ABSTRACT
Background and Aim: Spinal cord injury [SCI] is one of the worst kinds of traumatic injuries with remarkable social and economic effects on communities
Methods and Materials/Patients: In this prospective randomized clinical trial, 122 patients with traumatic spinal cord injury were admitted to Poursina hospital within 48 hours of injury to compare granulocyte colony stimulating factor [G-CSF] and high-dose methylprednisolone as neuroprotective therapy
Results: In this research, 122 patients were studied out of whom 62 patients were included in the granulociote colony-stimulating factor [G-CSF] group with a mean age of 40.4, and 60 patients in the methylprednisolone group with an average age of 40.10 years. 55 out of 122 patients [45%] were completely paralyzed [Grade AIS:A] and 67 [55%] were with incomplete spinal injury [Grade AIS:B,C,D]. The average American spinal injury association [ASIA] sensory scores in the two groups were similarly compared in the same four time intervals, and p values were 0.7, 0.3, 0.2, and 0.1. They were not statistically significant
Conclusion: According to the results, the G-CSF was shown to be beneficial in average ASIA motor and sensory scores in the two groups of male patients at six months of onset of G-CSF treatment [p value=0.04], and average ASIA motor scores improvement in the falls subgroup patients also differed significantly within six months of onset of G-CSF treatment [p value=0.03]. A multicentre prospective randomized clinical trial to compare the placebo effect with G-CSF protocol's treatment, and also assessment of the cost benefits of the common medical treatment versus G-CSF are needed
ABSTRACT
Background and Importance: Hydatid disease of the spine is rare but constitutes approximately 50% of bone involvement cases in human hydatidosis. It is a severe condition associated with a high rate of morbidity, disability and mortality
Case Presentation: In the present paper, we report an intriguing case of cervical spinal hydatid disease mimicking traumatic burst fracture
Conclusion: A high degree of suspicion combined with good-quality neuroimaging is important for early and correct diagnosis. Because of the location and the potential for progression, spinal hydatid disease surgical treatment is the mainstay of treatment
ABSTRACT
Introduction: Thermal ablation by microwave [MWA] has proven efficacy in treatment of primary and metastatic cancers. Soft tissue tumors could be ablated completely using MWA. However, bony tissue metastasis particularly spinal vertebral metastasis ablation has not reported yet
Case presentation: A 50 year old male patient with primary diagnosed colon cancer undergone surgical resection of tumor. Recently, he was diagnosed with metastasis to liver and spinal vertebral bone. He was referred to pain clinic with severe non-radiating back pain. In MRI Imaging, hyperdensity lesions were identified on body of L5 and T12 and in spinal canal of L1 indicating metastatic involvement. Under fluoroscopy guidance, the metastatic tumor was ablated by MWA and the generator was powered to 20 Watt/3 minutes in the temperature control mode. Patient had no low back pain afterward
Conclusion: MWA could be used to ablate vertebral bone metastasis without any complications and with good prognosis
ABSTRACT
Background and Aim: the purpose of this study was to evaluate and compare the pain of patients with spondylolisthesis who had undergone either of the surgery techniques: posterolateral fusion [PLF] or posterior lumbar interbody fusion [PLIF]
Methods and Materials/Patients: in a prospective observational study, 102 surgical candidates with low grade degenerative and isthmic spondylolisthesis were enrolled from 2012 to 2014. The observed patients were into two groups: PLF and PLIF. Assessing of pain has been done by a questionnaire using Visual Analogue Scale [VAS] scores. The questionnaire was completed by all patients before surgery, the day after surgery, after six months and after one year
Results: there were no statistically significant differences in terms of age and sex distribution, type of spondylolisthesis and pre-operation pain between groups [p>0.05]. Comparison of the mean VAS scores of two groups over the whole study period showed a significant statistical difference [p-value<0.05], although comparison of VAS at three points in time showed a mixed result. VAS scores showed no significant differences between two groups before surgery, the day after surgery and one year after surgery [p>0.05], but the difference of mean VAS scores between groups 6 months after surgery was statistically significant [p<0.05]. Analyzing the course of VAS scores over the study period showed a descending pattern for either of the groups [p<0.0001]
