Pub Date : 2020-10-01DOI: 10.21608/ESJ.2021.64438.1172
Mahmoud Alkharsawi, H. Boehm, M. Shousha, M. Alhashash
Background Data: Calcium pyrophosphate dihydrate (CPPD) deposition disease is a metabolic disorder caused by the deposition of CPPD crystals in the articular or periarticular structures that leads to inflammation of the joints. Spine affection is rare. Purpose: To present a rare case of lumbar facet joint cyst caused by calcium pyrophosphate arthropathy. Study Design: A case report with a brief review of the literature. Patient and Methods: Seventy-three-year-old man, who underwent PLIF L5/S1 ten years ago, presented with right L4 nerve root compression symptoms that have started two months ago. Clinical examination revealed no motor function disturbance but hypoesthesia in the L4 dermatome. He has no history of crystal deposition disorder. The patient underwent decompression and fusion at this level. Results: The symptoms were completely resolved postoperatively and after one-year follow-up. Histopathological examination of the cyst revealed fibrous granulation tissue. Examination of the tissue under polarized light showed positively birefringent, short blunt crystals of calcium pyrophosphate dihydrate. Conclusion: Calcium pyrophosphate arthropathy, although rare, should be incorporated into the differential diagnosis of cystic lesions of the facet joints. (2020ESJ221)
{"title":"Lumbar Facet Joint Cyst Caused by Calcium Pyrophosphate Arthropathy of the Spine: Case Report and Review of Literature","authors":"Mahmoud Alkharsawi, H. Boehm, M. Shousha, M. Alhashash","doi":"10.21608/ESJ.2021.64438.1172","DOIUrl":"https://doi.org/10.21608/ESJ.2021.64438.1172","url":null,"abstract":"Background Data: Calcium pyrophosphate dihydrate (CPPD) deposition disease is a metabolic disorder caused by the deposition of CPPD crystals in the articular or periarticular structures that leads to inflammation of the joints. Spine affection is rare. \u0000Purpose: To present a rare case of lumbar facet joint cyst caused by calcium pyrophosphate arthropathy. \u0000Study Design: A case report with a brief review of the literature. \u0000Patient and Methods: Seventy-three-year-old man, who underwent PLIF L5/S1 ten years ago, presented with right L4 nerve root compression symptoms that have started two months ago. Clinical examination revealed no motor function disturbance but hypoesthesia in the L4 dermatome. He has no history of crystal deposition disorder. The patient underwent decompression and fusion at this level. \u0000Results: The symptoms were completely resolved postoperatively and after one-year follow-up. Histopathological examination of the cyst revealed fibrous granulation tissue. Examination of the tissue under polarized light showed positively birefringent, short blunt crystals of calcium pyrophosphate dihydrate. \u0000Conclusion: Calcium pyrophosphate arthropathy, although rare, should be incorporated into the differential diagnosis of cystic lesions of the facet joints. (2020ESJ221)","PeriodicalId":11610,"journal":{"name":"Egyptian Spine Journal","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2020-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42962843","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 : 2019-10-01DOI: 10.21608/esj.2020.11774.1096
Ahmed M. Elsayed, A. Hamad, O. E. Ahmed
Background Data: In double- and triple-segment lumbar disc herniation, a facet hypertrophy is more encountered specially in the same side of disc herniation with subsequent ipsilateral concave curve scoliosis. Lumbar fixation with interbody fusion surgery is a scientific and feasible option. Some authors believe that unilateral pedicle screw fixation can provide similar biomechanical support to the traditional bilateral pedicle screw fixation. Purpose: To assess the strategy of use of unilateral pedicle screw fixation with lumbar interbody fusion in surgical treatment of multilevel (2-3) symptomatic lumbar disc herniation syndromes. Study Design: Retrospective observational analytic study. Patients and Methods: Retrospective evaluation of 216 patients' files who underwent unilateral pedicular screws fixation for management of degenerative lumbar disc pathology, from July 2007 to June 2017. Only 24 patient’s files were selected with multilevel symptomatic lumbar disc prolapse who were managed by unilateral pedicular screw fixation with interbody fusion. All patients were presented with symptoms of nerve root compression. Patients' data included age, gender, levels of disc prolapse, preoperative and postoperative Visual Analogue Scale (VAS) for back and leg and Oswestry Disability Index (ODI) for functional outcome, presence of complications, and finally patients’ satisfaction according to Odom’s criteria. VAS and ODI were retrieved preoperatively, immediately postoperatively, and 6 months postoperatively. Results: They were 18 males (75%) and 6 females (25%) with a male-to-female ratio of 3:1 and age ranging 35–63 years with a mean age of 49±9.8 years. Double-level disc prolapse was recorded in 20 (83.3%) patients, while it was triple in 4 cases (16.7%). At the last follow-up, back pain VAS improved from 7.5±1.47 to 1.12±1.03, leg pain VAS from 8.7±1.04 to 0.33±0.63, and ODI from 78±8.3 to 11.08±4.6. Excellent and good Odom’s outcomes were reported in 95% of our patients. Conclusion: Our study suggests that unilateral pedicular screw fixation with interbody fusion for the management of multiple level ipsilateral lumbar disc disease could be considered as an effective and less invasive method with satisfying clinical outcomes. (2019ESJ191)
{"title":"Multilevel Unilateral Pedicular Screw Fixation with Interbody Fusion in Surgery of Double- and Triple-Segment Lumbar Disc Pathology","authors":"Ahmed M. Elsayed, A. Hamad, O. E. Ahmed","doi":"10.21608/esj.2020.11774.1096","DOIUrl":"https://doi.org/10.21608/esj.2020.11774.1096","url":null,"abstract":"Background Data: In double- and triple-segment lumbar disc herniation, a facet hypertrophy is more encountered specially in the same side of disc herniation with subsequent ipsilateral concave curve scoliosis. Lumbar fixation with interbody fusion surgery is a scientific and feasible option. Some authors believe that unilateral pedicle screw fixation can provide similar biomechanical support to the traditional bilateral pedicle screw fixation. \u0000Purpose: To assess the strategy of use of unilateral pedicle screw fixation with lumbar interbody fusion in surgical treatment of multilevel (2-3) symptomatic lumbar disc herniation syndromes. \u0000Study Design: Retrospective observational analytic study. \u0000Patients and Methods: Retrospective evaluation of 216 patients' files who underwent unilateral pedicular screws fixation for management of degenerative lumbar disc pathology, from July 2007 to June 2017. Only 24 patient’s