Use of folded vascularized rib graft in anterior fusion after treatment of thoracic and upper lumbar lesions

2001 ◽  
Vol 94 (2) ◽  
pp. 323-327 ◽  
Author(s):  
Hiroaki Nakamura ◽  
Yoshiki Yamano ◽  
Masahiko Seki ◽  
Sadahiko Konishi
Keyword(s):  
Anterior Approach ◽  
Spinal Metastasis ◽  
Intercostal Nerve ◽  
Bone Union ◽  
Autogenous Bone ◽  
Anterior Fusion ◽  
Content Type ◽  
Grafting Technique ◽  
Vascularized Rib ◽  
Fine Print

✓ For lesions involving the anterior and/or middle column of the spine, an anterior approach is adequate for curetting the lesion and restoring spinal stability. Materials such as autogenous bone grafts, cages with bone chips, some artificial materials, or allografts are used as strut materials. Rib material is usually removed when the anterior approach is conducted for thoracic or thoracolumbar lesions. A rib itself is not rigid enough to support the load, and a bone union is not easily obtained. The purpose of this paper is to describe a method of grafting vascularized rib in folded form to fill the defects left after removal of a spinal lesion. The rib, with the artery and vein at two levels cranial to the involved vertebral body, was isolated from surrounding tissues such as the intercostal nerve, muscles, and pleura. After curetting the lesion, the rib was folded into three or four pieces to a length adequate to fill the defect and inserted as a pedicled vascularized graft. A total of 23 cases, including 14 men and nine women, underwent surgery in which this grafting technique was used. The pathological conditions requiring anterior decompression and fusion were spinal trauma in nine cases, spinal infection in six cases, osteoporotic fracture in seven cases, and spinal metastasis in one case. In all cases a solid bone union was obtained and all infections resolved. With vascularized rib graft folded into three to four pieces, solid bone union can be obtained without use of any other grafted materials even in cases of infection and osteoporosis.

Posterolateral microdiscectomy for cervical monoradiculopathy caused by posterolateral soft cervical disc sequestration

1990 ◽  
Vol 72 (3) ◽  
pp. 370-377 ◽  
Author(s):  
Francois Aldrich
Keyword(s):  
Anterior Approach ◽  
Posterior Longitudinal Ligament ◽  
Clinical Results ◽  
Skin Incision ◽  
Posterolateral Approach ◽  
Cervical Disc ◽  
Attractive Alternative ◽  
Disc Space ◽  
Content Type ◽  
Fine Print

✓ The controversy over whether to use a posterior or anterior approach for surgical treatment of soft cervical discs is still largely unsettled. However, although the posterior approach may be underutilized, it has distinct advantages when there are specific indications. Out of a large pool of cases, 53 patients presented with acute monoradiculopathy caused by soft cervical disc herniation. In 36 of these, the disc was sequestered (nonconfined) and was posterolateral to the disc space as seen on computerized tomography-myelography. Distinct motor weakness was a common clinical finding in all 36 cases. These patients were treated by using a 2- to 3-cm skin incision for the posterolateral microsurgical approach. The extent of the lateral facetectomy depended upon the relationship between the nerve root and the disc. All fragments were lateral to the dural sac and were sequestered through the anulus fibrosus and the posterior longitudinal ligament. Sequestrations were removed under direct microscopic vision, but the disc space was not entered. Pain relief and motor-power improvement in the affected radicular distribution were immediate in all patients. Sensory deficit and residual motor loss improved dramatically with normalization at approximately 6 months. No complications occurred and the mean hospital stay was 2 days. The follow-up period varied from 4 to 42 months with a mean of 26 months. Thus far, there have been no recurrences or other associated complications. By using strict selection criteria and a microsurgical posterolateral approach with removal of the sequestered disc fragment, excellent results with normalization of the monoradiculopathy can be obtained. The ease of this technique, low risk, minimal complications, and excellent results make it an attractive alternative to the anterior approach. The clinical presentations, specific indications, surgical technique, and clinical results are discussed; and a prototype of a small cervical self-retaining retractor is described.

