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Postoperative 3D CT reconstruction of the whole spine at 18 months follow-up showing lateral views of the corrected spine  

Postoperative 3D CT reconstruction of the whole spine at 18 months follow-up showing lateral views of the corrected spine  

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A primary Echinococcus granulosus infection of the spine involving the vertebrae T8 and T9 of a 6-year-old child was treated elsewhere by thoracotomy, partial corporectomy, multiple laminectomies and uninstrumented fusion. Owing to inappropriate stabilization, severe deformity developed secondary to these surgeries. X-rays, CT and MRI scans of the...

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Background Patients with adolescent idiopathic scoliosis (AIS) are usually investigated by serial imaging studies during the course of treatment, some imaging involves ionizing radiation, and the radiation doses are cumulative. Few studies have addressed the correlation of spinal deformity captured by these different imaging modalities, for which p...
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In this study, the important kinematic and post-operative changes in the spinal column and rib cage after corrective surgery of scoliosis using the pedicle screw and rod derotation method was determined using a finite element scoliosis spine model, and the optimized instrumented levels for scoliosis correction was determined. A three dimensional FE...

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... In a large case series reported by Kafaji et al. (2013), most of the patients had severe neurological symptoms on first diagnosis that required urgent surgery before chemotherapy. Similarly, Thaler et al. (2010) performed immediate surgery without full length preoperative chemotherapy owing to the critical neurological status of their patient. In our series, only nine patients received preoperative chemotherapy because most neurosurgeons and orthopedists had a weak awareness of preoperative pharmacotherapy for spinal hydatidosis before the year 2005, and some patients without typical imaging characteristics were misdiagnosed before the first intervention. ...
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Objective: Spinal hydatid disease is rare, and remains a serious health problem that is associated with high rates of recurrence. We reported our experience in treating patients with thoracic spinal hydatidosis through a monocentric case-series. Methods: Sixteen patients with thoracic spinal hydatidosis were treated in our center between 1995 to 2017. Total en bloc spondylectomy (TES) was performed in 3 patients. Five patients were treated posterior decompression and stabilization after removing the involved elements. The remaining patients underwent curettage and resection of the infected bone. The therapy was completed by medical treatment or radiotherapy. Results: There were 7 men and 9 women, with a mean age of 38.5 years (range 28-60 years). The infected area was upper thoracic, mid thoracic, and lower thoracic levels in 1, 8, and 7 patients, respectively. There was paraplegia in 4 patients and paraparesis in 7 patients before surgery. At last follow-up, the neurologic damage recovered successfully in 5 patients. During a mean follow-up of 4.75 years (range 2-12 years), eight patients had local recurrence, but no patients who underwent TES had recurrence. Conclusions: An individualized surgical strategy should be decided carefully for each patient in the first intervention. At the early stages of the disease, TES should be considered as a treatment for suitable cases of primary thoracic spinal hydatidosis.
... In children, spinal column deformity often occurs following multilevel laminectomies performed for spinal lesions. In such a situation, in addition to intact removal of cysts, correction of spinal deformity is advocated using appropriate anterior and posterior instrumented stabilization techniques [20,33]. It is usually done in one approach under direct visualization of the cord and intraoperative neuromonitoring. ...
... Early surgical treatment with intact cyst removal yields the best outcome. Total removal of the cysts without rupture is a challenge but best treatment remains an active nationwide prevention [33]. ...
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Hydatid disease of the central nervous system is rare and comprises about 2-3% of all the hydatid cyst cases reported in the world. Spinal hydatid is still rare. It is endemic in sheep and cattle-raising regions, seen mainly in Mediterranean countries including Turkey and Syria. Pediatric neurosurgeons in nonendemic countries face a challenge when they are encountered with hydatid cyst of the central nervous system due to lack of awareness and diagnostic dilemmas. It is also a mammoth economic problem in developing countries due to improper hygiene and lack of dedicated veterinary practice. The clinical features are largely nonspecific. However, with the advent of MR imaging, the diagnostic accuracy has increased. Intact removal of the cyst without causing any spillage is the goal and key to cure. In this manuscript, the current literature on hydatid cyst of the brain and spine is reviewed to understand the epidemiological, diagnostic accuracy and advances in therapeutics. A heightened clinical suspicion about hydatid disease, role of MR imaging and improving surgical strategies is discussed. A nationwide prevention of the disease is the ultimate goal.
