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1.
Medicine (Baltimore) ; 99(5): e18851, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-32000386

RESUMO

BACKGROUND: The pathogenesis of cervical spondylotic is degenerative changes of the cervical intervertebral disc, or bone hyperplasia of the posterior and hook joints, and instability of the joints of the cervical vertebrae. It causes the nerve roots to be stimulated and oppressed. The clinical manifestations are the sensation, movement, and reflex disorder of the cervical spinal nerve roots that are stimulated and oppressed, especially the numbness and pain of the neck, shoulders, upper limbs, and fingers. In this systematic review, we aimed to evaluate the efficacy and safety of acupuncture and chiropractic in the treatment of cervical spondylotic. METHODS AND ANALYSIS: We will search for PubMed, Cochrane Library, AMED, Embase, WorldSciNet; Nature, Science online and China Journal Full-text Database (CNKI), China Biomedical Literature CD-ROM Database (CBM), and related randomized controlled trials included in the China Resources Database. The time is limited from the construction of the library to September 2019. We will use the criteria provided by Cochrane 5.1.0 for quality assessment and risk assessment of the included studies, and use the RevMan 5.3 and Stata 13.0 software for meta-analysis of the effectiveness, recurrence rate, and symptom scores of cervical spondylotic. ETHICS AND DISSEMINATION: This systematic review will evaluate the efficacy and safety of acupuncture and chiropractic for cervical spondylotic. Because all of the data used in this systematic review and meta-analysis have been published, this review does not require ethical approval. Furthermore, all data will be analyzed anonymously during the review process trial.


Assuntos
Terapia por Acupuntura , Manipulação Quiroprática , Radiculopatia/terapia , Humanos , Radiculopatia/etiologia , Espondilose/complicações
2.
World Neurosurg ; 133: e452-e458, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31526879

RESUMO

OBJECTIVE: The most common cause of contralateral symptoms after unilateral transforaminal lumbar interbody fusion (TLIF) is contralateral foraminal stenosis (FS). This retrospective cohort study aimed to investigate the cause of and risk factors for contralateral FS after unilateral TLIF with a single cage. METHODS: Patients with degenerative lumbar spinal disorders who underwent unilateral TLIF at L4-5 were divided into 2 groups: those without contralateral radicular symptoms after surgery (group A; n = 340) and those with contralateral radicular symptoms after surgery (group B; n = 16). We investigated the influence of various radiological and cage-related factors on postoperative contralateral FS with radicular symptoms. The cage location indicates whether the cage's anterior tip crosses the disc midline-exceeding 50%-and in such a case, how far. RESULTS: Group B showed significantly increased postoperative coronal angle and sagittal angle and decreased contralateral foraminal height and foraminal area. Statistically significant (P < 0.01) factors according to the multivariate logistic regression analysis were the preoperative sagittal range of motion (odds ratio [OR]: 1.562, P = 0.004) and cage location (OR: 2.047, P = 0.015). The cutoff values for the sagittal range of motion and the cage location were 9.0° and 50.5%, respectively. The preoperative and postoperative 6-month visual analog scale scores and Oswestry disability index values were not significantly different between the groups. CONCLUSIONS: The 2 most meaningful risk factors were the preoperative sagittal range of motion and cage location. Inserting the cage beyond the disc midline, especially in patients with a high preoperative sagittal range of motion (≥9.0°), would help reduce postoperative complications.


Assuntos
Fixadores Internos/efeitos adversos , Vértebras Lombares/cirurgia , Complicações Pós-Operatórias/etiologia , Radiculopatia/etiologia , Fusão Vertebral/efeitos adversos , Estenose Espinal/cirurgia , Adulto , Idoso , Antropometria , Avaliação da Deficiência , Feminino , Humanos , Dor Lombar/epidemiologia , Dor Lombar/etiologia , Masculino , Pessoa de Meia-Idade , Variações Dependentes do Observador , Medição da Dor , Dor Pós-Operatória/epidemiologia , Dor Pós-Operatória/etiologia , Complicações Pós-Operatórias/epidemiologia , Curva ROC , Radiculopatia/epidemiologia , Amplitude de Movimento Articular , Fatores de Risco , Ciática/epidemiologia , Ciática/etiologia , Fusão Vertebral/instrumentação , Fusão Vertebral/métodos , Estenose Espinal/complicações , Espondilolistese/complicações , Espondilolistese/cirurgia
3.
World Neurosurg ; 133: 163-166, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31606498