files were selected with multilevel symptomatic lumbar disc prolapse who were managed by unilateral pedicular screw fixation with interbody fusion. All patients were presented with symptoms of nerve root compression. Patients' data included age, gender, levels of disc prolapse, preoperative and postoperative Visual Analogue Scale (VAS) for back and leg and Oswestry Disability Index (ODI) for functional outcome, presence of complications, and finally patients’ satisfaction according to Odom’s criteria. VAS and ODI were retrieved preoperatively, immediately postoperatively, and 6 months postoperatively. \u0000Results: They were 18 males (75%) and 6 females (25%) with a male-to-female ratio of 3:1 and age ranging 35–63 years with a mean age of 49±9.8 years. Double-level disc prolapse was recorded in 20 (83.3%) patients, while it was triple in 4 cases (16.7%). At the last follow-up, back pain VAS improved from 7.5±1.47 to 1.12±1.03, leg pain VAS from 8.7±1.04 to 0.33±0.63, and ODI from 78±8.3 to 11.08±4.6. Excellent and good Odom’s outcomes were reported in 95% of our patients. \u0000Conclusion: Our study suggests that unilateral pedicular screw fixation with interbody fusion for the management of multiple level ipsilateral lumbar disc disease could be considered as an effective and less invasive method with satisfying clinical outcomes. (2019ESJ191)","PeriodicalId":11610,"journal":{"name":"Egyptian Spine Journal","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42020793","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 : 2019-10-01DOI: 10.21608/esj.2020.18106.1109
M. Mohamed, M. Shater
Abstract Background Data: Balloon Kyphoplasty allows surgeons to directly reduce the fractured vertebral body using inflatable balloons. However, the reduction cannot be maintained following balloon deflation and removal. Therefore, mechanical kyphoplasty techniques we Background Data: Balloon kyphoplasty allows surgeons to directly reduce the fractured vertebral body using inflatable balloons. However, the reduction cannot be maintained following balloon deflation and removal. Therefore, mechanical kyphoplasty techniques were designed to avoid loss of the reduction before cement injection and restore the vertebral body indefinitely. Study Design: A prospective cohort clinical case study. Purpose: To assess efficacy and safety of mechanical kyphoplasty using the Spine Jack® system in treatment of osteoporotic vertebral compression fractures (VCFs) of the thoracolumbar spine. Patients and Methods: During the period from April 2016 to March 2018, seventeen patients who sustained recent osteoporotic VCFs of the thoracolumbar spine, presenting with intractable back pain following one-month trial of conservative treatment, were included. Patients with pathological fractures, those with neurological deficits, or those medically unfit were excluded. The study included 6 males and 11 females with mean age of 60.37 years. Fractures were surgically treated using the Spine Jack® system that was inserted percutaneously through the transpedicular approach. Back pain intensity and degree of functional recovery were assessed using the Visual Analogue Scale (VAS) and the Oswestry Disability Index (ODI), respectively, whereas segmental deformity of the fractured vertebra was evaluated using standing plain X-rays and CT scan, including measurement of the local kyphotic angle and Beck Index. Results: Patients were followed for at least 6 months (mean 7.4±1.2). At final follow-up, there was significant improvement in mean VAS score (7.3 to 2.9) and mean ODI score (61.4 to 28.7). Postoperative imaging showed significant improvements in mean Beck Index (0.68 to 0.77) and mean local kyphotic angle (21.4° to 14.3°). Cement leakage was noted in 2 patients (11.7%) with no clinical relevance. None of the patients developed neurological deterioration, adjacent fracture, or hardware-related complication during the follow-up. Conclusion: Percutaneous stabilization of osteoporotic VCFs of the thoracolumbar spine using the Spine Jack® system is effective and safe even with posterior wall involvement, with significantly better outcome in terms of pain relief, functional recovery, and vertebral body restoration. (2019ESJ182) re designed to avoid loss of the reduction before cement injection, and restore the vertebral body indefinitely. Study Design: A prospective cohort clinical case study. Purpose: To assess efficacy and safety of mechanical kyphoplasty using the Spine Jack® system in treatment of osteoporotic vertebral compression fractures (VCFs) of the thoraco-lumbar s
{"title":"Spine Jack® System for Percutaneous Stabilization of Osteoporotic Vertebral Compression Fractures: Clinical and Radiological Results","authors":"M. Mohamed, M. Shater","doi":"10.21608/esj.2020.18106.1109","DOIUrl":"https://doi.org/10.21608/esj.2020.18106.1109","url":null,"abstract":"Abstract Background Data: Balloon Kyphoplasty allows surgeons to directly reduce the fractured vertebral body using inflatable balloons. However, the reduction cannot be maintained following balloon deflation and removal. Therefore, mechanical kyphoplasty techniques we \u0000Background Data: Balloon kyphoplasty allows surgeons to directly reduce the fractured vertebral body using inflatable balloons. However, the reduction cannot be maintained following balloon deflation and removal. Therefore, mechanical kyphoplasty techniques were designed to avoid loss of the reduction before cement injection and restore the vertebral body indefinitely. \u0000Study Design: A prospective cohort clinical case study. \u0000Purpose: To assess efficacy and safety of mechanical kyphoplasty using the Spine Jack® system in treatment of osteoporotic vertebral compression fractures (VCFs) of the thoracolumbar spine. \u0000Patients and Methods: During the period from April 2016 to March 2018, seventeen patients who sustained recent osteoporotic VCFs of the thoracolumbar spine, presenting with intractable back pain following one-month trial of conservative treatment, were included. Patients with pathological fractures, those with neurological deficits, or those medically unfit were excluded. The study included 6 males and 11 females with mean age of 60.37 years. Fractures were surgically treated using the Spine Jack® system that was inserted percutaneously through the transpedicular approach. Back pain intensity and degree of functional recovery were assessed using the Visual Analogue Scale (VAS) and the Oswestry Disability Index (ODI), respectively, whereas segmental deformity of the fractured vertebra was evaluated using standing plain X-rays and CT scan, including measurement of the local kyphotic angle and Beck Index. \u0000Results: Patients were followed for at least 6 months (mean 7.4±1.2). At final follow-up, there was significant improvement in mean VAS score (7.3 to 2.9) and mean ODI score (61.4 to 28.7). Postoperative imaging showed significant improvements in mean Beck Index (0.68 to 0.77) and mean local kyphotic angle (21.4° to 14.3°). Cement leakage was noted in 2 patients (11.7%) with no clinical relevance. None of the patients developed neurological deterioration, adjacent fracture, or hardware-related complication during the follow-up. \u0000Conclusion: Percutaneous stabilization of osteoporotic VCFs of the thoracolumbar spine using the Spine Jack® system is effective and safe even with posterior wall involvement, with significantly better outcome in terms of pain relief, functional recovery, and vertebral body restoration. (2019ESJ182) \u0000re designed to avoid loss of the reduction before cement injection, and restore the vertebral body indefinitely. Study Design: A prospective cohort clinical case study. Purpose: To assess efficacy and safety of mechanical kyphoplasty using the Spine Jack® system in treatment of osteoporotic vertebral compression fractures (VCFs) of the thoraco-lumbar s","PeriodicalId":11610,"journal":{"name":"Egyptian Spine Journal","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42658148","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 : 2019-10-01DOI: 10.21608/esj.2020.19243.1114
Khaled Omran, Mohamed Atef Ahmed
Background Data: Lumbar spondylolysis is often managed by conservative methods in most patients. Operative interference is indicated in symptomatic patients not responding to medical treatment or patients with multilevel pars defect. Purpose: To evaluate the clinical, functional, and radiological results of bone graft and pedicular screw fixation and rod laminar hook construct in treatment of lumbar spondylolysis. Study Design: A prospective clinical case cohort study. Patients and Methods: Between October 2017 and January 2019, fifteen patients with symptomatic lumbar spondylolysis not responding to conservative treatment for more than 6 months were treated by reconstruction of pars defect by bone block autografting and fixation using pedicular screw laminar hook construct. The mean follow-up was 9.47±3.07 months. All patients were examined pre- and postoperatively and they were followed up clinically; for measuring their pain scale, Visual Analogue Scale (VAS); functionally, Oswestry Disability Index (ODI); radiologically (pars defect healing). Perioperative outcomes and complications were documented. Results: Clinical, radiological, and functional outcomes were significantly improved. Bony union was evident in all patients (100%). Blood loss, operative time, and hospital stay were reported. Two cases reported complications in this study: misplaced pedicular screw and superficial wound infection. Conclusion: Direct reconstruction of pars defect by bone graft and fixation using pedicular screw rod laminar hook constructis an effective feasible procedure in treating lumbar spondylosis. It preserves lumbar motion and hence may decrease adjacent segment problems. (2019ESJ194) Background context: Lumber Spondylolysis is often managed by conservative methods or the operative interference which is indicated for symptomatic not responding patients to medical treatment and cases with multilevel pars defect. Purpose: The goal of this study is to evaluate the clinical, functional and radiological results of using bone graft and fixation with pedicular screw rod laminar hook construct in treatment of Lumber Spondylolysis. Study Design: A prospective clinical study. Patients and methods: Between October 2017 and January 2019, fifteen patients with symptomatic lumbar spondylolysis not responding to conservative treatment more than 6 months were treated by reconstruction of pars defect by bone block autografting and fixation using pedicular screw laminar hook construct. The mean follow-up time was 9.47±3.07months. All patients were examined pre, postoperative and followed up clinically {pain (Visual Analogue Scale VAS)}, functionally {Oswestry Disability Index (ODI), Modified Prolo Functional Economic Scales (MPFES) and Macaneb's criteria}, radiologically (pars defect healing). Perioperative outcomes and complications were documented. Results: Clinical, radiological and functional outcomes were significantly improved. Bony union was evident in all patie
{"title":"Outcomes of Direct Lumbar Spondylolysis Reconstruction by Bone Graft and Fixation Using Pedicular Screw Rod Laminar Hook Construct","authors":"Khaled Omran, Mohamed Atef Ahmed","doi":"10.21608/esj.2020.19243.1114","DOIUrl":"https://doi.org/10.21608/esj.2020.19243.1114","url":null,"abstract":"Background Data: Lumbar spondylolysis is often managed by conservative methods in most patients. Operative interference is indicated in symptomatic patients not responding to medical treatment or patients with multilevel pars defect. \u0000Purpose: To evaluate the clinical, functional, and radiological results of bone graft and pedicular screw fixation and rod laminar hook construct in treatment of lumbar spondylolysis. \u0000Study Design: A prospective clinical case cohort study. \u0000Patients and Methods: Between October 2017 and January 2019, fifteen patients with symptomatic lumbar spondylolysis not responding to conservative treatment for more than 6 months were treated by reconstruction of pars defect by bone block autografting and fixation using pedicular screw laminar hook construct. The mean follow-up was 9.47±3.07 months. All patients were examined pre- and postoperatively and they were followed up clinically; for measuring their pain scale, Visual Analogue Scale (VAS); functionally, Oswestry Disability Index (ODI); radiologically (pars defect healing). Perioperative outcomes and complications were documented. \u0000Results: Clinical, radiological, and functional outcomes were significantly improved. Bony union was evident in all patients (100%). Blood loss, operative time, and hospital stay were reported. Two cases reported complications in this study: misplaced pedicular screw and superficial wound infection. \u0000Conclusion: Direct reconstruction of pars defect by bone graft and fixation using pedicular screw rod laminar hook constructis an effective feasible procedure in treating lumbar spondylosis. It preserves lumbar motion and hence may decrease adjacent segment problems. (2019ESJ194) \u0000Background context: Lumber Spondylolysis is often managed by conservative methods or the operative interference which is indicated for symptomatic not responding patients to medical treatment and cases with multilevel pars defect. Purpose: The goal of this study is to evaluate the clinical, functional and radiological results of using bone graft and fixation with pedicular screw rod laminar hook construct in treatment of Lumber Spondylolysis. Study Design: A prospective clinical study. Patients and methods: Between October 2017 and January 2019, fifteen patients with symptomatic lumbar spondylolysis not responding to conservative treatment more than 6 months were treated by reconstruction of pars defect by bone block autografting and fixation using pedicular screw laminar hook construct. The mean follow-up time was 9.47±3.07months. All patients were examined pre, postoperative and followed up clinically {pain (Visual Analogue Scale VAS)}, functionally {Oswestry Disability Index (ODI), Modified Prolo Functional Economic Scales (MPFES) and Macaneb's criteria}, radiologically (pars defect healing). Perioperative outcomes and complications were documented. Results: Clinical, radiological and functional outcomes were significantly improved. Bony union was evident in all patie","PeriodicalId":11610,"journal":{"name":"Egyptian Spine Journal","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44064140","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 : 2019-10-01DOI: 10.21608/esj.2020.21281.1116