... additional effort to reduce dissemination and recurrence after surgery. Preoperative administration of antihelminthics and irrigation of the operative field with a scolicidal solution could significantly reduce dissemination and recurrence after surgery (10). Therefore, it is of crucial importance that an accurate diagnosis be made before surgery. ...
Article
Aim: To report the four most common spinal parasites for providing insight into definitive therapy. Material and methods: Twelve patients with spinal parasites were diagnosed between 2009 and 2016. A definite diagnosis was established in the form of histopathology (n=9) and response to drug therapy (n=3). The minimum follow-up was 0.9 years and ranged to a maximum of 8 years, with a median of 3 years. Results: Twelve patients aged between 8 and 69 years were reviewed, including nine hydatidosis and three non-hydatid cases. Occupational exposure to the endemic area and unclean food were the main routes of infestation. Spinal parasites can present symptoms that correlated with the level of the lesion. There was complete paraplegia in four patients and paraparesis in six patients before surgery. Seven hydatid patients underwent posterior decompression and pedicle screw fixation with posterolateral fusion. Two non-hydatid patients experienced laminoplasty after posterior decompression. Six hydatid patients had reoccurrences and two patients with intramedullary hydatidosis died of severe complications one year after surgery. Conclusion: Spinal hydatidosis significantly differs from the three other non-hydatid parasites in diagnosis and treatment. The final prognosis of spinal hydatidosis remains poor, especially for intramedullary hydatidosis.
... The thoracolumbar spine is susceptible to tumors (both primary and metastatic), traumatic and osteoporotic fractures, degenerative deformities, and infections. [1][2][3][4][5][6][7][8] All these can subsequently threaten spinal stability and lead to impingement of critical neural structures. The purpose of a surgical intervention focuses on pain control, spinal decompression, and mechanical stabilization. ...
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Objective: This study aims to improve the understanding of the anatomic variations along the thoracic and lumbar spine encountered during an all-posterior vertebrectomy, and reconstruction procedure. This information will help improve our understanding of human spine anatomy and will allow better planning for a vertebral body replacement (VBR) through either a transpedicular or costotransversectomy approach. Summary of Background Data: The major challenge to a total posterior approach vertebrectomy and VBR in the thoracolumbar spine lies in the preservation of important neural structures. Methods: This was a retrospective analysis. Hundred normal magnetic resonance imaging (MRI) spinal studies (T1–L5) on sagittal T2-weighted MRI images were studied to quantify: (1) mid-sagittal vertebral body (VB) dimensions (anterior, midline, and posterior VB height), (2) midline VB and associated intervertebral discs height, (3) mean distance between adjacent spinal nerve roots (DNN) and mean distance between the inferior endplate of the superior vertebrae to its respective spinal nerve root (DNE), and (4) posterior approach expansion ratio (PAER). Results: (1) The mean anterior VB height gradually increased craniocaudally from T1 to L5. The mean midline and posterior VB height showed a similar pattern up to L2. Mean posterior VB height was larger than the mean anterior VB height from T1 to L2, consistent with anterior wedging, and then measured less than the mean anterior VB height, indicating posterior wedging. (2) Midline VB and intervertebral disc height gradually increased from T1 to L4. (3) DNN and DNE were similar, whereby they gradually increased from T1 to L3. (5) Mean PAER varied between 1.69 (T12) and 2.27 (L5) depending on anatomic level. Conclusions: The dimensions of the thoracic and lumbar vertebrae and discs vary greatly. Thus, any attempt at carrying out a VBR from a posterior approach should take into account the specifications at each spinal level.
... The thoracolumbar spine is susceptible to tumors (both primary and metastatic), traumatic and osteoporotic fractures, degenerative deformities, and infections. [1][2][3][4][5][6][7][8] All these can subsequently threaten spinal stability and lead to impingement of critical neural structures. The purpose of a surgical intervention focuses on pain control, spinal decompression, and mechanical stabilization. ...
