Abstract

Resumen

Introduction

Materials and methods

Procedure

Statistics

Results

Discussion

Conclusion

Level of evidence

References

Abstract

Introduction
The correction of thoracic and lumbar spine fractures with a short instrumentation using Schanz screws, is an effective method for stabilization and sagittal balance restoration.

Materials and methods
Bidirectional observational study, included patients undergoing arthrodesis with Schanz screws to manage thoracic and lumbar fractures, the general characteristics, type, and location of the fracture, besides the gain in height of the vertebral body and segmental angle were analyzed before and after surgery. Clinical and imaging control was performed postoperatively and 1 month after this. p-value < .05 was statistically significant.

Results
Of 35 patients undergoing arthrodesis, 13 were excluded due to the absence of images and follow-up. There was a higher proportion of men, the main location of the fracture and AO spine classification was in T12 and type A4/B1 respectively, there was no intraoperative complication, no transfusion was required, and a short hospital stay. A mild complication was presented in the follow-up. The average pre and postoperative change was 12 degrees in the Cobb angle and 5.2 mm vertebral body height in the fractured vertebra, these changes were statistically significant.

Conclusion
Thoracolumbar and lumbar spine fracture correction with short segment fixation using Schanz screws, is an effective, safe and fast, showing significantly vertebral height gain and segmental angle correction, as a consequence, a correction of the balance and alignment of the spine.

Materials and methods

A bidirectional case series study (retrospective and prospective) was performed, of patients who had undergone surgery for arthrodesis with Schanz screws for the management of traumatic thoracic and lumbar fractures. Patients were excluded from the study if data were lacking from their medical records, or there were no control and/or follow-up postoperative images. Sociodemographic information was collected, together with location and type of fracture in accordance with the AO Spine classification,4 pre and postoperative height of the fracture vertebral body and the Cobb angle (also called segmentary angle), and intra and postoperative complications. Regarding clinical and imaging follow-up, this was performed on the first postoperative day and month (Fig. 1). Routine radiography and computerized axial tomography (CAT) was taken for all patients of the thoracic and lumbar spine at the time of the trauma. Given the availability of hospital resources, magnetic resonance of the thoracic and lumbar sacral spine was made of selected patients who were waiting for this, to determine lesion of the posterior ligament complex.

Procedure

The patient was placed in prone position, with upper members extended, with pressure areas protected by rolls. Fluoroscopy marked the mid line and the pedicles of the vertebrae above and below the surgical fracture line. Subperiosteal dissection followed to expose posterior elements of the spine. Biplane fluoroscopy was used to place the Schanz screws bilaterally. The diameter of the screws had been previously measured in imaging. The screws were always to be placed proximal in bloodflow direction for better leverage. Reduction and ligamentotaxis manoeuvres followed with fixation of patellas and rods. Sharp round bur was used for scarification of bone surface and heterologous bone graft placement. Haemostasis was confirmed, layered closure and 1/8 epifascial hemovac drainage was left as required. In some cases, where bone fragments may be found inside the canal, laminectomy and impaction is performed on them (Fig. 2).

Abstract

Keywords

1. Introduction

2. Methods

3. Discussion

4. Conclusion

Conflict of Interest

CRediT authorship contribution statement

Appendix A. Supplementary data

Research Data

References

Abstract

Purpose
We sought to determine methods of precise gradation of hydrocephalus in patients with spina bifida. Symptomatic hydrocephalus is a common condition associated with myelomeningocele (open spina bifida). Traditionally, hydrocephalus is treated with insertion of the ventriculo-peritoneal (VP) shunt. This has been the standard of treatment since the introduction of the Holter shunt valve for the VP shunt in the early 1960s.

Methods
We have analized the results of surgical treatment of 81 patients aged between 1 month and 1.5 year old with hydrocephalus and MMC. All patients underwent surgery in Republican center of neurosurgery of Uzbekistan for MMC with hydrocephalus in the period of 2013–2018. We suggest to use the ventricular index to determine the precise degree of hydrocephalus in patients with spina bifida and the method for selecting valve parameters.

Results
Patients with suspection of associated hydrocephalus, in order to arresting the risk of MMC rupture and prevention of possible leakage after the back closure a VP shunt was performed. According to above mentioned 52 (64.2%) patients for the 1st stage underwent VP shunt surgery with a low-pressure valve, 23 (28.4%) patients with medium pressure and 6 (7.4%) with high pressure valve. MMC repair was done in 1–3 month after VP shunt placement. To all patients we used regular valve shunts due to high cost of adjustable one and lack of official distributors (health insurance has not yet implemented in our country).

