-
Spine Oct 2016Systematic literature review and expert survey OBJECTIVE.: The aim of this study was to determine factors associated with neurologic improvement in patients with... (Review)
Review
STUDY DESIGN
Systematic literature review and expert survey OBJECTIVE.: The aim of this study was to determine factors associated with neurologic improvement in patients with neurologic deficits secondary to metastatic epidural spinal cord compression (MESCC). Clear understanding of these factors will guide surgical decision-making by helping to elucidate which patients are more likely to benefit from surgery and how surgeons can increase the probability of neurologic and functional restoration.
SUMMARY OF BACKGROUND DATA
Surgical spinal cord decompression has been shown to improve neurologic function in patients with symptomatic MESCC. However, prognostication of neurologic improvement after surgery remains challenging, owing to sparse data and complexity of these patients.
METHODS
PubMed and Embase databases were searched for relevant publications. PRISMA Statement guided publication selection and data reporting. GRADE guidelines were used for evidence quality evaluation and recommendation formulation.
RESULTS
Low-quality evidence supports the use of the duration and severity of neurologic deficit as predictors of neurological recovery in patients with MESCC. Low-quality evidence supports the use of thoracic level of compression and previous irradiation as adverse predictors of neurological recovery. Nearly all of the AOSpine Knowledge Forum Tumor members who responded to the survey agreed that ambulation with assistance represented a successful surgical result and that duration of ambulation loss and the severity of weakness should be considered when trying to predict whether surgery would result in restoration of ambulation.
CONCLUSIONS
Review of literature and expert opinion support the importance of duration of ambulation loss and the severity of neurologic deficit (muscle strength, bladder function) in prediction of neurologic recovery among patients with symptomatic MESCC. Efforts to reduce the duration of ambulation loss and to prevent progression of neurologic deficits should be made to improve the probability of neurologic recovery.
LEVEL OF EVIDENCE
2.
Topics: Decompression, Surgical; Epidural Space; Humans; Recovery of Function; Spinal Cord Compression; Spinal Neoplasms
PubMed: 27488300
DOI: 10.1097/BRS.0000000000001827 -
Zhurnal Voprosy Neirokhirurgii Imeni N.... 2021Retropleural and/or retrodiaphragmatic approach is one of the options for anterolateral access to the thoracic spine and thoracolumbar region. This technique has no... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Retropleural and/or retrodiaphragmatic approach is one of the options for anterolateral access to the thoracic spine and thoracolumbar region. This technique has no disadvantages associated with thoracotomy or extensive tissue dissection following posterolateral approaches.
OBJECTIVE
Systematic analysis of foreign and national researches devoted to the possibility, safety and effectiveness of lateral retropleural approach to the thoracic spine and meta-analysis of the most common complications associated with this approach.
MATERIAL AND METHODS
Initial searching revealed 133 abstracts for further study. Inclusion criteria: 1) available full-text version of the manuscript in English or Russian; 2) age of patients over 18 years; 3) description of lateral retropleural or retrodiaphragmatic approach complicated or not complicated by access-associated complications. According to these criteria, we enrolled 10 manuscripts.
RESULTS
Meta-analysis showed high (10.6%) probability of pleural injury associated with surgical approach. Compared to endoscopic transthoracic interventions, the above-mentioned access is characterized by similar or slightly greater blood loss (401.2 ml vs. 100-775 ml) and slightly longer surgery time (200.5 vs. 97.5-186 min) that may be due to small number of interventions and relatively little experience of such operations. The number of patients with approach-related complications is comparable to that for endoscopic transthoracic access (5% vs. 3.7-13.3%). Compared to transthoracic minithoracotomy, this approach is characterized by similar blood loss (401.2 vs. 391 ml), longer surgery time (200.5 vs. 168 min) and similar or lower morbidity (5% vs. 5-13.5%).