RESUMO

BACKGROUND: Cervical disk arthroplasty is now a widely accepted alternative to anterior cervical interbody fusion, which is known to reduce normal cervical motion and increase the incidence of adjacent segment disease. Although multiple studies report the use of cervical disk arthroplasty to treat multilevel cervical disease, this is the first report in the literature detailing the placement of multiple, noncontiguous artificial disks. CASE DESCRIPTION: We describe a 41-year-old male who presented with myelopathy and left upper extremity radiculopathy resulting from 2 cervical disk herniations separated by a normal intervening level. He underwent an anterior cervical diskectomy and placement of an artificial disk prosthesis at cervical (C) 4-5 and C6-7 while leaving C5-6 intact. CONCLUSIONS: This approach serves to preserve cervical motion, spinal stability, and lordosis across all 3 levels, thus demonstrating that it is a viable alternative to a multilevel anterior cervical interbody fusion.


Assuntos
Vértebras Cervicais/cirurgia , Discotomia/métodos , Deslocamento do Disco Intervertebral/cirurgia , Disco Intervertebral/cirurgia , Radiculopatia/cirurgia , Doenças da Medula Espinal/cirurgia , Substituição Total de Disco/métodos , Adulto , Humanos , Deslocamento do Disco Intervertebral/complicações , Masculino , Radiculopatia/etiologia , Doenças da Medula Espinal/etiologia , Resultado do Tratamento
4.
Ned Tijdschr Geneeskd ; 1632019 09 24.
Artigo em Holandês | MEDLINE | ID: mdl-31556497

RESUMO

Lumbar spondylolisthesis is usually asymptomatic. However, symptomatic spondylolisthesis results in back and/or leg pain such as radicular syndrome or neurogenic claudication. Variation in symptoms is caused by different types of spondylolisthesis. Lytic spondylolisthesis, most common at L5S1, is caused by spondylolysis of the pars interarticularis. This results in foraminal nerve compression and radicular symptoms. Degenerative spondylolisthesis, most common at L4L5 in patients >50 years old, is caused by slippage of the vertebral body and lamina, resulting in lumbar spinal stenosis and neurogenic claudication. Iatrogenic spondylolisthesis develops in 1.6-32.0% of patients after decompression surgery, causing recurrent neurogenic symptoms. It is important to understand the main symptoms patients experience: back or leg pain. In both cases, the preferred treatment is conservative. Surgery is only an option if patients have persistent/progressive leg pain. Shared decision-making is necessary to select the most accurate surgery for each individual patient while also taking into account age, comorbidities and symptoms. Further research is necessary to determine the advantages of each surgery in order to improve advice to patients.


Assuntos
Dor nas Costas/etiologia , Claudicação Intermitente/etiologia , Vértebras Lombares/patologia , Radiculopatia/etiologia , Estenose Espinal/etiologia , Espondilolistese/complicações , Idoso , Descompressão Cirúrgica/efeitos adversos , Descompressão Cirúrgica/métodos , Feminino , Humanos , Vértebras Lombares/cirurgia , Masculino , Pessoa de Meia-Idade , Espondilolistese/patologia , Espondilolistese/cirurgia
5.
World Neurosurg ; 132: 67-68, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31479794

RESUMO

Ehlers-Danlos syndrome can be associated with cerebrospinal fluid (CSF) disturbances including recurrent CSF leak and Chiari I malformations. Persistent pseudomeningoceles are known to be associated with raised intracranial pressure. We present an unusual case of a compressive epidural CSF collection occurring after a computed tomography-guided L5 nerve root block and describe an effective management strategy.


Assuntos
Vazamento de Líquido Cefalorraquidiano/etiologia , Síndrome de Ehlers-Danlos/complicações , Injeções Epidurais/efeitos adversos , Hipertensão Intracraniana/complicações , Compressão da Medula Espinal/etiologia , Adulto , Malformação de Arnold-Chiari/complicações , Vazamento de Líquido Cefalorraquidiano/diagnóstico por imagem , Vazamento de Líquido Cefalorraquidiano/cirurgia , Feminino , Humanos , Vértebras Lombares , Bloqueio Nervoso , Radiculopatia/tratamento farmacológico , Radiculopatia/etiologia , Compressão da Medula Espinal/diagnóstico por imagem , Compressão da Medula Espinal/cirurgia , Espondilolistese/complicações , Tomografia Computadorizada por Raios X
6.
Rinsho Shinkeigaku ; 59(9): 592-595, 2019 Sep 25.
Artigo em Japonês | MEDLINE | ID: mdl-31474639

