Management of spine fractures in ankylosing spondylitis and diffuse idiopathic skeletal hyperostosis: a challenge

OBJECTIVE Ankylosing spinal disorders (ASDs) such as ankylosing spondylitis (AS) and diffuse idiopathic skeletal hyperostosis (DISH) are complex diseases regarding diagnostics, treatment, and patient outcome, especially in trauma. Originating from rigid biomechanics and low bone quality in considerably comorbid patients, serious spinal injury requires thorough and immediate imaging and is frequently missed. The aim of this study was to evaluate patient characteristics as well as procedures in patients with ASD in order to identify the major particularities of treatment. METHODS A total of 60 patients aged 78.5 ± 8.9 years were retrospectively included. Preoperative imaging as well as surgical treatment procedures and postoperative patient outcome were analyzed, including 30-day readmissions. RESULTS CT imaging of the entire spine was performed within 24 hours after the initial trauma in 73.3% of patients. A delay in diagnostics (> 24 hours) occurred in 41.7% of patients transferred from primary care centers. At admission, 25.0% of patients had fracture-related neurological deficits (American Spinal Injury Association [ASIA] grades A and B in 4 patients, and ASIA grades C and D in 11 patients). A spinal epidural hematoma was found in 21.2% of patients and was symptomatic in 72.7% of those patients. Of the patients with fracture-related neurological deficits, 93.3% were operated on within 48 hours from symptom onset. One patient (1.7%) developed neurological deficits from diagnosis to surgery. Postoperatively, 18.3% of patients had surgical complications, and 76.7% of patients developed further medical issues, with pneumonia (38.3%), pulmonary decompensation (25.0%), and cardiac decompensation (20.0%) being the leading causes. The 30-day mortality rate was high at 10.0%. CONCLUSIONS Treatment of patients with ASDs is complex. While surgical outcome is usually good, the multimorbid nature of these patients results in a high rate of major medical complications. If an ankylosing disease is suspected, MRI of the entire spine is mandatory. Upon diagnosis, treatment should be performed in centers capable of managing all aspects of the regular complications these patients will develop.

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Fracture of L2 with massive spinal epidural hematoma in a patient with ankylosing spondylitis

Osteologie/Osteology ◽

10.1055/s-0037-1619977 ◽

2011 ◽

Vol 20 (01) ◽

pp. 50-52

Author(s):

C.-M. Chou ◽

F.-C. Lien ◽

Y.-H. Huang ◽

W.-H. Chih ◽

L.-Y. Chao

Keyword(s):

Ankylosing Spondylitis ◽

Epidural Hematoma ◽

Neurological Deficits ◽

Spinal Epidural Hematoma ◽

Decompression Surgery ◽

Posterior Decompression ◽

Posterior Aspect ◽

Automobile Accident ◽

Weighted Magnetic Resonance Imaging ◽

Spinal Epidural

SummaryIt has been reported that even mild trauma may result in a fracture and a spinal epidural hematoma in patients with ankylosing spondylitis (AS). We herein presented a case of a patient with AS who sustained a fracture of L2 in an automobile accident and developed a massive spinal epidural hematoma. Findings The patient had few neurological symptoms until numbness and pain developed 50 hours after the initial trauma. T2-weighted magnetic resonance imaging showed an epidural hematoma over the posterior aspect of the spinal canal, reaching from T12 to L4. Posterior decompression surgery was performed. The neurological deficits resolved completely after the surgery. Conclusion Early surgical decompression of a massive epidural hematoma produced a favorable outcome in a patient with AS with neurological deficits.

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Salvage of advanced squamous cell carcinomas of the head and neck: internal carotid artery sacrifice and extracranial–intracranial revascularization

Neurosurgical FOCUS ◽

10.3171/foc.2003.14.3.7 ◽

2003 ◽

Vol 14 (3) ◽

pp. 1-5 ◽

Cited By ~ 16

Author(s):

Iman Feiz-Erfan ◽

Patrick P. Han ◽

Robert F. Spetzler ◽

Giuseppe Lanzino ◽

Mauro A. T. Ferreira ◽

...

