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1.
Agri ; 34(2): 139-144, 2022 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-35848812

RESUMO

Transient ischemic attack (TIA) of spinal cord (SC) is very rare and characterized by sudden onset of paralysis, sensory loss, back pain. We present a patient with acute painful paraplegia and symptoms resolved within a few hours. We identified 10 patients in literature search. Five of them were male, the mean age of patients was 53.8. Paraparesis/pleji was present in all. Only two patients did not have radicular pain. Vascular risk factors were hypertension in five patients, smoking in five and diabetes mel-litus in one. TIA period ranged from 1 min to 24 h. The most common etiology was aortic dissection (n=6). Four patients had aortic thrombosis. Six patients were treated with medical and surgical methods; other four were treated with only medically. SC ischemia and aortic diseases should be kept in mind in short term/persistent acute spinal syndromes with pain.


Assuntos
Aneurisma Dissecante , Ataque Isquêmico Transitório , Aneurisma Dissecante/diagnóstico , Aneurisma Dissecante/diagnóstico por imagem , Feminino , Humanos , Ataque Isquêmico Transitório/complicações , Ataque Isquêmico Transitório/diagnóstico , Masculino , Dor , Paraplegia/etiologia , Medula Espinal/irrigação sanguínea
2.
Pediatr Surg Int ; 38(10): 1427-1434, 2022 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-35867126

RESUMO

PURPOSE: Resection of pediatric posterior thoracic tumors (PTTs) can be complicated by Artery of Adamkiewicz (AKA) injury. Post-op spinal ischemia occurs in approx. 3.2% of patients, typically due to iatrogenic vascular injury. Pre-op angiography (PSA) may help to avoid this complication. Herein, we aim to evaluate outcomes after initiation of routine PSA prior to PTT resection. METHODS: A single-institution retrospective review identified 25 children (< 18 years) treated for PTTs from 2009 to 2021. PTTs included: posterior mediastinum, paraspinal thorax and posterior chest wall tumors. PSA patients were compared to those without pre-operative angiography (NA). Demographics, perioperative and long-term outcomes and event-free survival (EFS) were assessed. RESULTS: Prior to 2012, eleven patients were treated without PSA. However, the last developed post-operative paraplegia secondary to spinal ischemia. Since this event, PSA has become routine for all PTTs (n = 14) identifying six AKAs and nine accessory spinal arteries. Resection was performed in ten (90.1%) NA patients and eight (57.1%) PSA patients. Based on PSA findings, resection was not offered to six patients and planned partial resection was performed in three patients. Five PSA patients required radiation therapy for local control vs two NA patients. There were no differences in recurrence or overall EFS. CONCLUSION: PSA aids in identifying patients with high-risk thoracic vascular anatomy and may prevent risk of post-operative paraplegia associated with PTT resection.


Assuntos
Angiografia , Neoplasias Torácicas , Criança , Humanos , Isquemia , Paraplegia/etiologia , Paraplegia/prevenção & controle , Estudos Retrospectivos , Neoplasias Torácicas/diagnóstico por imagem , Neoplasias Torácicas/cirurgia
4.
Acta Neurochir (Wien) ; 164(9): 2351-2355, 2022 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-35759148

RESUMO

We describe the first ever-reported occurrence of a post-operative tension pneumosyrinx occurring after a resection of an intradural intramedullary spinal tumour in a 40-year-old patient. Post-operatively, he developed sudden onset paraplegia and imaging revealed a tension pneumosyrinx which was subsequently surgically decompressed. He made a gradual neurological recovery. This is an extremely rare complication with potentially long-lasting deleterious effects on patients' neurological status if not recognized. We aim to bring this pathology to the attention of our neurosurgical colleagues and share our surgical approach and management to assist those who may encounter this pathology in the future.


