Cases reported "Spondylolisthesis"

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1/67. Spondyloptosis and multiple-level spondylolysis.

    An unusual case of a combination of multiple bilateral spondylolyses (L2, 3 and 4), spondylolisthesis at L3/4, spondyloptosis at L4/5 and sacralization of L5 in a teenage female is described. The patient had severely increasing lower back pain radiating to the left lower limb. radiography identified the abnormalities and myelography revealed complete obstruction and compression of the thecal sac at the L4/5 level. The case was treated surgically by posterior decompression, corpectomy and fusion in a three-stage operation. The follow-up was extended to 2 years with no complications. No similar case has previously been reported.
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keywords = back pain, back
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2/67. diagnosis and treatment of severe dysplastic spondylolisthesis.

    spondylolisthesis, the anterior or posterior displacement of one vertebra on another, usually affects the lumbar region. Five percent of the population has one of the five classes of spondylolisthesis, which include dysplastic, isthmic, degenerative, traumatic, and pathologic spondylolisthesis. This article focuses on the dysplastic type, which makes up 14% to 21% of all spondylolisthesis. Dysplastic spondylolisthesis usually causes no symptoms in children; pain usually begins in adolescence. The key to diagnosis is the appropriate use of radiography in the evaluation of low back pain. This report describes a case involving a 21-year-old woman presenting with back pain to the family physician. Also, it details how the diagnosis was achieved and evaluates conservative and aggressive treatment options.
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keywords = back pain, back
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3/67. Iatrogenic spondylolysis leading to contralateral pedicular stress fracture and unstable spondylolisthesis: a case report.

    STUDY DESIGN: A case report of iatrogenic spondylolysis as a complication of microdiscectomy leading to contralateral pedicular stress fracture and unstable spondylolisthesis. OBJECTIVE: To improve understanding of this condition by presenting a case history and roentgenographic findings of a patient that differ from those already reported and to propose an effective method of surgical management. methods: A 67-year-old woman with no history of spondylolysis or spondylolisthesis underwent an L4-L5 microdiscectomy for a left herniated nucleus pulposus 1 year before the current consultation. For the preceding 8 months, she had been experiencing low back and bilateral leg pain. Imaging studies revealed a left L4 spondylolytic defect and a right L4 pedicular stress fracture with an unstable Grade I spondylolisthesis. RESULTS: The patient was treated with posterior spinal fusion, which resulted in complete resolution of her clinical and neurologic symptoms. CONCLUSIONS: Iatrogenic spondylolysis after microdiscectomy is an uncommon entity. However, it can lead to contralateral pedicular stress fracture and spondylolisthesis, and thus can be a source of persistent back pain after disc surgery. Surgeons caring for these patients should be aware of this potential complication.
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ranking = 1.0731460425427
keywords = back pain, back
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4/67. vertigo, tinnitus, and hearing loss in the geriatric patient.

    OBJECTIVE: To document clinical changes after a course of chiropractic care in a geriatric patient with vertigo, tinnitus, and hearing loss. Clinical Features: A 75-year-old woman with a longstanding history of vertigo, tinnitus, and hearing loss experienced an intensified progression of these symptoms 5 weeks before seeking chiropractic care. Radiographs revealed a C3 retrolisthesis with moderate degenerative changes C4-C7. Significant decreases in audiologic function were evident, and the RAND 36 health Survey revealed subjective distress. Intervention and Outcome: The patient received upper cervical-specific chiropractic care. Paraspinal bilateral skin temperature differential analysis was used to determine when an upper cervical adjustment was to be administered. Radiographic analysis was used to determine the specific characteristics of the misalignment in the upper cervical spine. Through the course of care, the patient's symptoms were alleviated, structural and functional improvements were evident through radiographic examination, and audiologic function improved. CONCLUSION: The clinical progress documented in this report suggests that upper cervical manipulation may benefit patients who have tinnitus and hearing loss.
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keywords = upper
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5/67. Minimum 10-year follow-up study of anterior lumbar interbody fusion for isthmic spondylolisthesis.

    The aims of the current study were to evaluate the long-term clinical and radiologic results of anterior lumbar interbody fusion (ALIF) for isthmic spondylolisthesis. Between 1981 and 1988, a total of 35 patients underwent ALIF for isthmic spondylolisthesis. Of these, 23 patients were followed clinically and radiographically for more than 10 years (average, 13.3 years). The Japanese Orthopaedic association low-back pain score was used to evaluate the outcome of subjective symptoms and clinical signs. The preoperative and postoperative percentage of slip, preoperative and postoperative intervertebral disk height, interbody graft union, and pars defect union were evaluated by serial radiographs. The adjacent disk degeneration was also evaluated by radiographs and magnetic resonance imaging. Although the low-back pain score worsened after 5 years, ALIF provides satisfactory overall long-term clinical results. The preoperative percentage of slip and the disk height were corrected after surgery, but at the time of interbody graft union, slip and disk height recurred as a result of grafted bone collapse. The rate of union in the grafted area was 83%. In the nonunion cases, the scores gradually deteriorated with time, but the overall results were not different from those of union cases. Radiographs showed adjacent disk degeneration in 52% of cases in the upper adjacent level and in 70% of cases in the lower adjacent level, but these changes were not correlated with clinical outcomes.
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keywords = back pain, back, upper
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6/67. Retained surgical sponges, a denied neurosurgical reality? Cautionary note.

