Pub Date : 2021-07-01DOI: 10.21608/esj.2022.105957.1203
Ankit S Patel, D. Ranade, Bhagirath More, apurva lachke
Background Date: In all cases of spontaneous spinal hemorrhage (epidural, subdural, and intramedullary hemorrhage), spinal subdural hemorrhage is extremely rare. Bleeding diathesis is a commonly associated complication of Dengue fever along with multisystemic complications, such as renal toxicity, heart failure, shock, and electrolyte abnormalities. Dengue fever presenting as a neurological complication is extremely rare, <1% of patients. Study Design: A case report. Purpose: To report a rare case of dengue fever with spontaneous subdural hematoma (SDH) and subarachnoid hemorrhage (SAH) in the spine. Case Report: A 52-year-old female patient presented with acute onset of progressive bilateral lower limb weakness accompanied with difficulty in micturition and headache for a 5-day duration. She also had a history of fever prior to lower limb weakness and headache. Clinical examination revealed grade 2 motor power in both lower limbs, absent deep tendon reflexes, and equivocal Babinski’s reflex. There was no definite sensory deficit. Results: Patient improved postoperatively after hematoma evacuation. Conclusion: Spontaneous SDH with SAH can be a rare presentation of dengue fever. Prompt intervention is very important to prevent irreversible neurological deficits. (2021ESJ241)
{"title":"A Rare Case of Spontaneous Subdural Hemorrhage in Dengue Fever That Mimics a Tumor on MRI: A Case Report","authors":"Ankit S Patel, D. Ranade, Bhagirath More, apurva lachke","doi":"10.21608/esj.2022.105957.1203","DOIUrl":"https://doi.org/10.21608/esj.2022.105957.1203","url":null,"abstract":"Background Date: In all cases of spontaneous spinal hemorrhage (epidural, subdural, and intramedullary hemorrhage), spinal subdural hemorrhage is extremely rare. Bleeding diathesis is a commonly associated complication of Dengue fever along with multisystemic complications, such as renal toxicity, heart failure, shock, and electrolyte abnormalities. Dengue fever presenting as a neurological complication is extremely rare, <1% of patients. Study Design: A case report. Purpose: To report a rare case of dengue fever with spontaneous subdural hematoma (SDH) and subarachnoid hemorrhage (SAH) in the spine. Case Report: A 52-year-old female patient presented with acute onset of progressive bilateral lower limb weakness accompanied with difficulty in micturition and headache for a 5-day duration. She also had a history of fever prior to lower limb weakness and headache. Clinical examination revealed grade 2 motor power in both lower limbs, absent deep tendon reflexes, and equivocal Babinski’s reflex. There was no definite sensory deficit. Results: Patient improved postoperatively after hematoma evacuation. Conclusion: Spontaneous SDH with SAH can be a rare presentation of dengue fever. Prompt intervention is very important to prevent irreversible neurological deficits. (2021ESJ241)","PeriodicalId":11610,"journal":{"name":"Egyptian Spine Journal","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43677526","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2021-07-01DOI: 10.21608/esj.2021.97745.1191
Mohamed Mahmoud, Mohamed Shamia, Mostafa Kofi, A. Abou-Madawi
Background Data: Degenerative lumbar spine, including spondylolisthesis, is a common clinical condition that affects humans in the most productive period of their life. There are many surgical options for the management of such conditions after the failure of conservative therapy. Recently, there has been a great debate regarding the use of minimally invasive (MI) versus open transforaminal lumbar interbody fusion (O-TLIF) in the treatment of single-level low-grade lumbar spondylolisthesis, so there was a need to reach a consensus over this issue. Purpose: To compare the clinical efficacy and safety of MI-TLIF versus O-TLIF in the treatment of single-level low-grade degenerative lumbar spondylolisthesis. Study Design: A systematic review for recent studies in the context and meta-analysis. Patients and Methods: We searched online databases of PubMed, Google Scholar, Cochrane Library, and DOAJ (2016–2020), and the search yielded 1352 articles. Based on our inclusion and exclusion criteria, we included retrospective, prospective, and randomized control trials, which came down to 11 research articles. Operative time, blood loss, hospital stay, back pain scores (Visual Analogue Scale), functional score (Oswestry Disability Index), complication rate, and reoperation rate for both techniques were recorded and presented as means. We then performed a meta-analysis. Results: There is an overall advantage for the MI-TLIF over the O-TLIF in different parameters. There was a statistically significant difference in blood loss of −0.954 ml (p = 0.000) and hospital stay of −1.19 days (P = 0.000), favoring M-TLIF. There was a statistically insignificant difference in the total operative time (P = 0.071), the postoperative VAS of −0.22 (P = 0.384), and the postoperative ODI of −2 (P = 0.331). Moreover, there was a reduced combined odds ratio for complications and a reduced odds ratio for re-operation. SYSTEMATIC REVIEW EgySpineJ 39:2-17, 2021
