1,720,978 research outputs found
Spinal epidural lipomatosis. weight loss cure
No full textA 47-year-old male patient presented at our neurosurgery unit with neurogenic claudication symptoms. The patient had a history of low back pain and lower extremity pain for 2 years. He had a body mass index of 38. Magnetic resonance imaging of the lumbar spine demonstrated severe stenosis due to spinal epidural lipomatosis. The patient was treated conservatively, and after weight loss in 13 months (body mass index of 29) he had full recovery of neurologic symptoms. A follow-up magnetic resonance image obtained 14 months after showed complete resolution of spinal epidural lipomatosis
Atlantoaxial anterior transarticular screw fixation. a case series and reappraisal of the technique
No full textBACKGROUND CONTEXT:
Atlantoaxial instability is commonly treated with C1-C2 fixation performed via posterior approaches. Although anterior transarticular screw (ATS) fixation, performed with a classic retropharyngeal approach, was described more than 10 years ago, the published literature still lacks a comprehensive analysis of the procedure and a real case series.
PURPOSE:
We report a series of patients treated with atlantoaxial ATS, describing the surgical procedure in detail and discussing advantages and disadvantages of the technique.
STUDY DESIGN:
The study design includes case series and technical report.
METHODS:
We prospectively enrolled 15 patients affected by atlantoaxial instability secondary to trauma, degenerative diseases, or inflammatory diseases. Anterior transarticular screw fixation was performed with anteroposterior open-mouth and lateral intraoperative radiographs. All patients were evaluated radiologically at follow-up to identify bone fusion.
RESULTS:
Anterior transarticular screw was performed successfully in 14 patients without complications. The procedure was aborted in a case of vertebral invagination, and one case required revision surgery owing to C2 articular bone fracture. Solid C1-C2 fusion was achieved in all cases (at 10- to 21-week follow-up) except in an elderly patient affected by severe osteoporosis. No complications occurred.
CONCLUSIONS:
Although the procedure is still not widely known, ATS allows the effective and safe treatment of C1-C2 instability even in patients with systemic comorbidities. It offers several advantages over posterior approaches.
Copyright © 2015 Elsevier Inc. All rights reserved
Anterior to Psoas/OLIF Approach for Adult Spondylolisthesis
No full textDegenerative spinal disease (DSD) is the main pathology among patients referred to neurosurgeons. Neurosurgical approaches to DSD draw on a vast armamentarium of anterior, lateral, or posterior spinal fusion techniques to manage and treat spinal diseases as diverse as spondylolisthesis, degenerative disc disease, recurrent disc herniation, pseudarthrosis, and spinal deformity. Choosing the optimal technique on a case-by-case basis can help minimize the risk of comorbidities associated with blood loss and length of hospitalization and to maximize postoperative fusion rate and clinical outcome for all patients, including those planning to return to their professional or sporting career. Here we briefly discuss the differences between the anterior and posterior approaches, focusing mainly on the surgical technique and main features of the oblique lateral interbody fusion (OLIF). The OLIF procedure is fast becoming an attractive choice for spine surgeons on account of the overall benefits associated with reduced damage to soft and nerve tissues and the sparing of the posterior structure. In the absence of major evidence-based indications in the literature with regard to the relative advantages and disadvantages of OLIF in cases of lumbar spondylolisthesis, this chapter aims to provide an illustrative overview of this case scenario, inclusive of a full description, surgical tips, and operative strategies
Minimally invasive surgery for treatment of patients with advanced cancer and thoraco-lumbar spine metastases
Full text linkSpinal metastases are common in patients with cancer. Spinal cord compression is the initial symptom of 5–10% of patients with diffuse cancer, and about 70% of lesions are found in the thoracic vertebrae. Patients with advanced cancer are generally excluded from major spine surgery, to reduce postoperative morbidity and mortality. Minimally invasive spine surgery (MISS) has recently been advocated as a useful approach for spinal metastases, especially in advanced cancer patients, seeking to decrease the morbidity of more traditional open spine surgery; furthermore, reducing the recovery time, MISS permits the post-operative chemotherapy and radiotherapy to begin sooner
Aggressive Vertebral Hemangioma Causing Acute Spinal Cord Compression