RESUMO

A 72-year-old man presented with continuous hyperCKemia and intermittent claudication. He exhibited no calf muscle hypertrophy at that time or afterward. Other than an increased creatine kinase (CK) level (1,525 U/l), none of the laboratory tests was abnormal, including that for myositis-related autoantibodies. Electromyography showed neurogenic changes in the left gastrocnemius. Lumbar magnetic resonance imaging revealed spinal canal stenosis (L3/4, L4/5), left L4 radiculopathy, and bilateral S1 radiculopathy. T2-weighted and short tau inversion recovery images showed high signal intensity in the bilateral biceps femoris and gastrocnemius. Histopathological evaluation of a specimen obtained from the right gastrocnemius muscle revealed neurogenic changes. The patient was diagnosed with S1 radiculopathy caused by lumbar spinal canal stenosis with hyperCKemia. Although S1 radiculopathy with hyperCKemia is usually associated with calf muscle hypertrophy, we should consider S1 radiculopathy in patients with intermittent claudication and hyperCKemia even in the absence of calf muscle hypertrophy.


Assuntos
Creatina Quinase/sangue , Radiculopatia/diagnóstico , Radiculopatia/etiologia , Idoso , Imagem de Difusão por Ressonância Magnética , Humanos , Hipertrofia , Vértebras Lombares , Masculino , Músculo Esquelético/diagnóstico por imagem , Músculo Esquelético/patologia , Radiculopatia/diagnóstico por imagem , Estenose Espinal/complicações , Estenose Espinal/diagnóstico por imagem , Estenose Espinal/etiologia
7.
World Neurosurg ; 132: 295-299, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31526881

RESUMO

BACKGROUND: Pedicle screw insertion is a common procedure in spine surgery, and freehand, fluoroscopic, and robotic-assisted techniques all are used. These are indirect methods that use fluoroscopy, and direct visualization of canal involvement has not been possible. However, owing to the development of high-definition imaging modalities, delicate procedures that use endoscopy are possible. CASE DESCRIPTION: A 47-year-old man presented with severe radiating pain in his leg after undergoing L5-S1 level endoscopic transforaminal lumbar interbody fusion and percutaneous pedicular screw fixation. The patient then underwent an endoscopy-assisted technique for violated spinal canal and screw revision in which the misplaced screw was directly visualized using endoscopy and the trajectory of the misplaced screw was changed. With 30° endoscopy, we directly visualized the screw thread and root compression. Then with 0° endoscopy, we changed the screw trajectory inside the pedicle with an anatomic landmark. The patient's radiating pain was completely relieved after revision of the malpositioned screw. Postoperative imaging showed the revised screw trajectory inside the pedicle. CONCLUSIONS: Endoscopy-assisted pedicle screw insertion does not require an additional incision, and early recovery after the procedure is possible. Accurate diagnosis of canal pathology and treatment are possible with direct visualization using endoscopy.


Assuntos
Vértebras Lombares/cirurgia , Neuroendoscopia/métodos , Parafusos Pediculares/efeitos adversos , Complicações Pós-Operatórias/diagnóstico , Radiculopatia/diagnóstico , Fusão Vertebral , Humanos , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/cirurgia , Radiculopatia/etiologia , Radiculopatia/cirurgia , Reoperação
9.
S Afr J Surg ; 57(3): 58, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31392870

RESUMO

BACKGROUND: Intradural extramedullary (IDEM) spinal masses are common lesions with varying histological diagnoses often associated with significant neurological deficits. This study aimed to describe the epidemiology, management and perioperative outcome of IDEM tumours seen at the teaching hospitals of the University of the Witwatersrand, Johannesburg, between 2014 and 2017. RESULTS: 92 patients were included in the study. The ages ranged from 21 to 87 years, sex ratio was M:F 1:1.4, and duration of symptoms prior to diagnosis ranged between 3 days to 18 months. Local and radicular type pain as well as motor weakness were the commonest symptoms. 67% had severe neurological deficit McCormick Grade III and IV. Schwannoma (26) Neurofibromas (21) and Meningiomas (16) and were the most frequent tumour types. Meningiomas predominantly occurred at the cranio-cervical and thoracic levels. Nerve sheath tumours were mostly found at the cervical and lumbar levels while filum terminale ependymomas occurred at the thoracolumbar area. Laminectomy was the commonest surgical approach employed, and the extent of resection varied, with total excision in half the cases. Neurological function was regained in 3 patients, deteriorated in two and was unchanged in the remainder. CONCLUSION: IDEM tumours are an important subset of spinal cord compressive lesions Presentation with severe neurological deficit is common and though resection is feasible neurological deficit remains in the vast majority. Earlier detection should improve the results of surgery.