Conclusion: both surgical fusion techniques [PLF and PLIF] showed to be effective in treating low grade degenerative and isthmic spondylolisthesis, but PLIF was related to better outcome with respect to pain control
ABSTRACT
Background and Aim: spondylolisthesis is a visible deformity in lumbosacral region with vertebral slip and fracture or other deformities of pars interarticularis. This study aims at investigating the characteristics of spondylolisthesis surgery in operated patients
Methods and Materials/Patients: this is a retrospective study which included all the patients who had undergone spondylolisthesis surgery by one same surgeon from 2006 to 2011. Demographic characteristics such as age, gender, and surgery information including type of spondylolisthesis, incision site, laminectomy site, foraminotomy site, fixation site of vertebra and site of vertebral disc evacuation were collected. The data were analyzed using SPSS [Version16]
Results: 52 of 63 enrolled patients were women [82.5%] and 11 men [17.5%] with mean age of 49.6 years. Based on frequency, spondylolisthesis types were 60 degenerative [95.2%], 2 post-surgical [3.2%] and 1 post-traumatic [1.6%], respectively. 58 patients had spondylolisthesis only in one vertebra and 5 patients in two vertebrae. The total number of slipped vertebrae was 68, in which slip was seen in L3, L4 or L5 vertebrae. In 42 patients, laminectomy was performed only in one vertebra, in 19 patients in two vertebrae, in 1 patient in three vertebrae and in 1 patient in five vertebrae. The total number of vertebrae with foraminotomy was 106. The highest frequency of foraminotomy was seen in L5, L4, and S1 vertebrae, respectively. Except in one case, the rest 62 patients underwent fixation surgery in two or three vertebrae
Conclusion: based on the results, the frequency of spondylolisthesis was approximately five times in women compared to men. The most common type was degenerative spondylolisthesis. Type of surgery was fixation with pedicle screw and fusion
ABSTRACT
Background and Aim: traumatic subdural hygroma is the accumulation of CSF [cerebrospinal fluid] in subdural space following head trauma. The mass effect of hygroma on brain can impinge on consciousness. There are still many ambiguities on indications of hygroma surgery. This is an 11-year follow-up study which involves the patients suffering traumatic subdural hygroma who underwent surgery
Methods and Materials/Patients: in this retrospective study, clinical records of 16 patients who were operated due to traumatic subdural hygroma were studied. The data from existing records in the hospital were collected and analyzed. They were then analyzed by Repeated Measures ANOVA using SPSS [Version 18]. The differences were considered statistically significant at P
Results: in this study, there were 13 men [81.3%] and 3 women [18.7%] [Mean age=62 years old]. In 87.75% of patients, hygroma was diagnosed 6 days after head injury. It wasunilateral in majority of patients [56.3%] and located in fronto-parietal area [81.3%]. The most frequent concomitant injuries were contusions [25%] and subarachnoid hemorrhage [18.8%], respectively. GCS trend on admission and at discharge was significantly different fromthat of hygroma formation [P<0.05]. One-fourth of patients had recurrence of hygroma after surgery. All patients [except one] had good outcome
Conclusion: subdural hygroma is a delayed lesion and surgical treatment improves the level of consciousness [LOC] in afflicted patients
ABSTRACT
Background and Aim: DBS [deep brain stimulation] is a new and successful technique in treatment of symptoms of Parkinsonism especially after drug resistance. Research in this field is mostly designed for evolution of this technique. The present study aimed at evaluating the relationship between the angle formed in midsagittal and STN [sub-thalamic nucleus] axis line and recording length in the final electrode p lacement
