Long run end result of therapy of vertebral physique hemangiomas with direct ethanol injection and quick section stabilization.
Backbone J. 2018 Jun 08;:
Authors: Chandra PS, Singh P, Ok R, Agarwal D, Tandon V, Kale SS, Sarkar C
BACKGROUND: Vertebral physique (VH) hemangiomas with myelopathy are troublesome to handle.
OBJECTIVE: To guage the position of intra-operative ethanol embolization, surgical decompression and instrumented quick section fusion in VH with myelopathy and long-term end result (>24 months).
METHODS: Potential examine: Symptomatic VH with wire compression with myelopathy. Excluded: pathological fractures, and/or deformity or multi-level pathologies. Surgical procedure consisted of intra-operative bilateral pedicular absolute alcohol (<1% hydrated ethyl alcohol) injection, laminectomy and rope decompression on the stage of pathology adopted by a brief section instrumented fusion utilizing pedicle screws.
RESULTS: 33 sufferers (Imply 26.9 + 13.2, vary: 10-68 years, 18 females).
CLINICAL FEATURES: myelopathy all (5 paraplegic), sphincter involvement (13), and mid again/ decrease ache (7). Pre-operative American Spinal Damage Affiliation (ASIA) scores: A(7), B(11), C(6), D(eight) and E(1). Majority had single vertebral involvement (30), three a number of stage. Six underwent surgical procedure earlier (1 alcohol embolization right here). Imply surgical time: 124+39 minutes, common blood: 274+80 cc. Imply quantity of absolute alcohol injected: 14.6+5.7 cc. (2 requiring 20 & 25 cc). Rapid embolization achieved in all, permitting laminectomy and soft-tissue hemangioma removing simply. Put up-surgery, 1 affected person had transient deterioration, relaxation all sufferers improved (sphincters improved in 9) at a observe up ranging 28-103 months (imply 47.6+22.three). Comply with-up ASIA scores: E(26), D(four), B(2) & C(1). All sufferers confirmed proof of bone sclerosis and reduction of wire compression on follow-up imaging.
CONCLUSIONS: That is largest examine in literature exhibiting wonderful enchancment, low re-operation charges following ethanol embolization and quick section fixation.
PMID: 29890263 [PubMed – as supplied by publisher]