinal lesion. Retrospective chart review of prospectively maintained surgical database, queried by diagnosis and site codes, 2002-2017. Retrospective radiographic review, with initial screening via keyword search of MR reports for "T2" and "hypointense." Four primary and one metastatic spinal SFT/HPCs were operatively treated during the study period (median follow-up 12 months; range 10-92). Three demonstrated marked T2 hypointensity on preoperative MRI, underwent primary resection-GTR in two, STR in one-and have remained progression-free on routine postoperative surveillance. Two patients with isointense lesions recurred within the follow-up period. Radiographic review identified a host of predominantly rare T2-hypointense lesions, including arteriovenous malformation, disk fragmentations, calcific arachnoiditis, calcifying pseudoneoplasm of the neuraxis, cavernoma, cord hemorrhage/acute blood, desmoid, granulocytic sarcoma, pigmented villonodular synovitis, Edheim-Chester, extramedullary hematopoiesis, IgG4-negative inflammatory pseudotumor, idiopathic hypertrophic pachymeningitis, B-cell lymphoma, primary melanoma neoplasm, melanotic schwannoma, meningioma, opacification of the posterior longitudinal ligament, osteoblastoma, osteochondroma, osteosarcoma, and synovial cyst. T2 hypointensity is associated with SFT/HPC, and may be an indicator relative indolence. "Dark" T2 spinal lesions are rare, with a narrow differential populated predominantly by rare entities.


Assuntos
Hemangiopericitoma/diagnóstico por imagem , Hemangiopericitoma/cirurgia , Tumores Fibrosos Solitários/diagnóstico por imagem , Tumores Fibrosos Solitários/cirurgia , Neoplasias da Coluna Vertebral/diagnóstico por imagem , Neoplasias da Coluna Vertebral/cirurgia , Idoso , Idoso de 80 Anos ou mais , Diagnóstico Diferencial , Feminino , Humanos , Imagem por Ressonância Magnética/métodos , Masculino , Pessoa de Meia-Idade , Recidiva Local de Neoplasia/diagnóstico por imagem , Recidiva Local de Neoplasia/cirurgia , Estudos Prospectivos , Estudos Retrospectivos
19.
Medicine (Baltimore) ; 99(22): e20397, 2020 May 29.
Artigo em Inglês | MEDLINE | ID: mdl-32481429

RESUMO

RATIONALE: Diffuse idiopathic skeletal hyperostosis (DISH) is characterized by ossification along the anterolateral aspect of at least 4 contiguous vertebral bodies. A fracture involving the fused vertebra in patients with DISH often leads to severe instability and spinal cord injury. Spinal metastasis (Mets) and DISH can coexist in elderly patients and increase their risk of pathologic vertebral fractures. However, there are few reports on concomitant spinal Mets and DISH. PATIENT CONCERNS: A 78-year-old man who complained of gradual onset of paraparesis, sensory loss below the umbilicus, and incontinence (case 1) and a 63-year-old woman who complained of severe back pain and urinary incontinence (case 2). DIAGNOSIS: Two patients were diagnosed with spinal Mets and DISH. INTERVENTIONS: Decompression surgery was performed at the metastatic sites in case 1 whereas instrumentation surgery was performed in case 2 despite the fracture having a benign appearance with no associated neurologic symptoms. OUTCOMES: A vertebral fracture developed at the metastatic vertebra after decompression surgery in case 1. Severe instability of the surgical site in this case resulted in persistent paralysis even after subsequent revision surgery with instrumentation. In contrast, the clinical course was benign without any neurologic dysfunction at the 2-year follow-up in case 2. LESSONS: Instrumentation surgery should be performed in patients with DISH who develop spinal Mets even if there is no apparent instability.


Assuntos
Hiperostose Esquelética Difusa Idiopática/complicações , Neoplasias da Coluna Vertebral/secundário , Idoso , Blefaroptose , Neoplasias da Mama/patologia , Anormalidades Congênitas , Descompressão Cirúrgica/métodos , Feminino , Fixação Interna de Fraturas/métodos , Humanos , Hiperostose Esquelética Difusa Idiopática/cirurgia , Região Lombossacral/anormalidades , Masculino , Pessoa de Meia-Idade , Neoplasias da Próstata/patologia , Fraturas da Coluna Vertebral/etiologia , Fraturas da Coluna Vertebral/cirurgia , Neoplasias da Coluna Vertebral/complicações , Neoplasias da Coluna Vertebral/cirurgia , Vértebras Torácicas/lesões , Vértebras Torácicas/cirurgia
20.
Am J Med Sci ; 360(2): 206-207, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32387118

Assuntos
Fraturas por Compressão/etiologia , Fraturas Espontâneas/etiologia , Plasmocitoma/complicações , Fraturas da Coluna Vertebral/etiologia , Neoplasias da Coluna Vertebral/complicações , Adulto , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Bortezomib/administração & dosagem , Descompressão Cirúrgica , Dexametasona/administração & dosagem , Progressão da Doença , Feminino , Fraturas por Compressão/diagnóstico por imagem , Fraturas Espontâneas/diagnóstico por imagem , Humanos , Fraturas do Úmero/etiologia , Fraturas do Úmero/cirurgia , Imunoglobulina A/sangue , Imunoglobulina G/sangue , Imunoglobulina M/sangue , Laminectomia , Lenalidomida/administração & dosagem , Mieloma Múltiplo/sangue , Mieloma Múltiplo/complicações , Mieloma Múltiplo/diagnóstico por imagem , Mieloma Múltiplo/tratamento farmacológico , Plasmocitoma/diagnóstico por imagem , Plasmocitoma/patologia , Plasmocitoma/cirurgia , Tomografia por Emissão de Pósitrons , Compressão da Medula Espinal/diagnóstico por imagem , Compressão da Medula Espinal/etiologia , Compressão da Medula Espinal/patologia , Compressão da Medula Espinal/cirurgia , Fraturas da Coluna Vertebral/diagnóstico por imagem , Neoplasias da Coluna Vertebral/diagnóstico por imagem , Neoplasias da Coluna Vertebral/patologia , Neoplasias da Coluna Vertebral/cirurgia , Vértebras Torácicas/diagnóstico por imagem , Vértebras Torácicas/cirurgia , Tomografia Computadorizada por Raios X
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA
...