tailieunhanh - Spinal Disorders: Fundamentals of Diagnosis and Treatment Part 100

Spinal Disorders: Fundamentals of Diagnosis and Treatment Part 100. Spinal disorders are among the most common medical conditions with significant impact on health related quality of life, use of health care resources and socio-economic costs. Spinal surgery is still one of the fastest growing areas in clinical medicine. | 992 Section Tumors and Inflammation Case Study 2 A 78-year-old man with a history of lung adenocarcinoma presented with severe mid thoracic pain and signs ofcord compression in both lower extremities. Radiological assessment including plain X-rays and MRI revealed a pathological fracture of T5 with very severe cord compression at the same level a-c . Due to limited general conditions the patient was selected for a posterior approach. Large cord decompression was obtained by T5 laminectomy resection of both pedicles and partial posterolateral vertebrectomy. Spinal reconstruction followed using bone cement and T4-T6 pedicular screw instrumentation d-e . The patient was still alive 1 year after surgery. port 1 8 . This procedure is consequently indicated for patients with limited general health condition and life expectancy. Endovascular embolization plays a critical role in the management of certain spinal tumors. Some metastatic lesions such as renal cell or thyroid tumors are extremely hypervascular which may result in tremendous intraoperative blood loss. Preoperative angiography and embolization offer a means of reducing the blood supply to the tumor mass thus significantly reducing the morbidity associated with surgical resections with only a minimal complication rate 31 . This procedure is recommended to be performed within the 48 h preceding surgery. Metastasis of the lumbar spine can be approached from an anterior as well as a posterior approach Lumbar Spine Metastatic lesions localized between L1 and L4 can be managed tumor debulking and spinal reconstruction in a similar fashion to the tumors of the midlower thoracic spine as previously described. Depending on the location a lateral retroperitoneal lumbotomy or a low thoracotomy with release of the diaphragm will be required to expose the lumbar spine 3 9 11 35 . Tumor localized in L5 can be resected through an anterior retroperitoneal or transperitoneal approach. Due to the localization the instrumentation