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1.
J Med Case Rep ; 15(1): 180, 2021 Apr 20.
Artigo em Inglês | MEDLINE | ID: mdl-33875013

RESUMO

BACKGROUND: Dermatofibrosarcoma protuberans (DFSP) is a rare skin fibroblastic tumor, with a high rate of recurrence. The treatment of DFSP is generally surgical, and wide local excision is the mainstay of surgical treatment. Therefore, complete assessment of all surgical margins is fundamental before definitive reconstruction. The reconstruction is a challenge for plastic surgeons, especially in particular anatomical areas (for aesthetic or functional problems) or in patients who are not candidates for more complex surgical treatments. We describe an alternative approach for reconstructive treatment of the lumbar area after wide excision of DFSP (without fresh-frozen sections) in a young obese woman with a history of smoking, using a new type of acellular dermal matrix (ADM) in a combined management protocol. The benefits of ADM are numerous: immediate wound closure and prevention of infections and excessive drying; minimal donor site morbidity; and good functional and aesthetic outcomes. Moreover, it is a temporary cover while the anatomical specimen is histologically analyzed, without donor site morbidity or prevention of any future surgery (if the margins are not tumor-free) or radiotherapy. CASE PRESENTATION: In October 2019, a 34-year old obese Caucasian Woman with a history of smoking came to our institute for a multinodular growing polypoid mass in her lumbar region. An incisional biopsy diagnosed DFSP. The patient underwent proper staging. A wide local excision with 3 cm clinically healthy tissue margins down to the muscle fascia was performed and the defect was repaired using a combined approach with a new artificial bilaminar dermal template (Pelnac®, Gunze Ltd., Osaka, Japan) and a negative-pressure wound therapy system (V.A.C.®, KCI, San Antonio, USA). After the final histological examination revealed tumor-free margins, a split-thickness graft was harvested from the right gluteus and fixed to the new derma with negative-pressure wound therapy. Postoperative radiotherapy was not necessary. After 15 days, the wound had healed without complications, with satisfactory aesthetic outcome and with no limitation of back motion or pain. After 6 months of follow-up, the patient was free from disease. CONCLUSIONS: This is the first reported case of Pelnac® use in DFSP reconstruction of the lumbar region. We believe that the multistep approach described herein may be a good alternative approach in selected patients with wide resections in particular anatomical areas, especially when frozen sections (with Mohs micrographic surgery) are not available.


Assuntos
Dermatofibrossarcoma/cirurgia , Região Lombossacral/cirurgia , Neoplasias Cutâneas/cirurgia , Derme Acelular , Adulto , Dermatofibrossarcoma/patologia , Feminino , Humanos , Japão , Recidiva Local de Neoplasia , Qualidade de Vida , Neoplasias Cutâneas/patologia
2.
Int J Mol Sci ; 22(7)2021 Mar 31.
Artigo em Inglês | MEDLINE | ID: mdl-33807361

RESUMO

Transforaminal lumber interbody fusion (TLIF) is the last resort to address the lumber degenerative disorders such as spondylolisthesis, causing lower back pain. The current surgical intervention for these abnormalities includes open TLIF. However, in recent years, minimally invasive TLIF (MIS-TLIF) has gained a high momentum, as it could minimize the risk of infection, blood loss, and post-operative complications pertaining to fusion surgery. Further advancement in visualizing and guiding techniques along with grafting cage and materials are continuously improving the safety and efficacy of MIS-TLIF. These assistive techniques are also playing a crucial role to increase and improve the learning curve of surgeons. However, achieving an appropriate output through TLIF still remains a challenge, which might be synergized through 3D-printing and tissue engineering-based regenerative therapy. Owing to their differentiation potential, biomaterials such as stem/progenitor cells may contribute to restructuring lost or damaged tissues during MIS-TLIF, and this therapeutic efficacy could be further supplemented by platelet-derived biomaterials, leading to improved clinical outcomes. Thus, based on the above-mentioned strategies, we have comprehensively summarized recent developments in MIS-TLIF and its possible combinatorial regenerative therapies for rapid and long-term relief.


Assuntos
Vértebras Lombares/cirurgia , Fusão Vertebral/métodos , Fusão Vertebral/tendências , Materiais Biocompatíveis/farmacologia , Transplante Ósseo/tendências , Cerâmica , Humanos , Degeneração do Disco Intervertebral/cirurgia , Região Lombossacral/cirurgia , Procedimentos Cirúrgicos Minimamente Invasivos/métodos , Procedimentos Cirúrgicos Minimamente Invasivos/tendências , Medicina Regenerativa/métodos , Espondilolistese/cirurgia , Resultado do Tratamento
3.
Spine (Phila Pa 1976) ; 46(4): E257-E266, 2021 Feb 15.
Artigo em Inglês | MEDLINE | ID: mdl-33475277

