European spine journal : official publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society
-
Spinal metastases are common in patients with cancer. Following lung and liver, spine is the most common site for cancers to metastasize. Many of them are hypervascularized. These cases are a particular challenge for the surgeon and represent a significant danger of massive blood loss during surgery. Hypervascularized metastases of the cervical spine also include the risk of postoperative bleeding with severe neurological impairment. We report a case of a 67-year-old women with breast cancer (BC) metastasis within the vertebral bodies of C3 and C4 with nearly complete bony destruction of the ventral column and intraspinal tumor masses compressing the spinal cord at level C3 and C4. The hypervascularized tumor was supplied by multiple minor vessels from both vertebral arteries, too small to be coiled individually. Due to an allergy to aspirin, intravascular stenting of the vertebral arteries was not an option. We decided to perform a preoperative direct injection of onyx-18 for embolization of the tumor. ⋯ Presurgical direct injection of Onyx-18 for treating hypervascular spinal metastases of breast cancer seems to be an effective and safe technique and reduces intraoperative bleeding to a minimum.
-
Traumatic spinal cord injuries (TSCI) are among the most devastating conditions in developed and developing countries, which can be prevented. The situation of TSCI around the world is not well understood which complicates the preventive policy decision making in fight against TSCI. This study was aimed to gather the available information about incidence of TSCI around the world. ⋯ Data of epidemiologic information in TSCI are available for 41 countries of the world, which are mostly European and high-income countries. Researches and efforts should be made to gather information in developing and low-income countries to plan appropriate cost-effective preventive strategies in fight against TSCI.
-
Review Case Reports
Spinal hemangiopericytoma: an institutional experience and review of literature.
Hemangiopericytoma is a rare tumor of CNS with potential for recurrence and widespread metastasis, even outside CNS with even rare involvement of spinal cord. This case series presents five patients to evaluate the clinical presentation, radiological features, management, pathology and outcome of spinal hemangiopericytomas. ⋯ Spinal hemangiopericytoma is a rare tumor. Strong clinical suspicion is required to diagnose it pre-operatively. Gross total resection is the goal and radiotherapy should be given in case of residual tumor or high-grade tumors.
-
Case Reports
Surgical treatment of an atlantoaxial fracture after a delayed diagnosis in a comatose patient.
Case report. ⋯ To avoid unnecessary surgery, surgeons should recognize the possibility of cervical fractures that cannot be detected without CT, especially in patients who are comatose at injury. Atlantoaxial fixation with a hook and lamina screw in C2 is an option for old upper cervical fractures in cases where a pedicle screw cannot be inserted into C2.
-
Review Meta Analysis
Minimally invasive versus open transforaminal lumbar interbody fusion for treatment of degenerative lumbar disease: systematic review and meta-analysis.
While open TLIF (O-TLIF) remains the mainstay approach, minimally invasive TLIF (MI-TLIF) may offer potential advantages of reduced trauma to paraspinal muscles, minimized perioperative blood loss, quicker recovery and reduced risk of infection at surgical sites. This meta-analysis was conducted to provide an updated assessment of the relative benefits and risks of MI-TLIF versus O-TLIF. ⋯ In summary, the present systematic review and meta-analysis demonstrated that MI-TLIF appears to be a safe and efficacious approach compared to O-TLIF. MI-TLIF is associated with lower blood loss and infection rates in patients, albeit at the risk of higher radiation exposure for the surgical team. The long-term relative merits require further validation in prospective, randomized studies.