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Anterior Surgery in Multilevel Stenosis of the Lower Cervical spine: Technical Indications and Personal Experience. 12 Years Follow-Up

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International Journal of Clinical Medicine 2014年第4期5卷 157-161页

作者： Alessandro Landi Nicola Marotta Cristina Mancarella Carlotta Morselli Roberto Tarantino Andrea Ruggeri Roberto Delfini Department of Neurology and Psychiatry Division of Neurosur-gery University of Rome “Sapienza” Roma Italy

Objective: cervical spondylotic myelopathy is a progressive degenerative cervical spine disease. During later stages of segmental degeneration, kyphosis of the cervical spine can occur and further compromise the spinal cord and nerve roots. Optimal surgical approach remains controversial. The choice to perform an anterior, posterior or combined approach depends on: sagittal alignment, number of involved levels, main compression localization, and clinical status. The anterior approach is recommended when compression involves primarily anterior horn of spinal cord. Methods: between January 2001 and December 2005, 121 patients (42 F, 79 M, mean age 62 years) were operated for cervical spondylosis (98 myelopathy, 23 radiculopathy). Anterior surgical approach was performed in 81 patients. 63 patients were operated performing multilevel discectomy and fusion (ACDF) and 18 patients performing corpectomy and fusion and anterior plating (ACCF). Preoperative documentation collected consisted of cervical X-ray (static-dynamic), cervical spine TC, cervical MRI. Clinical documentation permitted us to obtained clinical status of each patient based on JOA, NDI and VAS. A Clinical and radiological follow-up was performed at 1 month, 3 months, 1 year, 6 years, 12 years. Results: the fusion rate was calculated based on the static and dynamic X-ray (flexion and extension position), only a little percentage of patients underwent CT scan. There were no significant differences between ACDF and ACCF in clinical outcome at 6 years evaluated by VAS and NDI. The rate of fusion at 6 years for 2 levels ACCF (92%) was higher than that for 2 levels ACDF (86%) but is not statistically significative. Conclusion: classifying degenerative disease and biomechanics feature, preoperatively in necessary to guide the surgeon to choose the best anterior approach for cervical spondylosis.

关键词： Corpectomy Discectomy Multilevel Cervical spine

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Isolation of <em>Mycobacterium celatum</em>from a Case of Koch’s spine

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Journal of Tuberculosis Research 2014年第1期2卷 1-3页

作者： Gayathri Devi P. Ashok Kumar R. Ranganath Department of Microbiology M.S. Ramaiah Medical College Bangalore India

Mycobacterium celatum is a newly discovered micro-organism causing disseminated infections in immuno compromised patients. Here we report a case of Mycobacterium celatum in an apparently immuno competent young patient with Koch’s spine, the organism was confirmed at tuberculosis research centre, Chennai. The patient was started with clarithromycin and ciprofloxin along with category-I ATT.

关键词： Mycobacterium celatum Tuberculosis Koch’s spine

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Do unemployment and payor category impact length of stay and hospital charges of spine fusion patients?

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Health 2012年第3期4卷 150-154页

作者： Mohammad Sami Walid Nadezhda Zaytseva Aaron C. M. Barth Joe Sam Robinson Jr. Medical Center of Central Georgia Macon USA

Introduction: In this paper we investigate the possible connection between socioeconomic status as demarcated by employment and in-surance status and consumption of healthcare resources in spine surgery patients. Methods: The clinical records of 1599 spine surgery pa-tients counted from 2008-2009 were reviewed. The largest groups of patients belonged to MS-DRG 460 (N = 585) and to MS-DRG 473 (N = 700). These two MS-DRG patient groups were used as the study cohort representing patients who, by definition, did not have serious comor-bidities or complications. Results: Unemployed non-cervical patients tended to stay on average 1.8 days longer in hospital and had on average $5800 higher hospital charges. No major differ-ences were noted in length of stay and hospital cost between government and private insurance patients. However, self-pay non-cervical fusion patients had notable increases in length of stay and hospital cost, especially in the >39 and <60 age group with the difference in length of stay amounting to 5 days and in hospital charges to $10,000. Univariate analysis with DRG (460 or 473) as a covariate showed significant impact from employment status on length of stay (F = 4.259, P = 0.014) and less significant impact from payor category on hospital charges (F = 2.229, P = 0.064) in the economically-productive 40 -59 age group. Conclusions: In general, no increase in hospital resource consumption was noted except among self-pay patients, the same group seemingly least able to afford expensive healthcare.

关键词： spine Fusion Hospital Charges Payor Category

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C1-C2 Pott’s Disease, a Rare Location of spine Tuberculosis

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Open Journal of Rheumatology and Autoimmune Diseases 2013年第4期3卷 224-226页

作者： Honoré Ntsiba Norbert Edgard Lamini N’Soundhat Daphtone Nkouala Kidédé Rheumatology Department of Brazzaville University Teaching Hospital Brazzaville Congo.

