RESUMEN
In the present case of postoperative lumbar spinal stenosis after non-instrumented intertransverse fusion with granules of hydroxyapatite (HA), bone union was not completed and the patient felt the recurrence of his symptoms within two years. We performed re-decompression with fusion, and in hematoxylin and eosin staining of HA granulation harvested during revision surgery, fibrous tissue with hyaline degeneration surrounded the cavity where the HA had existed. Multinuclear giant cells and lymphocytes infiltrated some parts of the marginal layer of the cavity, and no obvious bony bridge had regenerated from autologous bone. No tartrate-resistant acid phosphate (TRAP) -positive osteoclasts could be seen in the new bone, suggesting that the activity of osteoclasts in the new bone decreased during the seven years after the primary surgery. VIRTUAL SLIDES: The virtual slide(s) for this article can be found here: http://www.diagnosticpathology.diagnomx.eu/vs/3483360258050263.
Asunto(s)
Durapatita/efectos adversos , Vértebras Lumbares/cirugía , Fusión Vertebral/efectos adversos , Estenosis Espinal/inducido químicamente , Estenosis Espinal/cirugía , Anciano , Descompresión Quirúrgica , Células Gigantes/patología , Humanos , Inmunohistoquímica , Vértebras Lumbares/diagnóstico por imagen , Vértebras Lumbares/patología , Linfocitos/patología , Masculino , Osteoclastos/patología , Recurrencia , Reoperación , Estenosis Espinal/diagnóstico por imagen , Estenosis Espinal/patología , Coloración y Etiquetado , Factores de Tiempo , Tomografía Computarizada por Rayos X , Insuficiencia del TratamientoRESUMEN
BACKGROUND: Mechanisms underlying the development of noncommunicating syringomyelia are poorly understood. OBJECTIVE: To assess the influence of focal arachnoiditis and central canal (CC) occlusion (CCO) on the formation of noncommunicating syringomyelia in the adult rat cervical spinal cord. Expression of pericanalicular aquaporin-4 is also examined. METHODS: Sprague-Dawley rats were subjected to circumferential or dorsal arachnoiditis (n = 34). Rats undergoing CCO (n = 69) were divided into 4 groups: group A, kaolin injection at a single site in the dorsal columns near the CC; group B, kaolin injection at multiple sites in the dorsal columns near the CC; group C, saline injection at multiple sites in the dorsal columns near the CC; or group D, controls. Rats were killed at 1, 4, 8, and 12 weeks. The CC area and aquaporin-4 (AQP4) expression were measured at the level of maximal CC enlargement. RESULTS: Circumferential and dorsal arachnoiditis induced a mild increase in the CC area at 12 weeks. Single-site CCO induced slight CC enlargement. In contrast, multiple sites of CCO in proximity frequently induced a major expansion of the CC area (up to 50 times). Increased AQP4 expression was observed in pericanalicular astrocytes proportional to the degree of CC expansion. CONCLUSION: Multiple sites of CCO created a model of noncommunicating syringomyelia in adult rats. Increased astrocytic AQP4 expression was proportional to the degree of CC expansion. Modulation of aquaporin expression may be a novel target for therapeutic interventions to prevent syringomyelia.
Asunto(s)
Canal Medular/patología , Estenosis Espinal/complicaciones , Siringomielia/etiología , Animales , Acuaporina 4/metabolismo , Aracnoiditis/inducido químicamente , Aracnoiditis/complicaciones , Vértebras Cervicales , Modelos Animales de Enfermedad , Femenino , Regulación de la Expresión Génica/efectos de los fármacos , Caolín/toxicidad , Laminectomía , Ratas , Ratas Sprague-Dawley , Estenosis Espinal/inducido químicamente , Factores de TiempoRESUMEN
STUDY DESIGN: A retrospective review. OBJECTIVE: The purpose of this study is to document a series of cases of neurologic deficit following percutaneous vertebral stabilization, to identify patterns of neurologic injury, and to describe potential methods for avoiding these injuries. SUMMARY OF BACKGROUND DATA: Percutaneous vertebral stabilization procedures, including vertebroplasty and kyphoplasty, have become a widely used for the treatment of osteoporotic vertebral compression fractures, primary and metastatic vertebral tumors, and traumatic burst fractures. Despite an increasing array of indications, there have been few reports of adverse events. Neurologic complications associated with vertebroplasty and kyphoplasty have been described previously as case reports and have generally been considered as infrequent and minor in severity. METHODS: The clinical course of 14 patients with documented loss of neurologic function following percutaneous vertebral cement augmentation was retrospectively reviewed. RESULTS: The average patient age was 74.9 years (range, 46-88 years) with 3 male and 11 female patients. Four patients underwent a vertebroplasty procedure while 10 were treated with kyphoplasty. Six patients developed neurologic deficits acutely (<24 hours of procedure). The remaining 8 patients developed neurologic symptoms at an average of 37.1 days (range, 3-112 days) postprocedure. Neurologic deficits were recorded as ASIA A in 4 patients, ASIA B in 2 patients, ASIA C in 1 patient, and ASIA D in 7 patients. Twelve of 14 patients (85.7%) required revision open surgical intervention for treatment of their neurologic injury. CONCLUSION: Percutaneous vertebroplasty and kyphoplasty have been reported to be safe options for the treatment of painful osteoporotic vertebral fractures. Although complications are infrequent, there remains the potential for catastrophic neurologic injury. Physicians performing these procedures need to be aware of these potential complications and be prepared to respond in an emergent manner (surgically) if a need arises.
