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1.
World Neurosurg ; 133: 25-28, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31550539

RESUMO

BACKGROUND: Spinal dural arteriovenous fistulas (DAVFs) in the sacral region are extremely rare. The location and complex angioarchitecture of these lesions make both identification and treatment challenging, even in experienced hands. We report on a sacral DAVF with a unique angioarchitecture and discuss its specific anatomy. CASE DESCRIPTION: A 76-year-old male presented with progressive distal paraparesis and spinal ataxia. Three lumbar decompression surgeries were performed between 2016 and 2018 elsewhere on the basis of suspected degenerative lumbar syndrome. On admission to our center, the patient was wheelchair dependent due to extensive spinal ataxia associated with bilateral foot paresis and hypoesthesia. Spinal contrast-enhanced time-resolved magnetic resonance angiography and digital subtraction angiography were performed after admission to our center. Contrast-enhanced magnetic resonance angiography examinations suggested a sacral DAVF. Subsequent digital subtraction angiography demonstrated a spinal DAVF on the left side at the S2 vertebral level supplied via an arterial epidural branch from the right L4 segmental artery. The fistula was treated via surgical interruption of the proximal part of the radicular drainage vein. CONCLUSIONS: Sacral DAVFs present serious diagnostic difficulties and require a profound understanding of possible fistula-supplying arteries of the sacral region. Microsurgical interruption of the often ventrally located drainage vein presents an efficient treatment modality and could provide an immediate confirmation of fistula occlusion using indocyanine green videoangiography.


Assuntos
Malformações Vasculares do Sistema Nervoso Central/diagnóstico por imagem , Descompressão Cirúrgica , Sacro/diagnóstico por imagem , Idoso , Angiografia Digital , Malformações Vasculares do Sistema Nervoso Central/cirurgia , Humanos , Angiografia por Ressonância Magnética , Masculino , Sacro/cirurgia
2.
J Forensic Sci ; 65(1): 144-153, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31503337

RESUMO

Conducted electrical weapons are designed to cause temporary electro-muscular incapacitation (EMI) without significant injury. The objective of this study was to assess the risk and cause of spinal injury due to exposure to a benchtop EMI device. Porcine subjects were exposed to 19 and 40 Hz electrical stimuli for a prolonged duration of 30 sec. X-ray imaging, necropsy, and accelerometry found that lumbosacral spinal fractures occurred in at least 89% of all subjects, regardless of the stimulus group, and were likely caused by musculoskeletal fatigue-related stress in the lumbosacral spine. Spinal fractures occurred in the porcine model at an unusually high rate compared to human. This may be due to both the prolonged duration of electrical stimulation and significant musculoskeletal differences between humans and pigs, which suggests that the porcine model is not a good model of EMI-induced spinal fracture in humans.


Assuntos
Lesões por Armas de Eletrochoque , Vértebras Lombares , Fraturas da Coluna Vertebral , Animais , Lesões por Armas de Eletrochoque/diagnóstico por imagem , Lesões por Armas de Eletrochoque/patologia , Estimulação Elétrica/instrumentação , Medicina Legal , Fraturas Cominutivas/diagnóstico por imagem , Fraturas Cominutivas/patologia , Humanos , Vértebras Lombares/diagnóstico por imagem , Vértebras Lombares/lesões , Vértebras Lombares/patologia , Modelos Animais , Radiografia , Sacro/diagnóstico por imagem , Sacro/lesões , Sacro/patologia , Fraturas da Coluna Vertebral/diagnóstico por imagem , Fraturas da Coluna Vertebral/patologia , Suínos
3.
World Neurosurg ; 133: 14-16, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31557553

RESUMO

BACKGROUND: Schwannoma is a tumor arising from peripheral nerve sheaths and commonly occurs in the head, neck, and upper and lower extremities. Schwannoma in the presacral space is relatively rare and is often misdiagnosed before pathologic diagnosis is made. CASE DESCRIPTION: Here we discuss a case of giant presacral schwannoma in a 34-year-old man with an emphasis on imaging findings. CONCLUSIONS: Solid and encapsulated, round or oval, with rich blood supply may be the characteristic imaging findings of presacral schwannoma, which may narrow the differential diagnosis of hypervascular pelvic lesions.


