Clinical Neuroscience

[Changes in the approach and the methods in acute surgical treatment of severe thoraco-lumbar spinal injuries]

ZSOLCZAI Sándor, PENTELÉNYI Tamás

FEBRUARY 20, 2003

Clinical Neuroscience - 2003;56(01-02)

[The authors show the changes in the approach and methods concerning the acute surgical treatment of severe thoracolumbar spinal injuries. In the past 15 years, 878 acute surgical treatments have been done with ventral-, dorsal or combined method. The results are evaluated from the point of view of neurological function recovery, bony union, restoration of patients' comfort and complications. Authors discuss the changes of past 15 years regarding the basic ideas of the treatment of spinal injuries, the indications and methods of modern surgical techniques. The use of new surgical methods which are closely connected to the biomechanical characteristics of the injured spine are stressed, as well as the importance of the primary definitive ventral surgical treatment, in the case of a severe thoraco-lumbar spine injury.]

COMMENTS

0 comments

Further articles in this publication

Clinical Neuroscience

[Primary intramedullary glioblastoma multiforme of the spinal cord: report of eight cases]

BANCZEROWSKI Péter, SIMÓ Magdolna, SIPOS László, SLOWIK Felícia, BENOIST György, VERES Róbert

[Primary glioblastoma multiforme located intramedullary in the spinal cord is a very rare entity. The authors report eight cases and discuss the clinical features, the possibility of diagnosis, combinated treatment and pathomorphological signs focusing on the relevant literature and their experience.]

Clinical Neuroscience

[The role of electrical neuromodulation in the therapy for chronic lower urinary tract dysfunction]

BANYÓ Tamás

[The electrostimulation techniques may be used as a supplement or an alternative to standard therapy. Electrical therapy for chronic lower tract dysfunction comprises of noninvasive pudendal nerve neuromodulation and invasive sacral nerve stimulation. Short-term functional electrical stimulation seems favourable in selected patients with detrusor hyperreflexia. Sacral nerve stimulation may be a successful treatment option for patients with refractory detrusor overactivity and some forms of urinary retention.]

Clinical Neuroscience

[Unusually located metastatic tumors of the spine]

BAZSÓ Péter, NAGY László

[Metastatic spine tumors are representing a growing number of oncological patients. In this paper the authors would like to focus on a rare type of metastatic spine tumors, the unusually located ones. Since the advent of MRI and with the progress in general oncology this formerly rare tumors became more frequently recognized. Consequently these tumors are causing a new challenge for the oncologists, neurologists and neurosurgeons as well. The aim of the authors with this paper was to raise, especially the neurologists' attention to this emerging problem.]

Clinical Neuroscience

[Anterior and posterior stabilization following the resection of a thyroid gland tumor destroying more cervical segments]

FECZKÓ József, BARÁTH István, SÁRVÁRY András

[Case report - Authors report a case of thyroid gland carcinoma. The tumor had metastases into the CV-VI-VII vertebras. Through an anterior approach, they removed the malignant tumor together with the bodies of the affected cervical vertebras and a two stage combined (anterior and posterior) cervical instrumentation was performed. The anterior fusion was carried out with iliac crest bone grafting and plate fixation. After four years the patient is alive and well, without symptoms of tumor recurrence or neurologic deficiency. The ventral fusion is stable. Conclusions - Authors present a case of a successful operation of thyroid gland malignant tumor having metastatases in the CV-VI-VII vertebras. Tumor resection, fusion and instrumentation is suggested to be carried out in one stage. The anterior and posterior instrumentation is essential. Radical removal of the tumor is mandatory even with complex instrumentation and oncotherapy procedures.]

Clinical Neuroscience

[Spinal stabilizations in our department 1989-2002]

HÁVEL János, GÖBÖL László, GÖRÖMBEY Zoltán, KISS Tibor, LAJKÓ Albert, VALÁLIK István, VIOLA Árpád, JULOW Jenő

[With the aim to compare results to those found in the literature, authors present a retrospective overview of the spinal stabilisations carried out in the Neurosurgical Department at the St. John’s Hospital, Budapest, Hungary between 1989 and 2002. This 37 bed department provides neurosurgical services to the Buda region with its one million inhabitants. Out of 156 000 injuries in total in the past 13 years, the department has dealt with 9360 neurotraumatologic cases, 560 of them suffering from spinal injuries. In parallel, non-traumatic cases were also treated for tumour, infections, degenerative diseases and for the instability of the spine. The 224 stabilised cases were classified into three groups: cervical, thoracic, lumbar. The authors enumerate the type of operation in each level and they present the number of cases belonging to each type. Septic complications occured in 2.5% of cases. Screw breaking or slackening of the implanted devices was observed in 2% of the cases. The types of spinal operations applied provide satisfactory method for controlling the problems caused by the instability the spinal trauma, degenerative and tumourous cases. These results do not diverge from those found in the literature.]

