Using aneurysm clips for repair of cisterna chyli injury during posterior spinal fusion

Background: Injury to the cisterna chyli (CC) is a rare surgical complication with a lack of literature describing its repair. Aneurysm clips have been successfully used to repair durotomies. Its usage in lymphatic injury has never been described. We sought to demonstrate the use of aneurysm clips for the repair of lymphatic vessels. Case Description: A 60-year-old male retired physician with Parkinson’s disease underwent a lumbosacral instrumented fusion with pelvic fixation (L1-pelvis) in 2011. He returned 5 months postoperatively after a fall and was ambulatory with a cane upon admission. CT demonstrated worsening kyphosis with pedicular and superior endplate fracture at the fusion apex. MRI revealed spinal cord compression at the failed level. Extension thoracolumbar fusion was performed (T3-L1) with intraoperative violation of the anterior longitudinal ligament (ALL) during T12/L1 discectomy. CC laceration was suspected. The ALL was dissected from the CC and aorta, allowing visualization of the injury. Three curved aneurysm clips were applied to the lacerated CC, which was visually inspected to ensure a patent lumen. The disk space was filled with poly-methyl-methacrylate cement in place of an interbody cage, preventing migration of the clips. The patient underwent rehabilitation in an inpatient facility with improved ambulation. He has had regular clinic follow-up and was last seen in 2020 with no evidence of lymphedema noted. Conclusion: CC injury is rare, and usage of aneurysm clips in its repair has never been described. We demonstrate the safe use of aneurysm clips to repair CC injury with long-term favorable clinical outcomes.

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Long-Term Follow-Up and Predictors of Functional Outcome after Surgery for Spinal Meningiomas: A Population-Based Cohort Study

Cancers ◽

10.3390/cancers13133244 ◽

2021 ◽

Vol 13 (13) ◽

pp. 3244

Author(s):

Jenny Pettersson-Segerlind ◽

Alexander Fletcher-Sandersjöö ◽

Charles Tatter ◽

Gustav Burström ◽

Oscar Persson ◽

...

Keyword(s):

Spinal Cord ◽

Spinal Cord Compression ◽

Cord Compression ◽

Magnetic Resonance Images ◽

Motor Deficit ◽

Tumor Control ◽

Time To Surgery ◽

Spinal Meningiomas

Spinal meningiomas are the most common adult primary spinal tumor, constituting 24–45% of spinal intradural tumors and 2% of all meningiomas. The aim of this study was to assess postoperative complications, long-term outcomes, predictors of functional improvement and differences between elderly (≥70 years) and non-elderly (18–69 years) patients surgically treated for spinal meningiomas. Variables were retrospectively collected from patient charts and magnetic resonance images. Baseline comparisons, paired testing and regression analyses were used. In conclusion, 129 patients were included, with a median follow-up time of 8.2 years. Motor deficit was the most common presenting symptom (66%). The median time between diagnosis and surgery was 1.3 months. A postoperative complication occurred in 10 (7.8%) and tumor growth or recurrence in 6 (4.7%) patients. Surgery was associated with significant improvement of motor and sensory deficit, gait disturbance, bladder dysfunction and pain. Time to surgery, tumor area and the degree of spinal cord compression significantly predicted postoperative improvement in a modified McCormick scale (mMCs) in the univariable regression analysis, and spinal cord compression showed independent risk association in multivariable analysis. There was no difference in improvement, complications or tumor control between elderly and non-elderly patients. We concluded that surgery of spinal meningiomas was associated with significant long-term neurological improvement, which could be predicted by time to surgery, tumor size and spinal cord compression.

