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Biomedical subjects

M Payer

Publications and source records attributed to M Payer.

16 recordsLinked to original sources
PubMed2006

Implantation of a distractible titanium cage after cervical corpectomy: technical experience in 20 consecutive cases.

BACKGROUND: This prospective observational study was undertaken to investigate the advantages, the safety, and the drawbacks of reconstructing a cervical corpectomy with a distractible corpectomy cage. According to the author's literature search, this is the second clinical report on a distractible cervical corpectomy cage. METHOD: 20 Consecutive patients underwent a single- or multi-level cervical corpectomy for spondylotic myelopathy, traumatic fracture, or tumor. The corpectomy defect was reconstructed by means of a distractible titanium cage, and local bone from the corpectomy was layed around the cage for fusion. An anterior cervical plate and/or a posterior lateral mass or pedicle screw fixation was added in all patients. The average follow-up was 14 months, and all patients had at least 12 months of follow-up. FINDINGS: No hardware failure occurred in any of the patients. Construct stability was achieved in 19 out of 20 patients (95%) at 12 months postoperatively. The mean regional lordosis was 1 degrees preoperatively, 9 degrees postoperatively, and 7 degrees at the follow-up. Mean neck pain on a VAS was 3.9 preoperatively, and 2.6 at 12 months. There were three perioperative complications: transient neurological worsening in one patient, one transient vocal cord paralysis, and persistent dysphagia in one patient. CONCLUSION: A single- or multi-level cervical corpectomy can be safely and effectively reconstructed by a distractible titanium cage and local bone graft in combination with anterior cervical plating and/or posterior lateral mass/pedicle screw fixation. Potential advantages of this technique are an unforced cage insertion in its non-distracted position, press-fitting the cage into the corpectomy defect through cage distraction, correction of kyphosis or preservation of local lordosis through cage distraction, and the absence of donor site morbidity. However, the stability rate in the current series did not exceed the fusion rates of auto- or allografts.

Adult↗
PubMed2006

Resection of thoracic dumbbell neurinomas: single postero-lateral approach or combined posterior and transthoracic approach?

Dumbbell tumours are those with an intraspinal and a paraspinal component, connected through a frequently enlarged and eroded intervertebral foramen. Most dumbbell tumours are located in the thoracic spine, and most of them are schwannomas. The extraspinal tumour extension is usually larger than the intraspinal tumour part, but the intraspinal tumour component commonly causes the typical symptoms: local pain and symptoms from spinal cord compression in the thoracic spine. Diagnosis is best established by magnetic resonance imaging with and without contrast agent injection. Controversy exists as to whether to remove thoracic dumbbell tumours using a single posterior approach with posterolateral extension or using a combined posterior and transthoracic approach. We report the removal of a dumbbell neurinoma at T6/7 using a single posterior midline approach with laminectomy and costo-transversectomy and review the literature regarding the approaches to thoracic dumbbell tumours.

Humans↗
PubMed2006

Surgical management of cervical fractures in ankylosing spondylitis using a combined posterior-anterior approach.

The management of cervical fractures in ankylosing spondylitis patients is controversial. In the present article, a literature review is conducted, and the author's experience with four consecutive cases, operated on using a combined approach, is reported. One patient was operated on using the combined approach after developing progressive deformity in a halo fixator, one patient after early redislocation of an anterior monosegmental fixation, and two patients were operated on primarily using the combined approach. All four patients achieved good alignment and immediate stability and no dislocation or deformity was observed during the mean observation period of 11 months.

Aged↗
PubMed2005

Unstable burst fractures of the thoraco-lumbar junction: treatment by posterior bisegmental correction/fixation and staged anterior corpectomy and titanium cage implantation.

BACKGROUND: Controversy exists about the best treatment of unstable thoraco-lumbar (TL) burst fractures. Kyphosis correction and canal decompression in case of a neurological deficit are recognized treatment objectives, and various conservative and surgical strategies have been proposed. This prospective observational study evaluates the benefits and risks of a posterior bisegmental transpedicular correction/fixation and staged anterior corpectomy and titanium cage implantation in unstable TL junction burst fractures. METHOD: 20 consecutive patients with a single-level traumatic unstable burst fracture at the TL junction were operated on by a bisegmental posterior correction/fixation, followed by anterior corpectomy and titanium cage implantation 7-10 days later. The radiological and clinical course is documented over a period of 24 months. FINDINGS: The mean posttraumatic loss of anterior vertebral body height was 58% (45-70%). The posttraumatic mean regional kyphosis was 16 degrees and could be corrected by the posterior approach to a mean lordosis of 2 degrees. Mean secondary loss of the kyphosis correction was 3 degrees over 24 months. No hardware failure occurred, and construct stability was observed in all 20 patients. One surgical complication occurred during the posterior approach, and three transient surgical complications by the anterior approach. 12 of the 14 patients with an initial neurological deficit recovered an average of 1.5 grades on the ASIA scale. At 24 months postoperatively, the mean regional TL back pain on a VAS (0-10) was 1.6, and the mean pain at the anterior approach site was 1.2. CONCLUSION: Posterior bisegmental transpedicular correction/fixation and staged anterior corpectomy and titanium cage implantation is a safe and reliable surgical treatment option in unstable TL junction burst fractures. The advantages of this technique are a complete kyphosis correction, immediate stability, maintenance of kyphosis correction, and complete spinal canal decompression in case of a neurological deficit. However, these advantages have to be carefully weighed against the double approach morbidity.

