Surgical management of thoracic myelopathy from long-segment epidural lipomatosis with skip hemilaminotomies: illustrative case

BACKGROUND Thoracic spinal epidural lipomatosis (SEL) involves the pathological overgrowth of histologically normal, unencapsulated adipose tissue that can compress the spinal cord and cause myelopathy. SEL has been associated with multiple medical conditions, including Scheuermann kyphosis (SK). Optimal treatment strategies for SEL, especially in the setting of a sagittal spinal deformity, remain unclear. OBSERVATIONS In this report, the authors discussed surgical management of a patient with thoracic SEL and SK using skip hemilaminotomies for resection of the epidural adipose tissue. To the authors’ knowledge, only one other report described a similar surgical technique in a patient who did not have a spinal deformity. LESSONS When conservative efforts fail, thoracic SEL may require surgical treatment. Surgical planning must account for co-medical conditions such as SK. The described approach involving skip laminotomies, which minimizes spine destabilization, is a viable option to treat SEL spanning multiple spinal segments. Prognosis after surgical treatment varies and is impacted by multiple factors, including severity of preoperative neurological deficits.

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One-stage posterior-only approach in surgical treatment of single-segment thoracic spinal tuberculosis with neurological deficits in adults: a retrospective study of 34 cases

BMC Musculoskeletal Disorders ◽

10.1186/s12891-015-0640-0 ◽

2015 ◽

Vol 16 (1) ◽

Cited By ~ 14

Author(s):

Hao Zeng ◽

Penghui Zhang ◽

Xiongjie Shen ◽

Chengke Luo ◽

Zhengquan Xu ◽

...

Keyword(s):

Retrospective Study ◽

Surgical Treatment ◽

Spinal Tuberculosis ◽

Neurological Deficits ◽

Single Segment ◽

One Stage ◽

Thoracic Spinal ◽

Thoracic Spinal Tuberculosis

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Nonspecific pyogenic spondylodiscitis: clinical manifestations, surgical treatment, and outcome in 24 patients

Neurosurgical FOCUS ◽

10.3171/foc.2004.17.6.3 ◽

2004 ◽

Vol 17 (6) ◽

pp. 1-7 ◽

Cited By ~ 58

Author(s):

Sascha Mann ◽

Michael Schütze ◽

Steffen Sola ◽

Jürgen Piek

Keyword(s):

Surgical Treatment ◽

Spinal Deformity ◽

Multiorgan Failure ◽

Vertebral Osteomyelitis ◽

Clinical Manifestations ◽

Neurological Deficits ◽

Causative Organism ◽

Delay In Diagnosis ◽

Pyogenic Spondylodiscitis ◽

Antibiotic Drugs

Object Pyogenic vertebral osteomyelitis is of special interest to neurosurgeons because it often results in acute neurological deterioration and requires a combination of adequate surgical and conservative treatment. The aim of the current study was to evaluate the strategy of a primary surgical approach to this disease. Methods A group of 24 patients with the clinical and radiological signs of acute pyogenic spondylodiscitis was prospectively followed from 1998 to 2004. Of these, 20 had underlying diseases such as diabetes mellitus, chronic alcoholism, and liver cirrhosis. The main causative organism was Staphylococcus aureus. Most infections were localized in the thoracic or lumbar spine (10 cases each); 15 infections were associated with epidural abscesses. Because of a delay in diagnosis, 13 patients presented with neurological deficits on admission. Patients with a complete or rapidly progressing neurological deficit underwent immediate surgery. In patients with minor or no deficits or in a stable neurological condition, surgery was delayed for 3 to 5 days. This group was treated with immobilization and intravenous antibiotic drugs before surgery. Surgical procedures included ventral, dorsal, and combined approaches in one- or two-stage operations. Antibiotic treatment included the use of broad-spectrum antibiotic drugs delivered intravenously for at least 10 days, followed by orally administered antibiotics for 3 months. Twenty patients were independent on follow-up review, 15 with no or minor handicaps. Severe septicemia and multiorgan failure developed in two patients, and these two died of their disease. Major complications were mainly due to long-term antibiotic therapy. Conclusions Surgical treatment is the modality of choice in patients with acute spinal osteomyelitis. It is especially indicated in patients with progressive or severe neurological deficits and spinal deformity. In experienced hands, surgery is safe and offers the advantages of spinal cord decompression, immediate mobilization, and correction of spinal deformity. The decision whether an anterior or posterior approach should be used must be made on an individual basis.