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Surgical treatment for cervical spondylitic myelopathy

Journal of Neurosurgery ◽

10.3171/jns.1995.82.5.0745 ◽

1995 ◽

Vol 82 (5) ◽

pp. 745-751 ◽

Cited By ~ 201

Author(s):

Michael J. Ebersold ◽

Michel C. Pare ◽

Lynn M. Quast

Keyword(s):

Cord Compression ◽

Term Outcome ◽

Long Term Outcome ◽

Content Type ◽

Posterior Laminectomy ◽

Anterior Decompression And Fusion ◽

Anterior Group ◽

Fine Print

✓ The long-term outcome of cervical spondylitic myelopathy after surgical treatment was retrospectively reviewed and critically evaluated in 100 patients with documented cervical myelopathy treated between 1978 and 1988 at our institution. Eighty-four patients were available for long-term study. The median duration of follow up was 7.35 years (range 3 to 9.5 years). There were 67 men and 17 women; their ages ranged from 27 to 86 years. The duration of preoperative symptoms ranged from 1 month to 10 years. Preoperative functional grade as evaluated with the Nurick Scale for the group was 2.1. Thirty-three patients with primarily anterior cord compression, one- or two-level disease, or a kyphotic neck deformity were treated by anterior decompression and fusion. Fifty-one patients with primarily posterior cord compression and multiple-level disease were treated by posterior laminectomy. There was no difference in the preoperative functional grade in these two groups. The patients in the posterior treatment group were older (59 vs 55 years). There was no surgical mortality from the operative procedures; morbidity was 3.6%. Of the 33 patients undergoing anterior decompression and fusion, 24 showed immediate functional improvement and nine were unchanged. Of the 51 patients who underwent posterior laminectomy, 35 demonstrated improvement, 11 were unchanged, and five were worse. Six patients, one in the anterior group and five in the posterior group, demonstrated early deterioration. Late deterioration occurred from 2 to 68 months postoperatively. Four (12%) patients who had undergone anterior procedures had additional posterior procedures, and seven (13.7%) patients who had undergone posterior procedures had additional decompressive surgery. The final functional status at last follow-up examination for the 33 patients in the anterior group was improved in 18, unchanged in nine, and deteriorated in six. Of the 51 patients who underwent posterior decompression, 19 benefited from the surgery, 13 were unchanged, and 19 were worse at last follow up than before their initial surgical procedure. Age, severity of disease, number of levels operated, and preoperative grade were not predictive of outcome. The only factor related to potential deterioration was the duration of symptoms preoperatively. The results indicate that with anterior or posterior decompression, long-term outcome is variable, and a subgroup of patients, even after adequate decompression and initial improvement, will have late functional deterioration.

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Necrotizing Enterocolitis in a Dutch Cohort of Very Preterm Infants: Prevalence, Mortality, and Long-Term Outcomes

European Journal of Pediatric Surgery ◽

10.1055/s-0041-1741544 ◽

2022 ◽

Author(s):

Ceren Imren ◽

Lotte E. Vlug ◽

Barbara A. E. de Koning ◽

Tessa Diertens ◽

Heleen E. Snel ◽

...

Keyword(s):

Preterm Infants ◽

Necrotizing Enterocolitis ◽

Surgical Complication ◽

Intestinal Failure ◽

Very Preterm Infants ◽

Very Preterm ◽

Anastomotic Strictures ◽

Multidisciplinary Perspective

Abstract Introduction To improve counseling of parents and to guide care strategies, we studied the disease course and outcomes of necrotizing enterocolitis (NEC) up to 2 years of corrected age (CA) from a multidisciplinary perspective. Materials and Methods This was a retrospective cohort study in preterm infants (birth weight < 1,500 g, gestational age < 32 weeks), diagnosed with NEC (Bell's stage ≥ II) from 2008 through 2020. Data on prevalence, mortality, surgery, intestinal failure (IF), growth, and neurodevelopment at 2-year follow-up were separately analyzed for medically and surgically treated children. Results Of 3,456 preterm infants, 200 (6%) were diagnosed with NEC, of whom 135 developed an indication for surgery within 7 days after the diagnosis; 28/135 died before surgery, and 37/107 died after an open-and-close procedure. An enterostomy was constructed in 62 patients and an end-to-end anastomosis in 15. The postoperative course was described for 77 patients, of whom 23 developed surgical complications (12/23 incisional hernias, 9/23 anastomotic strictures), 13/77 a short bowel, and 25/77 IF. Sixty-day survival after birth for medical NEC patients was 88% (hazard ratio [HR]: 0.698; p = 0.318), and for surgically treated NEC patients was 40% (HR: 3.729; p < 0.001). At 2-year follow-up, one patient received parenteral nutrition. Severe delay in weight for age, motor, and cognitive development was seen in 3, 6, and 2%, respectively. Conclusion In this cohort, the mortality rate was high, especially in surgically treated NEC patients. The surgical complication rate is comparable to previous studies, but in surviving patients, persisting IF and severe delay in growth and neurodevelopment at 2 years CA were relatively rare.

