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Lorio MP, Watters WC, Grunch BH, Metzger AK, Lewandrowski KU, Block JE, Andersson GBJ. Utilization of Bone-Anchored Annular Defect Closure to Prevent Re herniation Following Lumbar Discectomy: Overcoming Barriers to Clinical Adoption and Market Access. Int J Spine Surg 2024:8592. [PMID: 38569929 DOI: 10.14444/8592] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/05/2024] Open
Abstract
While achieving premarket approval from the US Food and Drug Administration represents a significant milestone in the development and commercialization of a Class III medical device, the aftermath endeavor of gaining market access can be daunting. This article provides a case study of the Barricaid annular closure device (Barricaid), a reherniation reduction device, which has been demonstrated to decrease the risk of suffering a recurrent lumbar intervertebral disc herniation. Following Food and Drug Administration approval, clinical adoption has been slow due to barriers to market access, including the perception of low-quality clinical evidence, questionable significance of the medical necessity of the procedure, and imaging evidence of increased likelihood of vertebral endplate changes. The aim of this article is to provide appropriate examination, rationale, and rebuttal of these concerns. Weighing the compendium of evidence, we offer a definition of a separate and unique current procedural terminology code to delineate this procedure. Adoption of this code will help to streamline the processing of claims and support the conduct of research, the evaluation of health care utilization, and the development of appropriate medical guidelines.
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Lee PR, Chen HC. Spontaneous Temporomandibular Joint Herniation into External Auditory Canal. Ear Nose Throat J 2024; 103:NP232-NP233. [PMID: 34654325 DOI: 10.1177/01455613211053391] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Affiliation(s)
- Pei-Rong Lee
- Department of Otolaryngology-Head and Neck Surgery, Tri-Service General Hospital, Taipei, Taiwan
| | - Hsin-Chien Chen
- Department of Otolaryngology-Head and Neck Surgery, Tri-Service General Hospital, Taipei, Taiwan
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Liang JT, Liao YT, Chen TC, Huang J, Hung JS. Changing patterns and surgical outcomes of small bowel obstruction in the era of minimally invasive surgery for colorectal cancer. Int J Surg 2024; 110:1577-1585. [PMID: 38051917 PMCID: PMC10942203 DOI: 10.1097/js9.0000000000000980] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2023] [Accepted: 11/21/2023] [Indexed: 12/07/2023]
Abstract
INTRODUCTION This study aimed to investigate whether the incidence, patterns, and surgical outcomes of small bowel obstruction (SBO) have changed in the era of minimally invasive surgery (MIS) for primary colorectal cancer (CRC). METHODS Consecutive patients who underwent laparotomy for SBO were divided into MIS and traditional open surgery (TOS) groups based on the previous colorectal cancer operation technique used. The MIS group was selected from 1544 consecutive patients who underwent MIS as a treatment for primary CRCs between 2014 and 2022, while the TOS group was selected from 1604 consecutive patients who underwent TOS as a treatment for primary CRCs between 2004 and 2013. The demographics, clinicopathological features, and surgical outcomes were compared between the two groups. RESULTS The SBO incidence in patients who underwent MIS for primary CRC was significantly lower than that in patients who underwent TOS (4.4%, n =68/1544 vs. 9.7%, n =156/1604, P <0.0001). Compared with the TOS group, the MIS group had significantly different ( P <0.0001) SBO patterns: adhesion (48.5 vs. 91.7%), internal herniation (23.5 vs. 2.6%), external herniation (11.8 vs. 1.9%), twisted bowel limbs (4.4 vs. 0.6%), ileal volvulus with pelvic floor adhesion (5.9 vs. 1.9%), and nonspecific external compression (5.9 vs. 1.3%). A subset analysis of patients with adhesive SBO (ASBO) showed that the MIS group tended to ( P <0.0001) have bands or simple adhesions (75.8%), whereas the TOS group predominantly had matted-type adhesions (59.4%). Furthermore, SBO in the MIS group had an acute (<3 months) or early (3-12 months) onset (64.7%), while that in the TOS group ( P <0.0001) had an intermediate or a late onset. When the surgical outcomes of SBO were evaluated, the TOS group had significantly more ( P <0.0001) blood loss and longer operation time; however, no significant difference was observed in the surgical morbidity/mortality (Clavien-Dindo classification ≧3, 11.8 vs. 14.1%, P =0.6367), hospitalization, and readmission rates between the two groups. Postoperative follow-up showed that the estimated 3-year (11.37 vs. 18.8%) and 6-year (25.54 vs. 67.4%) recurrence rates of SBO were significantly lower ( P =0.016) in the MIS group than in the TOS group. CONCLUSIONS The wide adoption of MIS to treat primary CRC has led to a lower incidence, altered patterns, and reduced recurrence rates of SBO. Awareness of this new trend will help develop surgical techniques to prevent incomplete restoration of anatomical defects and bowel malalignments specifically associated with MIS for CRC, as well as facilitate timely and appropriate management of SBO complications whenever they occur.
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Affiliation(s)
- Jin-Tung Liang
- Department of Surgery, Division of Colorectal Surgery, National Taiwan University Hospital and College of Medicine, Taipei
| | - Yu-Tso Liao
- Department of Surgery, Division of Colorectal Surgery, National Taiwan University Hospital, Hsin-Chu Branch, Hsinchu
| | - Tzu-Chun Chen
- Department of Surgical Oncology, National Taiwan University Cancer Center, Taipei, Taiwan, Republic of China
| | - John Huang
- Department of Surgery, Division of Colorectal Surgery, National Taiwan University Hospital and College of Medicine, Taipei
| | - Ji-Shiang Hung
- Department of Surgery, Division of Colorectal Surgery, National Taiwan University Hospital and College of Medicine, Taipei
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Siyaji ZK, Nguyen AQ, Federico VP, Zbeidi S, Zavras AG, Baker JD, Basques BA, Sayari AJ, Phillips FM. Comparison of clinical outcomes in patients undergoing one- and two-level minimally invasive lumbar microdiscectomy. J Neurosurg Spine 2024; 40:169-174. [PMID: 37922555 DOI: 10.3171/2023.8.spine21761] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2021] [Accepted: 08/29/2023] [Indexed: 11/07/2023]
Abstract
OBJECTIVE Herniated nucleus pulposus (HNP) is one of the most common lumbar spine conditions treated surgically, often through a minimally invasive surgery (MIS) microdiscectomy approach. This technique attempts to reduce damage to the paraspinal muscular-ligamentous envelope. However, there are currently limited data regarding comparative outcomes using patient-reported outcome measures (PROMs) for one- and two-level MIS discectomies. The aim of this study was to quantify comparative clinical outcomes in patients undergoing one-level and two-level MIS lumbar microdiscectomy for HNP using PROMs. METHODS The authors performed a retrospective review of patients undergoing MIS lumbar microdiscectomy between 2004 and 2019 for the primary diagnosis of HNP at a single academic institution. All patients had a minimum 1-year follow-up. Patient demographics and comorbidities were collected to establish baselines between cohorts. PROMs and minimal clinically important differences (MCIDs) were used to examine the patient's perception of operative success. Bivariate and multivariate linear/logistic regression analyses were used to compare one- and two-level discectomies. The bivariate analysis included the t-test and chi-square test, which were used to assess continuous and categorical variables, respectively. Statistical significance was established at p < 0.05. RESULTS A total of 293 patients underwent one-level (n = 250) or two-level (n = 43) MIS discectomies. The mean follow-ups for the one- and two-level cohorts were 50.4 (SD 35.5) months and 61.6 (SD 39.8) months, respectively. Fewer female patients underwent two-level discectomies, and BMI and operative duration were higher in the two-level group (p < 0.001). Recurrent herniation requiring reoperation was recorded at rates of 6.80% and 11.6% in the one- and two-level groups, respectively (p = 0.270). Pre- and postoperative PROMs were largely similar between the cohorts; however, patients undergoing one-level discectomy had greater improvement in leg pain, and a significantly greater proportion of these patients achieved MCID for the leg pain visual analog scale score (p < 0.001). CONCLUSIONS At the 1-year clinical follow-up, patients who underwent two-level discectomy had significantly less improvement in leg pain scores with lower achievement of MCID for leg pain improvement than patients undergoing one-level procedures. At the 1-year follow-up, there were no other significant differences in PROMs between the two cohorts. Given these findings, patients should be counseled regarding the anticipated outcomes to better manage expectations. Further studies are warranted to examine the long-term clinical outcomes associated with single- and multilevel MIS discectomy.
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Affiliation(s)
- Zakariah K Siyaji
- 1Department of Orthopaedic Surgery, Division of Spine Surgery, Rush University Medical Center, Chicago, Illinois
- 2Regenerative Pain & Spine, Chicago, Illinois
| | - Austin Q Nguyen
- 1Department of Orthopaedic Surgery, Division of Spine Surgery, Rush University Medical Center, Chicago, Illinois
- 3Department of Orthopedics and Sports Medicine, Houston Methodist Hospital, Houston, Texas
| | - Vincent P Federico
- 1Department of Orthopaedic Surgery, Division of Spine Surgery, Rush University Medical Center, Chicago, Illinois
| | | | - Athan G Zavras
- 1Department of Orthopaedic Surgery, Division of Spine Surgery, Rush University Medical Center, Chicago, Illinois
- 4Department of Orthopaedic Surgery, Allegheny General Hospital, Pittsburgh, Pennsylvania
| | - James D Baker
- 1Department of Orthopaedic Surgery, Division of Spine Surgery, Rush University Medical Center, Chicago, Illinois
- 5Department of Orthopaedic Surgery, San Antonio Military Medical Center, San Antonio, Texas; and
| | - Bryce A Basques
- 6Department of Orthopaedics, Division of Spine Surgery, Brown University, Providence, Rhode Island
| | - Arash J Sayari
- 1Department of Orthopaedic Surgery, Division of Spine Surgery, Rush University Medical Center, Chicago, Illinois
| | - Frank M Phillips
- 1Department of Orthopaedic Surgery, Division of Spine Surgery, Rush University Medical Center, Chicago, Illinois
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Fukui H, Kamei N, Fujiwara Y, Nakamae T, Ohta R, Kotaka S, Adachi N. Intradiscal Condoliase Injection Therapy for Recurrent Lumbar Disc Herniation: Case Series and Literature Review. Medicina (Kaunas) 2023; 59:1561. [PMID: 37763680 PMCID: PMC10533059 DOI: 10.3390/medicina59091561] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/15/2023] [Revised: 07/25/2023] [Accepted: 08/09/2023] [Indexed: 09/29/2023]
Abstract
Background and objectives: Although chemonucleolysis with condoliase for lumbar disc herniation (LDH) has become common, few reports have described its application in the treatment of recurrent LDH. Therefore, this study aimed to evaluate the safety and efficacy of condoliase treatment in six patients with recurrent LDH and review the available literature on condoliase treatment for LDH. Materials and Methods: Six patients (four men and two women; mean age, 64.7 years) with recurrent LDH who were treated with condoliase at our hospital between 2019 and 2022 were included. The clinical records and images of the patients were retrospectively evaluated. In addition, the available English literature on condoliase treatment for LDH was retrieved and reviewed. Results: Among the six patients included in the study, three showed >50% improvement in leg pain after treatment, which is a lower efficacy rate than that in previous reports. In addition, two patients required surgery after treatment, which is a higher rate than that in previous reports. The mean intervertebral disc height significantly decreased from 8.4 mm before treatment to 6.9 mm after treatment, consistent with the results of previous studies. None of the cases showed Modic type I changes on magnetic resonance imaging. Conclusions: Although the efficacy of condoliase treatment for recurrent LDH may be lower than that for primary LDH, this treatment was found to be safe and applicable for recurrent LDH.
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Affiliation(s)
- Hiroki Fukui
- Orthopedics and Micro-Surgical Spine Center, Hiroshima City North Medical Center Asa Citizens Hospital, Hiroshima 731-0293, Japan; (Y.F.); (R.O.); (S.K.)
- Department of Orthopaedic Surgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima 734-8551, Japan; (N.K.); (T.N.); (N.A.)
| | - Naosuke Kamei
- Department of Orthopaedic Surgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima 734-8551, Japan; (N.K.); (T.N.); (N.A.)
| | - Yasushi Fujiwara
- Orthopedics and Micro-Surgical Spine Center, Hiroshima City North Medical Center Asa Citizens Hospital, Hiroshima 731-0293, Japan; (Y.F.); (R.O.); (S.K.)
| | - Toshio Nakamae
- Department of Orthopaedic Surgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima 734-8551, Japan; (N.K.); (T.N.); (N.A.)
| | - Ryo Ohta
- Orthopedics and Micro-Surgical Spine Center, Hiroshima City North Medical Center Asa Citizens Hospital, Hiroshima 731-0293, Japan; (Y.F.); (R.O.); (S.K.)
| | - Shinji Kotaka
- Orthopedics and Micro-Surgical Spine Center, Hiroshima City North Medical Center Asa Citizens Hospital, Hiroshima 731-0293, Japan; (Y.F.); (R.O.); (S.K.)
| | - Nobuo Adachi
- Department of Orthopaedic Surgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima 734-8551, Japan; (N.K.); (T.N.); (N.A.)
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Mishra S, Garg K, Chaurasia B, Budihal BR, Deora H, Tandon V, Phalak M, Mishra S, Kumar A, Umana GE, Lafuente J, Demetriades AK, Ha Y, Singh M, Chandra PS, Kale SS, Zileli M. An assessment of the variation in the practice of lumbar discectomy and its role in axial back pain. J Craniovertebr Junction Spine 2023; 14:259-267. [PMID: 37860028 PMCID: PMC10583805 DOI: 10.4103/jcvjs.jcvjs_46_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Accepted: 07/28/2023] [Indexed: 10/21/2023] Open
Abstract
Background Lumbar discectomy is performed for symptomatic lumbar disc herniation and is one of the most widely performed spinal surgical procedures worldwide in a variety of ways. This survey aimed at providing an overview/perspective of different practice patterns and the impact of lumbar discectomy on axial back pain with or without sciatica. Methods An online survey was performed using the application "Google Forms." The link to the questionnaire was distributed to neurosurgeons through personal E-mail and social media platforms. Results We received 333 responses. The largest percentage of responses across five continents was from Asia (66.97%, n = 223). The mean age of the respondents was 40.08 ± 10.5 years. A total of 66 respondents (20%) had a spine practice of 7%-90%, and 28 respondents had a spine practice of 90%-100% (8.4%). The number of respondents who practiced microscopic discectomy using a tubular retractor (n = 143 respondents, 42.9%) was nearly equal to the number of respondents who practiced open discectomy (n = 142 respondents, 42.6%). An almost equal proportion of respondents believed discectomy does not help in relieving axial back pain. Only 20.4% (n = 68) of respondents recommend bed rest for a longer duration postoperatively. Conclusions Our survey revealed that only 22.2% of spine surgeons recommended discectomy in patients with radiological disc herniation with axial back pain alone and preferred a minimally invasive method of discectomy. Almost half of them believed discectomy to be ineffective for axial low back pain and only a few recommended prolonged bed rest postoperatively.