Conclusion
The implantable shunt systems parameters were chosen before surgery in the surgical management of hydrocephalus in children with MMC are essential. This is important in order to prevent under or over drainage states, CSF leakage from the MMC sac. Management of hydrocephalus should be performed by considering MMC affecting craniospinal balance.

1. Introduction

The 3 main signs of spina bifida – hydrocephalus, paraplegia and dysfunction of the pelvic organs by the type of incontinence have been known for many centuries, although these signs were not associated with myelomeningocele (MMC) until the 17th century [5], [7], [17].

The first researcher who came close to the understanding of connection between myelomeningocele and hydrocephalus was Frederick Ruysch (1638–1731), but only the Italian pathologist Giovanni Battista Morgagni (1672–1771) clearly described this relationship and that myelomeningocele can be accompanied both with hydrocephalus and without it [6], [12], [13], [16], [18].

Gardner advanced the theory that overgrowth of the neural tube could be the cause of hydrocephalomyelia, but this interesting theory found rebuttal in modern neuroimaging and embryology [12].

Hydrocephalus basically accompanies open forms of spina bifida – myelomeningocele. Before the introduction of cerebrospinal fluid (CSF) shunting surgery in the early 1960s, hydrocephalus was the leading cause of death and disability in patients with myelomeningocele [1], [2], [3], [4], [8], [9], [14], [15].

The true frequency of hydrocephalus in patients with myelomeningocele is not known, although in the main multicenter studies the need for shunting procedures reaches the value 80–90% [10], [11], [19], [20], [21], [22], [23].

Introduction

Materials and methods

Results

Discussion

References

Abstract

Purpose: Questionnaire survey among the members of the German Spine Society (Deutsche Wirbels€ aulen-Gesellschaft, DWG) to objectify oncological infrastructure and current standard of care in spinal tumor treatment in Germany. Methods: All DWG-members were contacted via the society’s e-mail and asked to respond in anonymized form to a related questionnaire. Questions were asked regarding surgical specialty, type of institution involved, numbers of spinal procedures, as well as questions on treatment for primary tumors, whether the respondent belonged to a tumor center, decision-making procedures for surgery, and the type of procedure. Results: 84 centers providing surgical treatment for spinal tumors in their departments were identified. 52.6% were carrying out more than 500 spinal procedures per year. There was a significant association (P
0.05) between the numbers of spinal surgeries, the number of treated tumor patients per year, the organisation in a tumor center and the treatment of primary tumors. 76% are part of a local tumor center for interdisciplinary decision making (i.e.surgical treatment and adjuvant therapy). 74% of the institutions stated that conventional postoperative radiotherapy is standardly administered in the case of secondary lesions, with 24% of them referring patients to external services for radiotherapy. Conclusion: In spite of often large numbers of spinal operations, the centers perform relatively small numbers of tumor operations, particularly for primary tumors. A nearly three-quarter majority of the departments are integrated into interdisciplinary tumor care. However, there is a marked number that do not belong to an interdisciplinary organisation. Further advances in multidisciplinarity and oncology training are a continuous issue to increase treatment quality in spinal tumor patients.

Introduction

The diagnosis of a tumor on the spine is a severe and momentous event for those affected and represents an equally great challenge for the specialist disciplines treating these lesions. There is controversy regarding the value, necessity, options and extent of surgical interventions and on whether they are lastingly effective [1]. Oncological treatment is now primarily based on and guided by the biology of the underlying tumors, and currently a paradigm shift in surgical therapy is observed. Among the involved disciplines, the spinal surgeon is usually the first who is contacted either by the symptomatic patient or diagnostic radiologist. However, to provide the complete range of treatment, other disciplines as radiooncology, pathology, pain therapy, internal oncology etc. as well as the necessary infrastructure also have to be available locally to consecutively guarantee the patient a oncological treatment in accordance with the latest standards and guidelines. The treatments are mainly palliative in nature due to secondary lesions developing in 10e20% of all cancer patients [2]. Surgical procedures are aimed at relieving neurological complications, severe pain or restoring spinal integrity and vertebral stability in order to ensure an acceptable quality of life for the period remaining. With regard to primary tumors or so called „solitary“ metastases in definded constellations, the current data in the literature show that radical resection combined with adjuvant therapy is markedly superior to intralesional procedures [3e5].