Assuntos
Procedimentos Neurocirúrgicos , Neoplasias da Medula Espinal , Adulto , Humanos , Doença Iatrogênica , Masculino , Procedimentos Neurocirúrgicos/efeitos adversos , Paraplegia/etiologia , Neoplasias da Medula Espinal/cirurgia
5.
J Neuroeng Rehabil ; 19(1): 63, 2022 06 27.
Artigo em Inglês | MEDLINE | ID: mdl-35761399

RESUMO

BACKGROUND: Spinal cord injury leading to paraplegia affects the mobility and physiological well-being of one in a thousand people. Powered exoskeletons can temporarily restore the ability to walk. Their relevance in daily life is still limited because of low performance beyond ground that is even. CYBATHLON is an international competition promoting improvements in assistive technology. In this article, we present the latest design and results of testing of TWIICE One version 2018, one of the competing devices in the 2020 race. METHODS: A person with a motor-complete spinal cord injury at thoracic level T10 participated as race pilot. Training ahead of the race took place over one week at a rate of 2 h per day. The time to perform each of the seven tasks of the competition was recorded together with the number of repetitions. Performance is compared over the training period and against the 2016 race results. RESULTS: Progression was observed in all tasks and accounted for by both user training and technology improvements. Final competition rank was second out of seven participating teams, with a record time of 4'40". This represents an average improvement of 40% with respect to comparable obstacles of the 2016 race, explaining the two ranks of improvement since then. CONCLUSION: These results help understand which features had a positive impact on the real-life performance of the device. Understanding how design affects performance is key information to create devices that really improve the life of people living with paraplegia.


Assuntos
Exoesqueleto Energizado , Tecnologia Assistiva , Traumatismos da Medula Espinal , Humanos , Paraplegia/etiologia , Traumatismos da Medula Espinal/complicações , Caminhada
6.
J Med Case Rep ; 16(1): 213, 2022 May 30.
Artigo em Inglês | MEDLINE | ID: mdl-35644613

RESUMO

BACKGROUND: Spontaneous spinal cord hemorrhage is extremely rare in dengue fever. We report a case of spontaneous spinal intradural hemorrhage in dengue fever associated with severe thrombocytopenia. CASE PRESENTATION: A 48-year-old Indian woman presented with fever and body aches followed by acute onset of paraplegia with bladder and bowel dysfunction and loss of sensations below the level of the umbilicus. She had severe thrombocytopenia and positive dengue serology. Magnetic resonance imaging of the spine showed compression of the spinal cord due to intradural hematoma at the D7-D8 vertebral level. The patient received symptomatic treatment for dengue fever and steroids. Emergency D7-D8 laminectomy with excision of the clot and dural repair was done after stabilizing the platelet count with multiple platelet transfusions. The constitutional symptoms responded well to the treatment. There was good improvement in sensory symptoms but negligible improvement in paraplegia with a change in muscle power from grade 0/5 to grade 1/5 in the postoperative period. The patient was discharged from the hospital in a stable condition, but paraplegia showed little improvement during follow-up of 1 year. CONCLUSIONS: Spontaneous spinal cord hemorrhage can present as acute paraplegia in dengue fever. Failure to recognize this complication can delay initiating appropriate treatment with permanent loss of neurologic function.


Assuntos
Dengue , Trombocitopenia , Dengue/complicações , Feminino , Hematoma , Humanos , Pessoa de Meia-Idade , Paraplegia/etiologia , Coluna Vertebral , Trombocitopenia/complicações
7.
Spinal Cord Ser Cases ; 8(1): 63, 2022 06 30.
Artigo em Inglês | MEDLINE | ID: mdl-35773281

RESUMO

INTRODUCTION: Spinal hemangiomas are benign vascular tumors that most commonly originate from the osseous structures of the spinal column. Epidural spinal hemangiomas without osseous involvement are uncommon and are classified as pure epidural spinal hemangiomas. Extraosseous spinal epidural cavernous hemangiomas are rarely described and among available reports; most patients present with slowly progressive neurological symptoms. Herein, we present a novel case of acute neurological dysfunction from a pure spinal epidural hemangioma that was managed through surgical resection with good neurological recovery at follow-up. CASE PRESENTATION: A 45-year-old previously healthy man presented to the emergency room with sudden inability to ambulate and was found to have bilateral lower extremity weakness. Magnetic resonance imaging of the spine demonstrated an epidural mass extending out of the right T5/6 neural foramen. The mass enhanced heterogeneously, and the preoperative diagnosis favored an atypical schwannoma. The lesion was surgically removed en-bloc through a midline posterior decompression with instrumentation. Histopathologic examination confirmed cavernous hemangioma pathology. Within 6 weeks of the surgical intervention, the patient had regained full sensorimotor function and these effects were durable through long term follow-up. DISCUSSION: Pure spinal epidural hemangiomas are rare and generally have an insidious clinical course. This case report highlights that these uncommon lesions may present with substantial and acute neurological dysfunction requiring urgent neurosurgical intervention. This should prompt clinicians to consider cavernous hemangioma in the differential diagnosis of patients presenting with acute neurological deterioration and an epidural spinal tumor.