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Affiliation(s)
- Sandeep Mishra
- Department of Neurosurgery, Lok Nayak Hospital, New Delhi, India
| | - Kanwaljeet Garg
- Department of Neurosurgery, All India Institute of Medical Sciences, New Delhi, India
| | - Bipin Chaurasia
- Department of Neurosurgery, Neurosurgery Clinic, Birgunj, Nepal
| | - Bhargavi R Budihal
- MBBS Student, BGS Global Institute of Medical Sciences, Bengaluru, India
| | - Harsh Deora
- Department of Neurosurgery, National Institute of Mental Health and Neuro Sciences, Bengaluru, India
| | - Vivek Tandon
- Department of Neurosurgery, All India Institute of Medical Sciences, New Delhi, India
| | - Manoj Phalak
- Department of Neurosurgery, All India Institute of Medical Sciences, New Delhi, India
| | - Shashwat Mishra
- Department of Neurosurgery, All India Institute of Medical Sciences, New Delhi, India
| | - Amandeep Kumar
- Department of Neurosurgery, All India Institute of Medical Sciences, New Delhi, India
| | - GE Umana
- Department of Neurosurgery, Trauma Center, Gamma Knife Center, Cannizzaro Hospital, Catania, Italy
| | - Jesus Lafuente
- Department of Neurosurgery, Hospital Universitario del Mar, Barcelona, Spain
| | | | - Yoon Ha
- Department of Neurosurgery, Yonsei University, Seoul, South Korea
| | - Manmohan Singh
- Department of Neurosurgery, All India Institute of Medical Sciences, New Delhi, India
| | - PS Chandra
- Department of Neurosurgery, All India Institute of Medical Sciences, New Delhi, India
| | - SS Kale
- Department of Neurosurgery, All India Institute of Medical Sciences, New Delhi, India
| | - Mehmet Zileli
- Department of Neurosurgery, Ege University, Izmir, Turkey
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Gogos C, Filippiadis DK, Velonakis G, Kelekis N, Papagelopoulos P, Kelekis A. Intradiscal Gelified Ethanol Nucleolysis versus Endoscopic Surgery for Lumbar Disc Herniation Radiculopathy. Diagnostics (Basel) 2023; 13:2164. [PMID: 37443558 DOI: 10.3390/diagnostics13132164] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Revised: 06/02/2023] [Accepted: 06/19/2023] [Indexed: 07/15/2023] Open
Abstract
The purpose of this study was to retrospectively compare efficacy and safety between intradiscal injection of a gelified ethanol product and tubular discectomy in the treatment of intervertebral disk herniation. A bi-central institutional database research identified forty (40) patients suffering from symptomatic contained disc herniation. Nucleolysis Group included 20 patients [mean 50.05 ± 9.27 years-of-age (male/female 14/6-70/30%)] and Surgery Group included 20 patients [mean 48.45 ± 14.53 years-of-age, (male/female 12/8-60/40%)]. Primary outcome was overall 12-month improvement over baseline in leg pain (NVS units). Procedural technical outcomes were recorded, and adverse events were evaluated at all follow-up intervals. CIRSE classification system was used for complications' reporting. Mean pre-operative pain score in Nucleolysis Group was 7.95 ± 0.94 reduced to 1.25 ± 1.11 at month 1 and 0.45 ± 0.75 NVS units at year 1. Mean pre-operative pain score in Surgery Group was 7.65 ± 1.13 reduced to 1.55 ± 1.79 at month 1 and 0.70 ± 1.38 NVS units at year 1. Pain decrease was statistically significant after both procedures (p < 0.001). There was no statistically significant difference between pain reduction in both groups (p = 0.347). The decrease differences of the pain effect upon general activities, sleeping, socializing, walking, and enjoying life in the follow-up period between the two groups were not statistically significant. No complications were noted in both groups. Results from the current study report that intradiscal injection of a gelified ethanol and tubular discectomy were equally effective on terms of efficacy and safety for the treatment of symptomatic lumbar intervertebral disc herniation regarding the 12-month mean leg pain improvement. Both achieved similar rapid significant clinical improvement persisting throughout follow-up period.
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Affiliation(s)
- Christos Gogos
- Neurosurgery Clinic, General Hospital "Asklepieio", 16673 Athens, Greece
| | - Dimitrios K Filippiadis
- 2nd Department of Radiology, University General Hospital "ATTIKON", Medical School, National and Kapodistrian University of Athens, 12462 Athens, Greece
| | - Georgios Velonakis
- 2nd Department of Radiology, University General Hospital "ATTIKON", Medical School, National and Kapodistrian University of Athens, 12462 Athens, Greece
| | - Nikolaos Kelekis
- 2nd Department of Radiology, University General Hospital "ATTIKON", Medical School, National and Kapodistrian University of Athens, 12462 Athens, Greece
| | - Panayiotis Papagelopoulos
- Orthopaedic Surgery & Traumatology, University General Hospital "ATTIKON", Medical School, National and Kapodistrian University of Athens, 12462 Athens, Greece
| | - Alexis Kelekis
- 2nd Department of Radiology, University General Hospital "ATTIKON", Medical School, National and Kapodistrian University of Athens, 12462 Athens, Greece
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Erwin WM. Should you adjust that herniated disc? Thoughts from a chiropractor/molecular scientist. J Can Chiropr Assoc 2023; 67:7-18. [PMID: 37250457 PMCID: PMC10211408] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
Low back pain accounts for the most years lost to disability of any malady worldwide but most cases of disc herniation (DH) and degenerative disc disease (DDD) resolve with conservative methods. Numerous tissue sources of pain affecting the degenerative/herniated disc have been identified, with changes secondary to the influence of inflammation figuring prominently among them. Due to the proven linkage of inflammation to the pain and progression of disc degeneration, anti-inflammatory/anti-catabolic and pro-anabolic repair strategies are gaining prominence for novel therapeutic approaches. Current treatments include conservative therapies such as modified rest, exercise, anti-inflammatory treatments, and analgesics. There is no accepted proposed mechanism of action to support the direct role of spinal manipulation for the treatment of the degenerative and/or herniated disc. However, there are published accounts of very serious adverse events accompanying such treatments leading to the question; 'should a patient with suspected painful IVD be treated with manipulation?
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Affiliation(s)
- W. Mark Erwin
- Divisions of Neurological and Orthopaedic Surgery, University of Toronto
- Research, Canadian Memorial Chiropractic College
- Notogen Inc
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9
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Wan ZY, Zhang J, Shan H, Liu TF, Song F, Samartzis D, Wang HQ. Epidemiology of Lumbar Degenerative Phenotypes of Children and Adolescents: A Large-Scale Imaging Study. Global Spine J 2023; 13:599-608. [PMID: 33843321 DOI: 10.1177/21925682211000707] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
STUDY DESIGN Cross-sectional study. OBJECTIVE Recently, there has been a rise in children and adolescents developing low back pain and/or sciatica. Degenerative lumbar spine MRI phenotypes can occur in this population but reports have been sporadic and the true incidence of such spine changes remains debatable. As such, the study aimed to address the epidemiology of MRI phenotypes of the lumbar spine in this young population. METHODS 597 children and adolescents with lumbar MRIs were included in the study. T1- and T2-weighted lumbar images from L1/2 to L5/S1 were analyzed in axial and sagittal planes. Global phenotype assessment was performed of each level and based on established nomenclature protocols. RESULTS The cohort consisted of 57.3% (342) boys and 42.7% (255) girls, with a mean age of 10.75 ± 5.25 years (range: 0 to 18 years). The prevalence of imaging findings of lumbar disc degeneration (LDD) and lumbar disc herniation (LDH) were 2.2% (95% CI: 0.93-3.43) and 5.8% (95%CI: 2.58-8.99), respectively. There was significant difference between each disc segment from L1/2 to L5/S1 for both LDD and LDH. Schmorl's nodes were noted in 16 cases (2.7%, youngest case as 15 years), with 11 boys (68.8%) and most frequent segment as L3/4. Modic changes and high-intensity zones were absent in this cohort. CONCLUSIONS LDD can emerge as early as the first decade of life with Schmorl's nodes, without additional specific phenotypes, including Modic changes and high-intensity zones. The study provides valuable information of a unique age group that is often under-represented but equally important as adults.
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Affiliation(s)
- Zhong-Yuan Wan
- Department of Orthopedics, The Seventh Medical Center of Chinese PLA General Hospital, Beijing, People's Republic of China
| | - Jun Zhang
- Department of Orthopedics, Baoji Central Hospital, Baoji, Shaanxi Province, People's Republic of China
| | - Hua Shan
- Institute of Integrative Medicine, 107652Shaanxi University of Chinese Medicine, Xi'an, Shaanxi Province, People's Republic of China
| | - Tang-Fen Liu
- Institute of Integrative Medicine, 107652Shaanxi University of Chinese Medicine, Xi'an, Shaanxi Province, People's Republic of China
| | - Fang Song
- Department of Stomatology, PLA Rocket Force Characteristic Medical Center, Beijing, People's Republic of China
| | - Dino Samartzis
- Department of Orthopaedic Surgery, 2468Rush University Medical Center, Chicago, IL, USA
| | - Hai-Qiang Wang
- Institute of Integrative Medicine, 107652Shaanxi University of Chinese Medicine, Xi'an, Shaanxi Province, People's Republic of China
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Abulohoom F, Al‐wageeh S, Ahmed F, Al‐Sharani H, Al‐Muaalemi Z, Al‐Hutbany N, Badheeb M. Traumatic herniation of buccal fat pad into the oral cavity in an infant: A case report. Clin Case Rep 2023; 11:e7201. [PMID: 37064736 PMCID: PMC10099198 DOI: 10.1002/ccr3.7201] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2023] [Revised: 03/25/2023] [Accepted: 03/29/2023] [Indexed: 04/18/2023] Open
Abstract
Buccal fat herniation is a rare traumatic disease that should be included in differential diagnosis of infants' oral cavity mass. History of proceeding trauma, careful evaluation of mucosal perforation aiding the diagnosis.
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Affiliation(s)
- Faisal Abulohoom
- Department of Maxillofacial Surgery, School of MedicineIbb University of Medical SciencesIbbYemen
| | - Saleh Al‐wageeh
- Department of General Surgery, School of MedicineIbb University of Medical SciencesIbbYemen
| | - Faisal Ahmed
- Department of Urology, School of MedicineIbb University of Medical SciencesIbbYemen
| | - Hesham Al‐Sharani
- Department of Maxillofacial Surgery, School of MedicineIbb University of Medical SciencesIbbYemen
| | - Zakarya Al‐Muaalemi
- Department of Maxillofacial Surgery, School of MedicineIbb University of Medical SciencesIbbYemen
| | - Nassr Al‐Hutbany
- Department of Maxillofacial Surgery, School of MedicineIbb University of Medical SciencesIbbYemen
| | - Mohamed Badheeb
- Department of Internal Medicine, Faculty of MedicineHadhramaut UniversityHadhramautYemen
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Patel J, Stewart J, Biswas S, Zaid S. Spinal Cord Herniation into a Pseudomeningocele-A Delayed Presentation following a Traumatic Cervical Root Avulsion Injury. Indian J Radiol Imaging 2023; 33:264-266. [PMID: 37123578 PMCID: PMC10132880 DOI: 10.1055/s-0042-1760283] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/02/2023] Open
Abstract
Background Spinal cord herniation into a traumatic pseudomeningocele is a rare clinical entity. We present the sixth known case and describe surgical management. Case Presentation A 44-year-old male presented with Brown-Sequard syndrome three decades after a cervical nerve root avulsion injury. Imaging revealed hemicord herniation into a C7/T1 pseudomeningocele in addition to extra-axial cord compression from further pseudomeningoceles. Significant clinical improvement was achieved following surgical repair. The radiological findings and technique for operative repair are described. Conclusion The case highlights this rare pathology and presentation, describes the surgical measures for repair of cord herniation, and provides evidence for the favorable outcome that can be achieved by surgical intervention.
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Affiliation(s)
- Jay Patel
- Department of Neuroradiology, The Walton Centre, Liverpool, United Kingdom
- Address for correspondence Jay Patel, FRCR, MBChB Department of Neuroradiology, The Walton Centre NHS Foundation TrustLower Lane, Liverpool L9 7LJUnited Kingdom
| | - James Stewart
- Department of Neurosurgery, The Walton Centre, Liverpool, United Kingdom
| | - Shubhabrata Biswas
- Department of Neuroradiology, The Walton Centre, Liverpool, United Kingdom
| | - Sarsam Zaid
- Department of Neurosurgery, The Walton Centre, Liverpool, United Kingdom
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12
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Sweeney J, Bondoc M, Bandlamuri S, Holdaway M, Entezami P, O'Brien MW, Adamo MA. Risk of Neurological Decline in Patients With Temporal Lobe Brain Masses. Anticancer Res 2023; 43:663-668. [PMID: 36697071 DOI: 10.21873/anticanres.16203] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2022] [Revised: 11/25/2022] [Accepted: 12/05/2022] [Indexed: 01/26/2023]
Abstract
AIM The objective of this study was to assess which clinical and radiographic findings may be associated with neurological decline in patients with temporal lobe mass lesions. PATIENTS AND METHODS This represents a retrospective cohort study. Neurological decline was defined as a decline in Glasgow Coma Scale of 2 or more or new anisocoria. Adult patients aged 18 to 89 years with isolated temporal lobe, intra-axial, contrast-enhancing masses diagnosed between 1/1/2010 and 12/31/2020 were included. Clinical and radiographic findings were collected for each patient. Linear regression analysis was used to identify findings predictive of neurological decline. Patients with neurological decline were compared to stable patients to identify factors that may increase risk for neurological decline. RESULTS A total of 71 patients met the inclusion criteria. Four out of the 71 patients experienced neurological decline, representing an incidence of 6%. Linear regression analysis identified only radiographic transtentorial herniation as a predictor of neurological decline (β=0.26, p=0.03). A midline shift greater than 5 mm (100% vs. 40%; odds ratio=1.12, 95% confidence interval=1.00-1.32; p=0.05) and radiographic transtentorial herniation (75% vs. 18%; odds ratio=32.12, 95% confidence interval=3.91-264.18; p=0.03) were significantly more prevalent in patients with neurological decline and were associated with an increased risk of neurological decline. CONCLUSION Radiographic transtentorial herniation and a midline shift greater than 5 mm may be useful findings to suggest an increased risk of neurological decline in patients with masses of the temporal lobe. This knowledge may be useful to neurosurgeons and physicians in other specialties to best care for this patient population.
