Spontánní intrakraniální hypotenze je charakterizovaná ortostaticky vázanými bolestmi hlavy vznikajícími při samovolném úniku mozkomíšního moku do extradurálního prostoru. Magnetická rezonance má zásadní význam v diagnostice díky řadě typických znaků vyskytujících se u tohoto onemocnění u převážné většiny pacientů. Druhým krokem je identifikace místa úniku mozkomíšního moku, což vyžaduje již speciální diagnostické zobrazovací metody a techniku vyšetření. Spontánní intrakraniální hypotenze může i samovolně vymizet. Její léčba je především konzervativní a spočívá v klidovém režimu, objemové terapii a podávání analgetik. Na pomezí konzervativního a invazivního postupu je aplikace epidurální krevní zátky. Pokud tyto postupy nejsou úspěšné a je jasně identifikované místo úniku mozkomíšního moku, je indikována chirurgická terapie. V případě longitudinální durální trhliny její identifikace a uzávěr, u meningeálního divertiklu jeho ošetření s případnou plastikou u větší durální ektázie, přerušení likvoro-venózní fistuly, popřípadě lumbální durální rekonstrukční operace.
Spontaneous intracranial hypotension is characterized by postural headaches arising from leakage of cerebrospinal fluid without any previous insult into the extradural space. Magnetic resonance is of fundamental importance in the diagnosis of the disease due to a number of typical signs occurring in this disease in the vast majority of patients. The second step is the identification of the location of the cerebrospinal fluid leak, which requires special diagnostic imaging methods and examination techniques. Spontaneous intracranial hypotension can also disappear spontaneously. Its treatment is primarily conservative and consists of rest, volume therapy and administration of analgesics. The application of an epidural blood patch is on the border between conservative and invasive treatments. If these procedures are not successful and the site of cerebrospinal fluid leakage is clearly identified, the surgical treatment is indicated. In the case of a longitudinal dural tear, its identification and closure is performed, in the case of a meningeal diverticulum, its closure with possible duraplasty in patients with a larger dural ectasia is made, cutting off a CSF-venous fistula, or lumbar dural reconstruction surgery.
- Klíčová slova
- epidurální krevní zátka,
- MeSH
- bolesti hlavy etiologie MeSH
- intrakraniální hypotenze * chirurgie etiologie MeSH
- konzervativní terapie MeSH
- laminektomie metody MeSH
- laminoplastika metody MeSH
- lidé MeSH
- ligace metody MeSH
- magnetická rezonanční tomografie metody MeSH
- únik mozkomíšního moku chirurgie etiologie komplikace MeSH
- Check Tag
- lidé MeSH
From the works published so far, the endoscopic spine surgery of the lumbar spine has its justification. Miniinvasive approach spares muscles, minimizes postoperative pain, shortens hospitalization and of course recovery. It proves the results of our patients after disc herniation treated by endoscopic surgery. In patients we register less postoperative pain, less consumption of analgesics postoperatively, early verticalization and early return to everyday activities. We evaluate the endoscopic discectomy (interlaminar and transforaminal) as an efficient surgical method in treatment of lumbar disc herniation in cases such as radiculopathy, hyperalgic conditions even in cases with motoric deficit. Ideal candidates for lumbar spine endoscopy are patients with discogenic radiculopathy with early symptomatology where we predict soft disc herniation. In these cases, we choose the endoscopic discectomy as a first choice of treatment. Our purpose is to continue in education of spinal endoscopic procedures. We are reducing the amount of recurrent disc herniations with increasing skills. We enrich our experiences in other parts of spine such as cervical spine in treatment of cervical radiculopathy. In March 2023 we implemented the first cervical spine endoscopy, where the main purpose was to decompress the cervical spine nerve which was compressed by cervical disc herniation. In the future we plan to expand in indications criteria, even in cases of degenerative spine disorders, implantation of intervertebral disc cages with transpedicular stabilizations.