RESUMO

STUDY DESIGN: A retrospective study. OBJECTIVE: The aim of this study was to investigate the ability of Global Alignment and Proportion (GAP) score to predict the occurrence of adjacent segment degeneration (ASD) after fusion surgery for lumbar degenerative diseases. SUMMARY OF BACKGROUND DATA: The recently developed GAP score was applied to predict postoperative complications for adult spinal deformity, as well as to facilitate future outcome-based research on optimal treatment for various spinal conditions. However, it remains unclear whether reconstruction of alignment according to GAP score can reduce the ASD rates. METHODS: This study retrospectively reviewed 126 consecutive patients who had undergone lumbar fusion and had been followed over 2 years. Pre- and postoperative radiographs and MRI were analyzed for ASD. GAP scores were calculated based on the early postoperative spinopelvic parameters. Cochran-Armitage test of trend was performed to investigate the association between GAP score and the occurrence of ASD. Receiver-operating characteristic curves were used to analyze the predictive accuracy of the GAP score for ASD. RESULTS: Radiographical ASD (R-ASD) and symptomatic ASD (S-ASD) were diagnosed in 44 (34.9%) patients and in 13 (10.3%) patients, respectively. The patients with a proportioned spinopelvic state according to the GAP score had significantly lower rates of ASD (R-ASD and S-ASD) or S-ASD than those with a moderately or severely disproportioned spinopelvic state. The area under curve for the GAP score predicting ASD and S-ASD was 0.691 (95% confidence interval [CI]: 0.596∼0.785, P < 0.01) and 0.865 (95% CI: 0.771∼0.958, P < 0.01), respectively. CONCLUSION: Our study revealed a significant association between postoperative GAP score and occurrence of ASD after lumbar fusion surgery. Setting surgical goals according to the GAP score may help reduce the occurrence of ASD, especially for S-ASD.Level of Evidence: 4.


Assuntos
Vértebras Lombares/cirurgia , Procedimentos Cirúrgicos Reconstrutivos , Fusão Vertebral/efeitos adversos , Adulto , Idoso , Feminino , Humanos , Região Lombossacral/cirurgia , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias , Período Pós-Operatório , Radiografia , Estudos Retrospectivos , Doenças da Coluna Vertebral/cirurgia
4.
Spine (Phila Pa 1976) ; 46(4): 232-240, 2021 Feb 15.
Artigo em Inglês | MEDLINE | ID: mdl-33475278

RESUMO

STUDY DESIGN: A retrospective study. OBJECTIVE: The aim of this study was to investigate proximal junctional kyphosis (PJK) after lumbosacral long fusion according to preoperative Roussouly and lumbar degenerative kyphosis (LDK) types. SUMMARY OF BACKGROUND DATA: Although previous studies have suggested some risk factors for PJK, the effects of preoperative grade of sagittal imbalance and paraspinal muscles degeneration on PJK remain unclear. METHODS: Eighty-seven patients who had undergone lumbosacral fusion more than five levels with available clinical and radiological data were enrolled. The presence of PJK defined as sagittal Cobb angle ≥20° between the uppermost instrumented vertebra (UIV) and two supra-adjacent vertebrae at postoperative 2-year radiographs was recorded. Its occurrence was compared according to preoperative Roussouly and LDK types (Takemistu type) and the degree of paraspinal muscle degeneration at the upper level of UIV. Other sagittal radiographic parameters were also measured. RESULTS: In this series, 28 patients (group I, 32.2%) showed radiological PJK, whereas 59 patients did not show radiological PJK (non-PJK patients, group II, 67.8%) at postoperative 2 years. PJK presented more prevalence in type III and type IV of LDK types (26/27, 96.3%). However, Roussouly types did not show any significant difference in PJK prevalence. In radiological parameters, a larger preoperative SVA (P = 0.018) and PI-LL (P = 0.015) were associated with PJK. Also, smaller quantity and lower quality of paraspinal muscles at T12-L1 level showed significant (P < 0.001) relationship with PJK. On multivariate logistic regression, higher LDK type (odds ratio [OR]: 2.11, 95% confidence interval [CI]: 1.24-3.56), smaller quantity (OR: 1.03, 95% CI: 1.00-1.07), and higher degree of paraspinal muscle degeneration (OR: 1.46, 95% CI: 0.92-2.31) were independent predictors of postoperative PJK. CONCLUSION: Although various factors are related to PJK following long segment fusion, preoperative conditions such as LDK types and degree of paraspinal muscle degeneration might be related to the development of PJK.Level of Evidence: 3.


Assuntos
Cifose/classificação , Cifose/cirurgia , Vértebras Lombares/cirurgia , Músculos Paraespinais/patologia , Adulto , Idoso , Feminino , Humanos , Cifose/epidemiologia , Região Lombossacral/cirurgia , Masculino , Pessoa de Meia-Idade , Período Pós-Operatório , Prevalência , Radiografia , Estudos Retrospectivos , Fatores de Risco
5.
Spine (Phila Pa 1976) ; 46(2): E139-E145, 2021 Jan 15.
Artigo em Inglês | MEDLINE | ID: mdl-33347093

RESUMO

STUDY DESIGN: Retrospective observational study. OBJECTIVE: It has been shown that pedicle screw stimulation thresholds less than or equal to 8 mA yield a very high diagnostic accuracy of detecting misplaced screws in spinal surgery. In our study, we determined clinical implications of low stimulation thresholds. SUMMARY OF BACKGROUND DATA: Posterior lumbar spinal fusions (PSF), using pedicle screws, are performed to treat many spinal pathologies, but misplaced pedicle screws can result in new postoperative neurological deficits. METHODS: Patients with pedicle screw stimulation testing who underwent PSF between 2010 and 2012 at the University of Pittsburgh Medical Center (UPMC) were included in the study. We evaluated the sensitivity, specificity, and diagnostic odds ratio (DOR) to determine how effectively low pedicle screw responses predict new postoperative lower extremity neurological deficits. RESULTS: One thousand one hundred seventy nine eligible patients underwent 8584 pedicle screw stimulations with lower extremity somatosensory evoked potentials (LE SSEP) monitoring for lumbar fusion surgery. One hundred twenty one of these patients had 187 pedicle screws with a stimulation response at a threshold less than or equal to 8 mA. Smoking had a significant correlation to pedicle screw stimulation less than or equal to 8 mA (P = 0.012). A threshold of less than or equal to 8 mA had a sensitivity/specificity of 0.32/0.90 with DOR of 4.34 [1.83, 10.27] and an area under the ROC curve (AUC) of 0.61 [0.49, 0.74]. Patients with screw thresholds less than or equal to 8 mA and abnormal baselines had a DOR of 9.8 [95% CI: 2.13-45.17] and an AUC of 0.73 [95% CI: 0.50-0.95]. CONCLUSION: Patients with pedicle screw stimulation thresholds less than or equal to 8 mA are 4.34 times more likely to have neurological clinical manifestations. Smoking and LE deficits were shown to be significantly correlated with pedicle screw stimulation thresholds less than or equal to 8 mA. Low stimulation thresholds result in a high specificity of 90%. Pedicle screw stimulation less than or equal to 8 mA can serve as an accurate rule in test for postoperative neurological deficit, warranting reevaluation of screw placement and/or replacement intraoperatively.Level of Evidence: 3.


