Fluoroscopy-Guided Percutaneous Vertebral Body Biopsy Using a Novel Drill-Powered Device: Technical Case Series

2015 ◽  
Vol 39 (2) ◽  
pp. 290-295 ◽  
Author(s):  
Adam N. Wallace ◽  
Rafael A. Pacheco ◽  
Anderanik Tomasian ◽  
Andy C. Hsi ◽  
Jeremiah Long ◽  
...  
Keyword(s):  
2020 ◽  
Author(s):  
Romeo Ioan Chira ◽  
Alina Florea ◽  
Vlad Ichim ◽  
Liliana Rogojan ◽  
Alexandra Chira ◽  
...  

Aims: Vertebral lesions, either primary or more frequently metastasis, are difficult targets for percutaneous guided biopsies and surgical biopsies and are associated with greater risks of complications. We investigated the feasibility of endoscopic ultrasound (EUS) fine needle aspiration (FNA) biopsy in the assessment of vertebral osteolytic tumors as an alternative to CT guided biopsy which is the technique currently used.Material and methods: Four patients with osteolytic tumors of the vertebral bodies identified by imaging methods (CT or MRI) – 3 patients, and one with a tumor detected primarily during EUS procedure were included in order to evaluate the feasibility of the procedure. The lesions were located either at the dorsal or lumbar vertebrae. In all cases we performed EUS FNA of the osteolytic vertebral body lesions with 22G needles using the transesophageal or transgastric approach.Results: In all cases EUS FNA provided enough tissue for an accurate histopathological report, with no procedural complication. We diagnosed lung adenocarcinoma, hepatocarcinoma and a pancreatic adenocarcinoma vertebral metastasis and one case of lymphoma.Conclusions: EUS FNA is a valuable technique which should be considered in selected cases, when a “traditional approach” is not applicable or associated with a higher risk. Treatment guidelines are based on the histology of the tumor, histopathological examination being nowadays mandatory. Therefore, we propose for selected cases a feasible technique, with significantly lower procedural risks, as an alternative for open surgical biopsies or computed tomography guided biopsies


2019 ◽  
Vol 27 (3) ◽  
pp. 230949901986187
Author(s):  
Guan Shi ◽  
Fei Feng ◽  
Chen Hao ◽  
Jia Pu ◽  
Bao Li ◽  
...  

Background: Percutaneous vertebral augmentation (PVA) under local anesthesia has been widely used to treat osteoporotic vertebral compression fractures and vertebral body tumors. However, the occurrence of spinal cord or nerve root dysfunction may result in poor prognosis for patients. The aim of this study was to analyze the causes of transient paraplegia in 12 patients undergoing PVA. Methods: The medical records of 12 patients with transient paraplegia during PVA in our hospital were analyzed. Data, including operation, vertebral, anesthetic dose, operation time, recovery time, and follow-up, were extracted. Results: Among the 12 patients, ranging in age from 62 years to 83 years, with a mean age of 74 years, 8 were females and 4 were males. The average anesthetic dose injected per vertebral body was 6.38 ml. Patients required an average of 218.75 min to recover sensation and movement completely. However, the amount of anesthetic injected into each vertebral body was not related to the time required for complete recovery. Follow-up showed that all patients had regained normal bilateral sensation and motor function. Postoperative visual analog scale and Oswestry Disability Index values of the 12 patients were significantly improved compared with preoperative values. Conclusion: The complication of transient paraplegia was caused by local anesthetic drugs infiltrating into the spinal canal and inhibiting nerve conduction in the spinal cord.


