Tag: spinal decompression

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Ultra-Early (<12 Hours) Surgery Correlates With Higher Rate of American Spinal Injury Association Impairment Scale Conversion After Cervical Spinal Cord Injury

Neurosurgery, Volume 85, Issue 2, August 2019, Pages 199–203

Cervical spinal cord injury (SCI) is a devastating condition with very few treatment options. It remains unclear if early surgery correlated with conversion of American Spinal Injury Association Impairment Scale (AIS) grade A injuries to higher grades.

OBJECTIVE: To determine the optimal time to surgery after cervical SCI through retrospective analysis.

METHODS: We collected data from 48 patients with cervical SCI. Based on the time from Emergency Department (ED) presentation to surgical decompression, we grouped patients into ultra-early (decompression within 12 h of presentation), early (within 12- 24 h), and late groups (>24 h).We compared the improvement in AIS grade fromadmission to discharge, controlling for confounding factors such as AIS grade on admission, injury severity, and age. The mean time from injury to ED for this group of patients was 17 min.

RESULTS: Patients who received surgery within 12 h after presentation had a relative improvement in AIS grade from admission to discharge: the ultra-early group improved on average 1.3. AIS grades compared to 0.5 in the early group (P = .02). In addition, 88.8% of patients with an AIS grade A converted to a higher grade (AIS B or better) in the ultraearly group, compared to 38.4% in the early and late groups (P= .054).

CONCLUSION: These data suggest that surgical decompression after SCI that takes place within 12 hmay lead to a relative improved neurological recovery compared to surgery that takes place after 12 h.

 

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The Neurological Compromised Spine Due to Ewing Sarcoma. What First: Surgery or Chemotherapy?

The Neurological Compromised Spine Due to Ewing Sarcoma

Neurosurgery 77:718–725, 2015

The vertebral column is an infrequent site of primary involvement in Ewing sarcoma. Yet when Ewing sarcoma is found in the spine, the urge for decompression is high because of the often symptomatic compression of neural structures. It is unclear in alleviating a neurological deficit whether chemotherapy is preferred over decompressive laminectomy.

OBJECTIVE: To underline, in this case series, the efficiency of initial chemotherapy before upfront surgery in the setting of high-grade spinal cord or cauda equina compression of primary Ewing sarcoma.

METHODS: Fifteen patients with Ewing sarcoma primarily located in the spine were treated at our institution between 1983 and 2015. Localization, neurological deficit expressed as Frankel grade, and outcome expressed as Rankin scale before and after initial chemotherapy, the recurrence rate, and overall survival were evaluated. The multidisciplinary approach of 1 case will be discussed in detail.

RESULTS: Nine patients (60%) were female. The age at presentation was 15.0 ± 5.5 years (range: 0.9-22.8 years). Ten patients (67%) were initially treated with chemotherapy, and 1 patient (7%) was treated primarily with radiotherapy followed by chemotherapy. The remaining 4 patients (27%) were initially treated with decompressive surgery. All patients treated primarily nonsurgically improved neurologically at followup, showing the importance of chemotherapy as an effective initial treatment option.

CONCLUSION: Adequate and quick decompression of neural structures with similar results can be achieved by chemotherapy and radiotherapy, avoiding the local spill of malignant cells.

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Lumbar spinal stenosis in elderly patients: is a unilateral microsurgical approach sufficient for decompression?

J Neurosurg Spine 14:305–312, 2011. DOI: 10.3171/2010.10.SPINE09708

For the treatment of lumbar spinal stenosis, less invasive procedures, which preserve maximal bony and ligamentous structures, have been recommended to reduce associated morbidity. The authors examined the outcome after decompression of spinal stenosis in the elderly by comparing 3 different surgical approaches. Their focus was whether a unilateral microsurgical decompression provided sufficient outcomes in the elderly population.

Methods. The authors investigated 108 elderly patients (age ≥ 60 years) with lumbar spinal stenosis (mean age 71 years [range 60–93 years]) who underwent surgery between 2004 and June 2006 at the authors’ institution. Three different modes of decompression were analyzed in this study: a unilateral partial hemilaminectomy, a hemilaminectomy, and a laminectomy. The outcome was assessed 12 months postoperatively using the Quebec Back Pain Disability Scale and the Hannover Functional Back Pain Questionnaire.

Results. The authors performed a unilateral partial hemilaminectomy in 53 patients (49%). Patients who underwent unilateral partial hemilaminectomies achieved favorable results of at least 80% as assessed using the Quebec Back Pain Disability Scale and Hannover Functional Back Pain Questionnaire. Hemilaminectomies were performed in 45 patients (41.7%), and laminectomies were performed in 10 patients (9.3%). However, there was no statistically significant difference between the various techniques regarding the postoperative results (p < 0.05).

Conclusions. Laminectomies did not show any advantage when compared with unilateral transmedian approaches. A unilateral partial hemilaminectomy combined with a transmedian decompression sufficiently treated the stenosis. This method seemed advantageous in minimizing the procedure and associated morbidity in this elderly population. Further investigations with long-term results (> 5 years) are still necessary.

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