RESUMO
BACKGROUND Giant cell tumors of the bone (GCTB) are rare, locally aggressive benign neoplasms that primarily occur in the metaphyses of long bones. In less than 2% of cases, GCTBs arise in the spine, predominantly below the sacrum. We report the clinical manifestations, diagnostic approach, and successful surgical treatment of a patient with a GCTB of the thoracic spine. CASE REPORT A 21-year-old female patient presented to the Emergency Department with back pain and upper motor neuron syndrome. A thorough clinical and imaging examination revealed a tumor and pathological fracture of the T7 vertebra. Histopathological analysis confirmed the diagnosis of a GCTB. The tumor was successfully excised surgically via a posterior thoracic approach, including bilateral decompressive laminectomy, lateral costotransversectomy, and posterior corpectomy, followed by transpedicular instrumentation of the T5-T6 and T8-T9 vertebrae, and anterior arthrodesis with an autologous graft. The patient also received adjuvant radiotherapy. One year later, the patient had no signs of recurrence or physical limitations. CONCLUSIONS GCTBs located in the thoracic spine are uncommon and pose a significant challenge for healthcare professionals due to their non-specific clinical manifestations and the need for a multidisciplinary approach to their management. This case highlights the diagnostic and therapeutic implications of a GCTB of the thoracic spine and describes a successful surgical strategy resulting in complete recovery. The presented case adds to the limited published literature on GCTBs in this unusual location and further elaborates on their presentation and management.
Assuntos
Tumor de Células Gigantes do Osso , Neoplasias da Coluna Vertebral , Neoplasias Torácicas , Humanos , Feminino , Adulto Jovem , Adulto , México , Neoplasias da Coluna Vertebral/diagnóstico por imagem , Neoplasias da Coluna Vertebral/cirurgia , Vértebras Torácicas/cirurgia , Tumor de Células Gigantes do Osso/diagnóstico por imagem , Tumor de Células Gigantes do Osso/cirurgia , Neoplasias Torácicas/patologia , Células Gigantes/patologiaRESUMO
Background: This study correlated the extent of spinal canal compression from retropulsed traumatic burst cervical, thoracic, and lumbar spine fractures with the severity of neurological dysfunction. Methods: One hundred and sixty-nine patients with cervical, thoracic, or lumbar sub-axial traumatic burst fractures were seen in an emergency department from 2019 to 2021; 79.3% were men, averaging 37 years of age. The lumbar spine was most frequently involved (42%), followed by the thoracic (36.1%) and cervical (21.9%) levels. The extent of spinal canal compression was quantitated utilizing Hashimoto's method, and correlated with patients' extent of neurological injury based on their American Spinal Injury Association scores. Results: There was a positive correlation between the extent of cervical and thoracic spinal cord compression due to retro pulsed burst fragments and the severity of the patients' neurological deficits, but this was not true for the lumbar spine. Conclusion: The extent of spinal cord compression from retropulsed cervical and thoracic traumatic burst fractures was readily correlated with the severity of patients' neurological dysfunction. However, there was no such correlation between the extent of cauda equina compression from retropulsed lumbar burst fractures and the severity of their cauda equina syndromes.
