Pub Date : 2020-08-31DOI: 10.4172/2325-9701.1000342
P. Roblot, C. Roscop, J. Vital, O. Gille, K. Fara
We report the case of a 62-old patient who suffered from immediate post-operative cervical spondylotic myelopathy’s worsening. This is a rare complication due to patient positioning the most often. This case seems to be the first case due to a disk herniation described to the best of our knowledge. This patient was operated by C4 and C5 corpectomy because of a spinal cord compression associated with intra-medullary T2-weighted hyper signal. Neurological worsening with immediate motor deficit was noted in postoperative care unit. An immediate cervical spine MRI scan was done showing a discal fragment at C6-C7 level. Emergency surgery was so performed with a C6-C7 transdiscal way for resection of a compressive cervical herniation. During the immediate postoperative outcome, the neurological enhancing was subtotal. We think that emergency MRI scan is mandatory for immediate postoperative neuroworsening after anterior cervical spine surgery instead of emergency surgery if neuroworsening is not tetraplegia in order to avoid a diagnosis misunderstanding.
{"title":"Myelopathy’s Worsening Due to Adjacent Peroperative Discal Herniatio: Case Report.","authors":"P. Roblot, C. Roscop, J. Vital, O. Gille, K. Fara","doi":"10.4172/2325-9701.1000342","DOIUrl":"https://doi.org/10.4172/2325-9701.1000342","url":null,"abstract":"We report the case of a 62-old patient who suffered from immediate post-operative cervical spondylotic myelopathy’s worsening. This is a rare complication due to patient positioning the most often. This case seems to be the first case due to a disk herniation described to the best of our knowledge. This patient was operated by C4 and C5 corpectomy because of a spinal cord compression associated with intra-medullary T2-weighted hyper signal. Neurological worsening with immediate motor deficit was noted in postoperative care unit. An immediate cervical spine MRI scan was done showing a discal fragment at C6-C7 level. Emergency surgery was so performed with a C6-C7 transdiscal way for resection of a compressive cervical herniation. During the immediate postoperative outcome, the neurological enhancing was subtotal. We think that emergency MRI scan is mandatory for immediate postoperative neuroworsening after anterior cervical spine surgery instead of emergency surgery if neuroworsening is not tetraplegia in order to avoid a diagnosis misunderstanding.","PeriodicalId":90240,"journal":{"name":"Journal of spine & neurosurgery","volume":"2020 1","pages":"1-1"},"PeriodicalIF":0.0,"publicationDate":"2020-08-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44984820","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 : 2019-03-28DOI: 10.4172/2325-9701.1000320
F. Geisler, D. Maislin, B. Keenan, G. Maislin
This study was performed to evaluate the early clinical results at one year for the Simplify™ Cervical Artificial Disc. We compared outcomes for 150 Simplify Disc subjects at one-year followup in a prospective, multicenter, FDA IDE clinical trial with 119 propensity score matched historical control subjects who received conventional anterior cervical discectomy and fusion (ACDF) for single-level cervical degenerative disc disease. The outcome measures included the change from preoperative baseline to one-year in Neck Disability Index (NDI) and visual analog scales (VAS) for neck and arm pain, with scores for the few missing oneyear follow-up implicitly imputed using mixed models for repeated measures (MMRM). The MMRM was used to estimate within group and between group differences controlling for propensity score subclass and the relevant baseline value. The adjusted mean changes (and standard errors) in NDI from baseline to one year were -46.7 (SE=1.7, p<0.001) and -38.1 (SE=1.9, p<0.001) for Simplify Disc subjects and ACDF control subjects, respectively. The adjusted Simplify Disc vs. control difference in mean NDI change at one year was -8.7 (SE=2.7) with p=0.002; the 95% confidence interval for the mean difference was -14.0 to -3.3. The adjusted mean changes in VAS neck and arm pain from baseline to one year were -62.4 (SE=2.0, p<0.001) and -55.2 (SE=2.3, p<0.001) for Simplify Disc and ACDF controls, respectively. The adjusted Simplify Disc vs. control difference in mean VAS neck and arm pain change at one year was -7.3 (SE=3.3) with p=0.029 (95% CI -13.8 to 0.8). Therefore, it can be concluded that the one-year clinical results of the Simplify Disc are superior to ACDF for both 1) improvement of NDI and 2) improvement in VAS neck and arm pain. Inspection of all eight prior FDA cervical total disc replacement studies indicates that these good results for the Simplify Disc can be expected to continue for five years and beyond, but longer term follow-up is necessary for verification.