CONCLUSION
Minimally invasive anterolateral retropleural and/or retrodiaphragmatic approach to the thoracic spine and thoracolumbar junction for corpectomy and discectomy ensures effective spinal canal decompression and less incidence of complications following open or thoracoscopic thoracic spine surgery. Dissection of parietal pleura should be of special attention because injury of this structure occurs in 10.6% of cases. Skin incision 7.1 cm and rib resection for at least 5 cm may be valuable to prevent plural damage.
Topics: Adolescent; Decompression, Surgical; Diskectomy; Humans; Lumbar Vertebrae; Minimally Invasive Surgical Procedures; Russia; Spinal Canal; Thoracic Vertebrae; Treatment Outcome
PubMed: 34156211
DOI: 10.17116/neiro20218503194 -
World Neurosurgery Jul 2023Cervical spondylotic myelopathy (CSM) may seriously affect quality of life. In the literature, there is scarce evidence of the pros and cons of full endoscopic spine... (Review)
Review
BACKGROUND
Cervical spondylotic myelopathy (CSM) may seriously affect quality of life. In the literature, there is scarce evidence of the pros and cons of full endoscopic spine surgery in the treatment of CSM. The main purpose of this study was to conduct a systematic review to elucidate the efficacy of full endoscopic spine surgery in the management of patients with CSM.
METHODS
This systematic review was conducted in accordance with the PRISMA guidelines. A systematic search of Web of Science, PubMed MEDLINE, Embase, and Cochrane Library was conducted from the database inception to February 1, 2023.
RESULTS
The study included 183 patients and their age was 56.78 ± 7.87 years. The average surgical time calculated was 96.34 ± 33.58 minutes. Intraoperative blood loss ranged from a minimal amount to 51 mL. The average duration of hospital stay was 3.56 ± 1.6 days. The average span for follow-up was on an interval of 18.7 ± 6.76 months. Significant improvements were noted in all aspects of functional outcomes and image results after full endoscopic cervical spine surgery, with no major complications.
CONCLUSIONS
The current study found that both anterior transcorporeal and posterior surgical approaches could be used for the treatment of CSM with a full endoscopic technique. Indications of full endoscopic cervical spine surgery for CSM included cervical disc herniation, central canal stenosis, calcified ligamentum flavum, and ossification of the posterior longitudinal ligament. Improved postoperative outcomes with acceptable surgical complications were noted in this systematic review.
Topics: Humans; Middle Aged; Quality of Life; Spondylosis; Treatment Outcome; Spinal Cord Diseases; Cervical Vertebrae; Decompression, Surgical
PubMed: 37169077
DOI: 10.1016/j.wneu.2023.05.012 -
Orthopaedic Surgery Jul 2022Penetrating spinal cord injury (PSCI) with retained foreign bodies (RFB) is rarely observed in clinics and may result in a complete or incomplete neurological deficit....
BACKGROUND
Penetrating spinal cord injury (PSCI) with retained foreign bodies (RFB) is rarely observed in clinics and may result in a complete or incomplete neurological deficit. This study was performed to appraise the treatment effect of laminectomy for PSCI with RFB.
CASE PRESENTATION
This study presented three patients referred to a tertiary hospital between August 2011 and October 2018 due to PSCI with RFB and receiving laminectomy. The first patient was a 25-year-old female with a butcher's knife piercing the T lamina and T vertebral body obliquely; the second was a 49-year-old male who suffered a perforating wound of the cervical spinal canal and injury of vertebral artery from foreign glass, while the third was a 60-year-old male with a wooden stick penetrating stomach and terminating in the L lamina. The first and second patients immediately underwent laminectomy for debridement and removal of RFB, while the third received two-staged operations to remove the retained stick thoroughly. Unfortunately cases 1 and 3 eventually resulted in total paralysis and case 2 revealed no improvement in myodynamia. Then, Medline/PubMed, Embase and the Cochrane Library were systematically searched, and 23 articles involving 25 additional cases with this kind of injury were included for analysis.
