1/507. Postoperative gas bubble foot drop. A case report.STUDY DESIGN: An unusual case of foot drop occurring 10 days after disc surgery is reported. Imaging studies identified a gas bubble compressing the nerve root. OBJECTIVE: To describe the origin and management of a radiculopathy caused by an intraspinal gas bubble. SUMMARY OF BACKGROUND DATA: A recurrent lumbar disc herniation was diagnosed by clinical and imaging studies. A vacuum disc also was noted at the same level. These are common and not considered to be of pathologic significance. methods: The patient underwent a microdiscectomy for a lumbar disc extrusion. The postoperative course was excellent, with relief of symptoms and no neurologic deficit. Ten days later, the awoke with a foot drop and pain in the leg. Imaging studies showed a 4-mm gas bubble compressing the nerve root. Oral steroids were given for 10 days. RESULTS: Progressive improvement occurred, and the patient was asymptomatic 6 weeks later. Although in some instances it may be necessary to evacuate intraspinal gas, an initial period of observation is warranted, because the gas and its resulting symptoms may disappear spontaneously. CONCLUSION: Intradiscal gas accumulation, better known as vacuum disc, is considered to be a benign indication of degenerative disc disease. On occasion it can be a cause of symptoms. A case is reported in which gas leaked after surgery into the spinal canal, causing a foot drop. The symptoms and gas disappeared spontaneously without further treatment.- - - - - - - - - - ranking = 1keywords = pain (Clic here for more details about this article) |
2/507. Cervical foraminotomy: an effective treatment for cervical spondylotic radiculopathy.Between 1983 and 1994, posterior cervical foraminotomy as described by Frykholm was performed on 89 patients with exclusively radicular symptoms caused by cervical osteophytes. The main presenting feature was arm pain. Objective neurological signs were present in 50% of the patients. At mean postoperative follow-up of 8.6 months, 95.5% of patients reported excellent or good results, while 4.5% were not improved. No patient was rendered worse following the procedure. There were no deaths and the complication rate was 2.2%. Further surgery for recurrent root symptoms was required by 6.7% of patients. Our findings are in keeping with the good results and low complication rate of this procedure as described in other studies. Informal inquiries suggest that this procedure is not widely used, at any rate in the United Kingdom, and we present this series in order to emphasize the efficacy and safety of this procedure.- - - - - - - - - - ranking = 1keywords = pain (Clic here for more details about this article) |
3/507. Laser-assisted diskectomy performed by an internist resulting in cauda equina syndrome.An internist performed percutaneous laser-assisted diskectomies (PLADs) on a patient with a sequestrated disc and stenosis. Subspecialists who perform PLADs should be trained in patient selection and lumbar diskectomy techniques. chymopapain, percutaneous nucleotome-assisted diskectomy, and PLADs are alternatives to microdiskectomy for the management of lumbar disc herniations. PLADs were performed at the L4-5/L5-S1 levels in a 38-year-old woman with magnetic resonance (MR)-documented L4-5 stenosis and disc disease. After PLADs, she developed a subacute cauda equina syndrome. Two months later, a neurosurgeon performed an L4-5 coronal hemilaminectomy with diskectomy. Within 6 postoperative weeks, she was neurologically intact. Only specialists trained in the selection, neurodiagnostic, and surgical management of lumbar disc disease should perform PLADs.- - - - - - - - - - ranking = 1keywords = pain (Clic here for more details about this article) |
4/507. An uncommon mechanism of brachial plexus injury. A case report.PURPOSE: To report a case of brachial plexus injury occurring on the contralateral side in a patient undergoing surgery for acoustic neuroma through translabrynthine approach. CLINICAL FEATURES: A 51-yr-old woman underwent surgery for acoustic neuroma through translabrynthine approach in the left retroauricular area. She had a short neck with a BMI of 32. Under anesthesia, she was placed in supine position with Sugita pins for head fixation. The head was turned 45 degrees to the right side and the neck was slightly flexed for access to the left retroauricular area, with both arms tucked by the side of the body. Postoperatively, she developed weakness in the right upper extremity comparable with palsy of the upper trunk of the brachial plexus. hematoma at the right internal jugular vein cannulation site was ruled out by CAT scan and MRI. The only remarkable finding was considerable swelling of the right sternocleidomastoid and scalene muscle group, with some retropharyngeal edema. An EMG confirmed neuropraxia of the upper trunk of brachial plexus. She made a complete recovery of sensory and motor power in the affected limb over the next three months with conservative treatment and physiotherapy. CONCLUSIONS: brachial plexus injury is still seen during anesthesia despite the awareness about its etiology. Malpositioning of the neck during prolonged surgery could lead to compression of scalene muscles and venous drainage impedance. The resultant swelling in the structures surrounding the brachial plexus may result in a severe compression.- - - - - - - - - - ranking = 0.055244697653128keywords = upper (Clic here for more details about this article) |