{"title":"One-Year NDI and VAS Outcomes from the Single-Level PEEK-on-Ceramic SimplifyTM Disc FDA IDE Trial","authors":"F. Geisler, D. Maislin, B. Keenan, G. Maislin","doi":"10.4172/2325-9701.1000320","DOIUrl":"https://doi.org/10.4172/2325-9701.1000320","url":null,"abstract":"This study was performed to evaluate the early clinical results at one year for the Simplify™ Cervical Artificial Disc. We compared outcomes for 150 Simplify Disc subjects at one-year followup in a prospective, multicenter, FDA IDE clinical trial with 119 propensity score matched historical control subjects who received conventional anterior cervical discectomy and fusion (ACDF) for single-level cervical degenerative disc disease. The outcome measures included the change from preoperative baseline to one-year in Neck Disability Index (NDI) and visual analog scales (VAS) for neck and arm pain, with scores for the few missing oneyear follow-up implicitly imputed using mixed models for repeated measures (MMRM). The MMRM was used to estimate within group and between group differences controlling for propensity score subclass and the relevant baseline value. The adjusted mean changes (and standard errors) in NDI from baseline to one year were -46.7 (SE=1.7, p<0.001) and -38.1 (SE=1.9, p<0.001) for Simplify Disc subjects and ACDF control subjects, respectively. The adjusted Simplify Disc vs. control difference in mean NDI change at one year was -8.7 (SE=2.7) with p=0.002; the 95% confidence interval for the mean difference was -14.0 to -3.3. The adjusted mean changes in VAS neck and arm pain from baseline to one year were -62.4 (SE=2.0, p<0.001) and -55.2 (SE=2.3, p<0.001) for Simplify Disc and ACDF controls, respectively. The adjusted Simplify Disc vs. control difference in mean VAS neck and arm pain change at one year was -7.3 (SE=3.3) with p=0.029 (95% CI -13.8 to 0.8). Therefore, it can be concluded that the one-year clinical results of the Simplify Disc are superior to ACDF for both 1) improvement of NDI and 2) improvement in VAS neck and arm pain. Inspection of all eight prior FDA cervical total disc replacement studies indicates that these good results for the Simplify Disc can be expected to continue for five years and beyond, but longer term follow-up is necessary for verification.","PeriodicalId":90240,"journal":{"name":"Journal of spine & neurosurgery","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-03-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48404702","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 : 2019-03-25DOI: 10.4172/2325-9701.1000319
L. Cardoso, R. Nogueira, Lino Fonseca, A. Nabais
Objective: Epidermoid tumors are slow-growing benign lesions lined by squamous epithelium. Are rare, commonly intracranial and spinal intradural epidermoid tumors are extremely rare. The authors propose to describe a clinical case of a patient operated. Methods: We report a 75-year-old male referred to neurosurgical consultation by spondylolisthesis at L4-L5 with stenotic spinal canal and a left L4-L5 foraminal stenosis, revealed by lumbosacral CT scan. Neurologic exam revealed a claudicant gait, spastic paraparesis with muscular strenght of 3-/5 at left and 4+/5 at right. Deep tendon reflexes were increased at left with presence of patelar and ankle clonus, but normally at right. Below left D5 dermatome, he had sensory parestesia. MRI showed an intradural lesion, apparently exclusively extra-medullary at D6 level. This lesion determines a significant spinal cord compression and had identical signal to the CSF in all MRI ponderations. It was performed a D5 laminectomy and median linear durotomy with identification of an intradural tumor (pearl-white color), adjacent to the arachnoid, dissectable from spine cord. Gross total resection was achieved. Results: Postoperatively the patient remained clinically stable and without new deficits. At the 4th month of follow-up the patient progressively recovered and was presenting with muscle strength grade 4/5. Histopathology showed a sample of keratin lamellae, foci of gross calcification, compatible with diagnosis of epidermoid tumor. Conclusion: This case demonstrates that even being a rare pathology we must have it present in our clinical reasoning so we can diagnose it properly. It also reveals a case of associated pathology of the spine, which could delay the diagnosis, increasing the risk of worsening of permanent neurological deficit. The goal is always the complete surgical resection and so, because of is benign nature and low rate of recurrence the patients may improve clinically and can be considered cured.
