281/360. spinal canal stenosis with hypophosphatemic vitamin d-resistant rickets: case report. A 42-year-old woman with sex-linked hypophosphatemic vitamin d-resistant rickets presented with a 6-month history of progressive weakness and numbness in her lower extremities. Radiological studies revealed severe spinal canal stenosis extending from levels T4 to T10. Her symptoms improved markedly after extensive thoracic laminectomies. ( info) |
282/360. Severe lumbar stenosis caused by chronic spinal epidural hematoma and multiple disk disease--case report and review of the literature. We present a patient whose radicular syndrome resulted from combined compression by disk herniation and lumbar chronic spinal epidural hematoma (CSEH). The lesion was extensively studied by CT and MRI and the preoperative diagnosis confirmed by microscopic examination. CSEH is a rare entity, typical of elderly and invariably involving the lumbar canal: only 11 similar cases have been reported up to date. We propose that an undefined number of CSEH remains clinically silent, hidden in the roomy lumbar canal, displacing but not injuring the roots of the cauda. The routine use of Gd-DTPA MRI, even in emergency, will significantly decrease mistakes localization and will provide the correct differential diagnosis. ( info) |
| STUDY DESIGN. One hundred patients underwent lumbar nerve root decompression without fusion. All patients were registered preoperatively in a computer-coded protocol and followed at regular intervals: 4, 12, and 24 months after surgery. A number of subjective and objective variables were investigated including data on preoperative and postoperative working conditions and sick listing. patients' opinions on pain relief were assessed using a 4-grade scale. OBJECTIVES. Surgical results and impact on sick leave and working conditions in patients who underwent surgery for lateral spinal stenosis were evaluated in a prospective, consecutive study. SUMMARY OF BACKGROUND DATA. Preoperatively, 81 of the patients were employed, 21 in sedentary work, 36 in moderately heavy work, and 24 in heavy work. The majority of the patients (78%) were off work (sick listed) with a mean duration of 13 months. Mean preoperative duration of sciatic pain was 2.5 years. methods. Working conditions were classified into one of three categories: sedentary, moderately heavy, and heavy work. Distribution of working conditions preoperatively and postoperatively was assessed in conjunction with duration of sick leave. Change of work category postoperatively was evaluated and related to preoperative working conditions. RESULTS. The effect of decompression for sciatica due to lateral spinal stenosis was gratifying in most cases with excellent results in 65% and fair in 23% of the patients concerning leg pain. The majority of patients employed preoperatively (73%) returned to work after a postoperative sick leave of 5.5 months. patients who received disability pension postoperatively had significantly inferior surgical result concerning back pain and were also sick listed significantly longer preoperatively. CONCLUSION. Thus, lateral spinal stenosis was improved in the majority of patients (88%) who underwent surgery, and the majority of patients who were employed before surgery returned to work after. ( info) |
| spinal stenosis presents with the patient complaining that walking a certain distance causes leg pain or leg weakness. The underlying cause is narrowing of the spinal canal, resulting in nerve root compression. The resulting claudication or leg pain is actually vascular in origin. The nerve roots cannot receive the necessary blood supply because of the mechanical compression, and that restriction is the cause of the leg pain and why the characteristic claudication leg pain presents in a fashion similar to the claudication symptoms seen with peripheral vascular disease. If the problem is severe enough, the treatment is decompression of the appropriate nerve roots. Usually decompression can be performed without any instrumentation or fusion. For certain conditions, however, these additional surgical modalities are necessary to provide the patient with a lasting good result. Several medical, social, psychological, and nutritional factors should be evaluated preoperatively. The goal of the surgery is to allow the patient to walk longer distances and, therefore, to be a more functional member of society. With appropriate treatment and preoperative medical evaluation, we find that roughly 85% of patients are significantly helped with surgical treatment, 12% feel that they are not significantly better, and 3% feel they are worse. The incidence of serious postoperative complications has been surprisingly low. ( info) |