Methods and Materials/Patients: 46 patient candidates for DBS operation were studied in terms of demographic variables, STN nucleus length, the angle between midsagittal line and STN axis [p angle], the number of tested electrodes, force and length of final electrode registration and final coordinates of the placed electrode. The primary information was obtained from patients records and other technical information based on MRI imaging using Stereonata software and during surgery. The information were analyzed using SPSS [version 16] and descriptive analysis and linear relationship
Results: the mean force of the recording from trial microelectrodes implanted in the right side ranged from 1.49 +/- 1.45 to 2.65 +/- 1.42 and in the left side from 1.53 +/- 1.35 to 2.65 +/- 2.30. In comparative analysis, no significant statistical relationship was found between P angle of the right side and degree registered in the final electrode of the right side [Pearson correlation: 0.314, P value= 0.049]
Conclusion: not only accurate electrodes positioning in the STN can lead to improved outcome within bilateral STN DBS, but also optimizing defined P angle can have beneficial effects on intraoperative outcome after STN DBS
ABSTRACT
Background and Aim: glioblastoma multiforme [GBM], the highest grade glioma [grade IV], is the most malignant form of astrocytoma in adults. This study aimed at evaluating the relationship between demographic, clinical and medical factors with GBM outcome
Methods and Materials/Patients: through a cross-sectional design, 58 patients with newly diagnosed GBM were studied from 1999 to 2015 in Guilan province [North of Iran]. Demographic, clinical and medical data including age, gender, score of Karnofsky Performance Scale [KPS], status at discharge, extent of resection [EOR] and administration of post-operative radio-chemotherapy were recorded in an individual questionnaire. The data were analyzed using chi-square and fisher exact tests
Results: of all patients, 35 [60.3%] cases were men and 23 [39.7%] were women. Age range [at the time of diagnosis of GBM] was 18-82 years [54.86+/-16.34]. The most common side and location of tumor were left hemisphere and frontal lobe, respectively. 41 patients [70.7%] received total surgical resection. Half of patients were treated with simultaneous post-operative radiation therapy and chemotherapy.11 [19%] of all cases died. About 41 [70.6%] of patients demonstrated KPS 50-70
Conclusion: GBM is a frequent malignant brain tumor with male predominance and high occurrence in age range of ?50 years. The number of dead patients increases with decreased KPS. Total surgical resection followed by concomitant radiation therapy and chemotherapy were common standard therapeutic regimens
ABSTRACT
Blood loss in spine surgery is an important issue, even though it has been understudied compared with hip and knee arthroplasty. In this study, we evaluated the effect of oral clonidine as premedication on blood loss in lumbar spine fusion surgery under anesthesia with propofol and remifentanil. In this double-blind, randomized clinical trial, 30 patients who were undergoing lumbar spine posterior fusion surgery due to traumatic fracture were allocated randomly into 2 groups. The study group [clonidine group] received a 200-microg oral clonidine tablet 60-90 minutes before anesthesia, and the control group received placebo at the same time. Induction and maintenance of anesthesia and the mean target arterial pressure for controlled hypotension with remifentanil were the same in the 2 groups. We compared the amount of intraoperative blood loss, dose of remifentanil/hour administered, need for nitroglycerine to reach the mean target arterial pressure when remifentanil was insufficient, duration of operation, and surgeon's satisfaction of a bloodless field between groups. There was no statistically significant difference between groups in age [P = 0.115], sex [P = 0.439], weight [P = 0.899], operation time [P = 0.2], or American Society of Anesthesiologists physical status score [P = 0.390]. Intraoperative blood loss and remifentanil dose administered per hour in the clonidine group were significantly less than in the control group [P = 0.002 and P = 0.001, respectively], but there was no significant difference in surgeon's satisfaction between groups [P = 0.169]. As an oral premedication, clonidine can reduce surgical blood loss in lumbar spine posterior fusion surgery, even at the same levels of mean arterial pressure [MAP] with the control group. Its use can be studied in more complicated spine surgeries, such as scoliosis and spinal deformity surgeries