11/20. Posttraumatic total dislocation of the upper thoracic spine.BACKGROUND: Difficulty in proper visualization of the upper thoracic spine in plain radiographs allows for injuries at this level to be missed, especially in a busy trauma center. This window of error is increased when the patient presents with no symptoms or signs of neurologic or spinal involvement, as upper thoracic dislocations commonly present early. CASE DESCRIPTION: The authors report a 19-year-old girl who developed progressive paraparesis 18 hours following initial presentation with a scalp avulsion injury. Imaging revealed a complete dislocation at T1-T2, with cord compression. Emergency surgical decompression and reconstruction of her spinal column was performed with a 360-degree stabilization. There was immediate neurologic improvement and on follow-up the patient is neurologically normal. CONCLUSIONS: The case highlights the difficulty in visualization of the upper thoracic spine in routine radiographs taken in a casualty setting. Treating physicians should have a low threshold for investigation of cervico-thoracic dislocations. The possibility of a delayed progressive dislocation should be kept in mind when dealing with injuries with a potential for spinal injury.- - - - - - - - - - ranking = 1keywords = upper (Clic here for more details about this article) |
12/20. Extended cervicolumbar spinal epidural abscess associated with paraparesis successfully decompressed using a minimally invasive technique.STUDY DESIGN: A case of a multisegmental, cervicothoracolumbar epidural abscess, in an 80-year-old man, successfully decompressed by using a minimally invasive technique, is presented. OBJECTIVE: To review risk factors, diagnosis, treatment, decompression techniques, and morbidity and mortality regarding spinal epidural abscess. SUMMARY OF BACKGROUND DATA: Extended spinal epidural abscess is a rate entity. To our knowledge, this is the first report of a multilevel spinal epidural abscess, completely decompressed by limited laminectomies in combination with the use of a silicon catheter, epidurally. methods: The clinical and radiographic features associated with spinal epidural abscess, as well as decompression technique, are presented. The 80-year-old man, with a one week history of urinary tract infection, presented with fever and low back pain, mild weakness in his legs and jaundice. He underwent bilateral limited laminectomies at T2-T3 and a right hemilaminectomy at L1-L2 and the pus was drained, under mild continuous suction, using a 2.7 mm outer and 1.3 mm inner diameter silicon catheter, inserted caudally and cranially into the epidural space, at both the laminectomy sites. RESULTS: The patient experienced immediate relief of the low back pain, gradual fever subsidence and full neurological recovery during the next 3 weeks. CONCLUSION: In cases of suspected acute epidural abscess, especially in elderly debilitating patients: the whole spine should be scanned by MRI to exclude the possibility of multilevel involvement and adequate pus drainage, when indicated, could be performed with the above described minimally invasive technique.- - - - - - - - - - ranking = 60.139900323813keywords = back pain, back (Clic here for more details about this article) |
13/20. Intraosseous malignant peripheral nerve sheath tumor (MPNST) of the thoracic spine: a rare cause of spinal cord compression.OBJECTIVE: To describe the management of a patient presenting with intraosseous MPNST of the thoracic spine causing cord compression. SUMMARY OF BACKGROUND DATA: Malignant peripheral nerve sheath tumors (MPNST) are uncommon tumors of cells of peripheral nerve sheath origin. MPNST typically present as an enlarging mass originating from a peripheral nerve root in the trunk, extremities, and head and neck region. methods.: A 59-year-old woman presented with midthoracic back pain, paraparesis, and a T4 sensory level. Magnetic resonance image scan revealed a large enhancing and destructive lesion at the T3 level with cord compression. RESULTS: Decompressive laminectomies, tumor debulking, and instrumentation was performed from a posterior approach. At surgery, the lesion was noted to originate from the T3 vertebral body, and separate from the dura and spinal nerve roots. Surgical excision was incomplete and the spine was stabilized with a Ti frame. MPNST was confirmed histologically. Despite adjuvant radiotherapy, she developed metastatic deposits in the spine and femur. CONCLUSIONS: Intraosseous MPNST causing spinal cord compression has not been described as yet and should be added to the differential diagnosis of primary bone tumors causing cord compression. prognosis with MPNST can be poor, especially in patients with large tumors, undergoing subtotal surgical resection and in association with neurofibromatosis.- - - - - - - - - - ranking = 30.069950161906keywords = back pain, back (Clic here for more details about this article) |