Assuntos
Região Lombossacral/cirurgia , Parafusos Pediculares , Fusão Vertebral/métodos , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Eletromiografia , Feminino , Humanos , Extremidade Inferior , Vértebras Lombares/cirurgia , Masculino , Pessoa de Meia-Idade , Período Pós-Operatório , Estudos Retrospectivos
6.
Spine (Phila Pa 1976) ; 46(1): 1-8, 2021 Jan 01.
Artigo em Inglês | MEDLINE | ID: mdl-32925679

RESUMO

STUDY DESIGN: Randomized controlled trial. OBJECTIVE: The aim of this study was to compare the dosemetrically determined radiation exposure of surgeon and patient during minimally invasive transforaminal lumbar interbody fusion (MIS TLIF) using conventional 2D fluoroscopy (FLUORO) or 3D fluoroscopy-based navigation (NAV). SUMMARY OF BACKGROUND DATA: MIS TLIF was shown to exhibit higher radiation exposures compared to open techniques. In particular, the routinely exposed surgeon encounters the risks of increased radiation doses. With the additional use of intraoperative 3D navigation, major steps of the operation can be performed without exposing the operating room staff to ionizing radiation. METHODS: Forty-four patients undergoing monosegmental MIS TLIF were randomized into the two intraoperative imaging technique groups (FLUORO or NAV). The primary endpoint was the radiation exposure of the surgeon; the secondary endpoints were the radiation exposure of the patient and C-arm readings. RESULTS: After exclusion of three patients, 41 patients were analyzed. In general, the average radiation exposure of the surgeon was lower in the NAV group without being statistically significant. The radiation exposure of the patient was significantly higher in the NAV group at all dosemeter sites. The average fluoroscopy time was 63 ±â€Š36 versus 109 ±â€Š31 sec (FLUORO versus NAV group, P < 0.001). CONCLUSION: The additional use of intraoperative 3D fluoroscopy-based navigation compared to conventional 2D fluoroscopy alone showed a nonsignificant reduction of the radiation exposure of the surgeon in monosegmental MIS TLIF, while increasing the radiation exposure of the patient. LEVEL OF EVIDENCE: 1.


Assuntos
Fluoroscopia , Vértebras Lombares/cirurgia , Procedimentos Cirúrgicos Minimamente Invasivos/métodos , Exposição à Radiação , Fusão Vertebral/métodos , Feminino , Humanos , Região Lombossacral/cirurgia , Masculino , Pessoa de Meia-Idade , Salas Cirúrgicas , Duração da Cirurgia , Cirurgiões , Cirurgia Assistida por Computador/métodos
7.
Spine (Phila Pa 1976) ; 46(1): 35-40, 2021 Jan 01.
Artigo em Inglês | MEDLINE | ID: mdl-33315362

RESUMO

STUDY DESIGN: Retrospective cohort study. OBJECTIVE: The aim of this study was to determine whether the presence of a fellow or resident (F/R) compared to a physician assistant (PA) affected surgical variables or short-term patient outcomes. SUMMARY OF BACKGROUND DATA: Although orthopedic spine fellows and residents must participate in minimum number of decompression surgeries to gain competency, the impact of trainee presence on patient outcomes has not been assessed. METHODS: One hundred and seventy-one patients that underwent a one- to three-level lumbar spine decompression procedure at a high-volume academic center were retrospectively identified. Operative reports from all cases were examined and patients were placed into one of two groups based on whether the first assist was a F/R or a PA. Univariate analysis was used to compare differences in total surgery duration, 30-day and 90-day readmissions, infection and revision rates, patient-reported outcome measures (Short Form-12 Physical Component Score and Mental Component Score, Oswestry Disability Index, Visual Analog Scale [VAS] Back, VAS Leg) between groups. Multiple linear regression was used to assess change in each patient reported outcome and multiple binary logistic regression was used to determine significant predictors of revision, infection, and 30- or 90-day readmission. RESULTS: Seventy-eight patients were included in the F/R group compared to 93 patients in the PA group. There were no differences between groups for total surgery time, 30-day or 90-day readmissions, infection, or revision rates. Using univariate analysis, there were no differences between the two groups pre- or postoperatively (P > 0.05). Using multivariate analysis, presence of a surgical trainee did not significantly influence any patient reported outcome and did not affect infection, revision, or 30- and 90-day readmission rates. CONCLUSION: This is one of the first studies to show that the presence of an orthopedic spine fellow or resident does not affect patient short-term outcomes in lumbar decompression surgery. LEVEL OF EVIDENCE: 3.


