RESUMO
INTRODUCTION AND IMPORTANCE: A fracture-dislocation of the vertebral bone is mostly caused by high-energy trauma. Spondyloptosis is the severest form of spondylolisthesis (>100 %) which affects the sagital or coronal plane from the contiguous vertebral bone. Anterior spondyloptosis is known as fracture-dislocation where the proximal part of the vertebra is located infront of the distal vertebrae. Most cases are associated with spinal cord injury (SCI) and unstable hemodynamics, in this case the vital sign of the patient's tend to be stable. CASE PRESENTATION: A 21-year-old man had multiple traumas after having a traffic injury, pain and numbness were positive during physical examination, especially in both lower limb. A radiography examination shows that the patient had total spinal cord transection and anterior spondyloptosis in T12 until L1 segment. Additional examinations found minimal renal and liver contusion including the ischemic bowel. The interbody fusion procedure was chosen as our therapeutic modalities. CLINICAL DISCUSSION: We performed open surgical methods by using interbody fusion modalities usually in patient's with stable vital signs. This intervention could be the priority in managing patients with a rare case of anterior spondyloptosis. A visual analog Scale (VAS) was used for monitoring the degree of pain, and Oswestry Disability Index (ODI) questionnaire for evaluating the outcome for low back pain. CONCLUSIONS: Most traumatic spondyloptosis cases end with neurogenic shock, Due to the injury's rarity and collaborated with minimal soft tissue injury, early diagnosis and the use of an open surgical method may improve patient's outcome.
RESUMO
INTRODUCTION AND IMPORTANCE: Chordoma is a rare sarcoma of the bone with a slow-growing nature but an aggressive nature locally. The subtle onset and minor symptoms cause a delayed diagnosis. Unfortunately, Chordoma is discovered when the prognosis is poor, which make the management procedure more difficult. CASE PRESENTATION: A 56 years old woman presented with back pain, bowel and bladder dysfunction, and numbness around the anus for the last six months. Sensory examination revealed hypoesthesia on the S2-S4 dermatomes and the rectal toucher revealed a mass. Pelvic x-ray revealed an osteolytic lesion on the sacrum and a MRI revealed a sacrum mass on S2. Confirmed by a CT Scan lumbosacral contrast that revealed a solid mass with osteolytic and osteosclerotic changes on the sacrum bone from S2 to the coccyx. We performed a partial en bloc sacrectomy by posterior approach with an inverted goblet incision without lumbopelvic stabilization. CLINICAL DISCUSSION: A few months after surgery, the patient still had some similar complaints and went to physiotherapy and radiotherapy on a regular basis. 1 year follow-up, there was no recurrence process proven by adjunct examination and the improvement was demonstrated by the relief of back pain, and ability to do daily activities. CONCLUSION: Chordoma can be improved by partial sacrectomy without lumbopelvic stabilization that revealed good results from function and complication. A multi-professional approach to the patient is essential.
RESUMO
INTRODUCTION AND IMPORTANCE: Spondylitis tuberculosis is a spinal infection characterized by bone destruction, fracture, abscess, and resulting in deformity (kyphosis and gibbus formation). Therefore, early diagnosis and management of spondylitis tuberculosis have special importance in preventing complications. Surgery is reserved for progressive deformity or where the neurological deficit is not improved by anti-tubercular treatment. The spine can be approached anteriorly or posteriorly in a minimally invasive way. We reviewed the evaluation of clinical outcome, laboratory findings, and radiological post-minimal invasive endoscopic debridement in spinal tuberculosis with psoas abscess. CASE PRESENTATION: We collected data from two patients, a 24 years-old female and 27 years-old male, who was diagnosed with spondylitis tuberculosis with psoas abscess based on the history, physical, and supportive examination. Patients were given chemotherapy antituberculosis agents and performed percutaneous endoscopic debridement. The outcome was measured by clinical signs, laboratory findings, and radiology evaluation. DISCUSSION: Patients had pre-operative symptoms of unremitting lower back and thigh pain, febrile sensation, signs of paravertebral muscle tenderness, and limitation of spine motion. Post percutaneous endoscopic debridement, patients showed good response with clinical improvement seen from significant reduction of pain, paravertebral muscle tenderness, increasing spinal motion, laboratory improvement with a decline of ESR and CRP value, and radiology findings improvement with resorption of psoas abscess. No complications were found. CONCLUSION: Treatment of spondylitis tuberculosis remains controversial regarding optimal use of antituberculosis drugs and the approach used for surgical decompression. Patients had immediate pain relief and reduced disability in treating spinal tuberculosis after percutaneous endoscopic debridement.
