ABSTRACT
ABSTRACT Objectives: Evaluate the treatment outcome and the performance of the uCentum spinal fixation system in treating traumatic, degenerative, and tumoral diseases of the spine. Methods: This is a therapeutic study to investigate treatment outcomes and level of evidence III, including twenty-three adult patients of both sexes undergoing surgical treatment of degenerative (13 patients), traumatic (04 patients), or tumor diseases (06 patients). Patients were prospectively evaluated using clinical parameters: pain (visual analog scale), clinical and functional assessment questionnaires (SF-36, Oswestry and Roland-Morris), and radiological criteria (arthrodesis consolidation, loosening, breakage or deformation of the implants). Results: Twenty patients were followed for a period of 01 month to 12 month (mean 6,5±7,77). Three patients died due to complications unrelated to the primary disease (traumatic brain injury, septicemia, and lung tumor). Improvements were observed in clinical parameters and scores of the evaluation questionnaires used. No implant-related complications (breakage, loosening, deformation) were observed. Conclusion: the uCentum fixation system showed great versatility for performing the surgical treatment, allowing the performance of open, percutaneous procedures, the introduction of acrylic cement inside the implants, and conversion of polyaxial screws into monoaxial screws intraoperatively. Level of Evidence III; Therapeutic Studies - Investigating the Results of Treatment.
Resumo: Objetivos: Avaliar o resultado do tratamento e o desempenho do sistema uCentum de fixação vertebral no tratamento de doenças traumáticas, degenerativas e tumorais da coluna vertebral. Métodos: Trata-se de um estudo terapêutico de investigação dos resultados do tratamento e nível de evidência III, incluindo vinte e três pacientes adultos de ambos os sexos submetidos ao tratamento cirúrgico de doenças degenerativas (13 pacientes), traumáticas (04 pacientes) ou tumorais (06 pacientes). Os pacientes foram prospectivamente avaliados por meio de parâmetros clínicos: dor (escala visual analógica), questionários de avaliação clínica e funcional (SF-36, Oswestry e Roland-Morris), e critérios radiológicos (consolidação da artrodese, soltura, quebra ou deformação dos implantes). Resultados: vinte pacientes foram seguidos por um período de 01 a 12 meses (média 6,5 ± 7,77). Três pacientes foram a óbito devido a complicações não relacionadas com a doença primária (trauma cranioencefálico, septicemia e tumor pulmonar). Foi observada melhora dos parâmetros clínicos e escores dos questionários de avaliação utilizados. Não foram observadas complicações relacionadas com os implantes (quebra, soltura, deformação). Conclusão: o sistema de fixação uCentum apresentou grande versatilidade para a realização do tratamento cirúrgico, permitindo a realização de procedimentos abertos, percutâneos, introdução de cimento acrílico no interior dos implantes e conversão dos parafusos poliaxiais em monoaxiais no intra-operatório. Nível de Evidencia III; Estudos terapêuticos - Investigação dos resultados do tratamento.
Resumen: Objetivos: Evaluar el resultado del tratamiento y el desempeño del sistema de fijación vertebral uCentum en el tratamiento de enfermedades traumáticas, degenerativas y tumorales de la columna vertebral. Métodos: Este es un estudio terapéutico para investigar los resultados del tratamiento y el nivel de evidencia III, que incluye veintitrés pacientes adultos de ambos sexos sometidos a tratamiento quirúrgico de enfermedades degenerativas (13 pacientes), traumáticas (04 pacientes) o tumorales (06 pacientes). Los pacientes fueron evaluados prospectivamente mediante parámetros clínicos: dolor (escala analógica visual), cuestionarios de evaluación clínica y funcional (SF-36, Oswestry y Roland-Morris) y criterios radiológicos (consolidación de artrodesis, aflojamiento, rotura o deformación de los implantes). Resultados: veinte pacientes fueron seguidos durante un período de 1 a 12 meses (media 6,5 + 7,77). Tres pacientes fallecieron por complicaciones no relacionadas con la enfermedad primaria (lesión cerebral traumática, septicemia y tumor pulmonar). Se observaron mejoras en los parámetros clínicos y puntuaciones de los cuestionarios de evaluación utilizados. No se observaron complicaciones relacionadas con el implante (rotura, aflojamiento, deformación). Conclusión: el sistema de fijación uCentum mostró una gran versatilidad para realizar el tratamiento quirúrgico, permitiendo la realización de procedimientos abiertos, percutáneos, introducción de cemento acrílico en el interior de los implantes y conversión de los tornillos poliaxiales en tornillos monoaxiales en el intraoperatorio. Nivel de Evidencia III; Estudios terapéuticos - Investigación de los resultados del tratamiento.
