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Copyright of Clinical Neuroscience / Ideggyógyászati Szemle is the property of LifeTime Media Kft. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Anterior sacral meningocele is a protrusion of the dural sac through a bone defect in the sacrum anterior wall. It can occur in isolation or be associated with other malformations, such as the Currarino syndrome, which is part of the classic triad together with hemisacrum and anorectal malformation, although it has great variability. This is the case of an adult woman with chronic constipation, recurrent urinary infection and marked abdominal distension, diagnosed with giant anterior sacral meningocele and incomplete Currarino syndrome. The patient underwent a sacral laminectomy and thecal sac ligation at the level of the bone defect. This article describes this rare type of occult spinal dysraphism as well as the surgical technique used. [ABSTRACT FROM AUTHOR]

Copyright of Revista Médica Clínica Las Condes is the property of Editorial Sanchez y Barcelo and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Epidural anesthesia is a technique that is performed blindly and therefore is not free of complications, among them, a rare complication is the formation of a true knot. We discuss the case of a pregnant woman in whom an epidural block with a true knot formation was placed, which was surgically removed. Conclusion: If an epidural catheter cannot be removed easily, maneuvers described for removal should be applied and imaging studies such as CT or MRI may be used to determine the shape and position of the catheter and whether the catheter has communication with the outside must be extracted surgically. [ABSTRACT FROM AUTHOR]

Objective : Tomographic analysis of the T1 vertebra in children from 0 to 12 years of age, in order to obtain anatomical parameters that assist intralaminar fixation in this pediatric population. Methods : Retrospectively analysis of the spine with CT (cervical and thoracic) of individuals aged between 0 and 12 years old, of both sexes, without anatomical deformities. The CT scans were evaluated separately, on each side, for length and thickness of the laminas as well as spinolaminar angle. The morphometric analysis was performed with iSite PACS Philips Healthcare Informatics(r) program and the values were expressed in millimeters (mm). The variables were correlated with age groups and sex of individuals. Statistical analysis was performed using t test and the results were considered significant when p

Resumo Justificativa e objetivo Pacientes submetidos a procedimentos cirúrgicos espinhais podem evoluir com perda visual pós‐operatória. Apresentamos quadro de perda visual bilateral total em paciente que, apesar de apresentar fatores de risco clínicos e cirúrgicos para lesão orgânica, evoluiu com distúrbio visual conversivo. Relato de caso Masculino, 39 anos; 71 kg; 1,72 m; ASA I, admitido para realização de artrodese e discectomia em L4‐L5 e L5‐S1. Venóclise, cardioscopia, oximetria, PANI; indução com remifentanil, propofol e rocurônio; intubação com TOT 8,0 mm seguida por capnografia e diurese por sondagem vesical. Manutenção em anestesia venosa total alvo‐controlada. Durante fixação e laminectomia, evoluiu com importante sangramento e choque hipovolêmico. Após 30 minutos obteve‐se hemostasia e estabilidade hemodinâmica com infusão de noradrenalina, expansão volêmica e hemoderivados. Na UTI, evoluiu com confusão mental, fraqueza em membros e perda visual bilateral. Não foi possível identificar achados clínicos, laboratoriais ou de imagem para lesão orgânica. Evoluiu com episódios de ansiedade, labilidade emocional e distúrbio de linguagem; foi aventada hipótese de síndrome conversiva com componente visual após avaliação psiquiátrica. Apresentou melhoria total de sintomas visuais após educação e introdução de baixas doses de antipsicótico, antidepressivo e benzodiazepínico. Houve regressão dos demais sintomas com alta no décimo segundo dia pós‐operatório. Encontrava‐se assintomático após 60 dias. Conclusões Distúrbios conversivos podem apresentar diversos sinais e sintomas de origem não orgânica, incluindo componente visual. Destaca‐se que a ocorrência desse tipo de disfunção visual no pós‐operatório de cirurgias espinhais é evento raro e deve ser lembrado como diagnóstico diferencial. Background and objective Patients undergoing spinal surgeries may develop postoperative visual loss. We present a case of total bilateral visual loss in a patient who, despite having clinical and surgical risk factors for organic lesion, evolved with visual disturbance due to conversion disorder. Case report A male patient, 39 years old, 71 kg, 1.72 m, ASA I, admitted to undergo fusion and discectomy at L4‐L5 and L5‐S1. Venoclysis, cardioscopy, oximetry, NIBP; induction with remifentanil, propofol and rocuronium; intubation with ETT (8.0 mm) followed by capnography and urinary catheterization for diuresis. Maintenance with full target‐controlled intravenous anesthesia. During fixation and laminectomy, the patient developed severe bleeding and hypovolemic shock. After 30 minutes, hemostasis and hemodynamic stability was achieved with infusion of norepinephrine, volume expansion, and blood products. In the ICU, the patient developed mental confusion, weakness in the limbs, and bilateral visual loss. It was not possible to identify clinical, laboratory or image findings of organic lesion. He evolved with episodes of anxiety, emotional lability, and language impairment; the hypothesis of conversion syndrome with visual component was raised after psychiatric evaluation. The patient had complete resolution of symptoms after visual education and introduction of low doses of antipsychotic, antidepressant, and benzodiazepine. Other symptoms also regressed, and the patient was discharged 12 days after surgery. After 60 days, the patient had no more symptoms. Conclusions Conversion disorders may have different signs and symptoms of non‐organic origin, including visual component. It is noteworthy that the occurrence of this type of visual dysfunction in the postoperative period of spinal surgery is a rare event and should be remembered as a differential diagnosis. [ABSTRACT FROM AUTHOR]

Lumbar stenosis is an increasingly common pathological condition that is becoming more frequent with increasing mean life expectancy, with high costs for society. It has many causes, among which degenerative, neoplastic and traumatic causes stand out. Most of the patients respond well to conservative therapy. Surgical treatment is reserved for patients who present symptoms after implementation of conservative measures. Here, a case of severe stenosis of the lumbar spine at several levels, in a female patient with pathological and surgical antecedents in the lumbar spine, is presented. The patient underwent two different decompression techniques within the same operation.

OBJECTIVE: Evaluate and correlate the functional response of patients with cervical myelopathy with the current clinical scores in patients who underwent surgical treatment. METHODS: We analyzed medical records of 34 patients with cervical myelopathy who underwent four different types of surgery. All patients were evaluated preoperatively and postoperatively with the application of the JOA and Nurick questionnaires. RESULTS: Functional clinical improvement was statistically significant. The mean preoperative JOA was 8.5 ± 3.06 and 10.7 ± 3.9 in the postoperative; Nurick was 3.2 ± 1.1 preoperatively and 2.8 ± 1.3 postoperatively. CONCLUSION: There is benefit with the surgical procedure in patients with cervical myelopathy. The neurological function after surgery depends on the previous function (the higher the duration of the previous symptoms, the greater the progression of the disease and, therefore, worse the neurological function) and the age is not a relevant factor of improvement, as already shown in other series. The clinical functional improvement of patients is visible with surgical treatment, regardless of surgical technique.

OBJECTIVE: To analyze the development of mechanical complications as a result of spinal decompression or cauda equina in patients with metastatic tumors of the spine via laminectomy or laminoartrectomy without fixation. METHODS: We studied the medical records of all patients submitted to spine decompression with laminectomy without fixation. The decompression was indicated to treat cord compression or cauda equina caused by metastatic tumors. Patients were evaluated for the development of postoperative mechanical instability by comparing the preoperative radiological examinations with the latest one available in the medical record review.. In these images, we evaluated the emergence of new deformity in the sagittal or coronal planes and translational deformity. We consider new deformity, signs of deformity greater or equal to 5° in the coronal or sagittal planes and signs of increased vertebral translation greater than or equal to 3 mm. RESULTS: No patient developed radiological instability in the period evaluated with an average follow-up of 163.24 days (3-663). The complication rate in our sample was not higher than the previously reported in the literature. CONCLUSION: Isolated laminectomy at one or more levels is a safe procedure for the treatment of metastatic spinal cord compression where the spine is judged stable before surgery.

