101/291. Diabetic thoracic radiculopathy: an unusual cause of post-thoracotomy pain. Persistent pain is common following thoracotomy. A 64-year-old retired electrician with Type 2 diabetes presented with chest wall and abdominal pain 3 months following video-assisted thoracoscopic surgery (VATS). Postoperatively the patient had suffered pain despite a functioning thoracic epidural catheter. Following investigation, his persistent pain was due to diabetic thoracic radiculopathy (DTR). The disorder is characterized by pain, sensory loss, abdominal and thoracic muscle weakness in patients with diabetes. As in this patient, the pain and sensory loss usually resolve within one year after onset. The disorder may be distinguished from intercostal neuralgia based upon clinical and electromyographic features. ( info) |
102/291. A child with neurobrucellosis. An 11-year-old boy presented with chronic meningitis followed by acute flaccid paralysis. The aetiology remained uncertain until the brucellar serology test became positive and there was a good response to specific antimicrobial therapy. Nerve conduction studies confirmed a proximal radiculopathy. awareness of the condition and performance of the appropriate tests will differentiate neurobrucellosis from other chronic central nervous system infections. ( info) |
103/291. calcium pyrophosphate dihydrate crystal deposition disease in cervical radiculomyelopathy. One patient had cervical spinal canal stenosis with radiculomyelopathy due to deposition of calcium pyrophosphate dihydrate within the ligamentum flavum. The MRI of cervical spine showed a calcified nodule over C5-6 level ligamentum flavum with obvious cord compression. After posterior decompressive laminectomy with removal of the calcified nodule, the symptom and sign relieved remarkedly and the pathology showed calcium pyrophosphate dihydrate deposition within the ligamentum flavum. We presented this case and reviewed the literature to acknowledge so-call "pseudogout syndrome." ( info) |
104/291. Radicular pain after vertebroplasty: compression or irritation of the nerve root? Initial experience with the "cooling system". STUDY DESIGN: During vertebroplasty (VP), polymethylmethacrylate (PMMA) may leak into the posterior epidural venus plexus, provoking symptoms ranging from radicular pain to medullar compression. OBJECTIVES: To propose and test the feasibility of a procedure (cooling system) to prevent radicular irritation caused by foraminal PMMA leakage. SUMMARY OF BACKGROUND DATA: Foraminal leak of PMMA, as observed during VP, may lead to radiculalgia. Several mechanisms of nerve root irritation have been proposed. Considering heat or local chemical irritation has led us to treat immediately by local periradicular irrigation with a cooling liquid. methods: Four consecutive patients with observed foraminal leakage were treated by local fluid injection. Immediately after observation of a foraminal leak, a 20-gauge Chiba needle was positioned to reach the foramen. Ten cubic centimeters of lidocaine (0.2%) was followed by 100-200 cc of pressurized saline perfusion within 10-20 minutes (cooling system). RESULTS: In all patients with foraminal leakage, no radicular pain existed after application of the cooling system. No complications were observed with its use. CONCLUSION: In presence of a foraminal leakage, the immediate application of a cooling irrigation may protect the root from injury, which is explained by the hypothesis that the main mechanism of injury may be more related to heat or chemical irritation of the nerve than compression. ( info) |
105/291. L5 radiculopathy due to sacral stress fracture. We report the case of a 70-year-old man who presented with a history of left buttock pain with radiation into the left leg in an L5 distribution. MRI of the lumbar spine revealed a left sacral stress fracture with periosteal reaction involving the left L5 nerve root anterior to the sacral ala. With spontaneous healing of the fracture, the patient's symptoms resolved completely. ( info) |
106/291. Artificial disc insertion following anterior cervical discectomy. OBJECTIVE AND IMPORTANCE: Fusion following anterior cervical discectomy has been implicated in the acceleration of degenerative changes in the adjacent spinal segments. Discectomy followed by implantation of an artificial cervical disc maintains the functionality of the spinal unit, while still providing excellent symptomatic relief. We describe our preliminary experience with implantation of the Bryan Cervical Disc System in two cases of single-level cervical disc herniation. CLINICAL PRESENTATION: Two male patients presented with a left C6 radiculopathy, without evidence of myelopathy. magnetic resonance imaging revealed a disc herniation at C5-6 in both cases. Pre-operative flexion and extension radiographs demonstrated preserved motion at the involved levels. INTERVENTION/TECHNIQUE: Following a standard anterior cervical decompression, precision drilling of the vertebral endplates was carried out using a drill attached to a bed-mounted, gravitationally-referenced retraction frame. An artificial cervical disc, composed of a polyurethane nucleus with titanium endplates, was fitted between the contoured endplates without fixation to the vertebral bodies. No complications were experienced during the insertion of the prosthesis, or in the postoperative course. Both patients experienced immediate postoperative resolution of their radicular pain and were discharged from hospital the following day. At nine months following surgery, both patients continue to have complete relief of radicular symptoms. Postoperative radiographs at six months following surgery confirm accurate placement of the prosthesis and preserved mobility of the functional spinal unit. CONCLUSION: Insertion of the Bryan artificial cervical disc prosthesis following anterior cervical discectomy is a relatively straightforward procedure, which appears to be safe and provides good clinical results, without requiring additional surgical time. Long-term follow-up is required to assess its safety, efficacy, and ability to prevent adjacent segment degeneration. ( info) |