14/20. paralysis after transforaminal epidural injection and previous spinal surgery.OBJECTIVE: This case discusses a rare but devastating complication of transforaminal epidural injection. elements in the patient's history that may be risk factors are discussed. CASE REPORT: A 64-year-old man was evaluated for chronic low-back pain after multiple spine surgeries. After the most recent surgery, he suffered transient cauda equina symptoms. Because conservative therapy was not helpful for spinal stenosis and neuroclaudication, a left L2 transforaminal epidural injection was attempted, but a posterolateral fusion mass made this procedure impossible. A left L1 transforaminal approach was successful, and 1 mL of iopamidol (Isovue) contrast was injected, followed by 5 mL of a solution of 0.125% bupivacaine and 40 mg of triamcinolone. Approximately 1 to 2 minutes after injection, the patient described discomfort in the lower abdomen, and 1 minute later, he was unable to move his lower extremities. An MRI showed T2 signal change in the conus medullaris gray matter at T11-12, consistent with an acute vascular infarct. Spinal shock protocol with high-dose methylprednisolone was begun without change. More than 4 years later, the patient continues to be troubled by persistent paraparesis and chronic pain. CONCLUSIONS: This case report is part of a new and growing body of literature that demonstrates the potential risk of transforaminal injection. Further study is necessary to ensure that spinal vascular injuries can be kept to an acceptably rare level.- - - - - - - - - - ranking = 30.069950161906keywords = back pain, back (Clic here for more details about this article) |
15/20. Symptomatic thoracic vertebral hemangioma: a case report and literature review.Vertebral hemangiomas are relatively common, but those causing spinal cord compression are rare. A man in his early sixties with back pain that had not resolved with conservative treatment was seen in an outpatient physiatrist office. Subsequent workup with computed tomography scan showed a large hemangioma in the T5 vertebra extending to the posterior elements where his pain was located. Three weeks later, the patient had progressive weakness and numbness in his lower extremity. He subsequently underwent a T3-5 laminectomy, with a subtotal resection of the mass. He reported improvement in lower-extremity strength and sensation and completed a course of inpatient rehabilitation. Recognizing when to expect neurologic symptoms and the proper time to intervene can be very critical. From this case study and other similar instances, one can conclude that vertebral hemangiomas are not always benign and are capable of causing cord compression. Proper diagnosis and treatment may prevent the development of neurologic symptoms.- - - - - - - - - - ranking = 30.069950161906keywords = back pain, back (Clic here for more details about this article) |
16/20. Facet joint cysts causing cauda equina compression.Facet joint cysts are commonest at the L4-L5 level and are associated with facet joint degeneration and type III (degenerative) spondylolisthesis. It is extremely rare for facet joint cysts to cause symptomatic cauda equina compression. Three elderly patients presented to us with significant cauda equina compression caused by facet joint cysts. One presented with classic symptoms and signs of a cauda equina syndrome, a second with bilateral lower limb neurologic loss associated with uncontrolled epilepsy, and the third with bilateral leg symptoms as well as an upper limb tremor and fasciculation. The diagnosis was easily made after magnetic resonance scanning in two patients, although in one patient, it was significantly delayed because of his confounding neurologic picture. Lumbar spine surgery (decompression and cyst resection) was successful in resolving symptoms in all three, even though two patients had significant neurologic compromise before surgery. The occurrence of facet joint cysts in older patients can be associated with other degenerative neurologic conditions, and the diagnosis might not be apparent early. We suggest that in older patients who have a mixed picture of central and peripheral neurologic compromise, this diagnosis should be considered and investigation of the whole of the spine, not just the brain and spinal cord, should be undertaken.- - - - - - - - - - ranking = 0.14285714285714keywords = upper (Clic here for more details about this article) |
17/20. Spinal intradural extramedullary haemangioma: MRI and neurosurgical findings.Haemangiomas, have rarely been encountered in the spinal intradural extramedullary space and the MRI findings of this entity have been described only in a few cases. We present the magnetic resonance imaging (MRI) and surgical findings of a rare case of intradural extramedullary cavernous angioma located at the T1-T2 level in a 65-year-old man presented progressive paraparesis and upper thoracic back pain. On MRI, a well-circumscribed intradural solid mass, 1 cm in diameter, was detected and another enhancing nodular mass was found at the nerve roots of the cauda equina. The thoracic spinal lesion was removed and the histological diagnosis confirmed cavernous haemangioma. Although very uncommon, haemangioma should be included in the differential diagnosis when a spinal intradural extramedullary lesion is discovered and some neuroradiological findings could allow a presumptive diagnosis.- - - - - - - - - - ranking = 30.212807304763keywords = back pain, back, upper (Clic here for more details about this article) |