Assuntos
Neurilemoma/diagnóstico por imagem , Sacro/diagnóstico por imagem , Neoplasias da Coluna Vertebral/diagnóstico por imagem , Adulto , Humanos , Imagem por Ressonância Magnética , Masculino , Neurilemoma/cirurgia , Sacro/cirurgia , Neoplasias da Coluna Vertebral/cirurgia , Tomografia Computadorizada por Raios X , Ultrassonografia
4.
World Neurosurg ; 133: e84-e88, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31470152

RESUMO

BACKGROUND: Spinopelvic sagittal parameters have a significant influence on adjacent segment degeneration (ASD) after fusion surgery. The association between ASD and sagittal balance is not well understood. The purpose of this study was to investigate the biomechanical influence of various sacral slope (SS) degrees on adjacent segments after transforaminal lumbar interbody fusion (TLIF) at the L4-L5 level. METHODS: We conducted a finite element model of the L1-S1 based on computed tomography scan images. The L1-S1 model with L4-L5 TLIF was modified with various SS degrees (33°, 38°, 43°, and 48°) to investigate the biomechanical influence of SS on adjacent segments. The range of motion (ROM) and intradiscal pressure (IDP) of the adjacent segments (L3-L4 and L5-S1) were compared among models using various SS angles. RESULTS: When the SS angle increased, the ROM and IDP in L5-S1 decreased gradually after TLIF at the L4-L5 level in all motion patterns. Nevertheless, the ROM and IDP in L3-L4 were not significantly different among various SS angles. CONCLUSIONS: Decreased SS after lumbar fusion surgery may pose a higher risk of ASD. Therefore, restoring appropriate SS should be considered during decision-making prior to fusion surgery to reduce the risk of degenerative changes.


Assuntos
Vértebras Lombares/cirurgia , Sacro/diagnóstico por imagem , Fusão Vertebral/métodos , Antropometria , Fenômenos Biomecânicos , Análise de Elementos Finitos , Humanos , Disco Intervertebral/fisiopatologia , Vértebras Lombares/diagnóstico por imagem , Pressão , Amplitude de Movimento Articular , Sacro/patologia , Tomografia Computadorizada por Raios X
5.
Clin Nucl Med ; 45(1): e36-e38, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31693621

RESUMO

A patient enrolled in a clinical trial (NCT02802969) with suspicion of chordoma underwent an [F]FAZA PET/CT, a radiolabeled nitroimidazole analog of hypoxia PET imaging. The patient's images showed a different tumor profile compared to those observed in other hypoxic or nonhypoxic chordoma patients. The motivation for using [F]FAZA pharmacokinetic imaging was to compare this profile with histologically confirmed cases of chordoma. Through visual imaging and quantification of blood and tumor time-activity curves, we excluded the hypothesis that it was a chordoma, diagnosing a paraganglioma.


Assuntos
Processamento de Imagem Assistida por Computador , Nitroimidazóis/farmacocinética , Tomografia Computadorizada com Tomografia por Emissão de Pósitrons , Sacro/diagnóstico por imagem , Neoplasias da Coluna Vertebral/diagnóstico por imagem , Neoplasias da Coluna Vertebral/metabolismo , Ensaios Clínicos como Assunto , Feminino , Humanos , Masculino
6.
World Neurosurg ; 135: 267-272, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-31883482

RESUMO

BACKGROUND: Sacral schwannomas are rare tumors arising from nerve sheath Schwann cells. They are classified into 3 types: first type schwannoma arising from the sacrum, second type schwannoma eroding the sacrum, and third type schwannoma extending extensively, involving anterior, posterior, and retroperitoneal space. Among these type 2 sacral tumors, according to Klimo's classification, an eroding sacrum extending all over posteriorly, anteriorly, and laterally is still rarer. Only 38 cases have been reported in literature reviews. Only 6 cases of giant tumors of >10 cm in any 1 dimension have been reported. CASE DESCRIPTION: We present such a giant sacral schwannoma, with invasiveness eroding the sacrum; compressing the ureters, aortic bifurcation, bladder, and bowel; and presenting as lower abdominal pain, hydronephrosis, dysuria, and constipation. This is the first case reported in the literature that has described a large retroperitoneal tumor compressing retroperitoneal structures-aortic bifurcation vascular compression and ureter compression causing hydronephrosis. CONCLUSIONS: Though complete resection, which caused various severe postoperative complications in the reported cases, is the best option, a less morbid procedure would be appropriate; hence we underwent subtotal excision of the tumor, with complete recovery of our patient's symptoms without neurologic deficit.