Full text linkA 46-year-old woman presented to our emergency department with sudden onset of lower extremity weakness after physical activity. She referred only dorsal back pain before these symptoms. Neurologic examination revealed weakness 2/5 of lower limbs, hyperreflexia of deep tendon reflex of lower limbs, hypoesthesia under D7 level, and no sphincteric dysfunction. A computed tomography scan showed an accentuation of trabecular markings within the vertebral body and areas of lysis ([Figs. 1A] [F]). Contrast-enhanced magnetic resonance images show diffuse abnormal marrow signal throughout the T6 vertebral body with epidural components with spinal cord compression ([Fig. 1B] [H]
Completely Thrombosed Distal Middle Cerebral Artery Aneurysm Mimicking a Cavernous Angioma. Case Report and Review of the Literature
No full textBackground Distal middle cerebral artery (MCA) aneurysms originate from branches of MCA distal to its main bifurcation or the peripheral branches. Distal MCA aneurysms are uncommon compared with saccular aneurysms, which develop along the proximal trunks of MCA. However, thrombotic aneurysms, characterized by organized intraluminal thrombus and solid mass, are frequently in the large and giant size range, whereas complete thrombosis of non-giant MCA aneurysms is very rare. Case Presentation We present the clinical case of a 53 years-old woman with a completely thrombosed medium distal MCA aneurysm mimicking a cavernous angioma. She came to our emergency department after the onset of tinnitus and persistent headache. Magnetic resonance imaging performed subsequently showed a nodular mass surrounded by edema located in the temporal lobe with a homogeneous peripheral contrast enhancement. Furthermore, angiography showed regular flow in the MCA and confirmed the diagnosis of cavernous angioma. The patient underwent surgery, and the lesion was found to be a thrombosed aneurysm originating from the distal temporal branch of the left MCA (M2 segment). Conclusions To our knowledge, this is the first report of a thrombosed distal medium MCA aneurysm that mimicked a cavernous angioma. The completely thrombosed aneurysm can be confused with intracranial lesions or cavernous malformations, which can have similar radiographic features without angiographic anomalies, so it is mandatory to consider the possibility of a thrombosed aneurysm for a correct differential diagnosis
Percutaneous instrumentation with cement augmentation for traumatic hyperextension thoracic and lumbar fractures in ankylosing spondylitis: a single-institution experience
No full textThe typical traumatic thoracolumbar (TL) fracture in patients with ankylosing spondylitis (AS) is a hyperextension injury involving all three spinal columns, which is associated with unfavorable outcomes. Although a consensus on the management of these highly unstable injuries is missing, minimally invasive surgery (MIS) has been progressively accepted as a treatment option, since it is related to lower morbidity and mortality rates. This study aimed to evaluate clinical and radiological outcomes after percutaneous instrumentation with cement augmentation for hyperextension TL fractures in patients with AS at a single institution
Percutaneous Carbon-PEEK instrumentation for spine tumors: a prospective observational study
No full textBackground: Minimally invasive spine surgery (MISS) has been progressively accepted as a useful approach for spine tumors. Recently released carbon-PEEK implants have been already reported as effective in open surgeries for spine tumors. This study aimed to evaluate the feasibility, surgical, clinical and radiological outcomes of a new percutaneous carbon-PEEK instrumentations for spine tumors. Methods: This is a prospective case-control observational study. Demographical, clinical, surgical, and radiological data were collected from May 2018 to August 2019. Visual analogue scale for back pain (VAS), the Oswestry Disability Index (ODI) questionnaire, EORTC QLQ-C30 questionnaire for quality of life, and ASIA impairment scale (AIS) were collected before surgery and at 6 weeks and follow-up visits. Data were compared with the control group, a retrospective series of 23 metastatic patients that underwent titanium pedicle screw fixation. Results: Twenty-one patients met inclusion criteria. Mean age was 59.2 years (range, 35-78) and mean follow-up was 14.2 months (7-22). Thoracic spine was involved in 14 (66.7%) cases, lumbar spine in 7 (33.3%). The mean length of surgery was 75 (42-185) minutes, mean blood loss was 90ml (50-215) and every patient was mobilized within 24 hours after surgery. The VAS (8.3±1.1 to 2.9±1.0, p<0.05) and ODI (54.6±11.7 to 25.1±5.4, p<0.05) scores significantly improved over follow-up. AIS improved in 7 (33.3%) patients and remained unchanged in 14 (66.7%). The EORTC QLQ-C30 global health/QoL, functional and symptomatic scales significantly improved postoperatively and at the last follow-up. Only two minor complications (9.5%) were recorded. No statistically significant difference was observed between the two groups related to clinical, radiological outcomes, complications rate and implant failure. Conclusions: Percutaneous Carbon/PEEK implants could be considered as alternative to standard titanium implants in oncological patients, according to their lower rate of MRI artifacts, facilitating radiological follow-up and adjuvant radiotherapy. Further clinical trials and biomechanical evaluations are needed to confirm our preliminary results