CONCLUSIONS
The optimal treatment strategy for penetrating spinal cord injury with retained foreign bodies remains challenging and should be assessed case-by-case. If possible, surgical removal of foreign bodies by laminectomy is preferred immediately to prevent delayed presentation and persistent contamination. Meanwhile, a multidisciplinary team is needed to address concomitant injuries.
Topics: Adult; Female; Foreign Bodies; Humans; Laminectomy; Male; Middle Aged; Spinal Canal; Spinal Cord Injuries; Wounds, Stab
PubMed: 35678132
DOI: 10.1111/os.13332 -
Skeletal Radiology Apr 2024To perform a systematic literature review on the diagnostic utility of 3D MRI sequences in the assessment of central canal, recess and foraminal stenosis in the spine. (Review)
Review
OBJECTIVE
To perform a systematic literature review on the diagnostic utility of 3D MRI sequences in the assessment of central canal, recess and foraminal stenosis in the spine.
METHODS
The databases PubMed, MEDLINE (via OVID) and The Cochrane Central Register of Controlled Trials, were searched for studies that investigated the diagnostic use of 3D MRI to evaluate stenoses in various parts of the spine in humans. Three reviewers examined the literature and conducted systematic review according to PRISMA 2020 guidelines.
RESULTS
Thirty studies were retrieved from 2 595 publications for this systematic review. The overall diagnostic performance of 3D MRI outperformed the conventional 2D MRI with reported sensitivities ranging from 79 to 100% and specificities ranging from 86 to 100% regarding the evaluation of central, recess and foraminal stenoses. In general, high level of agreement (both intra- and interrater) regarding visibility and pathology on 3D sequences was reported. Studies show that well-optimized 3D sequences allow the use of higher spatial resolution, similar scan time and increased SNR and CNR when compared to corresponding 2D sequences. However, the benefit of 3D sequences is in the additional information provided by them and in the possibility to save total protocol scan times.
CONCLUSION
The literature on the spine 3D MRI assessment of stenoses is heterogeneous with varying MRI protocols and diagnostic results. However, the 3D sequences offer similar or superior detection of stenoses with high reliability. Especially, the advantage of 3D MRI seems to be the better evaluation of recess stenoses.
PubMed: 38676747
DOI: 10.1007/s00256-024-04689-1 -
Clinical Neurology and Neurosurgery Nov 2022Spontaneous resolution of syringomyelia has rarely been reported in the literature. Rarer still are cases wherein this process is associated with pregnancy and... (Review)
Review
BACKGROUND
Spontaneous resolution of syringomyelia has rarely been reported in the literature. Rarer still are cases wherein this process is associated with pregnancy and parturition. We review theories on syringomyelia development and spontaneous resolution to better understand the role pregnancy and parturition may play in both processes.
METHODS
We present a 30-year-old female with MRI-confirmed spontaneous syrinx regression following caesarean delivery of a full-term pregnancy. We additionally review the literature to identify previously reported cases of spontaneous syrinx regression both independent of and associated with pregnancy.
RESULTS
Including the present case, 39 cases describing spontaneous regression of syringomyelia have been reported in the literature, of which only four are associated with pregnancy and parturition. 75% of all reported cases were associated with type I Chiari malformation, though several disorders of the craniocervical junction and spinal canal were implicated. Complete syrinx regression was achieved in 33.3% of cases and 5% of cases described recurrence of syringomyelia following the spontaneous resolution.
CONCLUSION
Syringomyelia likely develops due to disturbance of the physiologic flow of cerebrospinal fluid around the craniocervical junction and the obex. Several mechanisms including fissuring of the spinal cord parenchyma and reduction of subarachnoid scarring are likely involved in this process. In the setting of pregnancy, additional mechanisms surrounding the increased intraabdominal forces imparted by a growing fetus, Valsalva-like strain experienced during labor, and hemodynamic changes that occur to accommodate gestation are likely implicated. Nevertheless, patients should continue to be monitored periodically for syrinx recurrence.