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Spontaneous resolution of idiopathic thoracic spinal cord herniation: case report

Journal of Neurosurgery Spine ◽

10.3171/2014.12.spine14950 ◽

2015 ◽

Vol 23 (3) ◽

pp. 306-308 ◽

Cited By ~ 12

Author(s):

Nardin Samuel ◽

Christina L. Goldstein ◽

Carlo Santaguida ◽

Michael G. Fehlings

Keyword(s):

Spinal Cord ◽

Neurological Impairment ◽

Primary Treatment ◽

Spontaneous Resolution ◽

Neurological Deficits ◽

Thoracic Myelopathy ◽

Thoracic Spinal Cord ◽

Thoracic Spinal ◽

Spinal Cord Herniation ◽

Idiopathic Spinal Cord Herniation

Spinal cord herniation is a relatively rare but increasingly recognized clinical entity, with fewer than 200 cases reported in the literature to date. The etiology of this condition remains unknown, and surgery is used as the primary treatment to correct the herniation and consequent spinal cord compromise. Some patients without clinical progression have been treated with nonoperative measures, including careful follow-up and symptomatic physical therapy. To date, however, there has been no published report on the resolution of spinal cord herniation without surgical intervention. The patient in the featured case is a 58-year-old man who presented with mild thoracic myelopathy and imaging findings consistent with idiopathic spinal cord herniation. Surprisingly, updated MRI studies, obtained to better delineate the pathology, showed spontaneous resolution of the herniation. Subsequent MRI 6 months later revealed continued resolution of the previous spinal cord herniation. This is the first report of spontaneous resolution of a spinal cord herniation in the literature. At present, the treatment of this disorder is individualized, with microsurgical correction used in patients with progressive neurological impairment. The featured case highlights the potential variability in the natural history of this condition and supports considering an initial trial of nonoperative management for patients with mild, nonprogressive neurological deficits.

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Ninety-degree rotation of the thoracic spinal thecal sac

Journal of Neurosurgery ◽

10.3171/jns.1998.89.1.0133 ◽

1998 ◽

Vol 89 (1) ◽

pp. 133-138 ◽

Cited By ~ 4

Author(s):

Sagun K. Tuli ◽

R. John Hurlbert ◽

David Mikulis ◽

J. F. Ross Fleming

Keyword(s):

Spinal Cord ◽

Adipose Tissue ◽

Magnetic Resonance Images ◽

Nerve Roots ◽

Thoracic Spinal Cord ◽

Content Type ◽

Epidural Lipomatosis ◽

Thoracic Spinal ◽

History Of ◽

Fine Print

✓ This 44-year-old man presented with a 4-year history of progressive spastic weakness of his legs. He was found to have epidural lipomatosis behind the thoracic spinal cord, and the nerve roots exited from the posterior and anterior midline planes of the dura, indicating a 90° rotation of the thoracic cord. Magnetic resonance images clearly demonstrated the segmental thoracic nerve roots exiting from the dorsal midline of the dura, a finding confirmed at surgery. The authors found only one previously published case of rotation of the spinal cord. Directed mechanical stress caused by deformation of the rotated spinal cord, rather than compression from adipose tissue, is proposed as the mechanism of the myelopathy. The extent, location, and thickness of the associated extradural adipose tissue is suggestive of epidural lipomatosis. The lipomatous tissue might have been an epiphenomenon and cord rotation an isolated congenital anomaly. Alternatively, asymmetrical growth of epidural fat may have exerted torque, rotating the thecal sac.