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Long-Term Follow-Up of Patients with Metastatic Epidural Spinal Cord Compression from Solid Tumors Submitted for Surgery Followed by Radiation Therapy

World Neurosurgery ◽

10.1016/j.wneu.2018.04.136 ◽

2018 ◽

Vol 115 ◽

pp. e681-e687 ◽

Cited By ~ 1

Author(s):

Federico Pessina ◽

Pierina Navarria ◽

Giulio Alberto Carta ◽

Giuseppe Roberto D'Agostino ◽

Elena Clerici ◽

...

Keyword(s):

Spinal Cord ◽

Radiation Therapy ◽

Solid Tumors ◽

Spinal Cord Compression ◽

Cord Compression ◽

Long Term Follow Up

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Infection after the use of INFIX in Pelvic Ring Injuries

SICOT-J ◽

10.1051/sicotj/2021047 ◽

2021 ◽

Vol 7 ◽

pp. 46

Author(s):

Rahul Vaidya ◽

Karun Amar ◽

Derrek Woodbury ◽

Austen Washington

Keyword(s):

Pelvic Ring ◽

X Rays ◽

Pelvic Fixation ◽

Pelvic Ring Injuries ◽

Small Series ◽

Loss Of Reduction ◽

Irrigation And Debridement ◽

Radiographic Union

Introduction: The purpose of this study is to report on infection with anterior subcutaneous internal pelvic fixation (INFIX) for pelvic ring injuries and the outcomes of treatment. Methods: An IRB-approved retrospective study was performed using trauma databases of a level one and level two trauma center from 2012–2018. Infection after the INFIX procedure was diagnosed in 10 of 179 cases. Treatment included formal irrigation and debridement, removal of the hardware, and culture-specific antibiotics. Patients were followed for a minimum of 12 months. Recorded outcomes include X-rays, Majeed scores, and the presence of any loss of reduction using reduction parameters. Results: Time to detect the infection was 54.2 ± 24.3 days (range 24–90, median 56 days). Staphylococcus aureus was the most common bacteria isolated. The average follow-up was 830 ± 170 days (range 575–1088 days). All patients went on to the radiographic union. There were no recurrent infections or osteomyelitis at the latest follow-up. Patients maintained their reduction after INFIX removal (KI), and Majeed scores ranged from 72 to 96 (seven good, three excellent). Discussion: Infections after using the INFIX procedure were dealt with by irrigating and debriding the wounds, removing the INFIX with culture-specific antibiotics for 2–6 weeks. Implants were maintained for at least 25 days, and there was no loss of reduction. There were no long-term sequelae noted in this small series or the literature review included in this paper.

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Posterior only instrumented fusion provides incomplete curve control for early-onset scoliosis in type 1 neurofibromatosis

10.21203/rs.2.13661/v2 ◽

2019 ◽

Author(s):

Jianguo zhang ◽

Siyi Cai ◽

zhenyao Li ◽

Guixing Qiu ◽

Jianxiong shen ◽

...

