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BACKGROUND: Lung perfusion defects (PDs) have been described in COVID-19 using dual-energy computed tomography pulmonary angiography (DE-CTPA). We assessed the prevalence and characteristics of PDs in COVID-19 patients with suspected pulmonary embolism (PE) and negative CTPA. METHODS: This retrospective study included COVID-19 and non-COVID-19 pneumonia groups of patients with DE-CTPA negative for PE. Two radiologists rated the presence of PD within the lung opacities and analyzed the type of lung opacities and PD pattern (i.e. homogeneous or heterogeneous). The clinical, biological, radiological characteristics including time from first symptoms and admission to DE-CTPA, oxygen requirements, CRP, D-dimer levels, duration of hospital admission and death were compared within the COVID-19 group between patients with (PD +) or without PD (PD-). RESULTS: 67 COVID-19 and 79 non-COVID-19 patients were included. PDs were more frequent in the COVID-19 than in the non-COVID-19 group (59.7% and 26.6% respectively, p < 0.001). Patterns of PDs were different, with COVID-19 patients exhibiting heterogenous PDs (38/40, 95%) whereas non-COVID-19 patients showed mostly homogeneous perfusion defects (7/21 heterogeneous PDs, 33%), p < 0.001. In COVID-19 patients, most consolidations (9/10, 90%) exhibited PDs while less than a third of consolidations (19/67, 28%) had PDs in non-COVID-19 patients. D-dimer, oxygen levels and outcome were similar between COVID-19 PD + and PD- patients; however, time between admission and DE-CTPA was longer in PD + patients (median [IQR], 1 [0-7] and 0 [0-2]; p = 0.045). CONCLUSION: Unlike in bacterial pneumonia, heterogeneous PDs within lung opacities are a frequent feature of COVID-19 pneumonia in PE-suspected patients.
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BACKGROUND: Minimally invasive spine (MIS) fusion is an increasingly common procedure, with advantages over open approach in the form of minimal dissection and superior early clinical outcome. The frequency of complications is known, but the most appropriate surgical revision for this technique remains unclear. HYPOTHESIS: The main hypothesis was that early revision surgery, for acute complications after MIS, was possible through mini-invasive approach. METHODS: A retrospective study of patients undergoing MIS has been performed, with or without transforaminal interbody fusion (TLIF) using specific navigation and ancillary. All surgical revisions were done by minimally invasive approach. Preoperative and surgical data, as well as postoperative complications have been analyzed. The primary endpoint was clinical outcome obtained after surgical revision. RESULTS: Data of 187 patients undergoing MIS procedure at 1-4 levels was analyzed. The rate of early revision (within one month) was 5.3%: 0.5% for infection, 1.6% for compressive hematoma, and 2.1% for misplaced screw. The use of intraoperative navigation decreased the frequency of screw misplacement from 4.5% to 1.4%. The rate of surgical revision was 7.8% for surgeons in their learning curve and 3.6% for experienced surgeons. DISCUSSION: On these large series, MIS early revision rates were lower than previously reported for conventional fusions. Surgeon's experience in MIS procedures seems to be crucial to decrease revision and complications rates. Hemorrhagic complications led to multidisciplinary discussions and the establishment of a management protocol. Surgical revisions can be performed by minimally invasive techniques, regardless of the indication. LEVEL OF EVIDENCE: IV, retrospective study.