11/260. Imaging features of cervical spondylolysis--with emphasis on MR appearances. AIM: To describe the imaging features of cervical spondylolysis, with emphasis on magnetic resonance imaging (MRI) appearances. MATERIALS AND methods: The clinical and imaging features (plain radiographic, CT and MRI) of three patients with cervical spondylolysis were reviewed. RESULTS AND CONCLUSIONS: Three cases of C6 cervical spondylolysis have been described and the world literature reviewed. The plain radiographic features in two cases with bilateral defects showed spondylolisthesis and abnormalities of the pars and adjacent facet joints. CT demonstrated well corticated defects and associated spina bifida occulta in all cases. The defects were seen in only one case on MRI but in all cases, absence of the spinous process of C6 was noted on sagittal sequences due to the spina bifida occulta. Cervical spondylolysis is an uncommon condition that must be distinguished from an acute fracture and diagnosed radiologically to prevent mismanagement. Although the defect may be difficult to identify on MRI, absence of the spinous process on sagittal sequences should raise the suspicion of the abnormality. ( info) |
12/260. Iatrogenic spondylolysis leading to contralateral pedicular stress fracture and unstable spondylolisthesis: a case report. STUDY DESIGN: A case report of iatrogenic spondylolysis as a complication of microdiscectomy leading to contralateral pedicular stress fracture and unstable spondylolisthesis. OBJECTIVE: To improve understanding of this condition by presenting a case history and roentgenographic findings of a patient that differ from those already reported and to propose an effective method of surgical management. methods: A 67-year-old woman with no history of spondylolysis or spondylolisthesis underwent an L4-L5 microdiscectomy for a left herniated nucleus pulposus 1 year before the current consultation. For the preceding 8 months, she had been experiencing low back and bilateral leg pain. Imaging studies revealed a left L4 spondylolytic defect and a right L4 pedicular stress fracture with an unstable Grade I spondylolisthesis. RESULTS: The patient was treated with posterior spinal fusion, which resulted in complete resolution of her clinical and neurologic symptoms. CONCLUSIONS: Iatrogenic spondylolysis after microdiscectomy is an uncommon entity. However, it can lead to contralateral pedicular stress fracture and spondylolisthesis, and thus can be a source of persistent back pain after disc surgery. Surgeons caring for these patients should be aware of this potential complication. ( info) |
| OBJECTIVE: To document clinical changes after a course of chiropractic care in a geriatric patient with vertigo, tinnitus, and hearing loss. Clinical Features: A 75-year-old woman with a longstanding history of vertigo, tinnitus, and hearing loss experienced an intensified progression of these symptoms 5 weeks before seeking chiropractic care. Radiographs revealed a C3 retrolisthesis with moderate degenerative changes C4-C7. Significant decreases in audiologic function were evident, and the RAND 36 health Survey revealed subjective distress. Intervention and Outcome: The patient received upper cervical-specific chiropractic care. Paraspinal bilateral skin temperature differential analysis was used to determine when an upper cervical adjustment was to be administered. Radiographic analysis was used to determine the specific characteristics of the misalignment in the upper cervical spine. Through the course of care, the patient's symptoms were alleviated, structural and functional improvements were evident through radiographic examination, and audiologic function improved. CONCLUSION: The clinical progress documented in this report suggests that upper cervical manipulation may benefit patients who have tinnitus and hearing loss. ( info) |
14/260. Outcome of one-level posterior lumbar interbody fusion for spondylolisthesis and postoperative intervertebral disc degeneration adjacent to the fusion. STUDY DESIGN: review of the clinical and radiologic records of patients who underwent one-level posterior lumbar interbody fusion (PLIF) at L4-L5. OBJECTIVE: To determine whether adjacent intervertebral disc degeneration after PLIF affects the clinical results, and whether preoperative caudal disc (L5-S1) degeneration affects postoperative clinical results. SUMMARY OF BACKGROUND DATA: There is little reliable information in the literature regarding clinical results and adjacent disc degeneration after PLIF. methods: Forty-five patients who underwent L4-L5 PLIF for spondylolisthesis with more than 5 years of postoperative observation were included in this study. PLIF was performed in conjunction with posterior instrumentation. The posterior lumbar intervertebral grafting was performed using both autograft and a ceramic spacer. Intervertebral disc heights at L2-L3, L3-L4, and L5-S1 were measured before and after surgery. The patients were divided into two groups based on the presence or absence of the preoperative L5-S1 narrowing. Correlation between clinical status evaluated by the recovery rate of the Japanese Orthopedic association (JOA) score and disc heights were determined. RESULTS: All intervertebral disc heights adjacent to the fusion decreased after surgery (P < 0.05). However, no significant correlation was seen between clinical results estimated by the recovery rate and postoperative disc narrowing. There was also no significant difference in clinical results between patients with or without preoperative L5-S1 narrowing. CONCLUSIONS: There is no evidence from the results that postoperative narrowing of the adjacent disc and preoperative narrowing of the L5-S1 disc affects the clinical outcome of L4-L5 PLIF. ( info) |
15/260. The musculoskeletal manifestations of Werner's syndrome. Werner's syndrome is a rare condition usually presenting as premature ageing in adults. Over a period of 30 years we have followed two siblings with extensive musculoskeletal manifestations including a soft-tissue tumour, insufficiency fractures, nonunion and tendonitis, with associated problems of management. The literature is reviewed. ( info) |
