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INTRODUCTION: Spinal tumors (ST) often result in dire prognosis, carrying risks such as permanent paralysis, sensory loss, and sphincter dysfunction. Data on their incidence and etiology in pediatric populations are markedly scant. Our study investigates the etiology, clinical manifestation, treatment, and outcomes of pediatric ST. METHODS: We conducted a retrospective review of our institutional pediatric oncology and neurosurgery database, examining 14 patients under 18 years admitted with ST due to oncological diseases since 2005. We analyzed the clinical presentations, evaluations, molecular diagnostics and treatments for these patients. RESULTS: The study spanned 15 years and included 14 pediatric patients, each diagnosed with distinct spinal tumor entity. The mean patient age was approximately 19.6 ± 10.1 months. Severe axial pain along the vertebral column was observed in 13 patients, while acute neurological deterioration manifested in 7 patients. As a first-line intervention, 13 patients underwent decompressive surgery through laminectomy and tumor resection, and only one patient received chemotherapy solely. Before surgery, seven patients were unable to walk; post-surgery, six of them regained their ability to ambulate. The diagnosis encompassed a range of neoplasms: two instances of Ewing sarcoma, 3 instances of teratoma, one case presenting an atypical teratoid Rhabdoid tumor, two instances each of low-grade astrocytoma and neuroblastoma, and single instances of ependymoma, meningioma, rhabdomyosarcoma, and embryonal tumors with multilayered rosettes (ETMRs). Three patients succumbed two years after initiating therapy. CONCLUSION: Despite their rarity, intraspinal tumors in pediatric patients pose substantial therapeutic challenges. The intertwined complexities of the disease entity and the patient's neurological status demand swift initiation of an individualized therapeutic strategy. This crucial step helps optimize outcomes for this patient cohort, who frequently grapple with debilitating health conditions. Inclusion of these patients within a registry is mandatory to optimize treatment outcomes due to their rarity in pediatric population.
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Neoplasias de la Columna Vertebral , Humanos , Masculino , Femenino , Estudios Retrospectivos , Preescolar , Niño , Lactante , Adolescente , Resultado del Tratamiento , Neoplasias de la Columna Vertebral/cirugía , Neoplasias de la Columna Vertebral/complicaciones , Sarcoma de Ewing/cirugía , Sarcoma de Ewing/terapia , Sarcoma de Ewing/complicaciones , Neoplasias de la Médula Espinal/cirugía , Neoplasias de la Médula Espinal/complicaciones , Ependimoma/terapia , Ependimoma/cirugía , Ependimoma/diagnóstico , Laminectomía , Descompresión Quirúrgica/métodos , Teratoma/complicaciones , Teratoma/cirugía , Teratoma/diagnóstico , Teratoma/terapia , Procedimientos Neuroquirúrgicos/métodos , Neuroblastoma/cirugía , Neuroblastoma/complicaciones , Astrocitoma/complicaciones , Astrocitoma/cirugía , Astrocitoma/terapia , Tumor Rabdoide/terapia , Tumor Rabdoide/complicaciones , Meningioma/cirugía , Meningioma/terapia , Meningioma/complicaciones , Meningioma/diagnósticoRESUMEN
BACKGROUND: Unilateral laminotomy for bilateral decompression (ULBD) has yielded positive results in the treatment of lumbar spinal stenosis (LSS). Unilateral biportal ULBD (UB-ULBD) and percutaneous endoscopic ULBD (PE-ULBD) are gaining popularity because of the progress that has been made in minimally invasive surgery (MIS). The objective of this study was to evaluate and compare the radiographic and clinical results of UB-ULBD and PE-ULBD. METHODS: This study retrospectively enrolled patients who underwent ULBD surgery for LSS. The patients were categorized into two groups on the basis of the surgical method: the UB-ULBD group and the PE-ULBD group. Data on the general demographic data, surgical details, clinical efficacy, radiography and complications were compared between the two groups were compared. The minimum follow-up duration was 12 months. RESULTS: A total of 113 LSS patients who had undergone ULBD at our institution were included, of whom 61 patients underwent UB-ULBD surgery and 52 underwent PE-ULBD surgery. The UB-ULBD group had a significantly shorter operation time (P < 0.05). The facet was significantly better preserved in the UB-ULBD group than in the PE-ULBD group, and the angle of ipsilateral facet joint resection in the UE-ULBD group was significantly smaller (P < 0.05). The ODI score, VAS score and modified Macnab criteria improved postoperatively in both groups. The UB-ULBD group had a 95.08% rate of excellent or good patient outcomes, whereas the PE-ULBD group had a 92.30% rate. CONCLUSION: Both UB-ULBD and PE-ULBD can provide favourable clinical outcomes when used to treat LSS. UB-ULBD is beneficial because of its shorter operation time, smaller angle of ipsilateral facet joint resection and better facet preservation, making it a viable and safe option for treating LSS while ensuring spinal stability.
