Clinical Neuroscience

[Herniated disc operation without complication in a case of haemophilia A]

SZAPPANOS László1, BODA Zoltán2, SZÜCS Gabriella1

JANUARY 20, 1993

Clinical Neuroscience - 1993;46(01-02)

[The authors present a case of herniated diso operation in a haemophilic A patient whose bleeding disorder had not been diagnosed earlier. They draw attention to the importance of inquiring about haemophilia in the case of surgery and the laboratory screening tests. Special aspects of preoperative examinations, the operation and follow-up treatment are described.]

AFFILIATIONS

  1. Debreceni Orvostudományi Egyetem Ortopédiai Klinika
  2. Debreceni Orvostudományi Egyetem II. Belgyógyászati Klinika

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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

[Relation of acute and long-therm care of the spinal-cord-injured patients in up-to-date management]

KLAUBER András, ZSOLCZAI Sándor, PENTELÉNYI Tamás, MOLNÁR Ferenc

[The acute emergency management of the spinal-cord-injured patients is one of the most important steps in the long-lasting complex treatment which has great significance for the final results. The method of primary neurosurgical operation must be chosen with regard to the special aspects of subsequent rehabilitation. All conditions of emergency surgery have to be assured during the first 6-8 hours. According to the experiences of the last two decades the problems of the management of spinal-cord-injured patients originated in the shortage of financial sources, theoretical concepts and organization, lack of interest and scientific information. Even now there is no spinal-cord-injured center in Hungary which would provide for the complex management including primary neurosurgical treatment and all details up till the end of paraplegic rehabilitation. Primary treatment (either operative or conservative) and rehabilitation are performed in separate departments. Though there is a significant development in emergency spinal surgery during the last years (and it is a pity this can not be seen in rehabilitation in Hungary), it is still an important demand that emergency surgery should be performed with rehabilitation aspects. Until we have no proper financial conditions to organize spinal centers for both emergency and rehabilitation treatment, our most important task is to develop a unified rehabilitational view of all specialists involved in the complex treatment of spine-injured patients.]

Clinical Neuroscience

[Tethered cord syndrome in adults]

VÁRADY Péter, BENOIST György, PÁSZTOR Emil

[The tethered cord syndrome is resulted from the abnormally low position and traction of the conus medullaris in the lumbosacral region, that leads to progressive dysfunction of the caudal spinal segments. It originates from various ectodermal abnormalities, all due to errors of embryonic development in the 3rd-4th weeks. The disorder is manifested by progressive motor, sensory and trophic deficits in the legs and by incontinence. The adult onset is rare. The MRI is the most important procedure for pathoanatomic evaluation. The surgical aim is to stop progressivity and to cure the reversible deficits. We report our six cases and present the data of the literature concluding the caracteristics, the surgical indications and outcome of the tethered cord syndrome in adults.]

Clinical Neuroscience

[Operative treatment of craniocervical instabilities caused by rheumatoid arthritis]

TURÓCZY László, KENÉZ József, VERES Róbert, NAGY Aladár, PÁSZTOR Emil

[We have investigated and operatively treated 30 patients with craniocervical instabilities caused by rheumatoid arthritis. The evaluation of this patient-material seems to be important, because the indications of operations in the different stages of the disease are not completely clear, according to our knowledge. The atlanto-axial instabilities at the beginning stage, when the serious neurologic signs are absent, can be treated with low risk dorsal stabilization, while we believe the advanced instabilities need combined neurosurgical approach for successful treatment. We must emphasize the importance of detailed early diagnostics, and the prevention in neurosurgical approaches, in accordance of the opinions, expressed in different contributions in the literature, dealing with the subject. In 20 cases we had to perform combined surgical interventions, and only in 10 cases, the simple dorsal fixation proved to be satisfactory, which fact shows, that we got patients mainly in more serious stages. We detected a new sign ("ghost tumor") in the natural course of the disease.]

Clinical Neuroscience

[Our experiences in the conservative treatment of the compression fractures of the thoracolumbar spine]

URBÁN Ferenc, TAKÁCS Ferenc

[The authors at the DOTE Department of Traumatology made follow-up examinations of 136 patients treated for compression fractures of the thoracolumbar spine. 63 patients (46,3%) were treated with plaster corset, 73 patients (53,7%) with modified Magnus method. They compared the two methods of treatment for their possibilities and effectiveness. They used plaster corset after reposition in females under 55 years of age and in males under 60 years of age, if the patients' physical and general condition were suitable and the compression was more than 10 degrees. 47,9% of the patients treated functionally recovered well and 31,5% were in a satisfactory state. And 47,6% of the patients treated with plaster corset recovered well and 46,0% recovered satisfactorily. While in the first group i.e.those treated functionally, 17,8% of the patients had severe pain, only 6,4% of the patients treated with corset had similar pain. The authors ascertain that as the anatomical reposition of the fractures is not possible indefinitely, the insertion of the plaster corset when the compression exceeds 10–15 degrees is more suitable. When the deformity decreases, the subjective complaints of the patients decrease too. In the case of small compression, functional treatment is recommended and the patient must lie in bed to alleviate the pain. Both the methods used under appropriate conditions are useful and complement each other. ]

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[Operative treatment of pressure sores of the pelvic region in spinal cord-injured patients]

JÓSVAY János, DONÁTH Antal, KERTÉSZ Györgyi, KLAUBER András

[by either conservative or surgical methods. Shortened healing period and long lasting results can be achieved by surgery. Between 1993 and 2001 the authors performed 64 operations with musculocutaneous or musculo-fasciocutaneous flaps in all cases. All patients healed primary except one, whose 20-year-old pressure sore transformed malignant and gave metastasis. The complication rate was 21.42%, that equals with the data of the literature. Measuring the late postoperative results by follow-up questionnaire, a 9.52% ratio of recurrence was found, which was significantly smaller than data of the literature (19-82%). Authors analyse the causes of their (good) results.]

