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
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This prospective demographic study was undertaken to review the epidemiology and demographics of all acute admissions to the National Spinal Injuries Unit in Ireland for the 5 years to 2003. The study was conducted at the National Spinal Injuries Unit, Mater Miscericordiae University Hospital, Dublin, Ireland. Records of all patients admitted to our unit from 1999 to 2003 were compiled from a prospective computerized spinal database. ⋯ The cervical spine was most commonly affected (51%), followed by lumbar (28%) and thoracic (21%). On admission 38% of patients were ASIA D or worse, of which one-third were AISA A. Understanding of the demographics of spinal column injuries in unique populations can help us to develop preventative and treatment strategies at both national and international levels.
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Case Reports
Surgical resection without dural reconstruction of a lumbar meningioma in an elderly woman.
Meningiomas of the spine occur in the thoracic spine in approximately 80%, followed in frequency by the cervical and lumbar regions. The treatment of spinal meningiomas is complete surgical resection. As intraspinal meningiomas are almost always adherent to the dura, extensive dural resection or diathermic treatment of the dural attachment is usually performed to prevent tumor recurrence. ⋯ Neither complication nor tumor recurrence has occurred in the 5 years since surgery. Dural preservation during surgical resection of spinal meningioma obviates the need for dural reconstruction and should reduce surgical morbidity. However, the patient should be followed long-term to watch for recurrence.
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Randomized Controlled Trial Multicenter Study Comparative Study
Comparison of a minimally invasive procedure versus standard microscopic discotomy: a prospective randomised controlled clinical trial.
A Prospective randomised controlled study was done to determine statistical difference between the standard microsurgical discotomy (MC) and a minimally invasive microscopic procedure for disc prolapse surgery by comparing operation duration and clinical outcome. Additionally, the transferability of the results was determined by a bicentric design. The microscopic assisted percutaneous nucleotomy (MAPN) has been advocated as a minimally invasive tubular technique. ⋯ The results demonstrate that a shorter operation duration and concomitant quicker recovery is comprehensible at an experienced minimally invasively operating centre. These advantages could not be found at the transfer centre within 25 minimally invasive procedures. In conclusion both procedures show equal mid term clinical results and the same complication rate even if the suggested advantages for the minimally invasive procedure could not be confirmed for the transfer centre within the framework of this study.
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Review Case Reports
Extension injury of the thoracic spine with rupture of the oesophagus and successful conservative therapy of concomitant mediastinitis.
The case of an upper oesophageal perforation as a concomitant injury of an isolated fracture of the upper thoracic spine without neurological compromise has not been described so far. A Case report and review of the literature is presented here. Concomitant oesophageal perforations carry a high risk of being missed initially. ⋯ There are no systematic data on thoracic spine fractures with concomitant oesophageal perforations. Mediastinitis secondary to oesophageal perforation might be treated conservatively with endoscopic stent placement rather than surgically. As the radiological signs of concomitant soft tissue injury, like oesophageal perforations, in fractures of the upper thoracic spine are subtle and easily missed initially only anticipation of concomitant injuries by the treating physician based on the trauma mechanism ensures a timely diagnosis.
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Review Case Reports
Brain abscess and generalized seizure caused by halo pin intracranial penetration: case report and review of the literature.
The objective of our study is to report a rare complication of halo pin insertion associated with an epileptic seizure and brain abscess, and to discuss the diagnostic and therapeutic approach to its management. The treatment of unstable cervical spine injuries with a halo vest is an established procedure. Complications of pin penetration such as brain abscess and seizure are rare, and need to be urgently treated. ⋯ In conclusion, complications of halo pin penetration are rare which need immediate intervention. Any neurologic or infectious, local or generalized, symptom need to be investigated urgently with available imaging techniques and treated promptly. Pin over-tightening may cause bone penetration and possible deep cranial infection with serious complications.