Accuracy and complications of pedicle screw insertion for lumbar and thoracolumbar fractures

 Background: The accuracy of pedicle screw placement is essential for lumbar and thoracolumbar spine fracture fixation.Purpose: The aim of the present study was to assess the accuracy of the pedicle screw placement with conventional C-arm fuoroscopy-guided in these patients.Methods: A retrospective review identified patients who underwent operative management with thoracolumbar instruments at our hospital between June 2012 and August 2013. Clinical data were acquired from medical records and final screw positions were graded based on a classification of Gertzbein and Robbins.Results: A total of 216 pedicle screws in 52 patients (34 males, mean age 32.6±5.8 years) were evaluated. They were instrumented with transpedicular posterior fixation technique within 72 hours. The follow-up time was 6.1 months (ranging from 1 to 14 months). The screws were graded A (n=43 [19.9%]), B (n=89 [41.2%]), C (n=62 [28.7%]), D (n=21 [9.7%]), and E (n=1 [0.5%]). One of the screws was revised on the second day after surgery due to screw malposition.Conclusion: Based on existing facilities, the findings showed that the pedicle instrumentation screws with transpedicular posterior fixation technique in patients with lumbar and thoracolumbar fractures can be done with acceptable complication rate. However, more advanced equipment as CT navigation (O-arm) is recommended for higher accuracy

Treatment of Cystic Craniopharyngioma with Intracystic Stereotactic Instillation of Phosphorus 32

