scholarly journals Remote Hemorrhage in the Cerebellum and Temporal Lobe after Lumbar Spine Surgery

2015 ◽  
Vol 2015 ◽  
pp. 1-5
Author(s):  
Shotaro Watanabe ◽  
Seiji Ohtori ◽  
Sumihisa Orita ◽  
Kazuyo Yamauchi ◽  
Yawara Eguchi ◽  
...  
Keyword(s):  
Cerebrospinal Fluid ◽  
Lumbar Spine ◽  
Temporal Lobe ◽  
Dura Mater ◽  
Spine Surgery ◽  
Cerebrospinal Fluid Leak ◽  
Leg Pain ◽  
Lumbar Spine Surgery ◽  
Neurosurgical Procedures ◽  
Fluid Leak

Cerebellar hemorrhage remote from the site of surgery can complicate neurosurgical procedures. However, this complication after lumbar surgery is rare. Furthermore, hemorrhage in both the cerebellum and the temporal lobe after spine surgery is rarer still. Herein we present a case of remote hemorrhage in both the cerebellum and the temporal lobe after lumbar spine surgery. A 79-year-old woman with a Schwannoma at the L4 level presented with low back and bilateral leg pain refractory to conservative management. Surgery was undertaken to remove the Schwannoma and to perform posterior fusion. During the surgery, the dura mater was removed in order to excise the Schwannoma. Reconstruction of the dura mater was performed; postoperatively the patient had a cerebrospinal fluid leak. Five days after surgery, clouding of consciousness started gradually, and hemorrhage in the cerebellum and the temporal lobe was revealed by computed tomography. Emergent evacuation of the hemorrhage was performed and the patient recovered consciousness after the surgery. Leakage of cerebrospinal fluid may have induced this hemorrhage. While rare, intracranial hemorrhage after spine surgery can occur, sometimes requiring emergent intervention.

Pneumocephalus leading to the diagnosis of cerebrospinal fluid leak and esophageal perforation after cervical spine surgery

2016 ◽  
Vol 26 ◽  
pp. 141-142 ◽  
Author(s):  
C. Rory Goodwin ◽  
Christine E. Boone ◽  
James Pendleton ◽  
Benjamin D. Elder ◽  
Zhikui Wei ◽  
...  
Keyword(s):  
Cerebrospinal Fluid ◽  
Cervical Spine ◽  
Spine Surgery ◽  
Esophageal Perforation ◽  
Cerebrospinal Fluid Leak ◽  
Cervical Spine Surgery ◽  
Fluid Leak

scholarly journals Is the Hospital Anxiety and Depression Scale Associated With Outcomes After Lumbar Spine Surgery?

2019 ◽  
Vol 10 (3) ◽  
pp. 266-271 ◽  
Author(s):  
Leah Y. Carreon ◽  
Annette B. Jespersen ◽  
Christian C. Støttrup ◽  
Karen H. Hansen ◽  
Mikkel O. Andersen
Keyword(s):  
Lumbar Spine ◽  
Spine Surgery ◽  
Short Form ◽  
Depression Scale ◽  
Leg Pain ◽  
Anxiety And Depression ◽  
Lumbar Spine Surgery ◽  
Consecutive Series ◽  
Medical Patients ◽  
Hospital Anxiety

