It is not possible to detect dural tear and nerve root entrapment in greenstick lamina fracture before surgery. Therefore, if there is any suspicion of such an occurrence, it should be the rule to begin with posterior approach and use the open book technique to expose the dura safely before any reduction maneuver.
We present a case of a 44-year-old woman with an unusual location of a brown tumor in the sacral vertebrae due to parathyroid adenoma. She was admitted to our clinic with the complaint of low-back pain and was later diagnosed to have a brown tumor. The patient underwent surgery and partial sacrectomy and iliac wing resection was performed in Orthopedic Surgery Department. Subsequently the patient underwent parathyroid adenoma excision in General Surgery Department. On her control examination at postoperative 3 months, she had no pain and was able to perform daily activities without any problem. We believe it is an interesting clinical case both because it shows a very rare localization of brown tumor and points out the importance of employing a wide clinical scope in the differential diagnosis of back pain.
Lumbar burst fractures (L3-L5) represent a small percentage of all spinal fractures. The treatment of fractures involving the lumbar spine has been controversial. Lamina fractures may be complete or of the greenstick type. Dural tears and nerve root entrapment may accompany these lamina fractures. The aim of this retrospective study was to determine the incidence of dural tear in patients who had lumbar burst fractures with greenstick lamina fractures and the importance of these lamina fractures when choosing the optimum treatment. Twenty-six patients with 28 lumbar burst fractures were treated from 1995 through 2002. The average follow-up was 60 months (range 32-110 months). The male to female ratio was 21:5 and the mean age was 37 years (17-64). Dural tear was detected in seven (25%) out of 28 burst fractures. The functional outcome of the entire study group was assessed using the Smiley-Webster Scale. Good to excellent results were obtained in 24 (92%) of 26 patients. Lumbar burst fractures with greenstick lamina fractures occur mostly in the L2-L4 area. In the surgical treatment, any reduction manoeuvre will close the fracture and crush the entrapped neural elements. Therefore, it may be better to explore the greenstick lamina fracture whether there is any neural entrapment or not, before any reduction manoeuvre is attempted.
To compare simultaneous with sequential onestage (same anaesthesia) combined anterior and posterior spinal surgery in the treatment of spinal infections in terms of the operation time, blood loss and complication rate. Fifty-six patients who underwent one-stage (same anaesthesia) simultaneous or sequential anterior decompression and posterior stabilisation of the involved vertebrae for spinal infection from January 1994 to December 2002 were reviewed. In group I (n=29), sequential anterior and posterior surgery was performed. In group II (n=27), simultaneous anterior and posterior spinal surgery was performed. With regard to age and gender, there was no statistical difference between both groups (P=0.05). The analysed and compared data between the two groups included the age, gender, blood loss, operation time and postoperative complications. There was a statistically significant difference between the two groups in terms of the duration of surgery, amount of blood transfusion needed and occurrence of major postoperative complications (P<0.05). The mean correction of the kyphotic deformity was similar in both groups (P>0.05) without a subsequent loss of correction on follow-up radiographic films at a mean follow-up of 6.5 years (range, 3 to 11 years). Simultaneous anterior and posterior surgery is a good alternative procedure. It provides the ability to manipulate both anterior and posterior aspects of the spine at the same time and appears to result in less blood loss, a shorter operative time and fewer complications. However, gaining experience and the availability of two surgical teams are important factors in the success of the procedure.Résumé Nous avons voulu comparer le traitement en un temps ou en un temps avec différentes séquences thérapeu-tiques (même anesthésie) combinant voie antérieure, voie postérieure dans le traitement des affections rachidiennes en comparant la durée opératoire, les pertes sanguines et le taux des complications. 56 patients ont bénéficié, en un temps (même anesthésie) d'une décompression antérieure et stabilisation postérieure pour affection rachidienne entre janvier 84 et décembre 2002 et ont été revus. Dans le groupe I (n=29) une chirurgie type séquentielle a été réalisée, dans le groupe II (n=27) une chirurgie avec abords simultanés antérieur postérieur. Les deux groupes ont été comparés en termes d'âge, de sexe, pertes sanguines, temps opératoire et complications. il y avait une différence significative entre les deux groupes en termes de temps opératoire, pertes sanguines, avec nécessité de transfusion et de complications post-opératoires (P<0.05). La correction de la cyphose a été identique dans les deux groupes (P>0.05) sans augmentation excessive des pertes de correction après un suivi de 6.5 ans (3 à 11 par an). la chirurgie réalisée de façon simultanée par devant et par derrière est un bon procédé chirurgical, elle permet de diminuer les pertes sanguines, de raccourcir le temps opératoire et diminuer le taux des complications. Cependant, l'expérience et la po...
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