{"title":"Minimally Invasive versus Conventional Transforaminal Lumbar Interbody Fusion in Treatment of Single-Level Low-Grade Lumbar Spondylolisthesis: A Systematic Review and Meta-Analysis","authors":"Mohamed Mahmoud, Mohamed Shamia, Mostafa Kofi, A. Abou-Madawi","doi":"10.21608/esj.2021.97745.1191","DOIUrl":"https://doi.org/10.21608/esj.2021.97745.1191","url":null,"abstract":"Background Data: Degenerative lumbar spine, including spondylolisthesis, is a common clinical condition that affects humans in the most productive period of their life. There are many surgical options for the management of such conditions after the failure of conservative therapy. Recently, there has been a great debate regarding the use of minimally invasive (MI) versus open transforaminal lumbar interbody fusion (O-TLIF) in the treatment of single-level low-grade lumbar spondylolisthesis, so there was a need to reach a consensus over this issue. Purpose: To compare the clinical efficacy and safety of MI-TLIF versus O-TLIF in the treatment of single-level low-grade degenerative lumbar spondylolisthesis. Study Design: A systematic review for recent studies in the context and meta-analysis. Patients and Methods: We searched online databases of PubMed, Google Scholar, Cochrane Library, and DOAJ (2016–2020), and the search yielded 1352 articles. Based on our inclusion and exclusion criteria, we included retrospective, prospective, and randomized control trials, which came down to 11 research articles. Operative time, blood loss, hospital stay, back pain scores (Visual Analogue Scale), functional score (Oswestry Disability Index), complication rate, and reoperation rate for both techniques were recorded and presented as means. We then performed a meta-analysis. Results: There is an overall advantage for the MI-TLIF over the O-TLIF in different parameters. There was a statistically significant difference in blood loss of −0.954 ml (p = 0.000) and hospital stay of −1.19 days (P = 0.000), favoring M-TLIF. There was a statistically insignificant difference in the total operative time (P = 0.071), the postoperative VAS of −0.22 (P = 0.384), and the postoperative ODI of −2 (P = 0.331). Moreover, there was a reduced combined odds ratio for complications and a reduced odds ratio for re-operation. SYSTEMATIC REVIEW EgySpineJ 39:2-17, 2021","PeriodicalId":11610,"journal":{"name":"Egyptian Spine Journal","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42011256","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2021-04-01DOI: 10.21608/ESJ.2021.62071.1170
Wassim Abouzeid Fooz, M. Khattab, M. Maziad
Background Data: Surgical fixation of the cervicothoracic junction (CTJ) is difficult due to the complex anatomy and biomechanical properties of this area. Several important vascular, visceral, and soft tissue structures make access to this region challenging; therefore, knowledge of these structures is essential for decompression and fixation. The posterior approach is commonly used in many diseases of the spine but is inadequate when targeting the anterior spinal elements; thus, it can result in a higher complication rate and can disturb spinal stability. For these reasons, different posterolateral and anterior approaches have been developed. Study Design: Systematic review of the literature Purpose: To compare these different anterior and posterior surgical approaches to the CTJ, indicating pathologies, outcomes, and complications. Patients and Methods: This review was done using the standard methodology outlined in the Cochrane Handbook and reported the findings in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement guidelines. An initial search has been carried out using PubMed, Embase, Cochrane Library, Ovid, Scopus, and Google Scholar databases using the following keywords; cervicothoracic junction, C7/T4, surgical fixation; posterior approach; anterior approach. Results: Our systematic review yielded 12 studies with 419 patients that met our inclusion criteria, including seven studies using the anterior and five posterior approaches for treating different spinal pathologies. In this review, most patients with traumatic and neoplastic injuries were treated through the anterior approach, and those with degenerative and infectious diseases were treated through the posterior one. Assessment of the reported neurological status change pre- and postoperatively showed a significant difference between the anterior and posterior groups favoring the anterior one, and the rate of complications of the posterior approach was higher than that in the anterior approach. Conclusion: The data in this review may demonstrate both the effectiveness and safety of the anterior approach compared to the posterior one. These data indicate that patients who underwent the anterior approach have a higher incidence of improvement in their neurological functions and that complications in the anterior group are relatively less than those in the posterior one.(2021ESJ231)