M. Ali, A. El-Naggar, A. Elwany, M. Abdel-Bary
Abstract: Background Data: Lumbar interbody fusion surgeries are the gold standard surgical option in degenerative disc disorders and spondy Background Data: Lumbar interbody fusion surgeries are the gold standard surgical option in degenerative disc disorders and spondylolisthesis. Achieving solid arthrodesis at the operated segment remains the main goal of surgery. Yet, the correlation of sound radiological fusion with better clinical outcomes is not well established. In recent years, spinal surgeons had much greater awareness of the influence of vitamin D deficiency and cigarette smoking on spinal fusion. Purpose: To assess the influence of vitamin D deficiency and cigarette smoking on the rate of spinal arthrodesis after posterior lumbar interbody fusion (PLIF) in degenerative disc disorders and whether successful fusion correlates with clinical outcomes. Study Design: A prospective cohort study. Patients and Methods: The study was conducted on 67 patients (with a total of 92 levels) who underwent operation for PLIF with pedicle screw fixation. Twenty-six patients had degenerative spondylolisthesis, 20 had herniated discs, and 21 patients showed degenerative disc changes with segmental canal stenosis. In 29 patients, a local bone graft was used as soft PLIF. In the remaining 38 patients, a PEEK interbody cage was utilized. Patients were categorized according to both their serum vitamin D status (39 low; 28 normal) and cigarette smoking habits (18 smokers; 49 non-smokers). The final assessment was done 6 months postoperatively. Clinical outcomes were measured by the Oswestry Disability Index (ODI) and Visual Analogue Scale (VAS) for low back pain. Radiological fusion status was assessed on plain radiographs and graded according to Bridwell’s interbody fusion grading system. The relationship between vitamin D status and cigarette smoking and radiological outcomes was also evaluated. Results: Twenty-two males and 45 females were included in this study. The mean age was 55.8±±3.78 years. L4-L5 was the most commonly operated level, followed by L5-S1 and L3-4 (51.1%, 36.95%, and 11.95%, resp.). There were significant improvements in the mean ODI and VAS measures at final assessment regardless of the differences in vitamin D status or smoking habits. The fusion rate in the low vitamin D group was 79.5% versus 96.4% in the normal level group (P=0.045). 66.7% of those with poor radiological fusion were smokers versus 20.7% of those with sound fusion (P=0.004). There was no significant difference in fusion rates between the PEEK cage group and the bone graft group (P=0.128). There was no significant correlation between sound radiological fusion and better clinical outcomes (P=0.077 and P=0.157 for ODI and VAS, resp.). Conclusion: Smoking habits and low serum vitamin D seem to have a significant negative effect on the success of radiological spinal fusion. There was no significant relationship between radiological fusion and clinical outcomes. (20
{"title":"The Effect Of Cigarette Smoking And Vitamin D Status on Fusion Rates After Posterior Lumbar Interbody Fusion (PLIF) surgery. Does Sound Radiological Fusion Correlates With Better Clinical Outcomes?","authors":"M. Ali, A. El-Naggar, A. Elwany, M. Abdel-Bary","doi":"10.21608/esj.2020.21281.1116","DOIUrl":"https://doi.org/10.21608/esj.2020.21281.1116","url":null,"abstract":"Abstract: Background Data: Lumbar interbody fusion surgeries are the gold standard surgical option in degenerative disc disorders and spondy \u0000Background Data: Lumbar interbody fusion surgeries are the gold standard surgical option in degenerative disc disorders and spondylolisthesis. Achieving solid arthrodesis at the operated segment remains the main goal of surgery. Yet, the correlation of sound radiological fusion with better clinical outcomes is not well established. In recent years, spinal surgeons had much greater awareness of the influence of vitamin D deficiency and cigarette smoking on spinal fusion. \u0000Purpose: To assess the influence of vitamin D deficiency and cigarette smoking on the rate of spinal arthrodesis after posterior lumbar interbody fusion (PLIF) in degenerative disc disorders and whether successful fusion correlates with clinical outcomes. \u0000Study Design: A prospective cohort study. \u0000Patients and Methods: The study was conducted on 67 patients (with a total of 92 levels) who underwent operation for PLIF with pedicle screw fixation. Twenty-six patients had degenerative spondylolisthesis, 20 had herniated discs, and 21 patients showed degenerative disc changes with segmental canal stenosis. In 29 patients, a local bone graft was used as soft PLIF. In the remaining 38 patients, a PEEK interbody cage was utilized. Patients were categorized according to both their serum vitamin D status (39 low; 28 normal) and cigarette smoking habits (18 smokers; 49 non-smokers). The final assessment was done 6 months postoperatively. Clinical outcomes were measured by the Oswestry Disability Index (ODI) and Visual Analogue Scale (VAS) for low back pain. Radiological fusion status was assessed on plain radiographs and graded according to Bridwell’s interbody fusion grading system. The relationship between vitamin D status and cigarette smoking and radiological outcomes was also evaluated. \u0000Results: Twenty-two males and 45 females were included in this study. The mean age was 55.8±±3.78 years. L4-L5 was the most commonly operated level, followed by L5-S1 and L3-4 (51.1%, 36.95%, and 11.95%, resp.). There were significant improvements in the mean ODI and VAS measures at final assessment regardless of the differences in vitamin D status or smoking habits. The fusion rate in the low vitamin D group was 79.5% versus 96.4% in the normal level group (P=0.045). 66.7% of those with poor radiological fusion were smokers versus 20.7% of those with sound fusion (P=0.004). There was no significant difference in fusion rates between the PEEK cage group and the bone graft group (P=0.128). There was no significant correlation between sound radiological fusion and better clinical outcomes (P=0.077 and P=0.157 for ODI and VAS, resp.). \u0000Conclusion: Smoking habits and low serum vitamin D seem to have a significant negative effect on the success of radiological spinal fusion. There was no significant relationship between radiological fusion and clinical outcomes. (20","PeriodicalId":11610,"journal":{"name":"Egyptian Spine Journal","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46077475","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 : 2019-10-01DOI: 10.21608/esj.2020.10409.1093