Assuntos
Meningioma/cirurgia , Neurilemoma/cirurgia , Neurofibroma/cirurgia , Neoplasias da Medula Espinal/cirurgia , Adulto , Idoso , Idoso de 80 Anos ou mais , Dor nas Costas/etiologia , Feminino , Hospitais de Ensino , Humanos , Laminectomia , Masculino , Meningioma/complicações , Meningioma/epidemiologia , Pessoa de Meia-Idade , Debilidade Muscular/etiologia , Neurilemoma/complicações , Neurilemoma/epidemiologia , Neurofibroma/complicações , Neurofibroma/epidemiologia , Radiculopatia/etiologia , África do Sul/epidemiologia , Compressão da Medula Espinal/etiologia , Neoplasias da Medula Espinal/complicações , Neoplasias da Medula Espinal/epidemiologia , Adulto Jovem
10.
World Neurosurg ; 131: e408-e414, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31376560

RESUMO

OBJECTIVE: To investigate the occurrence and progression of heterotopic ossification (HO) in patients treated by anterior cervical discectomy with arthroplasty. It was evaluated if HO affects clinical outcome and range of motion (ROM). Risk factors of HO was studied as well. METHODS: Patients who underwent anterior cervical discectomy with arthroplasty for a cervical radiculopathy because of a herniated disc from the NECK and PROCON trial were analyzed for HO at 12 and 24 months postoperatively. HO was scored according to the McAfee-Mehren classification. The index ROM was defined by a custom developed image analysis tool, and global cervical ROM was measured by Cobb's angle. Clinical outcome was evaluated by means of the Neck Disability Index and the 36-Item Short Form Health Survey. RESULTS: The occurrence of HO was 60% at 1 year, and it increased to 76% at 2-year follow-up. A total of 31% of patients were scored as high-grade HO at 1-year follow-up, and this percentage increased to 50% at 2-year follow-up. Clinical outcome does not correlate to HO grade, and no risk factor for high-grade HO could be identified. The ROM at the index level was significantly higher in low-grade HO group than those patients with high-grade HO, but in 15%-38% HO grade does not correspond to ROM. CONCLUSIONS: HO occurs in three fourths of the patients at 2 years after surgery, but does not necessarily correspond to clinical outcome, nor loss or preservation of ROM. The McAfee-Mehren classification should be combined with ROM evaluation to properly study HO.


Assuntos
Artroplastia , Vértebras Cervicais/cirurgia , Discotomia , Deslocamento do Disco Intervertebral/cirurgia , Ossificação Heterotópica/epidemiologia , Complicações Pós-Operatórias/epidemiologia , Radiculopatia/cirurgia , Amplitude de Movimento Articular , Adulto , Idoso , Feminino , Humanos , Deslocamento do Disco Intervertebral/complicações , Masculino , Pessoa de Meia-Idade , Ossificação Heterotópica/fisiopatologia , Complicações Pós-Operatórias/fisiopatologia , Radiculopatia/etiologia , Ensaios Clínicos Controlados Aleatórios como Assunto , Resultado do Tratamento
11.
World Neurosurg ; 132: 197-201, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31450001