Topics: Pregnancy; Female; Humans; Adult; Syringomyelia; Arnold-Chiari Malformation; Subarachnoid Space; Magnetic Resonance Imaging; Parturition
PubMed: 36049402
DOI: 10.1016/j.clineuro.2022.107413 -
European Spine Journal : Official... Jun 2010Transforaminal endoscopic techniques have become increasingly popular in surgery of patients with lumbar stenosis. The literature has not yet been systematically... (Meta-Analysis)
Meta-Analysis Review
Transforaminal endoscopic techniques have become increasingly popular in surgery of patients with lumbar stenosis. The literature has not yet been systematically reviewed. A comprehensive systematic literature review up to November 2009 to assess the effectiveness of transforaminal endoscopic surgery in patients with symptomatic lumbar stenosis was made. Two reviewers independently checked all retrieved titles and abstracts and relevant full text articles for inclusion criteria. Included articles were assessed for quality, and relevant data, including outcomes, were extracted by two reviewers independently. No randomized controlled trials were identified, but seven observational studies. The studies were of poor methodological quality and heterogeneous regarding patient selection, indications, operation techniques, follow-up period and outcome measures. Overall, 69-83% reported the outcome as satisfactory and a complication rate of 0-8.3%. The reported re-operation rate varied from 0 to 20%. At present, there is no valid evidence from randomized controlled trials on the effectiveness of transforaminal endoscopic surgery for lumbar stenosis. Randomized controlled trials comparing transforaminal endoscopic surgery with other surgical techniques are direly needed.
Topics: Clinical Trials as Topic; Endoscopy; Humans; Lumbar Vertebrae; Outcome Assessment, Health Care; Radiography; Spinal Canal; Spinal Stenosis; Treatment Outcome
PubMed: 20087610
DOI: 10.1007/s00586-009-1272-6 -
Children (Basel, Switzerland) Dec 2022Adolescent idiopathic scoliosis (AIS) is the most frequent pediatric spinal deformity. Its treatment still shows limited results due to the existent lack of knowledge... (Review)
Review
Adolescent idiopathic scoliosis (AIS) is the most frequent pediatric spinal deformity. Its treatment still shows limited results due to the existent lack of knowledge regarding etiopathogenesis. Thus, the purpose of the study is to check the existence of vestibular morphological alterations among idiopathic scoliosis patients. To meet the objective, we performed this systematic review searching studies in PubMed Medline, SCOPUS, Web of Science, CINAHL Complete and SciELO until 15 September 2022. Articles that analyzed the morphology of the vestibular apparatus were selected, comparing subjects with AIS versus healthy subjects. Variables were selected that measured the orientation of the channels as well as the general conformation of the vestibular apparatus. One hundred and eighty-five records were retrieved in the preliminary searches, of which five studies were finally included, providing data from 154 participants (83 cases and 71 healthy controls) with a mean age 16.07 ± 2.48 years old. Two studies conclude that the superior and lateral semicircular canals are longer and thinner in patients with AIS. One study concluded that the measure between centers of superior and lateral canals and the angle whose vertex is placed the center of posterior canal were significantly shorter in subjects with AIS than in healthy controls in the left-side of vestibular apparatus. Two studies found an asymmetry in the verticality of the lateral canals on both sides in subjects with AIS, although it is not clear whether the left canal is in a more horizontal or vertical position. Patients with AIS seem to present morphological asymmetries of the vestibular apparatus, fundamentally on the left side. These anomalies seem to correlate with the location of the curve but not with its laterality or severity.
