Neurological Complications after Surgical Treatment of Metastatic Tumours of the Spine

2017 ◽  
Vol 19 (3) ◽  
pp. 227-237 ◽  
Author(s):  
Piotr Biega ◽  
Grzegorz Guzik ◽  
Tomasz Pitera
Keyword(s):  
Spinal Cord ◽  
Surgical Treatment ◽  
Postoperative Period ◽  
Neurological Complications ◽  
Neurological Function ◽  
Prognostic Scores ◽  
Neurological Deficits ◽  
Neoplastic Disease ◽  
Spinal Cord Damage ◽  
Function Impairment

Background. Postoperative impairment of neurological function is a rare but serious complication of surgical treatment of metastatic tumours located in the spine. This paper presents an analysis of the causes, symptoms and methods of treatment of spinal cord function impairment in the postoperative period. Materials and methods. The study retrospectively analysed the treatment of 525 patients diagnosed with compression of neural structures and neurological deficits in the course of metastatic disease who were operated on in 2012-2015. The baseline degree of spinal cord damage was assessed with the Frankel scale. Surgical treatment methods were selected based on the results obtained with the Tomita system as well as the Tokuhashi and Bauer scores. Results. A total of 8 (1.5%) cases of impaired neurological function were identified in the postoperative period. The spinal cord damage had no discernible cause in 6 cases. Symptoms of neurological function impairment occurred with a delay in 6 patients. In 2 cases, the symptoms were observed immediately after the end of the surgery. One patient demonstrated improved neurological status after revision surgery. Conclusions. 1. Surgical decompression of the spinal cord in the course of neoplastic disease is rarely complicated by neurological function impairment. 2. Neurological complications occurred mainly after treatment of tumours located in the thoracic section of the spine. 3. Prognostic scores used for qualifying patients for appropriate surgical treatment focus mainly on patient survival and do not account for potential complications.

Late-onset recurrence of neurological deficits after surgery for spinal arachnoid diverticula

2017 ◽  
Vol 182 (13) ◽  
pp. 380-380 ◽  
Author(s):  
Emili Alcoverro ◽  
James Fraser McConnell ◽  
Daniel Sanchez-Masian ◽  
Luisa De Risio ◽  
Steven De Decker ◽  
...  
Keyword(s):  
Spinal Cord ◽  
Surgical Treatment ◽  
Medical Treatment ◽  
Medical Records ◽  
Late Onset ◽  
Clinical Signs ◽  
Neurological Deficits ◽  
Laminectomy Membrane ◽  
Spinal Cord Dysfunction ◽  
Time To Relapse

Spinal cord dysfunction secondary to spinal arachnoid diverticula (SAD) has been widely reported in the veterinary literature and there is some suggestion that surgical treatment may provide better outcomes than medical treatment. Despite this, previous reports have mentioned cases with recurrence of clinical signs following surgical treatment but the cause for this has not been further investigated. The medical records of seven dogs and one cat which presented for investigation of recurrence of neurological deficits at least six months after surgery for SAD were retrospectively reviewed. Median time to relapse of the neurological deficits was 20.5 months after surgery. On repeated imaging, 3/8 cases showed clear regrowth of diverticulum, 2/8 cases showed dorsal compression at the previous laminectomy site (presumed to be the laminectomy membrane), and 3/8 cases showed herniation of the spinal cord through the laminectomy defect associated with a stellate appearance to the spinal cord with small multiloculated areas of dilation of the subarachnoid space. Repeat surgical intervention was most successful in the cases where SAD recurrence was identified while medical treatment resulted in either subtle improvement or stabilisation on the clinical signs, sometimes followed by slow deterioration.