Subject(s)
Humans , Male , Female , Fracture Fixation , Orthopedic ProceduresABSTRACT
Introducción: Los tumores intramedulares son poco usuales y se generan dentro del tejido de la médula espinal, desplazando o invadiendo la materia blanca, los tractos y los cuerpos neuronales. Objetivo: Caracterizar a pacientes con tumores y seudotumores raquídeos intradurales intramedulares según variables clínicas, imagenológicas (resonancia magnética) e histopatológicas. Métodos: Se realizó un estudio observacional, descriptivo, longitudinal y prospectivo de 11 pacientes con diagnóstico clínico provisional de tumor o seudotumor raquídeo intramedular, confirmado por medio de la resonancia magnética, quienes fueron atendidos en el Departamento de Imagenología del Hospital General Docente Dr. Juan Bruno Zayas Alfonso de Santiago de Cuba de enero de 2014 a igual mes de 2017, procedentes de los hospitales generales de esta provincia y de Guantánamo. Resultados: En la investigación primaron las féminas (63,6 %), sobre todo en las edades de 40 a 59 años (45,4 %), así como las manifestaciones clínicas de debilidad muscular (100,0 %) y dolor en la columna vertebral (81,8 %). De acuerdo a la intensidad de las señales obtenidas en la resonancia magnética, resultaron más frecuentes las imágenes heterogéneas, predominantemente en la zona dorsal. Asimismo, sobresalió la mielopatía compresiva dorsal (27,3 %) como diagnóstico clínico de sospecha, mientras que 54,5 % de los diagnósticos imagenológicos fueron confirmados histopatológicamente, con un mayor porcentaje en el caso de los astrocitomas (36,4). Conclusiones: La resonancia magnética es el método imagenológico de elección para la identificación de estos tumores, dado que ofrece una aproximación al diagnóstico definitivo, el cual es corroborado mediante el estudio anatomopatológico.
Introduction: The intramedullary tumors are not very usual and they are generated inside the tissue of the spinal cord, displacing or invading the white matter, tracts and neuronal bodies. Objective: To characterize patients with intradural intramedullary spinal canal tumors and seudotumors according to clinical, imaging (magnetic resonance) and histopatologic variables. Methods: An observational, descriptive, longitudinal and prospective study of 11 patients with clinical provisional diagnosis of intramedullary spinal canal tumor or seudotumor was carried out, confirmed by means of magnetic resonance who were assisted in the Imaging Department of Dr. Juan Bruno Zayas Alfonso Teaching General Hospital in Santiago de Cuba from January, 2014 to the same month in 2017, coming from the general hospitals of this province and Guantánamo. Results: In the investigation there was a prevalence of females (63.6 %), mainly in the ages of 40 to 59 (45.4 %), as well as the clinical signs of muscular weakness (100.0 %) and pain in the spine (81.8 %). According to the intensity of signs obtained in the magnetic resonance, the heterogeneous images were more frequent, predominantly in the dorsal area. Also, dorsal compressive myelopathy was notable (27.3 %) as clinical diagnosis of suspicion, while 54.5 % of the imaging diagnosis was histopathologically confirmed, with a higher percentage in the case of astrocytomas (36.4). Conclusions: The magnetic resonance is the radiological method of election for the identification of these tumors, since it offers an approach to the definitive diagnosis, which is corroborated by means of the pathologic study.
Subject(s)
Spinal Neoplasms , Magnetic Resonance Imaging , Astrocytoma , EpendymomaABSTRACT
Angiolipomas are usually found in the soft tissues of the extremity, trunk, or neck. Spinal angiolipomas are rare, accounting for between 0.14% and 1.2% of spinal axis tumors, and the majority are extradural. We report a case of surgically proven extradural spinal angiolipoma with a high vascular content and involving the thoracic level.