2015 ◽  
Vol 39 (3) ◽  
pp. 488-488
Author(s):  
Adam N. Wallace ◽  
Rafael A. Pacheco ◽  
Anderanik Tomasian ◽  
Andy C. Hsi ◽  
Jeremiah Long ◽  
...  
Keyword(s):  

Neurosurgery ◽  
2008 ◽  
Vol 63 (3) ◽  
pp. 537-545 ◽  
Author(s):  
Mark P. Arts ◽  
Wilco C. Peul

ABSTRACT OBJECTIVE Vertebral body reconstruction after corpectomy has become a common surgical procedure. The authors describe a prospectively followed case series of patients treated with expandable cages for various indications. METHODS Sixty patients underwent single or multilevel corpectomy for degenerative stenosis (13 patients), herniated disc (7 patients), deformity (14 patients), traumatic fracture (3 patients), infection (1 patient), or tumor (22 patients). Six different expandable vertebral body systems were used in the cervical spine (41 patients), thoracic spine (15 patients), and lumbar spine (4 patients). All patients were evaluated clinically and radiographically. RESULTS Thirty-nine patients underwent single-level corpectomy, 18 patients underwent two-level corpectomy, and 3 patients underwent three-level corpectomy. Anterior reconstruction alone was performed in 30 patients; circumferential reconstruction was performed in 30 patients, 9 of whom underwent reconstruction through a posterior approach only. At the time of the final follow-up examination (mean, 9 mo), the Nurick grade improved significantly. Ninety-five percent of the patients maintained or improved their Frankel score and 67% had good clinical results. The regional angulation was corrected significantly (4.0 ± 9.0 degrees, P = 0.002), and the segment height increased significantly (3.5 ± 8.0 mm, P = 0.002). Bony fusion was achieved in 93% of the cases. Subsidence was documented in nearly half of the patients (1.4 ± 2.0 mm) and was reduced after circumferential fusion (0.9 ± 1.9 mm, P = 0.08). Eighteen patients (30%) had complications and 12 patients (20%) underwent revision surgery. CONCLUSION Expandable vertebral body replacement systems can provide solid anterior column constructs with restoration of height and sagittal alignment. Favorable clinical outcome was shown in most patients, although the complication and reoperation rates are rather high.


2018 ◽  
Vol 4 (2) ◽  
pp. 374-382 ◽  
Author(s):  
Haider Kareem ◽  
Muhammad Hasan Raza ◽  
Vassilios Kontojannis ◽  
Amr Nimer ◽  
Kevin Tsang

2017 ◽  
Vol 43 (2) ◽  
pp. E3 ◽  
Author(s):  
Martin Stangenberg ◽  
Lennart Viezens ◽  
Sven O. Eicker ◽  
Malte Mohme ◽  
Klaus C. Mende ◽  
...  

OBJECTIVEThe treatment of cervical spinal metastases represents a controversial issue regarding the type, extent, and invasiveness of interventions. In the lumbar and thoracic spine, kypho- and vertebroplasties have been established as minimally invasive procedures for patients with metastases to the vertebral bodies and without neurological deficit. These procedures show good results with respect to pain reduction and low complication rates. However, limited data are available for kypho- and vertebroplasties for cervical spinal metastases. In an effort to add to existing data, the authors here present a case series of 14 patients who were treated for osteolytic metastases of the cervical spine using vertebroplasty alone or in addition to another surgical procedure involving the cervical spine in a palliative setting to reduce pain and restore stability.METHODSFourteen patients consisting of 8 males and 6 females, with a mean age of 64.7 years (range 44–85 years), were treated with vertebroplasty at the authors’ clinic between January 2015 and November 2016. In total, 25 vertebrae were treated with vertebroplasty: 10 C-2, 5 C-3, 2 C-4, 2 C-5, 3 C-6, and 3 C-7. Two patients had an additional posterior stabilization and 5 patients an additional anterior stabilization. In 13 cases, the surgical approach was a modified Smith-Robinson approach; in 1 case, the cement was injected into the corpus axis from posteriorly. Patients with osteolytic defects of the posterior wall of the vertebral body did not undergo surgery, nor did patients with neurological deficits. Preoperatively, on the 2nd day after surgery, and at the follow-up, neck pain was rated using the visual analog scale (VAS).RESULTSTwelve patients were examined at follow-up (mean 9 months). Neck pain was rated as a mean of 6.0 (range 3–8) preoperatively, 2.9 on Day 2 after surgery (range 0–5), and 0.5 at the follow-up (range 0–4), according to the VAS. The mean Neck Disability Index at follow-up was 3.6% (range 0%–18%).CONCLUSIONSAnterior vertebroplasty of the cervical spine via an anterolateral approach represents a safe and minimally invasive procedure with a low complication rate and appears suitable for reducing pain and restoring stability in cases of cervical spinal metastases. Vertebroplasties can be combined with other anterior and posterior operations of the cervical spine and, in the axis vertebra, can be performed transpedicularly from posteriorly. Thus, in cases in which the posterior wall of the vertebral body is intact, vertebroplasty represents a less invasive alternative to vertebral replacement in oncological surgery. Prospective randomized trials with a longer follow-up period and a larger patient cohort are needed to confirm the encouraging results of this case series.