RESUMO
BACKGROUND: Fracture dislocations of the thoracolumbar spine are, to a great extent, associated with neurologic deficit and instability, so a large percentage of them require surgical treatment. Being pregnant does not rule out the possibility of having this type of lesions. There are only a few bibliographic references concerning these cases and medical and treatment ignorance about them is frequent. OBJECTIVE: Present a review of concepts and specifications for the correct and safe imaging diagnosis as well as considerations on the surgical treatment of patients with traumatic thoracolumbar spine lesions who are pregnant. MATERIAL AND METHODS: A bibliographic review will be presented together with a clinical case of the CALRM, a 31-year-old female with a fracture dislocation at T12-L1, ASIA E, who at the time of the lesion was nine weeks pregnant, and was managed with a multidisciplinary approach that included the following services: Obstetrics and Gynecology, Pediatrics, Anesthesiology, Radiology and Imaging, Legal Medicine, Spine Surgery, and the hospital's Ethics Committee. RESULTS: The diagnosis and characteristics of the lesion were assessed properly with standard X-rays and the support of MRI. The patient underwent posterior stabilization with a transpedicular system while she was pregnant, and bone graft harvesting and application with an anterior approach after the pregnancy, without any complications. CONCLUSIONS: The correct understanding of the nature of ionizing radiation allows using an acceptable dose range according to the study performed and the patient's gestational age. Any patient with a fracture dislocation of the thoracolumbar spine who can tolerate the procedure should be stabilized. Moreover, the fetal risks of the surgical and anesthetic procedure may be avoided with an appropriate selection of the technique and the anesthetic agents, as well as with continuous maternal and fetal monitoring.
Assuntos
Luxações Articulares , Vértebras Lombares/lesões , Complicações na Gravidez , Fraturas da Coluna Vertebral , Vértebras Torácicas/lesões , Adulto , Diagnóstico por Imagem , Feminino , Humanos , Luxações Articulares/diagnóstico , Luxações Articulares/terapia , Gravidez , Complicações na Gravidez/diagnóstico , Complicações na Gravidez/terapia , Fraturas da Coluna Vertebral/diagnóstico , Fraturas da Coluna Vertebral/terapiaRESUMO
OBJECTIVE: To determine changes in neurological status in patients with traumatic cord lesions before and after surgical treatment. MATERIAL AND METHODS: We conducted a descriptive cohort study, and measured 61 points of neurologic evaluation (sensory, motor, reflexes) of the Sequential Clinical History. RESULTS: We studied 28 patients with complete cord lesion (ASIA A) and 16 with incomplete cord lesions (9 ASIA B, 4 ASIA C, and 3 ASIA D). In the patients classified as ASIA-A, twenty-six did not change, and 2 had improvement in one neurologic level (sensory). In ASIA-B patients, four remained with no changes, and in 5 the lesion improved. The four patients with type C lesion, improved. All patients with ASIA-D, improved to ASIA-E. CONCLUSION: In patients with complete cord lesions (ASIA-A) and the worst prognosis, we did not find improvement in neurologic lesion. In incomplete cord injuries, improvement was variable, and it was more prevalent in preoperative period.
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Traumatismos da Medula Espinal/fisiopatologia , Técnicas de Diagnóstico Neurológico , Humanos , Estudos Longitudinais , Prontuários MédicosRESUMO
INTRODUCTION: Spinal Cord Injury ASIA A (tetraplegia) is a frequent pathology that may affect population regardless of age, sex or race, and that can induce metabolic abnormalities that may worsen the nutritional status of these patients. There are no existing specific protocols to treat these disorders in the specialized units in Mexico. MATERIAL AND METHODS: We analyzed 16 patients at the Spine Clinic SS-DF, 18 years or older without any drug treatment or any previous disease, known or diagnosed when admitted to the hospital. Laboratory samples were obtained as well as the nutritional status was calculated at their admittance and discharge. Individually calculated nutritional support was administered starting at their third day of hospital stay. RESULTS: 100% of the patients showed some type of metabolic disorder associated to the neurological injury. 50% of the patients were classified with severe malnutrition, 25% moderate and 25% mild, all improved at their discharge. CONCLUSIONS: We confirmed the presence of metabolic changes in these patients, the efficacy of routine laboratory in the Spine Clinic SS-DF for their evaluation, and that adequate nutritional support may help correct metabolic disorders in this patients.