{"title":"Spinal Epidermoid Tumor – A Rare and Silent Occurrence","authors":"L. Cardoso, R. Nogueira, Lino Fonseca, A. Nabais","doi":"10.4172/2325-9701.1000319","DOIUrl":"https://doi.org/10.4172/2325-9701.1000319","url":null,"abstract":"Objective: Epidermoid tumors are slow-growing benign lesions lined by squamous epithelium. Are rare, commonly intracranial and spinal intradural epidermoid tumors are extremely rare. The authors propose to describe a clinical case of a patient operated. Methods: We report a 75-year-old male referred to neurosurgical consultation by spondylolisthesis at L4-L5 with stenotic spinal canal and a left L4-L5 foraminal stenosis, revealed by lumbosacral CT scan. Neurologic exam revealed a claudicant gait, spastic paraparesis with muscular strenght of 3-/5 at left and 4+/5 at right. Deep tendon reflexes were increased at left with presence of patelar and ankle clonus, but normally at right. Below left D5 dermatome, he had sensory parestesia. MRI showed an intradural lesion, apparently exclusively extra-medullary at D6 level. This lesion determines a significant spinal cord compression and had identical signal to the CSF in all MRI ponderations. It was performed a D5 laminectomy and median linear durotomy with identification of an intradural tumor (pearl-white color), adjacent to the arachnoid, dissectable from spine cord. Gross total resection was achieved. Results: Postoperatively the patient remained clinically stable and without new deficits. At the 4th month of follow-up the patient progressively recovered and was presenting with muscle strength grade 4/5. Histopathology showed a sample of keratin lamellae, foci of gross calcification, compatible with diagnosis of epidermoid tumor. Conclusion: This case demonstrates that even being a rare pathology we must have it present in our clinical reasoning so we can diagnose it properly. It also reveals a case of associated pathology of the spine, which could delay the diagnosis, increasing the risk of worsening of permanent neurological deficit. The goal is always the complete surgical resection and so, because of is benign nature and low rate of recurrence the patients may improve clinically and can be considered cured.","PeriodicalId":90240,"journal":{"name":"Journal of spine & neurosurgery","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-03-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45621775","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 : 2019-03-01DOI: 10.4172/2325-9701.1000317
S. Bejell, Sviridova Ge
Trigeminal Neuralgia is a common condition affecting the quality of life of millions across the world. The introduction of Microvascular decompression has significantly added to the armamentarium of the neurosurgeon in tackling this dreaded disease. Some anatomical variants where large ectatic basilar and vertebral arteries compressing on the Vth nerve are challenging to tackle. Many suggestions such as fascia vasculopexy, Teflon vasculopexy and sub temporal realignment of the basilar have been proposed to address the situation. We propose a simple technique where Teflon rings taken from a vascular graft are used to shield the nerve from the arteries in question, thereby liberating it from the pulsatile pressure of the vessels. We present our experiences regarding this novel technique here.