M. Elsebaey, Hassan Elshatoury, Mohamed Salman
Background Data: Brown tumor is a lytic bone tumor and has variable symptoms according to the affected site. It is called brown because of its characteristic brown color believed to have occurred after accumulation of blood, fibrous tissue, and hemosiderin. Hyperparathyroidism can result in a brown tumor whether it is primary or secondary, but this case is much rarer in primary hyperparathyroidism. It rarely affects the spine, while it is extremely rare to compromise the spinal canal. Purpose: To report a rare case of lumbar spinal brown tumor with primary hyperparathyroidism. Study Design: A case report of brown tumor of the lumbar spine (5th lumbar vertebrae). Patients and Methods: Our case was a forty-year-old female patient presenting with persistent dull aching low back pain. There was no history of any chronic illness. She had a 5-month history of slowly progressive left lower limb radicular pain and not associated with sphincter disturbance. Magnetic resonance imaging of the spine demonstrated lesion affecting the 5th lumbar vertebrae invading the left pedicle and compressing the spinal canal. Results: Team did neural decompression, biopsy harvesting, and partial corpectomy with reconstruction of the affected lumbar vertebra (L5) followed by fixation by rods and screws. The patient showed relief of the radicular pain and back pain on VAS. Histopathological analysis of the biopsy showed evidence of giant-cell tumor (brown tumor). Parathyroid survey was done and showed normal calcium levels. By revising the literature, we claim that this present study is reporting the 10th case of brown tumor of lumbar spine in patient with primary hyperparathyroidism. Conclusion: The diagnosis of brown tumor of spine could be considered in patients with lytic spine lesions. (2019ESJ192) Background Data: Brown tumor is a lytic bone tumor and has variable symptoms according to the affected site. It is called brown as its characteristic brown color that believed to be occurred after accumulation blood, fibrous tissue and hemosiderin. Hyperparathyroidism can cause it whatever it is primary or secondary. It is rarely affects the spine and extremely rare compromises the spinal canal. Purpose: To describe a case presentation of brown tumor affecting the lumbar spine. Study design: A case report of brown tumor of the lumbar spine (5th lumbar vertebrae) Patients and Methods: Our case was a forty years old female patient presenting with persistent dull aching low back pain. She had a 5 month history of slowly progressive left lower limb radicular pain and not associated with sphincter disturbance. Magnetic resonance imaging of the spine demonstrated lesion affecting the 5th lumbar vertebrae that invading the left pedicle and compressing the spinal canal. Results: Under general anesthesia, prone position, low back midline skin incision and dissection, insertion of paired poly-axial screws at the level above (L4) and level below (S1) the affected vertebra (L5) wa
{"title":"Brown Tumor of Lumbar Spine in a Patient with Primary Hyperparathyroidism: Case Report","authors":"M. Elsebaey, Hassan Elshatoury, Mohamed Salman","doi":"10.21608/esj.2020.10409.1093","DOIUrl":"https://doi.org/10.21608/esj.2020.10409.1093","url":null,"abstract":"Background Data: Brown tumor is a lytic bone tumor and has variable symptoms according to the affected site. It is called brown because of its characteristic brown color believed to have occurred after accumulation of blood, fibrous tissue, and hemosiderin. Hyperparathyroidism can result in a brown tumor whether it is primary or secondary, but this case is much rarer in primary hyperparathyroidism. It rarely affects the spine, while it is extremely rare to compromise the spinal canal. \u0000Purpose: To report a rare case of lumbar spinal brown tumor with primary hyperparathyroidism. \u0000Study Design: A case report of brown tumor of the lumbar spine (5th lumbar vertebrae). \u0000Patients and Methods: Our case was a forty-year-old female patient presenting with persistent dull aching low back pain. There was no history of any chronic illness. She had a 5-month history of slowly progressive left lower limb radicular pain and not associated with sphincter disturbance. Magnetic resonance imaging of the spine demonstrated lesion affecting the 5th lumbar vertebrae invading the left pedicle and compressing the spinal canal. \u0000Results: Team did neural decompression, biopsy harvesting, and partial corpectomy with reconstruction of the affected lumbar vertebra (L5) followed by fixation by rods and screws. The patient showed relief of the radicular pain and back pain on VAS. Histopathological analysis of the biopsy showed evidence of giant-cell tumor (brown tumor). Parathyroid survey was done and showed normal calcium levels. By revising the literature, we claim that this present study is reporting the 10th case of brown tumor of lumbar spine in patient with primary hyperparathyroidism. \u0000Conclusion: The diagnosis of brown tumor of spine could be considered in patients with lytic spine lesions. (2019ESJ192) \u0000Background Data: Brown tumor is a lytic bone tumor and has variable symptoms according to the affected site. It is called brown as its characteristic brown color that believed to be occurred after accumulation blood, fibrous tissue and hemosiderin. Hyperparathyroidism can cause it whatever it is primary or secondary. It is rarely affects the spine and extremely rare compromises the spinal canal. Purpose: To describe a case presentation of brown tumor affecting the lumbar spine. Study design: A case report of brown tumor of the lumbar spine (5th lumbar vertebrae) Patients and Methods: Our case was a forty years old female patient presenting with persistent dull aching low back pain. She had a 5 month history of slowly progressive left lower limb radicular pain and not associated with sphincter disturbance. Magnetic resonance imaging of the spine demonstrated lesion affecting the 5th lumbar vertebrae that invading the left pedicle and compressing the spinal canal. Results: Under general anesthesia, prone position, low back midline skin incision and dissection, insertion of paired poly-axial screws at the level above (L4) and level below (S1) the affected vertebra (L5) wa","PeriodicalId":11610,"journal":{"name":"Egyptian Spine Journal","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48017085","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 : 2019-10-01DOI: 10.21608/esj.2020.17351.1105