Study Design:Longitudinal cohort.Objectives:The Hospital Anxiety and Depression Scale (HADS) was developed to provide clinicians a reliable, valid, and practical tool to identify and quantify the anxiety and depression in medical patients. Several studies have shown that patients with chronic low back pain may have subclinical depression and impairments in mental health and that these in turn may lead to less than optimal results after lumbar spine surgery. The purpose of this study is to determine if there are associations between preoperative HADS and differences in pre- and postoperative health-related quality-of-life (HRQOLs) scores after spine surgery.Methods:From a single center, a consecutive series of patients completed the HADS, Oswestry Disability Index (ODI), Short Form-36 (SF-36), EuroQOL-5D (EQ-5D), and Visual Analog Scale (VAS) for back and leg pain. Except for HADS, the patients completed the same HRQOLs 1 year after surgery.Results:Of 308 eligible cases, 208 (68%) had follow-up data available and were included in the analysis. Patients in the HADS-Anxiety (HADS-A) Abnormal category had the worst preoperative HRQOLs but had the greatest improvement in 1-year postoperative scores. Except for VAS Leg Pain, preoperative HRQOLs were better in patients in the HADS-Depressed (HADS-D) Normal category. Patients in the HADS-D Abnormal category had statistically significantly greater improvement in 1-year postoperative EQ-5D and ODI scores when compared with the other cohorts.Conclusion:Worse HADS-A and HADS-D scores are associated with worse preoperative HRQOL scores in patients with lumbar degenerative disorders scheduled for spine surgery. However, similar improvements in HRQOLs can be expected 1 year postoperative regardless of the patients’ HADS scores.

Low Back Pain Versus Back-Related Leg Pain: How Do Patient Expectations and Outcomes of Lumbar Spine Surgery Compare?

2021 ◽  
pp. 155633162110104
Author(s):  
Christopher M. Brusalis ◽  
Roland Duculan ◽  
Frank P. Cammisa ◽  
Andrew A. Sama ◽  
Alexander P. Hughes ◽  
...  
Keyword(s):  
Low Back Pain ◽  
Back Pain ◽  
Lumbar Spine ◽  
Spine Surgery ◽  
Patient Expectations ◽  
Leg Pain ◽  
Pain Patient ◽  
Lumbar Spine Surgery ◽  
Low Back ◽  
Preoperative Expectations

Background: An increasing number of lumbar spine conditions are treated surgically. Such intervention, however, is commonly thought to be more effective in addressing leg pain than low back pain. Patient expectations may also contribute to self-reported surgical outcomes. Questions/Purposes: We sought to compare the expectations of patients in 2 groups undergoing lumbar spine surgery: those with predominantly low back pain and those with predominantly leg pain. We also sought to evaluate how these expectations were fulfilled for each group. Methods: We carried out a retrospective analysis of prospectively collected data from a prior study in which patients scheduled for lumbar spine surgery at a single institution completed validated surveys preoperatively and at 2 years postoperatively, including a 20-item survey on expectations for lumbar spine surgery. The patients were enrolled in the study between February 2010 and August 2012, and were divided into 2 cohorts: a “Back > Leg” group that consisted of patients with back pain that was isolated or greater than leg pain, and a “Leg ≥ Back” group that consisted of patients with leg pain that equaled or exceeded back pain. The primary analysis compared composite expectation scores (range, 0–100) between groups. Results: A total of 366 patients were deemed eligible for the study; of these, 162 patients were allocated to the Back > Leg group and 204 patients were allocated to the Leg ≥ Back group. Patients in the Leg ≥ Back group had a greater mean preoperative expectation score compared with those in the Back > Leg group. Multivariate analysis demonstrated that higher preoperative expectations were associated with leg pain symptoms after controlling for disease diagnosis. Both groups reported similar proportions of fulfilled expectations. Conclusion: Patients with predominantly leg pain hold greater preoperative expectations for lumbar spine surgery than do patients with predominantly back pain. That these patient groups reported similar fulfillment of their expectations at 2 years postoperatively illustrates the greater clinical outcomes achieved among patients who presented with predominantly leg pain.

scholarly journals Unique Bone Suture Anchor Repair of Complex Lumbar Cerebrospinal Fluid Fistulas

2020 ◽  
Vol 11 ◽  
pp. 153
Author(s):  
Marc Agulnick ◽  
Benjamin R. Cohen ◽  
Nancy E. Epstein
Keyword(s):  
Cerebrospinal Fluid ◽  
Lumbar Spine ◽  
Spine Surgery ◽  
Suture Anchor ◽  
Hand Surgery ◽  
Lumbar Spine Surgery ◽  
Lumbar Spinal Surgery ◽  
Lumbar Cerebrospinal Fluid ◽  
Dural Tears ◽  
Lumbar Spinal