{"title":"Outcome of Surgical Fixation to Cervicothoracic Junction: A Systematic Review of Literature","authors":"Wassim Abouzeid Fooz, M. Khattab, M. Maziad","doi":"10.21608/ESJ.2021.62071.1170","DOIUrl":"https://doi.org/10.21608/ESJ.2021.62071.1170","url":null,"abstract":"Background Data: Surgical fixation of the cervicothoracic junction (CTJ) is difficult due to the complex anatomy and biomechanical properties of this area. Several important vascular, visceral, and soft tissue structures make access to this region challenging; therefore, knowledge of these structures is essential for decompression and fixation. The posterior approach is commonly used in many diseases of the spine but is inadequate when targeting the anterior spinal elements; thus, it can result in a higher complication rate and can disturb spinal stability. For these reasons, different posterolateral and anterior approaches have been developed. \u0000Study Design: Systematic review of the literature \u0000Purpose: To compare these different anterior and posterior surgical approaches to the CTJ, indicating pathologies, outcomes, and complications. \u0000Patients and Methods: This review was done using the standard methodology outlined in the Cochrane Handbook and reported the findings in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement guidelines. An initial search has been carried out using PubMed, Embase, Cochrane Library, Ovid, Scopus, and Google Scholar databases using the following keywords; cervicothoracic junction, C7/T4, surgical fixation; posterior approach; anterior approach. \u0000Results: Our systematic review yielded 12 studies with 419 patients that met our inclusion criteria, including seven studies using the anterior and five posterior approaches for treating different spinal pathologies. In this review, most patients with traumatic and neoplastic injuries were treated through the anterior approach, and those with degenerative and infectious diseases were treated through the posterior one. Assessment of the reported neurological status change pre- and postoperatively showed a significant difference between the anterior and posterior groups favoring the anterior one, and the rate of complications of the posterior approach was higher than that in the anterior approach. \u0000Conclusion: The data in this review may demonstrate both the effectiveness and safety of the anterior approach compared to the posterior one. These data indicate that patients who underwent the anterior approach have a higher incidence of improvement in their neurological functions and that complications in the anterior group are relatively less than those in the posterior one.(2021ESJ231)","PeriodicalId":11610,"journal":{"name":"Egyptian Spine Journal","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48521351","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2021-04-01DOI: 10.21608/esj.2022.97159.1190
Walid Abouzeid, M. Almamoun, Tamer Niazy, Mohamed Abdel Tawab
Background Data: Anterior cervical discectomy and fusion (ACDF) is a gold-standard option for treating cervical degenerative disc diseases (DDD). Anterior plating enhances stabilization with improved outcomes and reduced risk of pseudarthrosis yet with annoying morbidities. Fusion with stand-alone cages avoids such complications, although its use in multilevel disc arthrodesis is still controversial. Study Design: Retrospective multicenter comparative cohort study. Purpose: To evaluate clinical and radiological long-term outcomes after ACDF with stand-alone polyetheretherketone (PEEK) cages versus ACDF with cages and plating. Patients and Methods: Patients who underwent four-level stand-alone ACDF (Group 1) or ACDF with plating (Group 2) between July 2012 and May 2016 and followed up for at least two years were recruited for this study. In this study, the reported outcome parameters included operative time, operative blood loss, fusion rate, cervical curve, neck disability index (NDI), Visual Analogue Score (VAS) of neck pain, patient satisfaction, and perioperative morbidity. Results: Forty-seven patients, including 25 males and 22 females, were reported. The mean age was 50.8 and 50.1 years in Groups 1 and 2, respectively. Twenty-four patients underwent stand-alone ACDF and 23 underwent ACDF with plating. The baseline characteristics data of both groups were homogeneous between groups. The outcome parameters (NDI, cervical curve VAS scores, fusion rate, complications, reoperation rate, and patient satisfaction) showed no significant difference between the two groups at different time points of follow up. Preand postoperative NDI and VAS showed significant improvement in both groups. Dysphagia was reported more frequently in Group 2. Conclusion: Four-level ACDF with stand-alone PEEK cage is equally effective as ACDF with anterior plating in patients treated for four-level cervical DDD with less incidence of dysphagia. (2021ESJ233)