Ahmad Abdalla Kelani, M. Ragaee
Background Data: Lumbar spinal stenosis is common in elderly and obese patients. Surgical intervention should be considered only after all conservative treatment options have been proven unsuccessful. Wide laminectomy was the gold standard of treatment, but surgical failures have been reported. Recently, a less invasive decompressive surgical procedures have emerged as an alternative technique. Purpose: To compare between the unilateral laminotomy approach and conventional laminectomy approach for the treatment of lumbar canal stenosis, regarding clinical outcomes. Study Design: This is a prospective clinical randomized controlled study. Patients and Methods: This study included 30 patients with lumbar canal stenosis. 15 patients underwent unilateral laminotomy approach (Group A), while the other 15 patients underwent conventional laminectomy approach (Group B). Surgical operative time, blood loss, and hospital stay were recorded. Clinical outcomes have been assessed by Visual Analogue Scale (VAS) of leg pain and Oswestry Disability Index (ODI). Patients were followed up for 1 year postoperatively. Results: Male to female ratio was 12:18 patients. The mean age was 52.5±6.62 years in Group A and 52.2±7.24 years in Group B. The mean operative time was 73.5±14.54 minutes in Group A and 85.5±17.07 minutes in Group B. Less blood loss was recorded in Group A (127±37.43 ml) than Group B (152±50.95 ml). Three patients suffered unintended durotomy in both groups and no postoperative CSF leak occurred. Marked reduction of VAS and ODI was achieved in both groups at one-year follow-up without statistically significant difference. Conclusion: Unilateral laminotomy approach used for bilateral neural compression is an effective technique for treatment of lumbar canal stenosis in comparison to conventional laminectomy approach. (2019ESJ184)
{"title":"Unilateral laminotomy versus conventional laminectomy in treatment of lumbar canal stenosis. A prospective comparative study","authors":"Ahmad Abdalla Kelani, M. Ragaee","doi":"10.21608/esj.2020.17351.1105","DOIUrl":"https://doi.org/10.21608/esj.2020.17351.1105","url":null,"abstract":"Background Data: Lumbar spinal stenosis is common in elderly and obese patients. Surgical intervention should be considered only after all conservative treatment options have been proven unsuccessful. Wide laminectomy was the gold standard of treatment, but surgical failures have been reported. Recently, a less invasive decompressive surgical procedures have emerged as an alternative technique. \u0000Purpose: To compare between the unilateral laminotomy approach and conventional laminectomy approach for the treatment of lumbar canal stenosis, regarding clinical outcomes. \u0000Study Design: This is a prospective clinical randomized controlled study. \u0000Patients and Methods: This study included 30 patients with lumbar canal stenosis. 15 patients underwent unilateral laminotomy approach (Group A), while the other 15 patients underwent conventional laminectomy approach (Group B). Surgical operative time, blood loss, and hospital stay were recorded. Clinical outcomes have been assessed by Visual Analogue Scale (VAS) of leg pain and Oswestry Disability Index (ODI). Patients were followed up for 1 year postoperatively. \u0000Results: Male to female ratio was 12:18 patients. The mean age was 52.5±6.62 years in Group A and 52.2±7.24 years in Group B. The mean operative time was 73.5±14.54 minutes in Group A and 85.5±17.07 minutes in Group B. Less blood loss was recorded in Group A (127±37.43 ml) than Group B (152±50.95 ml). Three patients suffered unintended durotomy in both groups and no postoperative CSF leak occurred. Marked reduction of VAS and ODI was achieved in both groups at one-year follow-up without statistically significant difference. \u0000Conclusion: Unilateral laminotomy approach used for bilateral neural compression is an effective technique for treatment of lumbar canal stenosis in comparison to conventional laminectomy approach. (2019ESJ184)","PeriodicalId":11610,"journal":{"name":"Egyptian Spine Journal","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47944650","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 : 2019-10-01DOI: 10.21608/esj.2020.17415.1107
M. Saleh, F. Samir, S. Agamy
Background: Revision surgeries of spinal deformity are difficult and technically demanding with high rate of complications. Combined anterior and posterior approaches are usually required in such cases. Decreased quality of life, pain, physical limitations, and dissatisfaction with self-image are the main sequelae of revision spinal deformities. Durability of interventions for deformity treatment is the main concern for surgeons, as the revision rate is considered high. Purpose: The aim of this study is evaluation of the short-term outcomes of posterior-only approach in correction of revision spinal deformities. Study Design: Case series, prospective. Patients and Methods: Twenty patients with revision spinal deformities were included in this study between February 2015 and December 2017. The mean age was 16±5.9 (16–35) years. The patients were assessed radiologically and clinically using Visual Analogue Scale (VAS) of pain and Oswestry Disability Index (ODI). Clinical diagnosis was failed spinal deformity correction of different etiologies in patients aged more than 15 years old. All patients treated via Ponte osteotomies and fusion mass osteotomies with pedicular screw fixation through posterior approach. Results: The mean follow-up time was 27±6.2 months. The mean estimated blood loss (EBL) was 1829±388.7 ml (range, 1300–2600). The mean coronal Cobb angle showed 75.64% correction. The Visual Analogue Scale (VAS) of back pain showed 75.97% improvement. There was statistically significant improvement of the clinical scores and all radiological parameters at the end of the follow-up period. There were seven complications without serious morbidities (3 dural tears, 1 postoperative ileus, 1 delayed extubation, 1 superficial wound infection, and 1 anemia). Conclusion: Revision deformity surgeries are technically demanding procedures and should be done by well-trained spine surgeons. The posterior-only approach is an effective and safe option in management of deformity correction and achieves good union even in cases of pseudoarthrosis without serious complications. (2019ESJ183)