Article
Full-text available
Introduction: This study aims to improve the understanding of the anatomic variations along the thoracic and lumbar spine encountered during an all-posterior vertebrectomy, and reconstruction procedure. This information will help to improve our understanding of human spine anatomy and will allow better planning for a vertebral body replacement via either a transpedicular or costo-transversectomy approach, The major challenge to a total posterior approach vertebrectomy and vertebral body replacement in the thoracolumbar spine lies in the preservation of important neural structures. Materials and Methods: Retrospective analysis of 100 normal MRI spinal studies (T1-L5) on sagittal T2 weighted MRI images were studied to quantify: 1) mid-sagittal vertebral body (VB) dimensions (anterior, midline and posterior vertebral body height); 2) midline VB and associated intervertebral discs height; 3) mean distance between adjacent spinal nerve roots (DNN) and mean distance between the inferior endplate of the superior vertebrae to its respective spinal nerve root (DNE) and 4) posterior approach expansion ratio (PAER). Results: 1) The mean anterior VB height gradually increased cranio-caudally from T1 to L5. The mean midline and posterior VB height showed a similar pattern up to L2. Mean posterior VB height was larger than the mean anterior VB height from T1 to L2, consistent with anterior wedging, and then measured less than the mean anterior VB height, indicating posterior wedging. 2) Midline VB and intervertebral disc height gradually increased from T1 to L4. 3) DNN and DNE were similar, whereby they gradually increased from T1 to L3. 5) Mean PAER varied between 1.69 (T12) and 2.27 (L5) depending on anatomic level. Conclusions: The dimensions of the thoracic and lumbar vertebrae and discs vary greatly. Thus, any attempt at carrying out a VB replacement from a posterior approach should take into account the specifications at each spinal level.
... H ydatid cyst caused by Echinococcus granulosus is an endemic public health problem, especially in Mediterranean countries including Turkey. 1,2 Humans are the intermediary hosts. The lungs and the liver are the most commonly affected sites of human body. ...
Article
Hydatid cyst is a contagious disease formed by the pathogen Echinococus granulosus. Pulmonary and liver hydatidosis is the common form of the disease. However primary spinal hydatid cyst is rarely seen and compromise less than 1% of all hydatid cases. Primary spinal hydatid cyst and vertebral compression fracture association is very unusual. In this report we present a case of thoracic vertebral compression due to primary spinal hydatid cyst and discuss the important features of this rare disease.
... During 1999 to 2010, hydatidosis incidence (cases per 100,000 inhabitants) in Austria ranged between 0.04 (in 2006) and 0.59 (in 1999) (WHO Regional Offi ce for Europe 2011 ). During 1995 and 2010, two cases with neurohydatidosis were reported in the literature: a 28-year-old female patient (AE of the liver, lungs, and brain) (Schmid et al. 1995(Schmid et al. , 1998Reittner et al. 1996 ) and a 6-year-old girl originally from Bulgaria (CE of the spine involving T8-T9 vertebrae) (Thaler et al. 2010 ). ...
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Hydatidosis (also known as echinococcosis or hydatid disease) is one of Europe's neglected infections of poverty. Cystic echinococcosis (CE) is endemic in Southwestern and Eastern parts of Europe. Although alveolar echinococcosis was considered a rare disease in Central Europe, recent studies have shown its emerging nature and demonstrated that the endemic areas for this parasite are broader than previously thought. This chapter aims not only to review but also to bring to light new epidemiological and clinical data regarding hydatidosis of the central nervous system (CNS) in the countries of Eastern and Central Europe where information was available. At the same time, we intend to shed light on particular or interesting cases reported in the literature. Special emphasis will be given to the casuistic from Romania, listed in 1995 among the countries with the highest prevalence of CE worldwide and where, in the past, at least one person from 45.5 % of its localities underwent surgery for CE. Although rare in Central and Eastern Europe, hydatidosis of the CNS should always be considered in the differential diagnosis of any patient with seizures, focal neurological deficits, and symptoms of increased intracranial pressure, especially when that person comes from regions with high disease prevalence.
... The location and the extent of the lesion(s) determine the surgical approach and the necessary surgical procedure (table 2). After resection of affected bone, a wide spectrum of techniques has been employed to stabilize the vertebral column (including bone grafts[17,[25][26][27][28][29][30][31][32][33][34][35][36][37][38][39][40][41][42][43], dorsal stabilisation by pedicle screw systems[9,26,27,37,[44][45][46][47][48], Harrington[9,27,36,39,[49][50][51]and Luque[9,45,50,51]rods, vertebral body replacement by titanium cage implantation[44,52,53], plating[25,35,52,54], bone cement[26,55,56]). However, in the absence of evidence no recommendations regarding the use of a specific technique can be given besides possibly bone grafting. ...
... The location and the extent of the lesion(s) determine the surgical approach and the necessary surgical procedure (table 2). After resection of affected bone, a wide spectrum of techniques has been employed to stabilize the vertebral column (including bone grafts[17,[25][26][27][28][29][30][31][32][33][34][35][36][37][38][39][40][41][42][43], dorsal stabilisation by pedicle screw systems[9,26,27,37,[44][45][46][47][48], Harrington[9,27,36,39,[49][50][51]and Luque[9,45,50,51]rods, vertebral body replacement by titanium cage implantation[44,52,53], plating[25,35,52,54], bone cement[26,55,56]). However, in the absence of evidence no recommendations regarding the use of a specific technique can be given besides possibly bone grafting. ...