Objective: To introduce a new minimally invasive surgical approach to anterior and lateral craniocervical junction diseases, preserving the midline posterior cervical spine stabilizing elements and reducing the inherent morbidity risk associated with traditional approaches. Methods: We describe a novel surgical technique in four cases of extra-medullary anterolateral compressive lesions located in the occipito-cervical junction, including infections and intra- and/or extradural tumor lesions. We used a paramedian trasmuscular approach through an anatomical muscle corridor using a micro MaXcess(r) surgical expandable retractor, with the purpose of reducing morbidity and preserving the posterior muscle and ligamentous tension band. Results: This type of surgical approach provides adequate visualization and microsurgical resection of lesions and reduces muscle manipulation and devascularisation, preserving the tension of the ligament complex. There was minimal blood loss and a decrease in postoperative pain, with rapid start of rehabilitation and shorter hospitalization times. There were no intraoperative complications, and all patients recovered from their pre-operative symptoms. Conclusions: This novel surgical technique is feasible and adequate for the occipito-atlanto-axial complex, with better results than traditional procedures.

Copyright of Arquivo Brasileiro de Medicina Veterinaria e Zootecnia is the property of Universidade Federal de Minas Gerais, Escola de Veterinaria and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Chiari malformation is characterized by caudal displacement of the cerebellar tonsils that penetrate into the spinal canal through the foramen magnum, achieving reach the atlas or axis. trunk and any drop of the fourth ventricle is observed. Typically is seen in young adults. In some cases scoliosis and Syringomyelic cavities may occur. The authors present (as far as they know) the first case in the literature with long term follow-up, of a caucasian woman with an unusual form of cerebellar atrophy and Chiari Type I malformation, suffering from weakness in his upper and lower extremities with rapidly progression. The patient was successfully treated with suboccipital decompression and C1 laminectomy. [ABSTRACT FROM AUTHOR]

El hematoma epidural espinal es un hallazgo poco frecuente en la práctica médica. Se presenta un caso de una paciente portadora en la región dorsal, donde su forma de presentación también se consideró muy inhabitual y confusa; esta debutó con un dolor precordial con irradiación del brazo izquierdo, la espalda y el estómago, instaurándose después una mielitis transversa dorsal. Se presenta el resultado de la resonancia magnética nuclear dorsal, con consideraciones diagnósticas de los diferentes tipos de hematomas espinales. Se realizó una laminectomía desde D3 a D6 y se evacuó un extenso hematoma epidural desde D1 a D8.Epidural spinal hematoma is an infrequent finding in medical practice. A case of a female patient suffering from a pain in the dorsal region, with its way of presentation was also considered as an unusual and confuse occurrence; it started with precordial pain irradiating left arm, back and stomach, establishing a dorsal transverse myelitis. The result of a nuclear magnetic resonance is presented with diagnostic considerations of different types of spinal hematomas. A laminectomy from D3 to D6 was performed and a large epidural hematoma from D1 to D8 was evacuated.

OBJECTIVE: Extradural arachnoid cysts (EACs) are rare causes of spinal cord compression and cauda equina. These benign lesions appear in the literature mainly as single case reports. In this article, we present the largest series found in literature, with four new cases of spinal extradural arachnoid cysts. The characteristic imaging features, details of surgical steps and strategies to prevent postoperative kyphosis in this cystic pathology will be discussed.

Se presenta el caso clínico de un paciente de 57 años de edad, de la raza blanca, con cuadro clínico de compresión medular dorsal, por lo cual se le realizó una laminectomía de D5-D7, con resección de una lesión extradural, de color vino, redondeada, de 3x2x2 cm. Los resultados de la biopsia confirmaron el diagnóstico de una malformación angiomatosa (cavernoma). La cirugía es el tratamiento ideal para estos tipos de lesiones y la resonancia magnética de columna, un estudio útil para diagnosticar y tratar a los afectados.The clinical case of a white 57 year-old patient is presented, with clinical pattern of dorsal medullary compression, reason why a laminectomy of D5-D7 was carried out, with resection of an extradural, rounded, wine colored lesion, of 3x2x2 cm. The results of the biopsy confirmed the diagnosis of an angiomatous malformation (cavernoma). Surgery is the ideal treatment for these types of lesions and the spine magnetic resonance is an useful study to diagnose and to treat those affected.

OBJETIVO: La espondilolistesis ístmica del adulto se puede tratar con reparación del defecto, descompresión (sola o con fusión), fusión circunferencial, y reducción con fijación posterior. El objetivo de este trabajo es valorar los resultados a medio plazo de la descompresión y fusión in situ en pacientes operados por un solo cirujano. MÉTODO: Criterios de Inclusión: 1) Espondilolistesis Ístmica L5-S1. 2) Operados en madurez esquelética. 3) Laminoartrectomía de L5 con Artrodesis posterolateral instrumentada sin reducción. 4) Más de 3 años de seguimiento. 5) Ausencia de pseudoartrosis al seguimiento. 6) Valoración funcional y radiológica por observador independiente. Comparación de datos con bibliografía. Análisis estadístico con t - test, Chi cuadrado y ANOVA. RESULTADOS: 16 pacientes (12 ♀/4 ♂) evaluados. Edad promedio: 40,6 años (17 - 66); seguimiento promedio: 10.3 años (3.3 - 18). Deslizamiento promedio: 42,9%. Nueve presentaban dolor radicular, 3 dolor lumbar y 4 dolor lumborradicular. Score del dolor (SRS) preoperatorio promedio: 1.38, sin diferencias entre bajo y alto grado (p=0.887). 15/16 mejoraron (score final promedio: 4.44). 13/16 retornaron a su actividad previa (81%). Hubo 2 infecciones; no hubo complicaciones neurológicas. Los parámetros espinopélvicos finales, comparados con la literatura no mostraron diferencias estadísticas. La comparación entre listesis de bajo y alto grado en la serie no mostró diferencia significativa en dichos parámetros, ni en tiempo de seguimiento, niveles artrodesados, síntomas ni retorno al trabajo. CONCLUSIÓN: La descompresión y fusión posterolateral instrumentada in situ permite un 80% de buenos resultados en la espondilolistesis ístmica lumbosacra del adulto sin importar el grado.OBJETIVO: A espondilolistese ístmica dos adultos pode ser tratada com reparo do defeito, descompressão (isolada ou com fusão), fusão circunferencial e redução com fixação posterior. O objetivo foi avaliar os resultados a médio prazo da descompressão e fusão in situ em pacientes submetidos a tratamento cirúrgico por um só cirurgião. MÉTODO: Critérios de inclusão: 1) Espondilolistese ístmica L5-S1. 2) Cirurgia depois da maturidade esquelética. 3) Lâmino-artrectomia e artrodese póstero-lateral instrumentada em L5 sem redução. 4) Mais de três anos de acompanhamento. 5) Ausência de pseudoartrose no acompanhamento. 6) Avaliação funcional e radiológica por observadores independentes. Comparação com a literatura. Análise estatística por teste "t", qui quadrado e ANOVA. RESULTADOS: Foram avaliados 16 pacientes (12 ♀ e 4 ♂). Média de idade: 40,6 anos (17-66), acompanhamento médio: 10,3 anos (3,3-18). Média do deslizamento: 42,9%. Nove tinham dor radicular, 3 lombar, 4 dor radicular e lombar. Pontuação de dor pré-operatória média (segundo SRS): 1,38, sem diferenças entre baixo e alto grau (p=0,887). Quinze em 16 pacientes tiveram melhora dos sintomas (pontuação final média: 4,44). Treze em 16 pacientes retornaram à atividade anterior (81%). Houve duas infecções, mas nenhuma complicação neurológica. Os parâmetros espino-pélvicos no final do acompanhamento não apresentaram diferenças estatísticas em relação com os valores encontrados na literatura. A comparação entre deslizamentos de baixo e alto grau da série não mostrou diferença significante nesses parâmetros nem em tempo de acompanhamento, níveis com artrodese, sintomas ou retorno ao trabalho. CONCLUSÃO: A descompressão póstero-lateral e fusão instrumentada in situ permitem 80% de bons resultados na espondilolistese ístmica lombossacral em adultos, independentemente do grau de deslizamento.OBJECTIVE: Adult isthmic spondylolisthesis can be treated with direct repair of the defect, decompression (alone or with posterolateral fusion), circumferential fusion, and reduction with posterior fixation. The aim of this work is to assess the mid-term results of decompression and in situ fusion among patients undergoing surgical treatment with the same surgeon. METHOD: Inclusion criteria: 1) L5-S1 Isthmic spondylolisthesis. 2) Surgery performed after skeletal maturity. 3) L5 laminectomy and arthrectomy with posterolateral instrumented fusion without reduction. 4) Follow-up greater than 3 years. 5) No pseudoarthrosis at follow-up. 6) Functional and radiological assessment by independent observers; literature review and data comparison; statistical analysis with t-test, chi-squared and ANOVA. RESULTS: 16 patients were evaluated (12 ♀/4 ♂). Mean age: 40.6 years (17-66); mean follow-up: 10.3 years (3.3-18). Average slip: 42.9%. Nine patients had radicular pain, 3 back pain and 4 both. Mean preoperative SRS pain score: 1.38 with no differences between low and high degree (p=0.887). Fifteen of 16 patients had improvement of symptoms (mean final score: 4.44). Thirteen of 16 patients returned to previous activity (81%). There were 2 infections, but no neurologic complications. The spino-pelvic parameters at the end of the follow-up showed no statistical differences compared with the values found in literature. The comparison between low and high degree listhesis in our series showed no significant difference in these parameters or in the follow-up period, fused levels, symptoms or return to work. CONCLUSION: The posterolateral decompression and instrumented fusion in situ allow 80% of good results in lumbosacral isthmic spondylolisthesis in adults regardless of the degree of slip.