{"title":"Spontaneous C1 Anterior Arch Fracture Following C1 Laminectomy for Cervical Meningioma: A Case Report and Review of Literature","authors":"S. Bejell, Sviridova Ge","doi":"10.4172/2325-9701.1000317","DOIUrl":"https://doi.org/10.4172/2325-9701.1000317","url":null,"abstract":"Trigeminal Neuralgia is a common condition affecting the quality of life of millions across the world. The introduction of Microvascular decompression has significantly added to the armamentarium of the neurosurgeon in tackling this dreaded disease. Some anatomical variants where large ectatic basilar and vertebral arteries compressing on the Vth nerve are challenging to tackle. Many suggestions such as fascia vasculopexy, Teflon vasculopexy and sub temporal realignment of the basilar have been proposed to address the situation. We propose a simple technique where Teflon rings taken from a vascular graft are used to shield the nerve from the arteries in question, thereby liberating it from the pulsatile pressure of the vessels. We present our experiences regarding this novel technique here.","PeriodicalId":90240,"journal":{"name":"Journal of spine & neurosurgery","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42535339","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 : 2019-03-01DOI: 10.4172/2325-9701.1000318
Clint P. Hill, K. Br, on Strenge
Background: Recently, material surface advancements have been promoted to improve spinal implant osseointegration. While rough and porous titanium implants have gained traction due to their osteoconductive properties, polyetheretherketone (PEEK) devices have remained popular due to their radiographic properties and similar modulus of elasticity to bone. However, traditional smooth PEEK devices elicit fibrous tissue responses leading to poor implant osseointegration. Recently, PEEK implants have been developed with surface porosity allowing for direct bone in-growth. Despite preclinical data suggesting implant osseointegration with porous PEEK implants, comparative clinical results between implants with and without porous surface architecture are heretofore reported. The objective of this single-site retrospective study was to comparatively evaluate early clinical efficacy in patients undergoing ACDF treated with porous PEEK interbody implants to patients treated with structural allograft or traditional smooth PEEK implants. Methods: 167 consecutive patients presenting with cervical degenerative disc disease and radiculopathy underwent ACDF using one of three implants (porous PEEK (Cohere®, NuVasive Inc., San Diego, CA), structural allograft, or smooth PEEK). After preop evaluation and surgery, patients were followed per standard of care 0.5, 1.5, 3, 6, and 12 months post-op. At each time, patient outcomes were measured by disability (Neck Disability Index) and pain (visual analogue score (VAS) neck/arm pain). Results: Patients treated with porous PEEK implants achieved significantly greater NDI and neck pain improvement by 6 weeks post-op when compared to patients receiving structural allograft or smooth PEEK devices. These significantly greater NDI and neck pain improvements for patients treated with porous PEEK devices compared to structural allograft and smooth PEEK were sustained through 12 months post-op. Conclusion: 12 month follow-up data in patients with degenerative disc disease and radiculopathy demonstrates a clear benefit of porous PEEK in promoting improved early outcomes over structural allograft and smooth PEEK in ACDF procedures.