5/507. Meralgia paresthetica secondary to limb length discrepancy: case report.Meralgia paresthetica consists of pain and dysthesia in the lateral thigh caused by entrapment of the lateral femoral cutaneous nerve (L2-L3) underneath the inguinal ligament. Abdominal distension, tight clothing, and hip hyperextension are all described causes of this condition. To our knowledge this has never been attributed to a limb length discrepancy. We present a 51-year-old man with a long-standing history of right sided meralgia paresthetica. history and physical and radiological examination were unrewarding except that his left leg was shorter than the right by 2 cm. Nerve conduction studies of the lateral femoral cutaneous nerve on the left had a normal latency and amplitude but were absent on the right. To prove the hpothesis that the limb length discrepancy was responsible for the condition, a single subject study was performed. The presence or absence of pain and dysesthesia in the right thigh was the observed behavior. Intervention consisted of wearing a 1.5-cm lift in the left or right shoe for 2 weeks each with an intervening 2-week lift-free period. Pain was recorded on a numeric scale and numbness as being present or absent. There was continuing pain without and with the lift in the right shoe but no pain or numbness with the lift in left shoe. It was concluded that the limb length discrepancy was responsible for the meralgia paresthetica. Pertinent literature and possible pathomechanics are discussed.- - - - - - - - - - ranking = 4keywords = pain (Clic here for more details about this article) |
6/507. Posterior epidural migration of sequestered lumbar disc fragments. Report of two cases.The posterior epidural migration of sequestered lumbar disc fragments is an uncommon event. The authors report two such cases in which patients presented with either intense radicular pain or cauda equina syndrome. The radiological characteristics were the posterior epidural location and the ring enhancement of the mass after injection of contrast material. The major diagnostic pitfalls are discussed.- - - - - - - - - - ranking = 1keywords = pain (Clic here for more details about this article) |
7/507. L4-5 disk lesion resulting in back pain with bowel, bladder and sexual dysfunction without paraparesis.This is a case report of a patient with bowel, bladder and sexual dysfunction associated with low back pain. This patient had an essentially normal neurological examination. There was radiological evidence of a disk lesion, and urodynamic findings consistent with lower motor neuron bladder dysfunction. His symptoms are attributed to a L4-5 disk herniation resulting in a partial cauda equina syndrome. The relevant anatomy is reviewed, and the differential diagnosis is discussed.- - - - - - - - - - ranking = 13.613159190283keywords = back pain, pain, back (Clic here for more details about this article) |
8/507. Radicular acute pain after epidural anaesthesia with the technique of loss of resistance with normal saline solution.Epidural anaesthesia using the loss of resistance to saline technique, without air, was successfully performed in a 65-year-old man scheduled for elective vascular surgery of the right leg. Epidural catheterisation was uneventful. Fifteen minutes after the initial dose of plain 0.5% bupivacaine, the patient experienced severe pain in his lower abdomen and legs which coincided with a supplementary injection of 2 ml bupivacaine and 50 microgram fentanyl, and a change from the lateral to the supine position. General anaesthesia was induced and CT and MRI scans were performed showing trapped air in the epidural space at the L4 level causing compression of the thecal sac. After excluding other causes, the spontaneous entry of air through the Tuohy needle was thought to be the most likely explanation for this complication. The patient recovered uneventfully.- - - - - - - - - - ranking = 5keywords = pain (Clic here for more details about this article) |
9/507. Post-traumatic distal nerve entrapment syndrome.Eleven patients with paralysis of muscle groups in the upper or lower extremity were clinically diagnosed after previous proximal direct trauma to the corresponding peripheral nerves, without complete nerve disruption. patients were seen within an average of 8 months after trauma (minimum 3 months and maximum 2 years after). Nerve lesions were caused either by gunshot, motor-vehicle accident, and other direct trauma or, in one case, after tumor excision. All patients presented with complete sensory and motor loss distal to the trauma site, but demonstrated a positive Tinel sign and pain on testing over the "classic" (distal) anatomic nerve entrapment sites only. After surgical release through decompression of the nerve compression site distal to the trauma, a recovery of sensory function was achieved after surgery in all cases. Good-to-excellent restoration of motor function (M4/M5) was achieved in 63 percent of all cases. Twenty-five percent had no or only poor improvement in motor function, despite a good sensory recovery. Those patients in whom nerve compression sites were surgically released before 6 months after trauma had an improvement in almost all neural functions, compared to those patients who underwent surgery later than 9 months post trauma. A possible explanation of traumatically caused neurogenic paralysis with subsequent distal nerve compressions is provided, using the "double crush syndrome" hypothesis.- - - - - - - - - - ranking = 1.0184148992177keywords = pain, upper (Clic here for more details about this article) |
10/507. Sinus tarsi pain: case history.An attempt was made to give the podiatrist some insight into the differential diagnosis of sinus tarsi pain. One possible etiology is discussed in detail along with case presentation and treatment.- - - - - - - - - - ranking = 5keywords = pain (Clic here for more details about this article) |
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