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Descompresión Quirúrgica , Endoscopía , Laminectomía , Vértebras Lumbares , Estenosis Espinal , Humanos , Estenosis Espinal/cirugía , Estenosis Espinal/diagnóstico por imagen , Femenino , Masculino , Estudios Retrospectivos , Descompresión Quirúrgica/métodos , Laminectomía/métodos , Persona de Mediana Edad , Anciano , Vértebras Lumbares/cirugía , Vértebras Lumbares/diagnóstico por imagen , Resultado del Tratamiento , Endoscopía/métodos , Estudios de Seguimiento , Tempo OperativoRESUMEN
INTRODUCTION: Ligamentum flavum haematoma (LFH) is an extremely rare entity, found mostly in the lumbar and thoracic ligamentum flavum and seldom in the cervical ligamentum flavum. Cervical LFH can cause paralysis in patients. We describe a case of LFH in the cervical spine that accepted surgical treatment. CASE PRESENTATION: A 70-year-old man with incomplete spinal cord injury presented with sudden paralysis of his left limbs for 10 days and hemi-hypaesthesia below the level of the right clavicle. Magnetic resonance imaging (MRI) showed a space-occupying lesion in the left ligamentum flavum between the C4 and C5 laminae. The preliminary diagnoses were concluded to be incomplete spinal cord injury, spinal epidural lesions, and cervical spinal stenosis. After a posterior C3-C6 laminectomy with lateral mass screw instrumentation, the muscle strength and sensation recovered partially. The lesion was greyish black and located in the ligamentum flavum. A pathological examination identified it as a haematoma of the ligamentum flavum. The patient was discharged 15 days after the operation and commenced rehabilitation. DISCUSSION: The LFH was mainly caused by slight trauma during gentle activities and contributed by many factors. MRI is an essential tool but pathological diagnosis is the gold standard. Most LFH patients can be treated surgically.
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Vértebras Cervicales , Hematoma , Ligamento Amarillo , Anciano , Humanos , Masculino , Vértebras Cervicales/diagnóstico por imagen , Vértebras Cervicales/cirugía , Hematoma/diagnóstico por imagen , Hematoma/etiología , Hematoma/cirugía , Laminectomía/métodos , Ligamento Amarillo/patología , Ligamento Amarillo/diagnóstico por imagen , Ligamento Amarillo/cirugía , Imagen por Resonancia Magnética , Traumatismos de la Médula Espinal/complicaciones , Traumatismos de la Médula Espinal/diagnóstico por imagen , Traumatismos de la Médula Espinal/cirugíaRESUMEN
Conventional open laminectomy has long been considered one of the important surgical options for lumbar central stenosis owing to its positive outcomes. However, newer approaches have emerged as alternatives, including full-endoscopic and biportal endoscopic laminectomy. Therefore, a comparison of the outcomes that are associated with each of these surgical methods is warranted. This prospective multicenter trial, initiated in February 2019, compared the outcomes of three lumbar central stenosis surgical approaches: open laminectomy (OPEN), uniportal endoscopy (UNIPORT), and biportal endoscopy (BIPORT). Among 115 participants from seven centers, one-year follow-ups assessed laboratory, radiological, and clinical outcomes. Despite all groups showing adequate decompression and clinical improvement, the OPEN group exhibited less improvement in Visual analog scale (VAS) for back pain scores (p < 0.05) and significant postoperative increases in most laboratory markers. Furthermore, the OPEN group experienced a significant decrease in multifidus muscle cross-sectional area compared to endoscopic groups (p < 0.001). Each surgical techniques produced similar clinical outcomes and dural space expansion. However, endoscopic surgery was associated with better muscle preservation and better relief of back pain. Endoscopic surgery is a reasonable alternative to conventional laminectomy for treating lumbar central stenosis.This trial was registered on CRIS (Clinical Research Information Service, KCT0004355).
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Descompresión Quirúrgica , Endoscopía , Laminectomía , Vértebras Lumbares , Estenosis Espinal , Humanos , Laminectomía/métodos , Estenosis Espinal/cirugía , Masculino , Descompresión Quirúrgica/métodos , Femenino , Vértebras Lumbares/cirugía , Endoscopía/métodos , Estudios Prospectivos , Anciano , Persona de Mediana Edad , Resultado del TratamientoRESUMEN
INTRODUCTION: Biportal endoscopic spine surgery (BESS) has gained traction for lumbar laminectomy and diskectomy. To justify the transition to BESS, outcomes and the surgical learning curve should be known. This study evaluates rates of complications with BESS and how these rates change with increased surgeon experience. METHODS: A single surgeon's consecutive patients who underwent BESS were evaluated. Patients older than 18 years who underwent BESS for lumbar laminectomy and diskectomy were included. Patients with previous spine surgery, multiple levels, or BESS for fusion were excluded. Demographics, length of surgery, intraoperative complications, postoperative complications, and revision surgery were recorded. The learning phase group and mastery phase group were based on a cumulative summation analysis based on surgical time. RESULTS: A total of 63 patients, with 31 and 32 patients in the learning and mastery group, respectively, were included. Surgical time decreased from 87 to 52 minutes in the mastery phase. Conversion to open decreased from 3 to 0 cases (P = 0.1803), intraoperative complications decreased from 3 to 0 (P = 0.1803), postoperative complications decreased from 7 to 2 (P = 0.017), and rates of revision surgery decreased from 4 to 1 (P = 0.4233). CONCLUSION: This study suggests a learning curve of 31 cases for adequate performance of BESS for lumbar laminectomy and diskectomy.