Keyword(s):

Spinal Fusion ◽

Early Onset ◽

Neurofibromatosis Type ◽

Posterior Spinal Fusion ◽

Early Onset Scoliosis ◽

Fusion Surgery ◽

Major Curve

Abstract Background: The mid-long term outcomes of posterior spinal fusion in pediatric neurofibromatosis type 1 (NF-1) patients are rarely reported, so does the effectiveness of itsorthopeidc maintenance function. This study aims to evaluate the mid-long term surgical outcomes of posterior only instrumented spinal fusion for early-onset scoliosis (EOS) in NF-1 patients. Methods: A retrospective review was performed on a cohort of 10 NF-1 patients having EOS from 2008 to 2014 in our hospital, including four male and six female patients with an age averaged at 7.8 years old when they underwent posterior only instrumented spinal fusion for their EOS. Both general clinical data and surgical specific data of the patients were collected and reviewed, and the dystrophic progression of EOS was evaluated during the follow-up. Results: The average duration of follow-up was 54 months (24 to 88 months). All patients underwent posterior only instrumented spinal fusion at 1 stage. The primary curves of EOS were thoracic in 9 cases and 1 patient had lumbar scoliosis. Preoperative major curve was significantly corrected (from 66.1 to 31.1 degrees). However, the major curve deteriorated significantly to 40.1 degrees on average at the end of the follow-up. The T1-S1 distance increased 2.8 cm on average and kept increasing at a rate of 0.6cm/year during the follow-up. Conclusions: Posterior only fusion surgery was not a good option to treat the EOS in NF-1 patients despite the relatively short segments involvement in the disease. The maintenance of orthopedic effect after treatment was not satisfactory.

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Primary Dumbbell-Shaped Lymphoma of the Thoracic Spine: A Case Report

Case Reports in Neurological Medicine ◽

10.1155/2012/647682 ◽

2012 ◽

Vol 2012 ◽

pp. 1-4 ◽

Cited By ~ 1

Author(s):

Antonio Meola ◽

Paolo Perrini ◽

Nicola Montemurro ◽

Paolo di Russo ◽

Giacomo Tiezzi

Keyword(s):

Thoracic Spine ◽

Cell Lymphoma ◽

B Cell Lymphoma ◽

Cord Compression ◽

Pathological Examination ◽

Subtotal Resection ◽

Large B Cell Lymphoma ◽

One Year

Primary spinal non-Hodgkin’s lymphoma is extremely rare, and the occurrence of spinal dumbbell-shaped lymphoma is exceptional. We present a case of primary spinal dumbbell-shaped lymphoma to clarify the diagnosis and the management of these lesions. A 45-year-old man presented with sensory symptoms for 8 months. Magnetic resonance imaging of the thoracic spine demonstrated a dumbbell-shaped lesion at the D4–D6 level with spinal cord compression and right foraminal extension at D4–D5 level. The patient underwent D4–D6 laminectomy, with a subtotal resection of the mass. Diffuse large B-cell lymphoma was diagnosed in the pathological examination. He underwent local spinal radiotherapy and chemotherapy. Follow-up evaluation at one year demonstrated no evidence of relapse. Although highly unusual, lymphoma should be included in the differential diagnosis for spinal dumbbell-shaped tumours. After surgery and adjuvant therapy a long-term clinical and neuroradiological followup is mandatory.

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Neural tube defects in Uganda: follow-up outcomes from a national referral hospital

Neurosurgical FOCUS ◽

10.3171/2018.7.focus18280 ◽

2018 ◽

Vol 45 (4) ◽

pp. E9 ◽

Cited By ~ 4

Author(s):

Linda W. Xu ◽

Silvia D. Vaca ◽

Joy Q. He ◽

Juliet Nalwanga ◽

Christine Muhumuza ◽

...