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Usefulness of the middle cerebellar peduncle approach for microsurgical resection of lateral pontine arteriovenous malformation

Neurosurgical Focus: Video ◽

10.3171/2020.10.focvid2063 ◽

2021 ◽

Vol 4 (1) ◽

pp. V11

Author(s):

Shinsuke Tominaga ◽

Miyahito Kugai ◽

Kou Matsuda ◽

Keisho Yamazato ◽

Toshihiko Inui ◽

...

Keyword(s):

Surgical Treatment ◽

Arteriovenous Malformation ◽

Surgical Management ◽

Neurological Deficits ◽

Review Of The Literature ◽

Treatment Results ◽

Total Resection ◽

Middle Cerebellar Peduncle ◽

Microsurgical Resection ◽

Cerebellar Peduncle

Surgical treatment of brainstem arteriovenous malformation (AVM) is challenging and associated with a higher risk of complications and a lower rate of gross-total resection. The authors present their experience with the surgical management of lateral pontine AVM using the middle cerebellar peduncle approach. All cases presented with neurological deficits that were caused by hemorrhage before surgery. In all cases, the AVM was not visualized on postoperative angiography, and there was no deterioration of neurological symptoms. In this video, the authors report the treatment results of one case and describe the technique with a review of the literature.The video can be found here: https://youtu.be/bFvEMtMnrKw

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The use of Integra dermal regeneration matrix in the surgical treatment of a recurrent, extensive malignant skin lesion in the temporal region

Orvosi Hetilap ◽

10.1556/oh.2013.29535 ◽

2013 ◽

Vol 154 (6) ◽

pp. 225-227 ◽

Cited By ~ 1

Author(s):

Csaba Halmy ◽

Zoltán Nádai ◽

Krisztián Csőre ◽

Adrienne Vajda ◽

Róbert Tamás

Keyword(s):

Surgical Treatment ◽

Skin Lesion ◽

Surgical Management ◽

Skin Grafting ◽

Skin Tumor ◽

Temporal Region ◽

Aesthetic Result ◽

Malignant Skin ◽

Dermal Regeneration Template ◽

Dermal Regeneration

Authors report on the use of Integra dermal regeneration template after excision of an extended, recurrent skin tumor in the temporal region. The area covered with Integra was 180 cm2. Skin grafting to cover Integra was performed on the 28th day. Both Integra and the skin transplant were taken 100%. Integra dermal regeneration template can provide good functional and aesthetic result in the surgical management of extended skin tumors over the skull. Orv. Hetil., 2013, 154, 225–227.

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Comprehensive Surgical Management of Chronic Suppurative Osteomyelitis Extending to The Lower Border of Mandible – A Case Report

International Journal of Recent Advances in Science and Technology ◽

10.30750/ijarst.532 ◽

2018 ◽

Vol 5 (3) ◽

Author(s):

Deepak Kaul ◽

Farahnaz Muddebihal ◽

Mohammed Anwar Ul Haque Chand

Keyword(s):

Developing Countries ◽

Case Report ◽

Surgical Treatment ◽

Surgical Management ◽

Surgical Debridement ◽

Reconstruction Plate ◽

Left Posterior ◽

High Nutrient ◽

Inferior Border ◽

Precipitating Factor

Osteomyelitis of maxillofacial skeleton is common in developing countries such as India. This case report describes successful surgical treatment of chronic suppurative osteomyelitis {CSO} of the mandible of a 35yr old female. The precipitating factor was thought to be eventful extraction in the {left } posterior body at the inferior border of mandible. Methods: Presurgical course of antibiotics ( Amoxycillin and metronidazole for 7 days and later followed by doxycycline for 1 month).Surgical debridement of the affected bone and reinforcing it with reconstruction plate using AO principles was done . Patient was kept on a high nutrient diet consisting of proteins. Conclusion: The case report demonstrates the typical features of CSO . The combination of the antibiotics therapy and surgical debridement was successful in the treatment of chronic suppurative osteomylitis.