Subject(s)
Angiolipoma , Axis, Cervical Vertebra , Extremities , NeckABSTRACT
PURPOSE: To differentiate malignant vertebral compression fractures from benign fractures, as seen onspin-echo T1-weighted, fast spin-echo T2-weighted, and fat-suppressed gadolinium-enhanced T1-weighted MR images. MATERIALS AND METHODS: Thirty two benign (18 acute and 14 chronic) and 28 malignant vertebral collapses werestudied in 54 patients aged between 15 and 78 (mean, 51) years. Malignant compression fractures involved onlymetastasis. We obtained sagittal and axial fast spin-echo T2-weighted images, and unenhanced and fat-suppressedgadolinium-enhanced T1-weighted images, and analyzed MR signal intensity, enhancement patterns, and morphologicchanges including convex posterior cortex vs retropulsion of a bone fragment, focal vs diffuse paraspinal mass,and epidural mass. RESULTS: All cases of acute benign and malignant compression fractures showed low signalintensity within the vertebral body on T1-weighted images, and substantial contrast enhancement on fat-suppressedgadolinium-enhanced T1-weighted images. Acute benign and malignant compression fractures were distinguished on thebasis of three signal intensity characteristics: hypointense band (acute benign cases 77% ; malignant cases 0%),diffuse low signal intensity(17% vs 86%) and involvement of pedicle (0% vs 75%). Fast spin-echo T2-weighted imagesplayed little role in distinguishing between the two. Three morphologic changes were suggestive of malignancy:convex posterior cortex (malignant cases 75% ; benign 0%), epidural mass (79% vs 5%), and focal paraspinal mass(57% vs 0%). Retropulsion of a bone fragment (benign cases 63% ; malignant cases 14%) was preferable forbenignancy. in addition, thin diffuse paraspinal mass (benign cases 15% ; malignant cases 14%) was seen.CONCLUSION: The morphologic and signal intensity characteristics seen on T1-weighted images were useful fordistingushing benign and malignant vertebral compression fractures. Fast spin-echo T2-weighted and fat-suppressedgadolinium-enhanced T1-weighted images played little role in distinguishing between the two.
Subject(s)
Humans , Fractures, CompressionABSTRACT
PURPOSE: To differentiate malignant vertebral compression fractures from benign fractures, as seen onspin-echo T1-weighted, fast spin-echo T2-weighted, and fat-suppressed gadolinium-enhanced T1-weighted MR images. MATERIALS AND METHODS: Thirty two benign (18 acute and 14 chronic) and 28 malignant vertebral collapses werestudied in 54 patients aged between 15 and 78 (mean, 51) years. Malignant compression fractures involved onlymetastasis. We obtained sagittal and axial fast spin-echo T2-weighted images, and unenhanced and fat-suppressedgadolinium-enhanced T1-weighted images, and analyzed MR signal intensity, enhancement patterns, and morphologicchanges including convex posterior cortex vs retropulsion of a bone fragment, focal vs diffuse paraspinal mass,and epidural mass. RESULTS: All cases of acute benign and malignant compression fractures showed low signalintensity within the vertebral body on T1-weighted images, and substantial contrast enhancement on fat-suppressedgadolinium-enhanced T1-weighted images. Acute benign and malignant compression fractures were distinguished on thebasis of three signal intensity characteristics: hypointense band (acute benign cases 77% ; malignant cases 0%),diffuse low signal intensity(17% vs 86%) and involvement of pedicle (0% vs 75%). Fast spin-echo T2-weighted imagesplayed little role in distinguishing between the two. Three morphologic changes were suggestive of malignancy:convex posterior cortex (malignant cases 75% ; benign 0%), epidural mass (79% vs 5%), and focal paraspinal mass(57% vs 0%). Retropulsion of a bone fragment (benign cases 63% ; malignant cases 14%) was preferable forbenignancy. in addition, thin diffuse paraspinal mass (benign cases 15% ; malignant cases 14%) was seen.CONCLUSION: The morphologic and signal intensity characteristics seen on T1-weighted images were useful fordistingushing benign and malignant vertebral compression fractures. Fast spin-echo T2-weighted and fat-suppressedgadolinium-enhanced T1-weighted images played little role in distinguishing between the two.