Background: Spine surgeons encounter occasional complex cerebrospinal fluid fistulas/dural tears (CSF/DT) during lumbar spinal surgery. In some cases, these leaks are found during the index procedure, but others may appear postoperatively, or in the course of successive procedures. Here we asked, whether these complex CSF fistulas/DT could be more readily repaired utilizing a “bone suture anchor” technique, particularly where there is no residual dural margin/remnant. Methods: With the combined expertise of the orthopedist and neurosurgeon, mini/micro bone suture anchors, largely developed for hand surgery, facilitated repair of complex DT occurring during lumbar spine surgery. This technique was utilized to suture in place fascia, periosteal, or muscle grafts, and was followed by the application of microfibrillar collagen, and a fibrin sealant. Results: This mini/micro suture anchor technique has now been utilized to repair multiple significant intraoperative and/or postoperative recurrent DT, largely avoiding the need to place lumbar drains and/or lumbo- peritoneal shunts. Conclusions: Here, we reviewed how to directly suture dural grafts utilizing a mini/micro bone suture anchor technique to repair complex intraoperative primary/recurrent DT occurring during lumbar spine surgery. The major advantages of this technique, in addition to obtaining definitive occlusion of the DT, largely avoids the need to place lumbar drains and/or lumbo-peritoneal shunts with their attendant risks and complications.

Impact of Dominant Symptom on 12-Month Patient-Reported Outcomes for Patients Undergoing Lumbar Spine Surgery

Neurosurgery ◽  
2020 ◽  
Vol 87 (5) ◽  
pp. 1037-1045 ◽  
Author(s):  
Clinton J Devin ◽  
Anthony L Asher ◽  
Kristin R Archer ◽  
Anshit Goyal ◽  
Inamullah Khan ◽  
...  
Keyword(s):  
Back Pain ◽  
Lumbar Spine ◽  
Return To Work ◽  
Spine Surgery ◽  
Important Determinant ◽  
Leg Pain ◽  
Lumbar Spine Surgery ◽  
Predominant Symptom ◽  
Significant Difference ◽  
The Impact

Abstract BACKGROUND The impact of symptom characteristics on outcomes of spine surgery remains elusive. OBJECTIVE To determine the impact of symptom location, severity, and duration on outcomes following lumbar spine surgery. METHODS We queried the Quality Outcomes Database (QOD) for patients undergoing elective lumbar spine surgery for lumbar degenerative spine disease. Multivariable regression was utilized to determine the impact of preoperative symptom characteristics (location, severity, and duration) on improvement in disability, quality of life, return to work, and patient satisfaction at 1 yr. Relative predictor importance was determined using an importance metric defined as Wald χ2 penalized by degrees of freedom. RESULTS A total of 22 022 subjects were analyzed. On adjusted analysis, we found patients with predominant leg pain were more likely to be satisfied (P < .0001), achieve minimum clinically important difference (MCID) in Oswestry Disability Index (ODI) (P = .002), and return to work (P = .03) at 1 yr following surgery without significant difference in Euro-QoL-5D (EQ-5D) (P = .09) [ref = predominant back pain]. Patients with equal leg and back pain were more likely to be satisfied (P < .0001), but showed no significant difference in achieving MCID (P = .22) or return to work (P = .07). Baseline numeric rating scale-leg pain and symptom duration were most important predictors of achieving MCID and change in EQ-5D. Predominant symptom was not found to be an important determinant of return to work. Worker's compensation was found to be most important determinant of satisfaction and return to work. CONCLUSION Predominant symptom location is a significant determinant of functional outcomes following spine surgery. However, pain severity and duration have higher predictive importance. Return to work is more dependent on sociodemographic features as compared to symptom characteristics.

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