Assuntos
Doenças da Aorta/etiologia , Hidronefrose/etiologia , Neurilemoma/complicações , Neoplasias da Coluna Vertebral/complicações , Aorta , Colo , Constipação Intestinal/etiologia , Feminino , Humanos , Hidronefrose/diagnóstico por imagem , Imagem por Ressonância Magnética , Pessoa de Meia-Idade , Invasividade Neoplásica , Neurilemoma/diagnóstico por imagem , Neurilemoma/patologia , Neurilemoma/cirurgia , Sacro/diagnóstico por imagem , Sacro/patologia , Sacro/cirurgia , Neoplasias da Coluna Vertebral/diagnóstico por imagem , Neoplasias da Coluna Vertebral/patologia , Neoplasias da Coluna Vertebral/cirurgia , Raízes Nervosas Espinhais , Carga Tumoral , Ureter
7.
Medicine (Baltimore) ; 98(50): e18413, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31852164

RESUMO

RATIONALE: Chondrosarcoma of the sacrum is a highly unusual disease without standard curative managements yet. The objective of this study is to report a very rare case of chondrosarcoma of the sacrum successfully operated by percutaneous vertebroplasty. The management of these unique cases has yet to be well-documented. PATIENT CONCERNS: A 45-year-old woman presented with a five-month history of continuous and progressive pain and numbness of left extremity. A lytic, expanding lesion of the sacrum and paraspinal region with severe epidural spinal cord compression was identified. DIAGNOSIS: MRI of spine showed spinal cord compression secondary to the epidural componant of the giant mass, with increased marrow infiltration of the left S2 vertebral and paravertebral region, which presented as a solid tumor. Post-operative pathology confirmed the diagnosis of sacral well-differentiated chondrosarcoma (stage I B). INTERVENTIONS: The patient underwent percutaneous vertebroplasty and cement augmentation of sacrum via a posterior approach. OUTCOMES: The patient's neurological deficits improved significantly after the surgery, but the patient died of multiple systemic metastases at the 2-year follow-up visit. There were no complications associated with the operation during the follow-up period. LESSONS: Taken together, the lesion's clinical features, imaging results, and pathological characteristics are unique. Combined efforts of specialists from orthopedics, radiology, neurosurgery, pathology, and medical oncology led to the successful diagnosis and management of this patient. Giant sacral chondrosarcoma, although rare, should be part of the differential diagnosis when the patient presents with back pain and radiculopathy. We recommend the posterior approach for spinal decompression of the sacral chondrosarcoma when the tumor has caused neurological deficits or other severe symptoms. Osteoplasty by cement augmentation is also a good choice for surgical treatment.


Assuntos
Condrossarcoma/cirurgia , Sacro/cirurgia , Neoplasias da Coluna Vertebral/cirurgia , Condrossarcoma/diagnóstico , Condrossarcoma/patologia , Evolução Fatal , Feminino , Humanos , Dor Lombar/etiologia , Imagem por Ressonância Magnética , Pessoa de Meia-Idade , Sacro/diagnóstico por imagem , Compressão da Medula Espinal/diagnóstico por imagem , Compressão da Medula Espinal/etiologia , Neoplasias da Coluna Vertebral/diagnóstico , Neoplasias da Coluna Vertebral/patologia , Vertebroplastia/métodos
8.
Eklem Hastalik Cerrahisi ; 30(3): 252-8, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31650922

RESUMO

OBJECTIVES: This study aims to investigate if pelvic mapping is applicable in iliosacral screw fixation to determine screw entry point and screw trajectory. PATIENTS AND METHODS: Clinical files and images of 16 patients (10 males, 6 females; mean age 35 years; range, 20 to 57 years) who underwent iliosacral screw fixation due to sacroiliac joint injury and sacrum fracture were retrospectively reviewed. Pelvic mapping was performed using preoperative tomography images of the patients and appropriate screw entry point and trajectory were determined. Postoperative computed tomography scans of all patients were obtained and these were used to evaluate the accuracy of the screw position. RESULTS: No intraoperative complications occurred. The entry points and trajectory of the screws were compatible for all patients pre- and postoperatively. CONCLUSION: Mapping of the pelvis is a method that can be used for preoperative planning of iliosacral screwing.


