1/34. ehlers-danlos syndrome associated with multiple spinal meningeal cysts--case report.A 40-year-old female with ehlers-danlos syndrome was admitted because of a large pelvic mass. Radiological examination revealed multiple spinal meningeal cysts. The first operation through a laminectomy revealed that the cysts originated from dilated dural sleeves containing nerve roots. Packing of dilated sleeves was inadequate. Finally the cysts were oversewed through a laparotomy. The cysts were reduced, but the postoperative course was complicated by poor wound healing and diffuse muscle atrophy. ehlers-danlos syndrome associated with spinal cysts may be best treated by endoscopic surgery.- - - - - - - - - - ranking = 1keywords = nerve (Clic here for more details about this article) |
2/34. Mechanical instability as a cause of gait disturbance in high-grade spondylolisthesis: a pre- and postoperative three-dimensional gait analysis.Mechanical instability of the spinopelvic junction is a suspected cause of abnormal gait in high-grade spondylolisthesis. Computerized three-dimensional gait analysis was performed on a 10-year-old with grade III spondylolisthesis at L-5. Preoperatively, the gait pattern was characterized by posterior pelvic tilt, decreased hip flexion, increased knee flexion, and decreased stride length and walking speed. All temporal and kinematic parameters of gait normalized after laminectomy and instrumented, in situ arthrodesis (L-4-S-1). The absence of any neurologic abnormalities on preoperative imaging, intraoperative somatosensory-evoked potentials (SSEP) monitoring, and nerve-root exploration, together with the observed improvement after stabilization of the spinopelvic junction, suggests a mechanical basis for the gait changes in high-grade spondylolisthesis.- - - - - - - - - - ranking = 1keywords = nerve (Clic here for more details about this article) |
3/34. 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.- - - - - - - - - - ranking = 1keywords = nerve (Clic here for more details about this article) |
4/34. Degenerative lumbar spondylolisthesis with an intact neural arch (pseudospondylolisthesis).Twenty patients treated for degenerative spondylolisthesis with an intact neural arch principally at the L4-5 interspace had neural compression caused by dislocation of the vertebral bodies and intrusions of lamina and enlarged, arthrotic facets into a stenotic spinal canal. The resulting "pincer" effect caused complete or partial block demonstrable on myelography, with nerve root and cauda equina compression. Most of the patients were women aged 45-84 years. Seven had neurogenic claudication. The majority had unrestricted straight-leg raising, and no signs of acute neural entrapment were seen as in patients with a herniated disc. Absent ankle reflexes, and weakness and atrophy of the anterior tibial muscle group were common, while sensation was relatively undisturbed. Treatment consisted of liberal laminar decompression including foraminotomy and medial or total facetectomy. Good-to-excellent results were obtained, and no patient was made worse by the procedure.- - - - - - - - - - ranking = 1keywords = nerve (Clic here for more details about this article) |
5/34. Remodelling of the sacrum in high-grade spondylolisthesis: a report of two cases.Two young patients are described, who were operated on for high-grade spondylolisthesis. A good posterolateral fusion was achieved, without decompression and without reduction. The clinical course was favourable, the tight hamstring syndrome resolved. Disappearance of the posterior-superior part of the sacrum and of the posterior part of the L5-S1 disc was observed on comparing pre- and postoperative magnetic resonance (MR) images. This resulted in normalisation of the width of the spinal canal. Around the L5 nerve roots in the L5-S1 foramina some fat reappeared. These anatomical changes on MRI could play a role in the disappearance of clinical symptoms.- - - - - - - - - - ranking = 1keywords = nerve (Clic here for more details about this article) |
6/34. Posterior transpediculate Zielke instrumentation in spondylolisthesis.Between July 1987 and June 1989, 82 patients with spondylolisthesis (degenerative in 49, isthmic in 33) underwent Zielke posterior transpediculate instrumentation. One-level fusion was performed in 42 patients, two-level fusion in 32 patients, and three-level fusion in 8 patients. A supplemental allograft using frozen femoral heads was implanted in seven of the patients who underwent three-level fusion. The follow-up period ranged from 1.3 to 3 years (average, 1.7 years). overall, 90.2% of the patients achieved solid fusion, and 85.4% had a good to excellent clinical result. Complications included nerve injury (one patient), rod breakage (four patients), nut loosening (11 patients), screw loosening (two patients), and screw breakage (three patients). The high incidence of instrumentation-related complications indicated that this technique must be further modified and refined.- - - - - - - - - - ranking = 1keywords = nerve (Clic here for more details about this article) |
7/34. A case study on osteoporosis in a male athlete: looking beyond the usual suspects.After presenting with chronic low back pain, a male track athlete was diagnosed with bilateral lysis at L5, slight listhesis at L5 on S1; asymmetrical lysis at L4; and right L5/S1 disc bulge with minimal S1 nerve root contact. Conservative treatment was chosen.After participating in a bone density pilot study using dual-energy X-ray absorptiometry (DEXA) investigating alcohol consumption patterns in intercollegiate athletes, he was diagnosed with osteopenia and osteoporosis in his lumbar spine. Therapeutic drug intervention and rehabilitation were initiated.athletes with normal physiologic functions can have idiopathic osteoporosis, which may or may not be related to alcohol consumption. Although the relationship among chronic alcoholism (South-Paul, 2001), weight-bearing exercise (Kalsson, 2001), and bone density have been established, the relationship among binge drinking, intercollegiate athletic participation, and bone density has not. Despite suspected normal presentation, nonresponsive low back pain should be investigated thoroughly for advanced bone conditions.- - - - - - - - - - ranking = 1keywords = nerve (Clic here for more details about this article) |
