Retraction: Staged Surgical Management in the Treatment of Primary Epidural Hydatidosis of the Spine: A Case Series and Review.

[This retracts the article DOI: 10.7759/cureus.401.].

Staged Surgical Management in the Treatment of Primary Epidural Hydatidosis of the Spine: A Case Series and Review.

Hydatid disease is a parasitic infection linked to the Echinococcus granulosus tapeworm. Infected cysts can present anywhere in the human body, but the liver is the most frequently involved organ, followed by the lungs. The prognosis is generally poor and may be comparable to that of neoplastic disease. Primary spinal hydatidosis accounts for less than 1% of all cases and virtually all these cases have extradural involvement. We describe a case review consisting of two patients who presented over a three week period with primary spinal extradural hydatidosis in the Western Cape region of South Africa. Both patients presented with lower limb paraparesis and were treated aggressively with two-stage surgical procedures, resulting in a dramatic improvement in their neurological status.

Hyperextension injury of the cervical spine with central cord syndrome.

PURPOSE: Traumatic central cord syndrome (TCCS) is the most commonly encountered type of incomplete spinal cord injury. TCCS typically occurs in patients over the age of 50 with a narrow spinal canal and follows an acute hyperextension injury of the cervical spine. Here, we report on the demographics of TCCS patients, their clinical course and outcomes, and the factors that may have influenced these outcomes. METHODS: We conducted a retrospective folder review of patients who presented to our facility between January 2004 and December 2008 following hyperextension injury of the cervical spine and with the clinical manifestations of a central cord syndrome. Patient details were obtained from the acute spinal cord injury register at Groote Schuur Hospital and the patient folders, radiographs and magnetic resonance imaging films were reviewed. Predetermined data points were identified, tabulated and analysed, with only information from the injury-related admission being included. RESULTS: An ASIA motor score of ≥60 on admission or discharge correlated with an 80 % chance of being able to walk at discharge from hospital. An ASIA motor score of ≤50 on admission correlated with an 80 % chance of not walking at discharge. An ASIA motor score of ≤50 at discharge meant a patient was not only unable to walk, but required placement in a spinal injury rehabilitation centre. Further, if a patient had a cervical spinal canal diameter of ≥8 mm they had a 50 % chance of clinical improvement and nearly 80 % chance of a functional outcome. CONCLUSION: The Groote Schuur Hospital patient population differs from the international norm, particularly with respect to age and mechanism of injury. The ASIA motor score and cervical spine canal diameter proved to be useful predictors of outcome. Within our patient group, timing of surgery did not appear to influence the outcome.

Brain tissue oxygen tension monitoring in pediatric severe traumatic brain injury. Part 1: Relationship with outcome.

INTRODUCTION: Intracranial pressure (ICP) monitoring and cerebral perfusion pressure (CPP) management are the current standards to guide care of severe traumatic brain injury (TBI). However, brain hypoxia and secondary brain injury can occur despite optimal ICP and CPP. In this study, we used brain tissue oxygen tension (PbtO(2)) monitoring to examine the association between multiple patient factors, including PbtO(2), and outcome in pediatric severe TBI. MATERIALS AND METHODS: In this prospective observational study, 52 children (less than 15 years) with severe TBI were managed with continuous PbtO(2) and ICP monitoring. The relationships between outcome [Glasgow Outcome Score (GOS) and Pediatric Cerebral Performance Category Scale] and clinical, radiologic, treatment, and physiological variables, including PbtO(2), were examined using multiple logistic regression analysis. RESULTS: Outcome was favorable in 40 patients (77%) and unfavorable (mortality, 9.6%; n = 5) in 12 (23%). In univariate analysis, the following variables had a significant association with unfavorable outcome: initial GCS, computed tomography classification, ICP(peak), mICP(24), mICP, CPP(low), CPP(<40), pupil reactivity, PbtO(2)(low), PbtO(2) < 5 mmHg, PbtO(2) < 10 mmHg, mPbtO(2)(24), and time-severity product. PbtO(2) parameters had the strongest independent association with poor outcome in multiple regression analysis. In particular, when PbtO(2) was <5 mmHg for >1 h, the adjusted OR for poor outcome was 27.4 (95% confidence interval, 1.9-391). No variables apart from PbtO(2) were independently associated with mortality when controlled for PbtO(2). CONCLUSION: Reduced PbtO(2) is shown to be an independent factor associated with poor outcome in pediatric severe TBI in the largest study to date. It appears to have a stronger association with outcome than conventionally evaluated measures.

Brain tissue oxygen tension monitoring in pediatric severe traumatic brain injury. Part 2: Relationship with clinical, physiological, and treatment factors.

INTRODUCTION: Brain tissue oxygen tension (PbtO(2)) monitoring is used increasingly in adult severe traumatic brain injury (TBI) management. Several factors are known to influence PbtO(2) in adults, but the variables that affect PbtO(2) in pediatric TBI are not well described. This study examines the relationships between PbtO(2) and (1) physiological markers of potential secondary insults commonly used in pediatric TBI, in particular intracranial pressure (ICP), cerebral perfusion pressure (CPP), and systemic hypoxia, and (2) other clinical factors and treatment received that may influence PbtO(2). MATERIALS AND METHODS: In this prospective observational study, 52 children (mean age, 6.5 +/- 3.4 years; range, 9 months to 14 years old) with severe TBI and a median post-resuscitation Glasgow Coma Score (GCS) of 5 were managed with continuous PbtO(2) monitoring. The relationships between PbtO(2) parameters (Pbt)(2)(low), PbtO(2) < 5, PbtO(2) < 10, and mPbtAO(2)(24)) and clinical, physiological, and treatment factors were explored using time-linked data and Spearman's correlation coefficients. RESULTS: No clinical, physiological, or treatment variable was significantly associated with all PbtO(2) parameters, but individual associations were found with initial GCS (PbtO(2) < 5, p = 0.0113), admission Pediatric Trauma Score (PbtO(2) < 10, 0.0175), mICP > 20 (mPbtO(2)(24), p = 0.0377), CPP(low) (PbtO(2)(low), p = 0.0065), CPP < 40 (PbtO(2)(low), p = 0.0269; PbtO(2) < 5, p = 0.0212), P(a)O(2) < 60 (mPbtO(2)(24), p = 0.0037), S(a)O(2) < 90 (PbtO(2)(low), p = 0.0438), and use of inotropes during ICU care (PbtO(2)(low), p = 0.0276; PbtO(2) < 10, p = 0.0277; p = mPbtO(2)(24)). CONCLUSION: Delivery of oxygen to the brain is important to limit secondary neuronal injury after severe TBI. Our data show that PbtO(2) is poorly predicted by clinical and physiological factors commonly measured in the pediatric ICU. Multimodality monitoring may be needed to detect all secondary cerebral insults in pediatric TBI.