OBJETIVO: Avaliar a eficácia do tratamento cirúrgico da mielorradiculopatia espondilótica cervical na produção de melhora neurológica pós-operatória, aferida em pontos pela escala da JOA e taxa de recuperação e as complicações do tratamento. MÉTODOS: Análise dos prontuários e os exames de imagem de 200 indivíduos submetidos a tratamento cirúrgico da mielorradiculopatia cervical no HC-FMUSP, no período de janeiro de 1993 a janeiro de 2007. A avaliação clínica foi quantificada pela escala da JOA, com média de segmento de 06 anos e 08 meses. RESULTADOS: Evidenciou-se melhora neurológica pós-operatória nas vias anterior e posterior, exceto nas laminectomias sem fusão, onde houve piora neurológica tardia. A via anterior mostrou um significante maior índice de complicações, relacionados a déficit de fusão intervertebral, deslocamento de enxerto, síndrome de disco adjacente, disfonia, disfagia, o mau posicionamento de enxerto e placas, lesão de raiz nervosa e significativo maior índice de re-intervenção cirúrgica. Na via posterior maior ocorrência de instabilidade em cifose pós-operatória na laminectomia, não sendo observada na laminoplastia, esta última com índices semelhantes aos encontrados na via anterior. Não houve melhora da dor axial nas laminoplastias e houve piora nas laminectomias, enquanto que nas discectomias e corpectomias houve significativa melhora do sintoma. CONCLUSÃO: As vias anterior e posterior foram eficazes em produzir melhora neurológica, exceto as laminectomias sem fusão. A via anterior produziu mais complicações, mas trata melhor a dor.OBJETIVO: Evaluar la eficacia del tratamiento quirúrgico de la mielorradiculopatía cervical espondilótica en la producción de la mejoría neurológica posoperatoria, medida en puntos en la escala de la JOA y la tasa de recuperación y las complicaciones de la terapia. MÉTODOS: Análisis de los registros médicos y de los exámenes de imagen de 200 pacientes sometidos a tratamiento quirúrgico de la mielorradiculopatía cervical en el HC-FMUSP, desde enero de 1993 a enero de 2007. La evaluación clínica se cuantificó mediante la escala de la JOA, con un segmento promedio de 06 años y 08 meses. RESULTADOS: Se observó una mejoría neurológica posoperatoria en las vías anterior y posterior, con excepción de las laminectomías sin fusión, donde hubo deterioro neurológico tardío. La vía anterior mostró una tasa significativamente mayor de complicaciones relacionadas con el déficit de fusión intervertebral, desplazamiento del injerto, síndrome de disco adyacente, disfonía, disfagia, o mala posición de injerto y placas, lesión de la raíz del nervio y tasa significativamente mayor de nueva intervención quirúrgica. En la vía posterior, mayor incidencia de inestabilidad en la cifosis posoperatoria, en la laminectomía, y en la laminoplastia no se observó esto, teniendo esta última tasas similares a las encontradas en la vía anterior. No hubo mejoría en el dolor axial en las laminoplastias y se agravó en las laminectomías, mientras que en las discectomías y las corpectomías se produjo una mejoría significativa de los síntomas. CONCLUSIÓN Las vías anterior y posterior fueron eficaces en la producción de mejoría neurológica, con excepción de las laminectomías sin fusión. La vía anterior produjo más complicaciones, pero el dolor es mejor tratado.OBJECTIVE: To evaluate the efficacy of surgical treatment of cervical spondylotic myeloradiculopathy in the production of postoperative neurological improvement, measured in points by the scale of JOA (Japanese Orthopaedic Association) and the recovery rate and complications of therapy. METHODS: Analysis of medical records and imaging studies of 200 patients undergoing surgical treatment of cervical myeloradiculopathy in HC-FMUSP, from January 1993 to January 2007. Clinical evaluation was quantified by the scale of the JOA, with an average follow-up of 6 years and 8 months. RESULTS: There was post-operative neurological improvement in the anterior and posterior approach, except in laminectomy without fusion, where late neurological deterioration was observed. The anterior approach showed a significantly higher rate of complications related to poor fusion, intervertebral displacement of the graft, adjacent disc syndrome, dysphonia, dysphagia, poor positioning of the graft and plates, nerve root injury and significant higher rate of re-operation. In the posterior approach, increased occurrence of instability and kyphosis in the postoperative, in laminectomy were found, whereas in laminoplasty these conditions were not observed, presenting similar rates to those found for the anterior approach. There was no improvement in axial pain in the laminoplasties and worsening in laminectomies, whereas in discectomias and corpectomias there was significant relief of symptoms. CONCLUSION: The anterior and posterior routes were effective in producing neurological improvement, except for laminectomy without fusion. The anterior approach produced more complications, but is better for pain treatment.

