1/114. 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) |
2/114. clostridium perfringens: a rare cause of postoperative spinal surgery meningitis.BACKGROUND: clostridium perfringens is a rare cause of central nervous system infections, particularly meningitis. The case of a 76-year-old man who developed fatal C. perfringens meningitis after routine decompressive laminectomy for spinal stenosis is described. CASE REPORT: Twelve days after surgery the patient presented with pain and serosangiunous drainage from the surgical incision site. A swab of the drainage revealed Gram-positive bacilli; MRI of the lumbosacral spine showed the appearance of air around the laminectomy site. The patient died within 6 hours of presentation. autopsy revealed acute cranial and spinal meningitis and choroid plexitis with organisms consistent with C. perfringens. CONCLUSION: No significant enteral pathology or source of endogenous infection was determined, suggesting postoperative wound contamination and meningeal seeding with this ubiquitous organism. Clostridial infection, although rare, should be considered in any patient with meningitis with a history of surgical intervention. survival with minimal neurological deficits was achieved in half of the previously reported cases.- - - - - - - - - - ranking = 1keywords = pain (Clic here for more details about this article) |
3/114. A case of cervical myelopathy with developmental canal stenosis at the level of the atlas. A case report.The craniocervical junction is one of the most common sites of malformations. Only three cases of myelopathy due to hypoplasia of atlas have been reported previously. Among these malformations, the hypoplasia of atlas was first described by Wackenheim in 1974. Although developmental canal stenosis due to the hypoplasia of atlas seems to have a tendency of causing the cervical myelopathy, only three cases of cervical myelopathy due to this condition have been reported previously. A 77-year-old man with severe canal stenosis at the level of the atlas is reported. The clinical manifestations were 20-year history of progressive gait disturbance and paresis of both upper and lower extremities. The spinal cord was markedly compressed at the level of the atlas. The clinical manifestations improved after a resection of posterior arch of the atlas.- - - - - - - - - - ranking = 0.039973610424601keywords = upper (Clic here for more details about this article) |
4/114. Nerve root herniation secondary to lumbar puncture in the patient with lumbar canal stenosis. A case report.STUDY DESIGN: A very rare case of nerve root herniation secondary to lumbar puncture is reported. OBJECTIVE: To describe the characteristic clinical features of this case and to discuss a mechanism of the nerve root herniation. SUMMARY OF BACKGROUND DATA: There has been no previous report of nerve root herniation secondary to lumbar puncture. methods: A 66-year-old woman who experienced intermittent claudication as a result of sciatic pain on her right side was evaluated by radiography and magnetic resonance imaging, the results of which demonstrated central-type canal stenosis at L4-L5. The right sciatic pain was exacerbated after lumbar puncture. myelography and subsequent computed tomography showed marked stenosis of the thecal sac that was eccentric to the left, unlike the previous magnetic resonance imaging finding. RESULTS: At surgery, a herniated nerve root was found through a small rent of the dorsocentral portion of the thecal sac at L4-L5, presenting a loop with epineural bleeding. The herniated nerve root was put back into the intrathecal space, and the dural tear was repaired. CONCLUSION: Lumbar puncture can be a cause of nerve root herniation in cases of lumbar canal stenosis. The puncture should not be carried out at an area of stenosis.- - - - - - - - - - ranking = 3.0125764112855keywords = back, pain (Clic here for more details about this article) |
5/114. The effect of Lipo prostaglandin E1 on cauda equina blood flow in patients with lumbar spinal canal stenosis: myeloscopic observation.STUDY DESIGN: Myeloscopic examination was performed to observe the cauda equina in patients with lumbar spinal canal stenosis before and after treatment with Lipo prostaglandin E1, a strong peripheral vasodilator. OBJECTIVES: The purpose of this study was to clarify the effects of Lipo prostaglandin E1 on blood flow in the cauda equina in patients with lumbar spinal canal stenosis. SETTING: japan, Kagoshima methods: We performed myeloscopic observations of morphological changes in blood vessels running along the cauda equina in 11 patients with lumbar spinal canal stenosis before and after treatment with Lipo prostaglandin E1. RESULTS: In six of these patients, dilation of the running blood vessels was observed immediately after administration. In all of the patients who exhibited a dilation of vessels on the surface of the cauda equina, intermittent claudication and lower extremity pain and/or numbness lessened immediately after examination. However, none of the patients who exhibited no morphological changes in the vessels along the cauda equina after administration of Lipo prostaglandin E1 experienced any improvement of symptoms at the time of examination. CONCLUSION: Results of this study suggest that Lipo prostaglandin E1 may enhance blood flow in the cauda equina and improve clinical symptoms in some patients with lumbar spinal stenosis.- - - - - - - - - - ranking = 1keywords = pain (Clic here for more details about this article) |