Assuntos
Articulação Sacroilíaca/diagnóstico por imagem , Articulação Sacroilíaca/cirurgia , Sacro/diagnóstico por imagem , Sacro/cirurgia , Fraturas da Coluna Vertebral/diagnóstico por imagem , Fraturas da Coluna Vertebral/cirurgia , Adulto , Parafusos Ósseos , Feminino , Fixação Interna de Fraturas , Humanos , Masculino , Pessoa de Meia-Idade , Cuidados Pré-Operatórios , Radiografia , Estudos Retrospectivos , Articulação Sacroilíaca/lesões , Sacro/lesões , Adulto Jovem
9.
J Pak Med Assoc ; 69(9): 1380-1382, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31511730

RESUMO

Sacral insufficiency fracture is a rare complication of the lumbar spinal surgery. It is normally reported as a late complication of the multi-segment spinal fixation in females with osteoporotic bone. We present the case of an elderly gentleman who suffered this complication spontaneously on the second postoperative day. To the best of our knowledge this has never been reported in Pakistan. Sacral alae are directly in line with weight bearingwhile walking and should be kept in mind when mobilizing a postoperative patient whose previous history indicates such risk factors. Once injury is suspected, CT scan is recommended as x-rays may not always reveal the injury. In literature, these fractures have almost always been treated conservatively.1 Conservative management wasnot tolerated well in our case and we proceeded with surgical management using S2 sacral alar iliac screws (S2 AI screws) to extend the previous lumbosacral fusion construct. S2 AI screws are a novel technique used for bone lumbosacral fusion and studies have shown to have lower rate of screw breakage under stress and need for revision surgery with their use.


Assuntos
Fraturas Espontâneas/diagnóstico por imagem , Fraturas de Estresse/diagnóstico por imagem , Complicações Pós-Operatórias/diagnóstico por imagem , Sacro/lesões , Fraturas da Coluna Vertebral/diagnóstico por imagem , Fusão Vertebral , Idoso , Repouso em Cama , Tratamento Conservador , Descompressão Cirúrgica , Fixação Interna de Fraturas , Fraturas Espontâneas/cirurgia , Fraturas de Estresse/cirurgia , Humanos , Vértebras Lombares/cirurgia , Masculino , Complicações Pós-Operatórias/cirurgia , Sacro/diagnóstico por imagem , Sacro/cirurgia , Fraturas da Coluna Vertebral/cirurgia , Estenose Espinal/cirurgia , Tomografia Computadorizada por Raios X
10.
Forensic Sci Int ; 303: 109955, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31541936

RESUMO

Sex estimation is an essential step in the process of the identification of the skeletal remains in forensic anthropology since it reduces the number of possible matches by half. In this study, sex estimation with 21 sacral and coccygeal metric parameters obtained from Computerized Tomography images of a Turkish population which consists of 480 patients that are equalized according to their sexes and ages, is performed. Univariate discriminant analysis, linear discriminant function analysis, stepwise discriminant function analysis, and multilayer perceptron neural networks are used in this study. A maximum of 67.1% accuracy for univariate discriminant analysis, 82.5% for linear discriminant function analysis, 78.8% for stepwise discriminant function analysis, and 86.3% for multilayer perceptron neural networks, were achieved. Although it does not reach an acceptable accuracy rate of 95% or more for sacrum and coccyx, sex estimation with neural networks is a promising field of research in corpses where identification is otherwise not possible, and further studies with other bones and with new techniques might give useful information.


Assuntos
Cóccix/diagnóstico por imagem , Análise Discriminante , Sacro/diagnóstico por imagem , Determinação do Sexo pelo Esqueleto/métodos , Tomografia Computadorizada por Raios X , Adulto , Idoso , Feminino , Antropologia Forense , Humanos , Masculino , Pessoa de Meia-Idade , Turquia , Adulto Jovem
11.
BMC Musculoskelet Disord ; 20(1): 369, 2019 Aug 09.
Artigo em Inglês | MEDLINE | ID: mdl-31399086