Assuntos
Neoplasias Epidurais , Hemangioma Cavernoso , Hemangioma , Neoplasias Epidurais/complicações , Neoplasias Epidurais/diagnóstico , Neoplasias Epidurais/cirurgia , Hemangioma Cavernoso/diagnóstico , Hemangioma Cavernoso/diagnóstico por imagem , Humanos , Masculino , Pessoa de Meia-Idade , Paraplegia/etiologia , Coluna Vertebral/patologia
8.
JBJS Case Connect ; 12(2)2022 04 01.
Artigo em Inglês | MEDLINE | ID: mdl-35696718

RESUMO

CASE: A 44-year-old man developed urinary retention due to a spontaneous spinal epidural hematoma (SSEH) at the cervicothoracic junction, without paraplegia. Symptoms improved with surgical treatment. CONCLUSION: SSEH is rare and causes acute neck or back pain and progressive paralysis. Patients with advanced myelopathy due to spinal cord compression lesion including SSEH often present with bladder and bowel disorders after exacerbation of quadriplegia. However, SSEH can cause predominant bladder and bowel disorders without paraplegia or quadriplegia. Physicians should consider that there can be a manifestation of myelopathy with bladder and bowel dysfunction without quadriplegia.


Assuntos
Hematoma Epidural Espinal , Compressão da Medula Espinal , Adulto , Hematoma Epidural Espinal/complicações , Hematoma Epidural Espinal/diagnóstico por imagem , Humanos , Imageamento por Ressonância Magnética , Masculino , Paraplegia/etiologia , Quadriplegia/complicações , Compressão da Medula Espinal/complicações , Bexiga Urinária
9.
Orthop Surg ; 14(9): 2380-2385, 2022 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-35732468

RESUMO

BACKGROUND: Spinal epidural abscess (SEA) is an uncommon clinical entity that is often subject to delayed diagnosis and suboptimal treatment. Untreated disease leads to compression of the spinal cord, resulting in devastating complications. CASE PRESENTATION: A 56-year-old man visited our hospital for progressive lower back and lower extremity pain of several days' duration. Significant pyrexia (39.5°C) and elevated C-reactive protein (89.2 mg/L) were detected during admission, but no positive neurological examination findings were observed. Magnetic resonance imaging revealed pyogenic discitis at L3-4. Despite the administration of directed antibiotic therapy, the patient's condition rapidly deteriorated, culminating in complete paraplegia secondary to an extensive SEA from L4 to C7. Emergency spinal decompression surgery was canceled due to his poor clinical condition and refusal of informed consent. After further deterioration, he consented to two-level selective laminectomies and irrigation. CONCLUSIONS: In contrast with prior case reports, this case illustrates the natural history of an extensive SEA during conservative and late surgical treatment. Early diagnosis and timely surgical decompression are of great importance for extensive SEA.


Assuntos
Abscesso Epidural , Antibacterianos/uso terapêutico , Proteína C-Reativa , Abscesso Epidural/complicações , Abscesso Epidural/cirurgia , Humanos , Laminectomia/efeitos adversos , Imageamento por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Paraplegia/diagnóstico , Paraplegia/etiologia , Paraplegia/cirurgia
10.
Top Companion Anim Med ; 50: 100681, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-35718281

RESUMO

Bichon frise (1) and Boxer (2), both with epileptic seizures, underwent lumbar taps for cerebrospinal fluid collection. After the procedure, the first dog became paraplegic, and the second dog did not recover from anesthesia and remained in a coma. Both dogs were euthanatized 12 h after the examination. The dogs were diagnosed with idiopathic epilepsy and fibrillar astrocytoma, respectively, after postmortem examination. They were also diagnosed with progressive myelomalacia, involving C1-C5 until the L4-S3 spinal segments. Since it was not possible to attribute the development of myelomalacia to the primary diseases observed, the lumbar tap likely caused this severe spinal cord injury. These reports highlight myelomalacia as a possible complication of lumbar taps.