{"title":"Long-Term Outcomes After Four-Level Cervical Arthrodesis with Stand-Alone PEEK Cage versus PEEK Cage with Anterior Plating: A Retrospective Multicenter Comparative Study","authors":"Walid Abouzeid, M. Almamoun, Tamer Niazy, Mohamed Abdel Tawab","doi":"10.21608/esj.2022.97159.1190","DOIUrl":"https://doi.org/10.21608/esj.2022.97159.1190","url":null,"abstract":"Background Data: Anterior cervical discectomy and fusion (ACDF) is a gold-standard option for treating cervical degenerative disc diseases (DDD). Anterior plating enhances stabilization with improved outcomes and reduced risk of pseudarthrosis yet with annoying morbidities. Fusion with stand-alone cages avoids such complications, although its use in multilevel disc arthrodesis is still controversial. Study Design: Retrospective multicenter comparative cohort study. Purpose: To evaluate clinical and radiological long-term outcomes after ACDF with stand-alone polyetheretherketone (PEEK) cages versus ACDF with cages and plating. Patients and Methods: Patients who underwent four-level stand-alone ACDF (Group 1) or ACDF with plating (Group 2) between July 2012 and May 2016 and followed up for at least two years were recruited for this study. In this study, the reported outcome parameters included operative time, operative blood loss, fusion rate, cervical curve, neck disability index (NDI), Visual Analogue Score (VAS) of neck pain, patient satisfaction, and perioperative morbidity. Results: Forty-seven patients, including 25 males and 22 females, were reported. The mean age was 50.8 and 50.1 years in Groups 1 and 2, respectively. Twenty-four patients underwent stand-alone ACDF and 23 underwent ACDF with plating. The baseline characteristics data of both groups were homogeneous between groups. The outcome parameters (NDI, cervical curve VAS scores, fusion rate, complications, reoperation rate, and patient satisfaction) showed no significant difference between the two groups at different time points of follow up. Preand postoperative NDI and VAS showed significant improvement in both groups. Dysphagia was reported more frequently in Group 2. Conclusion: Four-level ACDF with stand-alone PEEK cage is equally effective as ACDF with anterior plating in patients treated for four-level cervical DDD with less incidence of dysphagia. (2021ESJ233)","PeriodicalId":11610,"journal":{"name":"Egyptian Spine Journal","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47611763","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2021-04-01DOI: 10.21608/ESJ.2021.65846.1174
Wael Gad, Essam Elmorshidy, Mohammad Gamal Hassan, Moataz El-Sabrout, M. El-Sharkawi
Background Data: Although long-segment spinal fusion is well-established in achieving coronal balance in scoliotic deformities, its ability to achieve sagittal balance is variable. In some patients, the fusion needs to be extended to the sacrum/pelvis, which could be challenging. Purpose: This study aimed to compare the sagittal balance of adolescent idiopathic scoliosis (AIS) and congenital scoliosis (CS) patients after posterior spinal fusion and to assess the effect of extending the fusion to the sacrum/pelvis on sagittal balance. Study Design: Retrospective cohort study. Patients and Methods: The study protocol was approved by our institution review board. All available AIS and CS patients who underwent long-segment posterior spinal fusion were included in this study. Whole spine radiographs were taken at three time points: preoperative, 2-months postoperative, and at 2-year follow-up. The spinopelvic parameters were measured in lateral views. The fusion to the sacrum/pelvis was also recorded. Comparison of the radiological parameters at the three time points between the AIS and CS patients and those with and without fusion to the sacrum/pelvis was performed. Results: The sagittal vertical axis was significantly higher in CS patients with fusion to the sacrum/pelvis (53.4 mm postoperatively and 54.4 mm at follow-up) than in those without fusion (14.8 mm postoperatively and 11.9 mm at follow-up) and AIS patients with or without fusion to the sacrum/pelvis. In CS patients who needed fusion to the sacrum/pelvis, lumbar lordosis (LL) decreased significantly to 31° postoperatively and 34.1° at follow-up. Conclusion: AIS patients have a better chance to achieve a normal sagittal alignment than CS patients, especially if the fusion was extended to the sacrum. Patients with CS at the lumbar region have a retroverted pelvis, which is difficult to correct by posterior spinal fusion alone, and an additional posterior osteotomy may be needed to create an adequate LL matching their pelvic incidence. Saving a distal mobile segment preserves a compensatory mechanism and decreases the incidence of postoperative sagittal malalignment. (2020ESJ219)
{"title":"Sagittal Balance After Posterior Fusion in Adolescent Idiopathic Scoliosis Versus Congenital Scoliosis","authors":"Wael Gad, Essam Elmorshidy, Mohammad Gamal Hassan, Moataz El-Sabrout, M. El-Sharkawi","doi":"10.21608/ESJ.2021.65846.1174","DOIUrl":"https://doi.org/10.21608/ESJ.2021.65846.1174","url":null,"abstract":"Background Data: Although long-segment spinal fusion is well-established in achieving coronal balance in scoliotic deformities, its ability to achieve sagittal balance is variable. In some patients, the fusion needs to be extended to the sacrum/pelvis, which could be challenging. \u0000Purpose: This study aimed to compare the sagittal balance of adolescent idiopathic scoliosis (AIS) and congenital scoliosis (CS) patients after posterior spinal fusion and to assess the effect of extending the fusion to the sacrum/pelvis on sagittal balance. \u0000Study Design: Retrospective cohort study. \u0000Patients and Methods: The study