INTRODUCTION: This study aimed to assess the impact of midline lumbar fusion with cortical bone trajectory screws (MIDLF/CBT) on the multifidus muscles, focusing on the evaluation of their postoperative atrophy. CLINICAL RATIONALE FOR THE STUDY: MIDLF/CBT is a relatively new technique increasingly used to treat spinal instability. Despite its reduced invasiveness compared to traditional posterior lumbar interbody fusion with traditional pedicle screws (PLIF/TP), concerns remain about potential damage to the multifidus muscles that are crucial for spinal stability. Understanding the extent of muscular atrophy post-MIDLF/CBT is vital for improving surgical outcomes, and potentially patient rehabilitation strategies. MATERIAL AND METHODS: This study retrospectively analysed preoperative and postoperative MRI scans of patients who underwent MIDLF/CBT for degenerative segmental spondylolisthesis. The bilateral width of the multifidus muscles at the operated segment and adjacent segments was measured using axial T2-weighted MRI scans. Statistical comparisons were made using a paired t test, with significance set at p < 0.05. RESULTS: The study included 16 patients with an average age of 57 ± 10 years, 10 of whom (62.5%) were women, and featured a mean follow-up period of 37 ± 25 months. Postoperative measurements showed a significant reduction in the width of the multifidus muscles at the operated segment (mean difference -3.3mm, p = 0.02) and the inferior adjacent segment (-7.4 mm, p < 0.01). A decrease in muscle width at the superior adjacent segment was also observed, although this was not statistically significant. CONCLUSIONS AND CLINICAL IMPLICATIONS: Our study concluded that MIDLF/CBT results in significant multifidus muscle atrophy at and below the operated segment, potentially impacting postoperative rehabilitation and recovery. These findings highlight the need for further research comparing MIDLF/CBT to other spinal stabilisation techniques. Additionally, incorporating functional electromyographic assessments of paraspinal muscles could provide deeper insights into the long-term consequences of spinal surgeries and helpdevelop new approaches and strategies to mitigate paravertebral muscles atrophy, thus enhancing patient outcomes.
- MeSH
- bederní obratle * chirurgie diagnostické zobrazování MeSH
- fúze páteře * metody MeSH
- hluboké zádové svaly * diagnostické zobrazování patologie MeSH
- kortikální kost chirurgie diagnostické zobrazování MeSH
- lidé středního věku MeSH
- lidé MeSH
- magnetická rezonanční tomografie MeSH
- pedikulární šrouby MeSH
- pooperační komplikace diagnostické zobrazování MeSH
- retrospektivní studie MeSH
- senioři MeSH
- spondylolistéza * chirurgie diagnostické zobrazování MeSH
- svalová atrofie * etiologie diagnostické zobrazování MeSH
- Check Tag
- lidé středního věku MeSH
- lidé MeSH
- mužské pohlaví MeSH
- senioři MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
Reflecting the first wave COVID-19 pandemic in Central Europe (i.e. March 16th-April 15th, 2020) the neurosurgical community witnessed a general diminution in the incidence of emergency neurosurgical cases, which was impelled by a reduced number of traumatic brain injuries (TBI), spine conditions, and chronic subdural hematomas (CSDH). This appeared to be associated with restrictions imposed on mobility within countries but also to possible delayed patient introduction and interdisciplinary medical counseling. In response to one year of COVID-19 experience, also mapping the third wave of COVID-19 in 2021 (i.e. March 16 to April 15, 2021), we aimed to reevaluate the current prevalence and outcomes for emergency non-elective neurosurgical cases in COVID-19-negative patients across Austria and the Czech Republic. The primary analysis was focused on incidence and 30-day mortality in emergency neurosurgical cases compared to four preceding years (2017-2020). A total of 5077 neurosurgical emergency cases were reviewed. The year 2021 compared to the years 2017-2019 was not significantly related to any increased odds of 30 day mortality in Austria or in the Czech Republic. Recently, there was a significant propensity toward increased incidence rates of emergency non-elective neurosurgical cases during the third COVID-19 pandemic wave in Austria, driven by their lower incidence during the first COVID-19 wave in 2020. Selected neurosurgical conditions commonly associated with traumatic etiologies including TBI, and CSDH roughly reverted to similar incidence rates from the previous non-COVID-19 years. Further resisting the major deleterious effects of the continuing COVID-19 pandemic, it is edifying to notice that the neurosurgical community ́s demeanor to the recent third pandemic culmination keeps the very high standards of non-elective neurosurgical care alongside with low periprocedural morbidity. This also reflects the current state of health care quality in the Czech Republic and Austria.