RESUMO

BACKGROUND: Percutaneous transforaminal endoscopic discectomy (PTED) is widely used for the treatment of lumbar disc herniation. Facetectomy in PTED is necessary for accessing the intraspinal region and for decompressing the exiting nerve roots in patients who suffer from hypertrophy of the facet joints. However, this may increase morbidity in failed back surgery syndrome (FBSS) and has not been clearly elucidated. METHODS: A three-dimensional lumbosacral model was reconstructed and validated. And corresponding models after PTED with one-quarter and one-half excisions of the superior articular process were reconstructed. The maximum shear stress on the annulus in L5, von Mises stress of the facet cartilage, maximum principle capsular strain and deformation of the lumbosacral model were calculated using finite element methods. RESULTS: Calculated results show no significant differences in the complete model and the model with one-quarter excision of the superior articular process, but all biomechanical indexes have been deteriorated under most of the loading conditions tested in the model with one-half excision of the superior articular process. CONCLUSIONS: Less facetectomy is better because it may reduce the risk of biomechanical deterioration and consequently, that of FBSS.


Assuntos
Discotomia Percutânea/métodos , Endoscopia/métodos , Síndrome Pós-Laminectomia/prevenção & controle , Degeneração do Disco Intervertebral/cirurgia , Deslocamento do Disco Intervertebral/cirurgia , Discotomia Percutânea/efeitos adversos , Endoscopia/efeitos adversos , Síndrome Pós-Laminectomia/etiologia , Humanos , Imagem Tridimensional , Vértebras Lombares/diagnóstico por imagem , Vértebras Lombares/cirurgia , Imagem por Ressonância Magnética , Masculino , Modelos Anatômicos , Sacro/diagnóstico por imagem , Sacro/cirurgia , Tomografia Computadorizada por Raios X , Adulto Jovem
12.
Med Hypotheses ; 130: 109293, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31383334

RESUMO

Tarlov cysts (TCs) consist of dilated nerve root sheaths filled with cerebrospinal fluid (CSF) and are most frequently found in the sacrum. It is estimated that 25% of detected TCs cause chronic pain and intestinal and urogenital symptoms due to compression of the sacral nerve root fibers inside the TC. Unfortunately, symptomatic TCs are frequently overlooked. It is assumed that TCs result from pathologically increased hydrostatic pressure (HP) in the dural sac that forces CSF into the nerve root sheaths. We hypothesize that in patients with TCs, increased spinal hydrostatic pressure is always associated with increased intracranial pressure. This hypothesis of increased cerebrospinal pressure might explain why patients with sacral TCs frequently report distant symptoms, such as headaches and pain in the neck and arms. In this paper, we describe a case report that provides evidence for this hypothesis. A 30-year-old man presented for the first time in our clinic complaining of lower back, leg, thoracic, neck, and arm pain; headaches; and bladder, bowel, and sphincter symptoms. He was born prematurely and suffered cerebral intraventricular bleeding followed by progressive hydrocephalus. Progression was stabilized with acetazolamide and lumbar punctures. At 19 years of age, his head circumference had further increased and he reported back pain and headaches. Fundoscopy showed no papilledema, and lumbar puncture for CSF evacuation improved the headaches and back pain. The former medical team chose not to insert a ventriculo-external shunt. Brain magnetic resonance imaging (MRI) showed significant dilation of all the ventricles. No CSF flow obstruction between the ventricles was observed. Surprisingly, MRI of the lumbar and sacral spine showed multiple large TCs. This case report indicates that hydrocephalus with a patent aqueduct may be associated with TCs because the increased intracranial pressure is transferred to the spinal canal. While increased intracranial pressure causes dilation of the ventricles, the associated increased spinal pressure may cause dilation of multiple spinal nerve root sheaths to form TCs. Furthermore, while the increased volume of the ventricles gradually compresses the neurons and axons of the brain against the bony skull, simultaneously, the increased pressure inside the nerve sheaths may also gradually compress the neurons and axons located inside the dorsal root ganglia and spinal nerves, resulting in neuropathic pain, sensory abnormalities, and neurogenic bladder and bowel symptoms. Hydrocephalus patients reporting neuropathic pain should be screened for the presence of TCs.