PubMed: 36670586
DOI: 10.3390/children10010035 -
Medicina (Kaunas, Lithuania) Mar 2022The aim of this review was to analyze the existing literature and investigate the outcomes or complications of lateral lumbar interbody fusion (LLIF) combined with... (Review)
Review
The aim of this review was to analyze the existing literature and investigate the outcomes or complications of lateral lumbar interbody fusion (LLIF) combined with indirect decompression for degenerative lumbar spondylolisthesis (DS). A database search algorithm was used to query MEDLINE, COCHRANE, and EMBASE to identify the literature reporting LLIF with indirect decompression for DS between January 2010 and December 2021. Improvements in outcome measures and complication rates were pooled and tested for significance. A total of 412 publications were assessed, and 12 studies satisfied the inclusion criteria after full review. The pooled data available in the included studies showed that 438 patients with lumbar spondylolisthesis (mean age 65.2 years; mean body mass index (BMI) 38.1 kg/m) underwent LLIF. A total of 546 disc spaces were operated on. The most frequently treated levels were L4-L5 and L3-L4. Clinically, the average improvement was 32.5% in ODI, 46.3 mm in low back pain, and 48.3 mm in leg pain estimated from the studies included. SF-36 PCS improved by 51.5% and MCS improved by 19.5%. For radiological outcomes, a reduction in slippage was seen in 6.3%. Disc height increased by 55%, foraminal height increased by 21.1%, the foraminal area on the approach side increased by 21.9%, and on the opposite side it increased by 26.1%. The cross-sectional spinal canal area increased by 20.6% after surgery. Post-operative complications occurred in 5-40% of patients with thigh symptoms, such as anterior thigh numbness, dysesthesia, discomfort, pain, and sensory deficits. Indirect decompression by LLIF for DS is an effective method for improving pain and dysfunction with less surgical invasion. In addition, it has the effect of significantly improving disc height, foraminal height and area, and segmental lordosis on radiological outcomes compared to the posterior approach.
Topics: Aged; Cross-Sectional Studies; Decompression; Humans; Low Back Pain; Lumbar Vertebrae; Retrospective Studies; Spinal Fusion; Spondylolisthesis; Treatment Outcome
PubMed: 35454331
DOI: 10.3390/medicina58040492 -
World Neurosurgery Nov 2021To explore the relationship between spinal cord compression and hypertension through analysis of blood pressure (BP) variations in a cervical spondylotic myelopathy...
Surgical Decompression for Cervical Spondylotic Myelopathy in Patients with Associated Hypertension: A Single-Center Retrospective Cohort and Systematic Review of the Literature.
OBJECTIVE
To explore the relationship between spinal cord compression and hypertension through analysis of blood pressure (BP) variations in a cervical spondylotic myelopathy (CSM) cohort after surgical decompression, along with a review of the literature.
METHODS
A single-institution retrospective review of patients with CSM who underwent cervical decompression between 2016 and 2017 was conducted. Baseline clinical and imaging characteristics, preoperative and postoperative BP readings, heart rate, functional status, and pain scores were collected. In addition, a PRISMA guidelines-based systematic review was performed.
RESULTS
We identified 264 patients with CSM treated surgically; 149 (56.4%) of these had hypertension. The degree of spinal canal compromise and spinal cord compression, preoperative neurologic examination, and the presence of T2-signal hyperintensity on magnetic resonance imaging were associated with hypertension. Overall mean arterial pressure (MAP) decreased significantly at 1 and 12 months after surgery. Patients without T2-signal hyperintensity on imaging showed a MAP reduction at 12 months postoperatively, whereas those with T2-signal hyperintensity showed a transient MAP reduction at 1 month postoperatively before returning to preoperative values. At 12 months after surgery, 24 of 97 patients (24.7%) with initially uncontrolled hypertension had controlled BP values with significant reduction of MAP, systolic BP, and diastolic BP. Including the present study, 5 articles were eligible for systematic review, with all reporting a BP decrease in patients with CSM after decompression.
CONCLUSIONS
Analysis of our retrospective cohort and a systematic review suggest that cervical surgical decompression reduces BP in some patients with CSM. However, this improvement is less apparent in patients with preoperative spinal cord T2-signal hyperintensity.
Topics: Aged; Cervical Vertebrae; Decompression, Surgical; Female; Humans; Hypertension; Male; Middle Aged; Retrospective Studies; Spinal Cord Compression; Spondylosis; Treatment Outcome
PubMed: 34400323
DOI: 10.1016/j.wneu.2021.08.038