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Gheorghe Checiu, Cristian Filip, Daniel Serban, Niki Adrian Calina, Marius Podea, Costica Zamfir and Florin Exergian

Abstract

In the last years we observed an increased number of patients with multiple lesions after high energy accidents. Type C injuries of the thoracic spine are the most severe lesions, with the worse prognosis. The study analyzes the injury profile, management and outcome of all patients with thoracic spine, from T1- to T10, type C injuries treated in the Spinal Surgery Department of “Bagdsar- Arseni” Emergency Hospital, in the last 5 years. There were 26 patients admitted in the study, mostly male, 77%, with a mean age of 33.8 years. All of them were victims of high energy accidents, and all had spine injury associated with multiple lesions (head, thoracic, abdominal and limbs). We have chosen a posterior approach in all cases, with laminectomy or hemilaminectomy, permitting us to achieve all the major objectives of surgery, with the advantage of lower blood loss and a reduced operating time. The purpose of surgery was to achieve decompression of the spinal cord and stability of the thoracic spine. We treated 19 patient surgically and 4 patient conservative. Thoracic spine type C fractures remain a challenge for the spinal surgeon. These lesions require a multidisciplinary team approach for the treatment of associated lesions. The main goal of surgery is to achieve stability of the fractured segments. The timing for surgery is indicated mainly by associated respiratory problems.

Open access

Niki Adrian Calina, Cristian Filip, Daniel Serban, Marius Podea, Costica Zamfir, Gheorghe Checiu, Morosanu Eduard and Florin Exergian

Abstract

Objective: Spinal chordomas are rare, locally invasive, malignant neoplasm, representing 5% of all malignant tumors of the skeleton. In the majority of cases the segment involved is the sacrum. This study reviews our experience during the last 15 years at The Spinal Surgery Department of “Bagdasar-Arseni” Clinical Hospital, to determine the effects of various treatment methods on the overall course of this disease process.

Methods: A retrospective study was performed, from 2000 to 2015, in which, 31 patients with spinal chordomas were evaluated at our institution.

Results: Two thirds of patients were male, with a mean age of 57 years. Patients presented with local pain, radiculopathy and bladder-bowel dysfunction at hospital admission. There were 24 patients with sacral chordomas, 4 with cervical chordomas, 2 with thoracic and one with lumbar chordoma. All patients underwent at least one surgical procedure. The main goal of surgery was to achieve total resection of the tumor.

Conclusion: Our study suggests that spinal chordomas are rare tumors with a high risk of tumor recurrence. If total resection is achieved, the risk of recurrence diminishes. If the tumor resection is subtotal, than recurrence appears in all cases. After tumor resection, the surgeon faces the problem of spinal instability that needs solving. Based on these findings, we think that, whenever possible, radical resection should be the treatment of choice for spinal chordomas.