Keyword(s):

Carotid Artery ◽

Internal Carotid Artery ◽

Head And Neck ◽

Skull Base ◽

Squamous Cell ◽

Internal Carotid ◽

Tumor Resection ◽

High Rate ◽

Neurological Deficits ◽

Preoperative Imaging

Object Squamous cell carcinoma (SCC) of the head and neck may involve the carotid artery (CA) in the neck or skull base. Whether tumor resection should be associated with sacrifice of the CA is debatable. Methods Records obtained in five consecutive patients (three men, and two women; mean age 58 years, range 47–69 years) treated for recurrent or progressive SCC involving the internal carotid artery (ICA) at the skull base were reviewed retrospectively. The ICA was sacrificed, an extracranial–intracranial (EC–IC) bypass was performed using a saphenous vein graft, and the tumor and involved ICA segment were resected. Gross-total resection of the SCC was achieved in four cases. One patient died of an acute postoperative stroke due to bypass occlusion and did not undergo tumor resection. No other permanent ischemic or neurological deficits were noted. The other four patients died of tumor progression (survival range 2–40 months, mean 14 months). One patient survived for more than 2 years (2-year overall survival rate 20%). Histological tumor invasion of the CA wall was verified in one of the three evaluated specimens. Conclusions A high rate of morbidity and mortality is associated with cases in which skull base CA sacrifice and an EC–IC bypass are performed. Not all resected arteries are shown to have malignant infiltration on histological examination. Better preoperative imaging criteria are needed to define malignant infiltration of the ICA at the skull base. Chemotherapy and radiotherapy without aggressive tumor resection may be an option for these patients.

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ECG-guided PICC insertion using a new silicon catheter with a conductive tip: A retrospective clinical study

The Journal of Vascular Access ◽

10.1177/11297298211002572 ◽

2021 ◽

pp. 112972982110025

Author(s):

Yu-Xia Yin ◽

Wei Gao ◽

Sheng-Yu Feng ◽

Deng-Xu Wang ◽

Min Wan ◽

...

Keyword(s):

Clinical Study ◽

Daily Practice ◽

Patient Characteristics ◽

Mobile App ◽

High Rate ◽

Exit Site Infection ◽

Increased Risk ◽

Retrospective Clinical Study ◽

Operation Rate ◽

Catheter Tip

Objective: Safety and efficacy of ECG-guided PICC insertion using a new silicon catheter with a conductive tip was evaluated in daily practice. Methods: A retrospective study was conducted on 1659 patients who accepted successful tip-conductive PICC placement and clinically followed-up until the catheter removal between January 2018 and April 2019. Baseline of patient characteristics, catheter placement characteristics, date of dressing changes as well as records of catheter-related complications were extracted from a special designed mobile APP. Results: The first-attempt success (success of placing catheter tip to the ideal position by primary indwelling operation) rate of PICC placement was 99.3%. The average duration of PICC placement was 128.7 ± 39.5 days and 1535 patients (92.5%) reached the therapy end-point without any complications and removed the catheter normally. The cumulative rates of total complications were 7.5%, including exit site infection (2.5%), phlebitis (0.9%), DVT (1.0%), catheter malposition (1.1%), catheter breakage (0.1%), and liquid extravasation (1.8%). In multivariable logistic regression analyses, hyperlipidemia, diabetes mellitus, lung cancer, stomach cancer, and lymphoma were significantly associated with increased risk of complications, as the independent risk factors. Conclusions: This retrospective clinical study demonstrates that ECG-guided insertion of a new tip-conductive PICC is associated with a high rate of first-attempt success and low rate of catheter related complications.

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Rehabilitation of the canine patient following spinal cord injury: a practical guide

Companion Animal ◽

10.12968/coan.2020.0060 ◽

2021 ◽

Vol 26 (1) ◽

pp. 1-6

Author(s):

Cheryl Corral

Keyword(s):

Spinal Cord ◽

Spinal Cord Injury ◽

Spinal Injury ◽

Neurological Deficits ◽

Practical Guide ◽

Cord Injury ◽

Physical Therapies

This article forms part of a series exploring the rehabilitation of the canine shoulder, elbow, back, hip and stifle following injury or disease. Discussed here are different rehabilitation techniques used to address neurological deficits, pain and weakness following spinal injury, including physical therapies, electrotherapies and acupuncture.

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1631. Mycobacterium septicum: A 6-year Clinical Experience from a Tertiary Hospital and Reference Laboratory

Open Forum Infectious Diseases ◽

10.1093/ofid/ofaa439.1811 ◽

2020 ◽

Vol 7 (Supplement_1) ◽

pp. S807-S807

Author(s):

John Raymond U Go ◽

Cristina G Corsini Campioli ◽

Omar Abu Saleh ◽

John Wilson ◽

Sharon Deml ◽

...