Adult↗
PubMed2005

The anterior approach to anterior cervical meningiomas: review illustrated by a case.

Anterior cervical meningiomas have traditionally been operated on by a posterior approach. However, several reports of an anterior approach to anterior cervical meningiomas and other anterior cervical intradural lesions have documented important advantages: large bony window of access, extradural coagulation of anterior blood supply to meningiomas, visualization of the intradural pathology in front of the spinal cord, and absence of manipulation of the spinal cord during resection of the lesion. In this study, the literature about anterior approaches to anterior cervical meningiomas is systematically reviewed and the advantages and disadvantages of the technique are discussed. Furthermore, a case of complete resection of a large anterior cervical intradural extramedullary meningioma from C5-7 by a three-level corpectomy with progressive postoperative neurological recovery is illustrated, confirming the advantages of the anterior approach.

Aged↗
PubMed2005

Immediate open anterior reduction and antero-posterior fixation/fusion for bilateral cervical locked facets.

BACKGROUND: Bilateral cervical locked facets is a severe traumatic lesion, most frequently resulting in tetraplegia. The common treatment strategy has been an attempt of awake, closed reduction, adding general anesthesia, muscle relaxation and manual traction in difficult cases. In cases of failed closed reduction, open reduction has most commonly been performed by a posterior approach. Patients in the current series have been managed by immediate open anterior reduction and circumferential fixation/fusion. The technique is described and its potential advantages are discussed. METHOD: Five consecutive patients with traumatic bilateral cervical locked facets are reported. The injury level was C4/5 in one and C5/6 in four patients. Four patients had initial tetraplegia, one patient was neurogically intact. All patients underwent immediate open anterior reduction by interbody distraction and gentle manual traction, followed by circumferential fixation/fusion. Mean follow-up was 15 months. FINDINGS: Immediate anterior open reduction was rapidly and reliably achieved in all five patients. No surgical complication occurred. All patients showed fusion at the three-month follow-up. All four tetraplegic patients regained at least one functional root level, but remained tetraplegic. CONCLUSION: Immediate open anterior reduction of bilateral cervical locked facets and combined antero-posterior fixation/fusion was safe and reliable. This treatment strategy avoids time loss and patient discomfort from attempted closed reduction by traction, obviates the need for external immobilization, and results in an excellent fusion rate.

Aged↗
PubMed2005

Traumatic vertical atlantoaxial dislocation.

We present a case of traumatic vertical atlantoaxial dislocation of 16 millimetres with a fatal outcome. We hypothesize that this extremely rare traumatic vertical atlantoaxial dislocation results from insufficiency of the C1/C2 facet capsules after rupture of the tectorial membrane and the alar ligaments.

Atlanto-Axial Joint↗
PubMed2005

Unstable upper and middle thoracic fractures. Preliminary experience with a posterior transpedicular correction-fixation technique.

A number of conservative and operative approaches have been described for the treatment of unstable traumatic upper and middle thoracic fractures. The advantage of surgical correction and fixation/fusion lies in its potential to restore sagittal and coronal alignment, thereby indirectly decompressing the spinal cord. A consecutive series of 8 patients with unstable traumatic upper and middle thoracic fractures is reviewed. In all patients, polyaxial pedicle screws were inserted bilaterally into the two levels above and below the fracture. Rods that were less contoured ("undercontoured") than the regional hyperkyphosis at the injured level, were anchored to the caudal four screws. The cranial four screws, with the vertebrae to which they were inserted, were then progressively pulled posteriorly onto the undercontoured rods with rod reducers, thus correcting the hyperkyphosis and anterolisthesis. The mean follow-up was 15 months. The mean regional kyphosis was 23 degrees preoperatively, 17 degrees postoperatively and 18 degrees at follow-up. The mean anterolisthesis was 8 mm preoperatively, 1 mm postoperatively and 1 mm at follow-up. No hardware failure occurred. Five patients with complete spinal cord injury at presentation made no neurological recovery, two patients with incomplete spinal cord injury initially (ASIA B), recovered substantially (to ASIA D), and the patients who were neurologically intact at presentation remained so.

Accidents, Traffic↗
PubMed2004

Bilateral occipital condylar fracture. Case report about successful treatment with SOMI brace.

Treatment guidelines for occipital condyle fractures (OCFs) are not established. Options for unilateral OCF have been discussed in the literature, but not for bilateral cases. We describe a bilateral OCF type II (according to the Anderson/Montesano classification) in a 30-year-old patient, where immobilisation in a SOMI brace (sternal occipital mandibular immobilisation) was successfully used.

