1/726. The treatment of immature heterotopic ossification in spinal cord injury with combination surgery, radiation therapy and NSAID.Heterotopic ossification (HO) is a frequent complication associated with spinal cord injury. Management of HO consists of a combination of range-of-motion, diphosphonates, nonsteroidal antiinflammatory agents, radiation therapy, and in some cases, surgical resection. The appropriate timing of surgical resection has traditionally been based on maturity of the HO. The case presented is that of a 33-year-old male with T8 complete paraplegia who developed HO about the left hip resulting in impaired sitting. The patient underwent successful surgical wedge resection of the HO despite apparent immaturity of the HO. A comprehensive review of the literature is presented which suggests that early resection of immature HO may not be predictive of a higher recurrence rate.- - - - - - - - - - ranking = 1keywords = spinal (Clic here for more details about this article) |
2/726. Complete paraplegia due to multiple intracerebral and spinal cavernomas.We report on a 29-year-old male patient with multiple intracerebral and spinal cavernomas. Bleeding in the thoracic cord at admission and additional bleeding which occurred 12 days later in the cervical cord resulted in complete paraplegia below thoracic level 4 (Th4). Four years earlier multiple cerebral cavernomas had been diagnosed by magnetic resonance imaging (MRI). Based upon reported cases in the literature multiple intracerebral and spinal cavernomas are exceptional. Additionally, the clinical presentation in our case is uncommon.- - - - - - - - - - ranking = 1.2keywords = spinal (Clic here for more details about this article) |
3/726. paraplegia after thoracotomy--not caused by the epidural catheter.BACKGROUND: paraplegia and peripheral nerve injuries may arise after general anaesthesia from many causes but are easily ascribed to central block if the latter has been used. CASE REPORT: A 56-yr-old woman, with Bechterev disease but otherwise healthy, was operated with left-sided thoracotomy to remove a tumour in the left lower lobe. She had an epidural catheter inserted in the mid-thoracic area before general anaesthesia was started. bupivacaine 0.5% 5 ml was injected once and the infusion of bupivacaine 0.1% with 2 micrograms/ml fentanyl and 2 micrograms/ml adrenaline (5 ml/h) started at the end of surgery. The patient woke up with total paralysis in the lower limb and sensory analgesia at the level of T8, which remained unchanged at several observations. laminectomy, performed 17 h after the primary operation, showed a large piece of a haemostatic sponge (Surgicel) compressing the spinal cord, which was then decompressed but the motor and sensory deficit remained virtually unchanged both then and a year later. CONCLUSIONS: This case shows--once again--that although central blocks may cause serious neurological complications and paraplegia, other causes are possible and have to be considered. However, all patients with an epidural catheter must be monitored for early signs and symptoms of an intraspinal process and the appropriate treatment has to be instituted instantly.- - - - - - - - - - ranking = 0.4keywords = spinal (Clic here for more details about this article) |
4/726. paraplegia, a severe complication to epidural analgesia.We report four cases where continuous epidural analgesia resulted in epidural abscesses (EA) causing spinal cord damage and paraplegia. The first symptom of EA was intense back pain, which developed 0-20 days after removal of the epidural catheter. The diagnosis of EA was not made prior to the development of severe neurologic disturbances in any of the patients. In all cases there was a time lag of 2-4 days between the first symptoms and institution of the appropriate treatment.- - - - - - - - - - ranking = 0.2keywords = spinal (Clic here for more details about this article) |
5/726. spinal cord injury in a fetus.In her eighth month of pregnancy a woman was stabbed in the abdomen with a barbecue fork. Upon delivery one week later, the child was noted to have two scars in the thoracic region on the back. The legs were flaccid. Surgical exploration at the age of seven months revealed marked, dense scarring of spinal cord and arachnoid membrane. No similar case was found in the literature.- - - - - - - - - - ranking = 0.2keywords = spinal (Clic here for more details about this article) |
6/726. Special problems associated with abdominal aneurysmectomy in spinal cord injury patients.There were 8 patients with spinal cord injury in the last 100 consecutive patients with abdominal aortic aneurysm resected at the Long Beach veterans Administration Hospital. Emphasis is placed upon the problems in management not found in individuals without spinal cord injury. A successful outcome is dependent upon: (a) aggressive control of foci of infection, (b) early diagnosis and planned surgical intervention, (c) continuous intraoperative arterial and central venous pressure monitoring and (d) alertness to the prevention of postoperative complications, with emphasis upon careful tracheal toilet and anticipation of delayed wound healing.- - - - - - - - - - ranking = 1.2keywords = spinal (Clic here for more details about this article) |