Assuntos
Doenças do Cão , Doenças da Medula Espinal , Traumatismos da Medula Espinal , Animais , Doenças do Cão/patologia , Cães , Paraplegia/etiologia , Paraplegia/veterinária , Doenças da Medula Espinal/diagnóstico , Doenças da Medula Espinal/veterinária , Traumatismos da Medula Espinal/veterinária
12.
BMC Infect Dis ; 22(1): 405, 2022 Apr 25.
Artigo em Inglês | MEDLINE | ID: mdl-35468738

RESUMO

BACKGROUND: We report a case of spine infection with mucormycosis that manifested signs of paraplegia in a patient suffering from disseminated mucormycosis. Timely and effective surgery was performed. A review of the literature is included. CASE PRESENTATION: A patient with diabetic ketoacidosis complained of back pain and fatigue for one month, and his right lower extremity activity had been limited for 10 days. T4-T6 vertebral and paravertebral soft tissue-involved infections were identified by MRI, which were derived from right lung pneumonia. He underwent abscess debridement, spinal canal decompression, pedicle screw fixation and amphotericin B liposome injection. Histopathological examination revealed broad aseptate hyphae suggestive of invasive mucormycosis. There was improvement in neurological function after surgical and medical treatment. Three months after the surgery, the patient died of uncontrollable massive bleeding of the urinary system. Mucormycosis is characterized by rapid development and a high mortality rate. This case shows the significance of a multidisciplinary team in the diagnosis and treatment of patients with mucormycosis. In addition, orthopedic surgeons should design appropriate surgery plans for spine-involved mucormycosis patients. CONCLUSION: This case present a patient with paraplegia caused by the spread of pulmonary mucormycosis to the vertebral and paravertebral soft tissue of levels T4-T6. After medical treatment, surgical debridement and internal fixation, the patient recovered well but later patient died of possible disease dissemination to the renal or urinary tract which resulted in massive haemorrhage.


Assuntos
Mucormicose , Antifúngicos/uso terapêutico , Humanos , Imageamento por Ressonância Magnética , Masculino , Mucormicose/complicações , Mucormicose/diagnóstico , Mucormicose/terapia , Paraplegia/etiologia
13.
BMJ Case Rep ; 15(4)2022 Apr 22.
Artigo em Inglês | MEDLINE | ID: mdl-35459651

RESUMO

A woman in her 50s presented with uncontrolled hypertension, chest/back pain, paraplegia, right lower limb ischaemia and acute kidney injury. A CT angiogram demonstrated a type B aortic dissection originating distal to the left subclavian artery to bilateral common iliac arteries complicated by occlusion of the right renal artery and right common iliac artery. She was started on intravenous antihypertensive therapy and transferred to our institution for emergent thoracic endovascular aortic repair. Due to bleeding risk from coagulopathy, a spinal drain was not placed immediately post-operatively but instead was inserted after 24 hours while maintaining a mean arterial pressure of 80-100 mm Hg. Postoperatively, her right lower extremity perfusion was re-established, and her renal function recovered following temporary dialysis. At discharge on postoperative day 13, she regained full neurological function.


Assuntos
Aneurisma Dissecante , Aneurisma da Aorta Torácica , Implante de Prótese Vascular , Procedimentos Endovasculares , Aneurisma Dissecante/complicações , Aneurisma Dissecante/diagnóstico por imagem , Aneurisma Dissecante/cirurgia , Aorta Abdominal/cirurgia , Aneurisma da Aorta Torácica/complicações , Implante de Prótese Vascular/efeitos adversos , Procedimentos Endovasculares/efeitos adversos , Feminino , Humanos , Artéria Ilíaca/cirurgia , Isquemia/cirurgia , Paraplegia/etiologia , Paraplegia/cirurgia , Resultado do Tratamento
14.
Ann Ital Chir ; 92: 27-32, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-35342098

RESUMO

AIM: Paraplegia is an infrequent although fearsome complication of anesthesia and surgical procedures, such as epidural anesthesia and thoracotomy. It may occur in both adults and children and a medullary lesion may be confirmed by magnetic resonance imaging, rather than computed tomography. The aim of this study is to describe the experience of two pediatric tertiary centers, contextualizing it with the other cases reported in literature. MATERIAL AND METHODS: We reported three pediatric cases of post-operative paraplegia in oncological patients, focusing on the potential causes and underling the possible strategies to prevent this complication. RESULTS: From our study, two principal features emerged: 1) Epidural anesthesia may expose children to a greater risk of spinal cord permanent damage due to the execution of the procedure under general anesthesia, which deprives the anesthesiologist of an important feedback about the position of the device; 2) In thoracotomy, the risk of paraplegia tends to increase along with the proximity to the costo-vertebral angle, especially if electrocautery or hemostatic materials are used. CONCLUSIONS: A prompt post-surgical neurological status routine assessment in pediatric patients undergoing epidural anesthesia or thoracotomy should be mandatory and, associated with the correct imaging study, may lead to the most appropriate therapeutic pathway and to a better prognosis. KEY WORDS: Anesthesia, Children, Epidural, Thoracotomy, Paraplegia.