6/114. spinal canal stenosis at the level of axis.We describe a rare case of marked segmental stenosis of the axis secondary to developmental hypertrophy of the posterior neural arch causing severe neck pain and headache in the occipital region. The patient made a remarkable recovery following decompressive laminectomy and foraminal decompression.- - - - - - - - - - ranking = 1keywords = pain (Clic here for more details about this article) |
7/114. Destructive spondyloarthropathy mimicking spondylitis in long-term hemodialysis patients.A 63-year-old man with end-stage renal disease (ESRD) who had been undergoing hemodialysis for 18 years suffered persistent neck pain, progressive quadriparesis, and a deteriorating ataxic gait during the 6 months before admission. A sudden onset of aggravating quadriparesis and an inability to ambulate occurred during his trip to Sydney, australia, 1 week before this admission. Vertebral tuberculosis osteomyelitis of the C5/6 segment was considered and treated in a hospital there. Findings from cervical magnetic resonance imaging (MRI; low signal intensity on both T1- and T2-weighted images) were diagnostic of destructive spondyloarthropathy (DSA) and distinguishable from spinal osteomyelitis preoperatively. amyloid masses, mainly composed of B-2 microglobulin, filled in disc and paradiscal ligaments, with adjacent end-plate destruction by cytokine-mediated reactive inflammation, and appeared to be mostly related to the pathogenesis of DSA. The cervical spine, especially C5/6, is the most common site of DSA. Spinal instability and neurologic compression cause the clinical symptoms and signs. Adequate decompression and successful cervical fusion ensure the best therapeutic results.- - - - - - - - - - ranking = 1keywords = pain (Clic here for more details about this article) |
8/114. Unilateral psoas abscess following posterior transpedicular stabilization of the lumbar spine.A case of unilateral psoas abscess in a 58-year-old patient, shortly after posterior lower spine stabilization and fusion for spinal stenosis using transpedicular spine fixation is reported. The diagnosis was delayed because the patient's symptoms were referred to the thigh and the plain roentgenograms were negative for pathology. The technetium scintigram and computed tomography (CT) helped localization, diagnosis and treatment of the psoas abscess. Percutaneous CT-guided drainage was followed by recurrence of the abscess, and open surgical evacuation was performed successfully in combination with antibiotic treatment for 8 weeks. psoas abscess should always be suspected when recurrent pain is associated with fever and elevated erythrocyte sedimentation rate after instrumentation of the lumbar spine. Hardware of a low profile and volume should be used to decrease dead space in the fusion area, and the volume of bone substitutes should be limited for the same reason.- - - - - - - - - - ranking = 1keywords = pain (Clic here for more details about this article) |
9/114. Sterile, benign radiculitis associated with lumbosacral lateral recess spinal canal stenosis: evaluation with enhanced magnetic resonance imaging.Two cases of symptomatic lumbar lateral recess stenosis are described in which the compressed nerve root became focally enhanced on magnetic resonance imaging (MRI) studies performed with gadolinium dtpa. Two men with low back pain and lumbar radiculopathy were examined with contrast-enhanced MRI studies, which showed intradural enhancement of the symptomatic nerve roots. In selected cases of lateral recess stenosis, focal radicular injury may be visualized on enhanced MRI as a result of a breakdown of the blood-brain barrier.- - - - - - - - - - ranking = 11.935803907299keywords = back pain, back, pain (Clic here for more details about this article) |
10/114. Iliopsoas hematoma with femoral neuropathy presenting a diagnostic dilemma after spinal decompression.STUDY DESIGN: Case report of an iliopsoas hematoma with femoral neuropathy appearing 8 weeks after a posterior spinal decompression procedure. OBJECTIVES: To describe a potential complication and differential diagnosis for nerve root symptoms following spinal decompression. SUMMARY OF BACKGROUND DATA: Iliopsoas hematoma is usually a complication of anticoagulation, hemophilia, or trauma. It has not been described previously as a complication of posterior spinal decompression. femoral neuropathy results from compression within the iliopsoas compartment. methods: A 53-year-old woman reported pain in the right side of her groin and an increasing fixed flexion deformity of the right hip 8 weeks after a posterior, midline, spinal decompression. A femoral neuropathy later developed. magnetic resonance imaging and computed tomography were performed. RESULTS: Imaging studies demonstrated a diffusely enlarged iliopsoas. Exploration revealed a large hematoma, which was evacuated. The compartment was fully decompressed with resolution of the nerve root symptoms within 48 hours. CONCLUSIONS: Iliopsoas pathology is a rare cause of nerve root symptoms and presented diagnostic difficulties after an apparently successful spinal decompression.- - - - - - - - - - ranking = 1keywords = pain (Clic here for more details about this article) |
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