{"title":"Early Clinical Outcomes Comparing Porous PEEK, Smooth PEEK, and Structural Allograft Interbody Devices for Anterior Cervical Discectomy and Fusion","authors":"Clint P. Hill, K. Br, on Strenge","doi":"10.4172/2325-9701.1000318","DOIUrl":"https://doi.org/10.4172/2325-9701.1000318","url":null,"abstract":"Background: Recently, material surface advancements have been promoted to improve spinal implant osseointegration. While rough and porous titanium implants have gained traction due to their osteoconductive properties, polyetheretherketone (PEEK) devices have remained popular due to their radiographic properties and similar modulus of elasticity to bone. However, traditional smooth PEEK devices elicit fibrous tissue responses leading to poor implant osseointegration. Recently, PEEK implants have been developed with surface porosity allowing for direct bone in-growth. Despite preclinical data suggesting implant osseointegration with porous PEEK implants, comparative clinical results between implants with and without porous surface architecture are heretofore reported. The objective of this single-site retrospective study was to comparatively evaluate early clinical efficacy in patients undergoing ACDF treated with porous PEEK interbody implants to patients treated with structural allograft or traditional smooth PEEK implants. Methods: 167 consecutive patients presenting with cervical degenerative disc disease and radiculopathy underwent ACDF using one of three implants (porous PEEK (Cohere®, NuVasive Inc., San Diego, CA), structural allograft, or smooth PEEK). After preop evaluation and surgery, patients were followed per standard of care 0.5, 1.5, 3, 6, and 12 months post-op. At each time, patient outcomes were measured by disability (Neck Disability Index) and pain (visual analogue score (VAS) neck/arm pain). Results: Patients treated with porous PEEK implants achieved significantly greater NDI and neck pain improvement by 6 weeks post-op when compared to patients receiving structural allograft or smooth PEEK devices. These significantly greater NDI and neck pain improvements for patients treated with porous PEEK devices compared to structural allograft and smooth PEEK were sustained through 12 months post-op. Conclusion: 12 month follow-up data in patients with degenerative disc disease and radiculopathy demonstrates a clear benefit of porous PEEK in promoting improved early outcomes over structural allograft and smooth PEEK in ACDF procedures.","PeriodicalId":90240,"journal":{"name":"Journal of spine & neurosurgery","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42331622","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 : 2019-02-22DOI: 10.4172/2325-9701.1000309
Van Groningen Nj, Wijffels Mme
Thoracic trauma is common and may vary from simple contusions to lethal injuries. Uncommon thoracic injury is a costovertebral luxation of the first rib. Up till now only one other case report has been written in 1980. Therefore a case with this injury is presented.
{"title":"Luxation of the First Costovertebral Joint after Trauma of the Thorax","authors":"Van Groningen Nj, Wijffels Mme","doi":"10.4172/2325-9701.1000309","DOIUrl":"https://doi.org/10.4172/2325-9701.1000309","url":null,"abstract":"Thoracic trauma is common and may vary from simple contusions to lethal injuries. Uncommon thoracic injury is a costovertebral luxation of the first rib. Up till now only one other case report has been written in 1980. Therefore a case with this injury is presented.","PeriodicalId":90240,"journal":{"name":"Journal of spine & neurosurgery","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-02-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44055363","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 : 2019-02-22DOI: 10.4172/2325-9701.1000315
Caroline Figueiredo da Silva, C. Machado, Heloisa da Silva Schafaschek, Andre Possamai, M. R. Lang, Julio Aguiar Junior, M. Gonçalves
The thoracic spinal cord is most vulnerable to compression due to the space restriction between the spine and the thoracic spinal canal, and progressive neurological deficit is common. Magnetic resonance imaging (MRI) allows for the diagnosis of vascular diseases, given that the presence of neurological deficit involves other differential diagnoses. This case study’s main goal is to report a case about spinal infarct with surgical procedure of spinal decompression and bring a brief overview of current literature.
{"title":"Spinal Ischemia Secondary to Central Spine Thoracic Hernia","authors":"Caroline Figueiredo da Silva, C. Machado, Heloisa da Silva Schafaschek, Andre Possamai, M. R. Lang, Julio Aguiar Junior, M. Gonçalves","doi":"10.4172/2325-9701.1000315","DOIUrl":"https://doi.org/10.4172/2325-9701.1000315","url":null,"abstract":"The thoracic spinal cord is most vulnerable to compression due to the space restriction between the spine and the thoracic spinal canal, and progressive neurological deficit is common. Magnetic resonance imaging (MRI) allows for the diagnosis of vascular diseases, given that the presence of neurological deficit involves other differential diagnoses. This case study’s main goal is to report a case about spinal infarct with surgical procedure of spinal decompression and bring a brief overview of current literature.","PeriodicalId":90240,"journal":{"name":"Journal of spine & neurosurgery","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-02-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42028093","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 : 2019-02-21DOI: 10.4172/2325-9701.1000312
A. Rahimizadeh, W. Williamson, Shaghayegh Rahimizadeh, Mahan Amirzadeh
Os odontoideum (OO) is defined as an ossicle with smooth circumferential cortical margins representing the odontoid process that has no osseous continuity with the body of the C2 vertebrae. This pathology usually becomes symptomatic in the second or third decade of life. Middle-age individuals display the second highest incidence. However, the discovery of an OO in elderly individuals over the age of 67 years is rather scarce and has been confined to only 11 recorded cases. Here in the authors present a new symptomatic patient possessing an OO who is elderly.