Patterns of failure after single-dose radiosurgery for spinal metastasis

2004 ◽  
Vol 101 (Supplement3) ◽  
pp. 402-405 ◽  
Author(s):  
Samuel Ryu ◽  
Jack Rock ◽  
Mark Rosenblum ◽  
Jae Ho Kim
Keyword(s):  
Single Dose ◽  
Pain Control ◽  
Spinal Metastasis ◽  
Spinal Metastases ◽  
Tumor Control ◽  
Effective Treatment Option ◽  
Patterns Of Failure ◽  
Content Type ◽  
Spinal Radiosurgery ◽  
Fine Print

Object. Single-dose radiosurgery for solitary spinal metastases can achieve rapid and durable pain control. This study was conducted to determine the patterns of failure after spinal radiosurgery. Methods. Forty-nine patients with 61 solitary spinal metastases underwent radiosurgery between May 2001 and May 2003. Single-dose radiosurgery (10–16 Gy) was delivered only to the involved spinal segments. The authors undertook a retrospective review of clinical notes, including patient questionnaires and radiological studies (computerized tomography or magnetic resonance imaging), to analyze patterns of failure following radiosurgery with regard to the pain and tumor control. Complete and partial pain relief was achieved in 85% of the lesions treated. Relapse of pain at the treated site was noted in 7%. Radiologically, lesions progressively metastasized to the immediately adjacent spines in 5%. These patients also had progressive primary and/or other systemic metastatic diseases. Conclusions. Spine-related pain control/reduction was excellent. Tumor recurrence at the treated segment and progression to the immediately adjacent region were rare. The results support the use of spinal radiosurgery as an effective treatment option for solitary spinal metastasis.

Long-term outcome of anterior decompression and spinal fixation after placement of the Wellesley Wedge for thoracic and lumbar spinal metastasis

2002 ◽  
Vol 96 (1) ◽  
pp. 6-9 ◽  
Author(s):  
David Yen ◽  
Vikas Kuriachan ◽  
Jeff Yach ◽  
Andrew Howard
Keyword(s):  
Selection Process ◽  
Spinal Metastasis ◽  
Neurological Status ◽  
Long Term Results ◽  
Term Outcome ◽  
Long Term Outcome ◽  
Content Type ◽  
Lumbar Spinal ◽  
Fine Print

Object. The authors assessed the long-term results of anterior decompressive and vertebral body reconstructive surgery in which the Wellesley Wedge was applied in patients with metastatic spinal lesions over the life span of these individuals. Methods. The authors performed a retrospective review of the outcome of 27 consecutively treated patients who underwent surgery for thoracic or lumbar spine metastases. Decompressive surgery was performed via an anterior thoracotomy and/or retroperitoneal approach depending on the level of the lesion. The spine was reconstructed using a U-shaped plate with an interposed methylmethacrylate strut known as the Wellesley Wedge. Results. Thirty percent of patients suffered medical complications whereas 22% experienced postoperative improvement, as reflected by an improved Frankel grade. Used in patients with a variety of primary tumor types, a spectrum of ages and neurological status, and extensive preoperative osseous spinal involvement and deformity, the Wellesley Wedge resulted in spinal stability for the duration of patients' lives in 92%. Conclusions. In this series the patient selection process for surgery was a challenge yet to be solved; however, considering the durability of the Wellesley Wedge itself, the authors will continue to use it in selected patients.