Assuntos
Anestesia Epidural , Toracotomia , Adulto , Anestesia Epidural/efeitos adversos , Anestesia Epidural/métodos , Anestesia Geral/efeitos adversos , Criança , Humanos , Imageamento por Ressonância Magnética , Paraplegia/etiologia , Paraplegia/prevenção & controle , Toracotomia/efeitos adversos , Toracotomia/métodos
15.
Spinal Cord ; 60(9): 765-773, 2022 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-35220414

RESUMO

STUDY DESIGN: Systematic review with meta-analysis. OBJECTIVES: To explore temporal changes in incidence rates, demographic and injury characteristics of incident traumatic spinal cord injury (TSCI) in Nordic countries. METHODS: Peer-reviewed publications and periodic reports about epidemiology of TSCI in the Nordic countries (Denmark, Finland, Iceland, Norway, Sweden) are identified, reviewed and included in the meta-analysis. Data are stratified into 20-year intervals to allow for chronological comparisons. Pooled estimates are derived using random effects meta-analysis. RESULTS: Twenty-three data sources are included presenting a total of 5416 cases. The pooled incidence rate for 2001-2020 is 15.4 cases/million/year compared to 17.6 and 18.3 cases/million/year during the two previous 20-year intervals. The proportion of cases with TSCI in the 15-29 age-group decreases from 50% (1961-1980) to 20% (2001-2020), while it increases from 9% to 35% in 60+ age-group. Transportation-related injuries decrease from 44% (1961-1980) to 27% (2001-2020). Conversely, fall-related injuries increase from 32% (1961-1980) to 46% (2001-2020). The proportion of individuals with incomplete tetraplegia increases from 31% (1961-1980) to 43% (2001-2020), while complete paraplegia decreases from 25% to 16%. CONCLUSION: The characteristics of TSCI in the Nordic countries have changed drastically over the last six decades, in line with clinical experiences, and limited research evidence from other countries. These changes indicate the need for adapting research focus, prevention strategies, design and provision of care, rehabilitation and community services towards older individuals, fall-related injuries, and incomplete injuries in Nordic countries and other settings internationally where such changes occur.


Assuntos
Traumatismos da Medula Espinal , Humanos , Incidência , Noruega , Paraplegia/etiologia , Países Escandinavos e Nórdicos/epidemiologia , Traumatismos da Medula Espinal/epidemiologia , Traumatismos da Medula Espinal/etiologia , Traumatismos da Medula Espinal/reabilitação
16.
Artigo em Inglês | MEDLINE | ID: mdl-35179581

RESUMO

OBJECTIVES: Total arch replacement (TAR) using an endovascular approach has been initially introduced as the frozen elephant trunk technique (FET). In our institute, TAR using the FET with Frozenix has been used as the first-line treatment for distal aortic arch aneurysms since 2014. This study aimed to evaluate the early and long-term outcomes and demonstrate the efficacy of this procedure. METHODS: Between 2014 and 2021, 121 consecutive patients were treated with TAR using the FET with Frozenix for distal aortic arch aneurysms. Early and long-term outcomes were retrospectively analysed. RESULTS: The 30-day mortality rate was 2.5% (3/121). Of postoperative complications, paraplegia due to spinal cord injury occurred in 2 (1.7%) patients, stroke in 12 (9.9%) and acute renal failure in 10 (8.3%). At follow-up, 23 secondary aortic interventions were required and 8 (6.6%) patients underwent intended secondary thoracic endovascular aortic repair for residual descending aortic aneurysm. Late and aortic-related deaths occurred in 16 (13.2%) and 4 (3.3%) patients, respectively. The overall long-term survival rates at 1, 3 and 5 years were 87.6%, 83.1% and 65.4%, respectively, while the rates of freedom from aortic-related death at 1, 3 and 5 years were 95.7%, 95.7% and 84.8%, respectively. CONCLUSIONS: TAR using the FET with Frozenix for distal aortic arch aneurysms has acceptable early mortality and morbidity. Spinal cord injury and paraplegia occur less frequently than previously reported. The technique has satisfactory long-term survival and freedom from aortic-related death.


