1/6. Segmental motor paralysis after expansive open-door laminoplasty.STUDY DESIGN: A retrospective study was conducted to investigate patients in whom segmental motor paralysis developed after expansive open-door laminoplasty for cervical myelopathy. OBJECTIVE: To propose the involvement of the spinal cord as a possible mechanism in the development of segmental motor paralysis. SUMMARY OF BACKGROUND DATA: Segmental motor paralysis is seen occasionally in patients who undergo expansive open-door laminoplasty for cervical myelopathy, and has long been attributed to nerve root lesions caused by either traumatic surgical techniques or a tethering effect induced by excessive posterior shift of the spinal cord after decompression. Involvement of spinal cord pathology is not suggested in the English literature. methods: The study group consisted of 15 patients (11 men and 4 women) in whom postoperative segmental motor paralysis developed after expansive open-door laminoplasty during a minimum follow-up of 2 years. Their average age at the time of surgery was 56 years. Characteristics of the paralysis, clinical symptoms, recovery rates calculated using pre- and postoperative Japanese Orthopedic association scores, and radiographic findings including pre- and postoperative magnetic resonance images were analyzed retrospectively and compared with those of 126 patients without segmental paralysis who underwent expansive open-door laminoplasty. RESULTS: The paralysis occurred mainly, but not only, at C5, and eight patients had multilevel involvements predominantly in the hinge side, whereas two patients had paralysis on both sides. The paralysis had developed after an average of 4.6 days. Of the 15 patients, 14 reported severe numbness or dysesthesia in their hands before surgery, and their average recovery rate for upper extremity sensory disturbance was lower than for those without paralysis. Postoperative magnetic resonance imaging showed the presence of a T2 high-signal intensity zone in the spinal cord of all the patients. The level of such abnormal signal areas corresponded to the level of paralyzed segments in 10 of the 15 patients. paralysis resolved completely in 11 patients. CONCLUSIONS: Delayed onset of paralysis, dysesthesiain the upper extremities, and the presence of T2 high-signal intensity zones suggest that a certain impairment in the gray matter of the spinal cord may play an important role in the development of postoperative segmental motor paralysis.- - - - - - - - - - ranking = 1keywords = nerve (Clic here for more details about this article) |
2/6. Palsy of the C5 nerve root after midsagittal-splitting laminoplasty of the cervical spine.STUDY DESIGN: The imaging characteristics of postoperative C5 nerve root palsy after midsagittal-splitting laminoplasty for cervical myelopathy, including those observed on plain radiography, computed tomography, and magnetic resonance imaging, were analyzed. OBJECTIVE: To investigate the imaging findings that predict occurrence of C5 nerve root palsy after midsagittal-splitting laminoplasty. SUMMARY OF BACKGROUND DATA: There have been several reports on imaging findings for postoperative nerve root palsy after open-door laminoplasty. However, there have been no detailed reports on imaging characteristics that predict the occurrence of nerve root palsy after midsagittal-splitting laminoplasty. methods: The study included 45 consecutive patients undergoing midsagittal-splitting laminoplasty with sufficient pre- and postoperative imaging examinations: 27 patients with cervical spondylotic myelopathy (CSM), 14 patients with ossification of the posterior longitudinal ligament (OPLL), and 4 patients with cervical disc herniation. Characteristics of pre- and postoperative plain radiographs, computed tomography scans, and magnetic resonance images were compared between the patients with and those without C5 nerve root palsy. RESULTS: Palsy of the C5 nerve root developed in 4 patients, and did not develop in 41 patients. Of the four patients with C5 nerve root palsy, one had CSM and the other three had OPLL. The incidence of C5 nerve root palsy involved 3 of 14 patients with OPLL patients (21.4%) and 1 of 31 patients without OPLL (3.2%) (P = 0.08). For both diseases, the patients with palsy tended to have increased postoperative cervical lordosis (P = 0.21). As for anterior compression on the spinal cord at C3, the P value for the comparison between the group with and the group without palsy was 0.07 for preoperative compression and 0.01 for postoperative compression. CONCLUSIONS: The preliminary data suggest that patients who have OPLL with marked anterior compression on spinal cord at C3 can be at risk for postoperative C5 nerve root palsy after midsagittal-splitting laminoplasty. Also, a postoperative increase in cervical lordosis may be the cause of postoperative nerve root palsy.- - - - - - - - - - ranking = 14keywords = nerve (Clic here for more details about this article) |