How to Cite This Article: Shahzadi S, Soltani A, Shahzadi A, Parsa Kh. Treatment of Cystic Craniopharyngioma with Intracystic Stereotactic Instillation of Phosphorus 32. Iran J Child Neurol. Summer 2017; 11(3):31-36.AbstractObjectiveCystic craniopharyngiomas are considered the most common intracranial nonglial tumor in children with the tendency for cyst formations. The aim of this study was to evaluate the effect of intracystic phosphorus 32 (P32) therapies on controlling the growth of the cystic component of craniopharyngioma.Materials & MethodsThis clinical study was conducted on 47 patients with cystic craniopharyngioma from March 1998 to June 2012 at Shohada Tajrish Hospital, Tehran, Iran.Patients were treated with stereotactic intracystic P32. The mean cyst volume was 23.5 ml, and the dose of radiation to the inner cyst wall was 250 Gy.ResultsThe overall response rate was 78.1% and the mean survival was 113.1±11months.The survival rate at 1, 3, 5, and 10 years after p32 therapy was 91%, 77%, 73%, and 52%, respectively. There was no mortality related to the procedure and no visual or endocrinal deterioration. Visual improvement occurred in 88% of patients presented with recent deterioration due to the cyst enlargement.ConclusionIntracystic p32 therapy was an effective and almost safe procedure for the treatment of cystic component of craniopharyngioma. References1. Shahzadi S, Sharifi G, Andalibi R, Zali A, Ali-Asgari A. Management of cystic craniopharyngiomas with intracavitary irradiation with P32. Arch Iran Med 2008;11(1):30-4.2. Komotar RJ, Roguski M, Bruce JN. Surgical management of craniopharyngiomas. J Neurooncol 2009;92(3):283- 96.3. Garnett MR, Puget S, Grill J, Sainte-Rose C. Craniopharyngioma. Orphanet J Rare Dis 2007;2:18.4. Dekkers OM, Biermasz NR, Smit JW, et al. Quality of life in treated adult craniopharyngioma patients. Eur J Endocrinol 2006;154(3):483-9.5. Bartels U, Laperriere N, Bouffet E, Drake J. Intracystic therapies for cystic craniopharyngioma in childhood. Front Endocrinol (Lausanne) 2012;3:39.6. Basso A, Socolovsky M, Goland J. Actualization of treatment options in Craniopharyngioma: a comparative analysis of different therapeutic modalities. The World Federation of Neurosurgical Societies (WFNS): Available From: http://www.wfns.org/pages/read_the_reviews/97. php?rid=4 7. Leng LZ, Greenfield JP, Souweidane MM, Anand VK, Schwartz TH. Endoscopic, endonasal resection of craniopharyngiomas: analysis of outcome including extent of resection, cerebrospinal fluid leak, return to preoperative productivity, and body mass index. Neurosurgery 2012;70(1):110-23.8. Zhao R, Deng J, Liang X, Zeng J, Chen X, Wang J. Treatment of cystic craniopharyngioma with phosphorus-32 intracavitary irradiation. Childs Nerv Syst 2010;26(5):669-74.9. Kobayashi T, Kageyama N, Ohara K. Internal irradiation for cystic craniopharyngioma. J Neurosurg 1981;55(6):896-903.10. Trippel M, Nikkhah G. Stereotactic neurosurgical treatment options for craniopharyngioma. Front Endocrinol (Lausanne) 2012;3:63.11. Fahlbusch R, Honegger J, Paulus W, et al. Surgical treatment of craniopharyngiomas: experience with 168patients. J Neurosurg 1999;90(2):237-50.12. Elliott RE, Hsieh K, Hochm T, et al. Efficacy and safety of radical resection of primary and recurrentcraniopharyngiomas in 86 children. J Neurosurg Pediatr 2010;5(1):30-48.13. Müller HL, Gebhardt U, Teske C, et al. Post-operative hypothalamic lesions and obesity in childhood craniopharyngioma: results of the multinational prospective trial KRANIOPHARYNGEOM 2000 after 3-year follow-up. Eur J Endocrinol 2001;165(1):17-24.14. Clark AJ, Cage TA, Aranda D, et al. Treatmentrelated morbidity and the management of pediatric craniopharyngioma: a systematic review. J Neurosurg Pediatr 2012;10(4):293-301.15. Schoenfeld A, Pekmezci M, Barnes MJ, et al. The superiority of conservative resection and adjuvant radiation for craniopharyngiomas J Neurooncol 2012;108(1):133-9.16. Jang WY, Lee KS, Son BC, et al. Repeat operations in pediatric patients with recurrent craniopharyngiomas. Pediatr Neurosurg 2009;45(6):451-5.17. Barriger RB, Chang A, Lo SS, Timmerman RD, Des Rosiers C, Boaz JC, et al. Phosphorus-32 therapy for cystic craniopharyngiomas. Radiother Oncol 2011;98(2):207-12.18. Tian ZM. Stereotactic intracavitary irradiation of huge cystic craniopharyngiomas. Zhonghua Wai Ke Za Zhi 1992;30(2):102-3.19. Pollock BE, Lunsford LD, Kondziolka D, ad et al. Phosphorus-32 intracavitary irradiation of cystic craniopharyngiomas: current technique and long-term results. Int J Radiat Oncol Biol Phys 1995 ;33(2):437-46.20. Voges J, Sturm V, Lehrke R, et al. Cystic craniopharyngioma: long-term results after intracavitary irradiation with stereotactically applied colloidal beta-emitting radioactive sources. Neurosurgery 1997;40(2):263-9.21. Julow J, Backlund EO, Lányi F, et al. Long-term results and late complications after intracavitary yttrium-90 colloid irradiation of recurrent cystic craniopharyngiomas. Neurosurgery 2007;61(2):288-95.22. Hasegawa T, Kondziolka D, Hadjipanayis CG, Lunsford LD. Management of cystic craniopharyngiomas with phosphorus-32 intracavitary irradiation. Neurosurgery 2004;54(4):813-20.23. Anderson DR, Trobe JD, Taren JA, Gebarski SS. Visual outcome in cystic craniopharyngiomas treated with intracavitary phosphorus-32. Ophthalmology 1989;96(12):1786-92.24. Kodama T, Matsukado Y, Uemura S. Intracapsular irradiation therapy of craniopharyngiomas with radioactive gold: indication and follow-up results. Neurol Med Chir (Tokyo) 1981;21(1):49-58.25. Backlund EO, Axelsson B, Bergstrand CG, et al. Treatment of craniopharyngiomas--the stereotactic approach in a ten to twenty-three years’ perspective. I. Surgical, radiological and ophthalmological aspects. Acta Neurochir (Wien 1989;99(1-2):11-9.26. Van den Berge JH, Blaauw G, Breeman WA, et al. Intracavitary brachytherapy of cystic craniopharyngiomas. J Neurosurg 1992;77(4):545-50.

Reduction of negative afterimage duration in Parkinson’s disease patients: A possible role for dopaminergic deficiency in the retinal Interplexiform cell layer

AbstractDopaminergic deficiency may affect Parkinson’s disease patients (PD) in the central as well as the peripheral tissues. In the retina, the neuromodulatory role of the dopaminergic Interplexiform cell layer (IP) plays a major role in the retinal light adaptation and may account for the duration of the negative afterimage. Here we present results showing a significant reduction of negative afterimage duration in PD patients. This supports the hypothesis that the retinal dopaminergic system may be the main cause for the long duration of negative afterimage. We suggest that the observed reduction of afterimage duration is due to possible dopaminergic deficiency in patients with Parkinson’s disease