Assuntos
Aneurisma Dissecante , Aneurisma da Aorta Torácica , Aneurisma Aórtico , Implante de Prótese Vascular , Traumatismos da Medula Espinal , Aneurisma Dissecante/complicações , Aneurisma Dissecante/diagnóstico por imagem , Aneurisma Dissecante/cirurgia , Aorta Torácica/diagnóstico por imagem , Aorta Torácica/cirurgia , Aneurisma Aórtico/cirurgia , Aneurisma da Aorta Torácica/complicações , Aneurisma da Aorta Torácica/diagnóstico por imagem , Aneurisma da Aorta Torácica/cirurgia , Prótese Vascular/efeitos adversos , Implante de Prótese Vascular/efeitos adversos , Implante de Prótese Vascular/métodos , Humanos , Paraplegia/etiologia , Estudos Retrospectivos , Traumatismos da Medula Espinal/etiologia , Resultado do Tratamento
17.
JBJS Case Connect ; 12(1)2022 01 20.
Artigo em Inglês | MEDLINE | ID: mdl-35050910

RESUMO

CASE: A 68-year-old woman developed symptoms of acute paraplegia due to an occult cervical dural arteriovenous fistula (DAVF) after a minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF). She was subsequently diagnosed by angiography and treated with vascular embolization. A 2-year follow-up showed that the patient's upper limb muscle strength returned to normal, and the lower limb muscle strength partially improved with remnant motor dysfunction. CONCLUSION: For patients with symptoms of nerve injury inconsistent with the spinal surgery site, a possibility of DAVF should be considered, and related investigations should be performed. Once diagnosed, active treatment is required.


Assuntos
Malformações Vasculares do Sistema Nervoso Central , Fusão Vertebral , Idoso , Malformações Vasculares do Sistema Nervoso Central/complicações , Malformações Vasculares do Sistema Nervoso Central/diagnóstico por imagem , Feminino , Humanos , Vértebras Lombares/cirurgia , Procedimentos Cirúrgicos Minimamente Invasivos/métodos , Paraplegia/etiologia , Fusão Vertebral/efeitos adversos , Fusão Vertebral/métodos
18.
JBJS Case Connect ; 12(1)2022 01 26.
Artigo em Inglês | MEDLINE | ID: mdl-35081063

RESUMO

CASE: We report a 14-year-old girl with adolescent idiopathic scoliosis who experienced bilateral lower extremity paralysis related to postoperative hypotension 10 hours after posterior spinal fusion. She returned to the operating room for spinal cord decompression and hardware removal. Six weeks later, reinstrumentation was performed, and complete neurologic recovery was achieved. CONCLUSION: Delayed presentation of neurologic injury after scoliosis surgery is particularly uncommon. Close postoperative monitoring, with an emphasis on hypotensive etiologies and a low threshold to remove the instrumentation, is essential to rapidly diagnose and treat these catastrophic events.


Assuntos
Cifose , Escoliose , Traumatismos da Medula Espinal , Fusão Vertebral , Adolescente , Feminino , Humanos , Cifose/cirurgia , Paraplegia/etiologia , Paraplegia/cirurgia , Escoliose/complicações , Escoliose/cirurgia , Traumatismos da Medula Espinal/etiologia , Traumatismos da Medula Espinal/cirurgia , Fusão Vertebral/efeitos adversos
19.
Eur J Cardiothorac Surg ; 62(1)2022 Jun 15.
Artigo em Inglês | MEDLINE | ID: mdl-34734253

