Adjacent segment degeneration after posterolateral lumbar fusion: results and complications of posterior revision surgery.

BACKGROUND: Lumbar fusion is an important technique for the treatment of degenerative pathologies. Adjacent segment degeneration is a known complication after lumbar fusion that causes significant morbidity. Our objective was to evaluate the demographics, risk factors, type of surgery, and surgical complications in patients who underwent reoperation through a posterior route due to adjacent segment degeneration. METHODS: We performed a retrospective analysis of all patients who underwent instrumented posterolateral fusion in the lumbar spine for the treatment of degenerative diseases from January 2000 to December 2015 at a single institution. Patients who developed symptomatic adjacent segment degeneration requiring a second surgery were noted and compared with patients who did not develop adjacent segment degeneration. RESULTS: A total of 750 patients with degenerative pathologies who underwent fusion with instrumentation were identified. Forty-five patients (6%) required a second surgery for symptomatic adjacent segment degeneration. The average onset of adjacent segment degeneration symptoms after fusion was 5.89 years. Adjacent segment degeneration occurred above the level of fusion in 40 cases and below in 5 cases. The risk factor identified in our series was L5-S1 fusion. The main complication seen after the second surgery was infection in 5 cases (11%). CONCLUSIONS: This study identifies the L5-S1 fusion as a possible risk factor for adjacent segment degeneration. Reoperation through a posterior route is a therapeutic option but is associated with considerable morbidity. Further studies are necessary to elucidate this pathology and the best options for its management.

Percutaneous Foramen Ovale Puncture: Usefulness of Intraoperative CT Control, in the Eventuality of a Narrow Foramen.

BACKGROUND: Balloon compression of the gasserian ganglion has been a well-established percutaneous treatment of trigeminal neuralgia since the 1980s. However, puncture of the foramen ovale by conventional single-plane fluoroscopy can be difficult in cases of local anatomic abnormalities. CASE PRESENTATION: We present the case of a 49-year-old woman diagnosed with idiopathic trigeminal neuralgia refractory to pharmacological treatment. After failure of puncture by conventional fluoroscopy for percutaneous gasserian ganglion balloon compression due to a narrow foramen ovale, the patient was submitted to puncture guided by computed tomography. CONCLUSION: Alternative imaging methods, such as computed tomography, should be considered when puncture of the foramen ovale by conventional single-plane fluoroscopy fails, to minimize the risk of potential complications triggered by frustrated puncture attempts.

Primary Repair of Esophageal Perforation Following Anterior Cervical Fusion.

Introduction Anterior cervical fusion has been performed safely and effectively for decades for the treatment of multiple pathologies, with low rates of morbidity and mortality. Esophageal perforation is a rare but potentially serious complication of anterior cervical spine approaches. There is no consensus regarding the best treatment strategies for this complication. Objectives To determine the prevalence of esophageal perforation following anterior cervical fusion in a single institution and to describe two cases of this complication that were treated with primary repair. Methods We retrospectively analyzed all consecutive patients who underwent anterior cervical fusion in a single private institution from January 1999 to August 2017. Patients who developed esophageal perforation per- or postoperatively were included in the analysis. Results A total of 830 anterior cervical fusion surgeries were performed during the analyzed period. Two cases (0.24%), both of male patients, were complicated by esophageal perforation, one intraoperatively and the other four years after the first surgery. Both patients were treated with primary esophageal repair, and good outcomes were obtained. Conclusion Primary repair is a therapeutic option in cases of esophageal perforation after anterior cervical fusion. Satisfactory results were obtained in both cases. Further studies are necessary to elucidate the best therapeutic options for this rare complication.

The Results of Microsurgery without Fusion for Lumbar Synovial Cysts: A Case Series of 50 Patients.

OBJECTIVES: The treatments described for spinal synovial cysts range from percutaneous puncture to arthrodesis. There is a fear of postoperative instability after surgical resection of cysts, mainly when they are associated with degenerative spondylolisthesis. The objective of the article is to address the postoperative instability and recurrence rate of the symptoms after microsurgery without fusion. METHODS: We report a consecutive series of 50 patients with lumbar synovial cysts operated on with microsurgery without arthrodesis. Functional status was assessed postoperatively by the MacNab success scale and by self-assessment using the Weiner scale, the 36-item short-form health survey (SF-36), and the Oswestry scale. The presence of preoperative and postoperative instability was determined with static and dynamic lumbar spine X-rays before surgery and in the last follow-up at 2 years to evaluate the presence of spondylolisthesis before and after surgery. Facet inclination angle and stage of disc degeneration at the level of the cysts were evaluated. Disc degeneration was defined by the modified Pfirrmann grading system. RESULTS: The mean Oswestry index was 12 ± 12.6% (median 8, 0-53). Based on the MacNab scale, 98% were considered excellent and good. The Weiner scale showed that low back pain was present in 16% of patients postoperatively. There was significant improvement of leg strength and pain in 96% and 94%, respectively. Only 3 patients were reoperated on with late fusion. Total surgical resection was obtained in all cases, with a late fusion rate of only 6% and no recurrence at the operated site. CONCLUSIONS: The microsurgical treatment for synovial cysts without arthrodesis presented excellent and good results in the majority of cases. It is necessary to carry out prospective randomized studies to clarify the best therapeutic options.

[Penetrating brain injury due to a large asbestos fragment treated by decompressive craniectomy: case report]. / Lesão cerebral penetrante por grande fragmento de fibra de amianto tratada por craniectomia descompressiva: relato de caso.

We report the case of a 22-year-old man victim of penetrating brain injury due to a 15 x 12 asbestos fragment and a successfully treatment via decompressive craniectomy. Unlike gunshot wounds to the head, penetrating brain injury from low energy objects are unusual. Most cases reported involve cranio-orbitary injuries as well as self inflicted lesions in mentally ill patients. The reported case is noteworthy due to the large dimensions of the foreign body, the treatment via decompressive craniectomy and the good patient functional outcome.

Lesão cerebral penetrante por grande fragmento de fibra de amianto tratada por craniectomia descompressiva: relato de caso / Penetrating brain injury due to a large asbestos fragment treated by decompressive craniectomy: case report

Relata-se caso de paciente de 22 anos vítima de traumatismo cranioencefálico penetrante por fragmento de fibra de amianto medindo 15 x 12 cm, e seu tratamento bem sucedido por craniectomia descompressiva. Ao contrário da lesão encefálica por projétil de arma de fogo, lesão encefálica penetrante por objeto de baixa energia é incomum. A maioria dos casos relatados na literatura envolve lesões cranio-orbitárias ou autoflagelação em pacientes psiquiátricos. O caso relatado torna-se especial em virtude das grandes dimensões do objeto penetrante, do tratamento por craniectomia descompressiva e do bom resultado funcional alcançado.