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Discectomía , Endoscopía , Laminectomía , Curva de Aprendizaje , Vértebras Lumbares , Tempo Operativo , Complicaciones Posoperatorias , Humanos , Laminectomía/métodos , Masculino , Femenino , Vértebras Lumbares/cirugía , Persona de Mediana Edad , Discectomía/métodos , Adulto , Anciano , Estudios Retrospectivos , Resultado del Tratamiento , Competencia Clínica , Reoperación , Estados UnidosRESUMEN
Intraosseous occurrence of a spinal AVM is anecdotal, with only four such cases reported previously. This is the first report of a spinal intraosseous AVM in the cervical vertebrae. A 44-year-old male patient presented with a 2-month history of progressive quadriparesis and bladder dysfunction. Magnetic resonance imaging showed multiple flow voids within the C4 and C5 vertebral bodies, and an extradural component causing cord compression. CT showed extensive bony destruction at both levels. The diagnosis of an intraosseous AVM was confirmed with spinal angiography. The AVM was noted to be fed by branches from the ascending cervical arteries and the vertebral artery. The nidus was draining into the vertebral venous plexus and thence into the jugular vein through the marginal sinus. The patient underwent partial embolization of the AVM. Surgical resection was attempted but found to be unfeasible due to torrential bleeding. A 360-degree stabilization along with decompressive laminectomies was performed, resulting in clinical improvement and disease stabilization at one year follow-up. The case and its management dilemmas are discussed in light of a brief literature review.
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Malformaciones Arteriovenosas , Vértebras Cervicales , Embolización Terapéutica , Humanos , Masculino , Adulto , Vértebras Cervicales/cirugía , Vértebras Cervicales/diagnóstico por imagen , Malformaciones Arteriovenosas/diagnóstico por imagen , Malformaciones Arteriovenosas/cirugía , Malformaciones Arteriovenosas/terapia , Embolización Terapéutica/métodos , Arteria Vertebral/diagnóstico por imagen , Arteria Vertebral/cirugía , Arteria Vertebral/anomalías , Compresión de la Médula Espinal/cirugía , Compresión de la Médula Espinal/etiología , Compresión de la Médula Espinal/diagnóstico por imagen , Resultado del Tratamiento , Imagen por Resonancia Magnética , Laminectomía/métodos , Descompresión Quirúrgica/métodosRESUMEN
The authors report their experience with twenty-one consecutive patients who presented with symptoms and imaging characteristics of a herniated lumbar disc; of whom, at the time of surgery had a vascular loop instead. The procedure was performed on 14 women and seven men with a mean age of 39 years. Clinical complaints included lumbar aching with one limb overt radiculopathy in all patients; with additional sphincter dysfunction in two cases. Symptoms had developed within a mean period of three months. In all patients, the disc was exposed through an L5-S1 (n = 10); L4-L5 (n = 5) and L3-L4 (n = 6) open minimal laminotomy. In 16 patients, rather than a herniated disc they had a lumbar epidural varix, while an arterio-venous fistula was found in the remaining five cases. In all cases, the vascular disorder was resected and its subjacent disc was left intact. One patient had a postoperative blood transfusion. While the radiculopathy dysfunction improved in all patients, four patients reported lasting lumbar pain following surgery. The postoperative imaging confirmed the resolution of the vascular anomaly and an intact disc. The mean length of the follow-up period was 47 months. Either epidural varix or arterio-venous fistula in the lumbar area may mimic a herniated disc on imaging studies. With the usual technique they can be operated safely. Resection of the anomaly can be sufficient for alleviating radiculopathy symptoms.
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Desplazamiento del Disco Intervertebral , Vértebras Lumbares , Humanos , Desplazamiento del Disco Intervertebral/cirugía , Desplazamiento del Disco Intervertebral/diagnóstico , Masculino , Adulto , Femenino , Vértebras Lumbares/cirugía , Persona de Mediana Edad , Radiculopatía/cirugía , Radiculopatía/diagnóstico , Imagen por Resonancia Magnética , Diagnóstico Diferencial , Laminectomía/métodos , Adulto Joven , Fístula Arteriovenosa/cirugía , Fístula Arteriovenosa/diagnósticoRESUMEN
BACKGROUND: Minimally invasive hemilaminectomy is a safe and effective alternative to open laminectomy for treating intradural extramedullary tumors. There are no reports of postoperative kyphosis after this approach. This study aims to determine whether performing minimally invasive spine surgery hemilaminectomy for intradural extramedullary tumors can prevent the development of postlaminectomy kyphosis (PLK) or lordosis loss. MATERIAL AND METHODS: Sixty-five patients with spinal intradural extramedullary tumors who underwent minimally invasive hemilaminectomy surgery and complete pre and postoperative radiologic imaging were included. The effect of the surgical approach on the spinal sagittal axis was assessed by comparing pre- versus postoperative segmental and local Cobb angles at different spinal levels, considering anatomical localization (cervical, thoracic, lumbar, and transition segments) and functional features (mobile, semi-rigid, and transition segments), as well as the extent of the surgical approach (1, 2, or 3 levels) and follow-up. RESULTS: None of the patients had an increase in thoracic kyphosis nor a loss of cervical or lumbar lordosis greater than or equal to 10° after undergoing the minimally invasive spine surgery hemilaminectomy approach. More than 5° of increase in kyphosis was detected on 7.4% and 11.1%, for the segmental and the local angles, respectively; meanwhile, for patients with loss of lordosis, this deviation was detected in 5.3%, for both angles. The occurrence of PLK was more common than that of lordosis loss, but mainly manifested in postoperative angle impairment of less than 5°. No significant differences were evidenced, considering the approach length. CONCLUSIONS: Hemilaminectomy represents a promising approach for preventing PLK and postlaminectomy lordosis loss following intradural extramedullary tumor resection.