Asunto(s)
Procedimientos Neuroquirúrgicos/efectos adversos , Procedimientos de Cirugía Plástica/efectos adversos , Polimetil Metacrilato/efectos adversos , Complicaciones Posoperatorias/inducido químicamente , Compresión de la Médula Espinal/inducido químicamente , Fracturas de la Columna Vertebral/tratamiento farmacológico , Fracturas de la Columna Vertebral/cirugía , Administración Cutánea , Anciano , Anciano de 80 o más Años , Femenino , Humanos , Masculino , Persona de Mediana Edad , Polimetil Metacrilato/administración & dosificación , Polimetil Metacrilato/uso terapéutico , Complicaciones Posoperatorias/diagnóstico por imagen , Complicaciones Posoperatorias/patología , Presión/efectos adversos , Radiculopatía/inducido químicamente , Radiculopatía/diagnóstico por imagen , Radiculopatía/patología , Radiografía , Reoperación , Estudios Retrospectivos , Canal Medular/diagnóstico por imagen , Canal Medular/efectos de los fármacos , Canal Medular/patología , Compresión de la Médula Espinal/diagnóstico por imagen , Compresión de la Médula Espinal/patología , Fracturas de la Columna Vertebral/inducido químicamente , Estenosis Espinal/inducido químicamente , Estenosis Espinal/diagnóstico por imagen , Estenosis Espinal/patología , Columna Vertebral/diagnóstico por imagen , Columna Vertebral/patología , Columna Vertebral/cirugíaRESUMEN
Thoracic ossification of ligamentum flavum (OLF) caused by skeletal fluorosis is rare. Only six patients had been reported in the English literature. This study reports findings from the first clinical series of this disease. This was a retrospective study of patients with thoracic OLF due to skeletal fluorosis who underwent surgical management at the authors' hospital between 1993 and 2003. Diagnosis of skeletal fluorosis was made based on the epidemic history, clinical symptoms, radiographic findings, and urinalysis. En bloc laminectomy decompression of the involved thoracic levels was performed in all cases. Cervical open door decompression or lumbar laminectomy decompression was performed if relevant stenosis was present. Neurological status was evaluated preoperatively, at the third day postoperatively, and at the end point of follow-up using the Japanese Orthopaedic Association (JOA) scoring system of motor function of the lower extremities. A total of 23 cases were enrolled, 16 (69.6%) males and 7 (30.4%) females, age ranging from 42 to 72 years (mean 54.8 years). All patients came from a high-fluoride area, and 22 (95.7%) had dental fluorosis. Medical imaging showed OLF together with ossification of many ligaments and interosseous membranes, including interosseous membranes of the forearm (18/23 patients 78.3%), leg (14/23 patients 60.9%), and ribs (11/23 patients 47.8%). OLF was classified into five types based on MRI findings: localized (4/23 patients 17.4%), continued (12/23 patients 52.2%), skip (3/23 patients 13.0%), combining with anterior pressure (2/23 patients 8.7%), and combining with cervical and/or lumbar stenosis (2/23 patients, 8.7%). Urinalysis showed a markedly high urinary fluoride level in 14 of 23 patients (60.9%). Patients were followed up for an average duration of 4 years, 5 months. Paired t-test showed that the JOA score was slightly but nonsignificantly increased relative to preoperative measurement 3 days after surgery (P = 0.0829) and significantly increased at the end of follow-up (P = 0.0001). In conclusion, Fluorosis can cause ossification of thoracic ligamentum flavum, as well as other ligaments. Comparing with other OLF series, a larger number of spinal segments were involved. The diagnosis of skeletal fluorosis was made by the epidemic history, clinical symptom, imaging study findings, and urinalysis. En bloc laminectomy decompression was an effective method.