Assuntos
Descompressão Cirúrgica/métodos , Vértebras Lombares/cirurgia , Medidas de Resultados Relatados pelo Paciente , Adulto , Idoso , Feminino , Humanos , Região Lombossacral/cirurgia , Masculino , Pessoa de Meia-Idade , Medição da Dor , Estudos Retrospectivos , Fusão Vertebral
8.
Spine (Phila Pa 1976) ; 46(1): 29-34, 2021 Jan 01.
Artigo em Inglês | MEDLINE | ID: mdl-32925688

RESUMO

STUDY DESIGN: Retrospective database analysis. OBJECTIVE: This study aimed to compare costs and complication rates following single-level lumbar decompression in patients under age 75 versus patients aged 75 and older. SUMMARY OF BACKGROUND DATA: Lumbar decompression is a common surgical treatment for lumbar pathology; however, its effectiveness can be debated in elderly patients because complication rates and costs by age group are not well-defined. METHODS: The Medicare database was queried through the PearlDiver server for patients who underwent single-level lumbar decompression without fusion as an index procedure. The 90-day complication and reoperation rates were compared between age groups after matching for sex and comorbidity burden. Same day and 90-day costs are compared. RESULTS: The matched cohort included 89,388 total patients (n = 44,694 for each study arm). Compared to the under 75 age group, the 75 and older age group had greater rates of deep venous thrombosis (odds ratio [OR] 1.443, P = 0.042) and dural tear (OR 1.560, P = 0.043), and a lower rate of seroma complicating the procedure (OR 0.419, P = 0.009). There was no difference in overall 90-day reoperation rate in patients under age 75 versus patients aged 75 and older (9.66% vs. 9.28%, P = 0.051), although the 75 and older age group had a greater rate of laminectomy without discectomy (CPT-63047; OR 1.175, P < 0.001), while having a lower rate of laminotomy with discectomy (CPT-63042 and CPT-63030; OR 0.727 and 0.867, respectively, P = 0.013 and <0.001, respectively). The 75 and older age group had greater same day ($3329.24 vs. $3138.05, P < 0.001) and 90-day ($5014.82 vs. $4749.44, P < 0.001) mean reimbursement. CONCLUSION: Elderly patients experience greater rates of select perioperative complications, with mildly increased costs. There is no significant difference in overall 90-day reoperation rates. LEVEL OF EVIDENCE: 3.


Assuntos
Descompressão Cirúrgica/efeitos adversos , Descompressão Cirúrgica/economia , Vértebras Lombares/cirurgia , Idoso , Idoso de 80 Anos ou mais , Estudos de Coortes , Comorbidade , Bases de Dados Factuais , Discotomia/efeitos adversos , Discotomia/economia , Feminino , Humanos , Laminectomia/efeitos adversos , Laminectomia/economia , Região Lombossacral/cirurgia , Masculino , Medicare , Pessoa de Meia-Idade , Complicações Pós-Operatórias/etiologia , Reoperação/economia , Estudos Retrospectivos , Fusão Vertebral , Estados Unidos
9.
Spine (Phila Pa 1976) ; 46(1): E12-E22, 2021 Jan 01.
Artigo em Inglês | MEDLINE | ID: mdl-33315361

RESUMO

STUDY DESIGN: In silico finite element study. OBJECTIVE: The aim of this study was to evaluate effects of six construct factors on rod and screw strain at the lumbosacral junction in an in silico pedicle subtraction osteotomy (PSO) model: traditional inline and alternative Ames-Deviren-Gupta (ADG) multi-rod techniques, number of accessory rods (three-rod vs. four-rod), rod material (cobalt-chrome [CoCr] or stainless steel [SS] vs. titanium [Ti]), rod diameter (5.5 vs. 6.35 mm), and use of cross-connectors (CC), or anterior column support (ACS). SUMMARY OF BACKGROUND DATA: Implant failure and pseudoarthrosis at the lumbosacral junction following PSO are frequently reported. Clinicians may modulate reconstructs with multiple rods, rod position, rod material, and diameter, and with CC or ACS to reduce mechanical demand. An evaluation of these features' effects on rod and screw strains is lacking. METHODS: A finite element model (T12-S1) with intervertebral discs and ligaments was created and validated with cadaveric motion data. Lumbosacral rod and screw strain data were collected for 96 constructs across all six construct factors and normalized to the Ti 2-Rod control. RESULTS: The inline technique resulted in 12.5% to 51.3% more rod strain and decreased screw strain (88.3% to 95%) compared to ADG at the lumbosacral junction. An asymmetrical strain distribution was observed in the three-rod inline technique in comparison to four-rod, which was more evenly distributed. Regardless of construct features, rod strain was significantly decreased by rod material (CoCr > SS > Ti), and increasing rod diameter from 5.5 mm to 6.35 mm reduced strain by 9.9% to 22.1%. ACS resulted in significant reduction of rod (37.8%-59.8%) and screw strains (23.2%-65.8%). CONCLUSION: Increasing rod diameter, using CoCr rods, and ACS were the most effective methods in reducing rod strain at the lumbosacral junction. The inline technique decreased screw strain and increased rod strain compared to ADG. LEVEL OF EVIDENCE: N/A.


Assuntos
Simulação por Computador , Osteotomia/métodos , Coluna Vertebral/cirurgia , Fenômenos Biomecânicos , Ligas de Cromo , Humanos , Região Lombossacral/cirurgia , Parafusos Pediculares , Amplitude de Movimento Articular , Fusão Vertebral/métodos , Titânio
10.
J Clin Neurosci ; 82(Pt A): 134-140, 2020 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-33317722