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Affiliation(s)
- Jared Sweeney
- Department of Neurosurgery, Albany Medical Center, Albany, NY, U.S.A.
| | - Melanie Bondoc
- Department of Neurosurgery, Albany Medical Center, Albany, NY, U.S.A
| | - Sruti Bandlamuri
- Department of Neurosurgery, Albany Medical Center, Albany, NY, U.S.A
| | - Matt Holdaway
- Department of Neurosurgery, Albany Medical Center, Albany, NY, U.S.A
| | - Pouya Entezami
- Department of Neurosurgery, Albany Medical Center, Albany, NY, U.S.A
| | - Michael W O'Brien
- Department of Neurosurgery, Albany Medical Center, Albany, NY, U.S.A
| | - Matthew A Adamo
- Department of Neurosurgery, Albany Medical Center, Albany, NY, U.S.A
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13
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Kim ISY, Balogun OO, Prescott BR, Saglam H, Olson DM, Speir K, Stutzman SE, Schneider N, Aguilera V, Lussier BL, Smirnakis SM, Dupuis J, Mian A, Greer DM, Ong CJ. Quantitative pupillometry and radiographic markers of intracranial midline shift: A pilot study. Front Neurol 2022; 13:1046548. [PMID: 36561299 PMCID: PMC9763295 DOI: 10.3389/fneur.2022.1046548] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2022] [Accepted: 10/20/2022] [Indexed: 12/12/2022] Open
Abstract
Background Asymmetric pupil reactivity or size can be early clinical indicators of midbrain compression due to supratentorial ischemic stroke or primary intraparenchymal hemorrhage (IPH). Radiographic midline shift is associated with worse functional outcomes and life-saving interventions. Better understanding of quantitative pupil characteristics would be a non-invasive, safe, and cost-effective way to improve identification of life-threatening mass effect and resource utilization of emergent radiographic imaging. We aimed to better characterize the association between midline shift at various anatomic levels and quantitative pupil characteristics. Methods We conducted a multicenter retrospective study of brain CT images within 75 min of a quantitative pupil observation from patients admitted to Neuro-ICUs between 2016 and 2020 with large (>1/3 of the middle cerebral artery territory) acute supratentorial ischemic stroke or primary IPH > 30 mm3. For each image, we measured midline shift at the septum pellucidum (MLS-SP), pineal gland shift (PGS), the ratio of the ipsilateral to contralateral midbrain width (IMW/CMW), and other exploratory markers of radiographic shift/compression. Pupil reactivity was measured using an automated infrared pupillometer (NeurOptics®, Inc.), specifically the proprietary algorithm for Neurological Pupil Index® (NPi). We used rank-normalization and linear mixed-effects models, stratified by diagnosis and hemorrhagic conversion, to test associations of radiographic markers of shift and asymmetric pupil reactivity (Diff NPi), adjusting for age, lesion volume, Glasgow Coma Scale, and osmotic medications. Results Of 53 patients with 74 CT images, 26 (49.1%) were female, and median age was 67 years. MLS-SP and PGS were greater in patients with IPH, compared to patients with ischemic stroke (6.2 v. 4.0 mm, 5.6 v. 3.4 mm, respectively). We found no significant associations between pupil reactivity and the radiographic markers of shift when adjusting for confounders. However, we found potentially relevant relationships between MLS-SP and Diff NPi in our IPH cohort (β = 0.11, SE 0.04, P = 0.01), and PGS and Diff NPi in the ischemic stroke cohort (β = 0.16, SE 0.09, P = 0.07). Conclusion We found the relationship between midline shift and asymmetric pupil reactivity may differ between IPH and ischemic stroke. Our study may serve as necessary preliminary data to guide further prospective investigation into how clinical manifestations of radiographic midline shift differ by diagnosis and proximity to the midbrain.
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Affiliation(s)
- Ivy So Yeon Kim
- Boston University School of Medicine, Boston, MA, United States,Boston Medical Center, Boston, MA, United States,Mass General Brigham, Boston, MA, United States
| | - Oluwafemi O. Balogun
- Boston University School of Medicine, Boston, MA, United States,Boston Medical Center, Boston, MA, United States,Mass General Brigham, Boston, MA, United States
| | - Brenton R. Prescott
- Boston University School of Medicine, Boston, MA, United States,Boston Medical Center, Boston, MA, United States,Mass General Brigham, Boston, MA, United States
| | - Hanife Saglam
- Mass General Brigham, Boston, MA, United States,Harvard Medical School, Boston, MA, United States
| | - DaiWai M. Olson
- University of Texas Southwestern Medical Center, Dallas, TX, United States
| | - Kinley Speir
- University of Texas Southwestern Medical Center, Dallas, TX, United States
| | - Sonja E. Stutzman
- University of Texas Southwestern Medical Center, Dallas, TX, United States
| | - Nathan Schneider
- University of Texas Southwestern Medical Center, Dallas, TX, United States
| | - Veronica Aguilera
- University of Texas Southwestern Medical Center, Dallas, TX, United States
| | - Bethany L. Lussier
- University of Texas Southwestern Medical Center, Dallas, TX, United States
| | - Stelios M. Smirnakis
- Mass General Brigham, Boston, MA, United States,Jamaica Plain Veterans Administration Medical Center, Boston, MA, United States
| | - Josée Dupuis
- Boston University School of Public Health, Boston, MA, United States,Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, QC, Canada
| | - Asim Mian
- Boston University School of Medicine, Boston, MA, United States,Boston Medical Center, Boston, MA, United States
| | - David M. Greer
- Boston University School of Medicine, Boston, MA, United States,Boston Medical Center, Boston, MA, United States
| | - Charlene J. Ong
- Boston University School of Medicine, Boston, MA, United States,Boston Medical Center, Boston, MA, United States,Mass General Brigham, Boston, MA, United States,Harvard Medical School, Boston, MA, United States,*Correspondence: Charlene J. Ong
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14
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Yoshihara S, Yaegashi T, Matsunaga M, Kurata M, Naito M. Multimodality Imaging in a Case of Muscular Outlet Ventricular Septal Defect With Aortic Regurgitation due to Right Sinus of Valsalva Aneurysm Herniation. Circ Cardiovasc Imaging 2022; 15:e014080. [PMID: 36000391 DOI: 10.1161/circimaging.122.014080] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Affiliation(s)
- Shu Yoshihara
- Department of Diagnostic Radiology (S.Y., M.N.), Iwata City Hospital, Japan
| | - Taku Yaegashi
- Radiological Technology (T.Y.), Iwata City Hospital, Japan
| | | | | | - Masaaki Naito
- Department of Diagnostic Radiology (S.Y., M.N.), Iwata City Hospital, Japan
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15
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Mao L, Wang K, Huang Y, Wang F, Zhang R, Zhu B, Wu X. Transforaminal Endoscopic Lumbar Discectomy for Lumbosacral Junction Adolescent Lumbar Disc Herniation with High Iliac Crests. Orthop Surg 2022; 14:1715-1722. [PMID: 35768829 PMCID: PMC9363714 DOI: 10.1111/os.13355] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2021] [Revised: 05/11/2022] [Accepted: 05/18/2022] [Indexed: 12/01/2022] Open
Abstract
Objective To investigate the clinical results of transforaminal endoscopic lumbar discectomy for lumbosacral junction adolescent lumbar disc herniation with high iliac crest. Methods From February 2014 to September 2020, a retrospective analysis of 96 patients less than 21 years old with intervertebral disc herniation was carried out. We enrolled 44 patients diagnosed with lumbosacral junction disc herniation with high iliac crest who required transforaminal endoscopic lumbar discectomy. Pain in the back and the lower extremity was scored on Numeric Rating Scales (NRS) scores. Patient outcomes were graded as excellent, good, fair, and poor using modified MacNab criteria. The NRS scores before and after the operation were compared using the Wilcoxon two‐sample test. Results There were 30 male patients and 14 females. One patient underwent repeat surgery for an intervertebral disc pseudocyst. The NRS scores decreased significantly in both early and late follow‐up evaluations (p < 0.05). At the last follow‐up, 42 patients (95.45%) had an excellent outcome, one patient (2.27%) had a good outcome, and one patient (2.27%) had a fair outcome. The overall success rate was 97.7%. Conclusion This study's data suggest that targeted individualized foraminoplasty can effectively overcome the lumbosacral anatomical obstacles, and transforaminal endoscopic lumbar discectomy is an effective and valid option for lumbosacral junction adolescent lumbar disc herniation with high iliac crest.
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Affiliation(s)
- Lu Mao
- Department of Spine Surgery, Zhongda Hospital, School of Medicine, Southeast University, Nanjing, China
| | - Kun Wang
- Department of Spine Surgery, Zhongda Hospital, School of Medicine, Southeast University, Nanjing, China
| | - Yong Huang
- Department of Spine Surgery, Zhongda Hospital, School of Medicine, Southeast University, Nanjing, China
| | - Feng Wang
- Department of Spine Surgery, Zhongda Hospital, School of Medicine, Southeast University, Nanjing, China
| | - Rui Zhang
- Department of Spine Surgery, Zhongda Hospital, School of Medicine, Southeast University, Nanjing, China
| | - Bin Zhu
- Department of Orthopedics, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Xiaotao Wu
- Department of Spine Surgery, Zhongda Hospital, School of Medicine, Southeast University, Nanjing, China
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16
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Panjwani S, Walker D, Gates J, Katigbak M, Ricaurte D. Lung herniation following a severe traumatic chest wall injury. Trauma Surg Acute Care Open 2022; 7:e000880. [PMID: 35321529 PMCID: PMC8896028 DOI: 10.1136/tsaco-2021-000880] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Affiliation(s)
- Suraj Panjwani
- Surgery, St Mary's Hospital, Waterbury, Connecticut, USA
| | - Daniel Walker
- Surgery, Hartford Hospital, Hartford, Connecticut, USA
| | - Jonathan Gates
- Surgery, Hartford Hospital, Hartford, Connecticut, USA.,Surgery, University of Connecticut, Farmington, Connecticut, USA
| | | | - Daniel Ricaurte
- Surgery, Hartford Hospital, Hartford, Connecticut, USA.,Surgery, University of Connecticut, Farmington, Connecticut, USA
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17
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Ye F, Lyu FJ, Wang H, Zheng Z. The involvement of immune system in intervertebral disc herniation and degeneration. JOR Spine 2022; 5:e1196. [PMID: 35386754 PMCID: PMC8966871 DOI: 10.1002/jsp2.1196] [Citation(s) in RCA: 30] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2021] [Revised: 02/06/2022] [Accepted: 02/25/2022] [Indexed: 02/06/2023] Open
Abstract
Intervertebral disc (IVD) herniation and degeneration contributes significantly to low back pain (LBP), of which the molecular pathogenesis is not fully understood. Disc herniation may cause LBP and radicular pain, but not all LBP patients have disc herniation. Degenerated discs could be the source of pain, but not all degenerated discs are symptomatic. We previously found that disc degeneration and herniation accompanied by inflammation. We further found that anti‐inflammatory molecules blocked immune responses, alleviated IVD degeneration and pain. Based on our recent findings and the work of others, we hypothesize that immune system may play a prominent role in the production of disc herniation or disc degeneration associated pain. While the nucleus pulposus (NP) is an immune‐privileged organ, the damage of the physical barrier between NP and systemic circulation, or the innervation and vascularization of the degenerated NP, on one hand exposes NP as a foreign antigen to immune system, and on the other hand presents compression on the nerve root or dorsal root ganglion (DRG), which both elicit immune responses induced by immune cells and their mediators. The inflammation can remain for a long time at remote distance, with various types of cytokines and immune cells involved in this pain‐inducing process. In this review, we aim to revisit the autoimmunity of the NP, immune cell infiltration after break of physical barrier, the inflammatory activities in the DRG and the generation of pain. We also summarize the involvement of immune system, including immune cells and cytokines, in degenerated or herniated IVDs and affected DRG.
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Affiliation(s)
- Fubiao Ye
- Department of Spine Surgery, The First Affiliated Hospital Sun Yat-Sen University Guangzhou China.,Department of Orthopaedics, Fujian Provincial Hospital Provincial Clinical Medical College of Fujian Medical University Fuzhou Fujian China
| | - Feng-Juan Lyu
- Joint Center for Regenerative Medicine Research of South China University of Technology and The University of Western Australia, School of Medicine South China University of Technology Guangzhou China
| | - Hua Wang
- Department of Spine Surgery, The First Affiliated Hospital Sun Yat-Sen University Guangzhou China
| | - Zhaomin Zheng
- Department of Spine Surgery, The First Affiliated Hospital Sun Yat-Sen University Guangzhou China.,Pain Research Center Sun Yat-sen University Guangzhou China
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18
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Abstract
Continuous electroencephalography (cEEG) and quantitative analysis of EEG (qEEG) are used in various circumstances such as detecting seizures, identifying acute or delayed cerebral ischemia, monitoring sedative therapy, or assessing prognosis. The authors report 2 cases: (1) Case #1 was a patient with unilateral cerebral edema and uncal herniation with asymmetric cEEG and qEEG changes detected an hour before clinical examination changes were noted and (2) Case #2 was a patient with diffuse cerebral edema and trans-tentorial herniation with symmetric cEEG and qEEG changes detected an hour before clinical examination changes were noted. These cases demonstrate the ability of cEEG and qEEG in early detection of different types of cerebral herniation. qEEG can be utilized by intensive care unit (ICU) staff not trained in EEG interpretation as a surveillance method to detect cerebral herniation, which may provide an opportunity for early intervention in high-risk patients.
