Journal of neurosurgery. Spine
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Case Reports
Thoracic aortic pseudoaneurysm after spine trauma in ankylosing spondylitis. Case report.
Ankylosing spondylitis (AS) is a rheumatic disease characterized by consolidation of the articulating surfaces and inflammation of the vertebral column. Because of its associated spine stiffness and secondary osteoporosis, patients with this disorder are at increased risk of vertebral fractures. Ankylosing spondylitis presents a significant challenge to spine surgeons because of its complex effects on the spine, extraarticular organ manifestations, and potential neurological and functional sequelae. ⋯ The authors present a case of AS in a patient with a thoracic spine fracture and in whom a delayed thoracic aortic pseudoaneurysm ruptured. To the best of the authors' knowledge, only five cases of this complex condition have been reported since 1980. Recognition of the potential for aortic injury in patients with AS should prompt early investigation of the aorta in cases involving numerous fractures and assist in surgical planning to avoid this lethal injury.
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Recurrent laryngeal nerve (RLN) palsy is a well-known complication of cervical spine surgery. Nearly all previous studies were performed without laryngoscopy in asymptomatic patients. This prospective study was undertaken to discern the true incidence of RLN palsy. Because not every RLN palsy is associated with hoarseness, the authors conducted a prospective study involving the use of pre- and postoperative laryngoscopy. ⋯ Laryngoscopy revealed that the true incidence of initial and persisting RLN palsy after anterior cervical spine surgery was much higher than anticipated. Especially in cases without hoarseness this could be proven, but the initial incidence of hoarseness was higher than expected. Only one third of new RLN palsy cases could be detected without laryngoscopy. Resolution of hoarseness was approximately 70% in those with preoperative hoarseness. The true rate of RLN palsy underscores the necessity to reevaluate the surgery- and intubation-related techniques for anterior cervical spine surgery and to reassess the degree of presurgical patient counseling.
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The pathophysiology of syringomyelia is still not well understood. Current prevailing theories involve the assumption that cerebrospinal fluid (CSF) flows into the syrinx from the subarachnoid space through the perivascular space of Virchow-Robin. Reported here is the case of a patient with syringomyelia in which this course is clearly contradicted. ⋯ The medium-pressure shunt valve was replaced with an adjustable valve with a higher closing pressure setting, thus increasing the CSF pressure in the subarachnoid space. Contrary to prevailing theories, this procedure markedly reduced the size of the syrinx. This case provides direct evidence that the syrinx size is inversely related to subarachnoid CSF pressure and supports the hypothesis that the pressure gradient across the spinal cord parenchyma is the force that generates syringes in syringomyelia.
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Clinical Trial
Oscillating field stimulation for complete spinal cord injury in humans: a phase 1 trial.
An electrical field cathode (negative pole) has trophic and tropic effects on injured spinal cord axons in in vitro and in vivo models of sea lamprey, rodent, and canine spinal cord injury (SCI) and it improves functional outcome. A human oscillating field stimulator (OFS) was built, a Food and Drug Administration (FDA) exemption number was obtained, and institutional review board approval was given for a Phase 1 trial to study 10 humans with complete motor and sensory SCI. ⋯ The use of OFS treatment in patients with SCI is safe, reliable, and easy. Compared with the outcomes obtained in compliant NASCIS III plegic patients, the results of the present study indicate efficacy, and the FDA has given permission for enrollment of 10 additional patients.
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Comparative Study
Comparison of spinal and general anesthesia in lumbar laminectomy surgery: a case-controlled analysis of 400 patients.
Despite a history of safety and efficacy, spinal anesthesia is rarely used in lumbar surgery. Application of regional anesthetics is widely preferred for lower-extremity surgery, but general anesthesia is used almost exclusively in spine surgery, despite evidence that spinal anesthesia is as safe and may offer some advantages. ⋯ Spinal anesthesia was as safe and effective as general anethesia for patients undergoing lumbar laminectomy. Potential advantages of spinal anesthsia include a shorter anesthesia duration, decreased nausea, antiemetic and analgesic requirements, and fewer complications. Successful surgery can be performed using either anesthesia type.