protocol was approved by our institution review board. All available AIS and CS patients who underwent long-segment posterior spinal fusion were included in this study. Whole spine radiographs were taken at three time points: preoperative, 2-months postoperative, and at 2-year follow-up. The spinopelvic parameters were measured in lateral views. The fusion to the sacrum/pelvis was also recorded. Comparison of the radiological parameters at the three time points between the AIS and CS patients and those with and without fusion to the sacrum/pelvis was performed. \u0000Results: The sagittal vertical axis was significantly higher in CS patients with fusion to the sacrum/pelvis (53.4 mm postoperatively and 54.4 mm at follow-up) than in those without fusion (14.8 mm postoperatively and 11.9 mm at follow-up) and AIS patients with or without fusion to the sacrum/pelvis. In CS patients who needed fusion to the sacrum/pelvis, lumbar lordosis (LL) decreased significantly to 31° postoperatively and 34.1° at follow-up. \u0000Conclusion: AIS patients have a better chance to achieve a normal sagittal alignment than CS patients, especially if the fusion was extended to the sacrum. Patients with CS at the lumbar region have a retroverted pelvis, which is difficult to correct by posterior spinal fusion alone, and an additional posterior osteotomy may be needed to create an adequate LL matching their pelvic incidence. Saving a distal mobile segment preserves a compensatory mechanism and decreases the incidence of postoperative sagittal malalignment. (2020ESJ219)","PeriodicalId":11610,"journal":{"name":"Egyptian Spine Journal","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"68511462","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2021-04-01DOI: 10.21608/ESJ.2021.57290.1164
M. Nagy, M. Wahdan, A. Saleh
Background Data: Spondylodiscitis is a major clinical condition with significant health and economic burden. There is a controversy regarding the use of conservative therapy with systemic antibiotics alone versus combined with surgery to manage primary spondylodiscitis. Study Design: Retrospective clinical case study. Purpose: To assess the clinical outcome of treatment of the patients with primary spondylodiscitis. Patients and Methods: This study was conducted on 27 patients with primary spondylodiscitis. There were 17 males and 10 females. The mean age was 49.96 ± 9.83 years. All the patients presented with local pain over the involved vertebral level. The clinical outcomes were assessed using the Visual Analogue Scale (VAS), ASIA score, and Kirkaldy-Willis functional outcome criteria. Results: Eight patients (29.6%) were managed by medical treatment alone. Nineteen patients (70.4%) were managed surgically, including seven patients who were operated on by laminectomy and 12 patients by posterior decompression and fusion, followed by subsequent treatment with antibiotics. VAS score was reduced significantly in the patients treated surgically compared with the patients treated medically at 1 and 3 months (P value < 0.001 and = 0.010, respectively) but not at 6 and 12 months of the follow-up period (P value = 0.235 and 0.886, respectively). There was no significant difference between the two groups regarding CRP and ESR reduction levels, the functional outcome, and the complications at different time intervals. Conclusion: Posterior decompression with or without fusion was more effective than medical treatment in reducing the pain in patients with primary spondylodiscitis at 1 and 3 months of the follow-up period without influencing the final clinical outcome. (2021ESJ230)
{"title":"Management of Primary Spondylodiscitis: Clinical Outcome of a Series of Twenty-Seven Patients","authors":"M. Nagy, M. Wahdan, A. Saleh","doi":"10.21608/ESJ.2021.57290.1164","DOIUrl":"https://doi.org/10.21608/ESJ.2021.57290.1164","url":null,"abstract":"Background Data: Spondylodiscitis is a major clinical condition with significant health and economic burden. There is a controversy regarding the use of conservative therapy with systemic antibiotics alone versus combined with surgery to manage primary spondylodiscitis. \u0000Study Design: Retrospective clinical case study. \u0000Purpose: To assess the clinical outcome of treatment of the patients with primary spondylodiscitis. \u0000Patients and Methods: This study was conducted on 27 patients with primary spondylodiscitis. There were 17 males and 10 females. The mean age was 49.96 ± 9.83 years. All the patients presented with local pain over the involved vertebral level. The clinical outcomes were assessed using the Visual Analogue Scale (VAS), ASIA score, and Kirkaldy-Willis functional outcome criteria. \u0000Results: Eight patients (29.6%) were managed by medical treatment alone. Nineteen patients (70.4%) were managed surgically, including seven patients who were operated on by laminectomy and 12 patients by posterior decompression and fusion, followed by subsequent treatment with antibiotics. VAS score was reduced significantly in the patients treated surgically compared with the patients treated medically at 1 and 3 months (P value < 0.001 and = 0.010, respectively) but not at 6 and 12 months of the follow-up period (P value = 0.235 and 0.886, respectively). There was no significant difference between the two groups regarding CRP and ESR reduction levels, the functional outcome, and the complications at different time intervals. \u0000Conclusion: Posterior decompression with or without fusion was more effective than medical treatment in reducing the pain in patients with primary spondylodiscitis at 1 and 3 months of the follow-up period without influencing the final clinical outcome. (2021ESJ230)","PeriodicalId":11610,"journal":{"name":"Egyptian Spine Journal","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47639015","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2021-04-01DOI: 10.21608/ESJ.2021.72224.1178