Assuntos
Encéfalo/diagnóstico por imagem , Hidrocefalia/complicações , Cistos de Tarlov/complicações , Adulto , Axônios/metabolismo , Dor Crônica , Progressão da Doença , Humanos , Hidrocefalia/fisiopatologia , Pressão Hidrostática , Hipertensão Intracraniana/fisiopatologia , Pressão Intracraniana , Vértebras Lombares/diagnóstico por imagem , Masculino , Neurônios/metabolismo , Sacro/diagnóstico por imagem , Cistos de Tarlov/fisiopatologia
13.
J Orthop Surg Res ; 14(1): 264, 2019 Aug 20.
Artigo em Inglês | MEDLINE | ID: mdl-31451116

RESUMO

BACKGROUND: To investigate the incidence of scoliosis and trunk shift in patients with LDH (lumbar disc herniation) and analyze the differences in spinopelvic alignment among patients with or without trunk shift and non-symptom controls. MATERIALS AND METHODS: All included subjects had standard upright antero-posterior and lateral radiographs of the whole spine taken. Evidence of disc herniation was confirmed by computed tomography or magnetic resonance imaging. The parameters measured included trunk shift and Cobb angle, TK (thoracic kyphosis), TLK (thoraco-lumbar junction kyphosis), LL (lumbar lordosis), PI (pelvic incidence), SS (sacral slope), PT (pelvic tilt) and SVA (sagittal vertical axis). RESULTS: Sixty-eight patients with LDH and 61 controls were included. There were significantly more male patients with trunk shift than the patients without trunk shift. Forty-two patients had curve magnitudes ranging from 5 to 38°. The trunk shift ranged from 0.5 to 7.3 cm. A total of 54.76% of patients had a disc herniation on the concave side of the main curve. Fifty percent of patients showed a trunk shift towards the opposite side of disc herniation. There were significant differences in spinopelvic parameters among groups. Significant correlations were also observed between several spinopelvic parameters in the three groups. However, the degrees of correlations among the spinopelvic parameters differed among the three groups. CONCLUSION: Spinal sagittal morphology in LDH patients with trunk shift exhibits a more anterior shift of the C7 plumb line, less LL, and a more horizontal sacrum. Correlation analysis indicated a disharmonious spinopelvic interaction and a change in the compensatory model in patients with LDH.


Assuntos
Deslocamento do Disco Intervertebral/diagnóstico por imagem , Vértebras Lombares/diagnóstico por imagem , Postura/fisiologia , Escoliose/diagnóstico por imagem , Adulto , Idoso , Feminino , Humanos , Deslocamento do Disco Intervertebral/fisiopatologia , Vértebras Lombares/fisiologia , Masculino , Pessoa de Meia-Idade , Sacro/diagnóstico por imagem , Sacro/fisiologia , Escoliose/fisiopatologia , Vértebras Torácicas/diagnóstico por imagem , Vértebras Torácicas/fisiologia , Adulto Jovem
14.
BMC Musculoskelet Disord ; 20(1): 386, 2019 Aug 28.
Artigo em Inglês | MEDLINE | ID: mdl-31455346

RESUMO

BACKGROUND: This study evaluated the technical adequacy of trans-articular sacroiliac joint (SIJ) fusion using three screws for non-traumatic SIJ pain, considering different grades of sacral dysplasia. METHODS: Cadaveric CT data of unilateral sacropelvic complexes for 72 individuals (53.4 ± 8.4 years) were selected. A 3D model was reformatted into the plain lateral radiograph to mark the articular surface of the SIJ. Subjects were classified into dysplastic (DYS) and non-dysplastic sacrum (NDS) groups. Proximal (PS), middle (MS), and distal screws (DS) with 10-mm diameter were virtually introduced to the iliac bone and the SIJ on the lateral image with a 5-mm safety margin. On a corresponding axial image, each screw was advanced vertically to the sagittal plane with the same safety margin. The entry points for each screw to the endplate of S1 (S2) and to the corresponding anterior sacral margin on the lateral image were measured, along with the maximal screw lengths on the axial image. Whether each screw passed through the SIJ was determined. Different types of sacral dysplasia and screws were compared statistically. RESULTS: Thirty-eight (26.4%) cases were DYS, and 106 (73.6%) were NDS. The entry points of all screws were significantly more distal in DYS than in NDS groups. The PS and MS screw lengths differed significantly between the 2 groups. Incidences of short sacral fixation (< 10 mm) were significantly higher for the DS in both NDS (38.7%) and DYS (39.5%) groups. Incidences of screw pass were lowest for the MS in both NDS (43.4%) and DYS (47.4%) groups. CONCLUSIONS: Sacral dysplasia locates the SIJ more distally and therefore affects the entry point locations and screw lengths for all screws in trans-articular SIJ fusion, compared with a non-dysplastic sacrum. Moreover, three-screw fixation risks the development of unstable DS fixation and a high extra-articular fixation rate in MS.