Perioperative acute neurological deficits in instrumented pediatric cervical spine fusions

2019 ◽  
Vol 24 (5) ◽  
pp. 528-538
Author(s):  
Bram P. Verhofste ◽  
Michael P. Glotzbecker ◽  
Michael T. Hresko ◽  
Patricia E. Miller ◽  
Craig M. Birch ◽  
...  
Keyword(s):  
Cervical Spine ◽  
Neurological Complications ◽  
Neurological Function ◽  
Spine Fusion ◽  
Neurological Symptoms ◽  
Neurological Deficits ◽  
Complex Disorder ◽  
Spine Instrumentation ◽  
Estimated Blood Loss ◽  
Cervical Spine Fusion

OBJECTIVEPediatric cervical deformity is a complex disorder often associated with neurological deterioration requiring cervical spine fusion. However, limited literature exists on new perioperative neurological deficits in children. This study describes new perioperative neurological deficits in pediatric cervical spine instrumentation and fusion.METHODSA single-center review of pediatric cervical spine instrumentation and fusion during 2002–2018 was performed. Demographics, surgical characteristics, and neurological complications were recorded. Perioperative neurological deficits were defined as the deterioration of preexisting neurological function or the appearance of new neurological symptoms.RESULTSA total of 184 cases (160 patients, 57% male) with an average age of 12.6 ± 5.30 years (range 0.2–24.9 years) were included. Deformity (n = 39) and instability (n = 36) were the most frequent indications. Syndromes were present in 39% (n = 71), with Down syndrome (n = 20) and neurofibromatosis (n = 12) the most prevalent. Eighty-seven (48%) children presented with preoperative neurological deficits (16 sensory, 16 motor, and 55 combined deficits).A total of 178 (96.7%) cases improved or remained neurologically stable. New neurological deficits occurred in 6 (3.3%) cases: 3 hemiparesis, 1 hemiplegia, 1 quadriplegia, and 1 quadriparesis. Preoperative neurological compromise was seen in 4 (67%) of these new deficits (3 myelopathy, 1 sensory deficit) and 5 had complex syndromes. Three new deficits were anticipated with intraoperative neuromonitoring changes (p = 0.025).Three (50.0%) patients with new neurological deficits recovered within 6 months and the child with quadriparesis was regaining neurological function at the latest follow-up. Hemiplegia persisted in 1 patient, and 1 child died due a complication related to the tracheostomy. No association was found between neurological deficits and indication (p = 0.96), etiology (p = 0.46), preoperative neurological symptoms (p = 0.65), age (p = 0.56), use of halo vest (p = 0.41), estimated blood loss (p = 0.09), levels fused (p = 0.09), approach (p = 0.07), or fusion location (p = 0.07).CONCLUSIONSAn improvement of the preexisting neurological deficit or stabilization of neurological function was seen in 96.7% of children after cervical spine fusion. New or progressive neurological deficits occurred in 3.3% of the patients and occurred more frequently in children with preoperative neurological symptoms. Patients with syndromic diagnoses are at higher risk to develop a deficit, probably due to the severity of deformity and the degree of cervical instability. Long-term outcomes of new neurological deficits are favorable, and 50% of patients experienced complete neurological recovery within 6 months.

Contrasting Actions of Naloxone in Experimental Spinal Cord Trauma and Cerebral Ischemia: A Review

Neurosurgery ◽  
1985 ◽  
Vol 17 (5) ◽  
pp. 845-849 ◽  
Author(s):  
Allan J. Hamilton ◽  
Peter McL. Black ◽  
Daniel B. Carr
Keyword(s):  
Spinal Cord ◽  
Cerebral Ischemia ◽  
Opiate Receptor ◽  
Neurological Function ◽  
Neurological Deficits ◽  
Spinal Cord Trauma ◽  
Cardiovascular Parameters ◽  
Naloxone Administration ◽  
Therapeutic Implications ◽  
Cord Injury

Abstract Endorphins have been implicated in the pathophysiology of both spinal cord injury and cerebral ischemia. This review examines the nature of the experimental evidence to support this hypothesis. Present studies suggest that naloxone administration improves neurological function and outcome in the setting of the spinal cord trauma by centrally inhibiting an opiate receptor-mediated diminution of spinal cord flow. In the setting of spinal shock, naloxone administration is associated with improvement in vital sign and cardiovascular parameters as measured by mean arterial pressure, cardiac output, body temperature, and ventilation. Experiments using a variety of animal stroke models similarly support the notion that naloxone improves neurological function in the setting of cerebral ischemia by a stereospecific opiate receptor-mediated effect, but this improvement does not seem to be accompanied by augmentation of blood flow to affected areas of the brain or by any improvement in vital signs or cardiovascular parameters as seen in spinal cord trauma. A variety of mechanisms are discussed to explain these observations. The therapeutic implications of administering opiate agonists and antagonists in the setting of neurological deficits are outlined for the neurosurgeon.

