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Biomedical subjects

A Radek

Publications and source records attributed to A Radek.

At least 37 records · Page 2Linked to original sources
PubMedDate not supplied

[Fixating techniques of craniocervical junction: selection criteria].

Adequate choice of fixation technique at craniocervical junction depends on many factors: anatomical conditions at fusion site (e.g. anterior dislocations of the odontoid and rupture of the transverse ligament are contraindications for direct odontoid screw fixation. Sublaminar wiring and interlaminar clamps are useless in case of deficiency of posterior bony elements of C1 and C2 whether a result of laminectomy or destruction), bone quality (osteopenic bone is contraindication for screw techniques either transarticular or transpedicular). Enclosing of occipital bone into instrumentation may be difficult in wire and clamping techniques. In contrast screw techniques allow for easy grip the occipital bone. Screw techniques seem ideal in cases requiring enclosing of the occipital bone. The fusion rate at C1/C2 level seems independent of fixation techniques. When supplemented with external immobilization even biomechanically inferior wiring or interlaminar clamping provide nearly 100 rate of fusion. Screw techniques are technically demanding but they seem the method of choice when occipital bone is to be enclosed in instrumentation.

Fracture Fixation, Internal↗
PubMedDate not supplied

[Trans-sternal approach to the cervicothoracic junction].

Cervicothoracic junction and upper thoracic spine down to T4 can be reached through anterior approach via sternotomy. Transsternal approach is the best route to gain access to lesions localized within vertebral bodies of the upper thoracic spine allowing for their resection, interbody fusion and replacement with bone cement. Consecutive modifications of transsternal approach evolved toward less extensive osteotomy from full median sternotomy, through manubriotomy with clavicle resection and partial lateral manubriotomy. Less extensive modifications provide limited lateral exposure of the spine and are more demanding technically. We present two cases of upper thoracic spine tumours operated on through full medial sternotomy. We believe that median sternotomy has several advantages over less extensive modifications: it is technically simple to perform for trained thoracic surgeon, safer as it provides better exposure of the mediastinum and thus sufficient control of great vessels including subclavian ones, gives better exposure of T3, T4 and even T5 vertebral bodies, allows perpendicular sight and attack to anterior surface of the upper thoracic spine and therefore good visualizing of the posterior longitudinal ligament and dura, do not destabilize shoulder girdle nor affect function of the upper limb. Additional caudal exposure of the thoracic spine as down as T5 can be obtained by dissecting a plane between the brachiocephalic vein, vena cava superior and ascending aorta.

Aged↗
PubMedDate not supplied

[Screw fixation of craniocervical junction].

In recent years an increase has been observed of the use of screw techniques for the fixation of the craniocervical junction. For clinical use two techniques have been introduced: (1) transarticular screw fixation, and (2) transpedicular screw fixation. In the former the screw is inserted through the C2 lateral mass, the fissure of the C1-C2 joint, and the C1 lateral mass. (2) in the latter the screw is inserted into the C2 pedicle and anchored in C2 vertebral body. Transarticular or pedicle screws can be easily connected to longitudinal elements such as rods or plates, and combined with lateral mass screws of the remaining cervical vertebrae or occipital screws. In comparison to sublaminar wiring or interlaminar clamping the screw techniques: (a) strengthen the stiffness of the construct and speed up fusion, (b) allow fixation in the absence or deficiency of laminae as a result of trauma or laminectomy, and (c) can selectively include only the affected segments. Increased construct stiffness is due to deep anchorage of the screw in bone providing thus a solid grip on the vertebra. Both techniques require preoperative assessment of the course of the vertebral artery using imaging methods. In about 18% of cases abnormal course of the artery precludes screw use. Pedicle screw insertion requires direct control of the medial and superior walls of C2 pedicle with dissector introduced into the vertebral canal, which requires removal of the atlantoaxial ligament. Additional control can be achieved with lateral fluoroscopy. The entry point for transarticular screw is on the lateral mass of the odontoid 2-3 mm laterally to the medial margin of C2 facet and 2-3 mm above the C1/C2 articular fissure. The screw trajectory is 0-10 degrees in horizontal plane and towards the anterior C1 tuberculum in sagittal plane.

Atlanto-Axial Joint↗
PubMedDate not supplied

[The case of severe craniocervical dislocation due to rheumatoid arthritis].