{"title":"Surgical Management of an Elderly Patient with Free Floating Os Odontoideum","authors":"A. Rahimizadeh, W. Williamson, Shaghayegh Rahimizadeh, Mahan Amirzadeh","doi":"10.4172/2325-9701.1000312","DOIUrl":"https://doi.org/10.4172/2325-9701.1000312","url":null,"abstract":"Os odontoideum (OO) is defined as an ossicle with smooth circumferential cortical margins representing the odontoid process that has no osseous continuity with the body of the C2 vertebrae. This pathology usually becomes symptomatic in the second or third decade of life. Middle-age individuals display the second highest incidence. However, the discovery of an OO in elderly individuals over the age of 67 years is rather scarce and has been confined to only 11 recorded cases. Here in the authors present a new symptomatic patient possessing an OO who is elderly.","PeriodicalId":90240,"journal":{"name":"Journal of spine & neurosurgery","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-02-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47797984","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 : 2019-02-21DOI: 10.4172/2325-9701.1000313
Soltani S, Nogaro Mc, Haleem S, Rupani N, Pyrovolou N, Kieser Dc
Study design: Systematic review Objectives: Understand the typical presentation, risk factors, location, size, treatment and outcome of spontaneous spinal epidural haematomas (SSEH). Methods: Systematic review of the English literature from 1 January 1960 to 1 March 2018. Individual patient data was extracted and collated. Outcome measures were mode of presentation, risk factors, initial neurological findings, presumed diagnosis, diagnostic investigations, site and size of the SSEH, treatment, neurological recovery and survival. Results: 160 publications (254 patients) were reviewed. Most patients (98%) presented with back pain and radicular pain. Pregnancy was common in those aged under 40years (24%), whereas anticoagulation therapy (30%) and hypertension (30%) was common in those aged 50-80years. Most patients present with neurological dysfunction. 15% were initially suspected of having an alternative diagnosis, including 7.5% who were suspected of ischaemia for which anti-coagulation therapy was either planned or given. MRI and/or CT myelogram was performed in 98% of cases. The mid-cervical spine and cervico-thoracic junction were most commonly affected and the average haematoma size extended across 5.4 vertebral levels. Most patients underwent surgical decompression (76%) and most improved their neurological function (85%). Conclusions: SSEH affects all age groups and presents with variable neurological signs sometimes mimicking cerebral or cardiac ischaemia. Cross-sectional spinal imaging with MRI or CT is diagnostic and avoids inappropriate anticoagulation therapy. Most SSEHs are located in the mid-cervical spine and cervico-thoracic junction and affect multiple spinal levels. Surgical intervention is not always indicated, but with appropriate management most patients will improve or resolve their neurological deficit.