A. Younes, M. Khattab, N. Ghaly
Background Data: In adolescent idiopathic scoliosis (AIS), the upper thoracic spine (T1–T5) may represent an additional curve called the proximal thoracic curve (PTC), which is nearly equal and opposite to the main thoracic curve (MTC); this is a classic example of a ‘‘double thoracic curve pattern.” So, after selective thoracic fusion (STF) for MTC by either anterior or posterior instrumentation and fusion, what happens to the noninstrumented PTC and instrumented MTC? Study Design: Systematic review of literature and meta-analysis. Purpose: To evaluate the fate of the noninstrumented PTC and instrumented MTC after STF for the MTC by either anterior or posterior instrumentation and fusion. Methods: This study was conducted by searching the PubMed and Cochrane databases and included patients with AIS treated by STF between 1999 and 2020. The type of approach, degree of correction achieved in MTC, PTC, and apical vertebral rotation (AVR), and complications rate were reported independently by two authors. Results: Our systematic review yielded 1686 patients, with 18 studies meeting the required criteria. MTC has been corrected by 24.89 ± 8.45 degrees, while PTC has been corrected by 14.94 ± 7.18 degrees. Cobb’s angle was reported in seven studies for MTC angle and four studies for lumbar and thoracolumbar curves angle and has been corrected by 19.68 ± 6.55 degrees. Moreover, shoulder tilt has been corrected by 0.83 ± 0.83. Data for correction of AVR was reported in two studies and has been corrected by 15.95 ± 4.65 degrees. Conclusion: Anterior and posterior spinal fusion had no statistical significance difference regarding MTC, shoulder tilt, and AVRcorrection. However, PTC corrections was more significant after anterior spinal fusion (ASF) than posterior spinal fusion (PSF). (2021ESJ228)
{"title":"Fate of Thoracic Curves in Adolescent Idiopathic Scoliosis after Selective Thoracic Fusion: Systematic Review of Literature and Meta-Analysis","authors":"A. Younes, M. Khattab, N. Ghaly","doi":"10.21608/ESJ.2021.72224.1178","DOIUrl":"https://doi.org/10.21608/ESJ.2021.72224.1178","url":null,"abstract":"Background Data: In adolescent idiopathic scoliosis (AIS), the upper thoracic spine (T1–T5) may represent an additional curve called the proximal thoracic curve (PTC), which is nearly equal and opposite to the main thoracic curve (MTC); this is a classic example of a ‘‘double thoracic curve pattern.” So, after selective thoracic fusion (STF) for MTC by either anterior or posterior instrumentation and fusion, what happens to the noninstrumented PTC and instrumented MTC? \u0000Study Design: Systematic review of literature and meta-analysis. \u0000Purpose: To evaluate the fate of the noninstrumented PTC and instrumented MTC after STF for the MTC by either anterior or posterior instrumentation and fusion. \u0000Methods: This study was conducted by searching the PubMed and Cochrane databases and included patients with AIS treated by STF between 1999 and 2020. The type of approach, degree of correction achieved in MTC, PTC, and apical vertebral rotation (AVR), and complications rate were reported independently by two authors. \u0000Results: Our systematic review yielded 1686 patients, with 18 studies meeting the required criteria. MTC has been corrected by 24.89 ± 8.45 degrees, while PTC has been corrected by 14.94 ± 7.18 degrees. Cobb’s angle was reported in seven studies for MTC angle and four studies for lumbar and thoracolumbar curves angle and has been corrected by 19.68 ± 6.55 degrees. Moreover, shoulder tilt has been corrected by 0.83 ± 0.83. Data for correction of AVR was reported in two studies and has been corrected by 15.95 ± 4.65 degrees. \u0000Conclusion: Anterior and posterior spinal fusion had no statistical significance difference regarding MTC, shoulder tilt, and AVRcorrection. However, PTC corrections was more significant after anterior spinal fusion (ASF) than posterior spinal fusion (PSF). (2021ESJ228)","PeriodicalId":11610,"journal":{"name":"Egyptian Spine Journal","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47232812","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2021-04-01DOI: 10.21608/esj.2022.105366.1202
D. Ranade, I. Rege, Bhagirath More, Ankit S Patel