Clinical Neuroscience

Evaluation of the effectiveness of transforaminal epidural steroid injection in far lateral lumbar disc herniations

EVRAN Sevket, KATAR Salim

Far lateral lumbar disc herniations (FLDH) consist approximately 0.7-12% of all lumbar disc herniations. Compared to the more common central and paramedian lumbar disc herniations, they cause more severe and persistent radicular pain due to direct compression of the nerve root and dorsal root ganglion. In patients who do not respond to conservative treatments such as medical treatment and physical therapy, and have not developed neurological deficits, it is difficult to decide on surgical treatment because of the nerve root damage and spinal instability risk due to disruption of facet joint integrity. In this study, we aimed to evaluate the effect of transforaminal epidural steroid injection (TFESI) on the improvement of both pain control and functional capacity in patients with FLDH. A total of 37 patients who had radicular pain caused by far lateral disc herniation which is visible in their lumbar magnetic resonance imaging (MRI) scan, had no neurological deficit and did not respond to conservative treatment, were included the study. TFESI was applied to patients by preganglionic approach. Pre-treatment Visual Analogue Scale (VAS) and Oswestry Disability Index (ODI) scores of the patients were compared with the 3rd week, 3rd month and 6th month scores after the procedure. The mean initial VAS score was 8.63 ± 0.55, while it was 3.84 ± 1.66, 5.09 ± 0.85, 4.56 ± 1.66 at the 3rd week, 3rd month and 6th month controls, respectively. This decrease in the VAS score was found statistically significant (p = 0.001). ODI score with baseline mean value of 52.38 ± 6.84 was found to be 18.56 ± 4.95 at the 3rd week, 37.41 ± 14.1 at the 3rd month and 34.88 ± 14.33 at the 6th month. This downtrend of pa­tient’s ODI scores was found statistically significant (p = 0.001). This study has demonstrated that TFESI is an effective method for gaining increased functional capacity and pain control in the treatment of patients who are not suitable for surgical treatment with radicular complaints due to far lateral lumbar disc hernia.

Clinical Neuroscience

[The connection between the socioeconomic status and stroke in Budapest]

VASTAGH Ildikó, SZŐCS Ildikó, OBERFRANK Ferenc, AJTAY András, BERECZKI Dániel

[The well-known gap bet­ween stroke mortality of Eastern and Western Euro­pean countries may reflect the effect of socioeconomic diffe­rences. Such a gap may be present between neighborhoods of different wealth within one city. We set forth to compare age distribution, incidence, case fatality, mortality, and risk factor profile of stroke patients of the poorest (District 8) and wealthiest (District 12) districts of Budapest. We synthesize the results of our former comparative epidemiological investigations focusing on the association of socioeconomic background and features of stroke in two districts of the capital city of Hungary. The “Budapest District 8–12 project” pointed out the younger age of stroke patients of the poorer district, and established that the prevalence of smoking, alcohol-consumption, and untreated hypertension is also higher in District 8. The “Six Years in Two Districts” project involving 4779 patients with a 10-year follow-up revealed higher incidence, case fatality and mortality of stroke in the less wealthy district. The younger patients of the poorer region show higher risk-factor prevalence, die younger and their fatality grows faster during long-term follow-up. The higher prevalence of risk factors and the higher fatality of the younger age groups in the socioeconomically deprived district reflect the higher vulnerability of the population in District 8. The missing link between poverty and stroke outcome seems to be lifestyle risk-factors and lack of adherence to primary preventive efforts. Public health campaigns on stroke prevention should focus on the young generation of socioeconomi­cally deprived neighborhoods. ]

Clinical Neuroscience

Comparison of direct costs of percutaneous full-endoscopic interlaminar lumbar discectomy and microdiscectomy: Results from Turkey

ÜNSAL Ünlü Ülkün, ŞENTÜRK Salim

Microdiscectomy (MD) is a stan­dard technique for the surgical treatment of lumbar disc herniation (LDH). Uniportal percutaneous full-endoscopic in­terlaminar lumbar discectomy (PELD) is another surgical op­tion that has become popular owing to reports of shorter hos­pitalization and earlier functional recovery. There are very few articles analyzing the total costs of these two techniques. The purpose of this study was to compare total hospital costs among microdiscectomy (MD) and uniportal percutaneous full-endoscopic interlaminar lumbar discectomy (PELD). Forty patients aged between 22-70 years who underwent PELD or MD with different anesthesia techniques were divided into four groups: (i) PELD-local anesthesia (PELD-Local) (n=10), (ii) PELD-general anesthesia (PELD-General) (n=10), (iii) MD-spinal anesthesia (MD-Spinal) (n=10), (iv) MD-general anesthesia (MD-General) (n=10). Health care costs were defined as the sum of direct costs. Data were then analyzed based on anesthetic modality to produce a direct cost evaluation. Direct costs were compared statistically between MD and PELD groups. The sum of total costs was $1,249.50 in the PELD-Local group, $1,741.50 in the PELD-General group, $2,015.60 in the MD-Spinal group, and $2,348.70 in the MD-General group. The sum of total costs was higher in the MD-Spinal and MD-General groups than in the PELD-Local and PELD-General groups. The costs of surgical operation, surgical equipment, anesthesia (anesthetist’s costs), hospital stay, anesthetic drugs and materials, laboratory wor­kup, nur­sing care, and postoperative me­dication diffe­red significantly among the two main groups (PELD-MD) (p<0.01). This study demonstrated that PELD is less costly than MD.