{"title":"Spontaneous Spinal Epidural Haematomas in Adults: A Systematic Review","authors":"Soltani S, Nogaro Mc, Haleem S, Rupani N, Pyrovolou N, Kieser Dc","doi":"10.4172/2325-9701.1000313","DOIUrl":"https://doi.org/10.4172/2325-9701.1000313","url":null,"abstract":"Study design: Systematic review Objectives: Understand the typical presentation, risk factors, location, size, treatment and outcome of spontaneous spinal epidural haematomas (SSEH). Methods: Systematic review of the English literature from 1 January 1960 to 1 March 2018. Individual patient data was extracted and collated. Outcome measures were mode of presentation, risk factors, initial neurological findings, presumed diagnosis, diagnostic investigations, site and size of the SSEH, treatment, neurological recovery and survival. Results: 160 publications (254 patients) were reviewed. Most patients (98%) presented with back pain and radicular pain. Pregnancy was common in those aged under 40years (24%), whereas anticoagulation therapy (30%) and hypertension (30%) was common in those aged 50-80years. Most patients present with neurological dysfunction. 15% were initially suspected of having an alternative diagnosis, including 7.5% who were suspected of ischaemia for which anti-coagulation therapy was either planned or given. MRI and/or CT myelogram was performed in 98% of cases. The mid-cervical spine and cervico-thoracic junction were most commonly affected and the average haematoma size extended across 5.4 vertebral levels. Most patients underwent surgical decompression (76%) and most improved their neurological function (85%). Conclusions: SSEH affects all age groups and presents with variable neurological signs sometimes mimicking cerebral or cardiac ischaemia. Cross-sectional spinal imaging with MRI or CT is diagnostic and avoids inappropriate anticoagulation therapy. Most SSEHs are located in the mid-cervical spine and cervico-thoracic junction and affect multiple spinal levels. Surgical intervention is not always indicated, but with appropriate management most patients will improve or resolve their neurological deficit.","PeriodicalId":90240,"journal":{"name":"Journal of spine & neurosurgery","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-02-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46990384","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 : 2019-02-21DOI: 10.4172/2325-9701.1000310
S. Ganapathy, T. Ramakrishna, S. Gopal
First decribed by Sir Goeffrey Jefferson in London in 1924, the term Jefferson’s fracture has become an eponym for all fractures of the Atlas. Complex Jefferson fractures and unstable Jefferson fractures require surgical fusion to maintain stability of the spinal axis. This however results in debilitating loss of movement at the crucial C1C2 joint, the most versatile of spinal joints where stability and mobility are intricately balanced into a complex yet supremely agile structure. The desire to attempt in some way to preserve a degree of movement and to spare the patient the crippling loss of movement at this joint has led to many attempts at innovation, both surgical and technological. This has led to the discovery of C1 osteosynthesis. This revolutionary technique enables the anatomical fixation of the defect thus allowing motion preservation without compromising on stability, which is a major advantage given the extreme importance of both to the proper functioning of the C1C2 and C1C0 joints. We present a case report of a 54 year old man with an isolated Jefferson’s fracture which was treated successfully by this technique. We also present an overview of the biomechanics of C1 injury and the relevant review of literature regarding options for management of complex C1C2 injuries.
{"title":"C1 Arch Reconstruction: A Novel Alternative to Fusion in Maintaining Mobility of the Atlanto-Axial Joint","authors":"S. Ganapathy, T. Ramakrishna, S. Gopal","doi":"10.4172/2325-9701.1000310","DOIUrl":"https://doi.org/10.4172/2325-9701.1000310","url":null,"abstract":"First decribed by Sir Goeffrey Jefferson in London in 1924, the term Jefferson’s fracture has become an eponym for all fractures of the Atlas. Complex Jefferson fractures and unstable Jefferson fractures require surgical fusion to maintain stability of the spinal axis. This however results in debilitating loss of movement at the crucial C1C2 joint, the most versatile of spinal joints where stability and mobility are intricately balanced into a complex yet supremely agile structure. The desire to attempt in some way to preserve a degree of movement and to spare the patient the crippling loss of movement at this joint has led to many attempts at innovation, both surgical and technological. This has led to the discovery of C1 osteosynthesis. This revolutionary technique enables the anatomical fixation of the defect thus allowing motion preservation without compromising on stability, which is a major advantage given the extreme importance of both to the proper functioning of the C1C2 and C1C0 joints. We present a case report of a 54 year old man with an isolated Jefferson’s fracture which was treated successfully by this technique. We also present an overview of the biomechanics of C1 injury and the relevant review of literature regarding options for management of complex C1C2 injuries.","PeriodicalId":90240,"journal":{"name":"Journal of spine & neurosurgery","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-02-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42814681","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}
京公网安备 11010802042870号
京ICP备2023020795号-1
扫码关注我们
求助内容：
应助结果提醒方式：