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Unplanned hospital readmission after surgical treatment for thoracic spinal stenosis: incidence and causative factors

BMC Musculoskeletal Disorders ◽

10.1186/s12891-021-03975-6 ◽

2021 ◽

Vol 22 (1) ◽

Author(s):

Hui Wang ◽

Longjie Wang ◽

Zhuoran Sun ◽

Shuai Jiang ◽

Weishi Li

Keyword(s):

Surgical Treatment ◽

Spinal Stenosis ◽

Hospital Readmission ◽

Spinal Epidural Hematoma ◽

Control Group ◽

Unplanned Readmission ◽

Thoracic Spinal Stenosis ◽

Thoracic Spinal ◽

Causative Factors ◽

Csf Leakage

Abstract Background To assess the incidence and causative factors of unplanned hospital readmission within 90 days after surgical treatment of thoracic spinal stenosis (TSS). Methods Hospital administrative database was queried to identify patients who underwent surgical treatment of TSS from July 2010 through December 2017. All unplanned readmissions within 90 days of discharge were reviewed for causes and the rate of unplanned readmissions was calculated. Patients of unplanned readmission were matched 1:3 to a control cohort without readmission. Results Twenty-one patients (incidence of 1.7 % in 1239 patients) presented unplanned hospital readmission within a 90-day period and enrolled as the study group, 63 non-readmission patients (a proportion of 1: 3) were randomly selected as the control group. Causes of readmission include pseudomeningocele (8 patients; 38 %), CSF leakage combined with poor incision healing (6 patients; 29 %), wound dehiscence (2 patient; 9 %), surgical site infection (2 patients; 9 %), spinal epidural hematoma (1 patient; 5 %), inadequate original surgical decompression (2 patients; 9 %). Mean duration from re-admission to the first surgery was 39.6 ± 28.2 days, most of the patients readmitted at the first 40 days (66.7 %, 14/21 patients). When compared to the non-readmitted patients, diagnosis of OPLL + OFL, circumferential decompression, dural injury, long hospital stay were more to be seen in readmitted patients. Conclusions The incidence of 90-day unplanned readmission after surgical treatment for TSS is 1.7 %, CSF leakage and pseudomeningocele were the most common causes of readmission, the peak period of readmission occurred from 10 to 40 days after surgery, patients should be closely followed up within this period.

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Histopathology of experimental hematomyelia

Journal of Neurosurgery ◽

10.3171/jns.1991.75.6.0911 ◽

1991 ◽

Vol 75 (6) ◽

pp. 911-915 ◽

Cited By ~ 31

Author(s):

Thomas H. Milhorat ◽

David E. Adler ◽

Ian M. Heger ◽

John I. Miller ◽

Joanna R. Hollenberg-Sher

Keyword(s):

Spinal Cord ◽

Tissue Injury ◽

Central Canal ◽

Microglial Cells ◽

Neurological Deficits ◽

Thoracic Spinal Cord ◽

Content Type ◽

Thoracic Spinal ◽

Cellular Debris ◽

Dorsal Columns

✓ The pathology of hematomyelia was examined in 35 rats following the stereotactic injection of 2 µl blood into the dorsal columns of the thoracic spinal cord. This experimental model produced a small ball-hemorrhage without associated neurological deficits or significant tissue injury. Histological sections of the whole spinal cord were studied at intervals ranging from 2 hours to 4 months after injection. In acute experiments (2 to 6 hours postinjection), blood was sometimes seen within the lumen of the central canal extending rostrally to the level of the fourth ventricle. Between 24 hours and 3 days, the parenchymal hematoma became consolidated and there was an intense proliferation of microglial cells at the perimeter of the lesion. The cells invaded the hematoma, infiltrated its core, and removed erythrocytes by phagocytosis. Rostral to the lesion, the lumen of the central canal was found to contain varying amounts of fibrin, proteinaceous material, and cellular debris for up to 15 days. These findings were much less prominent in the segments of the canal caudal to the lesion. Healing of the parenchymal hematoma was usually complete within 4 to 6 weeks except for residual hemosiderin-laden microglial cells and focal gliosis at the lesion site. It is concluded that the clearance of atraumatic hematomyelia probably involves two primary mechanisms: 1) phagocytosis of the focal hemorrhage by microglial cells; and 2) drainage of blood products in a rostral direction through the central canal of the spinal cord.

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