Outcomes of Phosphorus-32 Intracavitary Irradiation for Craniopharyngiomas: A Review of The Literature

Purpose: To review on outcomes of Phosphorus-32 (32P) intracavitary irradiation for Craniopharyngiomas.Methods: A literature review of all full publications in English biomedical journals (1981-2014) was performed. The search strategy included a combination of key words “phosphorus-32”, “craniopharyngioma”, “intracystic treatment”, “brain”, “cyst”, “tumor”, “brachytherapy”, “intracavitary irradiation”, “isotope” in the title and abstract of the manuscripts using the PubMed. The major findings were summarized, with a focus on outcome as visual acuity, complications, cyst volume, and irradiation dose delivered to the cyst wall in Gy. Finally, the future of 32P intracavitary irradiation for Craniopharyngiomas was explored.Results: A total of 25 citations were identified and screened. In all, 19 citations were eligible for inclusion. The synthesis of the data showed several benefits and adverse events for 32P intracavitary. Overall benefits included improvements in visual, endocrinological, and neurological outcomes, while adverse effects included complications such as III palsy and diabetes insipidus.Conclusion: In general 32P intracavitary irradiation was found to be a reasonable option in treatment of highly selected patients with newly diagnosed or recurrent cystic craniopharyngioma. This approach can be expected to overcome some limitations introduced by other approaches with a relatively low complication rates

Role of the Self-Administered, Self-Reported History Questionnaire to Identify Types of Lumbar Spinal Stenosis: A Sensitivity Analysis

Study DesignCase-control design.PurposeTo evaluate the role of the self-administered, self-reported history questionnaire (SSHQ) in identifying types of lumbar spinal stenosis (LSS).Overview of LiteratureDiagnosis of types of LSS is controversial.MethodsA total of 235 patients with LSS were asked to respond to the SSHQ. All of these patients recovered following surgical treatment. The classification of LSS patients was based on history, physical examinations, and imaging studies. It is considered to be the gold standard. Radicular and neurogenic claudication types of LSS were based on the SSHQ developed by Konno et al. Two categories of LSS were determined based on the SSHQ tool and gold standard. Finally, a sensitivity analysis was carried out to evaluate the diagnostic value of the SSHQ.ResultsThe mean age of patients was 59.4 years. According to the criteria for gold standard, patients were diagnosed with the radicular type (n=103), and neurogenic claudication type (n=132). The questionnaire had desirable sensitivity, specificity, and accuracy in categorizing the two types of LSS: 97.8%, 66.6%, and 96.8% for the radicular type, and 97.0%, 80.0%, and 95.7% for the neurogenic claudication type.ConclusionsOur findings indicate that the SSHQ is a reliable and a valid measure and it may be a clinical diagnosis support tool for identifying patients with two types of LSS

Lumbar Spinal Canal Stenosis Classification Criteria: A New Tool

Study DesignCase-control study.PurposeTo design a new tool for classifying lumbar spinal canal stenosis (CLSCS).Overview of LiteratureGrading of patients with lumbar spinal canal stenosis (LSCS) is controversial.MethodsThe Oswestry disability index (ODI) and the neurogenic claudication outcome score (NCOS) were recorded. Four parameters, which indicate the severity of LSCS disease, including Hufschmidt-grade, grading of magnetic resonance imaging, self-paced walking test, and stenosis ratio (SR) were employed. For the SR, quartile analysis was applied for classifying LSCS and the Hufschmidt-grade was modified into a 4-grade score. An initial score was assigned to each metric based on the severity of LSCS. Using the inverse-variance weighting method, the relative weights of these domains and their categories were determined. The score for all of the cases was obtained based on their weight by summing up the points of the four variables. Quartile analysis was used and a CLSCS score was proposed. Finally, intra- and interobserver reliability, and validity were assessed.ResultsA total of 357 patients were studied. The final CLSCS score for each case ranged from 4 to 16.5. Based on the quartile analysis, using the new criteria set, the CLSCS score was divided into four categories: CLSCS<7 (grade 0); 7≤CLSCS<10 (grade 1); 10≤CLSCS<13 (grade 2); and 13≤CLSCS≤16.5 (grade 3). The kappa values of for the CLSCS score indicated a perfect agreement. The CLSCS was correlated with the ODI and NCOS. All patients with grade 3 CLSCS were observed in the surgical group.ConclusionsThe CLSCS score can be helpful for classifying LSCS patients and in the decision-making process

Decision-Making Process in Patients with Thoracolumbar and Lumbar Burst Fractures with Thoracolumbar Injury Severity and Classification Score Less than Four