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Affiliation(s)
| | | | | | - Lu Lin
- 1859Beth Israel Deaconess Medical Center, Boston, MA, USA
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19
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McBride R, Parker E, Garabed RB, Olby NJ, Tipold A, Stein VM, Granger N, Hechler AC, Yaxley PE, Moore SA. Developing a predictive model for spinal shock in dogs with spinal cord injury. J Vet Intern Med 2022; 36:663-671. [PMID: 35001437 PMCID: PMC8965241 DOI: 10.1111/jvim.16352] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2021] [Revised: 12/10/2021] [Accepted: 12/21/2021] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Reduced pelvic limb reflexes in dogs with spinal cord injury typically suggests a lesion of the L4-S3 spinal cord segments. However, pelvic limb reflexes might also be reduced in dogs with a T3-L3 myelopathy and concurrent spinal shock. HYPOTHESIS/OBJECTIVES We hypothesized that statistical models could be used to identify clinical variables associated with spinal shock in dogs with spinal cord injuries. ANIMALS Cohort of 59 dogs with T3-L3 myelopathies and spinal shock and 13 dogs with L4-S3 myelopathies. METHODS Data used for this study were prospectively entered by partner institutions into the International Canine Spinal Cord Injury observational registry between October 2016 and July 2019. Univariable logistic regression analyses were performed to assess the association between independent variables and the presence of spinal shock. Independent variables were selected for inclusion in a multivariable logistic regression model if they had a significant effect (P ≤ .1) on the odds of spinal shock in univariable logistic regression. RESULTS The final multivariable model included the natural log of weight (kg), the natural log of duration of clinical signs (hours), severity (paresis vs paraplegia), and pelvic limb tone (normal vs decreased/absent). The odds of spinal shock decreased with increasing weight (odds ratio [OR] = 0.28, P = .09; confidence interval [CI] 0.07-1.2), increasing duration (OR = 0.44, P = .02; CI 0.21-0.9), decreased pelvic limb tone (OR = 0.04, P = .003; CI 0.01-0.36), and increased in the presence of paraplegia (OR = 7.87, P = .04; CI 1.1-56.62). CONCLUSIONS AND CLINICAL IMPORTANCE A formula, as developed by the present study and after external validation, could be useful for assisting clinicians in determining the likelihood of spinal shock in various clinical scenarios and aid in diagnostic planning.
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Affiliation(s)
- Rebecca McBride
- Department of Veterinary Clinical Sciences, The Ohio State University College of Veterinary Medicine, Columbus, Ohio, USA
| | - Elizabeth Parker
- Department of Veterinary Preventive Medicine, The Ohio State University, Columbus, Ohio, USA
| | - Rebecca B Garabed
- Department of Veterinary Clinical Sciences, The Ohio State University College of Veterinary Medicine, Columbus, Ohio, USA
| | - Natasha J Olby
- Department of Clinical Sciences, College of Veterinary Medicine, North Carolina State University, Raleigh, North Carolina, USA
| | - Andrea Tipold
- Department of Small Animal Medicine and Surgery, University of Veterinary Medicine, Hannover, Germany
| | - Veronika Maria Stein
- Department of Clinical Veterinary Sciences, Vetsuisse Faculty, University of Bern, Bern, Switzerland
| | - Nicolas Granger
- Department of Small Animal Clinical Sciences, School of Veterinary Sciences, University of Bristol, Bristol, United Kingdom
| | - Ashley C Hechler
- Department of Veterinary Clinical Sciences, The Ohio State University College of Veterinary Medicine, Columbus, Ohio, USA
| | - Page E Yaxley
- Department of Veterinary Clinical Sciences, The Ohio State University College of Veterinary Medicine, Columbus, Ohio, USA
| | - Sarah A Moore
- Department of Veterinary Clinical Sciences, The Ohio State University College of Veterinary Medicine, Columbus, Ohio, USA
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20
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Wiggins A, Moynihan M, Canes D. Robotic-assisted reconstruction of a ureteral herniation into the psoas major fascia: A unique obstructive etiology and a surgical approach to management. Urol Ann 2022; 14:389-391. [PMID: 36505986 PMCID: PMC9731202 DOI: 10.4103/ua.ua_31_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2022] [Revised: 05/27/2022] [Accepted: 06/28/2022] [Indexed: 12/15/2022] Open
Abstract
Ureteral herniation has been described in urologic literature. Documented sites of herniation include the femoral and inguinal canals, obturator and sciatic foramen, and the thoracic cavity. Herein, we report what we believe to be the first described case of symptomatic obstruction from ureteral herniation through a defect in the psoas major muscle fascia and detail our approach to definitive robotic-assisted surgical management of this unique entity.
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Affiliation(s)
- Adam Wiggins
- Lahey Hospital and Medical Center, Burlington, MA, USA,Address for correspondence: Dr. Adam Wiggins, Lahey Hospital and Medical Center, Burlington, MA, USA. E-mail:
| | | | - David Canes
- Lahey Hospital and Medical Center, Burlington, MA, USA
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21
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Almohammad M, Tasabehji T, Awad A, Hanafi I. Herniation of the Mastoid Segment of the Facial Nerve During Cochlear Implantation Surgery. Ear Nose Throat J 2021:1455613211051655. [PMID: 34923876 DOI: 10.1177/01455613211051655] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND We aim to report a rare case of a herniated mastoid segment of the facial nerve that was accidently discovered during cochlear implantation surgery and how altering the surgery plan could achieve the implantation while preserving the nerve. CASE PRESENTATION A four-year-old girl presented with profound bilateral sensorineural hearing loss that did not completely resolve after 2 years of using hearing aids was scheduled for cochlear implantation surgery in the right ear. During surgery, a herniated mastoid segment of the facial nerve took an anterior course and obstructed the access to the round window. CONCLUSION When a traditional posterior tympanotomy approach in cochlear implantation surgery is limited in cases of a herniated facial nerve, a tunnel created near the inferior part of the posterior wall of the auditory canal provided safe insertion of the electrode. It also permitted placement of a piece of fascia between the electrode and the facial nerve, therefore, protecting the facial nerve from electrical stimuli.
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Affiliation(s)
- Mohammad Almohammad
- Otorhinolaryngology Department, Al- Mouwassat University Hospital, Damascus, Syria
| | - Tala Tasabehji
- Otorhinolaryngology Department, 37588Damascus Hospital, Damascus, Syria
| | - Abdulrahman Awad
- Otorhinolaryngology Department, Consultant ENT and Cochlear Implant Surgeon, 247263Tishreen Military Hospital, Damascus, Syria
| | - Ibrahem Hanafi
- Division of Neurology, Department of Internal Medicine, Faculty of Medicine, 251087Damascus University, Damascus, Syria
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22
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Carpenter K, Iwanaga J, Aysenne A, Dumont AS, Bui CJ, Tubbs RS. An anatomical model for studying cerebellar tonsillar herniation related to raised intracranial pressure. Clin Anat 2021; 35:251-255. [PMID: 34913515 DOI: 10.1002/ca.23827] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2021] [Accepted: 11/29/2021] [Indexed: 11/06/2022]
Abstract
Brain herniation is one of the most feared complications of many neurological pathologies. However, current understanding of the mechanisms behind brain herniation syndromes is poor. By investigating the correlations between raised intracranial pressure (ICP) and herniation of the cerebellar tonsils, we hope to develop a model that can be used to study intracranial fluid dynamics and its effects on brain tissue. This will facilitate evaluation of patients with elevated ICP and development of novel treatments including surgical approaches for decompressing the posterior cranial fossa and upper cervical spine. A standard suboccipital surgical approach was used to expose the foramen magnum and observe movements of the cerebellar tonsils in fresh cadavers. A urinary Foley catheter balloon in the parietal extradural space was used to simulate a mass effect while ICP was monitored. The baseline anatomy differed widely among the cadaver specimens. However, and overall, we found that as ICP rises, the cerebellar tonsils descend through the foramen magnum at a rate of 0.3 mm per 1 mmHg increase in ICP. A mean descent of 6.2 mm was observed for a mean ICP increase of 17 mmHg. In this cadaveric study, we present a method and model for exploring brain herniation syndromes in the context of ICP changes. This could allow for further models to study the effects of other neuropathologies on the cerebellar tonsils, including posterior cranial fossa mass lesions and cerebellar hemorrhage.
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Affiliation(s)
- Kennedy Carpenter
- Department of Neurosurgery and Ochsner Neuroscience Institute, Ochsner Health System, New Orleans, Louisiana, USA
| | - Joe Iwanaga
- Department of Neurosurgery, Tulane Center for Clinical Neurosciences, Tulane University School of Medicine, New Orleans, Louisiana, USA
| | - Aimee Aysenne
- Department of Neurosurgery, Tulane Center for Clinical Neurosciences, Tulane University School of Medicine, New Orleans, Louisiana, USA
| | - Aaron S Dumont
- Department of Neurosurgery, Tulane Center for Clinical Neurosciences, Tulane University School of Medicine, New Orleans, Louisiana, USA
| | - C J Bui
- Department of Neurosurgery and Ochsner Neuroscience Institute, Ochsner Health System, New Orleans, Louisiana, USA
| | - R Shane Tubbs
- Department of Neurosurgery and Ochsner Neuroscience Institute, Ochsner Health System, New Orleans, Louisiana, USA.,Department of Neurosurgery, Tulane Center for Clinical Neurosciences, Tulane University School of Medicine, New Orleans, Louisiana, USA.,Department of Anatomical Sciences, St. George's University, St. George's, Grenada.,Department of Structural & Cellular Biology, Tulane University School of Medicine, New Orleans, Louisiana, USA.,Department of Surgery, Tulane University School of Medicine, New Orleans, Louisiana, USA
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23
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Chang WW, Kao YL, Hung SH. Spontaneous Herniation of Temporomandibular Joint Into the External Auditory Canal. Ear Nose Throat J 2021:1455613211064236. [PMID: 34894808 DOI: 10.1177/01455613211064236] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
- Wei-Wen Chang
- Division of General Surgery, Department of Surgery, Wan Fang Hospital, Taipei Medical University
| | - Yi-Lin Kao
- Department of Otolaryngology, Wan Fang Hospital, 63499Taipei Medical University, Taipei, Taiwan
| | - Shih-Han Hung
- Department of Otolaryngology, Wan Fang Hospital, 63499Taipei Medical University, Taipei, Taiwan
- Department of Otolaryngology, School of Medicine, College of Medicine, 63499Taipei Medical University, Taipei, Taiwan
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24
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Borem R, Madeline A, Theos C, Vela R, Garon A, Gill S, Mercuri J. Angle-ply scaffold supports annulus fibrosus matrix expression and remodeling by mesenchymal stromal and annulus fibrosus cells. J Biomed Mater Res B Appl Biomater 2021; 110:1056-1068. [PMID: 34843173 DOI: 10.1002/jbm.b.34980] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2021] [Revised: 09/07/2021] [Accepted: 11/19/2021] [Indexed: 11/07/2022]
Abstract
The angle-ply multilaminate structure of the annulus fibrosus is not reestablished following discectomy which leads to reherniation of the intervertebral disc (IVD). Biomimetic scaffolds developed to repair these defects should be evaluated for their ability to support tissue regeneration by endogenous and exogenous cells. Herein a collagen-based, angle-ply multilaminate patch designed to repair the outer annulus fibrosus was assessed for its ability to support mesenchymal stromal and annulus fibrosus cell viability, elongation, alignment, extracellular matrix gene expression, and scaffold remodeling. Results demonstrated that the cells remained viable, elongated, and aligned along the collagen fiber preferred direction of the scaffold, upregulated genes associated with annulus fibrosus matrix and produced collagen on the scaffold yielding biaxial mechanical properties that resembled native annulus fibrosus tissue. In conclusion, these scaffolds have demonstrated their potential to promote a living repair of defects in the annulus fibrosus and thus may be used to prevent recurrent IVD herniations.
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Affiliation(s)
- Ryan Borem
- The Laboratory of Orthopaedic Tissue Regeneration & Orthobiologics, Department of Bioengineering, Clemson University, Clemson, South Carolina, USA
| | - Allison Madeline
- The Laboratory of Orthopaedic Tissue Regeneration & Orthobiologics, Department of Bioengineering, Clemson University, Clemson, South Carolina, USA
| | - Chris Theos
- The Laboratory of Orthopaedic Tissue Regeneration & Orthobiologics, Department of Bioengineering, Clemson University, Clemson, South Carolina, USA
| | - Ricardo Vela
- The Laboratory of Orthopaedic Tissue Regeneration & Orthobiologics, Department of Bioengineering, Clemson University, Clemson, South Carolina, USA
| | - Alex Garon
- The Laboratory of Orthopaedic Tissue Regeneration & Orthobiologics, Department of Bioengineering, Clemson University, Clemson, South Carolina, USA
| | - Sanjitpal Gill
- The Laboratory of Orthopaedic Tissue Regeneration & Orthobiologics, Department of Bioengineering, Clemson University, Clemson, South Carolina, USA.,Department of Orthopaedic Surgery, Medical Group of the Carolinas-Pelham, Spartanburg Regional Healthcare System, Greer, South Carolina, USA
| | - Jeremy Mercuri
- The Laboratory of Orthopaedic Tissue Regeneration & Orthobiologics, Department of Bioengineering, Clemson University, Clemson, South Carolina, USA.,Frank H. Stelling and C. Dayton Riddle Orthopaedic Education and Research Laboratory, Clemson University Biomedical Engineering Innovation Campus, Greenville, South Carolina, USA
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Beale CC, Secrest SA. MRI assessment of epaxial myosteatosis in dogs with intervertebral disc extrusions and associations with patient factors and outcome. Vet Radiol Ultrasound 2021; 62:687-696. [PMID: 34510632 DOI: 10.1111/vru.13019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2021] [Revised: 06/18/2021] [Accepted: 06/22/2021] [Indexed: 11/27/2022] Open
Abstract
Fat infiltration of skeletal muscle (myosteatosis) is a characteristic of reduced muscle quality. Objectives of this retrospective, observer agreement, methods comparison, cross-sectional study were to compare epaxial myosteatosis of dogs with surgically confirmed intervertebral disc extrusion (IVDE) using a visual semi-quantitative method and quantitative 2-point Dixon fat-water chemical-shift separation MRI method. Thoracolumbar MRI studies of 86 dogs were reviewed. Assessed locations were the site of extrusion and the adjacent intervertebral disc space immediately cranial. A visual fat score (VFS) was assigned to fat infiltration of the epaxial muscles. Quantitative assessment of fat infiltration was determined by calculating a muscle-fat fraction (MFF). There was moderate agreement between the two reviewers for VFS assessment (weighted Kappa 0.60, 95%CI 0.53-0.66) with moderate to strong correlation between scoring methods (P ≤ .001). Both VFS (P = .023, P = .02) and MFF (P = .041, P = .043) were significantly correlated with neurologic grade at presentation for the erector spinae muscle group at both sites. Higher VFS in the multifidus muscle increased the odds of a successful outcome when assessed at the extrusion site (odds ratio and 95%CI 4.3 (1.02-78.7), P = .0461). In summary, the visual and Dixon method of epaxial muscle-fat assessment are feasible in dogs with IVDE with moderate to strong correlation. Increased VFS of myosteatosis in the multifidus muscle at the extrusion site significantly increased the odds of a successful outcome. Further studies are indicated to assess the utility of myosteatosis as an MRI imaging biomarker in the preoperative imaging assessment of dogs with IVDE.