RESUMO

BACKGROUND: Gunshot wounds are the most common etiology of penetrating spine injuries and have been increasing in incidence in civilian populations. Although these injuries typically result in severe neurologic deficits, operative intervention remains is controversial and is usually reserved for patients with neurologic deterioration, a persistent externalized cerebrospinal fluid fistula, mechanical instability, metallic toxicity, or a bullet location at high risk of migration. CASE DESCRIPTION: A previously asymptomatic patient who had sustained a gunshot wound to the cervical spine 20 years previously presented with new-onset progressive myelopathy and radiculopathy secondary to heterotopic ossification (HO) surrounding the retained bullet fragments near the left lateral masses of C5-T1. Computed tomography myelography demonstrated no cranial migration of contrast material past this region of the spine, suggesting severe spinal canal stenosis. Intraoperatively, bullet shrapnel and heterotopic bone fragments were found within the central canal causing compression of the spinal cord. Following decompression and stabilization, the patient had complete resolution of his symptoms and returned to his neurologic baseline. Although HO has been reported as a complication following through and through gunshot wounds, there is a paucity of literature discussing HO formation around retained bullet fragments in the spine. CONCLUSIONS: HO surrounding retained bullet fragments in the spine is a rare cause of progressive neurologic deterioration following gunshot wounds. Surgical excision of the shrapnel and heterotopic bone can lead to symptomatic relief, and therefore surgery should be considered as a treatment option in carefully selected patients.


Assuntos
Vértebras Cervicais/diagnóstico por imagem , Vértebras Cervicais/lesões , Ossificação Heterotópica/diagnóstico por imagem , Ossificação Heterotópica/cirurgia , Traumatismos da Medula Espinal/diagnóstico por imagem , Traumatismos da Medula Espinal/cirurgia , Ferimentos por Arma de Fogo/diagnóstico por imagem , Ferimentos por Arma de Fogo/cirurgia , Adulto , Vértebras Cervicais/cirurgia , Descompressão Cirúrgica/efeitos adversos , Humanos , Laminectomia , Masculino , Procedimentos Neurocirúrgicos/métodos , Radiculopatia/etiologia , Tomografia Computadorizada por Raios X , Resultado do Tratamento
12.
J Nepal Health Res Counc ; 17(2): 242-246, 2019 Aug 04.
Artigo em Inglês | MEDLINE | ID: mdl-31455942

RESUMO

BACKGROUND: Selective Nerve Root Block using steroid is a proven technique for management of lumbar radiculopathy. The aim of the study was to determine the effectiveness of selective nerve root block in lumbar radiculopathy. METHODS: A prospective observational study was conducted for duration of one year in patients diagnosed with lumbar radiculopathy. Patients with leg pain, positive straight leg raising test and single level disc prolapse were included in the study. The procedure was performed under fluoroscopic guidance and Visual Analogue Pain rating scale and Oswestry Disability Index score was used for assessment pre-injection, 1 week, 1 month, 6 months and 1-year post injection. RESULTS: Total 35 patient with mean age of 37.7± 9.31 years were included in the study. The pre-injection Visual Analogue Pain Score(Mean ± S.D:7.8±0.7) was significantly reduced at one week (4.2±1.47, p <0.00001), one month (2.74±1.06, p <0.00001), six months (2.31±0.75, p <0.00001) and one year (2.62±0.84, p <0.00001). Similarly, pre-injection Oswestry Disability Index score (Mean ± S.D: 32.09±5.95) was significantly reduced at one week (19.51±7.26, p <0.00001), one month (12.71±4.56, p <0.00001), six months (9.8±2.87, p <0.00001) and one year (10.09±2.97, p <0.00001) but not significantly improved when compared at 6 months and 1 year (p < 0.44). CONCLUSIONS: Selective Nerve Root Block in lumbar radiculopathy significantly reduces Visual Analogue Pain Score up to a year, however, the reduction in pain plateaus around six months.Disability index score only reduces for first 6 months but doesn't significantly reduce from six months to one year.


Assuntos
Deslocamento do Disco Intervertebral/complicações , Vértebras Lombares , Bloqueio Nervoso/métodos , Radiculopatia/tratamento farmacológico , Radiculopatia/etiologia , Esteroides/administração & dosagem , Adulto , Avaliação da Deficiência , Feminino , Fluoroscopia , Humanos , Masculino , Medição da Dor , Estudos Prospectivos
13.
Eur Radiol ; 29(12): 6443-6446, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31278582

RESUMO

KEY POINTS: • Molecular intervertebral disc damage was associated with LBP and radiculopathy.• Patients with radiculopathy and LBP demonstrated a depletion of gagCEST values compared with healthy controls.• GagCEST imaging may be a non-invasive tool for investigation of degeneration processes of lumbar intervertebral discs (IVDs). GagCEST imaging may be an imaging biomarker for biochemical IVD alterations.