Adult↗
PubMed2004

Surgical treatment of cervical myelopathy of unclear aetiology.

In some cases neither the clinical pattern nor the findings of magnetic resonance imaging (MRI) can help to determine the cause of a cervical myelopathy. The differential diagnosis of such cases as a rule includes spondylotic myelopathy, a solitary focus of multiple sclerosis and an intramedullary tumour in early stage. Worsening of signs and symptoms due to the circumscribed lesion of the spinal cord can require surgical treatment, even if no certain diagnosis could be stated thus far. The question is how to choose a surgical procedure which is beneficial for all three kinds of spinal cord pathology in their initial stage, which at the same time does not jeopardise spine and spinal cord and allows secondary surgery if needed after the precise nature of the lesion has been assessed. Ventral decompression and fusion with or without dorsal decompression seems to be a convincing procedure.

Adult↗
PubMed2003

Idiopathic symptomatic epidural lipomatosis of the lumbar spine.

BACKGROUND: Symptomatic spinal epidural lipomatosis (SEL) of the lumbar spine is a rare disease, often associated with steroid overload. Idiopathic lipomatosis is even much less frequent. Signs and symptoms depend upon the level and degree of nerve root compression. Diagnosis is best based on MRI. Weight reduction can be curative, however after failure of medical treatment or in severe cases surgical decompression should be performed. METHOD: Four patients with severe symptoms of lumbar spinal epidural lipomatosis were treated by surgical decompression. Patient history and neurological examination are described, diagnostic imaging is demonstrated, surgical treatment and outcome are documented. Different surgical techniques including laminectomy, interlaminar fenestration and lateral recess decompression were applied and are discussed. FINDINGS: All four patients improved after surgery. No surgical complications were observed. Even though limited to four cases this is the second largest series of operated idiopathic spinal epidural lipomatosis. INTERPRETATION: Surgical decompression was effective in improving symptoms in severe lumbar idiopathic spinal epidural lipomatosis.

Aged↗
PubMed2003

Dysplastic dens of the axis: case report.

In a patient injured in a bicycle accident, radiological evaluation of the cervical spine revealed an oblique orientation of a dysplastic dens of the axis, which, to our knowledge, has not been reported in the literature. There were no other bony or soft tissue anomalies and no associated instability. This case should draw attention to congenital anomalies of the cranio-cervical junction in trauma patients.

Accidents, Traffic↗
PubMed1999

Solitary thoracic intradural extramedullary ependymoma.

Intradural extramedullary ependymomas of the cervical or thoracic spine are extremely rare. We present a 62-year-old woman with progressive thoracic back pain over 9 months. Magnetic resonance imaging rerevealed a thoracic intradural extamedullary tumour which was surgically removed in total. Histologic examination identified the tumour as ependymoma, WHO Grade II. Our radiological and surgical findings are consistent with the hypothesis that these tumours develop from heterotopic glial tissue pinched off from the neural tube during its closure. Copyright 1999 Harcourt Publishers Ltd.

Journal Article↗
PubMed1998

Intraoperative color-coded duplex sonography for localization of a distal middle cerebral artery aneurysm: technical case report.

OBJECTIVE AND IMPORTANCE: We describe the surgical treatment of a small, distal, middle cerebral artery (MCA) aneurysm, performed using intraoperative color-coded duplex sonography for localization. CLINICAL PRESENTATION: A 55-year-old man presented with a sudden intense headache. Computed tomographic scans revealed a subarachnoid hemorrhage. Angiography demonstrated two MCA aneurysms, one arising from the proximal bifurcation of the right MCA and the other from its distal bifurcation. TECHNIQUE: On Day 1, the proximal MCA aneurysm was clipped via the standard transsylvian approach. The distal MCA aneurysm was identified with the aid of color-coded duplex sonography and was successfully clipped with minimal additional dissection of the sylvian fissure. CONCLUSION: Color-coded duplex sonography provides a two-dimensional image of the brain parenchyma and color-coded flow imaging of cerebral vessels in real time. It may be used for rapid intraoperative localization of small, distally located, cerebral aneurysms.

Cerebral Angiography↗
PubMedDate not supplied

Malignant transformation of a spinal cord ganglioglioma--case report and review of the literature.

Gangliogliomas are tumors of mixed glial and neuronal phenotype that usually have a benign clinical course. Rare cases display anaplastic features at the time of first presentation or progress to anaplastic gliomas over extended times. We report on a ganglioglioma of the spinal cord that recurred as a malignant glioma one and a half years after resection. The initial neoplasm was composed of a mixture of well-differentiated ganglionic and astrocytic cells. The recurrent tumor was an anaplastic small-cell glioma. The sole unusual aspect in the initial neoplasm was an abundance of small vessels with calcified walls, which mimicked a vascular malformation.

Adult↗