RESUMO

INTRODUCTION: At L5-S1, anterior access can be performed with a supine anterior lumbar interbody fusion (ALIF) or lateral position oblique lumbar interbody fusion (LOLIF). We compared clinical and radiographic features of both approaches. METHODS: A retrospective study of L5-S1 ALIF and LOLIF patients (2013-2018) by 3 spine surgeons and a vascular surgeon at our hospital was performed. Inclusion criteria were patients undergoing L5-S1 anterior surgery only without other anterior or lateral fusion levels, and data collected were patient demographics, cage parameters, perioperative variables, and radiographic parameters. 58 patients were included (33 ALIF and 25 LOLIF). RESULTS: The average surgical time was 211.94 min for ALIF and 154.86 min for LOLIF (p < 0.001). The average blood loss was 214 ml for ALIF and 74 ml for LOLIF (p < 0.001). The average number of days to solid food was 2.55 for ALIF and 0.8 for LOLIF (p < 0.001). The average anterior L5-S1 disc height increase was 8.52 mm for ALIF and 5.02 mm LOLIF (p = 0.018), and the average posterior L5-S1 disc height increase was 3.34 mm for ALIF and 1.30 mm for LOLIF (p = 0.034). The average L5-S1 segmental lordosis increase was 6.82 degrees for ALIF and 7.63 degrees for LOLIF (p = 0.638). CONCLUSION: The LOLIF is a feasible option for L5-S1 anterior access compared to ALIF. However, supine ALIF afforded larger cages to be placed, resulting in greater postoperative disc height. There did not appear to be a significant difference in postoperative L5-S1 segmental lordosis between the two approaches.


Assuntos
Vértebras Lombares/cirurgia , Região Lombossacral/cirurgia , Fusão Vertebral/métodos , Adulto , Feminino , Humanos , Disco Intervertebral , Lordose , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos
11.
Rev Fac Cien Med Univ Nac Cordoba ; 77(4): 381-384, 2020 12 21.
Artigo em Inglês | MEDLINE | ID: mdl-33351385

RESUMO

Introduction: Chylous leakage into the retroperitoneum is a rare complication after spinal surgery using an anterior retroperitoneal approach. Chylothorax is the presence of lymphatic fluid in the pleural cavity and it is even less frequent during these surgeries. The aim of this work is to report the first case of isolated left chylothorax after a retroperitoneal Left Oblique Lumbar Interbody Fusion in supine position in an adult female patient. Case: A female 30-years-old patient underwent L4-L5 anterior interbody fusion. Four days after the intervention she was diagnosed with isolated left chylothorax that was drained and treated conservatively with good outcomes. Conclusion: Chylothorax is an extremely rare complication after anterior lumbar spine procedures, and it is usually secondary to a chyloretroperitoneum. We present a unique case of isolated chylothorax after anterior retroperitoneal lumbar approach successfully treated in a conservative manner. Key Words chylothorax; spine; lumbosacral region; arthrodesis.


Assuntos
Quilotórax , Adulto , Quilotórax/diagnóstico por imagem , Quilotórax/etiologia , Quilotórax/terapia , Feminino , Humanos , Vértebras Lombares/cirurgia , Região Lombossacral/cirurgia , Espaço Retroperitoneal/diagnóstico por imagem , Fusão Vertebral/efeitos adversos
12.
Medicine (Baltimore) ; 99(46): e21717, 2020 Nov 13.
Artigo em Inglês | MEDLINE | ID: mdl-33181634

RESUMO

OBJECTIVE: To compare the effects of milrinone, sodium nitroprusside (SNP), and nitroglycerin (NTG) on induced hypotension, cerebral perfusion, and postoperative cognitive function in elderly patients undergoing spine surgery. METHODS: Sixty patients >60 years scheduled for lumbar fusion surgery were assigned to receive milrinone (group M), SNP (group S), or NTG (group N). The administration of the study drug was initiated immediately after perivertebral muscle retraction and was stopped after completion of interbody fusion. Target blood pressure was a decrease of 30% in systolic blood pressure from baseline or mean blood pressure of 60 to 65 mm Hg. The regional cerebral venous oxygen saturation (rSVO2), as a measure of cerebral perfusion, and the change in perioperative Mini-Mental State Examination (MMSE) score, as a measure of postoperative cognitive function, were assessed. RESULTS: During the administration of the study drug, the overall and lowest intraoperative rSVO2 values were significantly higher (P = .01 and P = .01, respectively), and the duration of rSVO2 <60% was shorter in group M than in the other groups (P = .03). In group M, intraoperative rSVO2 was not different from the basal value, whereas in groups S and N, rSVO2 was significantly lower than the basal value during the administration of the study drug, but then returned to the basal value after terminating the study drug. Basal MMSE scores were comparable among the 3 groups. The MMSE score on postoperative day 5 was higher in group M than the other groups. CONCLUSIONS: Milrinone used to induce hypotension resulted in better intraoperative cerebral perfusion and postoperative cognitive function compared to SNP and nitroglycerin.


Assuntos
Circulação Cerebrovascular/efeitos dos fármacos , Milrinona/uso terapêutico , Idoso , Cardiotônicos/farmacologia , Cardiotônicos/uso terapêutico , Cognição/fisiologia , Feminino , Humanos , Região Lombossacral/cirurgia , Masculino , Milrinona/farmacologia , Procedimentos Neurocirúrgicos/efeitos adversos , Procedimentos Neurocirúrgicos/métodos , Período Pós-Operatório , Estudos Prospectivos , República da Coreia
13.
BMC Neurol ; 20(1): 303, 2020 Aug 15.
Artigo em Inglês | MEDLINE | ID: mdl-32799821

RESUMO

BACKGROUND: Perioperative cerebrospinal fluid (CSF) leakage is a major complication of pituitary adenomas transsphenoidal surgery. Lumbar drainage (LD) is a common method of treating CSF leakage. But whether intraoperative LD can prevent CSF leakage during the perioperative period of pituitary adenomas transsphenoidal surgery remains controversial. Clarity on the appropriate use of LD is needed. METHODS: A systematic literature review was conducted in the PubMed, EMBASE, and Web of science databases. Articles were included when they compared intraoperative LD with intraoperative no-LD CSF leakage rates during pituitary adenomas transsphenoidal surgery. RESULTS: Overall, 5 studies containing 678 cases met the inclusion criteria. When data were provided on intraoperative CSF leakage rates, the meta-analysis showed a significant difference in favor of intraoperative LD. When data were provided on postoperative CSF leakage rates, the meta-analysis also demonstrated a significant difference in favor of intraoperative LD. CONCLUSIONS: Although the results of this meta-analysis suggest intraoperative LD can reduce the risk of CSF leakage during the perioperative period of pituitary adenomas transsphenoidal surgery, the available evidence is indefinite. To some extent the results suggest intraoperative LD's potential positive role. Further studies that include well-designed prospective, randomized controlled clinical trials are necessary for further verification.