- MeSH
- chronický subdurální hematom * MeSH
- COVID-19 * MeSH
- lidé MeSH
- neurochirurgické výkony MeSH
- pandemie MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- časopisecké články MeSH
- Geografické názvy
- Evropa MeSH
BACKGROUND: Midline lumbar fusion (MIDLF) is one promising new surgical technique that has been developed to minimize perioperative damage to the paravertebral stabilizing musculotendinous system. The aim of this study was to assess long-term clinical and radiological effects of MIDLF. METHODS: This prospective cohort study evaluated patients who underwent MIDLF for degenerative spinal instability. Clinical and radiological examinations were performed before and after surgery. Perioperative and postoperative complications were recorded. Follow-up was 2 years. P ≤ 0.05 was considered statistically significant. RESULTS: The study included 64 patients (mean age 58.9 ± 10.7 years; 41 women [64.1%]). The most frequent indication for MIDLF was degenerative spondylolisthesis grade I (28 cases [43.8%]); the prevalent spinal segment to be fused was L4-L5 (35 cases [54.7%]). Mean duration of surgery was 148.2 ± 28.9 minutes. Relief of low back pain and leg pain was significant and stable in the postoperative period as assessed by visual analog scale (P < 0.001). Of patients, 86.9% reported fair, good, or excellent outcomes in terms of pain relief based on MacNab score 2 years after surgery. Patients' level of function in activities of daily living improved significantly based on Oswestry Disability Index score: from 66.8 ± 9.8 before surgery to 33.9 ± 16.5 2 years after surgery (P < 0.001). X-rays and computed tomography at 12 months showed interbody fusion in 46 cases (73.4%), inconclusive results in 13 cases (20.3%), and no fusion in 4 cases (6.3%). No damage to neural or vascular structures and no failure of hardware or screw loosening were recorded. CONCLUSIONS: MIDLF is a safe, efficient method for surgical treatment of lumbar spine instability. Its limited invasiveness contributes to better preservation of paravertebral muscles and enhanced postoperative spinal stability.
- MeSH
- bederní obratle diagnostické zobrazování patologie chirurgie MeSH
- degenerace meziobratlové ploténky diagnostické zobrazování patologie chirurgie MeSH
- dospělí MeSH
- fúze páteře * MeSH
- lidé středního věku MeSH
- lidé MeSH
- prospektivní studie MeSH
- senioři nad 80 let MeSH
- senioři MeSH
- výsledek terapie MeSH
- Check Tag
- dospělí MeSH
- lidé středního věku MeSH
- lidé MeSH
- mužské pohlaví MeSH
- senioři nad 80 let MeSH
- senioři MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
The world currently faces the novel severe acute respiratory syndrome coronavirus 2 pandemic. Little is known about the effects of a pandemic on non-elective neurosurgical practices, which have continued under modified conditions to reduce the spread of COVID-19. This knowledge might be critical for the ongoing second coronavirus wave and potential restrictions on health care. We aimed to determine the incidence and 30-day mortality rate of various non-elective neurosurgical procedures during the COVID-19 pandemic. A retrospective, multi-centre observational cohort study among neurosurgical centres within Austria, the Czech Republic, and Switzerland was performed. Incidence of neurosurgical emergencies and related 30-day mortality rates were determined for a period reflecting the peak pandemic of the first wave in all participating countries (i.e. March 16th-April 15th, 2020), and compared to the same period in prior years (2017, 2018, and 2019). A total of 4,752 emergency neurosurgical cases were reviewed over a 4-year period. In 2020, during the COVID-19 pandemic, there was a general decline in the incidence of non-elective neurosurgical cases, which was driven by a reduced number of traumatic brain injuries, spine conditions, and chronic subdural hematomas. Thirty-day mortality did not significantly increase overall or for any of the conditions examined during the peak of the pandemic. The neurosurgical community in these three European countries observed a decrease in the incidence of some neurosurgical emergencies with 30-day mortality rates comparable to previous years (2017-2019). Lower incidence of neurosurgical cases is likely related to restrictions placed on mobility within countries, but may also involve delayed patient presentation.
