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A fibrin sealant is commonly applied after closure of an incidental or intended durotomy to reduce the complications associated with the leakage of cerebrospinal fluid. Routine usage might not be essential after closure of an intended durotomy, which has clear cut-margins. We investigated the efficacy of fibrin sealants for primary intradural spinal cord tumor surgery.
A retrospective review was performed for 231 consecutive surgically treated patients with primary intradural spinal cord tumors without extradural extension. Fibrin sealants were not used for 47 patients (group I: age, 51.57±16.75 years) and were applied to 184 patients (group II: age, 48.8±14.7 years). The surgical procedures were identical except for the use of a fibrin sealant after closure of the durotomy. The primary outcome was the occurrence of complications (wound problems, hematoma collection, infection, and neurological deterioration). The covariates were age, sex, body mass index, operation time, pre-/postoperative ambulation, number of laminectomies, and type of tumor.
Schwannoma was the most common pathology (n=134), followed by meningioma (n=35) and ependymoma (n=31). Complications occurred in 13 patients (3 in group I and 10 in group II, p=0.73). The postoperative ambulation status (p<0.01; odds ratio, 28.8; 95% confidence interval, 6.9-120.0) and operation time (p=0.04; cutoff, 229 minutes; sensitivity, 62%; specificity, 72%) were significant factors, whereas the use of a fibrin glue was not (p=0.47).
The use of a fibrin sealant might not be essential to reduce complications after surgery for primary spinal intradural tumor.
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Spinal meningioma accounts for 25% of all spinal cord tumors and occurs mostly in the thoracic region. Spontaneous intraspinal bleeding associated with spinal meningioma has rarely been reported. Most cases of hemorrhage associated with meningiomas are extratumoral and subarachnoid, whereas subdural and intratumoral hemorrhage cases have been reported to occur rarely. We experienced a case of a 58-year-old woman with thoracolumbar spinal meningioma accompanied by intraspinal subdural hematoma. She presented with progressively worsened back pain and newly developed weakness in the right lower extremity after a selective nerve root block in the lumbar spine. She underwent the operation and progressively showed neurological recovery during the postoperative course. We report a thoracolumbarspinal meningioma with subdural and intratumoral hemorrhage after a spinal procedure that caused a sudden neurological deterioration.
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To analyze the effect of vertebroplasty on costal pain which develops following osteoporotic thoracic compression fractures (OTCFs).
The authors reviewed the medical records of 35 patients who underwent vertebral augmentation for the treatment of OTCFs over a five year period. The patients were divided into two groups: the costalgia group included patientswho had costal pain after a vertebral fracture and the non-costalgia group included patients without costalgia. To evaluate the effect of vertebroplasty on costal pain and factors related to costal pain, several factors including: vertebral body fracture type, pedicle injury, bone mineral density, the fracture level and clinical outcome were confirmed with magnetic resonance imaging and chart reviews.
Among 35 patients, ten patients (28.6%) complained of costal pain with back pain. Only five of the ten patients (50%) had improved costal pain after a vertebroplasty. In the remaining 5 patients, the costal pain was improved through the use of medication including pain killers or a costal block during the follow-up period. Although the incidence of wedge deformity in the costal group was low(10%), there was no significant relationship to the incidence of costal pain statistically. Pedicle injury, bone mineral density and the fracture level had no significant relation to costal pain.
The patients with wedge type, OTCFs may have a low incidence of costal pain as compared to those patients with bi-concave and crush deformities. The vertebroplasty effect on costal pain may not be effective. Therefore, before doing vertebroplasty, the surgeon should advise patients of this potential outcome in those treated for OTCFs.
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To determine the outcome of posterolateral fusion (PLF) for patients over 70 years of age with degenerative lumbar spinal disease.
The authors reviewed 18 patients (13 women and 5 men) over 70 years of age who underwent PLF with a minimum 2-years follow-up at a single institution. The parameters for analysis were clinical outcome, intraoperative bleeding, operating time, transfusion amount, fusion rate, decreased disc height at the operated level, and the incidence of adjacent disc degeneration.
The mean age and follow-up duration were 74.1 years and 44.7 months, respectively. The mean fusion level was 2.5 levels. 12 patients (66.7%) reported good or excellent outcomes, and 4 patients complained of poor outcomes. The fusion rate was 61.1%. The rate of adjacent segment degeneration was 61.1%. Among all of the patients, 5 had decreased intervertebral disc heights compared to their initial statuses. In correlative comparison analyses of parameters, a significant correlation was observed between a "good" or better clinical outcome and fusion (p=0.034). Also, there were significant relationships between a "fair" or better clinical outcome and fusion (p=0.045) and decreased disc height at the operated level (p=0.017). Other factors did not have a significant relationship with the clinical outcome.
Before performing instrumented PLF in patients over 70 years old, problems related to the low fusion rate and adjacent segment degeneration should be considered and relevant information should be provided to the patients and the family.
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