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Affiliation(s)
- Chelsea C Beale
- Department of Veterinary Biosciences and Diagnostic Imaging, College of Veterinary Medicine, Athens, Georgia, USA
| | - Scott A Secrest
- Department of Veterinary Biosciences and Diagnostic Imaging, College of Veterinary Medicine, Athens, Georgia, USA
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Iorio-Morin C, Fisher CG, Abraham E, Nataraj A, Attabib N, Paquet J, Hogan TG, Bailey CS, Ahn H, Johnson M, Richardson EA, Manson N, Thomas K, Rampersaud YR, Hall H, Dea N. Low-back pain after lumbar discectomy for disc herniation: what can you tell your patient? J Neurosurg Spine 2021; 35:715-721. [PMID: 34450579 DOI: 10.3171/2021.2.spine201625] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2020] [Accepted: 02/15/2021] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Lumbar discectomy (LD) is frequently performed to alleviate radicular pain resulting from disc herniation. While this goal is achieved in most patients, improvement in low-back pain (LBP) has been reported inconsistently. The goal of this study was to characterize how LBP evolves following discectomy. METHODS The authors performed a retrospective analysis of prospectively collected patient data from the Canadian Spine Outcomes and Research Network (CSORN) registry. Patients who underwent surgery for lumbar disc herniation were eligible for inclusion. The primary outcome was a clinically significant reduction in the back pain numerical rating scale (BPNRS) assessed at 12 months. Binary logistic regression was used to model the relationship between the primary outcome and potential predictors. RESULTS There were 557 patients included in the analysis. The chief complaint was radiculopathy in 85%; 55% of patients underwent a minimally invasive procedure. BPNRS improved at 3 months by 48% and this improvement was sustained at all follow-ups. LBP and leg pain improvement were correlated. Clinically significant improvement in BPNRS at 12 months was reported by 64% of patients. Six factors predicted a lack of LBP improvement: female sex, low education level, marriage, not working, low expectations with regard to LBP improvement, and a low BPNRS preoperatively. CONCLUSIONS Clinically significant improvement in LBP is observed in the majority of patients after LD. These data should be used to better counsel patients and provide accurate expectations about back pain improvement.
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Affiliation(s)
- Christian Iorio-Morin
- 1Division of Neurosurgery, Department of Surgery, Université de Sherbrooke, Centre de recherche du Centre Hospitalier Universitaire de Sherbrooke, Sherbrooke, Quebec
| | - Charles G Fisher
- 2Division of Spine Surgery, Vancouver General Hospital and the University of British Columbia, Vancouver, British Columbia
| | - Edward Abraham
- 3Department of Orthopaedic Surgery, Saint John Regional Hospital, Saint John, New Brunswick.,4Department of Orthopaedic Surgery, Dalhousie University, Halifax, Nova Scotia
| | - Andrew Nataraj
- 5Division of Neurosurgery, Department of Surgery, University of Alberta Hospital, Edmonton, Alberta
| | - Najmedden Attabib
- 3Department of Orthopaedic Surgery, Saint John Regional Hospital, Saint John, New Brunswick.,4Department of Orthopaedic Surgery, Dalhousie University, Halifax, Nova Scotia
| | - Jerome Paquet
- 6Department of Neurological Sciences, Université Laval, Quebec
| | - Thomas Guy Hogan
- 7Department of Orthopedic Surgery, Memorial University, St. John's, Newfoundland
| | - Christopher S Bailey
- 8Division of Orthopaedics, Department of Surgery, Schulich School of Medicine and Dentistry, Western University, London, Ontario
| | - Henry Ahn
- 9Division of Orthopaedic Surgery, University of Toronto, Toronto, Ontario
| | - Michael Johnson
- 10Section of Orthopaedic Surgery, Health Science Centre, Winnipeg, Manitoba
| | - Eden A Richardson
- 11Canadian Spine Outcomes and Research Network, Ontario; and.,11Canadian Spine Outcomes and Research Network, Ontario; and
| | - Neil Manson
- 3Department of Orthopaedic Surgery, Saint John Regional Hospital, Saint John, New Brunswick.,4Department of Orthopaedic Surgery, Dalhousie University, Halifax, Nova Scotia.,7Department of Orthopedic Surgery, Memorial University, St. John's, Newfoundland
| | - Ken Thomas
- 12Department of Surgery, Department of Clinical Neurosciences, University of Calgary, Alberta, Canada
| | - Y Raja Rampersaud
- 9Division of Orthopaedic Surgery, University of Toronto, Toronto, Ontario
| | - Hamilton Hall
- 9Division of Orthopaedic Surgery, University of Toronto, Toronto, Ontario
| | - Nicolas Dea
- 2Division of Spine Surgery, Vancouver General Hospital and the University of British Columbia, Vancouver, British Columbia
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Suominen EN, Sandelin H, Puhakka J, Repo J, Ovaska M. Traumatic Rupture and Herniation of the Peroneus Tertius Muscle Leading to Compartment Syndrome and Entrapment of the Superficial Peroneal Nerve: A Case Report. Surg J (N Y) 2021; 7:e154-e157. [PMID: 34295974 PMCID: PMC8289680 DOI: 10.1055/s-0041-1731423] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2020] [Accepted: 03/25/2021] [Indexed: 10/29/2022] Open
Abstract
We present a patient with compartment syndrome and entrapment of the superficial peroneal nerve due to a direct hit to the lateral part of the right lower extremity. The diagnosis of evolving compartment syndrome was made without delay and the patient was quickly taken to the operating theater. Intraoperatively, the entrapment of the superficial peroneal nerve caused by rupture and herniation of the peroneus tertius muscle was surprisingly observed at the site, where the nerve pierces the anterior compartment. The nerve was successfully released in conjunction with fasciotomies of the anterior and lateral compartments. Meticulous diagnosis of compartment syndrome is critical to prevent ischemic injury to muscles and nerves. Recognition of anatomy and anatomical variations is important to prevent iatrogenic injury in unusual circumstances.
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Affiliation(s)
- Eetu N Suominen
- Department of Clinical Medicine, University of Turku, Turku, Finland
| | - Henrik Sandelin
- Department of Orthopaedics and Traumatology, Helsinki University Hospital and University of Helsinki, Helsinki, Finland.,Department of Orthopaedics, Liverpool Hospital, Sydney, New South Wales, Australia
| | - Jani Puhakka
- Department of Orthopaedics and Traumatology, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Jussi Repo
- Department of Surgery, Tampere University Hospital, Tampere, Finland
| | - Mikko Ovaska
- Sports Clinic and Hospital, Pihlajalinna Dextra, Helsinki, Finland
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28
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Inui H, Sakamoto T, Ito T, Kitahara T. Magnetic resonance imaging of endolymphatic hydrops in patients with unilateral Meniere's disease: a comparison between with and without herniation into the posterior and lateral semi-circular canals. Acta Otolaryngol 2021; 141:671-677. [PMID: 34061704 DOI: 10.1080/00016489.2021.1928282] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
BACKGROUND The presence of endolymphatic hydrops (ELH) in patients with Meniere's disease (MD) is considered a pathological hallmark. AIMS/OBJECTIVES We aimed to conduct a quantitative volumetric measurement of inner ear ELH in patients with unilateral MD (uMD). The values of uMD with and without herniation into the posterior semi-circular canal (h-PSC) and the lateral semi-circular canal (h-LSC) were compared using 3 D magnetic resonance imaging. MATERIAL AND METHODS This study included 130 individuals (47 controls and 83 patients with uMD). We measured the total fluid space (TFS) and endolymphatic space (ELS) volumes. We also evaluated the ELS/TFS volume ratios (%). RESULTS The ELS/TFS volume ratios in the inner ear, cochlea, and vestibule were significantly different between the affected and contralateral sides in patients with h-PSC. Moreover, the ELS/TFS volume ratios of the inner ear, vestibule, and semi-circular canals in the affected ear were significantly higher in patients with h-PSC than in those without h-PSC. The vestibular ELS/TFS volume ratio in the affected ear was significantly higher in patients with h-LSC than in those without h-LSC. CONCLUSIONS AND SIGNIFICANCE H-LSC is present in extended vestibular ELH. However, this is a result of ELH progression in the inner ear.
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Affiliation(s)
| | | | - Taeko Ito
- Department of Otorhinolaryngology-Head and Neck Surgery, Nara Medical University, Nara, Japan
| | - Tadashi Kitahara
- Department of Otorhinolaryngology-Head and Neck Surgery, Nara Medical University, Nara, Japan
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Çetin H, Akkaşoğlu S, Çalışkan S. New approach to morphometric analysis of Huschke's foramen. Folia Morphol (Warsz) 2021; 81:749-755. [PMID: 34060643 DOI: 10.5603/fm.a2021.0056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Revised: 05/10/2021] [Accepted: 05/11/2021] [Indexed: 11/25/2022]
Abstract
BACKGROUND Aim of the present study is to analyze the demographic and anatomical details of the Huschke's foramen (HF) which are not previously studied and to present a new clinical perspective. MATERIALS AND METHODS MDCT (Multidedector Computed Tomography) images of 495 patients obtained were retrospectively evaluated. Presence of a HF, its' size, relations of it with side, age and gender were noted for every patient. Size of the foramen was measured in the axial plane, as well as on the reconstructed coronal and sagittal planes. RESULTS Of the 495 patients 99 (20%) had HF. There was no significant difference between females and males according to the presence of the HF and the side of the HF. When the dimension of the left- and the right-sided HFs were compared, there were no significant differences on none of the axes for the patients with unilateral or bilateral HF. There was no significant linear correlation between age and the dimension on axial axis, the dimension on the sagittal axis and the dimension on the coronal axis CONCLUSIONS: The present work presenting morphologic and statistical variables of HF provides a data for further studies which will indicate risk factor of herniation through HF. By the aid of MDCT which is sensitive for detection of the HF because of its thin sections, high spatial resolution, and multiplanar capabilities, lesions which were previously diagnosed as dehiscence were found to be defects.
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Affiliation(s)
- H Çetin
- Department of Radiology, Faculty of Medicine, Ankara Yıldırım Beyazıt University, Ankara, Turkey
| | - S Akkaşoğlu
- Department of Anatomy, Faculty of Medicine, Ankara Yıldırım Beyazıt University, Ankara, Turkey
| | - S Çalışkan
- Department of Anatomy, Faculty of Medicine, Ankara Yıldırım Beyazıt University, Ankara, Turkey.
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Alagheband SJ, Clapp AD, Narducci DM, Cudahy R, Pujalte G. Limbus Vertebra. Cureus 2021; 13:e13954. [PMID: 33880290 PMCID: PMC8051534 DOI: 10.7759/cureus.13954] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Athletes in their teenage years can present to clinics with back pain, without any history of trauma. Many sports require repetitive spinal extension, which may be pertinent to the evaluation of back pain as a chief complaint. Musculoskeletal and neurologic examinations are crucial in the evaluation of athletes presenting with back pain. Most back pain cases are caused by benign conditions that resolve with conservative treatment. However, radiographic imaging may be appropriate to look for possible spondylolysis in teenage athletes who perform repetitive extension in their sports, and who present with a positive stork test on examination. Limbus vertebra is a condition that can be seen in asymptomatic patients but can also be associated with back pain. Nevertheless, a conservative approach is still appropriate in these cases, with escalation to further testing or imaging only considered for recalcitrant pain. Limbus vertebra is not well known by clinicians and can be misdiagnosed. Therefore, early recognition is crucial to potentially prevent an unnecessary cascade of increasing expenses related to time, effort, medications, and resources to find the diagnosis when conservative treatment is preferred.