- MeSH
- COVID-19 mortalita MeSH
- dítě MeSH
- dospělí MeSH
- kojenec MeSH
- lidé středního věku MeSH
- lidé MeSH
- mladiství MeSH
- mladý dospělý MeSH
- neurochirurgické výkony mortalita trendy MeSH
- neurochirurgie metody MeSH
- novorozenec MeSH
- pandemie statistika a číselné údaje MeSH
- předškolní dítě MeSH
- retrospektivní studie MeSH
- senioři nad 80 let MeSH
- senioři MeSH
- Check Tag
- dítě MeSH
- dospělí MeSH
- kojenec MeSH
- lidé středního věku MeSH
- lidé MeSH
- mladiství MeSH
- mladý dospělý MeSH
- mužské pohlaví MeSH
- novorozenec MeSH
- předškolní dítě MeSH
- senioři nad 80 let MeSH
- senioři MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- multicentrická studie MeSH
- pozorovací studie MeSH
- Geografické názvy
- Evropa MeSH
PURPOSE OF THE STUDY Minimally invasive posterior lumbar interbody fusion and percutaneous instrumentation were introduced in the clinical practice with the aim to reduce the damage to musculoligamentous structures associated with open surgeries. The purpose of the study is to evaluate the clinical outcomes, radiological results and complications of the group of patients operated with the use of the minimally invasive posterior lumbar interbody fusion technique. MATERIAL AND METHODS The group of 31 patients operated for lumbar degenerative disc disease was followed-up prospectively. The surgical technique included a unilateral microsurgical decompression of the spinal canal with the insertion of interbody cages supplemented by percutaneous transpedicular fixation. The clinical outcomes were evaluated by means of the Oswestry Disability Index (ODI), Macnab classification, VAS score for low back pain (VAS LBP) and lower extremity pain (VAS LE) at 2, 6, 12 and 24 months postoperatively. The success rate of interbody fusion and complications was also assessed. RESULTS The inclusion criteria were met by 29 patients. The mean preoperative ODI score of 68.4 decreased to 25.1 at two-year follow-up (p 0.001). Based on the modified Macnab scale excellent and good outcomes were achieved at two-year-followup by 82.4% patients. The mean value of VAS LBP score decreased from 6.2 to 2.1 and in case of VAS LE from 5.38 to 1.34 (p ˂ 0.001). The mean time of operation was 157 minutes. Solid interbody fusion was achieved in 80% of patients. In one case, revision surgery for dislocation of the interbody cage was performed one year after the operation. A total of five misplaced transpedicular screws (5.2%) were recorded. DISCUSSION Dorsal minimally invasive spinal operational techniques, when compared with the open surgery, result in less iatrogenic injury to paravertebral muscles. From a short-term perspective, there is also less blood loss and lower frequency of infectious complications. Together with the reduction of postoperative pain and shorter hospital stay, they enable faster recovery and rehabilitation with comparable clinical effectiveness of the procedure. Apart from the above-mentioned benefits, also some shortcomings are discussed such as higher frequency of complications, longer time of operation, higher occurrence of implant malposition and higher exposure of the patient and the surgeon to radiation. CONCLUSIONS The minimally invasive posterior lumbar interbody fusion technique resulted in a statistically significant clinical improvement in the ODI, Macnab scale, VAS LBP and VAS LE scores. The percutaneous instrumentation technique shows an acceptable rate of incorrectly inserted screws. Key words: degenerative disc disease, minimally invasive spinal surgery, posterior lumbar interbody fusion, spine stabilization, lumbar interbody fusion complications.