Background Data: Kyphoscoliosis in conjunction with tethered cord is a rare and challenging spinal deformity to treat. The availability of intraoperative monitoring in recent times has helped reduce the incidence of operative neurological complications in spine deformity corrective surgery. The present case report underlines the value and utility of intraoperative neuromonitoring in corrective surgery for kyphoscoliosis. Study Design: Case report. Purpose: To report the importance of intraoperative neuromonitoring in the release of tethered cord along with deformity correction. Case Report: A 14-year-old male patient presented with a one-month history of progressive weakness in both lower extremities. Radiographs showed that he had thoracic kyphoscoliosis with a 30-degree scoliotic curve together with a 70-degree kyphotic curve with an apical vertebra of T12. The preoperative MRI and CT showed that the spinal cord was entrapped by the apical vertebra and a butterfly vertebra was noted at T12. This resulted in the right half being smaller in size, with the resultant convexity to the left side. The conus was low-lying and tethered at the L3 level. The patient underwent detethering of the cord with corrective surgery for kyphoscoliosis in the same setting under intraoperative neuromonitoring. Results: Scoliosis was corrected to 20 degrees and kyphosis was corrected to 40 degrees. The motor evoked potentials (MEPs) that previously showed very feeble tracings now showed persistent positive potentials. The SSEPs remained constant and the same as baseline throughout. The patient’s spinal cord function improved from Frankel C to Frankel D. A good trunk balance was evident at the two-month follow-up. Conclusion: Intraoperative neuromonitoring allowed safe and effective detethering and maintained correction of the kyphoscoliosis. (2021ESJ234)
{"title":"Importance of Intraoperative Neuromonitoring in Simultaneous Release of Tethered Cord and Corrective Surgery for Severe Kyphoscoliosis Deformity: A Case Report","authors":"D. Ranade, I. Rege, Bhagirath More, Ankit S Patel","doi":"10.21608/esj.2022.105366.1202","DOIUrl":"https://doi.org/10.21608/esj.2022.105366.1202","url":null,"abstract":"Background Data: Kyphoscoliosis in conjunction with tethered cord is a rare and challenging spinal deformity to treat. The availability of intraoperative monitoring in recent times has helped reduce the incidence of operative neurological complications in spine deformity corrective surgery. The present case report underlines the value and utility of intraoperative neuromonitoring in corrective surgery for kyphoscoliosis. Study Design: Case report. Purpose: To report the importance of intraoperative neuromonitoring in the release of tethered cord along with deformity correction. Case Report: A 14-year-old male patient presented with a one-month history of progressive weakness in both lower extremities. Radiographs showed that he had thoracic kyphoscoliosis with a 30-degree scoliotic curve together with a 70-degree kyphotic curve with an apical vertebra of T12. The preoperative MRI and CT showed that the spinal cord was entrapped by the apical vertebra and a butterfly vertebra was noted at T12. This resulted in the right half being smaller in size, with the resultant convexity to the left side. The conus was low-lying and tethered at the L3 level. The patient underwent detethering of the cord with corrective surgery for kyphoscoliosis in the same setting under intraoperative neuromonitoring. Results: Scoliosis was corrected to 20 degrees and kyphosis was corrected to 40 degrees. The motor evoked potentials (MEPs) that previously showed very feeble tracings now showed persistent positive potentials. The SSEPs remained constant and the same as baseline throughout. The patient’s spinal cord function improved from Frankel C to Frankel D. A good trunk balance was evident at the two-month follow-up. Conclusion: Intraoperative neuromonitoring allowed safe and effective detethering and maintained correction of the kyphoscoliosis. (2021ESJ234)","PeriodicalId":11610,"journal":{"name":"Egyptian Spine Journal","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47351747","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2021-04-01DOI: 10.21608/esj.2021.80068.1180
A. Balaha, Ebraheem Shamhoot, Esam A. Mokbel
Background Data: Safe surgical resection of intradural schwannomas in the lumbar region is considered challenging. This is due to the proximity and sometimes the adhesiveness of these lesions to the cauda
{"title":"Outcomes of Surgical Treatment of Intraspinal Intradural Lumbar Schwannomas","authors":"A. Balaha, Ebraheem Shamhoot, Esam A. Mokbel","doi":"10.21608/esj.2021.80068.1180","DOIUrl":"https://doi.org/10.21608/esj.2021.80068.1180","url":null,"abstract":"Background Data: Safe surgical resection of intradural schwannomas in the lumbar region is considered challenging. This is due to the proximity and sometimes the adhesiveness of these lesions to the cauda","PeriodicalId":11610,"journal":{"name":"Egyptian Spine Journal","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47517933","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2021-01-01DOI: 10.21608/ESJ.2021.60404.1167
A. Khalil, Hisham Aboul-Enein, Wael Foad, Ahmed Fayed