Keyword(s):

Lung Disease ◽

Treatment Duration ◽

Retrospective Chart Review ◽

Patient Characteristics ◽

Tertiary Hospital ◽

High Rate ◽

Clinical Microbiology Laboratory ◽

Reference Laboratory ◽

Peritoneal Dialysis Catheter ◽

Increased Risk

Abstract Background Mycobacterium septicum is a rapidly growing non-tuberculous mycobacterium. It is a ubiquitous organism capable of causing infections in both healthy and immunocompromised individuals. Only a few cases have been reported to date, and standard therapeutic regimens, and optimal treatment duration have not been defined. Methods We conducted a retrospective chart review of all patients seen at Mayo Clinic in Rochester, MN from July 2014 to March 2020 from whom Mycobacterium septicum was isolated in culture by our clinical microbiology laboratory. Results There were 12 patients identified with M. septicum infection – 7 males and 5 females. The average age was 67 years, with an age range of 48 to 80 years. Seven of 12 isolates obtained were from sputum samples. Only one patient was on immunosuppressive medication. Three cases were considered clinically significant infections for which directed anti-mycobacterial therapy was instituted. In two of these three cases, co-infection with Mycobacterium avium complex (MAC) was seen. Underlying structural lung disease was present in the two cases of pulmonary infections. Peritoneal dialysis catheter-related peritonitis was seen in the third case. All the isolates were susceptible to amikacin, ciprofloxacin, imipenem, linezolid, moxifloxacin, and trimethoprim-sulfamethoxazole (TMP-SMX). The isolates were resistant to clarithromycin and doxycycline. Patient Characteristics, Associated M. septicum Illness, and Therapy Provided Antimicrobial Susceptibility Profiles of the Mycobacterium septicum Isolates, MIC (mcg/mL) and Interpretation Patient Demographics and Specimen Source of Mycobacerium septicum Isolates Conclusion M. septicum is an unusual cause of non-tuberculous mycobacterial infection. The presence of a foreign body may increase the risk of infection. Individuals with underlying structural lung disease are also likely to be at increased risk of developing pulmonary infection. Generalized treatment recommendations are limited by the lack of prospective controlled trials; hence, optimal antibiotic regimen and treatment duration have not been firmly established. Susceptibility testing should be performed to guide treatment selection, but the use of combination therapy with potentially empiric agents like amikacin, ciprofloxacin, imipenem, linezolid, moxifloxacin, and TMP-SMX as demonstrated in this small study, can be considered. A high rate of macrolide resistance was noted in our study. Disclosures All Authors: No reported disclosures

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Novel free-hand T1 pedicle screw method: Review of 44 consecutive cases

Journal of Neurosciences in Rural Practice ◽

10.4103/0976-3147.139974 ◽

2014 ◽

Vol 05 (04) ◽

pp. 349-354 ◽

Cited By ~ 2

Author(s):

Mark A. Rivkin ◽

Jessica F. Okun ◽

Steven S. Yocom

Keyword(s):

Pedicle Screw ◽

Thoracic Spine ◽

Pedicle Screws ◽

High Rate ◽

Imaging Modalities ◽

Neurological Deficits ◽

Upper Thoracic Spine ◽

Starting Point ◽

Grade 3 ◽

Upper Thoracic

ABSTRACT Summary of Background Data: Multilevel posterior cervical instrumented fusions are becoming more prevalent in current practice. Biomechanical characteristics of the cervicothoracic junction may necessitate extending the construct to upper thoracic segments. However, fixation in upper thoracic spine can be technically demanding owing to transitional anatomy while suboptimal placement facilitates vascular and neurologic complications. Thoracic instrumentation methods include free-hand, fluoroscopic guidance, and CT-based image guidance. However, fluoroscopy of upper thoracic spine is challenging secondary to vertebral geometry and patient positioning, while image-guided systems present substantial financial commitment and are not readily available at most centers. Additionally, imaging modalities increase radiation exposure to the patient and surgeon while potentially lengthening surgical time. Materials and Methods: Retrospective review of 44 consecutive patients undergoing a cervicothoracic fusion by a single surgeon using the novel free-hand T1 pedicle screw technique between June 2009 and November 2012. A starting point medial and cephalad to classic entry as well as new trajectory were utilized. No imaging modalities were employed during screw insertion. Postoperative CT scans were obtained on day 1. Screw accuracy was independently evaluated according to the Heary classification. Results: In total, 87 pedicle screws placed were at T1. Grade 1 placement occurred in 72 (82.8%) screws, Grade 2 in 4 (4.6%) screws and Grade 3 in 9 (10.3%) screws. All Grade 2 and 3 breaches were <2 mm except one Grade 3 screw breaching 2-4 mm laterally. Only two screws (2.3%) were noted to be Grade 4, both breaching medially by less than 2 mm. No new neurological deficits or returns to operating room took place postoperatively. Conclusions: This modification of the traditional starting point and trajectory at T1 is safe and effective. It attenuates additional bone removal or imaging modalities while maintaining a high rate of successful screw placement compared to historical controls.