RESUMO

OBJECTIVES: The aim of this study was to assess risk factors for early neurological complications following thoracic endovascular aortic repair (TEVAR) for multiple thoracic aortic diseases using an aggregated dataset. METHODS: The Study to Assess Outcomes After Endovascular Repair for Multiple Throacic Aortic Disease dataset included data from 6 studies evaluating Zenith thoracic endografts. Post hoc analysis identified early (30-day) neurological complications by TEVAR indication and corresponding risk factors. RESULTS: The study included 594 TEVAR patients (67% male; mean age 66 ± 15 years) with thoracic aortic aneurysm (n = 329), ulcer (n = 56), acute (n = 126) or non-acute (n = 33) type B aortic dissection (TBAD) or blunt injury (n = 50). Overall early stroke rate was 3.5% (n = 21). Overall early paraplegia and paraparesis rates were 1.3% (n = 8) and 2.5% (n = 15), respectively. Multivariable analysis identified acute TBAD [versus others, odds ratio (OR) = 3.47, 95% confidence internal (CI): 1.41-8.52) and longer procedural time (OR = 1.33, CI: 1.02-1.73) as early stroke risk factors. Risk factors for paraplegia or paraparesis included more endografts deployed (OR = 2.43, CI: 1.30-4.55), older age (OR = 1.05, CI: 1.01-1.10) and higher preoperative serum creatinine (OR = 1.31, CI: 1.05-1.64). Endografts landing proximal to the left subclavian artery (LSA) increased stroke rate (versus distal to the LSA; 6.8% vs 2.3%, P = 0.014). Intraoperative LSA revascularization was performed in 20.9% of patients with endografts proximal to the LSA; revascularization did not significantly alter stroke rate (8.1% with revascularization vs 6.4% without, P = 0.72). CONCLUSIONS: Acute TBAD and prolonged procedure time increased early stroke risk, while more endografts placed, age and preoperative renal impairment increased early paraplegia or paraparesis risk. For acute TBAD, endograft placement proximal to the LSA, but not LSA patency, increased stroke risk.


Assuntos
Aneurisma Dissecante , Aneurisma da Aorta Torácica , Implante de Prótese Vascular , Procedimentos Endovasculares , Acidente Vascular Cerebral , Idoso , Idoso de 80 Anos ou mais , Aneurisma Dissecante/complicações , Aorta Torácica/cirurgia , Aneurisma da Aorta Torácica/complicações , Prótese Vascular/efeitos adversos , Implante de Prótese Vascular/efeitos adversos , Implante de Prótese Vascular/métodos , Procedimentos Endovasculares/efeitos adversos , Procedimentos Endovasculares/métodos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Paraparesia/complicações , Paraparesia/cirurgia , Paraplegia/etiologia , Estudos Retrospectivos , Fatores de Risco , Acidente Vascular Cerebral/epidemiologia , Acidente Vascular Cerebral/etiologia , Fatores de Tempo , Resultado do Tratamento
20.
J Cardiothorac Vasc Anesth ; 36(4): 1021-1028, 2022 04.
Artigo em Inglês | MEDLINE | ID: mdl-34446324

RESUMO

OBJECTIVES: To comparatively examine the risk of postoperative paraplegia between open surgical descending aortic repair and thoracic endovascular aortic repair (TEVAR) among patients with thoracic aortic disease. DESIGN: Retrospective cohort study. SETTING: Acute-care hospitals in Japan. PARTICIPANTS: A total of 6,202 patients diagnosed with thoracic aortic disease. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: The main outcome of this study was the incidence of postoperative paraplegia. Multiple logistic regression models, using inverse probability of treatment weighting and an instrumental variable (ratio of TEVAR use to open surgical repair and TEVAR uses), showed that the odds ratios of paraplegia for TEVAR (relative to open surgical descending aortic repair) were 0.81 (95% confidence interval: 0.42-1.59; p = 0.55) in the inverse probability of treatment-weighted model and 0.88 (0.42-1.86; p = 0.75) in the instrumental-variable model. CONCLUSIONS: There were no statistical differences in the risk of paraplegia between open surgical repair and TEVAR in patients with thoracic aortic disease. Improved perioperative management for open surgical repair may have contributed to the similarly low incidence of paraplegia in these two surgery types.


Assuntos
Aneurisma da Aorta Torácica , Doenças da Aorta , Implante de Prótese Vascular , Procedimentos Endovasculares , Aorta Torácica/diagnóstico por imagem , Aorta Torácica/cirurgia , Aneurisma da Aorta Torácica/complicações , Aneurisma da Aorta Torácica/cirurgia , Doenças da Aorta/complicações , Doenças da Aorta/cirurgia , Implante de Prótese Vascular/efeitos adversos , Procedimentos Endovasculares/efeitos adversos , Humanos , Japão/epidemiologia , Paraplegia/epidemiologia , Paraplegia/etiologia , Estudos Retrospectivos , Fatores de Risco , Resultado do Tratamento
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