UNLABELLED: The authors describe a case of craniocervical dislocation secondary to rheumatoid arthritis producing important canal narrowing: ventrally by migrated odontoid and dorsally by posterior arch of C-1 with medullary compression. Symptoms of hyperreflexia, spasticity and left hemiparesis with Babinski sign were present. SURGICAL PROCEDURE: transoral odontoidectomy was performed followed by suboccipital approach, C-1 laminectomy and occipitocervical fixation (Olerud device and bone graft). Outcome with neurologic improvement. CONCLUSIONS: Transoral odontoidectomy combined with occipitocervical decompression and fixation is effective approach for treatment of severe craniocerebral dislocation. Its advantages: ventral and dorsal decompression combined with immediate stabilisation.

Arthritis, Rheumatoid↗
PubMedDate not supplied

[Intradural spinal cysticercosis provoking radicular symptoms].

The authors describe a case of spinal intracanal cysticercosis. The cysts were situated intradurally, provoking radicular symptoms: pain, paresis. CT investigations showed herniation of discs L4/L5 and L5/S1 interpreted as the cause of the mentioned symptoms. Surgical treatment included discectomy L4/L5 and L5/S1. Recurrence of symptoms was investigated by means of MRI showing the presence of cysts situated among cauda equina roots. Intraoperative finding--cysticercosis was confirmed by pathologic investigation.

Aged↗
PubMedDate not supplied

[Posttraumatic ectopic calcification as an additional pathologic factor of brachial plexus palsy].

The authors describe a case of a 54-year-old male, who was attacked with a broken bottle and wounded in left supraclavicular region. No neurologic deficit was observed immediately after injury. Some days later signs of upper trunk brachial plexus palsy were detected. Gradually symptoms of the Erb syndrome have developed. He was operated on 5 months after injury. During surgery no discontinuity of the brachial plexus was found. Unexpectedly there were an inner scar and free bony fragment compressing the upper trunk and the suprascapular nerve. Both the scar and bony fragment were carefully dissected and removed. Result of surgery: pain relief, restoration of normal sensation and partial restoration of biceps function.

Brachial Plexus↗
PubMedDate not supplied

[Direct fixation of odontoid process base fractures].

Fractures of the base of odontoid process are serious spinal injuries. Their treatment still remains controversial. External rigid immobilisation is the way of conservative healing. Operations by posterior approach: posterior atlantoaxial fixation, atlantoaxial transarticular screw fixation or even occipitocervical fixation limit range of head motion. Direct odontoid screw fixation preserves normal motion of C1-C2 junction. Success of this method depends on proper patients selection. The authors present description of surgical technique based on literature review and their own experience. The authors perform odontoid fixation by means of single cannulated cancellous screw guided by K-wire. This wire provides stability of broken odontoid process during procedure of screw insertion. Old fracture--1 case in author's experience--has been curetted before fixation. The authors reviewed clinical efficacity and results of direct odontoid screw fixation published in current literature.

Atlanto-Axial Joint↗
PubMedDate not supplied

[Percutaneous vertebral surgery. Indications, technics and possibilities].

UNLABELLED: The authors report their own experience with percutaneous vertebroplasty, one of the so called--minimally invasive methods, used to treat a certain group of spinal lesions affecting the vertebral bodies. The paper contains a brief review of the current literature, basic problems, indications and operative technique. The authors remark, that insertion of the needle into the vertebral body gives an access for biopsy before cement injection. This procedure was realised in the case of diagnostic uncertainty. Technical details of transpedicular biopsy are described. The authors present 2 representative cases. FIRST CASE: a female with pathologic fracture of the Th7 vertebral body of osteoporotic origin. TREATMENT: combination of biopsy and vertebroplasty by percutaneous transpedicular approach. Second case: a female with cancer metastasis in L1 vertebral body, vertebroplasty was performed to support the anterior spinal column. Needle insertion was controlled either by radiofluoroscopy or by CT. The authors confirm pain relief related to vertebroplasty.

Biopsy, Needle↗
PubMedDate not supplied

[Anterior interbody fusion of cervical spine with case-plate PCB].

Two cases with cervical discopathy and radiculopathy are presented. Discectomy and anterior interbody fusion with cage-plate PCB manufactured by French company Scient'x was performed. Authors present the shape of the implant and technical details of implantation. The paper discusses the advantages of the PCB which simplifies and shortens the operation procedure, minimizes the risk of traditional bone graft harvesting and provides immediate stabilization of the operated segment.

Adult↗
PubMedDate not supplied

[Gelatinous cyst of the common peroneal nerve].

The authors report two cases of gelatinous cyst of the common peroneal nerve. They present two different approaches to surgical treatment used in their cases--decompression of the nerve trunk by simple drainage of the cyst in one case and total excision of the cyst and its wall with reconstruction of fascicles damaged by the lesion in another. Experiences and results of treatment by other authors are presented as well as their views on pathology and etiology of this rare entity.