Assuntos
Vazamento de Líquido Cefalorraquidiano , Drenagem/métodos , Região Lombossacral/cirurgia , Neoplasias Hipofisárias/cirurgia , Complicações Pós-Operatórias , Adenoma/cirurgia , Vazamento de Líquido Cefalorraquidiano/epidemiologia , Vazamento de Líquido Cefalorraquidiano/prevenção & controle , Vazamento de Líquido Cefalorraquidiano/terapia , Humanos , Cuidados Intraoperatórios , Hipófise/cirurgia , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/prevenção & controle , Complicações Pós-Operatórias/terapia , Osso Esfenoide/cirurgia
14.
Plast Reconstr Surg ; 146(3): 276e-282e, 2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-32842100

RESUMO

BACKGROUND: The deep inferior epigastric artery perforator (DIEP) flap is the gold standard in autologous breast reconstruction. When the abdomen is not available, alternative donor sites can be found at the buttock, the lumbar region, or the thighs. These flaps are referred to as second-choice flaps. This study compares the superior gluteal artery perforator (SGAP) flap and the lumbar artery perforator (LAP) flap to the DIEP flap using patient-reported outcomes. METHODS: A retrospective study was performed reviewing the records of 417 women who underwent a free flap breast reconstruction with either a DIEP, an LAP, or an SGAP flap, between 2006 and 2018. Patients were asked to fill out the BREAST-Q questionnaire, and patient-reported outcomes were analyzed and correlated to the demographic information. RESULTS: The response rate was 54.5 percent, with 50 LAP, 153 DIEP, and 25 SGAP flap patients participating. When questioned about their satisfaction with breasts and satisfaction with outcome, all three procedures were rated similarly high. When comparing the physical well-being of the donor site and appearance of the donor site, LAP flap patients reported significantly lower scores than DIEP and SGAP flap patients. CONCLUSIONS: Patients who undergo LAP or SGAP flap breast reconstruction seem similarly satisfied with the appearance and outcome of their free flap breast reconstruction compared with DIEP flap patients. The donor-site morbidity and its impact on the patient's well-being in SGAP and LAP flap patients have been underestimated. Despite more donor-site discomfort, the LAP and SGAP flaps are feasible alternatives whenever the DIEP flap is not possible.


Assuntos
Neoplasias da Mama/cirurgia , Mamoplastia/métodos , Medidas de Resultados Relatados pelo Paciente , Retalho Perfurante/irrigação sanguínea , Adulto , Artérias , Nádegas/irrigação sanguínea , Nádegas/cirurgia , Artérias Epigástricas , Feminino , Humanos , Região Lombossacral/irrigação sanguínea , Região Lombossacral/cirurgia , Pessoa de Meia-Idade , Estudos Retrospectivos
15.
Arq. bras. med. vet. zootec. (Online) ; 72(4): 1397-1402, July-Aug. 2020. ilus
Artigo em Inglês | LILACS, VETINDEX | ID: biblio-1131506

RESUMO

A captive adult male bush dog (Speothos venaticus) was referred to our Veterinary Medical Teaching Hospital from a local zoo due to a two-week history of progressive hind limb gait impairment and ataxia, non-responsive to clinical management. Computed tomography revealed decreased disc space at L3 - L4 level, with probable disc extrusion narrowing the right side of the spinal canal, compressing the spinal cord. We opted to surgically remove the disc material using both fenestration and right lateral pediculectomy (mini-hemilaminectomy) techniques. Twelve days after surgery there was mild residual proprioceptive ataxia. Gait was fully regained with remission of the neurological deficits around the 30th postoperative day. This is - to the best of our knowledge - the first successful report of a lumbar intervertebral disc extrusion in a bush dog (Speothos venaticus) surgically treated by pediculectomy and disc fenestration.(AU)


Um cachorro-vinagre (Speothos venaticus), macho, adulto, mantido em cativeiro, foi encaminhado ao Hospital Veterinário Universitário pelo zoológico local com histórico de duas semanas de comprometimento progressivo da marcha dos membros posteriores e ataxia, que não responderam ao tratamento clínico. Tomografia computadorizada revelou diminuição do espaço em disco no nível L3 - L4, com provável extrusão de disco estreitando o lado direito do canal vertebral, comprimindo a medula espinhal. Optamos por remover cirurgicamente esse material do disco usando técnicas de fenestração e pediculectomia lateral direita (mini-hemilaminectomia). Doze dias após a cirurgia, houve melhora na deambulação, com ataxia proprioceptiva residual leve. A marcha foi totalmente recuperada com remissão dos déficits neurológicos por volta do trigésimo dia de pós-operatório. Este é - até onde sabemos - o primeiro relato bem-sucedido de uma extrusão de disco intervertebral lombar em um cachorro-vinagre (Speothos venaticus) tratado cirurgicamente por pediculectomia e fenestração de disco.(AU)