Rozvojom optických systémov v medicíne sa endoskopia postupne etablovala vo viacerých chirurgických a nechirurgických medicínskych disciplínach, akými sú gastroenterológia, urológia, gynekológia a brušná chirurgia. Jej prienik je citeľný aj do spinálnej chirurgie a neurochirurgie. Dôvodom využitia endoskopie v spinálnej chirurgii je miniinvazivita so šetrením svalového aparátu. Tá umožňuje pacientom po spinálnych operáciách včasnú mobilizáciu a redukuje poooperačné bolesti, čo potenciálne môže viesť k skráteniu času hospitalizácie a včasný návrat do zamestnania. Šetrenie tkanív tiež prispieva k stabilite chrbtice, redukuje riziko instability a vzniku degeneratívnych zmien v budúcnosti. V nasledujúcom článku by sme radi predstavili vlastné skúsenosti s miniinvazívnou endoskopickou technikou ošetrenia výhrezov medzistavcovej platničky driekovej chrbtice.
BACKGROUND: Surgical site infection (SSI) is the most consistently reported complication of cranioplasty. No material showed a categorical superiority in the incidence of infection. Porous polyethylene (PE) is considered a low risk material regarding SSI. However, the literature data are very limited. Thus, our objective was to verify the assumed low incidence of SSI after PE cranioplasty in patients at high risk of SSI. The primary objective was the infection rate, while secondary objectives were implant exposure, revision and cosmetic results. METHOD: Patients who underwent three-dimensional (3D) personalized PE cranioplasty in the period 2014-2023 were evaluated prospectively. Only patients with an increased risk of SSI, and a satisfactory clinical conditions were included in the study. RESULTS: Thirty procedures were performed in 30 patients. Cranioplasty was performed 23 times after hemispheric decompressive craniectomy, five times after limited size craniotomy and two times after bifrontal decompressive craniectomy. Risk factors for the development of infection were 18 previous SSIs, 16 previous repeated revision surgeries, four intraoperatively opened frontal sinuses and two times radiotherapy. Neither infection nor implant exposure was detected in any patient. All patients were satisfied with the aesthetic result. In two cases, a revision was performed due to postoperative epidural hematoma. CONCLUSIONS: Three-dimensional personalized PE cranioplasty is associated with an extremely low incidence of SSI even in high-risk patients. However, our conclusions can only be confirmed in larger studies.
- MeSH
- dekompresní kraniektomie škodlivé účinky metody MeSH
- dospělí MeSH
- infekce chirurgické rány * epidemiologie etiologie MeSH
- kraniotomie škodlivé účinky metody MeSH
- lebka chirurgie MeSH
- lidé středního věku MeSH
- lidé MeSH
- polyethylen MeSH
- poréznost MeSH
- prospektivní studie MeSH
- rizikové faktory MeSH
- senioři MeSH
- zákroky plastické chirurgie * metody škodlivé účinky MeSH
- Check Tag
- dospělí MeSH
- lidé středního věku MeSH
- lidé MeSH
- mužské pohlaví MeSH
- senioři MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
BACKGROUND: In the first part of this report, the European Association of Neurosurgical Societies' section of peripheral nerve surgery presented a systematic literature review and consensus statements on anatomy, classification, and diagnosis of thoracic outlet syndrome (TOS) along with a subclassification system of neurogenic TOS (nTOS). Because of the lack of level 1 evidence, especially regarding the management of nTOS, we now add a consensus statement on nTOS treatment among experienced neurosurgeons. OBJECTIVE: To document consensus and controversy on nTOS management, with emphasis on timing and types of surgical and nonsurgical nTOS treatment, and to support patient counseling and clinical decision-making within the neurosurgical community. METHODS: The literature available on PubMed/MEDLINE was systematically searched on February 13, 2021, and yielded 2853 results. Screening and classification of abstracts was performed. In an online meeting that was held on December 16, 2021, 14 recommendations on nTOS management were developed and refined in a group process according to the Delphi consensus method. RESULTS: Five RCTs reported on management strategies in nTOS. Three prospective observational studies present outcomes after therapeutic interventions. Fourteen statements on nonsurgical nTOS treatment, timing, and type of surgical therapy were developed. Within our expert group, the agreement rate was high with a mean of 97.8% (± 0.04) for each statement, ranging between 86.7% and 100%. CONCLUSION: Our work may help to improve clinical decision-making among the neurosurgical community and may guide nonspecialized or inexperienced neurosurgeons with initial patient management before patient referral to a specialized center.
