Toxocariasis as a Rare Parasitic Complication of a Transthoracic Spine Surgery Procedure

Human toxocariasis is a helminthozoonosis caused by the migration of Toxocara species larvae through an organism. The infection in humans is transmitted either by direct ingestion of the eggs of the parasite, or by consuming undercooked meat infested with Toxocara larvae. This parasitosis can be found worldwide, but there are significant differences in seroprevalence in different areas, depending mainly on hot climate conditions and on low social status. However, the literature estimates of seroprevalence are inconsistent. Infected patients commonly present a range of symptoms, e.g., abdominal pain, decreased appetite, restlessness, fever, and coughing. This manuscript presents a case report of a polytraumatic patient who underwent a two-phase spinal procedure for a thoracolumbar fracture. After the second procedure, which was a vertebral body replacement via thoracotomy, the patient developed a pathologic pleural effusion. A microscopic cytology examination of this effusion revealed the presence of Toxocara species larvae. Although the patient presented no specific clinical symptoms, and the serological exams (Enzyme–linked immunosorbent assay (ELISA), Western blot) were negative, the microscopic evaluation enabled a timely diagnosis. The patient was successfully treated with albendazole, with no permanent sequelae of the infection.

Dorsal instrumentation with and without vertebral body replacement in patients with thoracolumbar osteoporotic fractures shows comparable outcome measures

Purpose In the surgical treatment of osteoporotic spine fractures, there is no clear recommendation, which treatment is best for the individual patient with vertebra plana and/or neurological deficit requiring instrumentation. The aim of this study was to evaluate clinical and radiological outcomes after dorsal or 360° instrumentation of osteoporotic fractures of the thoracolumbar spine in a cohort of patients representing clinical reality. Methods A total of 116 consecutive patients were operated on between 2008 and 2020. Inclusion criteria were osteoporotic fracture, thoracolumbar location, and dorsal instrumentation. In 79 cases, vertebral body replacement (VBR) was performed additionally. Patient outcomes including complications, EQ-5D at follow-up, and sagittal correction were analyzed. Results Medical and surgical complications occurred in 59.5% of patients with 360° instrumentation compared to 64.9% of patients with dorsal instrumentation only (p = 0.684). Dorsal instrumentation plus VBR resulted in a sagittal correction of 9.3 ± 7.4° (0.1–31.6°) compared to 6.0 ± 5.6° (0.2–22.8°) after dorsal instrumentation only, respectively (p = 0.0065). EQ-5D was completed by 79 patients after 4.00 ± 2.88 years (0.1–11.8 years) and was 0.56 ± 0.32 (− 0.21–1.00) for VBR compared to 0.56 ± 0.34 (− 0.08–1.00) without VBR after dorsal instrumentation (p = 0.994). Conclusion 360° instrumentation represents a legitimate surgical technique with no additional morbidity even for the elderly and multimorbid osteoporotic population. Particularly, if sufficient long-term construct stability is in doubt or ventral stenosis is present, there is no need to abstain from additional ventral reinforcement and decompression.

Radiological and Long-Term Patient-Reported Outcome after Stabilization of Traumatic Thoraco-Lumbar Spinal Fractures using an Expandable Vertebral Body Replacement Implant.

BackgroundA combined posterior and anterior stabilization was found to offer a better restoration of the sagittal profile of thoracolumbar fractures in comparison to posterior-only stabilization. Data on restoring the bisegmental kyphotic endplate angle (BKA) and on patient-reported outcome measures (PROM) is sparse.Patients and Methods136 patients with traumatic thoraco-lumbar spinal fractures were treated with an expandable VBR implant (Obelisc™, Ulrich Medical, Germany). in our trauma department between 2001 and 2015. Radiological data acquisition was completed pre- and postoperatively, after at least six months and approximately two years after surgery. The BKA was measured at each follow-up. The patient related outcome was evaluated prospectively.Results117 (31 female, 86 males; age: 52.7 ± 16.5 years) patients were included in the study. 64 patients (54.7% of included patients; age: 53.2 ± 14.8 years) completed the PROM questionnaires and therefore were assigned to the study group. An A4 fracture was seen in 99 cases (84.6%) and 85 (72.6%) fractures were located at the lumbar spine. Intraoperative reduction of the BKA in 117 patients was 6.6 ± 8.2° (p < 0.01). A significant loss of reduction of 2.6 ± 4.2° at the first follow-up (t1) and of 4.4 ± 6.6° at the second follow-up (t2) was measured (each p < 0.05). The consolidation rate was 95.7%. The total revision rate was 5.1%. 64 patients (54.7% of included patients; age: 53.2 ± 14.8 years) completed the PROM questionnaires and therefore were assigned to the study group. Mean time between index surgery and completion of the PROM questionnaire was 109.4 ± 44.6 months. Mean ODI of was 28.4 ± 17.6, the mean EQ-5D VAS reached 57.9 ± 2.5 points. The cohort showed significantly lower SF-36 values compared to a healthy reference population (each p < 0.05).ConclusionTreatment of traumatic thoraco-lumbar spinal fractures using an expandable VBR implant is an effective and safe procedure. A significant operative correction of the BKA could be achieved. Although the initial reconstruction of the BKA did not consist over time in the study group, satisfactory PROMs were found.

Vertebral Body Replacement With an Anchored Expandable Titanium Cage in the Cervical Spine: A Clinical and Radiological Evaluation

BACKGROUND Expandable cervical cages have been used successfully to reconstruct the anterior spinal column. OBJECTIVE To perform clinical and radiological evaluation of vertebral body replacement with an anchored expandable titanium cage in the cervical spine after single-level and 2-level corpectomies. METHODS Between 2011 and 2017, 40 patients underwent a single-level (N = 32) or 2-level (N = 8) anterior corpectomy and fusion using an anchored expandable vertebral body replacement cage. Clinical and radiological data at admission, postoperatively, and at 3- and 12-mo follow-up were retrospectively analyzed. Clinical assessment was performed via standardized neurological evaluation, Odom score, and McCormick classification. Radiological assessment was performed via evaluation of sagittal profile, postoperative position, fusion, and subsidence rates. RESULTS Mean last follow-up was 14.8 ± 7 mo. Overall clinical and myelopathy-related improvements were shown directly after operation and at last follow-up. A stable centralized positioning of cages was achieved in 37 patients (93%). A mild ventral (&gt;1.5 mm) malplacement was noted in 3 patients (7%) without clinical consequences. Sagittal alignment and preoperative cervical kyphosis improved significantly (7.8° gain of lordosis) and remained stable. Mean preoperative height of operated segments increased by 10 mm postoperatively and remained stable. Fusion rate in non-neoplastic patients and subsidence rate at last follow-up comprised 87.5% and 17.8%. With exception of 1 patient suffering from severe osteoporosis and cage subsidence, no patient needed additional secondary stabilization. CONCLUSION Anterior corpectomy and fusion by an expandable anchored titanium cage with anchor screws without additional instrumentation resulted in overall clinical improvement and radiological anterior column support, achieving significant and reliable restoration of the physiological sagittal cervical profile.