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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Review Case Reports
Recurrent esophageal perforation after anterior cervical spine surgery: case report.
Delayed esophageal perforation after anterior cervical discectomy and fusion (ACDF) is an extremely rare cause of infection such as spondylodiscitis. We present a rare case in which a patient had two delayed esophageal perforations occurring 20 and 25 years after ACDF. By sharing our experience of this rare case, we hope to provide new information related to delayed esophageal perforation. ⋯ We suggest that it is important to consider follow-up in patients with spontaneously healed esophageal perforations. Furthermore, any patient with symptoms subsequent to a spontaneously healed esophageal perforation, even after an interval of several years, should receive a thorough evaluation for possible recurrent esophageal perforation.
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Review Case Reports
Extreme proximal junctional kyphosis-a complication of delayed lambdoid suture closure in Hajdu-Cheney syndrome: a case report and literature review.
To describe the manifestations, surgical treatment, and potential complications of Hajdu-Cheney syndrome (HCS), and the management of these complications. ⋯ In patients with HCS and other conditions with delayed suture closure, the surgeon must be cognizant of the presence of mobility at the suture lines, and consider extending the fusion construct anteriorly over the skull vertex up to the frontal bones. Because of significant osteoporosis in these syndromes, multiple fixation points and augmentation with bone graft are important principles.
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The use of conventional percutaneous endoscopic lumbar discectomy (PELD) for high-grade down-migrated lumbar disc herniation medial to the pedicle via the transforaminal route can result in less favorable outcomes. We report a new PELD technique for the treatment of high-grade down-migrated lumbar disc herniation via a facet process and pedicle-complex approach. ⋯ PELD via a facet process and pedicle-complex approach may be an option for high-grade, down-migrated lumbar disc herniation with completely sequestrated nucleus pulposus.
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Review Case Reports
Resolution of traumatic bilateral vertebral artery injury.
Cerebrovascular ischaemia is a rare but serious complication of damage to the carotid or vertebral arteries in the neck caused by blunt injury to the neck. Screening for blunt cerebrovascular injury should be performed in patients with certain signs or symptoms and risk factors. We described a case of traumatic bilateral vertebral artery injury (VAI) including unilateral vertebral arterial occlusion that resolved 3 months post-injury with antiplatelet and direct oral anticoagulant therapy. This resolution of traumatic bilateral VAI is very rare. Vertebral artery injury should be suspected in patients with displaced fracture dislocation of the cervical spine, particularly in the elder and those with ankylosing spondylitis, and therefore imaging of these patients should include a modality to look at the patency of the vertebral arteries. ⋯ A 70-year-old man who was diagnosed with ankylosing spondylitis collapsed and presented with tetraplegia. Computed tomography showed C3 fracture dislocation, and magnetic resonance imaging showed a high-signal intensity and intense compression of the spinal cord from C2 to C3. Cerebral angiogram showed left vertebral artery occlusion and right vertebral artery stenosis. Heparin was administered to prevent posterior circulation stroke and he underwent posterior fixation. Three months post-injury, a cerebral angiogram showed the resolution of the bilateral VAI.
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With the advancement of minimally invasive spinal surgery, endoscopic lumbar decompression has been widely used for the treatment of degenerative lumbar spinal diseases. Iatrogenic dural tear is a relatively common complication in endoscopic lumbar spinal surgery. The golden standard of treatment for iatrogenic dural tear is immediate open conversion and direct repair under microscopic visualization. Recently, most of endoscopic spinal surgery is performed under local anesthesia. So, conversion to open surgery is very embarrassing situation because of the need of additional general anesthesia. But, direct endoscopic dural repair is very difficult procedure due to the limitation of manipulation. No report showed direct dural suture under full endoscopic situation. ⋯ The purpose of this surgical technique is to provide a method of full endoscopic dural suture repair without conversion to open surgery.