ObjectivePercutaneous vertebroplasty (PV) is a minimally invasive procedure designed to treat various spinal pathologies. The maximum number of levels to be injected at one setting is still debatable. This study was done to evaluate the usefulness and safety of multilevel PV (more than three vertebrae) in management of osteoporotic fractures. MethodsThis prospective study was carried out on consecutive 40 patients with osteoporotic fractures who had been operated for multilevel PV (more than three levels). There were 28 females and 12 males and their ages ranged from 60 to 85 years with mean age of 72.5 years. We had injected 194 vertebrae in those 40 patients (four levels in 16 patients, five levels in 14 patients, and six levels in 10 patients). Visual analogue scale (VAS) was used for pain intensity measurement and plain X-ray films and computed tomography scan were used for radiological assessment. The mean follow-up period was 21.7 months (range, 12–40). ResultsAsymptomatic bone cement leakage has occurred in 12 patients (30%) in the present study. Symptomatic pulmonary embolism was observed in one patient. Significant improvement of pain was recorded immediate postoperative in 36 patients (90%). ConclusionMultilevel PV for the treatment of osteoporotic fractures is a safe and successful procedure that can significantly reduce pain and improve patient’s condition without a significant morbidity. It is considered a cost effective procedure allowing a rapid restoration of patient mobility.
ObjectiveCorpectomy of the first lumbar vertebra (L1) for the management of different L1 pathologies can be performed using either an anterior or posterior approach. The aim of this study was to evaluate the usefulness of a retroperitoneal extrapleural approach through the twelfth rib for performing L1 corpectomy. MethodsThirty consecutive patients underwent L1 corpectomy between 2010 and 2016. The retroperitoneal extrapleural approach through the 12th rib was used in all cases to perform single-stage anterior L1 corpectomy, reconstruction and anterior instrumentation, except for in two recurrent cases in which posterior fixation was added. Visual analogue scale (VAS) was used for pain intensity measurement and ASIA impairment scale for neurological assessment. The mean follow-up period was 14.5 months. ResultsThe sample included 18 males and 12 females, and the mean age was 40.3 years. Twenty patients (67%) had sensory or motor deficits before the surgery. The pathologies encountered included traumatic fracture in 12 cases, osteoporotic fracture in four cases, tumor in eight cases and spinal infection in the remaining six cases. The surgeries were performed from the left side, except in two cases. There was significant improvement of back pain and radicular pain as recorded by VAS. One patient exhibited postoperative neurological deterioration due to bone graft dislodgement. All patients with deficits at least partially improved after the surgery. During the follow-up, no hardware failures or losses of correction were detected. ConclusionThe retroperitoneal extrapleural approach through the 12th rib is a feasible approach for L1 corpectomy that can combine adequate decompression of the dural sac with effective biomechanical restoration of the compromised anterior load-bearing column. It is associated with less pulmonary complication, no need for chest tube, no abdominal distention and rapid recovery compared with other approaches.
Introduction Subdural collections, following brain surgeries in pediatrics, are common and unfortunately not always easily treated; especially in huge parenchymal tumors, intraventricular tumors and paraventricular tumors. Different approaches for prevention and treatment of theses subdural collections have been discussed by several studies, but till now no solid consensus has been reached. One of these approaches is to approximate incised cortical edges by suturing the pia, use of fibrin adhesive glue and subsequent Ringer inflation. The aim of our study is to avoid cortical mantle collapse and to prevent the development of progressive pressurizing subdural fluid collections. Patients and methods This study included 12 pediatric cases operated for large sized brain tumors between 2014 and 2019, in the department of Pediatric Neurosurgery at Alexandria University. All cases were operated via transcortical approach. Patients were followed prospectively for postoperative complications including postoperative subdural collections. In all patients, gel foam and fibrin glue on the cortical and ependymal edges, with suture approximation of the cortical edges and subsequent Ringer lactate inflation in the residual cavity were routinely done. Results With the consecutive follow-up images, six cases (50%) showed persistent subdural collection following tumor resection. Three cases had 5–6 mm asymptomatic subdural collection thickness that resolved within 3 to 6 months, and the rest three cases showed more than 7 mm thickness subdural collection. In these 3/12 (25%) cases patients had symptomatic and progressive increase in the subdural fluid collections. A subdural-peritoneal shunt was necessary only for 1 patient (8%). After finishing his adjuvant therapy, it was possible to remove the subdural-peritoneal shunt. While in the other 2 patients, the subdural collection was managed surgically with just a burr hole evacuation. The clinical manifestations resolved postoperatively but complete resolution of these 2 subdural collections occurred within 7 and 9 months. Conclusion The use of sutures and fibrin adhesive to seal surgical defects with inflation of the residual cavity with Ringer lactate solution might decrease the development of subdural fluid collections, through avoiding the cortical mantle collapse.
Background Vertebral column resection (VCR) is a well-known technique used for correction of complex spinal deformities. VCR could be done through a posterior only approach (Pvcr), or a combined anteroposterior approach, with almost comparable results. Early studies of Pvcr have reported high rates of complications, while subsequent studies have reported a reasonable complication rate. In this study, the authors represent and evaluate the initial results of using the Pvcr technique to correct complex pediatric deformities. Objective To evaluate the safety and efficacy of performing Pvcr to correct complex pediatric deformities. Methods Retrospective cohort study of data was collected from the database of pediatric deformity patients who were operated for correction of their deformities using posterior instrumentation and Pvcr at a single institution from 2015 to 2019. Results Twenty-one pediatric patients with a mean age 15.2 ± 3.5 years were enrolled in this study. The mean follow-up period was 26.3 ± 3.1 months. The mean Cobb angle has been decreased significantly from 82.9 ± 23.9 degrees to 28.8 ± 14.2 immediately after correction (correction rate 66.9 ± 10.8%, p < 0.001) with slight increase to 30.2 ± 14.9 after 24 months of follow-up (correction loss 4.3 ± 3.1%). The mean kyphotic angle has decreased significantly from 74.1 ± 15.9 to 25.4 ± 4.5 immediately after correction (correction rate 65.4 ± 2.9%, p < 0.001) with slight increase to 26.7 ± 5.2 after 24 months of follow-up (correction loss 4.8 ± 3.5%). The mean estimated blood loss was 2816.7 ± 1441.5 ml. The mean operative time was 339 ± 84.3 min. Self-image domain (part of SRS-22 questionnaire) has significantly improved from a mean preoperative of 2.3 ± 0.5 to a mean postoperative of 3.9 ± 0.4 after 24 months of correction (p < 0.001). As regards complications, chest tubes were inserted in 17 cases (81%), one case (4.8%) had suffered from deep wound infection and temporary respiratory failure, while 3 cases (14.3%) had neurological deficits. Conclusion Posterior vertebral column resection is considered a highly effective release procedure that aids in the correction of almost any type of complex pediatric deformities with a correction rate reaching 66.9 ± 10.8%. However, Pvcr is a challenging procedure with high estimated blood loss and risk of neurological deficits, so it must be done only by experienced spine surgeons in the presence of good anesthesia and neuromonitoring teams.
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