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Surgical Outcomes after Traumatic Spinal Injury in Patients with Ankylosing Spondylitis - A Review of Ireland's National Spinal Unit

Global Spine Journal ◽

10.1055/s-0036-1582729 ◽

2016 ◽

Vol 6 (1_suppl) ◽

pp. s-0036-1582729-s-0036-1582729

Author(s):

Mark Berney ◽

Seamus Morris ◽

Mary Nugent

Keyword(s):

Ankylosing Spondylitis ◽

Surgical Outcomes ◽

Spinal Injury

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Spontaneous cervical epidural hematoma: Insight into this occurrence with case examples

Surgical Neurology International ◽

10.25259/sni_15_2021 ◽

2021 ◽

Vol 12 ◽

pp. 79

Author(s):

Brian Fiani ◽

Ryan Jarrah ◽

Nicholas J. Fiani ◽

Juliana Runnels

Keyword(s):

Epidural Hematoma ◽

Clinical Presentation ◽

Treatment Algorithm ◽

Region Of Interest ◽

Sudden Onset ◽

Neurological Deficits ◽

Spinal Epidural Hematoma ◽

Comprehensive Overview ◽

Case Examples ◽

First Case

Background: First characterized in the 19th century, spontaneous spinal epidural hematoma (SSEH) is known as the idiopathic accumulation of blood within the spinal canal’s epidural space, causing symptoms varying from general back pain to complete paraplegia. With varying etiologies, a broad spectrum of severity and symptoms, a time-dependent resolution period, and no documented diagnosis or treatment algorithm, SSEH is a commonly misunderstood condition associated with increasing morbidity. While SSEH can occur at any vertebrae level, 16% of all SSEH cases occur in the cervical spine, making it a region of interest to clinicians. Case Description: Herein, the authors present two case examples describing the clinical presentation of SSEH, while also reviewing the literature to provide a comprehensive overview of its presentation, pathology, and treatment. The first case is a patient with nontraumatic sudden onset neck pain with rapidly progressing weakness. The second case is a patient with painless weakness that developed while taking 325 mg of aspirin daily. Conclusion: Clinicians should keep SSEH in their differential diagnosis when seeing patients with nontraumatic sources of weakness in their extremities. The appropriate steps should be followed to diagnose and treat this condition with magnetic resonance imaging and surgical decompression if there are progressive neurological deficits. There is a continued need for more extensive database-driven studies to understand better SSEHs clinical presentation, etiology, and ultimate treatment.

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Retrospective Analysis on Intraoperative Neuromonitoring (IOM) of Potential Nerve Injury in Scoliosis Correction Surgery

Majalah Kedokteran Bandung ◽

10.15395/mkb.v53n1.2123 ◽

2021 ◽

Vol 53 (1) ◽

Author(s):

Omat Rachmat ◽

◽

Dohar AL Tobing ◽

Rr. Nur Fauziyah ◽

Jenifer Kiem Aviani ◽

...

Keyword(s):

Spinal Injury ◽

Rare Complication ◽

Intraoperative Neuromonitoring ◽

Neurological Deficits ◽

Neurological Injury ◽

Central Hospital ◽

Chi Square ◽

Post Surgery ◽

Scoliosis Correction ◽

Correction Surgery

Iatrogenic spinal injury resulting in paraplegia or paraparesis after surgical correction of scoliosis deformity is a rare complication but is very detrimental to the patient. Intraoperative Neuromonitoring (IOM) has become the gold standard to monitor surgical procedures which has potential risks to damage the spinal cord. This study aimed to retrospectively analyze the role of IOM in predicting the severity and extent of neurological injury during and after spinal correction surgery in adult idiopathic scoliosis cases related to surgical variables. This was a retrospective cohort study conducted at Dr. Cipto Mangunkusumo National Central Hospital, Fatmawati Central Hospital, and dr. Drajat Prawiranegara General Hospital during the period of 20 March 2018 to 20 August 2019. The primary outcomes were intraoperative monitoring status and post-operative neurological deficits status. Confounder data on scoliosis correction degree, intraoperative hemorrhage, and type of anesthesia used during surgery were retrieved. Chi-Square statistic was used in the analysis. Out of the ninety three patients eligible for this study, twenty two patients was detected as positive in IOM assessment. Four of the patients were found to be positive for post-operative neuromuscular defect. Thereby it can be concluded that IOM procedure can effectively prevent neurological deficits post-surgery with 81.8% specificity and 95.7% sensitivity among thosepositively detected by IOM. Some of the factors that could potentially influence false positive IOM results such as anesthetic used; dosage and administration procedures; magnitude of the scoliosis correction angle; and amount of bleeding during surgery have to be carefully analyzed.

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