Assuntos
Degeneração do Disco Intervertebral/diagnóstico por imagem , Disco Intervertebral/diagnóstico por imagem , Dor Lombar/fisiopatologia , Imagem por Ressonância Magnética/métodos , Radiculopatia/fisiopatologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Biomarcadores/análise , Feminino , Glicosaminoglicanos/metabolismo , Humanos , Disco Intervertebral/metabolismo , Degeneração do Disco Intervertebral/complicações , Degeneração do Disco Intervertebral/metabolismo , Dor Lombar/etiologia , Dor Lombar/metabolismo , Vértebras Lombares/metabolismo , Vértebras Lombares/fisiopatologia , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Radiculopatia/etiologia , Radiculopatia/metabolismo , Adulto Jovem
14.
Acta Med Port ; 32(6): 466-468, 2019 Jun 28.
Artigo em Inglês | MEDLINE | ID: mdl-31292029

RESUMO

Fibrous dysplasia is a bone disease characterized by an osteoblastic dysfunction resulting in a fibrous replacement of the normal medullary bone. We describe the case of a 33-year-old who presented with low back pain irradiating to her right leg. Both the computed tomography scan and magnetic resonance imaging showed an osteolytic, multicystic lesion of the right hemi-sacrum with invasion of the right S1 foramen. She underwent foraminotomy and curettage of the lesion. Histological diagnosis was fibrous dysplasia, without features of malignant transformation. Three years after surgery the patient is asymptomatic and imaging is stable. This is the fifth known case of monostotic fibrous dysplasia involving the sacrum, a rare entity that must be considered in the differential diagnosis when approaching patients with sacral lesions.


Assuntos
Displasia Fibrosa Monostótica/complicações , Dor Lombar/etiologia , Doenças Raras/complicações , Sacro , Adulto , Feminino , Displasia Fibrosa Monostótica/diagnóstico por imagem , Displasia Fibrosa Monostótica/cirurgia , Humanos , Dor Lombar/cirurgia , Imagem por Ressonância Magnética , Radiculopatia/etiologia , Doenças Raras/diagnóstico por imagem , Doenças Raras/cirurgia , Sacro/diagnóstico por imagem , Sacro/cirurgia , Tomografia Computadorizada por Raios X
15.
Spine (Phila Pa 1976) ; 44(18): 1318-1331, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31261274

RESUMO

STUDY DESIGN: Systematic review. OBJECTIVE: This review aims to (1) outline how neurological complications and disease progression are defined in the literature and (2) evaluate the quality of definitions using a novel four-point rating system. SUMMARY OF BACKGROUND DATA: Degenerative cervical myelopathy (DCM) is a progressive, degenerative spine disease that is often treated surgically. Although uncommon, surgical decompression can be associated with neurological complications, such as C5 nerve root palsy, perioperative worsening of myelopathy, and longer-term deterioration. Unfortunately, important questions surrounding these complications cannot be fully addressed due to the heterogeneity in definitions used across studies. Given this variability, there is a pressing need to develop guidelines for the reporting of surgical complications in order to accurately evaluate the safety of surgical procedures. METHODS: An electronic database search was conducted in MEDLINE, MEDLINE in Process, EMBASE and Cochrane Central Register of Controlled Trials for studies that reported on complications related to DCM surgery and included at least 10 surgically treated patients. Data extracted included study design, surgical details, as well as definitions and rates of surgical complications. A four-point rating scale was developed to assess definition quality for each complication. RESULTS: Our search yielded 2673 unique citations, 42 of which met eligibility criteria and were summarized in this review. Defined complications included neurological deterioration, late onset deterioration, perioperative worsening of myelopathy, C5 palsy, nerve root or upper limb palsy or radiculopathy, surgery failure, inadequate decompression and progression of ossified lesions. Reported rates of these complications varied substantially, especially those for neurological deterioration (0.2%-33.3%) and progression of ossified lesions (0.0%-86.7%). CONCLUSION: Reported incidences of various complications vary widely in DCM surgery, especially for neurological deterioration and progression of ossified lesions. This summary serves as a first step for standardizing definitions and developing guidelines for accurately reporting surgical complications. LEVEL OF EVIDENCE: 2.