Subject(s)
Humans , Fractures, CompressionABSTRACT
PURPOSE: To assess the characteristic features of MR findings which would be useful for the differentiation of various spinal diseases involving paraspinal soft tissue mass. MATERIALS AND METHODS: We retrospectively reviewed MR findings in 31 cases(M:F=20:11) of spinal disease in which paraspinal mass was involved. The breakdown of cases was as follows : spinal tuberculosis, 12; spinal metastasis, 13; multiple myeloma, 3; pyogenic spondylitis, 2; spinal aspergillosis; 1. RESULTS: The pattern of bone marrow invasion in spinal metastasis, multiple myeloma, spinal tuberculosis and aspergillosis was mixed ; focal, homogeneously diffuse and inhomogeneously patterns were seen. Pyogenic spondylitis showed inhomogeneously diffuse invasion; an intravertebral abscess was seen in the only five cases of spinal tuberculosis. Vertebral posterior compartment invasion was observed in seven cases of spinal tuberculosis, two of multiple myeloma, the one case of spinal aspergillosis and in all 13 cases of spinal metastasis. This and multiple myeloma showed no disc space invasion, in any case, but all cases of infectious spondylitis showed such invasion. Peripheral rim-enhancement in the paravertebral mass was seen in 11 cases of spinal tuberculosis, one case of pyogenic spondylitis and the case of aspergillosis. Bilobate anterior epidural mass was noted in 60% of spinal tuberculosis cases, 36% of spinal metastasis and one case of pyogenic spondylitis. CONCLUSION: MR findings of spinal disease involving a paraspinal soft tissue mass were useful for differentiation.
Subject(s)
Abscess , Aspergillosis , Bone Marrow , Diagnosis, Differential , Magnetic Resonance Imaging , Multiple Myeloma , Neoplasm Metastasis , Retrospective Studies , Spinal Diseases , Spondylitis , Tuberculosis , Tuberculosis, SpinalABSTRACT
Cobb's syndrome is characterized by spinal and vertebral hemangiomas with a skin nevus at the same metameric level. We report a case of Cobb's syndrome in a young female patient with radiologic findings including simple X-ray, magnetic resonance imaging, and angiography.
Subject(s)
Female , Humans , Angiography , Hemangioma , Magnetic Resonance Imaging , Nevus , SkinABSTRACT
Studies have shown that only a small percentage of metastatic lesions arising outside the central nervous system spreads to the spinal subarachnoid space. The MRI findings of the two cases of surgically proven intradural extramedullary metastases from systemic cancer are presented with a review of the literature. The size of these tumors were more than 2 cm. They were ill defined isointense signal lesions in comparison with spinal cord on T1 and T2 weighted image. On proton density image the tumors had more demarcated high signal intensity than the intermediate signal intensity of spinal cord and the lower signal intensity cerebral spinal fluid. The postcontrast T1 weighted MR images postcontrast revealed well contrast enhancement of the mass.
Subject(s)
Central Nervous System , Magnetic Resonance Imaging , Neoplasm Metastasis , Protons , Spinal Cord , Subarachnoid SpaceABSTRACT
Objective:To analyze the radionuclide bone imaging features of spine tumors and its clinical value.Methods and results:Data of radionuclide planar whole-body bone imaging with 99m Tc-MDP were analyzed in90patients with various spinal tumors confirmed by histopathology.In49patients with metastases,bone imaging was positive in43;37vertebra showed strong uptake;30patients involved the whole vertebra with symmetrical enlargement in18;other extravertebral bone foci were seen in29.In17patients with primary malignant bone tumors,bone imaging was positive in12;11vertebra showed strong uptake;and8involved the whole vertebra;3focal lesions had local irregular bulging;other extravertebral bone foci were seen in4.In24patients with benign bone tumors,bone imaging was positive in13;6vertebra showed strong uptake; other extravertebral bone foci were seen in1.Conclusion:Spinal metastases in bone imaging are mainly multiple,strong up-take of whole vertebra and accompanied by symmetrical enlargement with other extravertebral bone foci.Primary malignant bone tumor is mainly single or multiple,strong uptake of whole vertebra without symmetrical enlargement,some with local irregular bulging lesions. [