285/360. Post-operative central sleep apnoea complicating cervical laminectomy: case report. Breathing disorders following decompressive laminectomy for cervical stenosis are rare. We report a case of postoperative central apnoea following cervical laminectomy, and discuss the aetiology, management and potential relationship between upper cervical surgery and sleep apnoea. Preoperative evaluation of respiratory function, intraoperative monitoring and caution with sedative and anaesthetic drug use is important and the need for postoperative apnoea monitoring in cases with critical upper cervical compression with compromised breathing is emphasized. ( info) |
| spinal cord compression is an unusual but potentially catastrophic manifestation of hereditary multiple exostoses (HMEs). Isolated, osteochondromas are usually of little significance. However, if they are located near neurologic structures, they may cause irritation due to mechanical compression. In patients with HMEs who present with neck or back pain, and particularly in those who have neurologic symptoms in the upper or lower extremities, a diagnosis of intracanalicular osteochondroma should be presumed until proven otherwise. Prompt diagnosis and surgical excision affords the best prognosis for these patients who have spinal cord compression secondary to intracanalicular osteochondroma. ( info) |
287/360. Thoracic spinal stenosis: diagnostic and treatment challenges. Thoracic stenosis may be defined by a narrowing of the anteroposterior (AP) diameter of the thoracic spinal canal to < 10 mm. Primary thoracic stenosis, documented when myelography is carried beyond the thoracolumbar junction into the upper thoracic canal, is most frequently associated with lumbar stenosis, whereas secondary stenosis, attributed to endocrinopathies and systemic diseases, more typically involves the entire spinal canal. Recognition of the presence of primary or secondary thoracic stenosis and the entire extent of attendant disease in the adjacent cervical or lumbar regions is essential to proper surgical management. Nine cases of primary and one instance of secondary thoracic spinal stenosis were reviewed. Seven of nine patients with primary thoracic stenosis had accompanying lumbar involvement, whereas one patient with secondary stenosis attributed to acromegaly had cervical, thoracic, and lumbar stenosis. ( info) |
288/360. Intermittent priapism associated with lumbar spinal stenosis. Nine patients with intermittent priapism associated with lumbar spinal stenosis are described. They had severe intermittent claudication and priapism when walking, and 7 had sensory disturbances affecting the lumbosacral nerve roots at rest. Radiographs showed degenerative central stenosis in 6, and degenerative spondylolisthesis in 3. Seven were treated by surgical decompression and 2 refused operation. Six of the 7 had improvement in their priapism, but symptoms recurred in one as a result of spondylolisthesis developing after operation. ( info) |
| STUDY DESIGN. pseudohypoparathyroidism associated with disorders of the spine is rarely reported. In this report, the authors present a case of pseudohypoparathyroidism in a 41-year-old man who had narrow spinal canal and multiple disc herniation in the cervical spine. SUMMARY OF BACKGROUND DATA. The patient had progressive spastic tetraplegia due to cervical cord compression caused by multiple disc herniations at the C3-C4, C4-5, and C5-C6 levels in the developmentally narrow spinal canal. Based on the features of Albright's osteodystrophy, serum laboratory results, and an Ellsworth-Howard test, the diagnosis of pseudohypoparathyroidism, type I was confirmed. methods. The patient underwent expansive laminoplasty at C3 through C6 levels. RESULTS. His symptoms have gradually improved during the 1-year and 6-month periods after the surgery. CONCLUSIONS. A case of pseudohypoparathyroidism-associated spinal stenosis was reported. ( info) |
290/360. Combined form of developmental cervical-lumbar stenosis of the spinal canal in two young patients. Symptomatic combined cervical and lumbar developmental spinal canal stenosis without spondylosis in young patients has rarely been reported. Two such cases are presented here. The symptoms appeared at 21 and 18 years of age and progressed gradually for each patient. The main clinical manifestations included lower back pain, intermittent claudication, polyradiculopathy and myelopathy. Myelogram and computed tomography scanning showed developmental spinal canal stenosis without evidence of spondylosis in either the cervical or lumbar spine. Both of the patients underwent a canal expansive laminoplasty at the cervical level and a decompressive laminectomy at the lumbar level. They both showed satisfactory improvement after surgery. The pathologic features consisted mainly of thin and flat laminae at the cervical spine, and thick, hard laminae and facet joints at the lumbar spine. The mechanism of early onset of symptoms was probably due to the additive effects of irritation of both the spinothalamic tract at the cervical level and the nerve roots at the lumbar level. A one-staged operation is considered to be the most suitable treatment for this disease entity. ( info) |