Assuntos
Animais , Masculino , Ataxia/veterinária , Canidae/lesões , Disco Intervertebral/patologia , Região Lombossacral/cirurgia , Tomografia Computadorizada por Raios X/veterinária , Animais de Zoológico
16.
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
17.
Medicine (Baltimore) ; 99(29): e21049, 2020 Jul 17.
Artigo em Inglês | MEDLINE | ID: mdl-32702846

RESUMO

Lateral recess stenosis is a common pathology causing clinical syndromes in the elderly population, and there is some concern regarding the number of comorbidities that can occur when performing surgery for this condition in the elderly. However, little research has focused on the issues related to older age, and limited data is available to help the clinician counsel elderly patients undergoing percutaneous endoscopic transforaminal decompression. The present study aimed to explore the safety and efficacy of percutaneous endoscopic transforaminal decompression for lumbar degenerative disease in elderly patients with lumbar lateral recess stenosis and to determine whether age and comorbidity affect the outcome and complication rate.We identified 117 patients in our patient database who underwent percutaneous endoscopic transforaminal decompression for single-level lumbar lateral recess stenosis. Data regarding the Oswestry Disability Index and visual analog scale for back and leg pain were collected preoperatively, postoperatively, and at the last follow-up. Other data, including preoperative comorbidities, operation time, and intraoperative and postoperative complications, were recorded.The average follow-up period was 29.9 ±â€Š5.5 months, with a mean age of 69.8 ±â€Š5.4 years in elderly patients (group A) and 50.4 ±â€Š6.4 years in younger patients (group B). Group A had a higher percentage of comorbidity than group B (83.9% vs 18.0%, P < .001). Both visual analog scale scores for leg pain and Oswestry Disability Index were significantly improved in the 2 groups, and no difference was found between the groups regarding both parameters (P >.05). The elderly patients had the same high rate of favorable outcomes as group B (P > .05). Moreover, there was no difference in surgical complications, recurrence, and neurologic deficit recovery rate between both groups. No major complications or perioperative deaths occurred in both groups.The present study demonstrates that percutaneous endoscopic transforaminal decompression for lateral recess stenosis in elderly patients may be a reasonable treatment associated with substantial benefit.


Assuntos
Fatores Etários , Descompressão Cirúrgica/métodos , Região Lombossacral/cirurgia , Estenose Espinal/cirurgia , Adulto , Idoso , Idoso de 80 Anos ou mais , Descompressão Cirúrgica/estatística & dados numéricos , Endoscopia/métodos , Feminino , Humanos , Região Lombossacral/anormalidades , Região Lombossacral/diagnóstico por imagem , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Estenose Espinal/complicações , Estenose Espinal/epidemiologia , Resultado do Tratamento
18.
Spine (Phila Pa 1976) ; 45(12): E704-E712, 2020 Jun 15.
Artigo em Inglês | MEDLINE | ID: mdl-32479717

RESUMO

STUDY DESIGN: Retrospective cohort study of the 2012 to 2014 Healthcare Cost and Utilization Project Nationwide Readmissions Database. OBJECTIVE: To identify risk factors for 30- and 90-day readmission due to fluid and electrolyte disorders following posterior lumbar fusion. SUMMARY OF BACKGROUND DATA: Thirty- and 90-day readmission rates are important quality and outcome measures for hospitals and physicians. These measures have been tied to financial penalties for abnormally high rates of readmission. Furthermore, complex and high cost surgeries have been increasingly reimbursed in the form of bundled disease resource group payments, where any treatment within 90-day postdischarge is covered within the original bundled payment scheme. METHODS: A total of 65,121 patients in the Healthcare Cost and Utilization Project Nationwide Readmissions Database met our inclusion criteria, of which 1128 patients (1.7%) were readmitted within 30 days, and 1669 patients (2.6%) were readmitted within 90 days due to fluid and electrolyte abnormalities. A bivariate analysis was performed to compare baseline characteristics between patients readmitted with fluid and electrolyte disorders and the remainder of the cohort. A multivariate regression analysis was then performed to identify independent risk factors for readmission due to fluid and electrolyte disorders at 30 and 90 days. RESULTS: The strongest independent predictors of 30-day readmissions were age ≥80 years, age 65 to 79 years, age 55 to 64 years, liver disease, and drug use disorder. The five strongest predictors of 90-day readmissions were age ≥80 years, age 65 to 79 years, age 55 to 64 years, liver disease, and fluid and electrolyte disorders. CONCLUSION: Patients with baseline liver disease, previously diagnosed fluid and electrolyte disorders, age older than 55 years, or drug use disorders are at higher risk for readmissions with fluid and electrolyte disorders following posterior lumbar fusion. Close monitoring of fluid and electrolyte balance in the perioperative period is essential to decrease complications and reduce unplanned readmissions. LEVEL OF EVIDENCE: 3.


Assuntos
Região Lombossacral/cirurgia , Readmissão do Paciente/estatística & dados numéricos , Complicações Pós-Operatórias , Adulto , Idoso , Estudos de Coortes , Bases de Dados Factuais , Eletrólitos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Fatores de Risco , Adulto Jovem
19.
Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi ; 34(6): 761-768, 2020 Jun 15.
Artigo em Chinês | MEDLINE | ID: mdl-32538569