2021 ◽  
Vol 41 (01) ◽  
pp. 97-101
Author(s):  
Della Valle G

Traumatic lumbosacral joint dislocation (TLSJD) without L7 vertebral body fracture is a rare injury in dogs. This report describes clinical presentation, therapy and outcome in 3 dogs. Three crossbreed dogs with non-ambulatory paraparesis and lumbar pain were referred. Radiographs confirmed TLSJD and dorso-ventral displacement (DVD) was measured pre and postoperatively. Case 1 was treated by percutaneous transilial pinning. Cases 2 and 3 were treated by internal fixation with pins and PMMA. Within 72h after surgery all dogs were able to stand and walk, and faecal incontinence resolved. To the author’s knowledge this is the first description of a case series of TLSJD in the dog. The biomechanics of TLSJD in animals have not been investigated. It is likely that a single trauma severely hyper-extends L7-S1 causing disruption of the supra and inter-spinous ligaments with simultaneous shear and compression forces that cause ventral slipping of the sacrum. Pins and PMMA compared to percutaneous transilial pinning, provided more strength and stability. In conclusion, TLSJD requires appropriate surgical reduction and stabilization to allow fibrous healing of the L7-S1 junction, resulting in satisfactory neurological recovery


2020 ◽  
Vol 29 (2) ◽  
pp. 222-7
Author(s):  
Komang Agung Irianto ◽  
Marquee Kenny Tumbelaka

BACKGROUND Pedicle screws and rods are routinely inserted in the vertebrae thoracic to lumbar in scoliosis reconstruction surgery to gain deformity correction and fusion. Intraoperative imaging is often needed to ensure accuracy, but surgical time will be longer and there will be more radiation exposure. Meanwhile, freehand technique is accepted as safe. This study was aimed to evaluate the accuracy of screw insertion in the freehand technique used in adolescent scoliosis surgery. METHODS This case series evaluated a total of 127 pedicle screws inserted using the freehand technique in 8 out of 28 adolescent scoliosis patients from 2011 to 2016 whom agreed for computed tomography (CT) scan follow-up from 2011 to 2016 in Dr. Seotomo Hospital, Surabaya. The accuracy and safety of the freehand technique were evaluated postoperatively in each patient using a CT scan. A successful screw was considered accurate if it was within the vertebral body and inside the safety zone within the limit of 2–4 mm to the medial or lateral side of the vertebral body. RESULTS Of the 127 screws inserted, 106 (83.5%) were accurately placed, and 110 (86.6%) were within the safe zone. According to the level of the spine, in the upper and middle thoracic spine, the inserted screws were accurate in 69.4% and 74.9% within the safety zone, whereas in the lower thoracic and lumbar spine, 94.0% and 95.0% within the safety zone. CONCLUSIONS The freehand technique in scoliosis reconstructive surgery performed by experienced surgeons is accurate and safe. 


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