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Affiliation(s)
| | | | - Dusty M Narducci
- Department of Family Medicine, University of South Florida, Tampa, USA
| | - Ryan Cudahy
- Department of Family Medicine and Sports Medicine, Dignity Health Medical Group, San Francisco, USA
| | - George Pujalte
- Department of Family Medicine, Mayo Clinic, Jacksonville, USA
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Kaya M, Cankal F, Tekdemir I. Bone dehiscences of medial orbital wall on CT and assessment of terminological errors in literature. Folia Morphol (Warsz) 2021; 81:175-182. [PMID: 33511625 DOI: 10.5603/fm.a2021.0004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2020] [Revised: 11/20/2020] [Accepted: 12/21/2020] [Indexed: 11/25/2022]
Abstract
BACKGROUND The objective of this study is to investigate the position and frequency of dehiscences in the medial orbital wall and to reveal that dehiscences and orbital adipose tissue hernias are distinct entities. MATERIALS AND METHODS Two hundred-thirty medial orbital walls of 115 patients with a preliminary diagnosis of headache and sinusitis but without active ethmoidal sinusitis were examined by computer tomography in the axial plane. Two separate radiologists assessed continuity of the medial orbital wall and orbital fat tissue herniation in ethmoid cells. The medial orbital wall was divided into four quadrants and the dehiscence distribution was evaluated. RESULTS Bone defects were detected in 71 patients (30.9%) in 230 orbital medial wall reviews of 115 patients (59 males, 56 females). Eight of these cases (4 male, 4 female) (3.5%) had herniation of the orbital adipose tissue into the ethmoid sinus. Of the 108 dehiscences, 47 were localized in the posterior upper quadrant. A statistically significant difference was found in the dehiscence distribution according to the quadrants. No significant relationship was found among age, gender, side of dehiscence and frequency of dehiscence. CONCLUSIONS Dehiscences in the posterior upper quadrant are more common in the medial orbital wall. Although bone dehiscences in the medial orbital wall and the herniation of the orbital fat tissue are two different entities, they are used interchangeably in most of the literature and in radiological reporting.
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Affiliation(s)
- M Kaya
- Department of Radiology, Gazi University School of Medicine, Ankara, Turkey.
| | - F Cankal
- Department of Anatomy, Ankara Medipol University School of Medicine, Ankara, Turkey
| | - I Tekdemir
- Department of Anatomy, Ankara University School of Medicine, Ankara, Turkey
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Morita T, Niizuma K, Endo H, Tominaga T. Usefulness of the Double-Lumen Super-Compliant Balloon Catheter "Super-Masamune" for Balloon-Assisted Coil Embolization of Carotid-Cavernous Fistulas. J Neuroendovasc Ther 2021; 15:615-620. [PMID: 37501750 PMCID: PMC10370795 DOI: 10.5797/jnet.cr.2020-0110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/05/2020] [Accepted: 12/04/2020] [Indexed: 07/29/2023]
Abstract
Objective Transarterial embolization (TAE) of the cavernous sinus (CS) via a fistula formed in the internal carotid artery (ICA) is the standard for carotid-cavernous fistulas (CCFs). Depending on the fistula, an adjunctive technique using a balloon or stent is effective. We report a case in which the balloon-assisted technique using the super-compliant balloon catheter "Super-Masamune" was effective. Case Presentation A 44-year-old woman who sustained head trauma from a traffic accident 1 month prior presented with diplopia, conjunctival chemosis, and proptosis of the left eye. Digital subtraction angiography (DSA) revealed a left CCF with a reflex to the left superior ophthalmic vein (SOV). During TAE with the Super-Masamune assistance, we tightly embolized around the fistula using a small volume of coils and the CCF was obliterated. Conclusion The balloon of the Super-Masamune is made of a styrene-based elastomer, which has excellent compliance. Therefore, it is possible to reduce the volume of coils because the balloon is in close contact with the ICA or fistula. This may reduce the incidence of postoperative cranial nerve palsy and cost of treatment materials.
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Affiliation(s)
- Takahiro Morita
- Department of Neurosurgery, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan
- Department of Neurosurgery, Aomori Prefectural Central Hospital, Aomori, Aomori, Japan
| | - Kuniyasu Niizuma
- Department of Neurosurgery, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan
- Department of Neurosurgical Engineering and Translational Neuroscience, Graduate School of Biomedical Engineering, Tohoku University, Sendai, Miyagi, Japan
- Department of Neurosurgical Engineering and Translational Neuroscience, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan
| | - Hidenori Endo
- Department of Neurosurgery, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan
| | - Teiji Tominaga
- Department of Neurosurgery, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan
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Flanagan D. Postextraction sinus lining prolapse. Clin Case Rep 2021; 9:236-240. [PMID: 33489166 PMCID: PMC7812993 DOI: 10.1002/ccr3.3505] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2020] [Revised: 09/22/2020] [Accepted: 10/04/2020] [Indexed: 12/29/2022] Open
Abstract
A prolapse of the sinus lining through an extraction socket occurred after 4 weeks. The lining was pushed into the socket and maintained with a buccal fat pad pedicle graft. Healing was complete after several weeks. A sinus decongestant can be prescribed to promote sinus drainage and reduce pressure.
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Abstract
Background CSF drainage from the ventricular system is a popular and effective technique for intraoperative brain relaxation as it reduces ICP, enlarges extra-axial operative corridors, and slackens the brain increasing its tolerance for surgical manipulation. However, sometimes when the ventricular chambers distant from the site of pathology are tapped, there is a risk of neurological worsening due to paradoxical herniation of the brain, exemplified by the phenomenon of upward transtentorial herniation observed in posterior fossa tumors, consequent to a supratentorial ventriculostomy. Expectation of an analogous phenomenon precludes contralateral ventricular drainage in supratentorial brain tumors producing midline shift, subfalcine herniation, and resultant distension of the opposite lateral ventricles. Objective Demonstrating the safety and efficacy of intraoperative contralateral ventricular drainage in the presence of sub-falcine herniation. Methods Clinical and imaging information were retrospectively collected for four cases in which this technique was adopted. Results The first case was a large clinoidal meningioma with a midline shift and contralateral ventriculomegaly. EVD from the dilated ventricle provided optimum brain conditions for safe resection of the tumor through an orbitopterional approach. The second case required a contralateral EVD to reduce ICP intraoperatively, for a recurrent anaplastic ependymoma with severe mass effect. It reduced the venous hypertension related to raised ICP minimizing the blood loss. Contralateral EVD was utilized to enlarge the working corridor for interhemispheric approach in two cases. Conclusion Contralateral ventricular drainage is a safe, effective, and convenient operative step for reducing brain turgor in the presence of sub-falcine herniation produced by large supratentorial tumors.
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Affiliation(s)
- Hitesh Kumar Gurjar
- Department of Neurosurgery, All India Institute of Medical Sciences, New Delhi, India
| | - Shashwat Mishra
- Department of Neurosurgery, All India Institute of Medical Sciences, New Delhi, India
| | - Kanwaljeet Garg
- Department of Neurosurgery, All India Institute of Medical Sciences, New Delhi, India
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Brown NJ, Shahrestani S, Lien BV, Ransom SC, Tafreshi AR, Ransom RC, Sahyouni R. Spinal pathologies and management strategies associated with cervical angina (pseudoangina): a systematic review. J Neurosurg Spine 2020:1-8. [PMID: 33276331 DOI: 10.3171/2020.7.spine20866] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Accepted: 07/06/2020] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Cervical angina, or pseudoangina pectoris, is a noncardiac syndrome of chest pain that often mimics angina pectoris but is a disease of the spine. Diagnosis of cervical angina can be difficult and is often overlooked, although once identified, it can be successfully managed through conservative therapies and/or a variety of surgical interventions. Ultimately, cervical angina is an important component of the list of differential diagnoses in noncardiac chest pain. In the present study, the authors report the first comprehensive systematic review of the range of cervical and thoracic pathologies associated with cervical angina, as well as the different treatment methods used to manage this condition. METHODS A systematic review was performed according to PRISMA guidelines and using PubMed, Web of Science, and Cochrane databases from database inception to April 29, 2020, to identify studies describing spinal pathologies related to cervical angina. The following Boolean search was performed: ("cervical" OR "thoracic") AND ("angina" OR "chest pain") AND ("herniation" OR "OPLL"). Variables extracted included patient demographics, cervical angina pain location, pathology and duration of symptoms, treatment and/or management method, and posttreatment pain relief. RESULTS Upon careful screening, 22 articles published between 1976 and 2020 met the study's inclusion/exclusion criteria, including 5 case series, 12 case reports, and 5 retrospective cohort studies. These studies featured a total of 1100 patients, of which 95 met inclusion criteria (mean patient age 51.7 years, age range 24-86 years; 53.6% male). Collectively, symptom durations ranged from 1.5 days to 90 months. Cervical herniation (72.6%) accounted for the majority of cervical angina cases, and surgical interventions (84.4%) predominated over physical therapy (13.0%) and medical management strategies (9.1%). Every patient assessed at follow-up reported relief from symptoms related to cervical angina. CONCLUSIONS Cervical angina is a noncardiac syndrome of chest pain associated with a broad range of cervical and thoracic spinal pathologies, the most common of which is cervical disc herniation. Although difficult to diagnose, it can be successfully treated when identified through first-line conservative management or surgical interventions in refractory cases.
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Affiliation(s)
- Nolan J Brown
- 1School of Medicine, University of California, Irvine, California
| | | | - Brian V Lien
- 1School of Medicine, University of California, Irvine, California
| | - Seth C Ransom
- 3College of Medicine, University of Arkansas for Medical Sciences, Little Rock, Arkansas
| | - Ali R Tafreshi
- 4Department of Neurological Surgery, Geisinger Commonwealth School of Medicine, Scranton, Pennsylvania
| | - Ryan Chase Ransom
- 5Department of Neurologic Surgery, Mayo Clinic College of Medicine and Science, Rochester, Minnesota; and
| | - Ronald Sahyouni
- 1School of Medicine, University of California, Irvine, California.,6Department of Neurological Surgery, University of California, San Diego, California
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Bateman EA, VanderEnde J, Sequeira K, MacKenzie HM. Postural neurologic deficits after decompressive craniectomy: A case series of sinking skin flap syndrome in traumatic brain injury. NeuroRehabilitation 2020; 49:663-672. [PMID: 34744055 DOI: 10.3233/nre-210160] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
BACKGROUND Hemicraniectomy to manage raised intracranial pressure following traumatic brain injury (TBI) has improved survival but may increase the incidence of Sinking Skin Flap Syndrome (SSFS). SSFS is a clinical syndrome in which patients with craniectomy develop objective neurologic abnormalities due to the pressure of the atmosphere on the unprotected brain, often presenting with postural headaches and neurologic deficits that localize to the craniectomy site. Previously thought to be a rare complication of craniectomy after TBI, evidence suggests SSFS is under-recognized. OBJECTIVE To describe the clinical and radiographic features leading to diagnosis and the impact of temporizing and definitive management of SSFS on outcomes in inpatients with moderate/severe TBI. METHODS Two patients' symptoms, qualitative behaviour observation, physical and cognitive outcome measures, and neuroimaging pre- and post-temporizing measures and cranioplasty are presented. RESULTS Both patients demonstrated partial improvements with temporizing measures and substantial improvements in functional, cognitive, physical, and rehabilitation outcomes from the cranioplasty and resolution of SSFS. CONCLUSIONS Rehabilitation care providers are critical to the timely diagnosis and management of SSFS, including the use of temporizing measures and advocacy for definitive treatment with cranioplasty. These cases highlight the diverse clinical presentations and importance of SSFS diagnosis to improve patient outcomes.
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Affiliation(s)
- Emma A Bateman
- Department of Physical Medicine and Rehabilitation, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada.,Parkwood Institute, St Joseph's Health Care London, London, Ontario, Canada
| | - Jordan VanderEnde
- Department of Physical Medicine and Rehabilitation, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada.,Parkwood Institute, St Joseph's Health Care London, London, Ontario, Canada
| | - Keith Sequeira
- Department of Physical Medicine and Rehabilitation, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada.,Parkwood Institute, St Joseph's Health Care London, London, Ontario, Canada
| | - Heather M MacKenzie
- Department of Physical Medicine and Rehabilitation, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada.,Parkwood Institute, St Joseph's Health Care London, London, Ontario, Canada
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Lan Z, Richard SA, Li Q, Wu C, Zhang Q, Chen R, Yang C. Outcomes of patients undergoing craniotomy and decompressive craniectomy for severe traumatic brain injury with brain herniation: A retrospective study. Medicine (Baltimore) 2020; 99:e22742. [PMID: 33120775 PMCID: PMC7581028 DOI: 10.1097/md.0000000000022742] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
The treatment of severe traumatic brain injury (TBI) with brain herniation is challenging because outcomes are often associated with high mortality and morbidity. Our aim was to identity factors contributing to decompressive craniectomy (DC) and evaluate treatment outcomes in patients with severe TBI with brain herniation.In this retrospective study, we analyzed medical records of severe TBI with brain herniation from May 2009 to December 2013. We reviewed their demographic data, mechanism of injury, Glasgow Coma Scale (GCS) score, pupil status, computed tomography findings, surgical treatment methods, time interval between brain herniation and surgery, as well as outcomes. GCS and pupil status are clinical parameters for detecting increase intracranial pressure while brain parenchyma bulged above the inner plate of the skull during operation indicated brain swelling as well as increased intracranial pressure on which basis the decision to perform DC or craniotomy was determined intraoperatively.One hundred ninety-four patients were included in the study. We performed DC in 143 of the patients while 51 of them we performed craniotomy. There were no statistically significant differences in the age, gender, or injury mechanism between the 2 groups. GCS, pupillary dilation, midline shift, hematoma type and timing of surgery were associated with DC. Nevertheless, logistic regression analysis revealed that hematoma type and timing of surgery were significantly associated with favorable DC outcomes (P < .001 and P = .023). Subdural hematoma and timing of surgery >1 hour were both identified as risk factors for DC. Six months after TBI, 34.0% of patients exhibited favorable outcomes. Overall mortality rate was 30.4%. Age, GCS, pupil dilation, hematoma type, and timing of surgery were all associated with patient outcomes. Further logistic regression analysis revealed that, lower GCS, bilateral pupil dilation, timing of surgery >1 hour, and advanced age were independent risk factors for poor outcomes (P = .001, P = .037, P = .028, and P = .001, respectively).Our study revealed that, DC is not mandatory for all TBI patients with brain herniation. Nevertheless, DC decreases mortality rate in severe TBI patients with brain herniation. Subdural hematoma and timing of surgery >1 hour are key indicators for DC. Lower GCS, bilateral pupil dilation, delayed timing of surgery and advance age are indicators of poor outcomes.