- MeSH
- chirurgická dekomprese škodlivé účinky MeSH
- lidé MeSH
- neurochirurgické výkony škodlivé účinky MeSH
- periferní nervy chirurgie MeSH
- pozorovací studie jako téma MeSH
- prospektivní studie MeSH
- syndrom horní hrudní apertury * diagnóza chirurgie MeSH
- výsledek terapie MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- časopisecké články MeSH
- práce podpořená grantem MeSH
- systematický přehled MeSH
Herniated lumbar discs are a common cause of low back pain, which can negatively impact the quality of life of working-age individuals. This study aimed to evaluate changes in the quality of life in patients with sciatica who underwent endoscopic discectomy, a minimally invasive surgical procedure. The study (ClinicalTrials.gov NCT02742311) included 470 patients who underwent transforaminal, interlaminar, or translaminar endoscopic discectomy. Quality of life and pain perception were evaluated by comparing statistically weighted values of EQ-5D-5L, EQ-VAS, Oswestry disability index, and numerical pain scales for lower limb and back pain before and 12 months after the endoscopic procedure. After the procedure, there was a significant improvement in the reduction of back and lower limb pain, as well as in all monitored questionnaires (P < .001), which persisted 12 months after the endoscopy. All evaluated dimensions of the EQ-5D-5L questionnaire indicated a significant improvement in the assessed quality of life (P < .001). The study showed that percutaneous endoscopic lumbar discectomy is an effective pain-treating intervention that can improve the quality of life. There was no observed difference in the percentage of complications or re-herniations when comparing the transforaminal and interlaminar, approaches.
- MeSH
- bederní obratle chirurgie MeSH
- diskektomie MeSH
- endoskopie MeSH
- kvalita života MeSH
- lidé MeSH
- lumbalgie * etiologie chirurgie MeSH
- meziobratlová ploténka * MeSH
- perkutánní diskektomie * MeSH
- výhřez meziobratlové ploténky * chirurgie MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- časopisecké články MeSH
- klinické zkoušky MeSH
Acute traumatic intervertebral disc herniation of the thoracic spine is a rather rare injury with only a few reported cases to date. In this manuscript, we present a case of a 58-year-old male patient who sustained a car accident-related high-energy trauma, resulting in a disc herniation of the thoracic spine. Furthermore, we also discuss the possible implications of late diagnosis of such condition. The patient was initially referred from the Emergency Department as a case of head contusion with a left upper limb paresis. Due to only minimal bony trauma visible on the initial spine CT scan, the neurological deficit was attributed to the cranial trauma. The diagnosis of a traumatic disc herniation was therefore established only after the rapid onset of paraparesis, which gradually progressed into paraplegia, and a following spine MRI scan. Despite the subsequent urgent spinal decompression, the neurological functions of the lower limbs were not restored. This manuscript addresses the indications for performing MRI scans in polytrauma patients with a CT-verified spine trauma. Although it may be complicated to perform routine MRI scans in all such patients in daily practice, it can certainly help diagnose such injuries earlier and thus prevent potential permanent neurological damage to the patients. Key word: spine injury, traumatic disc herniation, thoracic spine, spine surgery.
- MeSH
- chirurgická dekomprese MeSH
- dolní končetina MeSH
- lidé středního věku MeSH
- lidé MeSH
- polytrauma * MeSH
- urgentní služby nemocnice MeSH
- výhřez meziobratlové ploténky * diagnostické zobrazování chirurgie MeSH
- Check Tag
- lidé středního věku MeSH
- lidé MeSH
- mužské pohlaví MeSH
- Publikační typ
- anglický abstrakt MeSH
- časopisecké články MeSH
- kazuistiky MeSH
INTRODUCTION: Percutaneous endoscopic cecostomy (PEC) is a viable treatment option for patients with persistent or recurrent acute colonic pseudo-obstruction (ACPO; Ogilvie's syndrome). It should be generally considered in patients that are refractory to pharmacologic and endoscopic decompression, especially those not amenable to surgical intervention due to an increased perioperative risk. Physicians are rather unfamiliar with this approach given the limited number of reports in the literature and paucity of guideline resources, although guidelines concerning ACPO and covering the role of endoscopy were recently published by three major expert societies, all within the last 2 years. PATIENTS AND METHODS: We retrospectively identified three consecutive patients who underwent PEC placement at a Czech tertiary referral center between May 2018 and December 2021: all for recurrent ACPO. In addition, we summarized the current guidelines in order to present the latest knowledge related both to the procedure and management approach in patients with ACPO. RESULTS: The placement of PEC was successful and resulted in clinical improvement in all cases without any adverse events. CONCLUSION: The results of our experience are in line with previous reports and suggest that PEC may become a very useful tool in the armamentarium of modalities utilized to treat ACPO. Furthermore, the availability of guideline resources now offers comprehensive guidance for informed decision-making and the procedural aspects.