Assuntos
Artralgia/cirurgia , Artrodese/métodos , Doenças do Desenvolvimento Ósseo/complicações , Parafusos Ósseos , Sacro/patologia , Artralgia/etiologia , Artrodese/instrumentação , Doenças do Desenvolvimento Ósseo/diagnóstico por imagem , Doenças do Desenvolvimento Ósseo/patologia , Cadáver , Feminino , Humanos , Ílio/diagnóstico por imagem , Ílio/cirurgia , Imagem Tridimensional , Masculino , Pessoa de Meia-Idade , Radiografia , Articulação Sacroilíaca/patologia , Articulação Sacroilíaca/cirurgia , Sacro/diagnóstico por imagem , Sacro/cirurgia
15.
Clin Nucl Med ; 44(8): e484-e485, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31274629

RESUMO

Bone tracer uptake related to ureteral stones has been reported several times before. We present a right ureteral stone mimicking abnormal focal sacral uptake on planar scan in a patient with rectal cancer. This case highlights the necessity of performing SPECT/CT to ascertain the origin of abnormal focal sacral uptake on planar scan, especially in patients with a history of kidney stones.


Assuntos
Sacro/metabolismo , Tomografia Computadorizada com Tomografia Computadorizada de Emissão de Fóton Único , Medronato de Tecnécio Tc 99m , Ureter/diagnóstico por imagem , Ureter/metabolismo , Cálculos Urinários/diagnóstico por imagem , Cálculos Urinários/metabolismo , Transporte Biológico , Diagnóstico Diferencial , Humanos , Masculino , Sacro/diagnóstico por imagem
16.
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
17.
Br J Radiol ; 92(1101): 20190155, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31276426

RESUMO

OBJECTIVE: To develop and validate clinical-radiomics nomograms based on three-dimensional CT and multiparametric MRI (mpMRI) for pre-operative differentiation of sacral chordoma (SC) and sacral giant cell tumor (SGCT). METHODS: A total of 83 SC and 54 SGCT patients diagnosed through surgical pathology were retrospectively analyzed. We built six models based on CT, CT enhancement (CTE), T1 weighted, T2 weighted, diffusion-weighted imaging (DWI), and contrast-enhanced T1 weighted features, two radiomics nomograms and two clinical-radiomics nomograms combined radiomics mixed features with clinical data. The area under the receiver operating characteristic curve (AUC) and accuracy (ACC) analysis were used to assess the performance of the models. RESULTS: SC and SGCT presented significant differences in terms of age, sex, and tumor location (tage = 9.00, χ2sex = 10.86, χ2location = 26.20; p < 0.01). For individual scan, the radiomics model based on diffusion-weighted imaging features yielded the highest AUC of 0.889 and ACC of 0.885, followed by CT (AUC = 0.857; ACC = 0.846) and CT enhancement (AUC = 0.833; ACC = 0.769). For the combined features, the radiomics model based on mixed CT features exhibited a better AUC of 0.942 and ACC of 0.880, whereas mixed MRI features achieved a lower performance than the individual scan. The clinical-radiomics nomogram based on combined CT features achieved the highest AUC of 0.948 and ACC of 0.920. CONCLUSIONS: The radiomics model based on CT and multiparametricMRI present a certain predictive value in distinguishing SC and SGCT, which can be used for auxiliary diagnosis before operation. The clinical-radiomics nomograms performed better than radiomics nomograms. ADVANCES IN KNOWLEDGE: Clinical-radiomics nomograms based on CT and mpMRI features can be used for preoperative differentiation of SC and SGCT.


Assuntos
Neoplasias Ósseas/diagnóstico por imagem , Cordoma/diagnóstico por imagem , Tumor de Células Gigantes do Osso/diagnóstico por imagem , Imagem Tridimensional/métodos , Cuidados Pré-Operatórios/métodos , Tomografia Computadorizada por Raios X/métodos , Adulto , Diagnóstico Diferencial , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Nomogramas , Estudos Retrospectivos , Sacro/diagnóstico por imagem
18.
World Neurosurg ; 130: e1077-e1083, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31323412