Assuntos
Vértebras Cervicais/cirurgia , Doenças da Medula Espinal/complicações , Doenças da Medula Espinal/cirurgia , Descompressão Cirúrgica/métodos , Progressão da Doença , Humanos , Masculino , Paralisia/etiologia , Radiculopatia/etiologia
16.
World Neurosurg ; 131: 27-31, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31356975

RESUMO

BACKGROUND: Ankylosing spondylitis (AS) is a systemic enthesopathy. In its presence, spinal fractures are often unstable. Acknowledging the preinjury level of kyphosis is key in the management of cervical fractures, and placement into a hard collar has been shown to result in life-threatening spinal cord complications. CASE DESCRIPTION: This report presents the unique case of a patient with AS who developed a unilateral C5 palsy after the application of a hard collar for a C5/6 fracture, to our knowledge the first such case presented to date. The patient subsequently went on to an anterior fixation and partially recovered from the C5 palsy/injury. After the case report is an examination of the currently available literature and evidence exploring the factors that may contribute to C5 palsy after the application of a collar for acute fracture in AS. CONCLUSIONS: We described the first case in the literature of a posttraumatic C5 palsy after application of a hard collar in AS. This report and literature review should act to underscore the importance of respecting a preexisting rigid kyphotic deformity in cervical fractures but also to stimulate further thoughts and investigations into what may contribute to a posttraumatic C5 palsy.


Assuntos
Discotomia , Aparelhos Ortopédicos/efeitos adversos , Radiculopatia/etiologia , Fraturas da Coluna Vertebral/terapia , Fusão Vertebral , Vértebras Cervicais , Humanos , Masculino , Pessoa de Meia-Idade , Radiculopatia/cirurgia , Fraturas da Coluna Vertebral/complicações , Espondilite Anquilosante/complicações
17.
World Neurosurg ; 131: e290-e297, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31356984

RESUMO

OBJECTIVE: To assess factors that may predict failure to improve at 12 and 24 months after unilateral laminotomy with bilateral decompression (ULBD) for the management of lumbar spinal stenosis. METHODS: A database of 255 patients who underwent microdecompression surgery by a single orthopedic spine surgeon between 2014 and 2018 was queried. Patients who underwent primary single-level ULBD of the lumbar spine were included. Visual analog scale (VAS) for back pain and leg pain and Oswestry Disability Index (ODI) results were collected preoperatively and at 12 and 24 months postoperatively. Demographic, radiographic, and operative factors were assessed for associations with failure to improve. Clinically important improvement was defined as reaching or surpassing the previously established minimum clinically important difference for ODI (12.8) and not requiring revision. RESULTS: A total of 68 patients were included. Compared with preoperative values for back pain, leg pain, and ODI (7.32, 7.53, and 51.22, respectively), there were significant improvements on follow-up at 12 months (2.89, 2.23, and 22.40, respectively; P < 0.001) and 24 months (2.80, 2.11, 20.32, respectively; P < 0.001). Based on the defined criteria, 50 patients showed clinically important improvement after ULBD. Of the 18 patients who failed to improve, 12 required revision. Independent predictors of failure to improve included female sex (adjusted odds ratio, 5.06; 95% confidence interval, 1.49-21.12; P = 0.014) and current smoker status (adjusted odds ratio, 5.39; 95% confidence interval, 1.39-23.97; P = 0.018). CONCLUSIONS: ULBD for the management of lumbar spinal stenosis leads to clinically important improvement that is maintained over a 24-month follow-up period. Female sex and tobacco smoking are associated with poorer outcomes.


Assuntos
Descompressão Cirúrgica , Laminectomia , Vértebras Lombares/cirurgia , Radiculopatia/cirurgia , Estenose Espinal/cirurgia , Idoso , Feminino , Humanos , Perna (Membro) , Dor Lombar/etiologia , Masculino , Pessoa de Meia-Idade , Diferença Mínima Clinicamente Importante , Razão de Chances , Dor , Medição da Dor , Radiculopatia/etiologia , Radiculopatia/fisiopatologia , Reoperação , Fatores Sexuais , Estenose Espinal/complicações , Estenose Espinal/fisiopatologia , Fumar Tabaco/epidemiologia , Falha de Tratamento
18.
World Neurosurg ; 131: e170-e175, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31330334