RESUMO

Objective: To compare the clinical and radiological effectiveness of oblique lumbar interbody fusion (OLIF) and posterior lumbar interbody fusion (PLIF) in the treatment of Cage dislodgement after lumbar surgery. Methods: The clinical data of 40 patients who underwent revision surgery due to Cage dislodgement after lumbar surgery betweem April 2013 and March 2017 were retrospectively analyzed. Among them, 18 patients underwent OLIF (OLIF group) and 22 patients underwent PLIF (PLIF group) for revision. There was no significant difference between the two groups in age, gender, body mass index, intervals between primary surgery and revision surgery, number of primary fused levels, disc spaces of Cage dislodgement, and visual analogue scale (VAS) scores of low back pain and leg pain, Oswestry disability index (ODI), the segmental lordosis (SL) and disc height (DH) of the disc space of Cage dislodgement, and the lumbar lordosis (LL) before revision ( P>0.05). The operation time, intraoperative blood loss, hospital stay, and complications of the two groups were recorded and compared. The VAS scores of low back pain and leg pain were evaluated at 3 days, 3, 6, and 12 months after operation, and the ODI scores were evaluated at 3, 6, and 12 months after operation. The SL and DH of the disc space of Cage dislodgement and LL were measured at 12 months after operation and compared with those before operation. CT examination was performed at 12 months after operation, and the fusion of the disc space implanted with new Cage was judged by Bridwell grading standard. Results: The intraoperative blood loss in the OLIF group was significantly less than that in the PLIF group ( t=-12.425, P=0.000); there was no significant difference between the two groups in the operation time and hospital stay ( P>0.05). Both groups were followed up 12-30 months, with an average of 18 months. In the OLIF group, 2 patients (11.1%) had thigh numbness and 1 patient (5.6%) had hip flexor weakness after operation; 2 patients (9.1%) in the PLIF group had intraoperative dural sac tear. The other patients' incisions healed by first intention without early postoperative complications. There was no significant difference in the incidence of complications between the two groups ( χ 2=0.519, P=0.642). The VAS scores of low back pain and leg pain, and the ODI score of the two groups at each time point after operation were significantly improved when compared with those before operation ( P<0.05); there was no significant difference between the two groups at each time point after operation ( P>0.05). At 12 months after operation, SL, LL, and DH in the two groups were significantly increased when compared with preoperative ones ( P<0.05); SL and DH in the OLIF group were significantly improved when compared with those in the PLIF group ( P<0.05), and there was no significant difference in LL between the two groups ( P>0.05). CT examination at 12 months after operation showed that all the operated disc spaces achieved bony fusion. According to the Bridwell grading standard, 12 cases were grade Ⅰ and 6 cases were grade Ⅱ in the OLIF group, and 13 cases were grade Ⅰ and 9 cases were grade Ⅱ in the PLIF group; there was no significant difference between the two groups ( Z=-0.486, P=0.627). During follow-up, neither re-displacement or sinking of Cage, nor loosening or fracture of internal fixation occurred. Conclusion: OLIF and PLIF can achieve similar effectiveness in the treatment of Cage dislodgement after lumbar surgery. OLIF can further reduce intraoperative blood loss and restore the SL and DH of the disc space of Cage dislodgement better.


Assuntos
Vértebras Lombares , Fusão Vertebral , Feminino , Humanos , Vértebras Lombares/cirurgia , Região Lombossacral/cirurgia , Masculino , Estudos Retrospectivos , Fusão Vertebral/métodos , Fusão Vertebral/normas , Resultado do Tratamento
20.
Pain Physician ; 23(3): 305-314, 2020 06.
Artigo em Inglês | MEDLINE | ID: mdl-32517397

RESUMO

BACKGROUND: Percutaneous endoscopic lumbar discectomy (PELD) via the transforaminal approach is difficult at L5-S1 in patients presenting with high iliac crests (HIC). The conventional wisdom is that measurement using lumbar radiography, computed tomography (CT), or magnetic resonance imaging (MRI) is necessary. OBJECTIVES: The objective of this study was to introduce a lumbo-iliac triangular (LI-Tri) technique based on biplane oblique fluoroscopy and verify whether it facilitated transforaminal PELD for patients with L5-S1 lumbar disc herniation (LDH) combined with HIC. STUDY DESIGN: A retrospective analysis. SETTING: All data were from Honghui Hospital in Xi'an. METHODS: One hundred patients with L5-S1 LDH combined with HIC were treated with PELD. The LI-Tri technique was used in the first 50 patients (applied group). The other 50 patients were classified as the nonapplied group, in which the conventional technique was performed. Clinical outcome evaluation included Oswestry Disability Index (ODI) and Visual Analog Scale (VAS) scores. The intervals of follow-up were scheduled at 1 day and 1, 3, 6, 12, and 24 months postoperatively. RESULTS: No significant difference was observed with respect to demographic information (P < .05, respectively). There were 8 patients in the nonapplied group with difficult punctures. Together with the remaining 50 patients, the puncture was successful with the LI-Tri technique. The mean operative duration was shorter in the applied group (55 vs 70 min, P < .01). Compared to the preoperative data, only the back pain VAS and ODI in the nonapplied group were nonsignificantly lower at one day postoperatively (P > .05, respectively). With the exception of the back pain VAS and ODI at one day postoperatively, no significant differences were observed in the 3 parameters at other time points postoperatively between 2 groups (P > .05, respectively). LIMITATIONS: The study is limited by its retrospective, nonrandomized controlled design. CONCLUSIONS: For patients with L5-S1 LDH combined with HIC treated by transforaminal PELD, the LI-Tri technique is simple and effective in preoperative evaluations, locating the skin entry point and guiding the puncture trajectory. Compared to the conventional technique, it shows advantages in terms of reducing intraoperative surgical duration and promoting fast postoperative recovery. KEY WORDS: Endoscopic discectomy, iliac crest, L5-S1 disc, PELD, percutaneous, transforaminal.


Assuntos
Discotomia Percutânea/métodos , Deslocamento do Disco Intervertebral/cirurgia , Radiografia Intervencionista/métodos , Adulto , Estudos de Casos e Controles , Endoscopia/métodos , Feminino , Fluoroscopia/métodos , Humanos , Região Lombossacral/cirurgia , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos
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