16/260. Minimum 10-year follow-up study of anterior lumbar interbody fusion for isthmic spondylolisthesis. The aims of the current study were to evaluate the long-term clinical and radiologic results of anterior lumbar interbody fusion (ALIF) for isthmic spondylolisthesis. Between 1981 and 1988, a total of 35 patients underwent ALIF for isthmic spondylolisthesis. Of these, 23 patients were followed clinically and radiographically for more than 10 years (average, 13.3 years). The Japanese Orthopaedic association low-back pain score was used to evaluate the outcome of subjective symptoms and clinical signs. The preoperative and postoperative percentage of slip, preoperative and postoperative intervertebral disk height, interbody graft union, and pars defect union were evaluated by serial radiographs. The adjacent disk degeneration was also evaluated by radiographs and magnetic resonance imaging. Although the low-back pain score worsened after 5 years, ALIF provides satisfactory overall long-term clinical results. The preoperative percentage of slip and the disk height were corrected after surgery, but at the time of interbody graft union, slip and disk height recurred as a result of grafted bone collapse. The rate of union in the grafted area was 83%. In the nonunion cases, the scores gradually deteriorated with time, but the overall results were not different from those of union cases. Radiographs showed adjacent disk degeneration in 52% of cases in the upper adjacent level and in 70% of cases in the lower adjacent level, but these changes were not correlated with clinical outcomes. ( info) |
17/260. Importance of correlating static and dynamic imaging studies in diagnosing degenerative lumbar spondylolisthesis. Degenerative spondylolisthesis in the lumbar spine is due to long-standing segmental instability. A standing plain radiograph is commonly the only imaging study needed to establish the diagnosis. Translatory motion in spondylolisthesis is traditionally assessed with lateral flexion and extension radiographs. These dynamic studies often demonstrate a decrease in the slip percentage between the vertebral segments with extension and an increase with forward flexion. Some low-grade spondylolisthetic deformities reduce anatomically on the operating table after the administration of an anesthetic. We encountered one case in which there was complete reduction of an L4-5 grade I degenerative spondylolisthesis with positioning of a non-anesthetized patient in the supine position during a lumbosacral magnetic resonance imaging (MRI) scan. The patient's condition was originally misdiagnosed, as the spondylolisthesis was not identified on recumbent plain radiographs or on lumbosacral MRI. This case stresses the importance of correlating static and dynamic imaging studies in developing a treatment plan for patients with degenerative spondylolisthesis. ( info) |
18/260. Retained surgical sponges, a denied neurosurgical reality? Cautionary note. Surgically acquired foreign bodies are well known but not widely reported. Only seven articles pertaining to this subject were found in the current neurosurgical literature. Are they a denied neurosurgical reality? In this report with a concededly provoking title, the authors elucidate clinical and medicolegal aspects of retained surgical sponges, with emphasis on spinal procedures. To highlight particulars, a case is presented in which a retained surgical sponge was encountered as the cause of progressive low back pain and tender swelling in the scar area after instrumented posterolateral lumbar spinal fusion combined with pedicle screw fixation for lumbosacral spondylolisthesis 4 years earlier. However, until today, no reported neurosurgical patient has suffered a serious complication due to a retained surgical sponge. The authors wish to remind the neurosurgical community to learn from unpleasant clinical and medicolegal experiences in other specialties before serious complications occur, and we suggest rigorous standardization of intraoperative habits to avoid this hazardous complication. ( info) |
19/260. Osteoporotic spondylolisthesis: a case report. STUDY DESIGN: A case of spondylolisthesis caused by osteoporosis is described. OBJECTIVES: To describe the different etiologies of spondylolisthesis, and to report a new cause of pathologic spondylolisthesis previously unreported in the literature. SUMMARY OF BACKGROUND DATA: The literature on the etiology of spondylolisthesis is reviewed. Pathologic spondylolisthesis has been described with structural abnormalities, such as Paget's disease and tumors, but not with osteoporosis. methods: A clinical and radiographic interpretation of the reported case is presented. RESULTS: De Novo development of a spondylolisthesis at L5-S1 occurred by gradual elongation of the pars interarticularis over a period of 3 years. CONCLUSION: The reported case adds to the literature on spondylolisthesis by describing another etiology for this conclusion. Osteoporotic spondylolisthesis may well be identified more frequently in the future given the high prevalence of osteoporosis in the elderly. ( info) |
20/260. Salvage reconstruction with vascularized fibular strut graft fusion using posterior approach in the treatment of severe spondylolisthesis. STUDY DESIGN: One case is reported in which a failed anterior fusion for Grade 4 spondylolisthesis was treated with a vascularized fibular strut graft using a posterior approach. OBJECTIVES: To demonstrate the applicability of this technique for salvage cases or patients with systemic conditions that may decrease the success of more standard techniques. SUMMARY OF BACKGROUND DATA: Surgical stabilization of spondylolisthesis through posterior approach with a fibular strut graft has been previously described. A vascularized strut graft can be used in the treatment of spondylolisthesis and may have applicability in those patients with underlying disease that may impair the use of more standard techniques or in salvage reconstruction. methods: With the patient under general anesthesia, through a posterior approach S1 and L4 were decompressed. The fibula with its vascularity intact was harvested and anastomosed with the superior gluteal artery and vein. The fibular strut was placed into the space formed by reaming between L5 and S1. Ilial autograft was used to augment the posterior fusion. After the procedure the patient was placed in a hip spica cast. RESULTS: At the 2-year follow-up the patient has incorporation of the graft, with no evidence of fracture and no significant progression of anterior slip. CONCLUSION: A vascularized fibular strut graft is a feasible alternative in the treatment of severe spondylolisthesis. No complications were encountered in the involved patient. Future application may include salvage reconstruction of failed arthrodesis or in individuals with systemic conditions that may impair graft incorporation using more standard techniques. ( info) |