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Cifosis , Laminectomía , Lordosis , Procedimientos Quirúrgicos Mínimamente Invasivos , Complicaciones Posoperatorias , Neoplasias de la Médula Espinal , Humanos , Laminectomía/métodos , Laminectomía/efectos adversos , Masculino , Persona de Mediana Edad , Femenino , Procedimientos Quirúrgicos Mínimamente Invasivos/métodos , Lordosis/cirugía , Lordosis/diagnóstico por imagen , Lordosis/prevención & control , Anciano , Adulto , Cifosis/cirugía , Cifosis/prevención & control , Cifosis/etiología , Cifosis/diagnóstico por imagen , Complicaciones Posoperatorias/prevención & control , Complicaciones Posoperatorias/etiología , Neoplasias de la Médula Espinal/cirugía , Neoplasias de la Médula Espinal/diagnóstico por imagen , Estudios Retrospectivos , Adulto JovenRESUMEN
In recent years, there has been growing interest in an alternative approach for treating TOLF, such as endoscopic decompression, which minimizes the disruption of surrounding tissues. It is important to understand the advantages, disadvantages, and potential differences in outcomes associated with each approach. This comparative study aims to evaluate and contrast the effectiveness, safety, and outcomes of these two surgical techniques, open laminectomy and endoscopic decompression, in the management of thoracic OLF. The literature review was conducted on Embase, PubMed, Scopus and Google Scholar databases. After a thorough screening of all search results, 14 studies were shortlisted, from which data was extracted, and statistical analysis was done. Pooled analysis was done to ascertain the intra-operative and post-operative outcomes after surgery for TOLF. Overall, 351 patients were included in the study for evaluation. 174 patients were operated on by open laminectomy, and 177 patients were seen in the endoscopy group. Decreased operative time was seen in the endoscopic subgroup. The mean length of hospital stay of 6.6 days. Both groups showed improvement in mJOA and VAS score. The recovery rate for the reported study cohort was 66.8%, with the Endoscopic surgical approach showing a positive correlation with the mean recovery rate. The dural tear was the most common complication, with a rate of 6.6%. The mean estimated infection rate was 2.7% and postoperative CSF leak was 3.7%, with a trend of significantly higher rates in the open subgroup. Both of the groups showed improvement in functional scores, VAS scores, and cross-sectional area. However, the Endoscopic decompression group experienced reduced hospital stays, operating times, and intraoperative blood loss. The most frequent side effects were CSF leak and dural tear. A few cases showed revision and infection. None of the problems differed between the groups.
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Descompresión Quirúrgica , Laminectomía , Ligamento Amarillo , Vértebras Torácicas , Humanos , Descompresión Quirúrgica/métodos , Endoscopía/métodos , Laminectomía/métodos , Ligamento Amarillo/cirugía , Neuroendoscopía/métodos , Osificación Heterotópica/cirugía , Complicaciones Posoperatorias/epidemiología , Vértebras Torácicas/cirugía , Resultado del TratamientoRESUMEN
STUDY DESIGN: A systematic review and Bayesian network meta-analysis (NMA). OBJECTIVE: To compare the effectiveness and safety of different posterior decompression techniques for LSS. Lumbar spinal stenosis (LSS) is one of the most common degenerative spinal diseases that result in claudication, back and leg pain, and disability. Currently, posterior decompression techniques are widely used as an effective treatment for LSS. METHODS: An electronic literature search was performed using the EMBASE, Web of Science, PubMed, and Cochrane Library databases. Two authors independently performed data extraction and quality assessment. A Bayesian random effects model was constructed to incorporate the estimates of direct and indirect treatment comparisons and rank the interventions in order. RESULTS: In all, 14 eligible studies comprising 1,260 patients with LSS were included. Five interventions were identified, namely, spinal processes osteotomy (SPO), conventional laminotomy/laminectomy (CL), unilateral laminotomy/laminectomy (UL), bilateral laminotomy/ laminectomy (BL), and spinous process-splitting laminotomy/laminectomy (SPSL). Among these, SPO was the most promising surgical option for decreasing back and leg pain and for lowering the Oswestry Disability Index (ODI). SSPL had the shortest operation time, while SPSL was associated with maximum blood loss. SPO and UL were superior to other posterior decompression techniques concerning lesser blood loss and shorter length of hospital stay, respectively. Patients who underwent BL had the lowest postoperative complication rates. CONCLUSION: Overall, SPO was found to be a good surgical choice for patients with LSS.
