RESUMO
Penetrating wounds of the spine caused by edged weapons are on the increase due to the growing insecurity, violence, availability and accessibility of these weapons, which are generally objects of everyday use (knife, axe, machete, screwdriver, bicycle spoke, scissors, garden fork, sickle and sharpened broom handle, etc.). These objects may be the cause of penetrating wounds responsible for neurological deficits with breaches of the dura mater, or they may be without neurological deficits due to the level of the weapon in the spine. We present two clinical cases of patients with penetrating knife wounds of the spine. One at cervical level with pneumorrhagic emphysema, spinal cord compression and pneunemoencephaly, with neurological deficit who had a surgicalintervention followed by physiotherapy and a progressive recovery, the other with a penetrating wound at L5 crossing the blade to the vertebral body without neurological deficit in whom the knife was extracted at the emergency department without secondarydeficit. Penetrating wounds of the spine are caused by stab wounds, including knives. In particular, emphysema, diffuse pneumorrhagia and pneumoencephalus are extremely rare in the same patient, this being due to the knife extraction technique. These lesions, associated with neurological deficit and cerebrospinal fluid (CSF) leakage, constitute a neurosurgical emergency.
RESUMO
STUDY DESIGN: Retrospective case series observational study. PURPOSE: Cancer patients are often aged and are further weakened by their illness and treatments. Our goal was to evaluate the efficiency and safety of using minimally invasive techniques to operate on spinal fractures in these patients. OVERVIEW OF LITERATURE: Vertebroplasty is now considered to be a safe technique that allows a significant reduction of the pain induced by a spinal tumoral fracture. However, few papers describe the kyphosis reduction that can be achieved by combining percutaneous fixation and anterior vertebral reconstruction. METHODS: We studied 35 patients seen between December 2013 and October 2016 who had at least one pathological spinal fracture and multiple vertebral metastases. The population’s mean age was 67 years, and no patients included had preoperative neurological deficits. The patients underwent a minimally invasive surgery consisting of a percutaneous pedicular fixation with cement-enhanced screws and anterior reconstruction comprising kyphoplasty when possible or corpectomy in cases of excessive damage to the vertebral body. Back pain, traumatic local and regional kyphosis, and Beck’s Index were collected pre- and postoperatively, and at 3-, 6-, and 12-month follow-ups. RESULTS: Mean follow-up time was 13.4 months. Significant reductions in back pain (p<0.001) and local (p<0.001) and regional kyphosis (p=0.006) were found at the 6-month follow-up (alpha risk level <0.05). Beck’s Index was also significantly increased, indicating good restoration of the anterior vertebral height. By the final follow-up, no screws had fallen/pulled out. There were no infectious or neurological complications. CONCLUSIONS: Percutaneous cement-enhanced fixation for pathological fractures has proven a safe and efficient technique in our experience, enabling weak patients to rapidly become ambulatory again without complications. Further follow-up of the patients is necessary to assess the long-term effects of this technique and the continued quality of life of our patients.