We report two cases of spontaneous spinal epidural hematoma with different clinical presentations without precipitating factors and a brief review of the literature. Our case first developed acute and had progressive cervical spinal cord signs that determined emergency decompressive laminectomy. On the other hand, the second patient, who was chronic, was operated almost five months after the initial symptoms and the radiological diagnosis was a large facet cyst. Early surgical intervention is the chosen treatment for spontaneous spinal epidural hematomas. Spinal surgeons should bear in mind that spontaneous spinal epidural hematomas may have different clinical presentations according to their location in order to perform a differential diagnosis.Fueron relatados dos casos de hematoma epidural espinal espontáneo con diferentes presentaciones clínicas sin factores precipitantes, y fue hecha una breve revisión de la literatura. Nuestro caso 1 tuvo un desarrollo agudo y mostró señales progresivas en la columna cervical que determinaron una laminectomía descompresiva de emergencia. Por otro lado, el segundo paciente, crónico, fue operado casi cinco meses después de los síntomas iniciales y el diagnóstico radiológico fue de un gran quiste sinovial. La intervención quirúrgica temprana es el tratamiento de elección para hematomas espontáneos epidurales espinales. El tratamiento quirúrgico representa la forma más común de terapia para todos los tipos de presentaciones clínicas. Debemos considerar que el tratamiento conservador (o no) sea más común en casos de presentación leve, principalmente en pacientes con hematoma espinal crónico. Para realizar un diagnóstico diferencial, los cirujanos deben recordar que los hematomas epidurales espinales espontáneos pueden tener distintas presentaciones clínicas según su ubicación.Os autores relatam dois casos de hematoma epidural espinhal espontâneo com diferentes apresentações clínicas e sua revisão da literatura. O primeiro paciente apresentava sinais e sintomas de compressão medular cervical, necessitando de laminectomia de urgência, enquanto no segundo paciente, que era crônico, havia sintomatologia de lombociatalgia por compressão nervosa de evolução de cinco meses e com diagnóstico radiológico de cisto facetário. A intervenção cirúrgica precoce é o tratamento de escolha para os hematomas epidurais espinhais espontâneos. Os hematomas epidurais espinhais espontâneos, conforme a localização na coluna vertebral, diferem na apresentação clínica e no manejo. Na região lombar, o diagnóstico diferencial deve ser feito com patologias degenerativas.

PURPOSE: Evaluate the anesthetic management in intrauterine surgery to induce myelomeningocele in non human primates Macaca mulatta. METHODS: A total of nine fetuses had intrauterine surgery; laminectomy was performed on them in L5 and L6. The studied variables were: maternal death, fetus death, cardiac frequency, respiratory frequency, arterial pressure, temperature, and oxygen saturation. RESULTS: No maternal or fetal deaths occurred; the only variable that was reported below the normal ranges was temperature. CONCLUSION: No maternal or fetal deaths occurred; the only variable that was reported below the normal ranges was temperature.OBJETIVO: Avaliar o manejo anestésico em cirurgia intra-uterina para induzir mielomeningocelo em primatas não humanos, Macaca mulatta. MÉTODOS: Operaram-se um total de nove fetos in útero que foram submetidos à laminectomia em L5 e L6. As variáveis a estudar foram mortes maternas ou fetais, freqüência cardíaca e respiratória, pressão arterial, temperatura e saturação de oxigênio. RESULTADOS: Não se apresentaram mortes maternas ou fetais, a temperatura se manteve abaixo dos 36°C, não tendo repercussões no bem-estar dos macacos. CONCLUSÃO: Não ocorreu nenhum óbito materno ou fetal, sendo que a única variável abaixo do normal foi a temperatura.

OBJETIVO: determinar la longitud de la raíz C5. MÉTODOS: se estudiaron con resonancia magnética (Signa 1,5 T, cortes axiales de 5 mm de espesura, TR=850, TE=26, FOV=200) las columnas cervicales de 50 pacientes (29 hombres - 21 mujeres) entre 26 y 68 años. Se incluyeron solo casos con cervicalgia y/o cervicobraquialgia. Se midió (en mm) la longitud de las raíces cervicales tercera a séptima, derechas e izquierdas. La comparación de los promedios se realizó a través del análisis de varianza, para un nivel de significación α=0,05 con IC de 95%. Las comparaciones post-hoc se hicieron empleando el test de Bonferroni. RESULTADOS: se observó que el lado (derecho o izquierdo) y el sexo (varón o mujer) no tuvieron incidencia estadísticamente significativa en el valor de la longitud de las raíces (p>0,05). La raíz C5 tuvo un tamaño significativamente diferente (pOBJETIVO: determinar o comprimento da raiz C5. MÉTODOS: as colunas cervicais de 50 pacientes (29 homens - 21 mulheres), com idades entre 26 e 68 anos foram analisadas com ressonância magnética (Signa 1,5 T, cortes axiais de 5 mm de espessura, TR=850, TE=26, FOV=200). Foram incluídos casos com dor cervical e/ou cervicobraquial. O comprimento das raízes C3 a C7, à direita e esquerda, foi medido. A comparação das médias foi realizada com uma análise de variância para um nível de significação α = 0,05 com IC de 95%. As comparações post-hoc foram feitas com o teste de Bonferroni. RESULTADOS: foi observado que o lado (direito ou esquerdo) e o sexo (homem ou mulher) não tiveram incidência estatística significante em relação ao valor do comprimento das raízes. A raiz C5 evidenciou um tamanho significativamente diferente (pOBJECTIVE: to determine the length of the C5 root. METHODS: the cervical spines of 50 patients (29 male and 21 female), between 26 and 68 years old, were studied with magnetic resonance imaging (Signa 1.5 T, axial images with 5 mm thickness, TR=850, TE=26, FOV=200). Only patients with cervical and/or arm pain were included. We measured (mm) the length of the right and left, third to seventh cervical roots. A comparison of the average lengths was made with the variance analysis for α=0.05 significance level and a 95% CI. Post-hoc comparisons were made with the Bonferroni test. RESULTS: it was noted that the side (right or left) and gender (male or female) had no influence on the roots' length differences (p>0.05). The C5 root had a length significantly different (p

O objetivo deste experimento foi isolar a musculatura epaxial da medula espinhal de cães submetidos à laminectomia dorsal modificada (LDM) e averiguar se os músculos influenciaram na formação da fibrose epidural, na compressão medular e no aparecimento dos sinais neurológicos. Para isso, dez cães hígidos foram submetidos à LDM entre as vértebras T13 e L1 e distribuídos aleatoriamente em dois grupos denominados controle (I) onde a medula espinhal permaneceu exposta sem a presença de implante, e tratado (II)onde foi colocado um im-plante a base de alumínio entre a musculatura epaxial adjacente e a medula espinhal exposta pela LDM. As avaliações constaram de exames neurológicos diários até 180 dias de pós-operatório (PO); mielografia, decorridos 15, 30 e 60 dias de PO; e avaliação macroscópica mediante a reintervenção cirúrgica. Não houve diferença durante as avaliações neurológicas. Aos 15 dias de PO, foi verificado na mielografia, que o grau de compressão da linha de contraste foi maior no grupo tratado (PThe purpose of this study was to isolate the adjacent epaxial musculature from exposed spinal cord by modified dorsal laminectomy in dogs with aluminum implant and to verify whether the muscles contribute to form epidural fibrosis, spinal cord compression, and development of neurological signs. Ten dogs were submitted to modified dorsal laminectomy between T13 and L1 and then distributed along two groups. Dogs in the group 1 remained with the spinal cord exposed without the implant; dogs in the group 2 had an aluminum implant inserted between the epaxial muscles and the exposed spinal cord. Neurological examination was daily performed until 180 days post surgery. Additionally, myelography at 15, 30, and 60 days post surgery and macroscopic evaluation of the implant at six months post surgery were done. There was no difference between groups in the neurological examination. A statistical difference in the degree of spinal compression was observed at day 15 post surgery in the group 2. In this group, the epaxial musculature adjacent to the spinal cord was not in contact with the epidural fibrosis, differently to what was observed in the control group. The implant was removed easily with some degree of deformity. The results showed that the adjacent musculature of the spinal cord submitted to a modified dorsal laminectomy in dogs can be isolated by aluminum implant, without any contact with epidural fibrosis or influence in the development of neurological signs.