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Teorema de Bayes , Descompresión Quirúrgica , Vértebras Lumbares , Metaanálisis en Red , Estenosis Espinal , Estenosis Espinal/cirugía , Humanos , Descompresión Quirúrgica/métodos , Vértebras Lumbares/cirugía , Resultado del Tratamiento , Laminectomía/métodosRESUMEN
To investigate the early efficacy and safety of unilateral biportal endoscopic posterior total laminectomy decompression in the treatment of cervical stenosis (CS). The clinical data of 28 patients with CS treated by unilateral biportal endoscopic posterior total laminectomy decompression from January 2021 to October 2022 in the Henan NO.3 Provincial People's Hospital were retrospectively analyzed. Of the patients, 16 were male and 12 were female, the mean age was (55.6±9.6) years. The CS occurred at C3-4 level in 1 cases, at C4-5 level in 3 cases, at C5-6 level in 16 cases and at C6-7 level in 8 cases. Each case was compared at the moment of pre-operation and final follow-up by the Japanese Orthopedic Association (JOA) score. The postoperative complications were recorded. The JOA improvement rate was computed at the final follow-up. As a result, all patients underwent successful surgery and were followed up for (11.6±4.7) months. The operation time was (43.0±5.3) min. Intraoperative blood loss (7.9±2.8) ml; Postoperative drainage volume (8.1±2.3) ml. The JOA score increased from 7.9±1.2 before surgery to 13.5±1.3 six months after surgery, and it was 13.7±1.2 at the last follow-up, the differences between postoperative and preoperative were both statistically significant (both P<0.001). No complications occurred, such as cerebrospinal fluid leakage, nerve injury and intraspinal hematoma. At the last follow-up, cervical spine X-ray or CT evaluation showed no instability in the operative segment. The overall curative effect was evaluated according to JOA score at the last follow-up: 16 cases got excellent outcome, 7 cases got good and 2 cases got medium outcome, with an excellent and good rate of 89.3% (25/28). This study shows that unilateral biportal endoscopic posterior total laminectomy decompression in the treatment of single-level cervical stenosis can achieve satisfactory efficacy, has no impact on spinal stability, and has a high safety.
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Vértebras Cervicales , Descompresión Quirúrgica , Endoscopía , Laminectomía , Estenosis Espinal , Humanos , Femenino , Masculino , Persona de Mediana Edad , Descompresión Quirúrgica/métodos , Laminectomía/métodos , Estudios Retrospectivos , Estenosis Espinal/cirugía , Vértebras Cervicales/cirugía , Endoscopía/métodos , Resultado del Tratamiento , Complicaciones PosoperatoriasRESUMEN
BACKGROUND: Minimally invasive treatments for spinal cord tumours are common. The aim of this study was to compare the perioperative outcomes of patients with thoracic extramedullary spinal tumours (TEST) treated by microendoscopic minimally invasive surgery-hemilaminectomy through a homemade tubular retractor (MIS-TR) and microscopic full laminectomy (open surgery). METHODS: Between February 2016 and February 2021, 51 patients with TEST were included. According to their clinical data, patients were classified into the MIS-TR group (n = 30) and the open surgery group (n = 21) and assessed. RESULTS: In both groups, the mean operation time, change in perioperative ASIA score, and modified Macnab score were comparable. The average postoperative hospital stay in the MIS-TR group was substantially shorter than that in the open surgery group (p < 0.0001). The mean blood loss volume in the MIS-TR group was substantially lower than that in the open surgery group (p = 0.001). The perioperative complication rate in the MIS-TR group was considerably lower than that in the open surgery group (p < 0.0001). At the 3-month follow-up, there was no substantial difference in the Oswestry Disability Index (ODI) score improvement between the two groups. Nonetheless, at the 12-month follow-up, the average ODI in the MIS-TR group was considerably lower than that in the open surgery group (p = 0.023). The main influencing factors for complete postoperative recovery were preoperative ASIA score (OR 7.848, P = 0.002), surgical complications (OR 0.017, P = 0.008) and age (OR 0.974, P = 0.393). CONCLUSIONS: MIS-TR is safer and more effective than open surgery for treating TEST, but the long-term recovery of MIS-TR is not better than that of open surgery.
