Eagle Syndrome: An Unusual Cause of Axial Neck Pain: A Case Report.

CASE: A 42-year-old woman presented with left-sided axial neck pain with radiation behind left ear of 3 months unresponsive to conservative treatment. As clinical examination revealed tenderness anterior to the mastoid process, she was referred to an otolaryngologist. Computed tomography showed an elongated left styloid process. Diagnostic local anesthetic infiltration provided complete pain relief confirming the diagnosis of Eagle syndrome (ES) after which a transoral excision of the left styloid process was performed. She was asymptomatic till the final follow-up of 15 months. CONCLUSION: ES should be considered in differential diagnosis of axial neck pain radiating to ear, and excision of the styloid process in resistant cases provides complete pain relief.

Minimally Invasive Transforaminal Lumbar Interbody Fusion: An Attractive Option for Select Failed Backs.

STUDY DESIGN: Retrospective case series. PURPOSE: To compare minimally invasive transforaminal lumbar interbody fusion (MI-TLIF) outcomes in primary and revision surgeries. OVERVIEW OF LITERATURE: Revision spinal fusion is often associated with an increased risk of approach-related complications. Patients can potentially benefit from the decreased approach-related morbidity associated with MI-TLIF. METHODS: Sixty consecutive MI-TLIF patients (20 failed back [Fa group], 40 primary [Pr group]) who underwent surgery between January 2011 and May 2012 were reviewed after Institutional Review Board approval to compare operative times, blood loss, complications, Oswestry Disability Index (ODI) scores, and Visual Analog Scale (VAS) scores for back and leg pain before surgery and at the last follow-up. RESULTS: Nineteen revision surgeries were compared with 36 primary surgeries. One failed back and four primary patients were excluded because of inadequate data. The mean follow-up times were 28 months and 24 months in the Pr and Fa groups, respectively. The mean pre- and postoperative ODI scores were 53.18 and 20.23 in the Pr group and 52.01 and 25.72 in the Fa group, respectively (ODI percentage change: Pr group, 60.36%±29.73%; Fa group, 69.32%±13.72%; p=0.304, not significant). The mean pre- and postoperative VAS scores for back pain were 4.77 and 1.75 in the Pr group and 4.1 and 2.0 in the Fa group, respectively, and the percentage changes were statistically significant (VAS back pain percentage change: Pr group, 48.78±30.91; Fa group, 69.32±13.72; p=0.027). The mean pre- and postoperative VAS scores for leg pain were 6.52 and 1.27 in the Pr group and 9.5 and 1.375 in the Fa group, respectively (VAS leg pain percentage change: Pr group, 81.07±29.39; Fa group, 75.72±15.26; p=0.538, not significant). There were no statistically significant differences in operative time and estimated blood loss and no complications. CONCLUSIONS: MI-TLIF outcomes were comparable between primary and revision surgeries. The inherent technique of MI-TLIF is particularly suitable for select failed backs because it exploits the intact paramedian corridor.

Is Autologous Salvaged Blood a Viable Option for Patient Blood Management in Oncologic Surgery?

Oncologic surgery is sometimes associated with substantial blood loss, and principles of patient blood management can be applied in the perioperative care of these patients. Although autologous salvaged blood is an option for perioperative blood conservation, it is often not used in oncologic surgery over concern of reinfusing tumor cells and thereby causing tumor dissemination. We reviewed the literature regarding safety and effectiveness of salvaged blood in oncologic surgery. Salvaged blood seems to be comparable to allogeneic blood in terms of safety. Because patients with primary or metastatic cancer are known to have circulating tumor cells in the absence of surgery, the concern of reinfusing malignant cells from the salvaged blood may be overstated. Reinfusion of salvaged blood has not been found to promote tumor dissemination or distant metastases. When used in patients with substantial blood loss, salvaged blood can be cost-effective. Intraoperative salvaged blood may be a useful adjunct to allogeneic blood resources.

Safety profile, feasibility and early clinical outcome of cotransplantation of olfactory mucosa and bone marrow stem cells in chronic spinal cord injury patients.

STUDY DESIGN: Prospective case series. PURPOSE: To study the safety and feasibility of cotransplantation of bone marrow stem cells and autologous olfactory mucosa in chronic spinal cord injury. OVERVIEW OF LITERATURE: Stem cell therapies are a novel method in the attempt to restitute heavily damaged tissues. We discuss our experience with this modality in postspinal cord injury paraplegics. METHODS: The study includes 9 dorsal spine injury patients with American Spinal Injury Association (ASIA) Impairment Scale (AIS) A neurological impairment who underwent de-tethering of the spinal cord followed by cotransplantation with bone marrow stem cells and an olfactory mucosal graft. Participants were evaluated at the baseline and at 6 monthly intervals. Safety and tolerability were evaluated through the monitoring for adverse events and magnetic resonance imaging evaluation. Efficacy assessment was done through neurological and functional outcome measures. RESULTS: Surgery was tolerated well by all participants. No significant difference in the ASIA score was observed, although differences in the Functional Independence Measure and Modified Ashworth Scale were statistically significant. No significant complication was observed in any of our patients, except for neurogenic pain in one participant. The follow-up magnetic resonance imaging evaluation revealed an increase in the length of myelomalacia in seven participants. CONCLUSIONS: The cotransplantation of bone marrow stem cells and olfactory mucosa is a safe, feasible and viable procedure in AIS A participants with thoracic level injuries, as assessed at the 24-month follow-up. No efficacy could be demonstrated. For application, further large-scale multicenter studies are needed.