... Among the reviewed cases with vertebral bone involvement we found an overall recurrence rate of 48%, but the stage of disease among the cases varied widely and data on follow-up was mostly scarce (table 1). The available literature states a recurrence rate of 30–100%[18,24,28,38,44,57,58]and in advanced cases interventions might generally be considered palliative with recurrence inevitable[3,38]. However, remarkable cases with extensive vertebral CE, multiple palliative operations and prolonged survival over many years and even decades have been described[59][60][61]. ...
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Author Summary Spinal cystic echinococcosis (CE) is a rare but malignant form of a truly neglected tropical disease. Despite significant advances in diagnostic imaging techniques as well as surgical and medical treatment of spinal CE, our basic understanding of the parasite's predilection for the spine remains poor at best. Information on the influence of parasite and host specific factors on anatomical manifestations and evolution of CE is currently lacking. We systematically reviewed all published case reports and case series of spinal CE from 1965 until 2012 to summarize and analyze the epidemiological and anatomical aspects of the disease and discuss the findings in light of the existing data.
... The location and the extent of the lesion(s) determine the surgical approach and the necessary surgical procedure (table 2). After resection of affected bone, a wide spectrum of techniques has been employed to stabilize the vertebral column (including bone grafts [17,25262728293031323334353637383940414243, dorsal stabilisation by pedicle screw systems [9,26,27,37,4445464748 , Har- [9,27,36,39,495051 and [9,45,50,51] rods, vertebral body replacement by titanium cage implantation [44,52,53], plating [25,35,52,54], bone cement [26,55,56]). However, in the absence of evidence no recommendations regarding the use of a specific technique can be given besides possibly bone grafting. ...
... The location and the extent of the lesion(s) determine the surgical approach and the necessary surgical procedure (table 2). After resection of affected bone, a wide spectrum of techniques has been employed to stabilize the vertebral column (including bone grafts [17,25262728293031323334353637383940414243, dorsal stabilisation by pedicle screw systems [9,26,27,37,4445464748 , Har- [9,27,36,39,495051 and [9,45,50,51] rods, vertebral body replacement by titanium cage implantation [44,52,53], plating [25,35,52,54], bone cement [26,55,56]). However, in the absence of evidence no recommendations regarding the use of a specific technique can be given besides possibly bone grafting. ...
... Among the reviewed cases with vertebral bone involvement we found an overall recurrence rate of 48%, but the stage of disease among the cases varied widely and data on follow-up was mostly scarce (table 1). The available literature states a recurrence rate of 30–100% [18,24,28,38,44,57,58] and in advanced cases interventions might generally be considered palliative with recurrence inevitable [3,38]. However, remarkable cases with extensive vertebral CE, multiple palliative operations and prolonged survival over many years and even decades have been described596061. ...
Article
Full-text available
Author Summary Spinal cystic echinococcosis (CE) is a rare but malignant form of a truly neglected tropical disease. Despite modern diagnostic imaging techniques, the advances in surgery over the last decades and the availability of pharmacological therapy, the clinical management of spinal CE cases remains a challenge for the treating physician. Ten years after the last extensive review on the topic was published by Pamir et al. (Spinal Cord, 2002), we aim to provide clinicians with a systematic review and comprehensive update on spinal CE to help them deal with the often very complex clinical management of these patients. By systematically reviewing all published case reports and case series of spinal CE from 1965 until now, we summarized and analyzed the existing data on treatment, follow-up, and outcome of the disease and discuss the findings in light of the existing data.
... The cysts consist of an outer fibrous layer and a cestode-derived inner germinal membrane containing scolices [9]. The innermost germinal layer produces hydatid fluid and may include numerous embryonal scolices termed ''hydatid sand'' [10]. Scolices, the infectious embryonic tapeworms, develop from an outpouching of the germinal layer known as the brood capsule. ...
... In ruptured cysts, the rate of recurrence will be higher and irrigation with normal saline as well as medical therapy should be performed. Totally, the rate of recurrence is dramatically high, and in different reports the intraoperative seeding is commonly leading to recurrence rates up to 18-100 % [7,10,[12][13][14][15]. Recurrences occur 2-28 months (mean 25.2 months) after the initial operation [16,17]. ...