- MeSH
- bederní obratle chirurgie MeSH
- cékostomie * MeSH
- chirurgická dekomprese metody MeSH
- gastrointestinální endoskopie MeSH
- lidé MeSH
- pseudoobstrukce tlustého střeva * chirurgie MeSH
- retrospektivní studie MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- audiovizuální média MeSH
- časopisecké články MeSH
- kazuistiky MeSH
- práce podpořená grantem MeSH
- přehledy MeSH
PURPOSE OF THE STUDY This article presents the evidence and the rationale for the recommendations for surgical treatment of degenerative lumbar stenosis (DLS) and spondylolisthesis that were recently developed as a part of the Czech Clinical Practice Guideline (CPG) "The Surgical Treatment of the Degenerative Diseases of the Spine". MATERIAL AND METHODS The Guideline was drawn up in line with the Czech National Methodology of the CPG Development, which is based on the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) approach. We used an innovative GRADE-adolopment method that combines adoption and adaptation of the existing guidelines with de novo development of recommendations. In this paper, we present three adapted recommendations on DLS and a recommendation on spondylolisthesis developed de novo by the Czech team. RESULTS Open surgical decompression in DLS patients has been evaluated in three randomized controlled trials (RCTs). A recommendation in favour of decompression was made based on a statistically significant and clinically evident improvement in the Oswestry Disability Index (ODI) and leg pain. Decompression may be recommended for patients with symptoms of DLS in the event of correlation of significant physical limitation and the finding obtained via imaging. The authors of a systematic review of observational studies and one RCT conclude that fusion has a negligible role in the case of a simple DLS. Thus, spondylodesis should only be chosen as an adjunct to decompression in selected DLS patients. Two RCTs compared supervised rehabilitation with home or no exercise, showing no statistically significant difference between the procedures. The guideline group considers the post-surgery physical activity beneficial and suggests supervised rehabilitation in patients who have undergone surgery for DLS for the beneficial effects of exercise in the absence of known adverse effects. Four RCTs were found comparing simple decompression and decompression with fusion in patients with degenerative lumbar spondylolisthesis. None of the outcomes showed clinically significant improvement or deterioration in favour of either intervention. The guideline group concluded that for stable spondylolisthesis the results of both methods are comparable and, when other parameters are considered (balance of benefits and risks, or costs), point in favour of simple decompression. Due to the lack of scientific evidence, no recommendation has been formulated regarding unstable spondylolisthesis. The certainty of the evidence was rated as low for all recommendations. DISCUSSION Despite the unclear definition of stable/unstable slip, the inclusion of apparently unstable cases of DS in stable studies limits the conclusions of the studies. Based on the available literature, however, it can be summarized that in simple degenerative lumbar stenosis and static spondylolisthesis, fusion of the given segment is not justified. However, its use in the case of unstable (dynamic) vertebral slip is undisputable for the time being. CONCLUSIONS The guideline development group suggests decompression in patients with DLS in whom previous conservative treatment did not lead to improvement, spondylodesis only in selected patients, and post-surgical supervised rehabilitation. In patients with degenerative lumbar stenosis and spondylolisthesis with no signs of instability, the guideline development group suggests simple decompression (without fusion). Key words: degenerative lumbar stenosis, degenerative spondylolisthesis, spinal fusion, Clinical Practice Guideline, GRADE, adolopment.