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Affiliation(s)
- Zhigang Lan
- Department of Neurosurgery, West China Hospital, Sichuan University, Chengdu, PR China
| | - Seidu A. Richard
- Department of Neurosurgery, West China Hospital, Sichuan University, Chengdu, PR China
- Department of Medicine, Princefield University, Ghana West Africa
| | - Qiang Li
- Department of Neurosurgery, West China Hospital, Sichuan University, Chengdu, PR China
| | - Cong Wu
- Department of Neurosurgery, West China Hospital, Sichuan University, Chengdu, PR China
| | - Qiao Zhang
- Department of Neurosurgery, West China Hospital, Sichuan University, Chengdu, PR China
| | - Ruiqi Chen
- Department of Neurosurgery, West China Hospital, Sichuan University, Chengdu, PR China
| | - Chaohua Yang
- Department of Neurosurgery, West China Hospital, Sichuan University, Chengdu, PR China
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Abstract
Imaging is integral in the diagnosis of canine intervertebral disc disease (IVDD) and in differentiating subtypes of intervertebral disc herniation (IVDH). These include intervertebral disc extrusion (IVDE), intervertebral disc protrusion (IVDP) and more recently recognized forms such as acute non-compressive nucleus pulposus extrusion (ANNPE), hydrated nucleus pulposus extrusion (HNPE), and intradural/intramedullary intervertebral disc extrusion (IIVDE). Many imaging techniques have been described in dogs with roles for survey radiographs, myelography, computed tomography (CT), and magnetic resonance imaging (MRI). Given how common IVDH is in dogs, a thorough understanding of the indications and limitations for each imaging modality to aid in diagnosis, treatment planning and prognosis is essential to successful case management. While radiographs can provide useful information, especially for identifying intervertebral disc degeneration or calcification, there are notable limitations. Myelography addresses some of the constraints of survey radiographs but has largely been supplanted by cross-sectional imaging. Computed tomography with or without myelography and MRI is currently utilized most widely and have become the focus of most contemporary studies on this subject. Novel advanced imaging applications are being explored in dogs but are not yet routinely performed in clinical patients. The following review will provide a comprehensive overview on common imaging modalities reported to aid in the diagnosis of IVDH including IVDE, IVDP, ANNPE, HNPE, and IIVDE. The review focuses primarily on canine IVDH due to its frequency and vast literature as opposed to feline IVDH.
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Affiliation(s)
- Ronaldo C da Costa
- Department of Veterinary Clinical Sciences, The Ohio State University, Columbus, OH, United States
| | - Steven De Decker
- Department of Clinical Sciences and Services, Royal Veterinary College, London, United Kingdom
| | - Melissa J Lewis
- Department of Veterinary Clinical Sciences, Purdue University College of Veterinary Medicine, West Lafayette, IN, United States
| | - Holger Volk
- Department of Small Animal Medicine and Surgery, University of Veterinary Medicine Hanover, Hanover, Germany
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Abstract
STUDY DESIGN Systematic review. OBJECTIVES Lumbar disc herniation (LDH) has been reported to affect 1 in 10 000 pregnant women. There is limited evidence available regarding the optimal management of LDH in pregnant patients. We aimed to review the current evidence for the management of symptomatic LDH in pregnancy through critical appraisal and analysis of the available literature. METHODS Searches were conducted in Medline, Embase, PubMed, Science Direct, and The Cochrane Library from inception using predetermined search terms. All peer-reviewed studies of pregnant women with symptomatic LDH were included. The quality of eligible articles was assessed and extracted data and characteristics were pooled for analysis. References cited by studies were screened to identify other relevant publications. RESULTS Thirty studies involving 52 patients were identified. Compared to surgically managed patients, conservatively managed patients had a higher full recovery rate (61.54% vs 56.41%) and reported a lower rate of persistent symptoms (30.77% vs 38.54%). Compared to patients who were treated surgically for cauda equina syndrome, patients treated surgically for sciatica had a higher full recovery rate (80.95% vs 27.78%) and reported a lower rate of persistent symptoms (14.29% vs 66.67%). CONCLUSION There is limited evidence to guide the management of pregnant patients with LDH. Despite a suggestion toward improved outcomes with conservative management, the presence of selection bias and the overall poor quality of current research precludes reliable conclusions from being drawn. Decision making for this patient group should be undertaken within a multidisciplinary setting.
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Affiliation(s)
- Emily Whiles
- Brighton & Sussex University Hospitals NHS Trust, Brighton,
UK
| | - Roozbeh Shafafy
- Royal London Hospital, Barts Health NHS Trust, London, UK,Roozbeh Shafafy, Department of Spinal
Surgery, Royal London Hospital, Barts Health NHS Trust, Whitechapel, London E1
1RD, UK.
| | | | - Chris Horton
- Sir William Dunn School of Pathology, University of Oxford, Oxford,
UK
| | | | - Oliver Stokes
- Royal Devon & Exeter NHS Foundation Trust, London, UK
| | - Sherief Elsayed
- Brighton & Sussex University Hospitals NHS Trust, Brighton,
UK,NMC Spine, Dubai, United Arab Emirates
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Sinopoli J, Strong A, Kroh M, Allemang M, Raymond DP. Spontaneous Chest Wall Herniation in Centrally Obese Patients: A Single-Center Experience of a Rare Problem. Am Surg 2020; 87:222-227. [PMID: 32927964 DOI: 10.1177/0003134820950280] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Spontaneous rib fractures, especially in association with chest wall herniation, represent an uncommon pathology. As such, there are little data analyzing approaches to treatment or regarding the success of intervention. The goal of this study was to analyze our cumulative experience with this unusual condition. METHODS A case series of 12 patients was gathered from a single institution based on outpatient visits between February 2015 and October 2018. Each chart was retrospectively reviewed with particular attention to age, gender, BMI, area of injury, and smoking history. Patients presented with complaints of dyspnea or pain related to rib fractures with or without intercostal neuralgia. Each of these patients was noted to have rib fractures with lung herniation either on imaging, outside hospital records, or physical exam. A thorough medical history was obtained with attempts to find common predisposing factors as well as data regarding any previous surgical intervention for their herniation. RESULTS Nine of the 12 patients reviewed had recent or prior surgical intervention. Every patient seen in the clinic with a spontaneous fracture and herniation incidentally had a BMI >30 and was therefore classified as obese. Additionally, every patient who had a recurrence after their first surgical attempt at repair had a BMI greater than or equal to 35. All 12 patients seen at our institution were males. The failure rate of operative intervention was 66%. CONCLUSIONS Obesity was a prevalent comorbidity in the patient population we reviewed. Given the role obesity plays in abdominal and hiatal hernia repair success rates, it should be considered that obesity is a significant contributor to chest wall herniation if rib fractures occur. With 66% chest wall repair failure, patient selection is critical in the success of surgical intervention. Perhaps additional patient optimization, especially weight loss, should be considered prior to surgery.
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Affiliation(s)
- Jillian Sinopoli
- Thoracic Department, Brigham & Women's Hospital, Boston, MA, USA
| | - Andrew Strong
- 443553 General Surgery Department, The Cleveland Clinic, Cleveland, OH, USA
| | - Matthew Kroh
- General and Bariatric Surgery, Digestive Disease Institute, The Cleveland Clinic, Abu Dhabi, UAE
| | - Matthew Allemang
- General Surgery Department, Minimally Invasive Surgery, The Cleveland Clinic, South Pointe Hospital, Warrensville Heights, OH, USA
| | - Daniel P Raymond
- General Thoracic Surgery, Center for Chest Wall Disease, The Cleveland Clinic, Cleveland, OH, USA
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41
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Tavakoli J, Diwan AD, Tipper JL. Advanced Strategies for the Regeneration of Lumbar Disc Annulus Fibrosus. Int J Mol Sci 2020; 21:E4889. [PMID: 32664453 DOI: 10.3390/ijms21144889] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2020] [Revised: 07/02/2020] [Accepted: 07/08/2020] [Indexed: 12/15/2022] Open
Abstract
Damage to the annulus fibrosus (AF), the outer region of the intervertebral disc (IVD), results in an undesirable condition that may accelerate IVD degeneration causing low back pain. Despite intense research interest, attempts to regenerate the IVD have failed so far and no effective strategy has translated into a successful clinical outcome. Of particular significance, the failure of strategies to repair the AF has been a major drawback in the regeneration of IVD and nucleus replacement. It is unlikely to secure regenerative mediators (cells, genes, and biomolecules) and artificial nucleus materials after injection with an unsealed AF, as IVD is exposed to significant load and large deformation during daily activities. The AF defects strongly change the mechanical properties of the IVD and activate catabolic routes that are responsible for accelerating IVD degeneration. Therefore, there is a strong need to develop effective therapeutic strategies to prevent or reconstruct AF damage to support operational IVD regenerative strategies and nucleus replacement. By the way of this review, repair and regenerative strategies for AF reconstruction, their current status, challenges ahead, and future outlooks were discussed.
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Bouma GJ, van den Brink W, Miller LE, Wolfs JF, Arts MP. Does Patient Blinding Influence Clinical Outcomes After Annular Closure Device Implantation? A Propensity Score-Matched Analysis. Orthop Res Rev 2019; 11:177-182. [PMID: 31807089 PMCID: PMC6850684 DOI: 10.2147/orr.s216980] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2019] [Accepted: 10/25/2019] [Indexed: 11/23/2022] Open
Abstract
Background Awareness of treatment group assignment in a clinical trial may influence patient behavior and bias outcome reporting. The objective of this study was to compare 2-year clinical outcomes in blinded vs unblinded patients who were treated with lumbar discectomy and a bone-anchored annular closure device (ACD) for prevention of lumbar disc reherniation. Methods This was a secondary analysis of a randomized trial comparing lumbar discectomy with (n=272) vs without (n=278) implantation of a bone-anchored ACD. Among patients who received ACD implantation, 35 (13%) were blinded and 237 (87%) were unblinded to treatment allocation. In patients treated with ACD, propensity score-matching (1:1) was performed to account for imbalances in patient characteristics between blinded and unblinded groups. Key clinical outcomes were back pain severity (0–100 scale), leg pain severity (0–100 scale), Oswestry Disability Index (ODI, 0–100 scale), symptomatic reherniation, reoperation at the treated lumbar level, and device- or procedure-related serious adverse events (AEs). Outcomes were reported through 2 years of follow-up, which coincided with the time at which blinded patients were unblinded. Results There were no statistically significant differences in 2-year outcomes between propensity score-matched blinded (n=35) and unblinded (n=35) patients treated with the ACD. In blinded vs unblinded ACD patients compared to baseline, back pain severity decreased by 40 vs 37 points (P=0.61), leg pain severity decreased by 75 points in each group (P>0.99), and ODI decreased by 47 vs 43 points (P=0.19). The risks of symptomatic reherniation (5.7% vs 9.1%; P=0.59), reoperation (8.6% vs 12.2%, P=0.62), and device- or procedure-related serious AEs (5.7% vs 8.9%, P=0.63) were comparably low in blinded and unblinded patients. Conclusion In patients treated with lumbar discectomy and a bone-anchored ACD, there were no clinically important or statistically significant differences in back pain, leg pain, ODI, symptomatic reherniation, reoperation, or serious AEs over 2 years of follow-up when comparing patients who were blinded vs unblinded to their treatment assignment. The main limitations of this study were the post hoc nature of the analysis and the potential for bias due to surgeon awareness of treatment assignment.
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Affiliation(s)
- Gerrit J Bouma
- Department of Neurosurgery, OLVG and Amsterdam University Medical Centers, Amsterdam, The Netherlands
| | | | | | - Jasper Fc Wolfs
- Haaglanden Medical Center Westeinde Antoniushove, Leidschendam, The Netherlands
| | - Mark P Arts
- Department of Neurosurgery, Haaglanden Medical Center Westeinde, The Hague, The Netherlands
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Edlow BL, Threlkeld ZD, Fehnel KP, Bodien YG. Recovery of Functional Independence After Traumatic Transtentorial Herniation With Duret Hemorrhages. Front Neurol 2019; 10:1077. [PMID: 31649617 PMCID: PMC6794605 DOI: 10.3389/fneur.2019.01077] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2019] [Accepted: 09/24/2019] [Indexed: 01/08/2023] Open
Abstract
Historically, Duret hemorrhages have conferred a devastating prognosis. However, recent case reports suggest that cognitive and functional recovery are possible after Duret hemorrhages. Here, we describe a patient who recovered consciousness, communication, and functional independence after Duret hemorrhages caused by traumatic transtentorial herniation. We performed prospective, standardized behavioral assessments, structural MRI scans and stimulus-based functional MRI (fMRI) scans during the first 2 years of recovery. The multimodal assessments revealed reintegration of neural networks mediating language and consciousness, concurrent with the reemergence of functional independence. These observations provide insights into network-based mechanisms of recovery from coma and add to a growing body of evidence indicating that Duret hemorrhages are not invariably associated with a poor prognosis.