Cerebral abscesses caused by dark-pigmented Fonsecaea fungi are rare, especially in otherwise healthy individuals. In this case report, we present a 61-year-old man from Moldova, living in the Czech Republic, who had worked as a locksmith on oil platforms in Turkmenistan, Kazakhstan, Sudan, and Iraq since 1999, and was admitted to a neurology ward for a sudden motion disorder of the right leg, dysarthria, and hypomimia. Imaging revealed presence of expansive focus around the left lateral ventricle of the brain and a pronounced peripheral edema. The intracranial infectious focus was excised under intraoperative SonoWand guidance. Tissue samples were histologically positive for dark-pigmented hyphae, suggesting dematiaceous fungi. Therefore, liposomal amphotericin B therapy was initiated immediately. Fonsecaea monophora was provisionally identified using ITS rDNA region sequencing directly from brain tissue. The identification was subsequently confirmed by cultivation and DNA sequencing from culture. The strain exhibited in vitro sensitive to voriconazole (MIC = 0.016 μg/mL) and resistance to amphotericin B (MIC = 4 μg/mL); therefore, the amphotericin B was replaced with voriconazole. Postoperatively, a significant clinical improvement was observed and no additional surgery was required. Based on the literature review, this is the third documented case of cerebral infection due to this pathogen in patients without underlying conditions and the first such case in Europe.
- MeSH
- absces mozku diagnostické zobrazování mikrobiologie chirurgie MeSH
- amfotericin B terapeutické užití MeSH
- antifungální látky farmakologie terapeutické užití MeSH
- Ascomycota účinky léků genetika izolace a purifikace MeSH
- imunokompetence MeSH
- lidé středního věku MeSH
- lidé MeSH
- mykózy diagnóza diagnostické zobrazování MeSH
- ribozomální DNA genetika MeSH
- výsledek terapie MeSH
- Check Tag
- lidé středního věku MeSH
- lidé MeSH
- mužské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- kazuistiky MeSH
- přehledy MeSH
- Geografické názvy
- Česká republika MeSH
Intradurálne extramedulárne nádory predstavujú pomerne malú skupinu spomedzi všetkých nádorov CNS. V tejto práci sú popísané ich najčastejšie typy, etiológia, makroskopická a histologická charakteristika, klinické prejavy, dia gnostika a liečba. Popisuje klinické výsledky pri jednotlivých operačných postupoch a ich vplyv na stabilitu chrbtice, radikalitu resekcie a výsledný neurologický stav pa cienta. Rozoberá dôležitosť predoperačnej prípravy, plánovania, polohy pa cienta počas operácie, perioperačnej medikamentóznej liečby a využitia možností prístrojového vybavenia. Hodnotí ich vplyv na pooperačný priebeh, možné komplikácie a celkovú prognózu pa cienta. Tieto aspekty práca hodnotí predovšetkým pri najčastejších typoch intradurálnych extramedulárnych nádorov, a to pri nádoroch nervových obalov a meningeóme. Stručne sú popísané aj menej časté nádory. V diskusii a závere práce sú zhrnuté jednoduché a stručné odporúčania týkajúce sa dia gnostiky a liečby intradurálnych extramedulárnych nádorov, ktoré sú zamerané na zlepšenie efektu liečby a minimalizovanie rizika vzniku komplikácií v súlade s dostupnými štúdiami.
Intradural extramedullary spinal cord tumors represent a relatively small group among all of the tumors of the CNS. This article describes the most frequent types of these tumors, their etiology, macroscopic and histologic characteristics, clinical symptoms, diagnosis and treatment. It describes the clinical outcome of several surgery techniques and their effect on the stability of the spine, the radicality of the resection and the consequent neurological condition of the patient. It analyses the importance of pre-operative preparation, planning, the position of the patient during surgery, perioperative medicamentous treatment and the use of instrumentation opportunities. It evaluates its impact on postoperative outcome, the eventual complications and the overall prognosis of the patient. These aspects are particularly pre-evaluated in the most frequent types of intradural extramedullary spinal cord tumors which are nerve sheath tumors and meningeoms. There is also a brief description devoted to less frequent tumors in this article. There are simple and concise recommendations on the diagnostics and therapy of these tumors in the discussion part and the closure, and these recommendations are aimed at the improvement of the treatment effect and minimizing the risk of complications in accordance with available studies.