7/726. Using seat contour measurements during seating evaluations of individuals with SCI.Measuring the shape of the buttock-cushion interface has been used successfully in research to study tissue loading and as a means to fabricate custom contoured cushions. Seat contours are also able to provide useful clinical information on the weight-bearing surface of the cushion, which can be used to address posture. This article offers specific case studies that demonstrate how the analysis of seat contours can be used to identify pelvic tilt, pelvic obliquity, and areas of high loading. Seat contour measurements complement other clinical measures, such as seat interface pressures and general postural assessments, to form a more complete picture of the buttock-cushion interface. They have become useful in the clinical management of various pressure and posture problems experienced by individuals with spinal cord injury and other wheelchair users.- - - - - - - - - - ranking = 0.2keywords = spinal (Clic here for more details about this article) |
8/726. Surgical treatment of vascular lesions of the spinal cord.Paravertebral block and resection of upper thoracic sympathetic ganglions were performed on cases in which vascular disturbance of the spinal cord was considered partly responsible. Block was performed in 14 cases and clinical improvement was seen in 10 cases out of them while resection was considered effective in 2 out of 3 cases. The evoked EMG of patients was assumed recovery of a part of synaptic function in the ischemic cord after the block. On the other hand, the skin temperature of the lower extremity did not show considerable change and this supports the view that the restoration of clinical picture was not due to the improvement of the periphral circulation of extremities. From these observations, it would be well presumed that favorable effect of sympathectomy consists partly in the improvement of vascular disturbance of the spinal cord.- - - - - - - - - - ranking = 1.2keywords = spinal (Clic here for more details about this article) |
9/726. Anaesthetic management of a woman who became paraplegic at 22 weeks' gestation after a spontaneous spinal cord haemorrhage secondary to a presumed arteriovenous malformation.A 19-yr-old woman developed a paraplegia with a T10 sensory level at 22 weeks' gestation. The spinal injury was caused by spontaneous bleed of a presumed arteriovenous malformation in the spinal cord. She presented for Caesarean section at term because of the breech position of her fetus. The successful use of a combined spinal epidural-regional anaesthetic is described and the risks of general and regional anaesthesia are discussed.- - - - - - - - - - ranking = 1.4keywords = spinal (Clic here for more details about this article) |
10/726. The risk of paraplegia through medical treatment.In the Orthopedic University Hospital of Heidelberg (section orthopedics II, treatment and rehabilitation of paraplegics), 21 patients with iatrogenic paraplegia were treated between 1968 and 1991. paraplegia occurred in nine cases after procedures close to the spinal cord. In 12 cases paraplegia complicated medical treatment. Procedures close to the spinal cord, such as laminectomy, vertebrotomy, spondylodesis, and peridural anaesthesia, involve the risk of mechanical damage to the spinal cord, the level of paraplegia depends on the area of treatment. Any previous damage to the spinal cord increases the risk of paraplegic complications. The main risks in procedures distant from the spinal cord, such as vascular surgery, angiography, radiotherapy, bronchial artery embolisation, and umbilical artery injection, are disturbances of the blood supply or toxic mechanisms. The ischaemic genesis of spinal cord damage is obvious in the case of vessel ligatures or cross-clamping of the aorta with resulting hypotonic discirculation. In radiomyelopathy as well, the damage to the spinal vessels outweighs the direct neuronal damage. Corresponding to the vascular cause, lesions are more likely to occur at the level of borderlines of blood supply in the middle thoracic cord or in the area of a non-anastomosed great radicular artery in the lumbar spinal cord. knowledge of the consequences and side effects of medical treatment is imperative. Knowing about the risk of a paraplegic lesion, we need a strict indication for diagnostic and therapeutic interventions. Due to progress in science some of the reasons of iatrogenic paraplegia have become manageable. Especially in radiotherapy, vascular surgery and angiography the risk of neurological complications has been lowered.- - - - - - - - - - ranking = 1.6keywords = spinal (Clic here for more details about this article) |
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