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Endoscopía , Laminectomía , Procedimientos Quirúrgicos Mínimamente Invasivos , Vértebras Torácicas , Humanos , Laminectomía/métodos , Femenino , Masculino , Persona de Mediana Edad , Vértebras Torácicas/cirugía , Procedimientos Quirúrgicos Mínimamente Invasivos/métodos , Endoscopía/métodos , Adulto , Neoplasias de la Médula Espinal/cirugía , Estudios Retrospectivos , Resultado del Tratamiento , Anciano , Tempo Operativo , Microcirugia/métodos , Tiempo de InternaciónRESUMEN
BACKGROUND: Extensive spinal epidural abscess (ESEA) is a rare clinical entity subject to delayed diagnosis, which can be explained by the extension of the epidural collection, thereby delaying the mass effect responsible for its clinical manifestations. METHODS: We report a rare case of an extensive C7-T10 epidural abscess in a 54-year-old man treated with antibiotics, laminectomy, and abscess drainage. In addition, we conducted a systematic literature search according to the "Preferred Reporting Items for Systematic Reviews" guidelines. Relevant studies (1980-2023) reporting patients with ESEA were identified from PubMed databases. RESULTS: A total of 48 studies reporting 55 patients were included in this study with a mean age of 55.7 ± 14.6 years with a male predominance of 61.8% (n = 34). The median duration of follow-up was 38 months (21.5-64.3). The mortality rate of ESEA was 1.8% for a 21.8% morbidity rate with 76.4% (n = 42) reported to have been improved after surgery. CONCLUSIONS: Both single and multilevel laminectomy with abscess drainage for ESEA leads to patient recovery from this devastating condition. Evaluation of the outcome with data on time-to-Nadir and Nadir-to-surgery is needed to codify ESEA management.
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Absceso Epidural , Laminectomía , Humanos , Absceso Epidural/cirugía , Persona de Mediana Edad , Masculino , Factores de Riesgo , Drenaje/métodos , Antibacterianos/uso terapéutico , Vértebras Torácicas/cirugía , Vértebras Torácicas/diagnóstico por imagen , Vértebras Cervicales/cirugíaAsunto(s)
Laminectomía , Vértebras Lumbares , Tornillos Pediculares , Fracturas de la Columna Vertebral , Vértebras Torácicas , Humanos , Fracturas de la Columna Vertebral/cirugía , Fracturas de la Columna Vertebral/complicaciones , Laminectomía/métodos , Vértebras Torácicas/cirugía , Vértebras Lumbares/cirugía , Cifoplastia/métodos , Masculino , Estenosis Espinal/cirugía , Titanio , Fijación Interna de Fracturas/métodos , Procedimientos de Cirugía Plástica/métodos , AdultoRESUMEN
BACKGROUND: Ultrasound imaging is inexpensive, portable, and widely available. The development of a real-time transcutaneous spinal cord perfusion monitoring system would allow more precise targeting of mean arterial pressure goals following acute spinal cord injury (SCI). There has been no prior demonstration of successful real-time cord perfusion monitoring in humans. METHODS: Four adult patients who had undergone posterior cervical decompression and instrumentation at a single center were enrolled into this prospective feasibility study. All participants had undergone cervical laminectomies spanning ≥2 contiguous levels ≥2 months prior to inclusion with no history of SCI. The first 2 underwent transcutaneous ultrasound without contrast and the second 2 underwent contrast-enhanced ultrasound (CEUS) with intravenously injected microbubble contrast. RESULTS: Using noncontrast ultrasound with or without Doppler (n = 2), the dura, spinal cord, and vertebral bodies were apparent however ultrasonography was insufficient to discern intramedullary perfusion or clear white-gray matter differentiation. With application of microbubble contrast (n = 2), it was possible to quantify differential spinal cord perfusion within and between cross-sectional regions of the cord. Further, it was possible to quantify spinal cord hemodynamic perfusion using CEUS by measuring peak signal intensity and the time to peak signal intensity after microbubble contrast injection. Time-intensity curves were generated and area under the curves were calculated as a marker of tissue perfusion. CONCLUSIONS: CEUS is a viable platform for monitoring real-time cord perfusion in patients who have undergone prior cervical laminectomies. Further development has the potential to change clinical management acute SCI by tailoring treatments to measured tissue perfusion parameters.
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Vértebras Cervicales , Medios de Contraste , Descompresión Quirúrgica , Microburbujas , Humanos , Descompresión Quirúrgica/métodos , Masculino , Persona de Mediana Edad , Vértebras Cervicales/cirugía , Vértebras Cervicales/diagnóstico por imagen , Femenino , Estudios Prospectivos , Médula Espinal/irrigación sanguínea , Médula Espinal/diagnóstico por imagen , Médula Espinal/cirugía , Anciano , Estudios de Factibilidad , Adulto , Laminectomía/métodos , Ultrasonografía/métodos , Traumatismos de la Médula Espinal/diagnóstico por imagen , Traumatismos de la Médula Espinal/cirugíaRESUMEN
Posterior lumbar interbody fusion (PLIF) is widely used to treat degenerative spondylolisthesis because it provides definitive decompression and fixation. Although it has several advantages, it has some disadvantages and risks, such as paraspinal muscle injury, potential intraoperative bleeding, postoperative pain, hardware failure, subsidence, and medical comorbidity. Lumbar decompressive bilateral laminectomy with interspinous fixation (DLISF) is less invasive and can be used on some patients with PLIF, but this has not been reported. To compare the efficacy and safety of DLISF in the treatment of low-grade lumbar spondylolisthesis with that of PLIF. We retrospectively analyzed the medical records of 81 patients with grade I spondylolisthesis, who had undergone PLIF or DLISF and were followed up for more than 1 year. Surgical outcomes, visual analog scale, radiologic outcomes, including Cobb angle and difference in body translation, and postoperative complications were assessed. Forty-one patients underwent PLIF, whereas 40 underwent DLISF. The operative times were 271.0â ±â 57.2 and 150.6â ±â 29.3 minutes for the PLIF and DLISF groups, respectively. The estimated blood loss was significantly higher in the PLIF group versus the DLISF group (290.7â ±â 232.6 vs 122.2â ±â 82.7 mL, Pâ <â .001). Body translation did not differ significantly between the 2 groups. Overall pain improved during the 1-year follow-up when compared with baseline data. Medical complications were significantly lower in the DLISF group, whereas perioperative complications and hardware issues were higher in the PLIF group. The outcomes of DLISF, which is less invasive, were comparable to PLIF outcomes in patients with low-grade spondylolisthesis. As a salvage technique, DLISF may be a good option when compared with PLIF.