8/34. Reduction of severe adolescent isthmic spondylolisthesis: a new technique.STUDY DESIGN: The case of a 14-year-old boy with a severe-grade isthmic spondylolisthesis who underwent reduction and stabilization using this technique is described. OBJECTIVE: To report a new sequential 3-stage procedure for reduction and stabilization of severe adolescent isthmic spondylolisthesis during 1 operative session. SUMMARY OF BACKGROUND DATA: Conventional reduction techniques do not address the important regional anatomic restraints on the L5 nerve root during the reduction maneuver, thereby leading to a high risk of neurologic deficit. Using certain technical refinements could reduce the risk of neurologic deficit. A literature review of reduction of high-grade spondylolisthesis and details of the technique are presented. methods: We describe a new 3-stage procedure in a 14-year-old boy who presented with persistent mechanical low back pain, bilateral buttock and leg pain secondary to a severe-grade L5/S1 isthmic spondylolisthesis. Radiologic investigations, including plain radiographs and computerized tomography confirmed the diagnosis. magnetic resonance imaging showed reduction of signal intensity in the disc at the L5/S1 level. We describe the 3 stages of this technique, which can provide complete sagittal correction. The technical variations to allow a safe reduction of the spondylolisthesis are illustrated. RESULTS: This new procedure can achieve almost complete reduction of severe grades of L5/S1 spondylolisthesis, leading to an excellent cosmetic result and also considerably reduces the risk of neurologic deficit. CONCLUSIONS: In severe-grade lumbosacral spondylolisthesis, isolated posterior fusion, even when supplemented with internal fixation, is not sufficient to prevent deformity progression. Therefore, a combined anterior and posterior fusion is necessary. Reduction of the deformity leads to restoration of normal sagittal alignment with an excellent cosmetic result. Reduction without release of posterior structures may lead to neurologic deficit. This 3-stage shortening procedure can provide sudden reduction of deformity with minimal risk of neurologic deficit. The procedure is technically demanding, and should be performed by spinal surgeons who are familiar with the principles of anterior and posterior fusions.- - - - - - - - - - ranking = 1keywords = nerve (Clic here for more details about this article) |
9/34. chiropractic and rehabilitative management of a patient with progressive lumbar disk injury, spondylolisthesis, and spondyloptosis.OBJECTIVE: To describe the chiropractic treatment for a patient with low back pain accompanied by sensory and motor deficits of his left leg and magnetic resonance imaging-documented lumbar spinal cord and nerve root impingement. CLINICAL FEATURES: A 57-year-old man experienced low back pain that radiated into his left leg and subsequently produced both sensory and motor deficits of the left thigh and quadriceps followed by a similar weakness and accompanying paresthesia of the lower left leg. Onsets were sudden and occurred during sleep, after prolonged sitting or during long periods of driving. Diagnostic studies revealed a slight impingement at the L5-S1 level due to anterior displacement of the L5 vertebra and a mild protrusion of the L4 disk. INTERVENTION AND OUTCOMES: Treatment consisted of chiropractic spinal manipulation, physical therapy modalities, and rehabilitative exercises. Outcome measurements in his case indicated that his rehabilitation was appropriate. CONCLUSION: There is an abundance of published reports describing treatment of disk injury, low back pain, and spondylolisthesis with a variety of manipulative methods. However, this appears to be the first case reported in indexed literature of a progressive multilevel lumbar disk injury with concomitant spondylolisthesis and spondyloptosis.- - - - - - - - - - ranking = 1keywords = nerve (Clic here for more details about this article) |
10/34. Dynamic degenerative lumbar spondylolisthesis: diagnosis with axial loaded magnetic resonance imaging.STUDY DESIGN: Retrospective review of case notes and imaging. OBJECTIVE: To show the advantage of axial loaded magnetic resonance imaging (MRI) for identification of dynamic degenerative spondylolisthesis as a suspected cause of spinal claudication. SUMMARY OF BACKGROUND DATA: Degenerative spondylolisthesis typically occurs at L4/L5 and is usually evident on plain radiography. However, dynamic degenerative spondylolisthesis may become evident on erect radiographs when not shown on supine radiographs or MRI. methods: The case notes and imaging (radiography, conventional MRI, and axial loaded MRI) in 2 patients with symptoms of spinal claudication were reviewed. RESULTS: A 44-year-old female presented with a 3-year history of intermittent low back pain and right leg numbness after a fall. A 52-year-old female presented with a 4-year history of low back pain, bilateral leg weakness, and right leg numbness. In both cases, conventional MRI studies showed mild-to-moderate degenerative disc disease only with no evidence of abnormal spinal alignment or nerve root compression. Axial loaded MRI clearly showed the development of a degenerative spondylolisthesis with central canal stenosis and facet ganglion formation in 1 case. CONCLUSIONS: Axial loaded MRI identified occult dynamic degenerative spondylolisthesis, which correlated with the clinical picture but was not shown on initial conventional MRI or plain radiography.- - - - - - - - - - ranking = 1keywords = nerve (Clic here for more details about this article) |
| | Next -> |