{"title":"Evaluation of posterior only approach using Ponte and fusion mass osteotomies in management of revision spinal deformities","authors":"M. Saleh, F. Samir, S. Agamy","doi":"10.21608/esj.2020.17415.1107","DOIUrl":"https://doi.org/10.21608/esj.2020.17415.1107","url":null,"abstract":"Background: Revision surgeries of spinal deformity are difficult and technically demanding with high rate of complications. Combined anterior and posterior approaches are usually required in such cases. Decreased quality of life, pain, physical limitations, and dissatisfaction with self-image are the main sequelae of revision spinal deformities. Durability of interventions for deformity treatment is the main concern for surgeons, as the revision rate is considered high. \u0000Purpose: The aim of this study is evaluation of the short-term outcomes of posterior-only approach in correction of revision spinal deformities. \u0000Study Design: Case series, prospective. \u0000Patients and Methods: Twenty patients with revision spinal deformities were included in this study between February 2015 and December 2017. The mean age was 16±5.9 (16–35) years. The patients were assessed radiologically and clinically using Visual Analogue Scale (VAS) of pain and Oswestry Disability Index (ODI). Clinical diagnosis was failed spinal deformity correction of different etiologies in patients aged more than 15 years old. All patients treated via Ponte osteotomies and fusion mass osteotomies with pedicular screw fixation through posterior approach. \u0000Results: The mean follow-up time was 27±6.2 months. The mean estimated blood loss (EBL) was 1829±388.7 ml (range, 1300–2600). The mean coronal Cobb angle showed 75.64% correction. The Visual Analogue Scale (VAS) of back pain showed 75.97% improvement. There was statistically significant improvement of the clinical scores and all radiological parameters at the end of the follow-up period. There were seven complications without serious morbidities (3 dural tears, 1 postoperative ileus, 1 delayed extubation, 1 superficial wound infection, and 1 anemia). \u0000Conclusion: Revision deformity surgeries are technically demanding procedures and should be done by well-trained spine surgeons. The posterior-only approach is an effective and safe option in management of deformity correction and achieves good union even in cases of pseudoarthrosis without serious complications. (2019ESJ183)","PeriodicalId":11610,"journal":{"name":"Egyptian Spine Journal","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44955730","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 : 2019-07-01DOI: 10.21608/esj.2019.12339.1098
Islam Sorour, S. Samy, A. Madkour
Background Data: Complex spine surgery is a challenging and difficult procedure. It has to be performed by senior spine surgeons to correct complex deformities. This type of corrective procedures can be challenging and commonly requires long Background Data: Complex spine surgery is a challenging and difficult procedure. It has to be performed by senior spine surgeons to correct complex deformities. This type of corrective procedures can be challenging and commonly requires long operations, with subsequent higher rates of complications when compared to ordinary spine operations. The literature has few data comparing the outcomes of single-stage posterior operation versus staged posterior correction of complex spine surgery. Single-session surgery entails the classical correction of complex deformities via a single-stage posterior operation, while staged posterior surgery means dividing the surgical maneuver into two posterior sessions with the final correction being performed in the second session. Studying the clinical and radiological data is extremely helpful in determining the safety and effectiveness of staginglong spinal operations for the correction of complex spinal deformities. Purpose: This study aims to compare perioperative and 1-year outcomes of single-stage posterior correction versus staged posterior surgical correction of complex spine deformities. Study Design: Prospective cohort study. Patients and Methods: Patient sample: A total of 22 patients with complex spinal deformity were recruited for this study (12, one-stage operation; 10, two-stage operation). Outcome measures: Perioperative and one-year postoperative clinical and radiological data were collected and analyzed. Data included operative time, blood loss, immediate postoperative Cobb angle, one-year Cobb angle and percentage of correction of the deformity, one-year loss of correction, and one-year complication rate. Results There were no significant differences between the 2 groups as regards immediate postoperative Cobb angle (33.0±15.0, one-stage operation; 30.8±14.8, two-stage operation; P=0.771); percentage of correction within one year (60.7±12.0%, one-stage operation; 60.1±16.1%, two-stage operation; P=0.974); one-year loss of correction % (7.8±3.2, one-stage operation; 6.3±3.3, two-stage operation; P=0.238); one-year complication rate (83.3%, one-stage operation; 60%, two-stage operation; P=0.348). However, statistically significant difference was found between the 2 groups in terms of the total blood loss (3366.7±499.7 ml, one-stage operation; 4035.0±887.0 ml two-stage operation; P=0.038) and total operative time (353.3±46.8 min, one-stage operation; 486.5±131.5 min two-stage operation; P=0.011). Neurological complications (16.7%) and malpositioned screws (25%) were reported only in one-stage operations (however, this was statistically nonsignificant when comparing total complications in both groups (c2=1.833 and 2.895, resp.; P=0.481 and 0.221, resp.). Neurolog
{"title":"Planned staging for posterior surgical correction of multi-planar spinal deformities, does it differ?","authors":"Islam Sorour, S. Samy, A. Madkour","doi":"10.21608/esj.2019.12339.1098","DOIUrl":"https://doi.org/10.21608/esj.2019.12339.1098","url":null,"abstract":"Background Data: Complex spine surgery is a challenging and difficult procedure. It has to be performed by senior spine surgeons to correct complex deformities. This type of corrective procedures can be challenging and commonly requires long Background Data: Complex spine surgery is a challenging and difficult procedure. It has to be performed by senior spine surgeons to correct complex deformities. This type of corrective procedures can be challenging and commonly requires long operations, with subsequent higher rates of complications when compared to ordinary spine operations. The literature has few data comparing the outcomes of single-stage posterior operation versus staged posterior correction of complex spine surgery. Single-session surgery entails the classical correction of complex deformities via a single-stage posterior operation, while staged posterior surgery means