RESUMEN
Background Self-locking stand-alone cages have increasingly been used in anterior cervical discectomy and fusion (ACDF) cervical degenerative disc disease. We studied clinical and radiological outcomes of patients who underwent zero-profile anchored spacer (ROI-C)-assisted ACDF without anterior plate fixation in cervical adjacent segment disease. Materials and Methods Fifteen patients suffering from cervical adjacent segment disease with various symptoms, such as radiculopathy, myelopathy, or both, were retrospectively evaluated. The cervical adjacent segment disease was confirmed by plain radiographs and magnetic resonance imaging. The patients underwent radiological evaluation to assess cervical curvature, intervertebral height, fusion, and subsidence. Clinical assessment was graded using a visual analog scale, Modified Japanese Orthopedic Association score, and the Neck Disability Index. Results There were 19 levels of operation. Single-level ACDF was performed in 11 patients and two level in 4 patients. In the postoperative period, our study revealed significant improvement in the clinical outcome. The cervical curvature and intervertebral height were significantly improved at 12-months follow-up ( p < 0.05). The fusion rate was 100%, whereas subsidence occurred in 5.3% but produced no symptoms. Of the 19 operated segment, 2 (5.3%) from 38 VerteBRIDGE plates had breakage. There was only one case of mild dysphagia, which resolved in less than 2 weeks. Conclusion This study indicates that zero-profile anchored spacer (ROI-C) in the treatment of cervical adjacent segment disease provides improvement of clinical outcomes, restoration of lordosis, high fusion rate, and low incidence of dysphagia. However, subsidence and breakage of VerteBRIDGE plate occurred in 5.3% cases, but did not cause clinical symptoms.
RESUMEN
Spontaneous regression of direct carotid-cavernous fistulas (CCFs) is extremely rare. Most of the patients with direct CCFs are usually treated using endovascular techniques. Spontaneous obliteration of the direct fistulas probably results from thrombosis of the venous drainage and/or cavernous sinus. We report spontaneous closure of nine direct CCFs in nine patients. From literature review, we found another 37 patients with 43 fistulas due to spontaneous obliteration of bilateral lesions in six cases. There was no spontaneous closure in large-sized fistula. The factors associated with spontaneous thrombosis of the fistulas may be low-flow and small-sized fistula, hypotension, severe ocular manifestations, dissections or spasm of carotid artery, and increased intracranial pressure. Spontaneous healing of direct traumatic CCFs should be confirmed with cerebral angiography. Conservative treatment of direct CCFs should be carefully restricted in patients with normal vision or minimal visual impairment, and the patients must be monitored closely for any changes in visual function. Prompt endovascular treatment for complete obliteration of the fistula should be performed in patients with rapidly progressive visual loss. Venous thrombosis can still effect vision and rerouting towards cortical veins remains a concern. Because spontaneous resolution cannot be reliably predicted, the fistula then should be treated rather than waiting for spontaneous thrombosis.
Asunto(s)
Fístula del Seno Cavernoso de la Carótida/diagnóstico por imagen , Fístula del Seno Cavernoso de la Carótida/etiología , Remisión Espontánea , Accidentes por Caídas , Accidentes de Tránsito , Adulto , Anciano , Angiografía Cerebral , Traumatismos Craneocerebrales/complicaciones , Femenino , Humanos , Angiografía por Resonancia Magnética , Imagen por Resonancia Magnética , Masculino , Persona de Mediana Edad , Tomografía Computarizada por Rayos XRESUMEN
We describe a patient with traumatic carotid-cavernous fistula (CCF), subsequently developing contralateral extensive hemorrhagic venous infarction from retrograde venous reflux into the opposite basal vein of Rosenthal. A 54-year-old woman was involved in a motor vehicle accident and sustained severe traumatic brain injury. Two months later, she developed bilateral proptosis and audible bruit. Magnetic resonance imaging (MRI) and magnetic resonance angiography (MRA) of the brain demonstrated the right direct CCF. Fluid-attenuated inversion recovery (FLAIR) images showed a small hyperintense area at the left basal ganglia. Ten days later, she developed right-sided grade 2/5 hemiparesis, facial upper motor neuron weakness, and cognitive impairment. Follow-up MRI showed significant progression of hyperintensities involving the left-sided centrum semiovale, basal ganglia, thalamus, midbrain, pons, cerebellum, basal frontal, temporal lobes, especially subcortical white matter on FLAIR images, and multiple hypointense foci of hemorrhagic component on T2*-weighted gradient-echo images, representing hemorrhagic venous infarction. While waiting for embolization, she rapidly developed right hemiplegia and aphasia, and became somnolent. Under general anesthesia, emergency endovascular treatment was performed successfully to obliterate the fistula without surgical intervention. Five months after endovascular treatment, MRI and MRA confirmed no residual fistula and revealed nearly complete resolution of abnormal increased signal intensity. In the present case, the factors related to the presence of this rare condition were absence of the ipsilateral basal vein of Rosenthal (BVR), occlusion of posterior segment of the contralateral superior petrosal sinus, and a developed uncal vein with hypoplastic second and third segments of the contralateral BVR.