Examinando por Autor "Pereira, Mariana"

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    Low-grade cartilaginous vertebral tumor: a rare cause of spinal cord compression
    (Gavin Publishers, 2023-12-19) Molina, Marcelo; Ceballos, Oscar; Pereira, Mariana
    Introduction: Osteochondroma is the most common benign primary neoplasm, representing up to 36% of benign bone tumors. Its location in the spine is rare, occurring in 4% to 7% of primary tumors in this location, and of these, around one-third present myelopathy secondary to spinal cord compression. Despite its low prevalence described in the literature, in recent years there has been an increase in reported cases. Objectives: To present a rare low-grade cartilaginous tumor with intracanal extension as an etiology of spinal cord compression syndrome with myelopathy. Treatment options were discussed. Material and Method: Informed consent was approved by the patient. Clinical information and images were obtained from the electronic file. A review of the literature was done for its analysis and discussion. Results: 52-year-old man, no medical history. He consulted for a 2-month history of progressive loss of strength on the left lower extremity (LLE). On physical examination, it presents hypoesthesia and 3/5 strength from L2 to S1 myotomes in the LLE. Neurological evaluation, spine CT, and MRI were done. Images show a T7 vertebral body tumor with a large extruded calcified mass occupying 80% of the canal at T6T7 with severe compression of the spinal cord. Surgical management was decided by performing posterior arthrodesis from T4 to T10 with posterolateral tumor resection and spinal cord decompression. The patient woke up with paraplegia after surgery. There was a gradual and significant improvement in the patient’s condition over the first four weeks. After a 6-month of following an intensive rehabilitation program, the patient progressed favorably, pain-free, with normal sensitivity, full recovery to 5/5 strength, walking independently, and some degree of spasticity. At 2 years follow up the patient has only mild gait disturbance secondary to spasticity. Discussion: A case of solitary osteochondroma as a cause of progressive compressive myelopathy was presented. Surgical options are evaluated depending on the location of the tumor, presence of mechanical pain, radiographic spinal alignment, vertebral collapse, posterolateral involvement, and neurological compromise of the spine. Most of the similar published reports show that this clinical picture is more frequent in the context of multiple hereditary exostoses and 132 new cases have been published from 2004 to 2016, which shows a 2.4-fold increase since 2003, of which, 27.2% presented with myelopathic symptoms. Conclusion: Osteochondroma is a rare spine tumor that can produce radicular or myelopathic symptoms. Surgery is recommended in spinal cord compression cases. Surgical options are evaluated depending on the location, morbidity, and complications.
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    Posterior hemivertebrectomy for correction of congenital kyphosis in adulthood: case report and literature review
    (Gavin Publishers, 2023-12-19) Molina, Marcelo; Pereira, Mariana; Khek, Pablo; Ballesteros, José Vicente
    Congenital kyphosis is an infrequent cause of kyphosis with a potential severe progressive deformity and neurological damage. There are few reports in the literature about congenital kyphosis focusing on adults. Case presentation: 24-year-old male with progressive dorsal pain, paresthesias, and numbness in his legs. Physical examination demonstrated a rigid kyphotic deformity with tenderness on the apex, neurologically intact. The diagnosis was a T10 butterfly posterior hemivertebra with segmental kyphosis of 48 degrees. The patient was treated surgically with a single posterior procedure, performing a complete T10 hemivertebrectomy and instrumented fixation from T8 to T12. The postoperative assessment demonstrated a segmental kyphosis of 14 degrees with 34º of correction, without surgical complications, and good functional results during 4 years of follow-up. Conclusion: Posterior-only hemivertebra resection is an effective procedure for treating congenital kyphosis, providing an excellent correction of the deformity with a good functional outcome. Intraoperative imaging tools, such as CT scans and navigation systems, can aid in performing the surgery and improve outcomes.
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    RECOSAN tumors study: analysis of patients with spine surgery due to oncologic pathology
    (Fortune Journals, 2024-11-01) Molina, Marcelo; Ceballos, Oscar; Pereira, Mariana; Lobos, Daniel; Yurac, Ratko; Otto, Juan Pablo; Barahona, Maximiliano
    Introduction: Primary bone tumors of the spine are rare and account for 2.8 to 13% of all bone tumors. On the other hand, the spine is a frequent location for metastatic disease. As local control of the primary tumor pathology continues to improve, survival rates improve, and, by extension, the chance of metastasis increases. Breast, lung, and prostate cancer are the main causes of spinal metastases. The RECOSAN (Santiago Spine Surgery Registry) project is the first multicenter, prospective, and national registry of spinal surgeries in Chile. Purpose: The objective was to describe the epidemiological, diagnostic, surgical information, complications, and biopsy results of patients operated on for tumor pathology in the RECOSAN registry. Materials and methods: The RedCap database of the RECOSAN project’s was used to obtain information on patients who underwent spinal surgery due to tumor pathology in five Chilean hospitals. Information on the biopsies of these patients was requested from the respective hospitals and clinics where they were admitted. Demographic data, surgical history, and results of biopsies performed were collected. Results: Out of 1225 patients admitted to the registry, 82 correspond to spinal surgeries due to tumor pathology. Biopsy reports were obtained from 63 patients who underwent surgical biopsy plus tumor resection and instrumentation. 52% of the patients were male, and the mean age was 57 years. 44% of the biopsies were in the dorsal spine and 40% in the lumbar spine. Of the total number of biopsies performed, 84.1% resulted in tumor lesions. Of these, 66% corresponded to metastases and 34% to primary tumors. The most frequent histological diagnoses were breast carcinoma (20.8%), prostate carcinoma (11.3%) and plasma cell neoplasia (9.4%). The percentage of intraoperative complications of the instrumented patients was 18%, and the percentage of reoperation was 4.7%. There was agreement between the preoperative and final diagnoses based on the biopsy of 66% of the cases, reaching a moderate concordance (Kappa=0.42). Conclusion: Vertebral biopsy is an essential procedure for histological diagnosis in both primary and metastatic tumor lesions. This is the first national multicenter registry in Chile for patients undergoing surgery for tumors. It covers epidemiological data, clinical information, surgical techniques, biopsy results, as well as intraoperative and postoperative complications. In this series, the most frequent histological diagnoses coincide with those reported in the literature. The concordance between the preoperative diagnosis and the biopsy is moderate, which supports the importance of obtaining a biopsy for the treatment of spinal tumor pathology.