Keyword(s):

Median Time ◽

Neural Tube ◽

Neural Tube Defects ◽

Surgical Complication ◽

Referral Hospital ◽

Third Ventriculostomy ◽

Good Recovery ◽

National Referral Hospital

OBJECTIVEChildren with neural tube defects (NTDs) require timely surgical intervention coupled with long-term management by multiple highly trained specialty healthcare teams. In resource-limited settings, outcomes are greatly affected by the lack of coordinated care. The purpose of this study was to characterize outcomes of spina bifida patients treated at Mulago National Referral Hospital (MNRH) through follow-up phone surveys.METHODSAll children presenting to MNRH with NTDs between January 1, 2014, and August 31, 2015, were eligible for this study. For those with a documented telephone number, follow-up phone surveys were conducted with the children’s caregivers to assess mortality, morbidity, follow-up healthcare, and access to medical resources.RESULTSOf the 201 patients, the vast majority (n = 185, 92%) were diagnosed with myelomeningocele. The median age at presentation was 6 days, the median length of stay was 20 days, and the median time to surgery was 10 days. Half of the patients had documented surgeries, with 5% receiving multiple procedures (n = 102, 51%): 80 defect closures (40%), 32 ventriculoperitoneal shunts (15%), and 1 endoscopic third ventriculostomy (0.5%). Phone surveys were completed for 53 patients with a median time to follow-up of 1.5 years. There were no statistically significant differences in demographics between the surveyed and nonrespondent groups. The 1-year mortality rate was 34% (n = 18). At the time of survey, 91% of the survivors (n = 30) have received healthcare since their initial discharge from MNRH, with 67% (n = 22) returning to MNRH. Hydrocephalus was diagnosed in 29 patients (88%). Caregivers reported physical deficits in 39% of patients (n = 13), clubfoot in 18% (n = 6), and bowel or bladder incontinence in 12% (n = 4). The surgical complication rate was 2.5%. Glasgow Outcome Scale–Extended pediatric revision scores were correlated with upper good recovery in 58% (n = 19) of patients, lower good recovery in 30% (n = 10), and moderate disability in 12% of patients (n = 4). Only 5 patients (15%) reported access to home health resources postdischarge.CONCLUSIONSThis study is the first to characterize the outcomes of children with NTDs that were treated at Uganda’s national referral hospital. There is a great need for improved access to and coordination of care in antenatal, perioperative, and long-term settings to improve morbidity and mortality.

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Posterior lumbar interbody fusion with bioabsorbable spacers and local autograft in a series of 27 patients

Neurosurgical FOCUS ◽

10.3171/foc.2004.16.3.9 ◽

2004 ◽

Vol 16 (3) ◽

pp. 1-6 ◽

Cited By ~ 17

Author(s):

Daniel E. Couture ◽

Charles L. Branch

Keyword(s):

Interbody Fusion ◽

Surgical Complication ◽

Posterior Lumbar Interbody Fusion ◽

Lumbar Interbody Fusion ◽

Radiographic Evidence ◽

Pedicle Fixation ◽

Term Evaluation ◽

Lost To Follow Up

Object The goal of this prospective study was to review a series of 27 patients who underwent bilateral posterior lumbar interbody fusion with instrumented pedicle fixation and two HYDROSORB (known generically as 70:30 poly[L-lactide-co-D,L-lactide]) rectangular cages packed with locally harvested autograft at a total of 48 levels, and to assess the safety and efficacy of this novel technique. This analysis, conducted at a mean of 26 months of follow up, is the first report of a long-term evaluation of this technique. Fusion rates and clinical outcomes are presented. Methods A prospective clinical and radiographic review of findings in 27 consecutive patients was performed. Fusion rates and clinical outcome were assessed at 6-month intervals up to the 32-month follow-up end point. Two patients with four corresponding fusion levels were lost to follow up. Radiographic evidence of satisfactory fusion was achieved in 42 (95.5%) of 44 levels fused. Satisfactory fusion at all levels was achieved in 23 (92%) of 25 patients. Two patients required repeated operations for treatment of symptomatic pseudarthrosis during the study period. The likelihood of all levels attaining fusion in a given patient decreased as the number of levels treated increased, which is consistent with previously published studies. Nonetheless, fusion rates per treated level were similar for patients in whom one to three levels were treated. No significant surgical complication occurred. Conclusions Posterior lumbar interbody fusion in which the HYDROSORB bioabsorbable implant packed with locally harvested autograft and segmental internal fixation are used appears to be an interbody fusion alternative whose efficacy is comparable with previously reported procedures.

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