World Neurosurg
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To perform a meta-analysis exploring the correlation between cervical lordosis (CL) and sagittal spine alignment in patients with adolescent idiopathic scoliosis (AIS) after surgery for determining a surgical strategy. ⋯ There is a strong negative correlation between CL and the T1 slope in patients with AIS. Given the lack of robust clinical evidence, these findings warrant verification by large prospective registries and randomized trials with long follow-up periods.
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Comparative Study
Early decompression (< 8 hours) improves the functional bladder outcome and mobility after traumatic thoracic spinal cord injury.
There is accumulating evidence of a potential beneficial effect of early surgical intervention after acute cervical spinal cord injury (SCI). However, around one third of all SCIs affect the thoracic spine. This cohort has not been extensively investigated, mainly because of less sensitive clinical readout measures. Apart from regaining full sensorimotor function, improvements in bladder and bowel management remain of the highest priority for patients with chronic paraplegia. Therefore, this study investigates the effect of early decompression (here defined as <8 hours) versus delayed management on neurologic and functional outcome. ⋯ Early decompression was an independent predictor for improved functional bladder outcome and mobility after 1 year. This effect needs to be studied in future prospective, multicenter studies.
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The use of cortical bone trajectory (CBT) pedicle screws for posterior fixation and fusion seems to constitute a viable alternative for spinal procedures, with the potential to mitigate risks, be minimally invasive, and cause less tissue damage than the traditional technique. This review analyzes the literature regarding CBT according to the rate of evidence of articles and their main focus. ⋯ Through the years, surgical technique has improved to gain a longer and safer trajectory than first described. Level 2 and 3 clinical studies suggest equal clinical and radiologic outcomes compared with pedicle trajectory fixation, but high-quality, level 1, randomized controlled trials are needed to confirm these results.
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Review Case Reports
Cauda Equina Syndrome Secondary to Diffuse Infiltration of the Cauda Equina by Acute Myeloid Leukemia: A Case Report and Literature Review.
Cauda equina syndrome (CES) results from the dysfunction of the lumbar, sacral, and coccygeal rootlets composing the cauda equina. The underlying etiology is most commonly compression secondary to a large herniated lumbosacral disk; however, any pathology affecting the rootlets can result in the syndrome. ⋯ Central nervous system involvement of leukemia is poorly understood, even though such lesions are not uncommon in advanced disease. As treatment has improved, many types of leukemia, such as AML, are believed to be curable, and patients with the disease are living longer. With improved survival, it is reasonable to suspect that such involvement by AML may become more common. Our patient is a classic presentation of CES secondary to diffuse infiltration by AML and serves as an example of this rare manifestation of hematologic malignancy.
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As a World Health Organization grade II tumor of the nervous system, clear cell meningioma (CCM) is an uncommon histologic variant of meningioma. Spinal CCMs are even rarer, with <100 spinal CCMs reported in the English literature. We present this study to characterize clinical manifestations of spinal CCMs and determine the factors predicting recurrence. ⋯ Spinal CCMs have their own unique clinical features compared with conventional spinal meningiomas and intracranial CCMs. Spinal CCMs have a predilection to affect younger patients, are prone to appear in the lumbar region, and have a high recurrence rate. Age ≤18 years, subtotal resection, and involvement of long segments (≥3 levels) are positive predictors of recurrence.