Incidental Dural Tears in lumbar decompressive surgery: Incidence, causes, treatment, results.

BACKGROUND: Incidental dural tears or durotomy (ID) during lumbar decompressive surgery is a relatively rare complication causing severe consequences. Their incidence varies widely among different authors (1-17%) and in general depends on the type and complexity of the spinal procedures performed. With the present investigation the authors aim to evaluate the incidence of incidental durotomies during the different types of decompressive and reconstructive surgical procedures in the lumbar region, also indicating the most common reasons for incidental durotomies, treatment options and the early and remote outcome. MATERIAL AND METHODS: The records of 553 consecutive patients with different types of posterior and posterolateral decompressive and reconstructive procedures in the lumbar region are investigated retrospectively for the period January 2005 - march 2009. RESULTS: The overall incidence of the incidental durotomies in the investigated group is 12.66%. In the subgroups it varies depending on the specificity of the surgical procedures performed. The biggest is the number of IDs in the reoperative spinal surgery subgroup, followed by the subgroup of the patients who sustained spinal trauma, followed by those with degenerative spinal stenosis, tumors and lumbar disc herniations. CONCLUSION: IDs should be considered as a serious complication with a multitude of unwanted consequences for the patients. Prevention is the best way to treat the complications and disability that attend the unwanted dural tears. Knowing about the mechanisms and predisposing factors for that objectionable complication is a matter of utmost importance when planning and performing spinal surgical procedures.

Cell proliferation index predicts relapse of brain metastases in non-irradiated patients.

BACKGROUND: Brain metastasis is a common complication and a major cause of morbidity and mortality in human malignancies. We investigated whether the proliferating cell index of surgically treated single brain metastasis would predict the relapse at a location remote from the initial resection site within 2 months of the excision in patients with uncontrolled systemic disease and not subjected to adjuvant whole brain radio-therapy. MATERIALS AND METHODS: Tissue biopsies derived from 25 patients with brain metastases specifically selected to be a single totally resected lesion and not treated subsequently by radiotherapy to the whole brain were stained by immunohistochemistry for the marker CDC47 and the proliferation index was calculated. The index was then analysed with respect to clinical parameters, including the incidence of brain relapse within 2 months of the first resection, the timing of diagnosis of brain metastasis as compared to the primary cancer diagnosis, and the perifocal brain oedema. RESULTS: Statistical evaluation of the indexes in the patients with brain metastases relapsing within 2 months after the first craniotomy (n = 13) revealed significantly higher values as compared to the patients with lesions which had not relapsed or which had relapsed more than 2 months after first craniotomy (n = 12). The synchronous brain metastasis (that is, those occurring before or within 2 months of the primary cancer diagnosis) had a significantly higher proliferation index than the metachronous lesions (those occurring more than 2 months after primary cancer diagnosis). CONCLUSIONS: The synchronous brain metastasis relapses within 2 months of primary resection and have a significantly higher proliferation index than the metachronous lesions which did not recur within 2 months. These results indicate that the estimation of the proliferation index of metastatic brain tumours may be helpful in predicting the course of disease progression.

Alcaptonuria with lumbar disc prolapse: case study and review of the literature.

BACKGROUND CONTEXT: Patients with alcaptonuria frequently complain of pain in the large joints and the spinal column, this condition is being assumed to be normal. It is very rare for patients with ochronosis to undergo lumbar surgery since the disk protrusion is not characteristic for them and overlaps with the general complaints due to the spondiloarthritic and stenotic changes. PURPOSE: To prove the possibility of a lumbar disc herniation in a patient with alcaptonuria as a real entity that causes lumbar and radiculalgic complaints. STUDY DESIGN: A case of a 33-year old patient with alcaptonuria and lumbar disc herniation is presented. METHODS: The case is presented together with its clinical course, the diagnostic techniques, the surgical findings, histological results and the treatment outcome. RESULTS: After the surgical treatment the patient's complaints were alleviated and almost no complaints were registered, during the next follow-up. CONCLUSIONS: The most common symptoms seen in alcaptonuria are complaints of pain in large joints and back pain. They are usually associated with the main disease. The case we present demonstrates that even there is a small likelihood for a prolapsed lumbar disk, it should be sought in such patients as the surgical treatment is able to yields a positive results.