dividing the surgical maneuver into two posterior sessions with the final correction being performed in the second session. Studying the clinical and radiological data is extremely helpful in determining the safety and effectiveness of staginglong spinal operations for the correction of complex spinal deformities. Purpose: This study aims to compare perioperative and 1-year outcomes of single-stage posterior correction versus staged posterior surgical correction of complex spine deformities. Study Design: Prospective cohort study. Patients and Methods: Patient sample: A total of 22 patients with complex spinal deformity were recruited for this study (12, one-stage operation; 10, two-stage operation). Outcome measures: Perioperative and one-year postoperative clinical and radiological data were collected and analyzed. Data included operative time, blood loss, immediate postoperative Cobb angle, one-year Cobb angle and percentage of correction of the deformity, one-year loss of correction, and one-year complication rate. Results There were no significant differences between the 2 groups as regards immediate postoperative Cobb angle (33.0±15.0, one-stage operation; 30.8±14.8, two-stage operation; P=0.771); percentage of correction within one year (60.7±12.0%, one-stage operation; 60.1±16.1%, two-stage operation; P=0.974); one-year loss of correction % (7.8±3.2, one-stage operation; 6.3±3.3, two-stage operation; P=0.238); one-year complication rate (83.3%, one-stage operation; 60%, two-stage operation; P=0.348). However, statistically significant difference was found between the 2 groups in terms of the total blood loss (3366.7±499.7 ml, one-stage operation; 4035.0±887.0 ml two-stage operation; P=0.038) and total operative time (353.3±46.8 min, one-stage operation; 486.5±131.5 min two-stage operation; P=0.011). Neurological complications (16.7%) and malpositioned screws (25%) were reported only in one-stage operations (however, this was statistically nonsignificant when comparing total complications in both groups (c2=1.833 and 2.895, resp.; P=0.481 and 0.221, resp.). Neurolog","PeriodicalId":11610,"journal":{"name":"Egyptian Spine Journal","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42269354","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 : 2019-07-01DOI: 10.21608/esj.2020.12492.1100
H. Elsobky, A. Zidan, Amin Sabry
Background Data : About 75% of Spinal schwannoms are intradural, 10%intra-extradural and 15% are completely extradural . These tumors are usually slowly growing and reach a large size before becoming symptomatic. The tumors which are totally or partially located in the epidural space (dumbbell tumors) are either intraspinal, foraminal or extraspinal. These dumbbell forms represent about 18 % of the total percentage of whole spinal schwannomas, but they are responsible for almost half of the cervical schwannomas When these tumors have large extraforaminal part it become so difficult to achieve total excision through a single approach . Study design : This is a retrospective study. Purpose: To evaluate the efficacy and safety of combined approach for excision of these large tumors closely related to the vertebral artery Patients and Methods : This study was conducted in Mansoura University Hospital on 6 patients two males and four females their age ranged (22-50) years with cervical spinal schwannoms with large lateral extra formaninal component. All patients were assessed clinically and radiologically using CT and MRI cervical spine and vertebral artery angiography before surgery. Posterior approach through a hemilaminectomy with facet preservation was used for excision of the intraspinal part without disturbing the cervical spine stability and with limited postoperative neck pain and a lateral approach for excision the extraspinal extension to avoid so much manibulation on the vertebral artery. Follow up MRI cervical spine was done postoperatively for follow up. Results : Combined approach was done for all patients with complete excision of the tumors . One patient developed CSF Leake after surgery that stopped after lumbar drain insertion . There was no mortality in this study. Conclusion : Cervical spinal schwannoms with large lateral extra formaninal component need combined approach to achieve complete surgical excision , avoid vertebral artery injury and preserve stability .
{"title":"Combined approach for cervical schwannomas with large extraforaminal extension","authors":"H. Elsobky, A. Zidan, Amin Sabry","doi":"10.21608/esj.2020.12492.1100","DOIUrl":"https://doi.org/10.21608/esj.2020.12492.1100","url":null,"abstract":"Background Data : About 75% of Spinal schwannoms are intradural, 10%intra-extradural and 15% are completely extradural . These tumors are usually slowly growing and reach a large size before becoming symptomatic. The tumors which are totally or partially located in the epidural space (dumbbell tumors) are either intraspinal, foraminal or extraspinal. These dumbbell forms represent about 18 % of the total percentage of whole spinal schwannomas, but they are responsible for almost half of the cervical schwannomas When these tumors have large extraforaminal part it become so difficult to achieve total excision through a single approach . Study design : This is a retrospective study. Purpose: To evaluate the efficacy and safety of combined approach for excision of these large tumors closely related to the vertebral artery Patients and Methods : This study was conducted in Mansoura University Hospital on 6 patients two males and four females their age ranged (22-50) years with cervical spinal schwannoms with large lateral extra formaninal component. All patients were assessed clinically and radiologically using CT and MRI cervical spine and vertebral artery angiography before surgery. Posterior approach through a hemilaminectomy with facet preservation was used for excision of the intraspinal part without disturbing the cervical spine stability and with limited postoperative neck pain and a lateral approach for excision the extraspinal extension to avoid so much manibulation on the vertebral artery. Follow up MRI cervical spine was done postoperatively for follow up. Results : Combined approach was done for all patients with complete excision of the tumors . One patient developed CSF Leake after surgery that stopped after lumbar drain insertion . There was no mortality in this study. Conclusion : Cervical spinal schwannoms with large lateral extra formaninal component need combined approach to achieve complete surgical excision , avoid vertebral artery injury and preserve stability .","PeriodicalId":11610,"journal":{"name":"Egyptian Spine Journal","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44349144","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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