Anterior approach to recurrent chordomas of the clivus

1972 ◽  
Vol 36 (5) ◽  
pp. 670-672 ◽  
Author(s):  
A. N. Guthkelch ◽  
R. G. Williams
Keyword(s):  
Soft Palate ◽  
Anterior Approach ◽  
Hard Palate ◽  
Content Type ◽  
Recurrent Tumors ◽  
Mucosal Incision ◽  
Fine Print

✓ A modified transpalatal transclival approach was used for removal of two recurrent tumors of the clivus. New features of the exposure include placing the mucosal incision immediately behind the line of the upper teeth, removal of the posterior third of the hard palate, increased mobilization of the soft palate, and removing the posterior ends of the inferior turbinals.

Surgical treatment of clival chordomas: the transsphenoidal approach revisited

1996 ◽  
Vol 85 (5) ◽  
pp. 784-792 ◽  
Author(s):  
Giulio Maira ◽  
Roberto Pallini ◽  
Carmelo Anile ◽  
Eduardo Fernandez ◽  
Fabrizio Salvinelli ◽  
...  
Keyword(s):  
Spinal Metastasis ◽  
Postoperative Radiotherapy ◽  
Primary Treatment ◽  
Transsphenoidal Approach ◽  
Total Removal ◽  
Partial Removal ◽  
Content Type ◽  
Mortality And Morbidity ◽  
Lower Clivus ◽  
Fine Print

✓ This is a report of 12 cases of clival chordomas that were surgically treated at the Catholic University Medical School, Rome, Italy, over a 7-year period. The study emphasizes the role of the transsphenoidal approach. The study group included seven men and five women whose ages ranged from 26 to 80 years (mean 49.8 years). Diplopia was the most common presenting symptom (eight cases). The tumor involved the upper and middle clivus in five cases, the middle clivus in five, and the lower clivus in two cases. One patient developed spinal metastasis. On histological examination, eight cases proved to be typical chordomas, three cases had a chondroid component, and one case of chordoma had atypical features. Immunohistological staining for vimentin and epithelial membrane antigen was positive in all cases. Follow-up periods ranged from 14 to 86 months (mean 40.2 months). The primary treatment consisted of surgery. Ten patients with chordomas of the upper and middle clivus underwent a total of 13 transsphenoidal procedures. Total tumor removal was achieved in seven cases, subtotal removal in two, and partial removal in one case. In the two cases of lower clival chordomas, total removal was accomplished in one and partial removal in the other. After total removal, no recurrence was noted at 14 to 86 months (mean 37.5 months). In the cases undergoing operation via a transsphenoidal approach, there was zero morbidity and one cerebrospinal fluid fistula that resolved without surgery. The tumor recurred in two patients after subtotal and partial removal, respectively. The authors opted to reoperate in cases of recurrence. Postoperative radiotherapy was administered in only two cases in which further surgery was not indicated because of medical reasons or because such a procedure was contrary to the patient's wishes. When mortality and morbidity rates of this group are compared to those of chordoma patients who were treated with extensive skull-base surgery, the results prompt a reappraisal of the transsphenoidal approach in the treatment of clival chordomas.

Os odontoideum associated with hypertrophic ossiculum terminale

2001 ◽  
Vol 94 (1) ◽  
pp. 140-144 ◽  
Author(s):  
Hiroshi Sakaida ◽  
Shiro Waga ◽  
Tadashi Kojima ◽  
Yoshichika Kubo ◽  
Shigehiko Niwa ◽  
...  
Keyword(s):  
Transoral Approach ◽  
Os Odontoideum ◽  
Autogenous Bone ◽  
Current Case ◽  
Content Type ◽  
Rare Association ◽  
Considerable Confusion ◽  
Ossiculum Terminale ◽  
Fine Print

✓ The authors report on the case of a 20-year-old man who presented with a transient tetraparesis. Neuroimaging studies demonstrated atlantoaxial dislocation and ventral compression of the rostral spinal cord caused by a quite rare association of os odontoideum and hypertrophic ossiculum terminale. The patient underwent removal of two free ossicula via a transoral approach and posterior fusion in which an autogenous bone graft was placed. The majority of cases of os odontoideum are believed to be an acquired form; however, controversy with regard to the congenital causes of os odontoideum remains. One hypothesis is that os odontoideum results from the failure of fusion and the hypertrophy of the proatlas, although considerable confusion surrounds this hypothesis because definitive classification of os odontoideum—to differentiate between similar anomalies—has not been established. This rare coincidence in the current case supports the belief that os odontoideum has a different embryological origin from ossiculum terminale, which is thought to be a proatlantal remnant.