107/291. Synovial chondromatosis presenting with cervical radiculopathy: a case report. STUDY DESIGN: A case report is presented. OBJECTIVES: To report a case of synovial chondromatosis of a cervical facet joint and describe the appearance with magnetic resonance imaging and computed tomography myelography. SUMMARY OF BACKGROUND DATA: Synovial chondromatosis is an uncommon disorder characterized by the presence of multiple cartilaginous or osteocartilaginous nodules in the synovium of a joint space. Synovial chondromatosis in the cervical facet joint is rare. METHOD: A 52-year-old woman experienced the sudden onset of severe pain in the dorsal shoulder girdle and in the ulnar side of her right arm and forearm. This refractory pain only responded to an epidural nerve root block. neurologic examination showed right nerve root signs that ranged from the C7 to Th1 segments of the spinal cord. Radiologic and electrophysiological examinations were carried out. RESULT: A mass was found in the right facet joint between C7 and Th1 with magnetic resonance imaging and computed tomography myelography. These investigations clearly indicated the location, size, and extent of the lesion accompanying the irregularity of the joint and osteolytic change. Somatosensory-evoked potentials with right ulnar nerve stimulation indicated a significant conduction block in the lower right cervical nerve roots. After surgical removal of this lesion, the neurologic symptoms markedly improved. The histopathology diagnosed synovial chondromatosis. CONCLUSION: Synovial chondromatosis should be included in the differential diagnosis of radiculopathies of unknown etiology. ( info) |
108/291. radiculopathy due to ossification of the yellow ligament at the lower lumbar spine. STUDY DESIGN: A case report. OBJECTIVES: To report a rare case of a 27-year-old female with ossification of yellow ligament at the lower lumbar spine presenting radiculopathy with a drop foot. SUMMARY OF BACKGROUND DATA: The majority of cases of ossification of yellow ligament occur at the lower third of the thoracic or the thoracolumbar spine. There are only a few reports of ossification of yellow ligament in the lumbar spine and radiculopathy due to ossification of yellow ligament at L4-L5 and L5-S1 levels is very uncommon. methods: A 27-year-old female with a prior fracture of posterior ring apophysis of L5 presented with leg pain and a drop foot. magnetic resonance imaging demonstrated stenosis with compression of the cauda equina at the L4-L5 and L5-S1 levels. RESULTS: Decompressive laminectomy of L5 and removal of the ossified yellow ligaments were performed. Histologic examination of en bloc specimen of ossification of yellow ligament revealed degenerative changes of the elastic fibers in the yellow ligament with adjacent chondrosis and ossification. The patient's severe leg pain disappeared completely, although the extent of the drop foot had not fully recovered at the final follow-up examination. CONCLUSIONS: The mechanism of ossification of yellow ligament in the present case was unclear. The patient did not have any previous generalized disorders besides the history of a ring apophysial fracture or any family history of treatment for ossification of the posterior longitudinal ligament or ossification of yellow ligament. Therefore, localized mechanical stress might have influenced the development of ossification of yellow ligament at lower lumbar spine. ( info) |
109/291. The extraforaminal juxtafacet cyst as a rare cause of L5 radiculopathy: a case report. STUDY DESIGN: This is a report of a case. OBJECTIVE: To document the clinical, radiographic, and histologic characteristics of a lumbar extraforaminal juxtafacet cyst. SUMMARY OF BACKGROUND DATA: Spinal juxtafacet cysts develop most frequently at the dorsal aspect of the zygapophysial joint, sometimes in the posterolateral area of the canal. In one case, they have been described in the foraminal and extraforaminal region. methods: Description of the case report. RESULT: The authors report one case of a strictly extraforaminal juxtafacet cyst responsible for L5 sciatica. CONCLUSIONS: Juxtafacet cysts of the spine represent an infrequent cause of sciatica, usually when they grow in the canal, or more exceptionally when they occupy the foraminal or extraforaminal areas. ( info) |
110/291. Upper thoracic spinal cord herniation after traumatic nerve root avulsion. Case report and review of the literature. Transdural herniation of the spinal cord, a rare but well-documented entity, has been reported sporadically for more than 25 years as a possible cause for various neurological signs and symptoms ranging from isolated sensory or motor findings to myelopathy and brown-sequard syndrome. The authors report, to the best of their knowledge, the first case of upper thoracic spinal cord herniation occurring after traumatic nerve root avulsion. ( info) |