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Descompresión Quirúrgica , Vértebras Lumbares , Fusión Vertebral , Espondilolistesis , Humanos , Espondilolistesis/cirugía , Masculino , Femenino , Fusión Vertebral/métodos , Fusión Vertebral/efectos adversos , Fusión Vertebral/instrumentación , Vértebras Lumbares/cirugía , Estudios Retrospectivos , Persona de Mediana Edad , Descompresión Quirúrgica/métodos , Descompresión Quirúrgica/efectos adversos , Descompresión Quirúrgica/instrumentación , Proyectos Piloto , Anciano , Resultado del Tratamiento , Complicaciones Posoperatorias/epidemiología , Complicaciones Posoperatorias/etiología , Laminectomía/métodos , Laminectomía/efectos adversos , Tempo OperativoRESUMEN
BACKGROUND: Gabapentin supplementation may have some potential in pain control after lumbar laminectomy and discectomy, and this meta-analysis aims to explore the impact of gabapentin supplementation on postoperative pain management for lumbar laminectomy and discectomy. METHODS: PubMed, EMbase, Web of science, EBSCO, and Cochrane library databases were systematically searched, and we included randomized controlled trials assessing the effect of gabapentin supplementation on the pain control of lumbar laminectomy and discectomy. RESULTS: Five randomized controlled trials were finally included in the meta-analysis. Overall, compared with control intervention for lumbar laminectomy and discectomy, gabapentin supplementation was associated with significantly lower pain scores at 2 hours (MDâ =â -2.75; 95% CIâ =â -3.09 to -2.41; Pâ <â .00001), pain scores at 4 hours (MDâ =â -2.28; 95% CIâ =â -3.36 to -1.20; Pâ <â .0001), pain scores at 24 hours (MDâ =â -0.70; 95% CIâ =â -0.86 to -0.55; Pâ <â .00001) and anxiety score compared to control intervention (MDâ =â -1.32; 95% CIâ =â -1.53 to -1.11; Pâ <â .00001), but showed no obvious impact on pain scores at 12 hours (MDâ =â -0.58; 95% CIâ =â -1.39 to 0.22; Pâ =â .16). In addition, gabapentin supplementation could significantly decrease the incidence of vomiting in relative to control intervention (ORâ =â 0.31; 95% CIâ =â 0.12-0.81; Pâ =â .02), but they had similar incidence of nausea (ORâ =â 0.51; 95% CIâ =â 0.15-1.73; Pâ =â .28). CONCLUSIONS: Gabapentin supplementation benefits to pain control after lumbar laminectomy and discectomy.
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Analgésicos , Discectomía , Gabapentina , Laminectomía , Vértebras Lumbares , Dolor Postoperatorio , Gabapentina/uso terapéutico , Gabapentina/administración & dosificación , Humanos , Laminectomía/efectos adversos , Laminectomía/métodos , Dolor Postoperatorio/prevención & control , Dolor Postoperatorio/tratamiento farmacológico , Dolor Postoperatorio/etiología , Discectomía/efectos adversos , Discectomía/métodos , Analgésicos/uso terapéutico , Analgésicos/administración & dosificación , Vértebras Lumbares/cirugía , Ensayos Clínicos Controlados Aleatorios como Asunto , Aminas/uso terapéutico , Aminas/administración & dosificación , Dimensión del Dolor , Manejo del Dolor/métodosRESUMEN
BACKGROUND: Cervical posterior instrumentation and fusion is often performed to avoid post-laminectomy kyphosis. However, larger comparative analyses of cervical laminectomy with or without fusion are sparse. METHODS: A retrospective, two-center, comparative cohort study included patients after stand-alone dorsal laminectomy with (n = 91) or without (n = 46) additional fusion for degenerative cervical myelopathy with a median follow-up of 59 (interquartile range (IQR) 52) months. The primary outcome was the C2-7 Cobb angle and secondary outcomes were Neck Disability Index (NDI), modified Japanese Orthopaedic Association (mJOA) scale, revision rates, T1 slope and C2-7 sagittal vertical axis (C2-7 SVA) at final follow-up. Logistic regression analysis adjusted for potential confounders (i.e. age, operated levels, and follow-up). RESULTS: Preoperative C2-7 Cobb angle and T1 slope were higher in the laminectomy group, while the C2-7 SVA was similar. The decrease in C2-7 Cobb angle from pre- to postoperatively was more pronounced in the laminectomy group (- 6° (IQR 20) versus -1° (IQR 7), p = 0.002). When adjusting for confounders, the decrease in C2-7 Cobb angle remained higher in the laminectomy group (coefficient - 12 (95% confidence interval (CI) -18 to -5), p = 0.001). However, there were no adjusted differences for postoperative NDI (- 11 (- 23 to 2), p = 0.10), mJOA, revision rates, T1 slope and C2-7 SVA. CONCLUSION: Posterior cervical laminectomy without fusion is associated with mild loss of cervical lordosis of around 6° in the mid-term after approximately five years, however without any clinical relevance regarding NDI or mJOA in well-selected patients (particularly in shorter segment laminectomies of < 3 levels).