RESUMO

BACKGROUND: Lateral interbody fusion (LIF) is an effective adjuvant for circumferential minimally invasive surgery (CMIS) treatment of adult spinal deformity (ASD). Accessing L5-S1 via an oblique LIF (OLIF) approach (OLIF 5-1) allows for anterior LIF (ALIF) at the lumbosacral junction without repositioning the patient. We review the early outcomes and complications of OLIF 5-1 at the bottom of a long construct for an MIS approach to treat ASD. METHODS: We queried a prospectively collected registry of 111 consecutive patients with ASD (Cobb angle >20°, sagittal vertical alignment [SVA] >50, or pelvic incidence [PI]-lumbar lordosis [LL] mismatch>10) patients who underwent CMIS correction between January 2015 and January 2019. Sixty patients had ≥4 levels fused and OLIF 5-1. Multilevel pre-psoas LIF + OLIF 5-1 were performed in the first stage. Three days later, stage 2 involved MIS installation of pedicle screws with aggressive rod contouring and derotation/translation. RESULTS: The mean patient age was 66.8 years (range, 48-79 years), and the mean duration of follow-up was 24 months (range, 3-60 months). A mean of 7 levels were fused (range, 4-9). Significant improvements in L5-S1 segmental lordosis (SL), LL, SVA, PI-LL mismatch, and pelvic tilt were seen following the first stage (P < 0.05). There was no intraoperative vascular, ureteral, or sympathetic chain injury, and no transient or permanent lumbar plexopathy. In 2 patients, OLIF 5-1 was abandoned due to difficult access, and transforaminal LIF was done at L5-S1 at the second stage. Five patients required intraoperative transfusion. No patient experienced postoperative ileus or L5-S1 pseudarthrosis. Significant improvements in visual analog scale pain score, Oswestry Disability Index, 36-Item Short Form Health Survey, and Scoliosis Research Society Outcomes Questionnaire were found. CONCLUSIONS: A single-position MIS OLIF 5-1 at the bottom of a long construct in conjunction with multilevel pre-psoas LIF seems to be a safe and effective technique for improving SL, global LL, and SVA with a low risk of perioperative and postoperative complications.


Assuntos
Lordose/cirurgia , Vértebras Lombares/cirurgia , Procedimentos Cirúrgicos Minimamente Invasivos/métodos , Ossos Pélvicos/cirurgia , Sacro/cirurgia , Fusão Vertebral/métodos , Idoso , Estudos de Coortes , Feminino , Humanos , Lordose/diagnóstico por imagem , Vértebras Lombares/diagnóstico por imagem , Masculino , Pessoa de Meia-Idade , Procedimentos Cirúrgicos Minimamente Invasivos/instrumentação , Ossos Pélvicos/diagnóstico por imagem , Estudos Prospectivos , Sacro/diagnóstico por imagem , Fusão Vertebral/instrumentação
19.
World Neurosurg ; 130: 285-292, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31323414

RESUMO

BACKGROUND: Flat back deformity is a disabling adverse outcome following instrumented lumbar fusion. As patients are often fused in this non-physiologic alignment, correction is complex and has conventionally required fracture of the preexisting fusion mass. Sacral osteotomy may be one effective means of correcting the positive sagittal balance in these patients. Here we report a case of flat back deformity corrected using a 3-column sacral osteotomy, and systematically review the available literature on the effectiveness of 3-column sacral osteotomy for correcting flat back deformity. METHODS: A systematic review was performed using the results of a search of the PubMed, EMBASE, Web of Science, and Cochrane databases according to PRISMA guidelines. We also include our patient as an example of the technique. RESULTS: Eight studies-all case reports or small case series-were identified describing 37 patients, including our case example. The variety of techniques was too heterogeneous for meta-analysis, but all studies reported good correction of sagittal deformity. Transient L5 palsy was the most common side effect of this technique, being reported in 21 patients (56.8%) across all studies. CONCLUSIONS: Sacral osteotomy is potentially an effective means of correcting positive sagittal balance in patients with flat back deformity secondary to high pelvic incidence.


Assuntos
Vértebras Lombares/cirurgia , Osteotomia , Sacro/cirurgia , Vértebras Torácicas/cirurgia , Feminino , Humanos , Região Lombossacral/cirurgia , Pessoa de Meia-Idade , Osteotomia/métodos , Complicações Pós-Operatórias/epidemiologia , Sacro/diagnóstico por imagem , Fusão Vertebral/métodos
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