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[Management of spinal cord compression in Togo].

Med Sante Trop. 2013 May 1;23(2):206-10

Authors: Kassegne I, Sakiye K, Kanassoua K, Beketi AK, Badiane SB, Balogou KA

PURPOSE: The aim of this study was to describe the epidemiologic, clinical, diagnostic and therapeutic aspects of spinal cord compression at the Lomé-Campus teaching hospital.
MATERIAL AND METHOD: We retrospectively analyzed the files of all patients hospitalized for spinal cord compression at Lome-Campus teaching hospital from January 1, 1998, through December 31, 2007.
RESULTS: 39 files were selected, mostly of men (77%). The mean age was 53 years (range: 22 to 79). Median time from the start of symptoms to hospital admission was 14.9 ± 24.5 weeks. The spinal cord compression was confirmed by myeloscan in 35 cases (90%), myelography in 2 (5%) and magnetic resonance imaging in 2 cases (5%). The thoracic spine was the most common site of involvement. The principal cause was malignant neoplasm (17 cases: 44%), followed by cervical spondylotic myelopathy (9 cases: 23%) and Pott’s disease (7 cases: 18%). Only one patient underwent surgery.
CONCLUSION: Spinal cord compression appears to be a rare condition in Togo. It is a true medical emergency and immediate intervention is required. Its management remains precarious and its prognosis poor.

PMID: 23816856 [PubMed – indexed for MEDLINE]

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Arch Iran Med. 2013 Sep;16(9):533-41
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Early posterior spinal canal decompression and circumferential reconstruction of rotationally unstable thoracolumbar burst fractures with neurological deficit.

Chin Med J (Engl). 2013 Jun;126(12):2343-7

Authors: Zheng GQ, Wang Y, Tang PF, Zhang YG, Zhang XS, Guo YZ, Tao S

BACKGROUND: Among the various treatments of neurologically involved unstable thoracolumbar burst fractures, the combination of anterior and posterior instrumentation provides the most stable reconstruction. However, the use of both approaches on a trauma patient may increase the morbidity. This study is a retrospective matched cohort study to evaluate the advantages of a single stage posterior approach for spinal canal decompression in combination with circumferential reconstruction by comparing the clinical and radiographic results.
METHODS: From March 2005 to September 2009, patients with matched type spinal fracture, ages at surgery, and involved levels in our institute underwent either a single stage posterior approach (group one, n = 12) or traditional combined approach (group two, n = 14) for spinal canal decompression and circumferential reconstruction were reviewed. Pre- and post-operative X-ray flms were reviewed and changes in Cobb angle of thoracolumbar spine were documented. Intra-operative, post-operative, and general complications were registered.
RESULTS: The mean follow-up was (27.7 ± 9.6) months (range, 14 to 56 months) in group one and (29.2 ± 7.4) months (range, 20 to 60 months) in group two (P > 0.05). The mean operation time was 214 minutes (range, 186 ± 327 minutes) in group one and 284 minutes (range, 219 ± 423 minutes) in group two (P < 0.05). The average volume of intraoperative blood loss was 1856 ml (range, 1250 ± 3480 ml) in group one and 2453 ml (range, 1600 ± 3680 ml) in group two (P < 0.05). There was no statistical difference between the groups one and two in average vertebral body height loss at the injured level and the average Cobb angle in sagittal plane before and immediately after surgery. Postoperatively, there was an epidural hematoma in one patient in group one and two patients in group two. Bony union after stabilization was obtained in all patients, without loosening or breakage of screws. Loss of correction (5°) was seen in 1 patient in group one at the 6th month owing to the subsidence of the Titanium mesh cages into the vertebra. In group two, totally four patients suffered respiratory-related complication, including pneumonia in two, severe atelectasis in one and pleural effusions in one. Importantly, there were no intraoperative or postoperative deaths in any group. All patients with incomplete neurologic deficits improved at least 1 Frankel grade.
CONCLUSION: Single-stage posterior vertebra resection in combination with circumferential reconstruction is a new option to manage severe thoracolumbar burst fractures.

PMID: 23786951 [PubMed – indexed for MEDLINE]

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[Once-weekly teriparatide treatment on osteoporosis].

Clin Calcium. 2014 Jan;24(1):100-5

Authors: Nakano T

Teriparatide (human PTH 1-34) transiently stimulate both bone formation and bone resorption and subsequently bone formation markers increased. The changes in bone turnover markers 24 h after each injection of once-weekly 56.5μg teriparatide were constant for 24 weeks. Once-weekly injections of teriparatide increased bone mineral density by 8.1% at the lumbar spine and reduced the risk of new vertebral fracture with a relative risk reduction of 80% compared to placebo for the patients with osteoporosis. Significant vertebral fracture risk reductions were also observed in the patients with high risk for fracture such as higher age, low bone mineral density, or sever vertebral fracture grade. Once-weekly teriparatide improved cortical bone parameters at proximal femur, may have the potential to prevent hip fracture. The duration of teriparatide treatment was limited. Therefore subsequent treatment for osteoporosis should be need. Bisphosphonates seem to be a useful choice as a subsequent treatment to once-weekly teriparatide.

PMID: 24369286 [PubMed – indexed for MEDLINE]

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Inflatable external leg compression prevents orthostatic hypotension in a patient with a traumatic cervical spinal cord injury.

Future Cardiol. 2013 Sep;9(5):645-8

Authors: Helmi M, Lima A, Gommers D, van Bommel J, Bakker J

High thoracic spine or cervical injury may cause long-term orthostatic hypotension (OH). To stabilize hemodynamics and prevent presyncope symptoms in these patients, noninvasive management is preferable. We describe a case of a 61-year-old man who experienced presyncope symptoms as a result of severe OH due to spinal cord injury, after 60° head-up tilt position. The patient was referred to the intensive care unit where he was successfully managed with an inflatable external leg compression (ELC). Accordingly, inflatable ELC succeeded not only in improving presyncope symptoms, but also in preventing orthostatic hypotension for several hours. ELC may be an alternative way to stabilize hemodynamics and prevent presyncope symptoms in patients with OH following spinal cord injury.

PMID: 24020666 [PubMed – indexed for MEDLINE]

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