Neurological function after total en bloc spondylectomy for thoracic spinal tumors

2010 ◽  
Vol 12 (3) ◽  
pp. 253-256 ◽  
Author(s):  
Hideki Murakami ◽  
Norio Kawahara ◽  
Satoru Demura ◽  
Satoshi Kato ◽  
Katsuhito Yoshioka ◽  
...  
Keyword(s):  
Spinal Cord ◽  
Neurological Function ◽  
Neurological Symptoms ◽  
Neurological Deficits ◽  
Spinal Tumors ◽  
Preoperative Embolization ◽  
Spinal Cord Blood Flow ◽  
Thoracic Spinal ◽  
Bloc Spondylectomy ◽  
Frankel Grade

Object Total en bloc spondylectomy (TES) for thoracic spinal tumors may in theory produce neurological dysfunction as a result of ischemic or mechanical damage to the spinal cord. Potential insults include preoperative embolization at 3 levels, intraoperative ligation of segmental arteries, nerve root ligation, and circumferential dural dissection. The purpose of this study was to assess neurological function after thoracic TES. Methods The authors performed a retrospective review of 79 patients with thoracic-level spinal tumors that had been treated with TES between 1989 and 2006. Neurological function was retrospectively analyzed according to the Frankel grading system. Of the 79 cases, 26 involved primary tumors and 53 involved metastatic tumors. The number of excised vertebrae was 1 in 60 cases, 2 in 13, and ≥ 3 in 6. The Frankel grade before surgery was B in 1 case, C in 16, D in 29, and E in 33. Results At the follow-up, the Frankel grade was C in 2 cases, D in 24, and E in 53. Of 46 cases with neurological deficits before surgery, neurological improvement of at least 1 Frankel grade was achieved in 25 cases (54.3%). Although the Frankel grade did not change in 21 patients, improvement in neurological symptoms within the same Frankel grade did occur in these patients. There were no cases of neurological deterioration. Conclusions There was no neurological deterioration due to preoperative embolization, ligation of segmental arteries, or ligation of thoracic nerve roots. Each of the cases with preoperative neurological deficits showed improvement in neurological symptoms. Data in the current study clinically proved that TES is a safe operation with respect to spinal cord blood flow. In TES, the spinal cord is circumferentially decompressed and the spinal column is shortened. An increase in spinal cord blood flow due to spinal shortening in addition to decompression was considered to have brought about a resolution of neurological symptoms with TES.

Use of Actuator-Driven Pulsed Water Jet in Brain and Spinal Cord Cavernous Malformations Resection

2015 ◽  
Vol 11 (3) ◽  
pp. 394-403 ◽  
Author(s):  
Toshiki Endo ◽  
Yoko Takahashi ◽  
Atsuhiro Nakagawa ◽  
Kuniyasu Niizuma ◽  
Miki Fujimura ◽  
...  
Keyword(s):  
Spinal Cord ◽  
Water Jet ◽  
Neurological Function ◽  
Neurological Deficits ◽  
Piezo Actuator ◽  
Partial Recovery ◽  
Cavernous Malformations ◽  
Brainstem Lesion ◽  
Pulsed Water Jet ◽  
Brain And Spinal Cord