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Affiliation(s)
- Brian L Edlow
- Department of Neurology, Center for Neurotechnology and Neurorecovery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States.,Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Charlestown, MA, United States
| | - Zachary D Threlkeld
- Department of Neurology and Neurological Sciences, Stanford School of Medicine, Stanford, CA, United States
| | - Katie P Fehnel
- Department of Neurosurgery, Harvard Medical School, Boston Children's Hospital, Boston, MA, United States
| | - Yelena G Bodien
- Department of Neurology, Center for Neurotechnology and Neurorecovery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States.,Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Boston, MA, United States
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44
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Owen RJ, Khan AZ, McAnany SJ, Peters C, Zebala LP. PROMIS correlation with NDI and VAS measurements of physical function and pain in surgical patients with cervical disc herniations and radiculopathy. J Neurosurg Spine 2019; 31:1-6. [PMID: 31277059 DOI: 10.3171/2019.4.spine18422] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2018] [Accepted: 04/09/2019] [Indexed: 11/06/2022]
Abstract
OBJECTIVE The aim of this study was to compare the patient-reported outcome measures Neck Disability Index (NDI) and visual analog scale (VAS) with the Patient Reported Outcomes Measurement Information System (PROMIS) physical function (PF) and pain interference (PI) measures, respectively, and to determine their correlations in a surgical population longitudinally.Legacy outcome measures such as NDI and VAS are essential for analyzing treatments in spine surgery for cervical disc herniations with radiculopathy. Despite their usefulness, administrative burdens impose limits on completion of these measures. PROMIS was developed as a patient outcome measure in order to improve reporting of patient symptoms and function and to reduce administrative burden. Despite early positive results of PROMIS in orthopedics, NDI and VAS scores have not been compared with PROMIS scores in patients with cervical disc herniations with radiculopathy. METHODS Eighty patients undergoing surgery for cervical disc herniations with radiculopathy were included. All patients were treated at the same tertiary spine center. Patients were seen and PROMIS PF and PI, NDI, and VAS arm and neck pain scores were collected preoperatively and at 1 year postoperatively. Correlations between NDI, VAS, and PROMIS PF and PI were quantified using Pearson correlation coefficients. Two-tailed Student t-tests were used to demonstrate correlation significance, with alpha = 0.05. RESULTS All 80 (100%) patients completed all preoperative questionnaires. Fifty-seven (72%) and 75 (94%) patients completed all questionnaires at baseline and at the 6-month and 1-year follow-ups, respectively. PROMIS PF and NDI scores demonstrated a strong negative correlation, with Pearson r values of -0.81, -0.77, and -0.75 at baseline, 6 months, and 1 year. PROMIS PI and VAS neck pain scores demonstrated a moderately positive correlation, with Pearson r values of 0.51, 0.61, and 0.6. PROMIS PI and VAS arm pain scores demonstrated a moderately positive correlation, with Pearson r values of 0.46, 0.47, and 0.45. CONCLUSIONS PROMIS PF scores have a strong negative correlation with NDI scores at baseline and in the postoperative course in patients undergoing surgery for cervical disc herniations with radiculopathy. PROMIS PI scores have a moderately positive correlation with VAS neck and arm pain scores at baseline and in the postoperative course. Surgeons may factor these correlation results into the interpretation of patient-reported outcome measures in patients with cervical radiculopathy. Use of PROMIS PF and PI for this patient population may reduce administrative burden while providing reliable outcomes data.
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Affiliation(s)
- Robert J Owen
- 1Washington University in St. Louis, St. Louis, Missouri; and
| | - Adam Z Khan
- 1Washington University in St. Louis, St. Louis, Missouri; and
| | | | - Colleen Peters
- 1Washington University in St. Louis, St. Louis, Missouri; and
| | - Lukas P Zebala
- 1Washington University in St. Louis, St. Louis, Missouri; and
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Alojan AA, Alsaad IS, Alghareeb FY, Al-issawi WM, Ammar AS. "Cable Suturing Technique" a Dural Obliteration Method for the Prevention of Cerebellar Herniation through a Large Occipital Meningocele. Asian J Neurosurg 2019; 14:1044-1047. [PMID: 31497162 PMCID: PMC6702993 DOI: 10.4103/ajns.ajns_60_19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
The authors present a patient who had a large occipital meningocele, which was transformed into an encephalocele after primary closure due to a large skull defect. Thus, the technical importance of classifying patients with occipital meningocele with a large skull defect and a tight dural obliteration is crucial, not to leave a wide dead space with a potential risk of cerebellar herniation. Encephalocele and meningocele are embryological anomalies, which result in intracranial structures herniation due to inborn skull defect. Acquired encephalocele may develop through the same defect with normal cerebellar tissues; since the prognosis of occipital encephalocele may worsen as the size of herniation increases, the patient underwent a modified dural obliteration technique (Cable Suturing Technique) to adjust the size of the dura and to strengthen it to prevent the risk of future herniation followed by cranioplasty and the cerebellar herniation regressed significantly after the procedure.
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Affiliation(s)
- Abdulrazaq Abdulmohsen Alojan
- Department of Neurosurgery, King Fahd University Hospital, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Ibtihal Sadiq Alsaad
- Department of Neurosurgery, King Fahd University Hospital, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Fatimah Yousef Alghareeb
- Department of Neurosurgery, King Fahd University Hospital, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Wisam Mostafa Al-issawi
- Department of Neurosurgery, King Fahd University Hospital, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Ahmed Sabry Ammar
- Department of Neurosurgery, King Fahd University Hospital, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
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Bouma GJ, Ardeshiri A, Miller LE, Van de Kelft E, Bostelmann R, Klassen PD, Flüh C, Kuršumović A. Clinical performance of a bone-anchored annular closure device in older adults. Clin Interv Aging 2019; 14:1085-1094. [PMID: 31354252 PMCID: PMC6590844 DOI: 10.2147/cia.s208098] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2019] [Accepted: 05/14/2019] [Indexed: 01/22/2023] Open
Abstract
Background: Lumbar discectomy is a common surgical procedure in middle-aged adults. However, outcomes of lumbar discectomy among older adults are unclear. Methods: Lumbar discectomy patients with an annular defect ≥6 mm width were randomized to receive additional implantation with a bone-anchored annular closure device (ACD, n=272) or no additional implantation (controls, n=278). Over 3 years follow-up, main outcomes were symptomatic reherniation, reoperation, and the percentage of patients who achieved the minimum clinically important difference (MCID) without a reoperation for leg pain, Oswestry Disability Index (ODI), SF-36 Physical Component Summary (PCS) score, and SF-36 Mental Component Summary (MCS) score. Results were compared between older (≥60 years) and younger (<60 years) patients. We additionally analyzed data from two postmarket ACD registries to determine consistency of outcomes between the randomized trial and postmarket, real-world results. Results: Among all patients, older patients suffered from crippling or bed-bound preoperative disability more frequently than younger patients (57.9% vs 39.1%, p=0.03). Among controls, female sex, higher preoperative ODI, and current smoking status, but not age, were associated with greater risk of reherniation and reoperation. Compared to controls, the ACD group had lower risk of symptomatic reherniation (HR=0.45, p<0.001) and reoperation (HR=0.54, p=0.008), with risk reductions comparable in older vs younger patients. The percentage of patients achieving the MCID without a reoperation was higher in the ACD group for leg pain (81% vs 72%, p=0.04), ODI (82% vs 73%, p=0.03), PCS (85% vs 75%, p=0.01), and MCS (59% vs 46%, p=0.007), and this benefit was comparable in older versus younger patients. Comparable benefits in older patients were observed in the postmarket ACD registries. Conclusion: Outcomes with lumbar discectomy and additional bone-anchored ACD are superior to lumbar discectomy alone. Older patients derived similar benefits with additional bone-anchored ACD implantation as younger patients.
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Affiliation(s)
- Gerrit J Bouma
- Department of Neurosurgery, OLVG and Amsterdam University Medical Centers, Amsterdam, the Netherlands
| | | | | | - Erik Van de Kelft
- Department of Neurosurgery, AZ Nikolaas, Sint-Niklaas, Belgium
- Antwerp University, Antwerp, Belgium
| | - Richard Bostelmann
- Department of Neurosurgery, University Clinic Düsseldorf, Duesseldorf, Germany
| | - Peter D Klassen
- Department of Neurosurgery, St. Bonifatius Hospital, Lingen, Germany
| | - Charlotte Flüh
- Department of Neurosurgery, University Medical Center Schleswig-Holstein, Kiel, Germany
| | - Adisa Kuršumović
- Department of Neurosurgery, Donauisar Klinikum Deggendorf, Deggendorf, Germany
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47
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Benko MJ, Danison AP, Marvin EA, Saway BF. Distal Cauda equina syndrome: A case report of lumbosacral disc pathology and review of literature. Surg Neurol Int 2019; 10:84. [PMID: 31528422 PMCID: PMC6744781 DOI: 10.25259/sni-152-2019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2018] [Accepted: 02/25/2019] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND Cauda equina syndrome (CES) is an uncommon entity that presents acutely with all or some of the following symptoms; urinary incontinence from retention, fecal incontinence from loss of sphincter tone, saddle area hypoesthesia or anesthesia, and acute or progressive weakness in one or both lower extremities. The protean symptomatology is often mixed and is vulnerable to confounding comorbidities making the accurate and timely diagnosis of this syndrome uniquely challenging. Here, we present the case of a man who developed isolated sacral nerve dysfunction from CES in the midst of a diabetic crisis. CASE DESCRIPTION A 53-year-old male with a long history of uncontrolled Type 2 diabetes presented with acute-onset urinary and fecal incontinence, scrotal anesthesia, and a 3-day history of lower back pain with intermittent bilateral leg pain. This patient displayed no objective changes in leg strength, sensation, or reflexes. In addition, the patient tested positive for cocaine and had a blood glucose level of 800 mg/dL which confounded his clinical picture. The patient underwent bilateral laminectomies from L4-S1 with the removal of a large sequestered disc fragment from the S1-S2 disc space within 8 h of presentation with reasonable recovery. CONCLUSION Highly variable presentations often confound the accurate and timely diagnosis of CES with severe implications on quality of life. Despite the limited functional recovery seen after surgical decompression, urgent or emergent intervention is paramount for treatment. Our patient's presenting symptomatology and comorbidities highlight the need for practitioners to maintain a high index of suspicion in anyone with incontinence and back pain, regardless of distractors and even in the absence of other anticipated motor or sensory findings.
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Affiliation(s)
| | | | | | - Brian F. Saway
- Division of Neurosurgery, Virginia Tech Carilion School of Medicine Roanoke, Virginia, United States
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Thaller DJ, Allegretti M, Borah S, Ronchi P, Beck M, Lusk CP. An ESCRT-LEM protein surveillance system is poised to directly monitor the nuclear envelope and nuclear transport system. eLife 2019; 8:e45284. [PMID: 30942170 PMCID: PMC6461442 DOI: 10.7554/elife.45284] [Citation(s) in RCA: 73] [Impact Index Per Article: 14.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2019] [Accepted: 04/02/2019] [Indexed: 12/22/2022] Open
Abstract
The integrity of the nuclear membranes coupled to the selective barrier of nuclear pore complexes (NPCs) are essential for the segregation of nucleoplasm and cytoplasm. Mechanical membrane disruption or perturbation to NPC assembly triggers an ESCRT-dependent surveillance system that seals nuclear pores: how these pores are sensed and sealed is ill defined. Using a budding yeast model, we show that the ESCRT Chm7 and the integral inner nuclear membrane (INM) protein Heh1 are spatially segregated by nuclear transport, with Chm7 being actively exported by Xpo1/Crm1. Thus, the exposure of the INM triggers surveillance with Heh1 locally activating Chm7. Sites of Chm7 hyperactivation show fenestrated sheets at the INM and potential membrane delivery at sites of nuclear envelope herniation. Our data suggest that perturbation to the nuclear envelope barrier would lead to local nuclear membrane remodeling to promote membrane sealing. Our findings have implications for disease mechanisms linked to NPC assembly and nuclear envelope integrity.
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Affiliation(s)
- David J Thaller
- Department of Cell BiologyYale School of MedicineNew HavenUnited States
| | - Matteo Allegretti
- Structural and Computational Biology UnitEuropean Molecular Biology LaboratoryMeyerhofstrasseGermany
| | - Sapan Borah
- Department of Cell BiologyYale School of MedicineNew HavenUnited States
| | - Paolo Ronchi
- Electron Microscopy Core FacilityEuropean Molecular Biology LaboratoryMeyerhofstrasseGermany
| | - Martin Beck
- Structural and Computational Biology UnitEuropean Molecular Biology LaboratoryMeyerhofstrasseGermany
| | - C Patrick Lusk
- Department of Cell BiologyYale School of MedicineNew HavenUnited States
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Lechner R, Putzer D, Krismer M, Haid C, Obwegeser A, Thaler M. Braking reaction time before and after surgery for patients with recurrent lumbar disc herniation. J Neurosurg Spine 2019; 31:15-19. [PMID: 30875684 DOI: 10.3171/2019.1.spine18859] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2018] [Accepted: 01/08/2019] [Indexed: 11/06/2022]
Abstract
OBJECTIVE The positive effect of primary lumbar disc surgery on braking reaction time (BRT) has already been shown. The authors investigated the effect of recurrent lumbar disc herniation surgery on BRT. METHODS Twenty-four patients (mean age 49.9 years) were investigated for BRT 1 day before surgery, postoperatively before hospital discharge, and 4 to 5 weeks after surgery. Thirty-one healthy subjects served as a control group. RESULTS Significant improvement of BRT following surgery was found in all patients (p < 0.05). For patients with right-sided recurrent disc herniation, median BRT was 736 msec before surgery, 685 msec immediately postoperatively, and 662 msec at follow-up. For patients with left-sided recurrent disc herniation, median BRT was 674 msec preoperatively, 585 msec postoperatively, and 578 msec at follow-up. Control subjects had a median BRT of 487, which differed significantly from the patient BRTs at all 3 test times (p < 0.05). CONCLUSIONS A significant reduction in BRT in patients with recurrent disc herniation was found following lumbar disc revision surgery, indicating a positive impact of surgery. Due to the improvement in BRT observed immediately after surgery, we conclude that it is appropriate to recommend that patients keep driving after being discharged from the hospital.
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Affiliation(s)
| | - David Putzer
- 2Orthopaedic Surgery, Experimental Orthopaedics; and
| | | | | | - Alois Obwegeser
- 3Neurosurgery; Medical University Innsbruck, Innsbruck, Austria
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Abstract
Spinal cord herniation (SCH) is an uncommon traumatic event that should be considered in patients with vertebral fractures who develop an unusual constellation of autonomic and motor deficits. Herein, we describe a case of rapidly deteriorating neurological function following cervical spine fracture including sequelae such as bilateral lower-extremity weakness, loss of upper extremity motor function, and priapism. Decompression of the spinal cord allowed for the identification of the unusual herniation of the spinal cord and prevention of any further worsening of the neurological injury. Hyperflexion of the cervical spine upon traumatic impact provided the impetus for vertebral retropulsion and subsequent incarceration of the spinal cord. This phenomenon should be considered in the setting of acute traumatic injury to the cervical spinal cord. Surgical intervention is likely to allow the preservation of the remaining neurological function.
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Affiliation(s)
- Nicolas K Khattar
- Neurological Surgery, University of Louisville School of Medicine, Louisville, USA
| | - Andrew M Donovan
- Neurological Surgery, University of Louisville School of Medicine, Louisville, USA
| | - Brent G Oxford
- Neurological Surgery, University of Louisville School of Medicine, Louisville, USA
| | - Shawn W C Adams
- Neurological Surgery, University of Louisville School of Medicine, Louisville, USA
| | - Thomas J Altstadt
- Neurological Surgery, University of Louisville School of Medicine, Louisville, USA
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