OBJETIVO: pacientes submetidos à laminectomia por via posterior geralmente reclamam de dor severa. A aplicação por via transdérmica de fentanil resulta em sua liberação contínua e poderia ser útil no controle da dor. Este estudo visou avaliar a eficácia do fentanil (F) transdérmico em dor aguda pós-operatória secundária à laminectomia por via posterior. MÉTODOS: após aprovação do Comitê de Ética em Pesquisa e consentimento adquirido, 24 pacientes foram distribuídos de forma aleatória e duplamente encoberta em dois grupos, sendo que 12 pacientes receberam o adesivo de F transdérmico (25 mcg/h) e outros 12 receberam o adesivo placebo. Todos os pacientes foram submetidos à laminectomia posterior, sob anestesia geral padronizada. Os adesivos transdérmicos foram colocados nos pacientes dez horas antes do início da cirurgia e removidos 24 horas após o término dessa. Cetoprofeno por via venosa foi administrado no início da cirurgia, dipirona estava disponível para analgesia de resgate, se necessário, a intervalos mínimos de seis horas. RESULTADOS: os pacientes que receberam F transdérmico apresentaram redução de 60% no consumo de dipirona no período pós-operatório (pOBJETIVO: pacientes sometidos a laminectomía por vía posterior generalmente reclaman de dolor severo. La aplicación por vía transdérmica de fentanil resulta en su liberación continua y podría ser útil en el control del dolor. Este estudio visó evaluar la eficacia del fentanil (F) transdérmico en el dolor agudo postoperatorio, secundario a la laminectomía por vía posterior. MÉTODOS: después de la aprobación por el Comité de Ética en investigación y consentimiento adquirido, 24 pacientes fueron distribuidos de forma aleatoria y duplamente ciegos en dos grupos, siendo que 12 pacientes recibieron el adhesivo de F transdérmico (25 mcg/h) y 12 pacientes recibieron el adhesivo de placebo. Todos los pacientes fueron sometidos a la laminectomía posterior sobre anestesia general estandarizada. Los adhesivos transdérmicos fueron colocados en los pacientes diez horas antes del inicio de la cirugía y removidos 24 horas después de haber terminado la misma. Cetoprofeno por vía venosa fue administrado por vía venosa en el inicio de la cirugía. Dipirona estaba disponible para analgesia de rescate, si era necesario, a intervalos mínimos de seis horas. RESULTADOS: los pacientes que recibieron F transdérmico presentaron reducción de 60% en el consumo de dipirona en el periodo postoperatorio (pObjectives: patients who are submitted to posterior laminectomy often complain of severe pain that is difficult to treat. The transdermal application of the potent opioid fentanyl results in its continuous liberation and consequently could be useful in controlling the pain. This study evaluated the efficacy of transdermal fentanyl (F) delivery system for acute postoperative pain after posterior laminectomy. METHODS: the study was approved by the local Ethic Committee and conducted in the Teaching Hospital. After the patient's consent, 24 patients were randomized to either transdermic F 25 mg/h (n=12) or transdermic placebo (n=12). All patients were submitted to posterior laminectomy under a standard general anesthesia. Transdermic systems were placed during 10 hours preoperatively and removed 24 hours later; 20 minute IV ketoprofen, 2.5 mg/kg was administered following traqueal intubation with propofol, alfentanil and atracurium. IV 20 mg/kg dipyrone act as rescue at a minimum six hours interval. Data was recorded for 36 hours. RESULTS: the transdermic F Group showed 60% of reduction in the rescue dipyrone consumption (p

Synovial sarcoma is an uncommon malignant soft tissue neoplasm, occurring primarily in adolescents and young adults. It is prevalent in the periarticular soft tissues near large joints of the extremities and rarely involves the trunk. Metastases are not uncommon and usually involve the lungs; metastasis to the thoracic spine is rare. We report the case of a 47-year-old man with a history of synovial sarcoma of the lower back, with subsequent metastases to the lung, penis, and perineum (all previously resected), presenting with a 3-month history of low back pain and lower extremity paresthesias. Magnetic resonance imaging (MRI) demonstrated multiple lesions involving multiple contiguous vertebral bodies, with the mass at T12 compressing the spinal cord. The patient underwent T11-T12 laminectomy, transpedicular decompression, tumor debulking, and posterior fixation and fusion. The patient died six months later due to disease progression. Although not curative, decompression and stabilization of the spine are often necessary in patients who present spinal cord compression.El sarcoma sinovial es una neoplasia rara de los tejidos blandos que afecta adolescentes y adultos jóvenes. Su mayor prevalencia es en las grandes articulaciones de las extremidades y raramente ataca el tronco. Las lesiones metastásicas son raras y generalmente atacan los pulmones, siendo que las metástasis de columna torácica son raras. Será relatado el cuadro clínico de un paciente de 47 años de edad con tres meses de historia de dolor lumbar y presentando metástasis de sarcoma sinovial en la columna lumbar. La resonancia magnética demostraba lesiones contiguas del cuerpo vertebral y compresión del canal vertebral al nivel de T12. El paciente fue sometido a la laminectomía de T11-T12, descompresión transpedicular, remoción de tejido tumoral y artrodesis con fijación posterior. El paciente fue a óbito después de seis meses debido a la progresión de la enfermedad. Aunque la descompresión y estabilización quirúrgica del canal vertebral no sea curativa, ese procedimiento puede ser necesario en los pacientes que presentan compresión de la médula espinal.O sarcoma sinovial é uma neoplasia rara dos tecidos moles que afeta adolescentes e adultos jovens. A sua maior prevalência é nas grandes articulações das extremidades e raramente acomete o tronco. As lesões metastáticas são raras e geralmente acometem os pulmões, e as metástases para a coluna torácica são raras. Relata-se o caso de um paciente de 47 anos de idade com 3 meses de história de dor lombar e que apresentava metástase de sarcoma sinovial na coluna lombar. A ressonância magnética demonstrava lesões contíguas do corpo vertebral e compressão do canal vertebral ao nível de T12. O paciente foi submetido à laminectomia de T11-T12, descompressão transpedicular, remoção tecido tumoral e artrodese e fixação posterior. O paciente foi a óbito após seis meses devido à progressão da doença. Embora a descompressão e estabilização cirúrgica do canal vertebral não sejam curativas, esses procedimentos podem ser necessários em pacientes que apresentam compressão da medula espinhal.

Pigmented Villonodular Synovitis (PVNS), a lesion of the synovial tissues, is rarely found in the spine. We present a 73-year-old male with increasing lower extremity weakness and paresthesias. MRI scans revealed disc herniation and spinal cord compression at the T11-T12 and T12- L1 levels. Intraoperative exploration revealed an epidural mass originating in the T12 lamina, compressing the spinal cord at T11-T12. Pathologic examination was consistent with pigmented villonodular synovitis.Sinovitis vellonodular pigmentada (PVNS) es una lesión del tejido sinovial y raramente se encuentra en la columna vertebral. Presentamos el caso de un hombre de 73 años de edad que mostró aumento de la flaqueza de la extremidad inferior y parestesias. El examen de imagen por resonancia magnética indicó una hernia de disco y compresión en el nivel de T11-T12 y T12-L1. La exploración quirúrgica evidenció una masa epidural originaria en T2 y compresión de la médula espinal a nivel de T11-T12. El examen patológico fue compatible con sinovitis vellonodular pigmentada.Sinovitis pigmentada vilonodular (PVNS) é uma lesão do tecido sinovial e raramente é encontrada na coluna vertebral. Apresentamos o caso de um homem de 73 anos de idade com aumento de fraqueza da extremidade inferior e parestesia. O exame de imagem por ressonância magnética revelou hérnia de disco e compressão no nível T11-T12 e T12-L1. A exploração cirúrgica evidenciou massa epidural orginária em T2 e compressão da medula espinhal no nível de T11-T12. O exame patológico foi compatível com sinovitis pigmentada vilonodular .