Abstract BACKGROUND A piezo actuator-driven pulsed water jet (ADPJ) system is a novel surgical instrument that enables dissection of tissue without thermal damage. It can potentially resect intra-axial lesions while preserving neurological function. OBJECTIVE To report our first experience of applying an ADPJ system to brain and spinal cord cavernous malformations. METHODS Four patients (2 women and 2 men, mean age 44.5 years) with brain (n = 3) and spinal cord (n = 1) cavernous malformations were enrolled in the study. All surgeries were performed with the aid of the ADPJ system. Postoperative neurological function and radiological findings were evaluated. RESULTS The ADPJ system was useful in dissecting boundaries between the lesion and surrounding brain/spinal cord tissues. The pulsed water jet provided a clear surgical view and helped surgeons follow the margins. Water jet dissection peeled off the brain and spinal cord tissues from the lesion wall. Surrounding gliotic tissue was preserved. As a consequence, the cavernous malformations were successfully removed. Postoperative magnetic resonance imaging confirmed total removal of lesions in all cases. Preoperative neurological symptoms completely resolved in 2 patients. The others experienced partial recovery. No patients developed new postoperative neurological deficits; facial palsy temporarily worsened in 1 patient who underwent a suprafacial colliculus approach for the brainstem lesion. CONCLUSION The ADPJ provided a clear surgical field and enabled surgeons to dissect boundaries between lesions and surrounding brain and spinal cord gliotic tissue. The ADPJ system is a feasible option for cavernous malformation surgery, enabling successful tumor removal and preservation of neurological function.

scholarly journals Significance of lipid peroxidation disorders in genesis of neurological disorders after carotid endarterectomy

2019 ◽  
Vol 1 (16) ◽  
pp. 13-16
Author(s):  
B. A. Shadymov ◽  
M. I. Neimark ◽  
V. V. Shmelyov ◽  
A. A. Shaidurov
Keyword(s):  
Lipid Peroxidation ◽  
Surgical Treatment ◽  
Carotid Artery ◽  
Succinic Acid ◽  
Carotid Endarterectomy ◽  
Postoperative Period ◽  
Neurological Disorders ◽  
Neuronal Damage ◽  
Neurological Complications ◽  
Comparative Characteristic

The article considers the question of the appropriateness of the use of the drug based on succinic acid in the surgical treatment of atherosclerotic occlusion of the carotid artery, for the prevention of neurological complications in the postoperative period. A comparative characteristic of the obtained data of oxidative, antioxidant statuses, as well as markers of neuronal damage in two groups was carried out. The results suggest that the use of cytoflavin during the stages of surgical treatment reduces the number of neurological disorders.

scholarly journals Clinical Improvement with Non-Surgical Management of Tuberculous Spondylitis

2019 ◽  
Vol 5 (1) ◽  
pp. 34-40
Author(s):  
Santoso Jaeri ◽  
◽  
Abdulloh Machin ◽  
Keyword(s):  
Spinal Cord ◽  
Surgical Treatment ◽  
Clinical Improvement ◽  
Spinal Cord Compression ◽  
Cord Compression ◽  
Neurological Deficits ◽  
Tuberculous Spondylitis ◽  
Osteoarticular Tuberculosis ◽  
Immunodeficiency Syndrome ◽  
Non Surgical Treatment

Background: Tuberculosis is the second most common fatal infectious disease after Acquired Immunodeficiency Syndrome (AIDS) in the world. The spine is involved in 50% of osteoarticular tuberculosis cases. Tuberculous Spondylitis (TS) is the most dangerous form of osteoarticular tuberculosis, because of its ability to destroy the vertebral body with subsequent permanent kyphosis and neurological deficits such as paraplegia. The treatment goals of TS are to eradicate the infection and provide stability for the affected spine. There is little information in the literature about systemic non-surgical treatment under the condition of spinal cord compression in TS. We report two cases of TS which was improved with non-surgical treatment. We believe that the clinico-radiological signs of spinal cord compression in these cases are not an emergency indication for surgery. Clinical Presentation and Intervention: Two women aged 34 and 26 years were hospitalized because of the upper motor neuron type weakness in both legs worsened gradually, descending numbness, without urinary or defecation problems. Magnetic resonance imaging depicted lesions on vertebral bodies supporting the diagnosis of TS. Both patients were received oral antituberculous therapy and their muscle force improved despite the kyphotic deformity in the first patient. Conclusion: Neuro-radiological evidence of spinal cord compression is not an emergency indication of surgery in the management of TS and clinical improvement can be obtained by non-surgical treatment.