The authors report a new case of spine tuberculosis of C1-C2 occurred in a 58-year-old negative HIV patient that was responsible of inflammatory cervical pain with multidirectional stiffness and complicated by spastic quadriplegia. The diagnosis was made on the basis of presumptive elements, including cervical spinal CT scan, which showed atlan-to-axial subluxation (C1-C2) with destruction of the odontoid apophysis and lateral mass of the atlas and favorable evolution under specific antibiotic treatment with ethambutol, isoniazid, rifampicin, pyrazinamide and immobilization with brace cast, despite the absence of bacteriological and anatomo-pathological evidence of certainty. The evolution has been favorable, with the disappearance of cervical pain, progressive motor recovery and resumption of autonomy of walking.

关键词： Pott’s Disease spine Tuberculosis C1-C2 Atlanto-Axial

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Antimicrobial and anticoagulant activities of the spine of stingray Himantura imbricata

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Journal of Coastal Life Medicine 2014年第2期2卷 89-93页

作者： Kaliyamoorthy Kalidasan Velayudham Ravi Sunil Kumar Sahu Murugan Lakshmi Maheshwaran Kathiresan Kandasamy Centre of Advanced Study in Marine Biology Faculty of Marine SciencesAnnamalai UniversityParangipettai-608502Tamil NaduIndia

Objective:To study the spine structure of stingray Himantura imbricata(H.imbricata)and to evaluate the anticoagulant properties of the spine extract obtained through various solvents extracts followed by antibacterial activity against human pathogens.Methods:spines of H.imbricata were collected from Nagappattinam coast,Tamil Nadu,India and their spines were observed under the light microscope.The grounded spines were subjected to extraction of metabolites using methanol,ethanol,chloroform and acetone.Antibacterial activity was evaluated by disc diffusion technique against 10 human pathogens.Similarly,anticoagulant activity was also assessed by following United States Pharmacopeia method.Results:Light microscopic observation of spine revealed that the venom apparatus of the stingray H.imbricata consisted of two to three spines,glandular tissue and a sheath.The spine extract showed potent antibacterial activity against all tested pathogen.Maximum activity(14 mm)was found against Staphylococcus aureus.Crude extract showed 91.50 USP units/mg of anticoagulant activity.Conclusions:Microscopic observations gave new insight about the spine structure of the stingray.The spine extracts of H.imbricate showed potent activity against human pathogens revealed by the good zone of inhibition.Chloroform extracts conferred the most prominent antibacterial activity.The anticoagulant activity was also comparable with that of standard heparin.

关键词： Stingrays Himantura imbricata spine Antimicrobial activity Anticoagulant activity

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Vitamin B12 Screening in Cervical spine Surgery Patients

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Neuroscience & Medicine 2011年第2期2卷 149-153页

作者： Abdullah Tolaymat Moataz Abbara M. Sami Walid Mohammed Ajjan Joe Sam Robinson Jr 不详

Introduction Vitamin B12 is very vital for the nervous system. Its deficiency can manifest with neurological symptoms like pain and paresthesias and in severe cases may cause not completely restorable neurological damage, especially in elderly patients. Methods The charts of 702 patients who underwent cervical spine surgery retrospectively reviewed and data collected . All patients were preoperatively seen by an internist who ordered Vit B12 levels for some of them. We used two thresholds for the diagnosis of vitamin B12 deficiency, 200 and 300 pg/mL as recommended by Yao et al. 1992. Data were also collected on gender, payor status, myelopathy, hemoglobin level, corpuscular parameters and glycosylated hemoglobin level (HbA1c). Vitamin B12 levels were compared between patients with HbA1c levels ≥ 6.1% and <6.1%. Differences between patients ≥ and < than the median age were studied. The median age of the patient cohort was 52. Results Hemoglobin level was recorded for 659 patients. Vit B12 levels were ordered for 291 patients only. Overall, 13.7% had decreased hemoglobin level (anemia), 30.2% had decreased Vit B12 levels by the 300 threshold, 6.9% had decreased Vit B12 levels by the 200 threshold, 6.3% decreased MCV (microcytosis), and 2.8% increased MCV (macrocytosis). Only four patients (0.7%), of whom older than 52, had decreased hemoglobin level and increased MCV (macrocytic anemia) and one patient (0.4%), who was also older than 52, had decreased hemoglobin level, increased MCV and Vit B12 level < 200 pg/mL (macrocytic anemia duo to Vit B12 deficiency). Dividing the patient sample into three age groups, <40, 40-59, and ≥ 60 years, we investigated the trend of cobalamin deficiency by age and found an increase in cobalamin deficiency after 40 from 0% to 7.4% (200 threshold). Uninsured patients (25%) using the 200 pg/mL threshold and workers’ compensation (54.5%) and uninsured patients (50.0%) had the highest rate of Vit B12 deficiency using the 300 pg/mL threshold. The few patients with macrocytic anemia (N=4)

关键词： Vitamin B12 cobalamin Cervical spine Surgery

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Successful Treatment of spine Fracture for Diffuse Idiopathic Skeletal Hyperostosis with Teriparatide—A Report of Two Cases

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Open Journal of Orthopedics 2013年第6期3卷 278-282页

作者： Yasuaki Iida Hiroshi Takahashi Yuichiro Yokoyama Yasuhiro Inoue Daisuke Suzuki Keiji Hasegawa Shintaro Tsuge Wataru Shishikura Katsunori Fukutake Ryo Takamatsu Kazumasa Nakamura Masayuki Sekiguchi Akihito Wada Department of Orthopaedic Surgery Toho University School of Medicine Tokyo Japan Department of Orthopaedic Surgery Toho University School of Medicine Tokyo Japan.