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Estado Nutricional , Quadriplegia/metabolismo , Traumatismos da Medula Espinal/metabolismo , Feminino , Humanos , MasculinoRESUMO
Sólo 20 de 193 casos de fractura, de un total de 265 casos que ingresaron a la clínica de columna de septiembre de 1991 a noviembre de 1992, tuvieron fractura tóraco-lumbar estable por lo que fueron tratados unicamente con un corsé tóraco-lumbar de fibra de vidrio. Como podría ser esperado el porcentaje de buenos resultados a los 6 meses fue de 70 por ciento y a los 12 meses fue de 100 por ciento.
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Humanos , Masculino , Feminino , Adulto , Adolescente , Pessoa de Meia-Idade , Fraturas Ósseas/terapia , Região Lombossacral/lesões , Traumatismos Torácicos/diagnóstico , Traumatismos Torácicos/terapia , Aparelhos OrtopédicosRESUMO
Se describe la técnica quirúrgica para fijación de la columna cervical baja denominada ®triaxial¼. Analizando los resultados de 81 pacientes atendidos en el periodo de 1994 a 1997, con un seguimiento mínimo de 12 meses, se revisan las indicaciones, para este procedimiento terapéutico
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Humanos , Masculino , Feminino , Adulto , Resultado do Tratamento , Vértebras Cervicais/cirurgia , Vértebras Cervicais/lesões , Dispositivos de Fixação Ortopédica , Fraturas ÓsseasRESUMO
En el Hospital General ®La Villa¼ del D.D.F. del 1o. de enero al 30 de junio de 1996 se internaron 107 pacientes con lesión de la columna vertebral, 37 de ellos correspondieron al segmento cervical de los cuales el 24.3 por ciento se les colocó halo para tracción cefálica por presentar invasión del cuerpo vertebral y/o fragmentos óseos hacia el conducto raquídeo, la causa principal de este tipo de lesiones son caídas de altura y en segundo lugar los accidentes automovilísticos. El 67 por ciento corresponde al sexo masculino y 33 por ciento al femenino, con una edad promedio de 38.6 años. En todos los casos se logró la alineación del conducto raquídeo y con esto la descompresión medular, instalándose ulteriormente su fijación quirúrgica
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Humanos , Masculino , Feminino , Adolescente , Adulto , Fixação de Fratura , Fraturas Ósseas/classificação , Fraturas Ósseas/reabilitação , Fraturas Ósseas/terapia , Tração , Vértebras Cervicais/cirurgia , Vértebras Cervicais/lesõesRESUMO
Las lesiones por proyectil de arma de fuego en la columna vertebral siguen siendo un problema de decisión terapéutica ante la posibilidad de brindar mejoría mediante procedimientos quirúrgicos dirigidos a retirar el proyectil o a efectuar una limpieza de la herida. En la actualidad se definen la literatura algunas indicaciones precisas para considerar adecuado el tratamiento quirúrgico. Se realizó una revisión de 5 años en el centro para la atención de lesionados raquimedulares en la Ciudad de México del I.S.S.D:F, en 221 pacientes y se reportan los resultados obtenidos con tratamiento quirúrgico y no quirúrgico
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Humanos , Coluna Vertebral/cirurgia , Ferimentos e Lesões/diagnóstico , Ferimentos e Lesões/terapia , Armas de Fogo , Tomada de Decisões/fisiologiaRESUMO
En la atención del paciente con lesión raquimedular aguda, el primer contacto hospitalario en la sala de urgencias, es de capital importancia para su futuro. La exploración física neurológica periférica, proporciona información fundamental para integrar el diagnóstico y tratamiento. Nula o insuficiente información limita el trabajo del personal médico y resta oportunidades a los pacientes. En 1985 con la creación del centro de atención a lesionados raquimedulares del I.S.S.D.F. se integró un proyecto de investigación para optimizar la atención médica a través de protocolos específicos, la historia clínica secuencial fue diseñada para satisfacer la necesidad de evaluar al paciente traumático de la columna vertebral en el primer contacto y registrar la evolución del estado neurológico. Se describe el documento y resultados de su uso en la institución