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8. Early postoperative MRI in detecting hematoma and dural compression after lumbar spinal decompression: prospective study of asymptomatic patients in comparison to patients requiring surgical revision

Author

Leonardi, Massimo, Zanetti, M., Saupe, N., Min, K., Leonardi, Massimo, Zanetti, M., Saupe, N., and Min, K.

Abstract

Early postoperative MRI after spinal surgery is difficult to interpret because of confounding postoperative mass effects and frequent occurrence of epidural hematomas. Purpose of this prospective study is to evaluate prevalence, extent and significance of hematoma in the first postoperative week in asymptomatic patients after decompression for lumbar stenosis and to determine the degree of clinically significant dura compression by comparing with the patients with postoperative symptoms. MRI was performed in 30 asymptomatic patients (47 levels) in the first week after lumbar spine decompression for degenerative stenosis. Eleven patients requiring surgical revision (16 levels) for symptomatic early postoperative hematoma were used for comparison. In both groups the cross-sectional area of the maximum dural compression (bony stenosis and dural sac expansion) was measured preoperatively and postoperatively by an experienced radiologist. Epidural hematoma was seen in 42.5% in asymptomatic patients (20/47 levels). The median area of postoperative hematoma at the operated level was 176mm2 in asymptomatic patients and 365mm2 in symptomatic patients. The median cross-sectional area of the dural sac at the operated level was 128.5 and 0mm2 in asymptomatic and symptomatic patients, respectively, at the site of maximal compression. In the symptomatic group 75% of the patients had a maximal postoperative dural sac area of 58.5mm2 or less, whereas in the asymptomatic group 75% of patients with epidural hematoma had an area of 75mm2 or more. The size of hematoma and the degree of dural sac compression were significantly larger in patients with symptoms needing surgical revision. Dural sac area of less than 75mm2 in early postoperative MRI was found to be the threshold for clinical significance

Published
2018

18. Early postoperative MRI in detecting hematoma and dural compression after lumbar spinal decompression: prospective study of asymptomatic patients in comparison to patients requiring surgical revision

Author

Leonardi, Massimo, Zanetti, M., Saupe, N., Min, K., Leonardi, Massimo, Zanetti, M., Saupe, N., and Min, K.

Abstract

Early postoperative MRI after spinal surgery is difficult to interpret because of confounding postoperative mass effects and frequent occurrence of epidural hematomas. Purpose of this prospective study is to evaluate prevalence, extent and significance of hematoma in the first postoperative week in asymptomatic patients after decompression for lumbar stenosis and to determine the degree of clinically significant dura compression by comparing with the patients with postoperative symptoms. MRI was performed in 30 asymptomatic patients (47 levels) in the first week after lumbar spine decompression for degenerative stenosis. Eleven patients requiring surgical revision (16 levels) for symptomatic early postoperative hematoma were used for comparison. In both groups the cross-sectional area of the maximum dural compression (bony stenosis and dural sac expansion) was measured preoperatively and postoperatively by an experienced radiologist. Epidural hematoma was seen in 42.5% in asymptomatic patients (20/47 levels). The median area of postoperative hematoma at the operated level was 176mm2 in asymptomatic patients and 365mm2 in symptomatic patients. The median cross-sectional area of the dural sac at the operated level was 128.5 and 0mm2 in asymptomatic and symptomatic patients, respectively, at the site of maximal compression. In the symptomatic group 75% of the patients had a maximal postoperative dural sac area of 58.5mm2 or less, whereas in the asymptomatic group 75% of patients with epidural hematoma had an area of 75mm2 or more. The size of hematoma and the degree of dural sac compression were significantly larger in patients with symptoms needing surgical revision. Dural sac area of less than 75mm2 in early postoperative MRI was found to be the threshold for clinical significance

19. [Herbal food supplements].

Author

Di Giorgi Gerevini V, Copparoni R, Dalfrà S, Leonardi M, and Guidarelli L

Subjects
Drug Labeling, European Union, Herb-Drug Interactions, Humans, Italy, Minerals standards, Minerals therapeutic use, Plants, Medicinal, Vitamins standards, Vitamins therapeutic use, Dietary Supplements adverse effects, Dietary Supplements analysis, Dietary Supplements standards, Herbal Medicine legislation & jurisprudence, Legislation, Drug, Legislation, Food, Plant Preparations adverse effects, Plant Preparations chemistry, Plant Preparations standards, Plant Preparations therapeutic use
Abstract

Dietary supplements are increasingly popular. Supplements include substances such as vitamins, minerals, amino acids, essential fatty acids, fibers and botanicals. Directive 2002/46/EC foresees the use as food supplements of vitamins and minerals listed in the Annexes to the Directive. The Directive challenged the importance of a European regulatory framework for this products to be adopted by the member states. To date herbal products without any therapeutic activity have been included in food supplements. This review summarizes the main legislations on food supplements focusing on herbal products or derivatives.

Published
2005

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