Study DesignCross-sectional.PurposeTo develop a strategy to determine a sound method for decision-making based on postoperative clinical outcome satisfaction.Overview of LiteratureThe ideal management of thoracolumbar and lumbar burst fractures (TLBF) without neurological compromise remains controversial.MethodsThis was a prospective study. Patients with thoracolumbar injury severity and classification score (TLICS) <4 were treated nonoperatively, with bed rest and bracing until the pain decreased sufficiently to allow mobilization. Surgery was undertaken in patients with intractable pain despite an appropriate nonoperative treatment (surgery group). The Oswestry disability index (ODI) measure was observed at baseline and at the last follow-up. Clinically success was defined at least a 30% improvement from the baseline ODI scores in both the conservative and surgery groups. All case records were assessed for gender, age, residual canal and angulations at the site of the fracture in order to determine which patients benefited from surgery or conservative treatment and which did not.ResultsIn all 113 patients with T11–L5, TLBFs were treated. The patients' mean age was 49.2 years. Patients successfully completed either nonoperative (n=99) or surgical (n=14) treatment based on ODI. Clinical examinations revealed that all of the patients had intact neurology. The mean follow-up period was 29.5 months. There was a significant difference between the two groups based on age and residual canal. The mean ODI score significantly improved for both groups (p <0.01). According to the findings, a decision matrix was proposed.ConclusionsThe findings confirm that TLICS <4, age, and residual canal can be used to guide the treatment of TLBF in conservative decision-making

Outcome Measure of Pain in Patients with Lumbar Disc Herniation: Validation Study of the Iranian version of Pain Sensitivity Questionnaire

Study DesignCross-sectional.PurposeTo translate and culturally adapt an Iranian version of the Pain Sensitivity Questionnaire (PSQ) in Iran.Overview of LiteratureInstruments measuring patient reported outcomes should satisfy certain psychometric properties.MethodsThe PSQ was translated following cross-cultural adaptation guidelines. A total of 101 patients with lumbar disc herniation (LDH), and 39 healthy cases were included in the study. All participants completed the PSQ and the Pain Catastrophizing Scale (PCS). The internal consistency, test-retest reliability, known group comparison, criterion validity and item-scale correlations were assessed.ResultsThe mean age of participants was 51.7 years. Reliability, validity and correlation of PSQ and PCS showed satisfactory results. Cronbach's alpha coefficients were 0.81 for PSQ-total, 0.82 for PSQ-minor, and 0.82 for PSQ-moderate. The intraclass correlation coefficients value was 0.84 (0.616–0.932) indicating an excellent test-retest reliability. The instrument discriminated well between sub-groups of patients who differed in a standard predictive measure of LDH surgery (the Finneson–Cooper score). Total PSQ were also significantly correlated with the total scores of the PCS, lending support to its good convergent validity. Additionally, the correlation of each item with its hypothesized domain on the PSQ indicated acceptable results, suggesting that the items had a substantial relationship with their own domains.ConclusionsThe adapted Iranian PSQ is a valid and reliable questionnaire for the assessment of pain in patients with LDH

Outcome Measures of Functionality, Social Interaction, and Pain in Patients with Cervical Spondylotic Myelopathy: A Validation Study for the Iranian Version of the Copenhagen Neck Functional Disability Scale

Study DesignCross-sectional.PurposeTo translate and validate the Iranian version of the Copenhagen Neck Functional Disability Scale (CNFDS).Overview of LiteratureInstruments measuring patient-reported outcomes should satisfy certain psychometric properties.MethodsNinety-three cases of cervical spondylotic myelopathy were entered into the study and completed the CNFDS pre and postoperatively at the 6 month follow-up. The modified Japanese Orthopedic Association Score was also completed. The internal consistency, test-retest, convergent validity, construct validity (item scale correlation), and responsiveness to change were assessed.ResultsMean age of the patients was 54.3 years (standard deviation, 8.9). The Cronbach α coefficient was satisfactory (α=0.84). Test-retest reliability as assessed by the intraclass correlation coefficient analysis was 0.95 (95% confidence interval, 0.92-0.98). The modified Japanese Orthopedic Association score correlated strongly with the CNFDS score, lending support to its good convergent validity (r=-0.80; p<0.001). Additionally, the correlation of each item with its hypothesized domain on the CNFDS was acceptable, suggesting that the items had a substantial relationship with their own domains. These results also indicate that the instrument was responsive to change (p<0.0001).ConclusionsThe findings suggest that the Iranian version of the CNFDS is a valid measure to assess functionality, social interaction, and pain among patients with cervical spondylotic myelopathy