Pure percutaneous pedicle screw fixation without arthrodesis of 32 thoraco-lumbar fractures: clinical and radiological outcome with 36-month follow-up
No full textTo evaluate the outcome of pure percutaneous fixation of unstable single level fractures at the thoraco-lumbar junction (A1 to B2 Magerl/AO Spine). Neurological intact patients were included in a 2-year prospective study (follow-up 36 months). Two groups were considered: the group in which additional short bilateral screws in the fractured vertebra were placed was called lordorizing screw group (LSG), the other was called non lordorizing screw group (nLSG). Clinical outcome was evaluated using the SF-36, the Oswestry disability index and the recovery time needed to go back work. The following radiological parameters were also evaluated on the follow-up exams: the Mid-Sagittal Index, the Cobb's angle and the Sagittal Index. In the LSG, the correction values of MSI, Cobb's angle and SI were statistically significantly higher than in nLSG. When feasible we recommend a pure percutaneous short segment pedicle screw fixation adding a lordorizing screw.PURPOSE:
To evaluate the outcome of pure percutaneous fixation of unstable single level fractures at the thoraco-lumbar junction (A1 to B2 Magerl/AO Spine).
METHOD:
Neurological intact patients were included in a 2-year prospective study (follow-up 36 months). Two groups were considered: the group in which additional short bilateral screws in the fractured vertebra were placed was called lordorizing screw group (LSG), the other was called non lordorizing screw group (nLSG). Clinical outcome was evaluated using the SF-36, the Oswestry disability index and the recovery time needed to go back work. The following radiological parameters were also evaluated on the follow-up exams: the Mid-Sagittal Index, the Cobb's angle and the Sagittal Index.
RESULTS:
In the LSG, the correction values of MSI, Cobb's angle and SI were statistically significantly higher than in nLSG.
CONCLUSION:
When feasible we recommend a pure percutaneous short segment pedicle screw fixation adding a lordorizing sc
Percutaneous Carbon-PEEK instrumentation for spine tumors. a prospective observational study
No full textBackground: Minimally invasive spine surgery (MISS) has been progressively accepted as a useful approach for spine tumors. Recently released carbon-PEEK implants have been already reported as effective in open surgeries for spine tumors. This study aimed to evaluate the feasibility, surgical, clinical and radiological outcomes of a new percutaneous carbon-PEEK instrumentations for spine tumors. Methods: This is a prospective case-control observational study. Demographical, clinical, surgical, and radiological data were collected from May 2018 to August 2019. Visual analogue scale for back pain (VAS), the Oswestry Disability Index (ODI) questionnaire, EORTC QLQ-C30 questionnaire for quality of life, and ASIA impairment scale (AIS) were collected before surgery and at 6 weeks and follow-up visits. Data were compared with the control group, a retrospective series of 23 metastatic patients that underwent titanium pedicle screw fixation. Results: Twenty-one patients met inclusion criteria. Mean age was 59.2 years (range, 35-78) and mean follow-up was 14.2 months (7-22). Thoracic spine was involved in 14 (66.7%) cases, lumbar spine in 7 (33.3%). The mean length of surgery was 75 (42-185) minutes, mean blood loss was 90ml (50-215) and every patient was mobilized within 24 hours after surgery. The VAS (8.3±1.1 to 2.9±1.0, p<0.05) and ODI (54.6±11.7 to 25.1±5.4, p<0.05) scores significantly improved over follow-up. AIS improved in 7 (33.3%) patients and remained unchanged in 14 (66.7%). The EORTC QLQ-C30 global health/QoL, functional and symptomatic scales significantly improved postoperatively and at the last follow-up. Only two minor complications (9.5%) were recorded. No statistically significant difference was observed between the two groups related to clinical, radiological outcomes, complications rate and implant failure. Conclusions: Percutaneous Carbon/PEEK implants could be considered as alternative to standard titanium implants in oncological patients, according to their lower rate of MRI artifacts, facilitating radiological follow-up and adjuvant radiotherapy. Further clinical trials and biomechanical evaluations are needed to confirm our preliminary results
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