- MeSH
- bederní obratle chirurgie MeSH
- chirurgická dekomprese metody MeSH
- fúze páteře * MeSH
- lidé MeSH
- spinální stenóza * chirurgie MeSH
- spondylolistéza * komplikace chirurgie MeSH
- stenóza chirurgie MeSH
- výsledek terapie MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- anglický abstrakt MeSH
- časopisecké články MeSH
- systematický přehled MeSH
PURPOSE OF THE STUDY The paper presents a monocentric retrospective study of patients treated surgically for spinal tuberculosis. Clinical and radiological results are analysed, early and late complications are recorded. The study aims to answer the following questions. 1. Can we use instrumentation to restore the stability and alignment in the infected spinal focus? 2. Should we always perform radical anterior resection of TBC lesions? 3. What is the prognosis of surgical treatment of TBC patients with neurological deficit manifestation? MATERIAL AND METHODS Between 2010 and 2020, a total of 12 patients were treated for spinal tuberculosis at our department, of whom 9 patients (5 men, 4 women) with the mean age of 47.3 years (range 29 to 83 years) underwent a surgery. A total of three patients were operated on before the final confirmation of the TBC and treatment with antituberculosis medication, four patients in the initial therapy phase and two patients in the continuous phase. Two patients only underwent a non-instrumented decompression surgery followed by external support fixation. In the other seven patients, always with spinal deformity, instrumentation was used (3 cases of isolated posterior decompression, transpedicular fixation, posterior fusion, 4 cases of anteroposterior instrumented reconstruction). In 2 cases a structural bone graft and in 2 cases an expandable titanium cage were used for anterior column reconstruction. RESULTS Of the total number of patients, altogether eight patients were assessed at 1 year after surgery (one 83-year-old patient died from heart failure 4 months after surgery). Of the remaining eight patients, three patients exhibited a neurological deficit and postoperative regression of the finding. The McCormick score improved from the preoperative mean score of 3.25 to 1.62 at 1 year after surgery (p < 0.001). The clinical VAS score regressed from 5.75 to 1.63 at 1 year after surgery (p < 0.001). Radiographic healing of the anterior fusion was achieved in all patients, both after decompression and instrumented surgery. The initial mean kyphosis of 20.36 degrees of the operated segment measured by the mCobb angle was corrected to 14.6 degrees postoperatively, with a subsequent slight deterioration to 14.86 degrees (p < 0.05). The greatest correction was achieved in patients who had undergone a two-stage surgery with anterior resection and AP reconstruction. DISCUSSION In our cohort, titanium instrumentation was used in seven of nine patients. One patient only manifested persistent tuberculosis with nonspecific bacterial flora superinfection. Revision surgery with anterior radical debridement and subsequent treatment with antituberculotic drugs healed the patient. There were four patients with major preoperative neurological deficit persisting more than 2 weeks before the final treatment with subsequent improvement in all cases. These patients were treated with anteroposterior reconstruction and anterior radical debridement. CONCLUSIONS No increased risk of recurrent infection associated with the use of spinal instrumentation was found in the study. Anterior radical debridement is performed in patients with manifested kyphotic deformity and spinal canal compression, followed by reconstruction with a structural bone graft or a titanium cage. The other patients are treated based on the principle of "optimal" debridement with or without the use of transpedicular instrumentation. If adequate spinal canal decompression and stability are achieved, neurological improvement can be anticipated even in case of a major neurological deficit. Key words: spine tuberculosis, tuberculous spondylitis, Pott's disease, anterior debridement, spine instrumentation.
- MeSH
- bederní obratle chirurgie MeSH
- chirurgická dekomprese MeSH
- debridement metody MeSH
- discitida * chirurgie MeSH
- dospělí MeSH
- fúze páteře * MeSH
- hrudní obratle chirurgie MeSH
- lidé středního věku MeSH
- lidé MeSH
- retrospektivní studie MeSH
- senioři nad 80 let MeSH
- senioři MeSH
- titan MeSH
- tuberkulóza páteře * chirurgie 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
- anglický abstrakt MeSH
- časopisecké články MeSH
- kazuistiky MeSH
