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
-
To determine whether particulate debris is present in periprosthetic tissue from revised Dynesys(®) devices, and if present, elicits a biological tissue reaction. ⋯ This is the first study to evaluate wear accumulation and local tissue responses for explanted Dynesys(®) devices. Polymer wear debris and an associated foreign-body macrophage response were observed in three of five cases.
-
Septic cervical facet joints arthritis is a rare pathology, usually revealed by fever and neck pain. As symptoms may be indolent, a high index of suspicion needs to be maintained. Magnetic resonance imaging (MRI) is effective for early diagnostic, looking for local spread and guiding potential preoperative planning. We present a case exhibiting an uncommon pathology with possible significant morbidity if misdiagnosed. ⋯ Atlantoaxial septic arthritis is an under reported and severe infection. Early use of MRI should avoid delayed diagnosis and would guide the practitioner in choosing an appropriate therapy. Early surgical treatment for uncontrolled sepsis is also a critical element of the prognosis.
-
Tracheostomy may become indispensable for patients with acute traumatic cervical spinal cord injuries. However, the early prediction of a tracheostomy is often difficult. Previous prediction models using the pulmonary function test (PFT) have limitations because some severely injured patients could not provide acceptable PFT results. We aim to develop an alternative model for predicting tracheostomy using accessible data obtained from the bedside. ⋯ We suggest using the CART model in clinical applications. Patients with AAMS ≤ 1 exhibit an increased likelihood of requiring a tracheostomy. For patients with an AAMS in the range of 2-22, surgeons should consider giving these patients a tracheostomy once respiratory complications occur. Surgeons should be cautious to give a tracheostomy to patients with an AAMS ≥ 23, if the patient experiences an incomplete spinal cord injury and the HSC in the spinal cord is at C3 level or lower based on MRI. For other patients, close observation is necessary; generally, patients with complete SCI might require a tracheostomy more frequently.
-
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.
-
Case Reports
Intractable hiccups caused by syringobulbia and syringomyelia associated with intramedullary spinal hemangioblastoma.
Hiccups caused by a neoplasm in the spinal cord are rare. ⋯ Intractable hiccups can be caused by syringobulbia associated with an intramedullary cord tumor in the cervical area and possible mechanisms of hiccups were reviewed.