3/6. Burst fracture of the fifth lumbar vertebra.Burst fracture of the fifth lumbar vertebra is a rare injury. We report the cases of seven patients who were treated conservatively by immobilization for six to eight weeks in a body-jacket cast that included one lower extremity to the knee. The patients were allowed to walk ten to fourteen days after the injury. A thoracolumbosacral orthosis was worn for an additional three months. No patient had an injury to the sacral root. Two patients had mild lower lumbar motor-root deficits that resolved within one year. All patients had an occasional backache, and two had intermittent radicular-type pain in the distribution of the fifth lumbar or first sacral-nerve root. The degree of compromise of the spinal canal could not be directly related to the degree of neurological deficit; that is, a large compromise of the spinal canal did not necessarily result in a major loss of neurological function. There was no early or late loss of lordosis between the cephalad end-plate of the fourth lumbar vertebra and the cephalad aspect of the sacrum, and there were no signs of progressive collapse of the vertebral body in any patient. In our series, the burst fractures of the fifth lumbar vertebra were stable injuries that caused minimum neurological deficits, and treatment by immobilization in a body-jacket cast was effective.- - - - - - - - - - ranking = 1keywords = nerve (Clic here for more details about this article) |
4/6. Bilateral C5 motor paralysis following anterior cervical surgery--a case report.Numerous authors have reported C5 root palsies following posterior cervical surgery, and several mechanisms of injury have been proposed. Similar deficits after anterior cervical procedures are considered to occur less commonly. We report on a 48-year-old male who underwent multi-level anterior discectomy and fusion for cervical spondylotic myelopathy. Bilateral C5 nerve root deficits were noticed in the immediate postoperative period, and treated non-operatively. A postoperative magnetic resonance imaging (MRI) scan showed an increase in cervical lordosis accompanied by a posterior shifting of the spinal cord. Potential mechanisms of nerve root injury in this situation are discussed, and the literature on postoperative C5 root deficits is reviewed. The patient returned to his preoperative occupation as an operating room nurse 6 months following surgery, with complete neurologic recovery occurring over an 11-month period. C5 deficits following anterior cervical surgery occur more frequently than generally assumed. Improved lordosis and longitudinal lengthening of the cervical spinal column in multilevel anterior decompression and interbody fusion can paradoxically result in a traction injury to the spinal cord and C5 nerve roots.- - - - - - - - - - ranking = 3keywords = nerve (Clic here for more details about this article) |
5/6. Sudden spasms following gradual lordosis--the stiff-person syndrome.BACKGROUND: A 28-year-old woman presented to hospital after an episode of severe lower back spasms that occurred during a stressful family gathering. She had a history of progressive difficulty bending forward and increasing lumbar lordosis. INVESTIGATIONS: physical examination, spine MRI scan, abdominal and pelvic ultrasound, electromyogram, nerve conduction studies, cerebrospinal fluid analysis, breast examination, Pap smear, transabdominal and endovaginal ultrasound. diagnosis: stiff-person syndrome with high titer of antibodies against glutamic acid decarboxylase. TREATMENT: benzodiazepines and intravenous immunoglobulins.- - - - - - - - - - ranking = 1keywords = nerve (Clic here for more details about this article) |
6/6. spinal stenosis caused by a Harrington hook in neuromuscular disease. A case report.In a 22-year-old woman with an unspecific congenital myopathy spinal stenosis developed 11 years after a T4-L5 spinal fusion. A slowly progressive lumbosacral lordosis developed, and the Harrington hook at L5 tilted into the canal, eroded the dura, and pressed on the nerve roots. Removal of the hook and fusion of L5-S1 relieved the symptoms.- - - - - - - - - - ranking = 1keywords = nerve (Clic here for more details about this article) |