18/20. paraparesis due to exacerbation of preexisting spinal pseudoarthrosis following infliximab therapy for advanced ankylosing spondylitis.BACKGROUND CONTEXT: Recent reports have described the long-term efficacy and safety of infliximab as a treatment for ankylosing spondylitis (AS). The most important adverse effects of infliximab are infections, malignancies, autoimmunities, and hypersensitivity reactions. There has never been a reported case of paraparesis after infliximab therapy for AS. PURPOSE: To describe a case with paraparesis caused by rapid exacerbation of preexisting spinal pseudoarthrosis after infliximab therapy for advanced AS. STUDY DESIGN/SETTING: Case report/Osaka University Graduate School of medicine, Suita, japan. PATIENT SAMPLE: A 55-year-old man with a 27-year history of AS. OUTCOME MEASURES: Case report. methods: A 55-year-old man with a 27-year history of AS was treated with infliximab, which provided considerable pain relief and improvement of activities of daily living. However, as the patient resumed vigorous daily activity, he felt back pain and subsequently developed paraparesis. Radiographs showed rapid exacerbation of preexisting spinal pseudoarthrosis at the T11-T12 level after infliximab therapy. RESULTS: After laminectomy and posterolateral fusion, the back pain and paraparesis improved sufficiently to allow independent walking, but moderate bladder dysfunction persisted. CONCLUSIONS: Although this patient could have certainly become myelopathic over time without undergoing infliximab therapy, the patient's history and radiographic course suggest that suppression of inflammation by infliximab improved his activities of daily living, which paradoxically exacerbated preexisting spinal pseudoarthrosis and quickened the onset of subsequent myelopathy.- - - - - - - - - - ranking = 60.139900323813keywords = back pain, back (Clic here for more details about this article) |
19/20. Intramedullary endometriosis of the conus medullaris: case report.OBJECTIVE: Intraspinal endometriosis is an extremely rare condition with characteristic symptoms, including lower back pain that increases in severity during each menstrual cycle. methods: Here, we report a case of endometriosis involving the conus cauda region. This patient presented with acute deterioration secondary to hemorrhage. We also review the relevant literature. RESULTS: magnetic resonance imaging scans of the dorsolumbar region showed a mass lesion within the spinal canal at the L1-L2 level with evidence of acute hemorrhage. The patient underwent an emergency D12-L2 laminectomy and microdecompression of the lesion. The histological and immunohistochemical features were characteristic of intraspinal endometriosis. CONCLUSION: Intraspinal endometriosis must be recognized as a potential cause of periodic neurological signs and symptoms in young and middle-aged women.- - - - - - - - - - ranking = 30.069950161906keywords = back pain, back (Clic here for more details about this article) |
20/20. Intraspinal lymphangioma: 2 case reports and literature review.BACKGROUND: lymphangioma of the soft tissue is not uncommon. However, as far as the authors know, intraspinal lymphangioma is clinically rare and very few cases have been reported previously. methods: Two patients who had backache and acratia of the lower limbs and difficulty in relieving themselves were examined by plain radiography and magnetic resonance imaging before surgery. Treatment consisted of the usual technique of surgical resection of the tumor microscopically. Histological examination of the resected material confirmed the diagnosis. Postoperative follow-up assessment was performed by magnetic resonance imaging. RESULTS: Intraspinal lymphangioma is very rare clinically and its cause remains controversial. magnetic resonance imaging can obtain precise position fixing, but it is hard to make preoperative qualitative determination. The most effective treatment of intraspinal lymphangioma is to excise it totally. CONCLUSIONS: The clinical appearance of intraspinal lymphangioma has no character. magnetic resonance imaging is important in diagnosing it. The most effective treatment of intraspinal lymphangioma is to excise it totally. Further observation is recommended because of the possibility of local recurrence.- - - - - - - - - - ranking = 1.8690725820265keywords = back (Clic here for more details about this article) |
| <- Previous || Next -> |