As hérnias discais extremolaterais correspondem a 10% das hérnias discais sintomáticas, mais comumente localizadas nos níveis L3-L4 e L4-L5. Por muitos anos, a abordagem cirúrgica das hérnias lombares foraminais e extraforaminais foi feita através de via de acesso posterior mediana com hemilaminectomia e facetectomia total ou parcial. A abordagem cirúrgica dessa patologia pela via paramediana, entre os músculos multífido e longuíssimo (via de Wiltse), tem a vantagem de poupar o paciente de perdas ósseas e permitir uma visão mais oblíqua do neuro-foramen. Essa abordagem permite, com mínima mobilização da raiz de L4, acesso ao disco L4-L5 e eventuais herniações extra-foraminais do mesmo. Nosso objetivo é avaliar se há relação entre características antropométricas de um indivíduo e a localização da raiz de L4 no espaço intertransversário, acessado pela via de Wiltse, para com isso poder antecipar alguns riscos cirúrgicos. Foram realizadas dissecções em 21 cadáveres (42 lados) e obtidas as respectivas medidas de peso e altura além da distância entre a base do processo transverso de L5 e o ponto onde a raiz de L4 o cruza. A análise dos dados nos permite concluir que não há relação estatisticamente significativa entre as variáveis envolvidas.Far lateral disc hernias account for ten percent of all symptomatic disc hernias, usually located at L3-L4 and L4-L5 levels. For many years, the surgical approach to foraminal and extraforaminal lumbar disc hernias was provided through the median posterior access way, with total or partial hemilaminectomy and facetectomy. The advantage of the surgical approach for this pathology through the paramedian way, between the multifidus and longissimus muscles (Wiltse’s access) is to spare patients from bone losses and to allow a more oblique view of the neuroforamen. Moreover, this approach allows for accessing the L4-L5 disc and its potential extraforaminal herniations with minimum L4 root mobilization. Our objective is to assess the potential correlation between anthropometric parameters and the L4 root topography. Twenty-one cadavers (42 sides) were dissected and some parameters were measured: cadavers’ weight and height, width of the L5 transverse process, distance between L5 transverse process base and the point where the L4 root crosses it. The analysis of data allows us to conclude that no statistically significant correlation exists among the involved variables.

Os autores investigaram a aplicação de uma membrana biológica, constituída de cortical óssea bovina descalcificada, em cirurgias de coluna vertebral de ratos, com o intuito de tratar o defeito ósseo minimizando ou impedindo a herniação do tecido muscular para dentro do canal raquidiano pós laminectomia, inibindo a formação de fibrose pós-operatória e avaliando a biocompatibilidade do material. O estudo foi feito utilizando-se de ratos Wistar-EPM, que após intervalos de 8, 16 e 24 semanas, foram sacrificados, sendo removidas as peças cirúrgicas para análise anatomopatológica. A membrana biológica evitou a herniação do tecido muscular para o canal raquidiano, sendo totalmente reabsorvida em todas as peças analisadas, demonstrando sua biocompatibilidade e favorecendo a neoformação óssea e evitando aderências.The prevention of fibrosis after lumbar and thoracic laminectomies by avoiding herniation of muscular tissue was studied using Wistar-EPM rats with a biological membrane made of decorticated bone of bovine material. The rats were sacrified after eight, sixteen and twenty four weeks and the materal was sent to anatomopathological study. This membrane proved to be biocompatible and its efficacy was seen by allowing formation of bone and preventing muscular tissue invasion of the epidural space and avoiding adherences.

The laminectomy in rats is a procedure commonly used in both functionality experimental designs and in electrophysiology assays. Also, rats had been used as an experimental model of traumatic and compressive lesions of the spinal cord. Laminectomies were performed in healthy rats anaesthetized and the degree of medullary inflammatory response was quantified after laminectomy and compared to non-operated rats which were anaesthetized and fixed in the same way. The acute meningeal inflammatory response in spinal segments exposed and those located cranially and caudally to the laminectomy was observed. [ABSTRACT FROM AUTHOR]

Background: Several authors and publications have focused on comparing the clinical course of nerve root decompressive surgery, with or without fusion, to treat degenerative lumbar stenosis. However, there are not many reports analyzing the clinical course after decompressive surgery of a single nerve root (the most symptomatic one) comparing it with decompression of all the roots in a segment. This study intends to compare the clinical course after decompressing the most symptomatic lumbar nerve root with the release of multiple lumbar nerve roots to relieve neuropathic pain resulting from degenerative lumbar stenosis. Material and methods: A prospective, observational, descriptive longitudinal study was performed. A total of 38 patients were divided into two groups that included each 19 cases. Patients underwent recalibration of either a single nerve root or multiple nerve roots of a segment. Percentages were calculated as well as the Student t test and the Pearson correlation. Results: In group A, a decrease of 46.63 points was seen in the Oswestry scale, representing a 66.73% improvement in pain. In group B, in turn, a me an decrease of 34.54 points was seen in the Oswestry scale, equivalent to a 47.23% improvement in pain, with a Student t in which p = 0.11 and a Pearson correlation coefficient of 0.08. Conclusions: No statistically significant differences were found between both study groups. [ABSTRACT FROM AUTHOR]

Ossificação do ligamento longitudinal posterior (OLLP) cervical é patologia rara em nosso meio que pode ser tratada por abordagem anterior ou posterior da coluna. Relatamos o caso de um homem japonês de 42 anos com paraparesia progressiva e TC e RM comprovando o diagnóstico de OLLLP, submetido a corpectomia anterior com artrodese. A fisiopatologia desta entesopatia, prevalência racial, quadro clínico, características radiológicas e opções do procedimento cirúrgico são revistos.

The aim is to present a rare case of ligamentum flavum hematoma in the lumbar region, discuss its physiopathology and treatment and review the literature. A woman aged 68 presented with neurogenic claudication due to degenerative lumbar spondylolisthesis that evolved into a sudden worsening with cauda equina syndrome. The magnetic resonance imagining (MRI) showed signs of degeneration of the lumbar spine, with a narrow spinal canal from L2 to S1, anterolisthesis L4 L5 and an expansive lesion hyperintense on T1-weighted and hypointense on T2-weighted images considered compatible with hematoma in the topography of the yellow ligament in L1-L2. The patient underwent laminectomy and lumbar fixation. Her evolution was good in the postoperative period and at 18 months of follow-up hse walked alone, despite the pain that is controlled with simple medications. Even though rare, it seems that ligamentum flavum hematoma has a relationship with the degeneration and rupture of small vessels associated with micro trauma to the spine. Its physiopathology is not well defined and treatment is similar to other spine compression processes.El objetivo es presentar un caso raro de un hematoma ligamento flavum en la región lumbar, discutir su fisiopatología y el tratamiento y revisión de la literatura. Una mujer de 68 años presentó claudicación neurogénica debido a la espondilolistesis lumbar degenerativa y que se convirtió en un repentino empeoramiento con el síndrome de cauda equina. Una imagen de resonancia magnética (RM) mostró signos de degeneración de la columna lumbar, con canal espinal estrecho de L2 a S1, anterolistesis L4 L5 y en la L1-L2, un proceso expansivo redondeado e hiperintenso en T1 y hipointenso en los bordes en T2, compatible con hematoma en la topografía del ligamento amarillo. La paciente fue sometida a laminectomía y fijación lumbar. Su evolución fue buena en el postoperatorio y, a los 18 meses de seguimiento caminaba sola, a pesar del dolor que se controla con medicamentos simples. Aunque raro, parece que el hematoma del ligamento amarillo tiene relación con la degeneración y la ruptura de pequeños vasos asociadas a micro-traumas en la columna vertebral. Su fisiopatología no está bien definida y el tratamiento es similar a otros procesos de compresión de la columna vertebral.O objetivo é apresentar um caso raro de hematoma do ligamento amarelo na região lombar, discutir sua fisiopatologia e tratamento e revisar a literatura. Uma mulher de 68 anos apresentou-se com claudicação neurogênica devido à doença degenerativa lombar e espondilolistese que evoluiu para uma piora súbita com a síndrome da cauda equina. A imagem por ressonância magnética (IRM) mostrou sinais de degeneração da coluna lombar, com um canal vertebral estreito de L2 a S1, ântero-listese de L4 L5 e, posteriormente no nível da L1-L2, um processo expansivo arredondado e hiperintenso em T1 e com bordas hipointensas em T2 ponderada, compatível com hematoma na topografia do ligamento amarelo. A paciente foi submetida a laminectomia e fixação lombar. Sua evolução foi boa no período pós-operatório e, aos 18 meses de follow-up andou sozinha, apesar da dor que é controlada com medicamentos simples. Mesmo sendo raro, parece que o hematoma do ligamento amarelo tem uma relação com a degeneração e ruptura de pequenos vasos associadas a microtraumas na coluna vertebral. Sua fisiopatologia ainda não é bem definida e o tratamento é semelhante ao de outros processos de compressão da coluna vertebral.