RESUMO

INTRODUCTION: The lateral transpsoas approach (LTPA) has gained popularity in thoracolumbar spine surgery procedures; however, there is an insufficient amount of data pertaining to motor and sensory complications that arise when a corpectomy is performed through the LTPA approach. METHODS: Patients who underwent a corpectomy through a LTPA at a single institution between 2006 and 2016 were analyzed. Demographics, neurological outcomes, and complications were recorded. The minimum follow-up was 6 months. Univariate analysis was performed to compare demographics, surgical characteristics, complications, and outcome scores. To compare categorical variables, the χ2 test was used. For continuous outcomes, simple linear regression was used. Statistical significance was set at P < 0.05. RESULTS: A total of 166 patients were included. The patients were divided into 2 groups; LTPA without corpectomy (n = 112) versus LTPA with corpectomy (n = 54). Patients without corpectomy showed a significantly lower rate of postoperative infections compared with patients with corpectomy (3.6% vs. 22.2%; P < 0.000). A higher percentage of postoperative complications was found in patients with corpectomy (31.5% vs. 13.4%; P = 0.006). The rate of neurologic complications at the 6-month follow-up and the reoperation rate (22.7% vs. 32.4%; P = 0.256) were higher in the corpectomy group (8.9% vs. 7.4%; P = 0.741), no significant difference was found between the groups. CONCLUSION: Patients who underwent an LTPA corpectomy have a higher risk to suffer from postoperative complications. The results at the 6-month follow-up did not significantly differ between the groups.


Assuntos
Vértebras Lombares/cirurgia , Procedimentos Neurocirúrgicos/métodos , Doenças da Coluna Vertebral/cirurgia , Fusão Vertebral/métodos , Vértebras Torácicas/cirurgia , Idoso , Feminino , Humanos , Dor Lombar/etiologia , Dor Lombar/cirurgia , Plexo Lombossacral/lesões , Masculino , Pessoa de Meia-Idade , Procedimentos Cirúrgicos Minimamente Invasivos , Complicações Pós-Operatórias/epidemiologia , Músculos Psoas , Radiculopatia/etiologia , Radiculopatia/cirurgia , Estudos Retrospectivos , Doenças da Coluna Vertebral/complicações , Fraturas da Coluna Vertebral/cirurgia , Neoplasias da Coluna Vertebral/cirurgia , Resultado do Tratamento
20.
Pain Physician ; 22(4): E287-E294, 2019 07.
Artigo em Inglês | MEDLINE | ID: mdl-31337170

RESUMO

BACKGROUND: Transforaminal epidural steroid injection (TFESI) can be administered with or without sedation in clinical practice. OBJECTIVES: The aim of this study was to compare both procedures in terms of patient and physician satisfaction, preoperative anxiety level, procedural pain level, and complications. STUDY DESIGN: A prospective randomized trial. SETTING: A university hospital interventional pain management center. METHODS: The study included patients scheduled for single-level unilateral TFESI. The patients were randomized into 2 groups. The first group underwent TFESI without sedation, whereas the second group underwent TFESI with sedation. The Likert scale was used to determine the patient and physician satisfaction, and the Numeric Rating Scale (NRS-11) was used to determine the procedural pain level. Cases in which the procedure was to be repeated, the patient was questioned if they desired to undergo the procedure with the same technique. RESULTS: A total of 64 patients, (31 [48.4%] in the sedation group) were included. In the sedation group, the patient and physician satisfaction were significantly higher (P = 0.0001), the periprocedural NRS-11 scores were significantly lower (P = 0.0001), and the rate of desire to have the intervention with the same technique was higher (P = 0.001). After the regression analysis, we reported that there was a significant correlation between being in the sedation group and NRS-11 procedure scores, the desire to have the same technique, and patient and physician satisfaction (odds ratio [OR], 0.341; OR, 0.648; OR, 0.329; OR, 0.514; P = 0.0001). LIMITATIONS: Both patients and physicians were unblinded. CONCLUSIONS: Coadministration of TFESI with sedation improves patient and physician satisfaction. Additionally, the low periprocedural pain level results in patients' demand for the intervention to be performed with sedation in the event of repetition of the procedure. KEY WORDS: Patient satisfaction, transforaminal epidural steroid injection, sedation, physician satisfaction.


Assuntos
Sedação Consciente/métodos , Injeções Epidurais/métodos , Deslocamento do Disco Intervertebral/tratamento farmacológico , Manejo da Dor/métodos , Satisfação do Paciente , Adulto , Idoso , Feminino , Humanos , Deslocamento do Disco Intervertebral/complicações , Masculino , Metilprednisolona/administração & dosagem , Pessoa de Meia-Idade , Estudos Prospectivos , Radiculopatia/tratamento farmacológico , Radiculopatia/etiologia
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