Surgical Treatment for Scoliosis

2018 ◽  
Vol 1 (2) ◽  
pp. 9
Author(s):  
Tjokorda Gde Bagus Mahadewa
Keyword(s):  
Spinal Cord ◽  
Surgical Treatment ◽  
Cobb Angle ◽  
Medical Technology ◽  
Neurological Deficits ◽  
Spinal Deformities

Recently, patients with spinal deformities, particularly scoliosis, could be handled well through surgical pathways. Generally, surgery is indicated in patients with scoliosis curve exceeding 45 degrees (COBB angle> 45). The ultimate goal is to reduce the curve as optimally as possible without disturbing spinal cord. Whether the result is straight or not, it also depends on the patient's spine flexibility before surgery.Surgical indications are for improving appearance, preventing increasing degrees of the curve, preventing interference to other organs such as the lungs, and preventing neurological deficits. Correction of Cobb angle below 25 degrees had already makes the patient feel more comfortable. The amount of screw and instrumentation length depends on the number of spines involved. After surgery treatment, 2-4 weeks of rest are required before returning to daily activity.Fusion principle states that the spine will be slightly stiff in order to be corrected but it is believed that patient's activity could still be done with the remaining flexibility. Surgical treatment of scoliosis that does meet the indications is imperative and relatively safe with advances in medical technology today.

scholarly journals Craniocervical instability in children with Down’s syndrome

2016 ◽  
Vol 4 (3) ◽  
pp. 71-77
Author(s):  
Nikita O Khusainov ◽  
Sergei V Vissarionov ◽  
Dmitriy N Kokushin
Keyword(s):  
Surgical Treatment ◽  
Treatment Options ◽  
Down's Syndrome ◽  
Down’S Syndrome ◽  
Neurological Complications ◽  
Neurological Deficits ◽  
Medical Specialties ◽  
Radiological Criteria ◽  
Neurological Improvement ◽  
Craniocervical Instability

Introduction. Pathology of the craniovertebral zone in children with Down’s syndrome is a very important topic, because of the high risk for developing neurological complications in these patients, after even a minor trauma.Material and methods. We performed a review of the literature highlighting the disorders of the cervical spine in children with Down’s syndrome.Results. We gathered data on the etiology, pathogenesis, and clinical presentation of craniocervical instability in children with Down’s syndrome. We reviewed the existing surgical treatment options, and presented our own clinical cases. We also developed a protocol for the management of these patients.Discussions. Understanding the several forms of craniocervical instability in children with Down’s syndrome is very important. As it is a very dangerous condition that can lead to devastating neurological deficits, all medical specialties working with these patients should be aware of them. There are clinical and radiological criteria for this condition that can help in the management of such patients. Surgical treatment is an effective option, but it has a high complication rate and rarely results in neurological improvement.

scholarly journals Use of intraoperative neurophysiological monitoring in surgical treatment of spinal diseases

2019 ◽  
Vol 147 (7-8) ◽  
pp. 502-505
Author(s):  
Vedrana Karan ◽  
Djula Djilvesi ◽  
Mladen Karan ◽  
Vladimir Papic ◽  
Petar Vulekovic
Keyword(s):  
Spinal Cord ◽  
Surgical Procedures ◽  
Neurological Complications ◽  
Neurological Deficits ◽  
Intraoperative Neurophysiological Monitoring ◽  
Neurophysiological Monitoring ◽  
Spinal Diseases ◽  
Optimal Monitoring ◽  
Methods Development ◽  
Care Costs

Intraoperative neurophysiological monitoring (IONM) is a method, which uses different kinds of electrophysiological methods for monitoring and mapping of neural structures during surgical procedures with the aim to preserve them. If we know how important the function of the spine, spinal cord, nerve roots, and all other structures are, it is obvious how important it is to preserve them in surgical procedures where these structures are under risk. Although the frequency of neurological complications is not high, it is considered that these deficits are devastating complications of spinal surgery, which can have serious consequences on the quality of life and can increase health care costs. Because of that, the accent is on intraoperative neurophysiological methods development, which provide optimal monitoring of the spinal cord function during routine and complex spinal procedures and has high efficacy detecting possible neurological deficits. The concept of multimodal neuromonitoring, which is used today, relies on advantages of each modality separately and then in combination of these modalities it achieves a more reliable estimation of functional integrity. Today IONM is routinely used worldwide, but in Serbia, its use is still limited even though its advantages are well known.

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