Se presenta un estudio de 31 pacientes con fracturas torácicas y lumbares inestables, tratados por la técnica de Luque, que consiste en acoplar dos varillas a ambos lados de la columna vertebral y por la parte posterior, ambas laterales a las apófisis espinosas y que se fijan con alambre número 18 de forma sublaminar a las láminas. Se evaluó la inestabilidad por los criterios de Denis, así como el alivio o la desaparición del dolor, recuperación funcional y la incorporación laboral; finalmente se registraron las complicaciones. El 41,9% de los afectados fueron mujeres y el 58%, hombres. La localización más frecuente fue la columna lumbar, con un 54,8%. El seguimiento de los pacientes estuvo entre siete y diez años. Se obtuvo un resultado muy satisfactorio, porque en la mayoría de los casos se consiguió el alivio del dolor y la recuperación de la función

O objetivo desta pesquisa foi verificar os efeitos da laminectomia dorsal do tipo Funkquist A em cães normais. A técnica realizada consistiu em abordagem dorsal à coluna vertebral; remoção (com ou sem a ajuda da elevação dos corpos vertebrais) das lâminas dorsais de T13 e L1; manutenção do ligamento supra-espinhal; colocação de gordura subcutânea como coxim supramedular; sutura da fáscia toracolombar, subcutâneo e pele; e bandagem compressiva por sete dias. Quarenta e oito horas após a cirurgia, todos os 10 cães submetidos a essa técnica exibiram perda das reações posturais e paresia de moderada a grave nos membros pélvicos. Hipoalgesia foi constatada em cinco deles. Tentando descobrir as causas, foram realizados estudos histológicos de medulas espinhais, coletadas 4 e 48 horas após a realização da laminectomia, porém com modificações como: não elevação dos corpos vertebrais durante a cirurgia e prevenção de qualquer tipo de compressão medular após a laminectomia. Analisando esses resultados, foi possível concluir que as disfunções neurológicas decorreram de lesões medulares ocasionadas possivelmente por: elevações dos corpos vertebrais durante a laminectomia, danificação de vasos espinhais, desestabilização da coluna vertebral e uma somatória de forças compressivas atuantes sobre a medula espinhal desprotegida. Na necropsia de cinco cães, acompanhados por quarenta e cinco dias, foi possível constatar: a permanência do ligamento supra-espinhal; que o enxerto de gordura não evita a penetração do tecido fibroso no canal vertebral nem sua aderência à dura- máter; notório (P< 0.01) achatamento do canal vertebral e deformação das medulas espinhais. Com base nos resultados, aconselha-se não realizar esses procedimentos cirúrgicos em cães acometidos de afeções medulares na junção toracolombar. A manutenção do ligamento supra-espinhal não perturba a realização da laminectomia, minimiza a ocorrência de defeitos estéticos na linha média dorsal e pode participar da compressão medular no pós-operatório imediato.The purpose of this research was to check the effects of the Funkquist A dorsal laminectomy in normal dogs. The technique accomplished consisted in dorsal approach to the spine; removal of T13-L1 laminae with or without vertebral bodies elevation; mantainement of the supraspinous ligament; placement of subcutaneous fat as supramedulary pad; suture of thoracolumbar fascia, subcutaneous and skin; and compressive bandage for seven days. Fourty-eight hours latter all the dogs (10) submitted to this technique showed loss of the postural reactions and paraparesis classified of moderated to serious. Hypalgesia was ascertained in five of them. Trying to discover the causes, was accomplished histologic studies of spinal cord collected 4 and 48 hours after the accomplishment of the laminectomies were conducted, however with modifications as: non-elevation of the vertebral bodies during the surgery and prevention of any type of compression spinal after the laminectomie. Examining these results was possible to conclude that the neurologic dysfunctions were originated from cord lesions caused for: elevation of the vertebral bodies during the laminectomy, possible damage of spinal vessels, destabilization of the spine and a somatory of compressive forces acting upon an uncovered spinal cord. At the necropsy of five dogs realized forty - five days latter were possible to verify: the permanence of the supraspinous ligament; that the fat grafts do not avoid the penetration of the fibrous tissue into the vertebral canal neither its adherency to the dura mater; notorious (p < 0.01) flattening of the vertebral canal and deformations of the spinal cords. With support on these results, isn't advise to furfill these surgery procedure in the thoracolumbar junction of dogs. The mantainement of the supraspinatus ligament do not perturb the realization of the laminectomy, minimize the occurrence of the aesthetics defects at the dorsal midline and can participate at the immediate postoperative cord compression.

As hérnias discais extremolaterais correspondem a 10% das hérnias discais sintomáticas, mais comumente localizadas nos níveis L3-L4 e L4-L5. Por muitos anos, a abordagem cirúrgica das hérnias lombares foraminais e extraforaminais foi feita através de via de acesso posterior mediana com hemilaminectomia e facetectomia total ou parcial. Inúmeras foram as variações propostas para essa técnica a fim de se evitar a facetectomia e suas repercussões biomecânicas, que ocasionavam com certa freqüência o surgimento de dor lombar baixa devido à instabilidade vertebral criada. A abordagem cirúrgica dessa patologia pela via paramediana, entre os músculos multífido e longuíssimo (via de Wiltse), tem a vantagem de poupar o paciente de perdas ósseas e permitir uma visão mais oblíqua do neuro-foramen. Essa abordagem permite, com mínima mobilização da raiz de L4, acesso ao disco L4-L5 e eventuais herniações extra-foraminais do mesmo. Nosso objetivo é apresentar um estudo do trajeto extra-foraminal da raiz de L4 no espaço intertransversário L4-L5. Para isso, foram realizadas dissecções em 10 cadáveres (20 lados) e obtidas as medidas baseadas em 6 parâmetros anatômicos. A análise dos dados nos permite concluir que as hérnias discais extremo-laterais no nível L4-L5 podem ser acessadas com relativa segurança através da via paramediana.End-lateral disc hernias account for 10% of the symptomatic disc hernias, most commonly localized at L3-L4 and L4-L5 levels. For many years, the surgical treatment of foraminal and extraforaminal lumbar hernias was made through median posterior port by hemilaminectomy and total or partial facetectomy. A number of variations to this technique have been proposed in order to avoid facetectomy and its biomechanical effects, which sometimes cause the onset of low lumbar pain as a result of vertebral instability. The surgical treatment of this pathology through paramedian port, between multifidus and longissimus muscles (Wiltse port), has the advantage of sparing the patient from bone losses and of allowing a more oblique view of the neuroforamen. This port enables, with a minimal L4 root movement, access to L4-L5 disc and its occasional extraforaminal hernias. Our objective is to present a study of the extraforaminal path of L4 root at the intertransversal space L4-L5. For this purpose, 10 cadavers (20 sides) have been dissected for obtaining measurements based on 6 anatomical parameters. Data analysis enables us to conclude that end-lateral disc hernias at L4-L5 level may be accessed with a relative safety through paramedian port.