    Surgically acquired foreign bodies are well known but not widely reported. Only seven articles pertaining to this subject were found in the current neurosurgical literature. Are they a denied neurosurgical reality? In this report with a concededly provoking title, the authors elucidate clinical and medicolegal aspects of retained surgical sponges, with emphasis on spinal procedures. To highlight particulars, a case is presented in which a retained surgical sponge was encountered as the cause of progressive low back pain and tender swelling in the scar area after instrumented posterolateral lumbar spinal fusion combined with pedicle screw fixation for lumbosacral spondylolisthesis 4 years earlier. However, until today, no reported neurosurgical patient has suffered a serious complication due to a retained surgical sponge. The authors wish to remind the neurosurgical community to learn from unpleasant clinical and medicolegal experiences in other specialties before serious complications occur, and we suggest rigorous standardization of intraoperative habits to avoid this hazardous complication.
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keywords = back pain, back
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7/67. candida albicans spinal epidural abscess secondary to prosthetic valve endocarditis.

    A 56-year-old woman, with underlying rheumatic heart disease status post mitral valve replacement, presented with fever, low back pain radiating to right leg, and congestive heart failure. magnetic resonance imaging detected an L5-S1 spinal epidural abscess. A vegetation on prosthetic mitral valve was found by transesophageal echocardiography. Cultures of epidural aspirate, surgical specimen, and blood all grew candida albicans. She received surgical drainage of the spinal epidural abscess and i.v. amphotericin b 1 mg/kg/day for eight weeks. Clinical symptoms improved gradually and she was discharged without neurologic sequelae. She remained well and continued to lead an active life two years after discharge.
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keywords = back pain, back
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8/67. Pneumococcal vertebral osteomyelitis: a unique case with atypical clinical course.

    STUDY DESIGN: A case report. OBJECTIVES: To report and discuss a case of pneumococcal vertebral osteomyelitis with meningitis in a previously healthy 51-year-old immunocompetent woman who presented with acute onset lower back pain. SUMMARY OF BACKGROUND DATA: To the authors' knowledge, pneumococcal vertebral osteomyelitis with meningitis in an immunocompetent person with no other predisposing factor has not been reported previously. methods: The patient was diagnosed to have pneumococcal meningitis 10 days after the onset of acute and severe lower back pain. Significant improvement of clinical symptoms from meningitis was achieved with appropriate antimicrobial treatment. Lumbar CT and MRI scans were performed on persistence of fever and lower back pain. Loss of height and peridiscal inflammation at L3-L4 and epidural and bilateral psoas abscesses were detected. RESULTS: diagnosis of pneumococcal vertebral osteomyelitis was established after evaluation of the material obtained from CT-guided aspiration of the psoas abscess and biopsy of the L3 body. With appropriate antimicrobial treatment, the patient's complaints resolved completely. CONCLUSION: To the authors' knowledge, this is the first reported case of pneumococcal vertebral osteomyelitis with meningitis.
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keywords = back pain, back
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9/67. Treatment of congenital spondyloptosis in an 18-month-old patient with a 10-year follow-up.

    STUDY DESIGN: Case report. OBJECTIVES: To present the case of a patient with congenital spondyloptosis treated and followed over 10 years. SUMMARY OF BACKGROUND DATA: The surgical management of spondyloptosis in children is variably reported in the literature. Some authors propose that posterior fusion in situ is a safe and reliable procedure, whereas others suggest that reduction of the slipped vertebra may prevent some of the adverse sequelae of in situ fusion, which include nonunion, bending of the fusion mass, and persistent lumbosacral deformity. Many investigators advocate a combined anterior and posterior fusion using instrumentation. methods: At the time of the first symptoms an 18-month-old boy with congenital spondyloptosis of L5-S1 was referred to the authors' institution. Because of the progression of pain, neurologic disturbance, mild foot deformity, muscle contractures, and lumbosacral kyphosis, surgical intervention was undertaken. Operative intervention began with a resection of the L5 lamina and wide bilateral L5 nerve root decompression. This was followed by anterior subtotal resection of L5 and interbody bone graft of the morcelized vertebral body for fusion from L5 to S1. The next step was reduction of the spondyloptosis and stabilization by posterior instrumentation L2-S1 with a sacral Cotrel-agraffe device. RESULTS: The procedure achieved almost complete reduction of the spondyloptosis with near-normal restoration of lumbar lordosis allowing more physiologic lumbar spinal biomechanics. There were no neurologic complications. After surgery there was no suggestion of back pain or gait disturbance and no progression of any deformity. CONCLUSION: In the treatment of severe congenital spondylolisthesis a staged procedure of decompression, reduction, and instrumented fusion is recommended for those cases in which intervention is indicated.
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keywords = back pain, back
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10/67. Combined dysplastic and isthmic spondylolisthesis: possible etiology.

    STUDY DESIGN: Four cases of combined dysplastic and higher-level isthmic spondylolisthesis were studied. OBJECTIVE: To attempt to understand the possible etiology of this unreported combination. SUMMARY OF BACKGROUND DATA: Dysplastic spondylolisthesis is thought to be hereditary. It is believed that isthmic spondylolisthesis, the more common type, is acquired. Multiple spondylolysis and spondylolisthesis have been reported, but no cases of combined dysplastic and isthmic spondylolisthesis. methods: The global and segmental Cobb angles of the lumbar vertebrae and sagittal vertical alignment were measured in four patients who presented with lower back pain and varying degrees of pain radiation to the lower limb. Posteroanterior and lateral radiographs were taken with patients standing barefooted. Three of the patients underwent surgery. The fourth patient refused surgery. RESULTS: The global and segmental Cobb angles were found significantly increased in these patients. Increased segmental extension angles were clearer at the levels above the dysplastic vertebrae and at the level of the isthmic defect. Large anterior translation of the thorax was noted in all cases. CONCLUSIONS: The authors believe that this unusual combination may have resulted from hyperlordosis occurring above the dysplastic vertebrae, which caused increased stresses that led to the isthmic defect. This combination should be investigated in patients with dysplastic spondylolisthesis and hyperlordosis.
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