Background Data: Identification of the prognostic factors of the surgical outcomes of intramedullary spinal cord tumors (IMSCTs) is essential. Many studies have established that early surgical intervention was associated with better outcomes and enhanced survival rates. Purpose: This study investigated the prognostic factors of the one-year surgical outcomes of patients with IMSCTs. Study Design: A prospective clinical case study. Patients and Methods: Twenty patients with IMSCTs, who underwent surgery in our institution and were followed up at our clinic were recruited for this study. Patients were followed up for one year to assess postoperative functional outcomes using the modified McCormick Scale (MMS). The reported parameters included preoperative MMS, use of operative monitoring, use of ultrasonic aspirator, the extent of tumor resection, and postoperative adjuvant therapy. Results: Operatively, 85% of patients underwent laminectomy, 55% reported growth total resection (GTR), 55% intraoperative monitoring, 75% underwent ultrasonic aspiration, 55% had syrinx, and 20% had duraplasty. The preoperative MMS improved from 3.0 to 2.32 and 2.42 postoperatively at six months and one year of follow-up, respectively. Patients with postoperative MMS ≤3 were more likely to undergo GTR with better postoperative MMS than those with preoperative MMS >3 at six-month follow-up (81.8% vs. 25%, respectively; p = 0.013) and at one-year follow-up (84.4 vs. 0%, respectively; p = 0.001). Good preoperative MMS, use of ultrasonic aspirator, and operative monitoring were associated with better MMS. There were no significant associations between MMS at the sixth month and reported parameters including gender, symptoms duration, tumor location, bony work whether laminectomy or laminoplasty, number of segments involved, tumor histopathology, duraplasty, and postoperative adjuvant therapy. Conclusion: The findings of the current study showed that patients with GTR, good preoperative MMS, intraoperative monitoring, and ultrasonic aspirator usage might be associated with better functional outcomes. (2021ESJ229)
背景资料:确定髓内脊髓肿瘤(IMSCTs)手术结果的预后因素至关重要。许多研究已经确定，早期手术干预与更好的结果和提高生存率有关。目的:本研究探讨影响imsct患者一年手术预后的因素。研究设计:前瞻性临床病例研究。患者和方法:本研究招募了20例在我院接受手术并在我院随访的imsct患者。患者随访一年，使用改良的McCormick量表(MMS)评估术后功能预后。报告的参数包括术前MMS、手术监测、超声吸引器的使用、肿瘤切除程度和术后辅助治疗。结果:手术中，85%的患者行椎板切除术，55%的患者行生长全切除术(GTR)， 55%的患者术中监测，75%的患者行超声抽吸，55%的患者行鼻灌管，20%的患者行硬膜成形术。术前MMS从3.0提高到2.32，术后随访6个月和1年MMS分别为2.42。6个月随访时，术后MMS≤3的患者比术前MMS≤3的患者更有可能接受术后MMS较好的GTR(分别为81.8% vs. 25%;P = 0.013)和1年随访时(分别为84.4 vs 0%;p = 0.001)。术前良好的MMS、超声吸引器的使用和手术监测与较好的MMS相关。6个月时的MMS与报告的参数(包括性别、症状持续时间、肿瘤位置、椎板切除术或椎板成形术的骨工作、累及的节段数量、肿瘤组织病理学、硬膜成形术和术后辅助治疗)之间没有显著关联。结论:本研究结果表明，GTR患者术前MMS良好，术中监测良好，超声吸引器使用可能与较好的功能预后相关。(2021 esj229)
{"title":"Factors Affecting Surgical Outcome of Intramedullary Spinal Cord Tumors: A Prospective One-year Follow-Up Study","authors":"A. Khalil, Hisham Aboul-Enein, Wael Foad, Ahmed Fayed","doi":"10.21608/ESJ.2021.60404.1167","DOIUrl":"https://doi.org/10.21608/ESJ.2021.60404.1167","url":null,"abstract":"Background Data: Identification of the prognostic factors of the surgical outcomes of intramedullary spinal cord tumors (IMSCTs) is essential. Many studies have established that early surgical intervention was associated with better outcomes and enhanced survival rates. \u0000Purpose: This study investigated the prognostic factors of the one-year surgical outcomes of patients with IMSCTs. \u0000Study Design: A prospective clinical case study. \u0000Patients and Methods: Twenty patients with IMSCTs, who underwent surgery in our institution and were followed up at our clinic were recruited for this study. Patients were followed up for one year to assess postoperative functional outcomes using the modified McCormick Scale (MMS). The reported parameters included preoperative MMS, use of operative monitoring, use of ultrasonic aspirator, the extent of tumor resection, and postoperative adjuvant therapy. \u0000Results: Operatively, 85% of patients underwent laminectomy, 55% reported growth total resection (GTR), 55% intraoperative monitoring, 75% underwent ultrasonic aspiration, 55% had syrinx, and 20% had duraplasty. The preoperative MMS improved from 3.0 to 2.32 and 2.42 postoperatively at six months and one year of follow-up, respectively. Patients with postoperative MMS ≤3 were more likely to undergo GTR with better postoperative MMS than those with preoperative MMS >3 at six-month follow-up (81.8% vs. 25%, respectively; p = 0.013) and at one-year follow-up (84.4 vs. 0%, respectively; p = 0.001). Good preoperative MMS, use of ultrasonic aspirator, and operative monitoring were associated with better MMS. There were no significant associations between MMS at the sixth month and reported parameters including gender, symptoms duration, tumor location, bony work whether laminectomy or laminoplasty, number of segments involved, tumor histopathology, duraplasty, and postoperative adjuvant therapy. \u0000Conclusion: The findings of the current study showed that patients with GTR, good preoperative MMS, intraoperative monitoring, and ultrasonic aspirator usage might be associated with better functional outcomes. (2021ESJ229)","PeriodicalId":11610,"journal":{"name":"Egyptian Spine Journal","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44368961","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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