Os autores relatam caso de compressão medular torácica por lesão da quinta articulação costovertebral à direita. O diagnóstico pré-operatório, com mielotomografia, foi de processo expansivo intrarraquidiano extradural ao nível de T5. Feita a abordagem cirúrgica por laminectomia, com ressecção apenas da lesão intrarraquidiana. O diagnóstico de fibroma condromixóide somente foi definido com o estudo histopatológico. A paciente teve importante melhora neurológica. Decidiu-se pelo acompanhamento clínico e radiológico. Após dois anos houve recidiva do processo para dentro do canal raquidiano. Desta vez, foi realizada abordagem posterolateral à direita, por costotransversectomia e retirada da lesão. O diagnóstico histopatológico foi o mesmo. A paciente evoluiu com melhora neurológica e está sendo feito o seguimento há dois anos. Chamamos a atenção para a raridade do caso e discutimos a conduta.A case of chondromyxoid fibroma (CMF) arising from the Sth right costovertebral junction and spreading into spinal canal causing spinal cord compression is presented. A myelotomography revealed a complete block at T5 level. The patient underwent a decompressive laminectomy with removal of an epidural tumor. This specimen was sent for pathological examination and interpreted as a CMF. The patient had a neurological improvement, post operative MRI revealed a spinal cord free of compression, and we decided on the follow up of the case. Two years later there was reccurrence of the tumor. A posterolateral access by costotransversectomy was made and the lesion was resected. The patient had a neurological improvement which persists on the follow up (two years, at present). Clinical, radiologic and histologic findings, surgical management and recurrence are discussed. The pertinent literature is reviewed.

Introduction: The inherent complexity of diseases demands a multidisciplinary attention to assure better results for patients. Intraspinal neoplasms are an example of this affirmation and however they don't have the highest frequency, the clinical and radiological characteristics could become in a challenge for medical staff. Objective: to present a patient with an uncommon lumbar intraspinal neoplasm. Clinical case: A 31 year old white male patient with an onset of back and sciatic pain and left leg paresthesias and signs of radicular entrapment of the fourth and fifth lumbar roots. Lumbar spine radiological study by computerized tomography and magnetic resonance imaging showed the presence of a neoplasm who invaded the spinal canal and infiltrated the third lumbar vertebral body. Surgical treatment was decided by a staff of orthopedics and neurosurgeons. A laminectomy of the second to forth lumbar vertebrae was made, total complete removal of the neoplastic lesion, curettage of the affected vertebral body, followed by vertebral fusion with spinous apophysis and Luque technique. The trans-operatory pathological diagnosis was Hodgkin lymphoma. The post-operatory follow up included hematology management with specific chemotherapy. The patient has a favorable evolution with two years of asymptomatic survival and without handicap. Conclusions: The precocious diagnosis of spine neoplasm toward an opportune and suitable treatment by a multidisciplinary team, assures the best results with a favorable repercussion in patients prognosis. [ABSTRACT FROM AUTHOR]

Here we report the case of a 19-year-old somalian man who has been admitted to our emergency department because of an important lumbago without trauma. The physical examination on arrival showed a diffuse painful percussion of the left paraspinal muscles without neurological impairment. The laboratory exams displayed a significant elevation of the inflammatory response (CRP 154mg/l, procalcitonin 0,05 [µg/l), the blood cultures were negative and a thoracic and lumbar computed tomography (CT) was not conclusive. The unclear clinical picture led to a magnetic resonance imaging, showing the presence of an abscess in the left thoraco-lumbar paraspinal musculature with ongoing invasion of the epidural space. The clinical picture became dramatic as the patient suddenly developed a frank nuchal rigidity associated with an acute con-fusional state, caused by the rupture of the abscess in the meningeal space with secondary meningitis, confirmed by a lumbar puncture, where S. aureus was found. [ABSTRACT FROM AUTHOR]

Objective: To analyze presentation and evolution of 26 adult's patients with spinal ependymoma assisted in Neurology and Neurosurgery Institute (La Habana, Cuba). Methods: A study of 26 patients with diagnosis of spinal ependymomas treated with microsurgical methods. Parameters such as clinical presentation and long time before diagnostic, radiographs characteristic, surgical resection strategy, postoperative results and prognostic factors were examined. Results: The age of patients was between 30 and 65 years, with 61.5 % between 41-50 years. Sensitivity disorders was the first symptoms and more persistent in admission in 21 patients (80.7 %). The majority of ependymomas occur in the filum terminal, conus and caudal equine region. The radical extirpation of the tumor was achieved in 22 patients. In only 2 cases there is evidence of recurrent and improves the outcome with radiation therapy. At a follow-up time, more than 80 % patients (20 cases) were functioning at a grade 1 of the McCormick Scale. Conclusions: The early diagnosis and the radical surgery of the tumor are decisive factors for minimum or null neurology morbidity. [ABSTRACT FROM AUTHOR]

Introduction: Cervical stenosis refers to the narrowing of the spinal canal or the intervertebral foramina at different anatomic levels, secondary to pathologic processes of the vertebral elements. Surgical management is used when conservative management fails. The anterior and posterior approaches are the most frequently used ones, and the surgical options resulting from these approaches are: anterior cervical diskectomy plus fusion, anterior corporectomy plus fusion, laminoplasty, laminectomy and arthroplasty. Material and method: This is an ambispective study conducted in 195 patients with a diagnosis of cervical stenosis who required surgical treatment at our hospital from January 1995 to January 2007. The neck disability index questionnaire was applied, as well as the Nurick scale. Descriptive statistics was used with frequency and percentage measures. Results: The review of the National Rehabilitation Institute electronic records from January 1st 1995 to December 31st 2007 showed that 195 patients underwent surgery for cervical stenosis. Females were predominant. The most affected age group was 46-55 years. The most frequently affected level was C5-C6. A significant improvement was seen in the neck disability index due to pain and the Nurick scale. Conclusion: According to world literature, mean age of patients with cervical stenosis is 57.2 years, and the most compromised levels were C4-C5 and C5-C6. Improvement was evident according to the neck disability index and the Nurick scale. [ABSTRACT FROM AUTHOR]

Introducción: La cirugía cuando existe una hernia discal es útil. El acto anestésico en estos pacientes puede proveer diverso grado de analgesia; sin embargo, estos pacientes sufren insatisfacción, pues aparejado al dolor de la cirugía tienen que permanecer en decúbito supino largos periodos lo cual provoca ciertas incomodidades en el postoperatorio inmediato. La morfina un agente con una larga data de empleo en medicina ha sido el agente en estudio de la presente Investigación. Objetivos: Evaluar la utilidad de la instilación de morfina a nivel del espacio epidural desde el acto quirúrgico luego de la cirugía para hernias discales teniendo en cuenta el grado de dolor encontrado en el periodo postoperatorio, así como las complicaciones derivadas del método objeto de estudio. Material y Métodos: Realizamos un estudio en 50 pacientes a los que se les realizó laminectomía lumbar y antes del cierre quirúrgico se instiló 2mg de morfina (liofilizada) epidural. Se comparó el grado de analgesia logrado con los pacientes que se trataron de forma convencional (Duralgina), según el valor de la Escala Visual Análoga (E.V.A.) Resultados: La Escala Visual Análoga fue como promedio de 5 en la primera hora y de 3 a las 24 horas, solo 4 pacientes (8 %) desarrollaron retención urinaria y ninguno depresión respiratoria. Conclusiones: Es un método sencillo y rápido de realizar, que mejora el status postoperatorio de los pacientes intervenidos de hernia de la columna lumbar con complicaciones escasas y fáciles de solucionar.