PURPOSE OF THE STUDY Cranioplasty is currently the most common neurosurgical procedure. The purpose of this study is to describe the first experience with successful use of the Cranio-Oss (PEEK) custom implant for cranioplasty. MATERIAL AND METHODS In the period 2012 to 2013, a total of 26 cranioplasties were performed. In fourteen patients, their own bone flap was used for reconstruction. In four cases, a synthetic Cranio-Oss bone implant made of PEEK was used. In six patients, the defect was covered by an intraoperatively-made Palacos implant and in two cases, minor defects were covered with a titanium mesh. The patients were followed up for at least five years. Cranio-Oss is a cranial implant made from polyetheretherketone (PEEK), a synthetic biocompatible material. The implant is created using the CAD/CAM method in the shape of the bone defect based on the CT scan. Creating optimal roughness of the implant surface and of the surface of the contact area attached to the bone bed is controlled and included already in the strategy for machining individual areas of the implant during its manufacturing at a 5-axis machining centre. RESULTS The Cranio-Oss implant was used in four younger patients to cover larger and complex-shaped defects. The mean age of patients in this group was 47 years. The implant was fixed to the skull by micro-plates. In all the cases the wound healed well with good cosmetic results without the necessity of revision with respect to the used implant. The follow-up CT scans always showed the implant in situ with no signs of malposition. DISCUSSION Autologous bone flap is the most suitable material for defect reconstruction after craniectomy. This option is affordable and represents one of the best methods of reconstruction of defects after craniectomy in terms of cosmetic results. In some cases, the original skull cannot be used for cranioplasty (e.g. if destructed by tumourous process, infected or in comminuted fractures). In such cases, the defect needs to be managed using a synthetic implant. In case of extensive defects, the most suitable option is a custom made implant from advanced biomaterials. CONCLUSIONS Authors prefer using autologous bone flaps during cranioplasty. In cases where this method is unavailable, a synthetic bone substitute has to be used. The first medium-term experience with the use of a Cranio-Oss implant made of PEEK showed that it is a suitable alternative to the patient's own bone. No complications associated with this synthetic implant were reported and its use to manage skull defects can be strongly recommended. With respect to legal and accreditationrelated difficulties connected with bone fragments storage and thanks to the continuous cost reduction of synthetic implants will their importance grow in the future. Key words: decompressive craniectomy, bone substitute, craniotrauma.
- MeSH
- biokompatibilní materiály aplikace a dávkování MeSH
- ketony aplikace a dávkování MeSH
- lebka chirurgie MeSH
- lidé středního věku MeSH
- lidé MeSH
- následné studie MeSH
- polyethylenglykoly aplikace a dávkování MeSH
- protézy a implantáty MeSH
- retrospektivní studie MeSH
- zákroky plastické chirurgie přístrojové vybavení metody MeSH
- Check Tag
- lidé středního věku MeSH
- lidé MeSH
- Publikační typ
- časopisecké články MeSH
Intraoperativní sonografické zobrazení (IOS) v neurochirurgii představuje standardní nástroj pro aktuální a reálné zobrazení mozkové tkáně a zájmových struktur. Technologický rozvoj sonografické techniky vedl k miniaturizaci sond a umožnil jejich použití v omezeném prostoru kraniotomie. Kvalita zobrazení se zvýšila zavedením vysokofrekvenčních sond s vysokým prostorovým rozlišením. Prostředí mozkové tkáně je z hlediska insonačních podmínek příznivé a umožňuje přesnou lokalizaci a navigaci operačního přístupu u všech běžných druhů mozkových nádorů, jako jsou gliomy, metastázy, meningeomy a kavernomy. Základní zobrazení je B mód (2D zobrazení), které