RESUMO
The authors describe the surgical method and results of nonexpansive one-piece multivel laminoplasty of the whole lumbar spine, for microsurgical resection of extensive spinal tumors. This technique allows a very comfortable approach to the dura and intradural content, as well as a perfect replacement of the posterior spinal arch with supporting elements and an optimal reconstruction of the spinal anatomy. A nonexpansive whole lumbar one-piece laminoplasty was performed for resection of extensive multilevel lumbar tumors. The authors report an illustrative case of a patient who initially presented with a three-year history of numbness on both legs and progressive difficulty in walking. Two months before admission, he complained of bilateral sciatica and rectourinary dysfunction. A spinal magnetic resonance imaging (MRI) documented an intradural tumor extending from L2 to S1. The patient underwent a nonexpansive whole lumbar one-piece laminoplasty and microsurgical removal of the intradural lesion. The postoperative course was uneventful, the sensory disturbances and bilateral sciatica early recovered while rectourinary disturbance gradually improved up to a complete resolution at one year follow-up. The authors believe that multilevel laminoplasty rather than laminectomy is the technique of choice as a posterior procedure for extensive lumbar spinal tumors. With this technique, it is possible to obtain a very confortable approach to the dura and intradural content, as well as a perfect replacement of the posterior spinal arch with supporting elements and an optimal reconstruction of the normal spine. Moreover, this method prevents postoperative instability and deformity and avoids the so called post-laminectomy epidural membrane.
Assuntos
Ependimoma/cirurgia , Laminectomia/métodos , Vértebras Lombares/cirurgia , Procedimentos de Cirurgia Plástica/métodos , Neoplasias da Medula Espinal/cirurgia , Dura-Máter/anatomia & histologia , Dura-Máter/cirurgia , Ependimoma/patologia , Humanos , Vértebras Lombares/anatomia & histologia , Imageamento por Ressonância Magnética , Masculino , Complicações Pós-Operatórias/prevenção & controle , Canal Medular/anatomia & histologia , Canal Medular/cirurgia , Medula Espinal/patologia , Medula Espinal/cirurgia , Neoplasias da Medula Espinal/patologia , Espaço Subaracnóideo/anatomia & histologia , Espaço Subaracnóideo/cirurgia , Resultado do Tratamento , Adulto JovemRESUMO
In brief We studied 3 years of stress fractures that occurred at a major university. We found an annual Incidence of 1.9% among athletes, but 67% of the injuries were in freshmen. In 86% of the cases, patients had abruptly changed their training-such as after summer break-and experienced symptoms an average of 4.5 weeks later. Students took, on average, another 3.5 weeks to seek medical care. These findings emphasize the need to carefully monitor freshman training regimens and to be alert for symptoms of stress fracture.
Assuntos
Febre/etiologia , Abscesso Hepático/diagnóstico , Adolescente , Adulto , Idoso , Diagnóstico Diferencial , Drenagem , Feminino , Humanos , Abscesso Hepático/cirurgia , Masculino , Pessoa de Meia-Idade , Morbidade , Mortalidade , Radiografia , CintilografiaRESUMO
This is a case of a benign leiomyoma of the cecum that perforated the bowel wall and manifested as an acute surgical abdomen. The literature was reviewed and the lesion was found to be uncommon. Clinical pictures may vary, but a colonic mass of this nature should be treated as a cancer, as it is not usually possible to distinguish benign from malignant lesions preoperatively.