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Vértebras Cervicales , Cifosis , Laminectomía , Fusión Vertebral , Humanos , Laminectomía/efectos adversos , Laminectomía/métodos , Masculino , Vértebras Cervicales/cirugía , Vértebras Cervicales/diagnóstico por imagen , Femenino , Fusión Vertebral/efectos adversos , Fusión Vertebral/métodos , Persona de Mediana Edad , Cifosis/cirugía , Cifosis/diagnóstico por imagen , Cifosis/etiología , Estudios Retrospectivos , Anciano , Complicaciones Posoperatorias/etiología , Complicaciones Posoperatorias/diagnóstico por imagen , Complicaciones Posoperatorias/epidemiología , Enfermedades de la Médula Espinal/cirugía , Enfermedades de la Médula Espinal/diagnóstico por imagen , Enfermedades de la Médula Espinal/etiología , Resultado del TratamientoRESUMEN
Low back pain due to epidural fibrosis is a major complication after spine surgery. Macrophages infiltrate the wound area post laminectomy, but the role of macrophages in epidural fibrosis remains largely elusive. In a mouse model of laminectomy, macrophage depletion decreased epidural fibrosis. CD146, an adhesion molecule involved in cell migration, is expressed by macrophages. CD146-defective macrophages exhibited impaired migration, which was mediated by reduced expression of CCR2 and suppression of the MAPK/ERK signaling pathway. CD146-defective macrophages suppress the MAPK/ERK signaling pathway by increasing Erdr1. In vivo, CD146 deficiency decreased macrophage infiltration and reduced extracellular matrix deposition in wound tissues. Moreover, the anti-CD146 antibody AA98 suppressed macrophage infiltration and epidural fibrosis. Taken together, these findings demonstrated that CD146 deficiency alleviates epidural fibrosis by decreasing the migration of macrophages via the Erdr1/ERK/CCR2 pathway. Blocking CD146 and macrophage infiltration may help alleviate epidural fibrosis.
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Antígeno CD146 , Fibrosis , Macrófagos , Ratones Endogámicos C57BL , Receptores CCR2 , Animales , Receptores CCR2/metabolismo , Receptores CCR2/genética , Macrófagos/inmunología , Macrófagos/metabolismo , Ratones , Antígeno CD146/metabolismo , Antígeno CD146/genética , Movimiento Celular , Ratones Noqueados , Espacio Epidural/patología , Masculino , Sistema de Señalización de MAP Quinasas/inmunología , Laminectomía , Modelos Animales de Enfermedad , Transducción de Señal , HumanosRESUMEN
STUDY DESIGN: Meta-analysis. OBJECTIVE: This meta-analysis investigates the outcomes of laminoplasty (LP) and laminectomy with fusion (LF) to guide effective patient selection for these 2 procedures. BACKGROUND: Although LF traditionally offers the ability for excellent posterior decompression, it may alter cervical spine biomechanics and increase the risk of adjacent segment degeneration. LP aims to preserve the natural kinematics of the spine but has not been universally accepted, and may be associated with inadequate decompression, neck pain, and recurrent stenosis. MATERIALS AND METHODS: PubMed, Cochrane, and Google Scholar (pages 1-20) were searched up until March 2024. The outcomes studied were surgery-related outcomes [operative time (OR) time, estimated blood loss (EBL), and length of stay], adverse events (overall complications, C5 palsy, and reoperations), radiographic outcomes (cervical lordosis, cervical sagittal vertical axis, and T1 slope angle), and patient-reported outcome measures (Neck Disability Index, Visual Analog Scale for neck pain, and Japanese Orthopaedic Association). RESULTS: Twenty-two studies were included in this meta-analysis, of which 19 were retrospective studies, 2 were prospective nonrandomized studies, and 1 was a randomized controlled trial. A total of 2128 patients were included, with 1025 undergoing LP and 1103 undergoing LF. Patients undergoing LP experienced significantly shorter operative time ( P = 0.009), less EBL ( P = 0.02), a lower rate of overall complications ( P < 0.00001) and C5 palsy ( P = 0.003), a lower T1 slope angle ( P = 0.02), and a lower Neck Disability Index ( P = 0.0004). No significant difference was observed in the remaining outcomes. CONCLUSION: This meta-analysis demonstrates that for cervical myelopathy, LP has the benefits of shorter operative time time, less EBL, and reduced incidence of C5 palsy as well as overall complication rate. Given these findings, LP remains an important surgical option with a favorable complication profile in patients with cervical myelopathy, although careful patient selection is still paramount in choosing the right procedure for individual patients. LEVEL OF EVIDENCE: 4.