lze pro zlepšení orientace doplnit o rekonstruované 3D zobrazení. Tumorózní expanze se v IOS jeví proti mozkové tkáni jako hyperechogenní struktury. Další usnadnění orientace v IOS přináší integrace sonografického přístroje s optickou neuronavigací. Vedle navigační funkce je IOS výhodné při detekci a lokalizaci reziduí při resekcích gliálních nádorů a metastáz. Přispívá tak k dosažení co největší radikality resekce. Použití sonografické kontrastní látky při IOS zlepšuje dále kvalitu obrazu a snižuje vliv artefaktů na kvalitu zobrazení během resekce nádoru. Duplexní zobrazení v barevném dopplerovském nebo energetickém módu umožňuje lokalizovat cévní struktury, vyhodnotit jejich vztah k tumoru nebo lokalizovat cévní zásobení. Kromě lokalizace tumoru lze posoudit vnitřní strukturu tumoru a navigovat podle toho biopsie a přístup. Hlavními přednostmi IOS jsou přesné a aktuální zobrazení, dostupnost, libovolná opakovatelnost a vysoká kvalita zobrazení. Předpokladem vysoké výtěžnosti IOS je dlouhodobá zkušenost s tímto zobrazením. Nedostatkem je nemožnost navigovat kraniotomii a výskyt artefaktů při kontrole resekce.
Intraoperative sonography (IOS) in neurosurgery is a standard acquisition tool for real-time imaging of brain tissue and target structures. The technological advance of ultrasound devices has led to miniaturisation of ultrasound probes and enabled their use in the limited space of craniotomy. The quality of IOS imaging improved after introducing high-frequency probes with high spatial resolution. The environment of brain tissue provides favourable insonation conditions and enables precise localisation and navigation of surgical access to all common brain tumours, including gliomas, metastases, meningiomas and cavernomas. The basic imaging is B-mode (two-dimensional; 2D) and can be supplemented by 3D (three-dimensional; 3D) reconstruction to improve orientation. Brain tumours are displayed as hyperechoic structures compared to the brain tissue. The integration of ultrasound devices with optical neuronavigation facilitates the orientation in IOS even more. Besides the navigational function, the IOS is suitable for detection and localisation of tumour remnants during removal of gliomas and metastases. In this way the IOS contributes to maximum extent of resection. The contrast-enhanced IOS further improves image quality and reduces the impact of artefacts. Duplex ultrasonography using colour Doppler or power Doppler makes it possible to localise vessels and to evaluate their relation to the tumour or to localise its vessel supply. In addition to localisation of tumours, it is possible to assess their internal structure and lead biopsies and navigate access. The main advantages of IOS are precise real-time information, availability, easy repeatability and high-quality imaging. The prerequisite for effective IOS imaging is long-term experience with this imaging modality. The drawbacks of the IOS include the impossibility to navigate craniotomy and the occurrence of artefacts during resection control.
- MeSH
- gliom chirurgie terapie MeSH
- intraoperační neurofyziologická monitorace MeSH
- lidé MeSH
- magnetická rezonanční tomografie využití MeSH
- meningeom MeSH
- nádory mozku diagnostické zobrazování chirurgie terapie MeSH
- neuronavigace * MeSH
- ultrasonografie dopplerovská transkraniální MeSH
- ultrasonografie * metody přístrojové vybavení využití MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- výukové testy MeSH
- MeSH
- glioblastom chirurgie MeSH
- laserová terapie * metody MeSH
- lasery * využití MeSH
- lidé středního věku MeSH
- lidé MeSH
- magnetická rezonanční tomografie metody využití MeSH
- nádory mozku * chirurgie MeSH
- neurochirurgické výkony * metody využití MeSH
- senioři MeSH
- thulium terapeutické užití MeSH
- výsledek terapie MeSH
- Check Tag
- lidé středního věku MeSH
- lidé MeSH
- mužské pohlaví MeSH
- senioři MeSH
- ženské pohlaví MeSH
- Publikační typ
- kazuistiky MeSH