We experienced 2 cases of spinal fracture in patients aged 80 years or older with diffuse idiopathic skeletal hyperostosis (DISH). Since they decided not to undergo surgical treatment, we provided conservative treatment with teriparatide. There has been no previous study on teriparatide for spine fracture in DISH. This is the first report of the successful use of teriparatide to treat spine fracture in DISH without surgical intervention. Our patients were treated with teriparatide for 8-9 months after diagnosis of the fracture. Union was obtained in two cases and no adverse events were observed during treatment. Our report showed that teriparatide could be an alternative to conventional intervention in spinal fracture of DISH.

关键词： Diffuse Idiopathic Skeletal Hyperostosis Teriparatide spine Fracture

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MR Evaluation: spine Changes after Radiotherapy

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Journal of Huazhong University of Science and Technology(Medical Sciences) 1999年第1期19卷 73-77页

作者：李小明王承缘周义成

Summary: To explore the changes in MR findings of the bone marrow of vertebral bodies after radiation therapy, 55 subjects who had been on irradiation treatment were studied. Irradiation dosage ranged from 2100 cGy to 7500 cGy. The interval between radiotherapy and MR examination varied from 7 weeks to 20 years. On T1WI images (T1WI) signal intensity increase of the bone marrow of those vertebral bodies was apparent. The areas with altered signal intensity rendered well defined margins corresponding to the field of irradiation. The similar finding was found on T2WI. On STIR or T1WI with fat suppression, the signal intensity of the areas was decreased. It is concluded that the changes of signal intensity on SE or STIR sequence is believed to be secondary to diffuse fatty infiltration and the results of replacement of the normal bone marrow by relatively increased yellow bone marrow.

关键词： MRI radiotherapy spine

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Epithelioid sarcoma of the spine: a case report and review

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Open Journal of Clinical Diagnostics 2011年第1期1卷 1-4页

作者： Jeong Hyun Yoo 不详

Epithelioid sarcoma is a rare malignant soft tissue neoplasm commonly involving extremities of young adults and rarely occurring in the trunk area. It re-sembles a chronic inflammatory process and mimics benign reactive granuloma or other benign diseases. Despite its indolence and slow growth, the prognosis is poor with high recurrence and early lymph node spreading and hematogeneous distant metastasis. Involvement of the spine is extremely rare and diffi-cult to diagnose correctly in clinical presentation and pathology. We describe our experience a case of epi-thelioid sarcoma involving lumbar spine. A pre-ope- rative spine MRI showed a large solid and necrotic paraspinal mass which extended into the spinal canal with cord compression, and bone destruction. Final correct diagnosis was confirmed by immunohisto-chemical studies. When young adults present with a spinal lesion that has unusual large necrotic soft tissue mass, immunohistochemical studies are recommended for promptly determining the possibility of spinal epithelioid sarcoma.

关键词： Sarcoma Epithelioid: spine Neoplasm: MR Image

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Peripheral T-Cell Lymphoma of Cervical spine

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Surgical Science 2012年第2期3卷 96-99页

作者： Foot-Juh Lian Wen-Chiuan Tsai Cheng-Ta Hsieh Department of Pathology Tri-Service General Hospital National Defense Medical Center Taipei Taiwan (China) Division of Neurosurgery Department of Surgery Cathay General Hospital Taipei Taiwan (China)

Peripheral T-cell lymphoma is a rather uncommon non-Hodgkin’s lymphoma with the initial manifestation of spinal cord compression. Herein, we reported a 74-year-old woman with sustained neck pain radiating into the right shoulder and arm and weakness of the right upper extremity. A mass that had invaded the C5 and C6 vertebral bodies, causing a kyphotic curvature and compressing the spinal cord, was discovered with magnetic resonance imaging. The patient then underwent anterior corpectomy at C5 and C6, and reconstruction with a titanic rod and bone cement. The pathology confirmed a diagnosis of peripheral T-cell lymphoma after serial H & E and immunohistochemical staining. She recovered well from her profound neurological deficit. Both chemotherapy and radiotherapy were used postoperatively. Surgical intervention is indicated in these cases to decompress the cord, remove the majority of the tumor mass, stabilize the spine and obtain tissue for pathological diagnosis.

关键词： Spinal Cord Compression Vertebral Neoplasm Cervical spine Peripheral T-Cell Lymphoma

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