Adolescent↗
PubMedDate not supplied

[Comparative evaluation of using autologous cable transplants and the classical microsurgical method of nerve anastomosis].

Using the microsurgical technique in 19 cases the union of 27 injured nerves was done within 24 hours after the injury, with simultaneous suture of the remaining anatomical structures of the extremity. In cases in which after adequate resection the gap in the nerve was not exceeding 2 cm the classical end-to-end suture was done (12 cases) in the remaining 15 cases autogenous bridging (cable) grafts were used. In cases with cable grafts very good or good results were obtained, in the cases of end-to-end suture a poor result was noted in one case. It was found that one-step reconstruction of all severed anatomical structures of the extremity (tendons, vessels, nerves) was undertaken during the first surgical intervention by microsurgical techniques was the best method, and autogenous cable grafts were superior to end-to-end anastomosis in primary reconstruction of damaged peripheral nerves.

Adolescent↗
PubMedDate not supplied

[Late results of the surgical treatment of spondylolisthesis complicated by injury of the cauda equina].

In 1971-1985 surgical treatment was carried out of 29 patients in the Neurosurgery Department WAM in Lódź and 5 in the Rehabilitation Centre in Konstancin for spondylolisthesis complicated with signs of cauda equina damage. In the surgical treatment the technique used was that of a combination of neurosurgical approach (full decompression of the nervous elements in the vertebral canal by laminectomy with foraminectomy or facetectomy, removal of protruding discs and osteophytes and parts of the vertebral bodies narrowing the vertebral canal), and orthopaedic procedures (spondylodesis between vertebral bodies posterior spondylodesis and a combination of both techniques). In one case spring alloplasty was done and in one case Harrington's rods were used. The operation was carried out at one time from the same posterior approach. The follow-up was from 1 to 15 years. A very good result was obtained in 20.6% of cases, good in 55.9%, satisfactory in 23.5%. In no case of worsening or lack of improvement were observed.

Adult↗
PubMedDate not supplied

[Aneurysmal cyst of the cervico-thoracic junction of the spine].

The authors report an extensive aneurysmal cyst of the spine at the cervicothoracic junction. During the disease in the patient (a girl aged 9 years) high-grade tetraparesis developed (with complete paralysis of lower extremities but with spared deep sensation and retained sphincter control). In the treatment a two-stage operation with radical removal of the cyst from anterior and posterior approach, spondylodesis and radiotherapy gave very good results as compared with the very poor condition before the operation. Nearly complete movements of all extremities returned, superficial sensation loss regressed. The usefulness of surgical treatment even in such advanced cases is stressed. CT was very helpful in the assessment of the extent of the tumour and its growth rate.

Bone Cysts↗
PubMedDate not supplied

[Gunshot wounds of the spine and spinal cord. Neurosurgical tactics].

In the Department of Neurosurgery, Medical Academy in Lódź in the years 1971-1986 out of 356 injuries to the spine and spinal cord 6 cases (1.7%) were shot wounds. The indications to surgical treatment were: high-grade posttraumatic spinal instability, intense liquorrhoea with threatening meningitis, and violent pains in lower extremities. The clinical material and the tactics of neurosurgical management are described.

Adult↗
PubMedDate not supplied

[Usefulness of computerized tomography in the diagnosis of peripheral nerve tumors].

After an analysis of cases of tumours situated on the peripheral nerves treated in hospital the authors stress the usefulness of computerized tomography in the diagnosis of these tumours. By demonstrating the internal structure of the tumour, its anatomical relationships to the surrounding tissues the investigation provides many important and practical data in the surgery of peripheral nerves.

Adult↗
PubMedDate not supplied

[An hourglass-shaped enteric cyst of the cervico-thoracic region with extra- and intramedullary location].

The authors report a case of a hourglass dysontogenetic tumour in a 7-year-old girl (enteric cyst) of the spine at the cervicothoracic region coexistent with a developmental anomaly of the spine and posture anomaly. Atypical symptoms (pains) suggesting a disease of the gastrointestinal tract or heart made the diagnosis very difficult. Contrast examination of the vertebral canal made possible a correct diagnosis and appropriate surgical intervention. Microsurgical technique permitted the tumour to be removed radically.

Bone Cysts↗
PubMedDate not supplied

[Facio-facial anastomosis. A new possibility of treating facial nerve damage].

The author describes a new method of treatment of facial nerve palsy, that is facio-facial anastomosis. The procedure includes a microsurgical anastomosis of the peripheral branches of the healthy facial nerve with the corresponding peripheral parts of the frontotemporal, zygomatic, buccal and mandibular branches of the paralyzed nerve. The early results demonstrate a good effect of the method.

Anastomosis, Surgical↗