Intracerebral oligodendroglioma with metastatic involvement of the spinal cord

1971 ◽  
Vol 35 (5) ◽  
pp. 610-613 ◽  
Author(s):  
Roberto Reggiani ◽  
Franco Solimé ◽  
Romeo Eugenio del Vivo ◽  
Vitaliano Nizzoli
Keyword(s):  
Spinal Cord ◽  
Spinal Metastasis ◽  
Content Type ◽  
Successful Removal ◽  
Metastatic Involvement ◽  
Fine Print

✓ A case of cerebral oligodendroglioma with a large metastasis in the spinal cord is reported. The patient had undergone two intracranial operations (1959 and 1961) before the successful removal (1966) of the spinal metastasis, and is still alive.

Subtotal neonatal calvariectomy

1979 ◽  
Vol 51 (5) ◽  
pp. 691-696 ◽  
Author(s):  
Laurence W. Mabbutt ◽  
Vincent G. Kokich ◽  
Benjamin C. Moffett ◽  
John D. Loeser
Keyword(s):  
Postoperative Period ◽  
Surgical Margin ◽  
Regenerative Process ◽  
Bone Union ◽  
Histological Techniques ◽  
Content Type ◽  
Rate Of Development ◽  
Definite Pattern ◽  
Fine Print

✓ A subtotal calvariectomy was performed on rabbits between 10 and 14 days of age. The animals were allowed to grow and were then sacrificed serially so that the sutural and skeletal redevelopment could be analyzed through a combination of gross, radiographic, and histological techniques. The results indicate that calvarial regeneration is a progressive process with a definite pattern and rate of development. During the regenerative process, bone was deposited both at the surgical margin and as islands within the surgical defect. The eventual approximation of these areas of ossification produced multiple fibrous articulations. The majority of these articulations were obliterated by bone union, except for the midsagittal, coronal, and metopic sutures, which were re-established in their appropriate anatomical positions. The maintenance of dural integrity during the surgical phase and the regeneration and establishment of pericranial continuity during the postoperative period were believed to be important in the re-establishment of normal sutural and skeletal architecture.

Immediate correction of sagittal synostosis

1978 ◽  
Vol 49 (5) ◽  
pp. 705-710 ◽  
Author(s):  
John A. Jane ◽  
Milton T. Edgerton ◽  
J. William Futrell ◽  
Tae Sung Park
Keyword(s):  
Bone Union ◽  
Cosmetic Result ◽  
Sagittal Synostosis ◽  
Content Type ◽  
Fine Print

✓ A technique for correction of sagittal synostosis with achievement of an immediately pleasing cosmetic result is presented. Even with replacement of bone and no attempt to inhibit bone union, premature reclosure does not occur. Moss' theory of dural tensions is discussed to explain the effect.

Unusual intradural spinal metastasis of a cranial chordoma

1971 ◽  
Vol 34 (4) ◽  
pp. 560-562 ◽  
Author(s):  
Daniel R. Stough ◽  
Joe T. Hartzog ◽  
Robert G. Fisher
Keyword(s):  
Spinal Cord ◽  
Unusual Case ◽  
Spinal Metastasis ◽  
Partial Resection ◽  
Content Type ◽  
Irradiation Therapy ◽  
Fine Print

✓ In this unusual case, multiple intradural spinal cord implants of chordoma were removed 5 years after partial resection of an intracranial chordoma. The “seeding” had occurred in spite of combined surgical and irradiation therapy.

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