Diário da Espinha

Background: Minimally invasive spine surgeries using endoscopic techniques have shown to be effective at treating lumbar spinal stenosis. However, there lacks evidence that bilateral decompression of the nerve root can be achieved through a unilateral endoscopic technique. Thus, this case study examines whether an outpatient surgical treatment for severe lumbar spinal stenosis (LSS) requiring bilateral decompression through a unilateral approach can be performed endoscopically.
Methods: A 63-year old non-smoking African American male presented with symptoms of pain in the left buttock that radiated into the posterior left thigh. Magnetic resonance imaging (MRI) confirmed severe L4/5 spinal stenosis bilaterally. The patient underwent out-patient minimally invasive unilateral laminotomy for bilateral L4/5 decompression of central canal stenosis. This procedure included a partial facetectomy with removal of the contralateral ligamentum flavum, and decompression of the lateral recesses.
Results: The procedure lasted one hour and 16 minutes. Post-operative MRI confirmed bilateral decompression of the spinal canal. The patient tolerated the surgery well and was released two hours post-operative awake and in stable condition. There were no operative complications and an estimated blood loss of 25 millilitres. The patient reported the ability to walk with complete resolution of ridiculer pain, tingling and numbness the same day as surgery as well as at 3-, 6- and 18-months post-operatively.
Conclusion: This case study indicates that an outpatient endoscopic unilateral laminotomy for bilateral decompression of the central canal and lateral recesses is effective at reducing pain and disability level immediately following surgery and up to 18-months post-operative. Results also indicate that this outpatient procedure can treat severe LSS with short operative times, no operative complications, and minimal blood loss.

Background: Radiation-induced malignant peripheral nerve sheath tumors (MPNSTs) may occur in any irradiated area of the body where primary malignant lesions existed. However, there have been isolated reports regarding the radiation-induced transformation of spinal schwannomas into MPNSTs in patients with neurofibromatosis type 2 (NF2).
Case material: A 47-year-old woman presented with gradually progressive paraparesis, bowel-bladder dysfunction, and acute consciousness disturbance. Fifteen years previously, she had undergone radical hysterectomy with adjuvant intraoperative para-aortic radiotherapy for the treatment of uterine cervical cancer. Magnetic resonance (MR) images of the brain revealed hydrocephalus and multiple intracranial tumors in bilateral oculomotor and vestibular nerves. Spinal MR images revealed numerous tumors in the cervical cord and cauda equina. Signal alteration in the lumbosacral vertebral bodies on MR images, which implies fatty degeneration, suggested that the cauda equina was included in the previous radiation field. Because the patient complained of severe pain in the lower back region and lower extremities, we partially resected the lumbosacral tumors to achieve pain control. Histological examination of the resected tumors revealed the lesions to be MPNSTs. Despite postoperative radiation therapy, the residual tumor regrew. The patient is now under palliative care.
Conclusion: We report a rare case of a primary MPNST in the cauda equina occurring 15 years after the administration of intraoperative irradiation for uterine cancer. In patients with NF2 who undergo irradiation for malignancies, long-term observation is mandatory because tardive malignant transformation may occur in pre-existing schwannomas in the irradiated field.

Objective: There are rare reports on the result of multilevel (≥ 3 levels) percutaneous pedicle screw fixation (PPF). The purpose of this study was to report the clinical experiences for multilevel PPF of the lumbar spine.

Methods: A total of 17 patients of lumbar spinal disease (7 degenerative diseases, 6 infectious diseases, and 4
traumatic instabilities) underwent neural decompression and multilevel PPF. There were 8 men and 9 women with a
mean age of 61.4 years (range: 25-84) and a mean follow-up period of 23.2 months (range: 13-48). The average PPF
level was 3.7. A retrospective review of clinical, radiological, surgical data was conducted.

Results: “Excellent” or “good” clinical results were obtained in 15 patients (88.2%). The average improvement of
visual analogue scale was 5.2 points (from 9.3 to 4.1), and the average improvement of Oswestry Disability Index was
36.2 (from 71.2 to 35.0) at the last visit (p<0.05).

The fusion rate was 88.2%, but, screw loosening was occurred in 2 patients, and adjacent segmental degeneration
was occurred in 2 patients. There was no statistical significance in the change of total lumbar lordotic angle. The
average operation time was 5.9 hours, with an EBL of 550 ml and bed rest duration of 2 days.

Conclusions: Although the current study examined a small sample with relatively short term follow up periods, our
study results demonstrate that multilevel PPF is feasible and safe for selective lumbar spinal disease.

Object: To provide the anatomic basis of imaging for the segmental vessels of the thoracolumbar spine side and measure the distance between two adjacent segmental arteries in the three-dimensional images.

Results: We could observe the course and the adjacent relationship of thoracolumbar spine lateral vascular. In between the upper and lower segmental vessels consists a relatively non-vascular nerve safe zone where the intervertebral space locates. And we surveyed the related datas.

Conclusion: Three-dimensional reconstruction of CT images can effectively observe the course and adjacent relationship of the thoracolumbar spinal lateral segmental artery, and can accurately measure the safe zone.

Background: The relationship between lumbosacral transitional vertebrae and low back pain is not clear. This controversy has been quite intriguing and has been the stimulus for carrying out this present study. The aim of this study was to determine, by plain radiography, if there is a relationship between lumbosacral transitional vertebrae and low back pain.

Material and methods: Five hundred lumbosacral radiographs of low back pain patients were examined. Dysplastic transverse process was classified according to the Castellvi radiographic classification system. The incidence of lumbosacral transitional vertebra in patients with low back pain was reported, and the patients who had anomaly were compared according to gender and age.

Results: Of these patients, 118 were classified as positive for transitional lumbosacral vertebra, resulted in an incidence of 23.6%. The most common anatomical variant was Castellvi Type IA (6.8%). No statistically significant difference was found between these two age groups according to incidence of lumbosacral transitional vertebra (p=0.207). There were no statistically significant differences between men and women who had anomaly (p=0.289). Higher incidences of Type IB and Type IIB were found in men, but those results were not statistically significant (p=0.112, p=0.514) when compared with the female group.

Conclusion: Based on our data, we conclude that lumbosacral transitional segments are common in the low back pain population. But no relationship found between age and genders.

Background: The relationship between lumbosacral transitional vertebrae and low back pain is not clear. This controversy has been quite intriguing and has been the stimulus for carrying out this present study. The aim of this study was to determine, by plain radiography, if there is a relationship between lumbosacral transitional vertebrae and low back pain.
Material and methods: Five hundred lumbosacral radiographs of low back pain patients were examined.
Dysplastic transverse process was classified according to the Castellvi radiographic classification system. The incidence of lumbosacral transitional vertebra in patients with low back pain was reported, and the patients who had anomaly were compared according to gender and age.
Results: Of these patients, 118 were classified as positive for transitional lumbosacral vertebra, resulted in an incidence of 23.6%. The most common anatomical variant was Castellvi Type IA (6.8%). No statistically significant difference was found between these two age groups according to incidence of lumbosacral transitional vertebra (p=0.207). There were no statistically significant differences between men and women who had anomaly (p=0.289). Higher incidences of Type IB and Type IIB were found in men, but those results were not statistically significant (p=0.112, p=0.514) when compared with the female group.
Conclusion: Based on our data, we conclude that lumbosacral transitional segments are common in the low back pain population. But no relationship found between age and genders.