Objective: To explore the magnetic resonance imaging (MRI) features of patients with brucellar spondylitis and try to classify them depending on the MRI findings. Material and methods: 67 patients (male&female: 50&17) with brucellar spondylitis were recruited in this study. MRI examinations were performed in all patients. Firstly, MRI data were analyzed by two senior radiologists. Secondly, according to the imaging findings, patients were divided into different types. Results: In all 67 patients with spinal brucellosis, 5 cases only had paravertebral soft tissue involved, 62 cases showed abnormal signal in single or multiple adjacent vertebrae. Thirty-five patients focused on the L4 vertebral involvement. 18 cases had appendage involvement. 27 cases hand intervertebral disc narrowing and cystic signal. Paravertebral, epidural and psoas abscesses were detected in 35, 20 and 8 cases. Patients were grouped according to MRI findings. The vertebral inflammatory type was the most frequently type with the rate of 35.8%, followed by discitis type 32.9%, adnexitis type 11.9%, paravertebral and psoas abscess type 11.9% and paravertebral soft tissue type 7.5%. Conclusion: It is not difficult to diagnose brucellar spondylitis in MRI findings based on clinical background and laboratory tests. According to the performance of MRI, five types can be classified.

Introduction

Brucellosis is an endemic zoonotic disease, especially in some developing countries including China [1]. The osteoarticular involvement of brucellosis is the most common complication and the ratio can range from 10 to 85% in the published series [2]. Osteoarticular involvement includes spondylitis, spondylodiscitis, sacroiliitis and arthritis, and paraspinal abscess et al. The spondylitis is the most prevalent manifestation, which is mainly located at the lumbar spine [3]. The diagnosis of brucellar spondylitis is always difficult, because the clinical and radiological findings are usually nonspecific and easy misdiagnosed as other disease. Despite all of these, it has been reported that MRI can differentiate brucellar spondylitis from other spinal infections, along with a good clinical background [4]. MRI is the most sensitive technique to the signal changes in vertebral, intervertebral disc and paravertebral soft tissues. The purpose of this study was to report the clinical and MRI findings of patients with brucellar spondylitis and try to classify the brucellar spondylitis into different types according to the performance of MRI.

Spinocerebellar ataxia (SCA) comprises a family of autosomal dominant inherited disorders that result from progressive degeneration of the cerebellum and its associated systems [1]. Besides cerebellar deterioration, SCA is often accompanied by degeneration of other sites of the nervous system, leading to noncerebellar signs such as pyramidal and extrapyramidal losses, which are uncommon in ataxia of other etiologies and that can worsen the impairments of people with SCA [2]. Among the motor deficits prompted by SCA, those related to gait and balance are the most common [3]. Gait in SCA is usually described as uncoordinated, unsteady, wide-based, and highly variable [4–6]. In turn, balance abnormalities in SCA are characterized by an increased postural sway and poor balance control during both static and dynamic tasks [7]. It is noteworthy that both the balance and gait impairments in SCA are strongly associated with an increased number of fall episodes [8, 9] and can favor physical inactivity, adversely affecting cardiorespiratory fitness [10]. Together, these problems can impair mobility, deteriorate general health, and yield physical and social consequences for these individuals [7]. Despite the huge recent advances in neurogenetic research, an effective pharmacological approach to face this condition is still unknown [11, 12]. Indeed, with the exception of a few kinds of hereditary ataxia (e.g., Niemann–Pick disease type C, cerebrotendinous xanthomatosis, coenzyme Q-10 responsive ataxia, or ataxia with vitamin E deficiency), no specific treatments exist for hereditary ataxia, including SCA (for a review, see Jayadev and Bird [13]). In this context, rehabilitation strategies could represent an alternative to improve the physical condition and to reduce the impairments of these individuals. But, sadly, clinical trials testing the effects of physical therapy approaches in ataxia are scarce and the few existing studies include cerebellar ataxias of different etiologies, beyond SCA (for a review, see Martins et al. [14]) [15, 16]. As the natural course and prognosis are different between SCA and cerebellar ataxias of other etiologies it could be artificial to generalize the results from the available clinical trials to the SCA population, especially considering the peculiarity of the progressive degeneration found in SCA. In this context, it is relevant to advance strategies of rehabilitation that could benefit SCA individuals.