All articles in the issue

Related contents

Hungarian Radiology

[Tarsal coalitions in our adult patients]

SZÁNTÓ Dezső

[INTRODUCTION - Tarsal coalition is an abnormal bony, cartilaginous or fibrous union between two or three bones of the mid and hindfoot. It occurs mostly (90%) in the calcaneonavicular and talocalcaneal joints. Coalitions are usually detected in the second decade of life, but several cases are noted in children and in later adulthood. Estimated incidence is 1-2% of the total population. CASE REPORTS - Cases of unilateral tarsal coalitions (five calcaneonavicular, three talocalcaneal) in four male and three female patients are presented. The average age of the patients is 30 years. The radiologic diagnosis was based on the secondary signs seen on the lateral plain films of the feet. These signs are parallel with clinical symptoms, in contrary to the primary radiologic signs. The two types of the anomaly coexisted in a female patient. CONCLUSION - Routine lateral not-magnified pedal radiographs are valuable screening tool for tarsal coalitions.]

Clinical Neuroscience

[Acute neurosurgical management of severe thoraco-lumbar spinal injuries]

ZSOLCZAI Sándor, PENTELÉNYI Tamás, TÚRÓCZY László, VERES Róbert

[Authors show their experiences with up-to-date segmental stabilization methods in the acute neurosurgical management of severe thoraco-lumbar spinal injuries. Among the 134 acute operations during 5 years with at least 1 year follow-up 81 were performed by Fixateur Interne (AO-ASIF, W. Dick), and 53 by angle-stable posterior plate-fixation (Steffee or Eger plates). Reduction, decompression and stabilization were achieved by these instrumentations. Results are evaluated from the points of view of neurological recovery, bony union, restoration of patients comfort and complications. Also the principles of modern management of spine-injured patients, developed through a long evolution in the last decade, are reviewed. It is stated that both segmental stabilization methods were used as routine, and they were suitable for the treatment of the most of severe thoraco-lumbar spinal injuries. Results of these methods are much better than those of the long-rod systems, but on condition that emergency neurosurgical treatment should be done in the first 6-8 hours together with early skilled and competent rehabilitation in a well trained center.]

Clinical Neuroscience

Alexithymia is associated with cognitive impairment in patients with Parkinson’s disease

SENGUL Yildizhan, KOCAK Müge, CORAKCI Zeynep, SENGUL Serdar Hakan, USTUN Ismet

Cognitive dysfunction (CD) is a common non-motor symptom of Parkinson’s disease (PD). Alexithy­mia is a still poorly understood neuropsychiatric feature of PD. Cognitive impairment (especially visuospatial dysfunction and executive dysfunction) and alexithymia share com­mon pathology of neuroanatomical structures. We hypo­thesized that there must be a correlation between CD and alexithymia levels considering this relationship of neuroanatomy. Objective – The aim of this study was to evaluate the association between alexithymia and neurocognitive function in patients with PD. Thirty-five patients with PD were included in this study. The Toronto Alexithymia Scale–20 (TAS-20), Geriatric Depression Inventory (GDI) and a detailed neuropsychological evaluation were performed. Higher TAS-20 scores were negatively correlated with Wechsler Adult Intelligence Scale (WAIS) similarities test score (r =-0.71, p value 0.02), clock drawing test (CDT) scores (r=-0.72, p=0.02) and verbal fluency (VF) (r=-0.77, p<0.01). Difficulty identifying feelings subscale score was negatively correlated with CDT scores (r=-0.74, p=0.02), VF scores (r=-0.66, p=0.04), visual memory immediate recall (r=-0.74, p=0.01). VF scores were also correlated with difficulty describing feelings (DDF) scores (r=-0.66, p=0.04). There was a reverse relationship bet­ween WAIS similarities and DDF scores (r=-0.70, p=0.02), and externally oriented-thinking (r=-0.77,p<0.01). Executive function Z score was correlated with the mean TAS-20 score (r=-62, p=0.03) and DDF subscale score (r=-0.70, p=0.01) Alexithymia was found to be associated with poorer performance on visuospatial and executive function test results. We also found that alexithymia was significantly correlated with depressive symptoms. Presence of alexithymia should therefore warn the clinicians for co-existing CD.