1/15. sciatica caused by cervical and thoracic spinal cord compression.STUDY DESIGN: Two case reports of sciatica that was considered to be caused by cervical and thoracic spinal cord compression. OBJECTIVES: To point out that sciatica can be an initial major symptom in patients with cervical or thoracic spinal cord lesions. SUMMARY OF BACKGROUND DATA: Usually, tract pain caused by cord compression is considered to be diffuse and does not resemble sciatica. methods: Medical history, physical findings, and the results of imaging studies were reviewed in one case of cervical cord tumor and one case of thoracic kyphosis. RESULTS: In both cases, sciatica was the initial and major symptom. Imaging studies showed no lesion in the lumbar spine. In one patient, a cervical dumbbell tumor was found to compress the cervical cord, and in the other the spinal cord was severely compressed at the thoracic kyphosis. The sciatica disappeared immediately after decompression surgery in both cases. CONCLUSIONS: leg pain resembling sciatica can be caused by cord compression at the cervical and thoracic level. Thoracic kyphosis may be a causative factor in sciatica, in addition to spinal cord tumor and disc herniation, which have been reported previously.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
2/15. Juxtafacet cyst of the lumbar spine. Clinical, radiological and therapeutic aspects in 28 cases.OBJECT: A consecutive series of 28 "operated" juxtafacet cysts is reported. We emphasize the clinical and radiological aspects leading to diagnosis. We also discuss the results of the surgical treatment. MATERIAL AND methods: Medical information and radiological studies involving 28 patients were analyzed. Each patient has been operated on by decompressive laminectomy and resection of the cyst. The diagnosis was always confirmed by a pathological examination. The cyst most frequently occurred at the L4-L5 level (n = 18), and seldom at the L5-S1 (n - 6) or L3-L4 (n - 4) levels. RESULTS: The differential diagnosis from other pathological causes responsible for a radicular compression could not be done by physical examination. spine x-rays or myelogram were nonspecific. Computed tomography or CT-myelography could help in the diagnosis but MR imaging was the most sensitive. In our series, the respective sensitivities of these techniques are 56, 42 and 77%. The preoperative diagnosis was correct in 18 patients (64%). The cyst was sometimes adherent to the underlying dura, then significantly increasing the risk of dural tear and spinal fluid leak, especially when located at L3-L4 level. Surgical ablation lead to a complete recovery or an important improvement in 26 patients. CONCLUSIONS: The diagnosis of the juxtafacet cyst of the lumbar spine is better achieved by MRI. Surgery is the gold standard treatment, safe and long-term effective. When a total cyst removal with an internal facetectomy are performed, recurrence is exceptional.- - - - - - - - - - ranking = 7.7589189621414keywords = physical examination, physical (Clic here for more details about this article) |
3/15. Recurrent transverse myelitis after lumbar spine surgery: a case report.STUDY DESIGN: A case of recurrent idiopathic transverse myelitis occurring after surgery is reported. OBJECTIVES: To present a case of idiopathic transverse myelitis recurring after surgery and to heighten awareness for the diagnosis and management of this disorder. SUMMARY AND BACKGROUND DATA: Transverse myelitis presenting with acute spinal pain and neurologic deficit must be considered along with structural causes of myelopathy by the spine specialist. This intramedullary spinal cord disorder may be caused by parainfectious and postvaccinal sequelae, multiple sclerosis, spinal cord ischemia, autoimmune disorders, and paraneoplastic syndromes. These various etiologies are often difficult to differentiate. However, a patient's history, clinical course, MRI studies, and laboratory findings often allow such classification. Determination of etiology provides pertinent information regarding potential recurrence, treatment, and prognosis. methods: The patient history, physical examination, radiologic and laboratory studies, and pertinent literature were reviewed. RESULTS: Thoracolumbar myelitis developed in the reported patient 6 weeks after lumbar spine surgery during an otherwise uncomplicated postoperative recovery. The workup did not identify a specific cause, and the patient recovered to ambulatory status. However, 4 months after surgery, acute transverse myelitis developed again, this time affecting the cervical spinal cord. Despite aggressive intervention with corticosteroids, the patient has remained nonambulatory with severe neurologic residua. In spite of an extensive workup, a definitive cause was not determined, although an autoimmune etiology was suspected. The patient has stabilized without recurrence using immunosuppressant therapies. CONCLUSIONS: Acute transverse myelitis is an intramedullary spinal cord disorder that may present to the spine specialist during the postoperative period. This diagnosis requires swift and aggressive diagnostic and treatment intervention. Although sometimes difficult, establishment of causation may help to determine therapy and prognosis.- - - - - - - - - - ranking = 7.7589189621414keywords = physical examination, physical (Clic here for more details about this article) |
4/15. A rare case of salmonella-mediated sacroiliitis, adjacent subperiosteal abscess, and myositis.We report the case of a 16-year-old female who was ultimately diagnosed with salmonella sacroiliitis, adjacent subperiosteal abscess, and myositis of the left iliopsoas, gluteus medius, and obturator internus muscles. Early and accurate recognition of this syndrome and other infectious musculoskeletal syndromes can prove difficult for the emergency physician, as these disease processes require special attention to pain of proportion to physical findings and a high index of suspicion.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
5/15. sciatica caused by piriformis muscle syndrome: report of two cases.The diagnosis of piriformis muscle syndrome, an unusual cause of sciatica, is difficult. However, with the advancement of imaging techniques, it has become clear that the condition is not just clinical speculation, but is a definite entity. We report on two cases with piriformis muscle syndrome, diagnosed on the basis of: a history of sciatica; physical findings, such as a tender point at the sciatic notch and around the piriformis muscle by palpation of the gluteal region, and by a digital pelvic examination; and computed tomography (CT) to demonstrate hypertrophy of the piriformis muscle. In both cases, a tenotomy of the piriformis muscle at the greater trochanter relieved entrapment of the sciatic nerve and gave satisfactory results. Since local tenderness at the piriformis muscle is the most reliable physical finding, a pelvic examination is recommended in the evaluation of suspected cases of piriformis muscle syndrome. CT is helpful in showing hypertrophy of the piriformis muscle. Detailed history taking, a careful physical examination, and versatile use of CT or magnetic resonance imaging can lead to an early, accurate diagnosis and proper treatment.- - - - - - - - - - ranking = 9.7589189621414keywords = physical examination, physical (Clic here for more details about this article) |
6/15. Rapid resolution of chronic sciatica with intravenous infliximab after failed epidural steroid injections.STUDY DESIGN: A case study of the use of infliximab to treat sciatica associated with disc herniation in a man who had failed extensive treatment, including 3 epidural injections, for several months. OBJECTIVE: To compare and contrast the clinical and imaging data before and after treatment with infliximab and to compare these results to those of a previously published case series. SUMMARY OF BACKGROUND DATA: One prior case series had reported good results in patients with sciatica and disc herniation of up to 3 months' duration. However, patients had not had previous epidural steroid injections, and no comparative imaging data were reported. methods: After 8 months of unrelenting sciatica, the patient received a single infusion of infliximab. He was evaluated using the same measures used in the previously published case series. pain scales, functional assessments, physical examinations, and imaging studies were performed immediately before infusion and for several months after treatment, with a final evaluation 6 months following infliximab treatment. RESULTS: One week after treatment, he reported >50% reduction in back and leg pain. Six months posttreatment, his back and leg pains were reduced by 89% and 86%, respectively. Strength and reflexes were restored to normal. magnetic resonance imaging performed 3 months postinfliximab showed a 50% reduction in the herniation and disappearance of previously noted S1 root compression. There were no side effects from the treatment. CONCLUSION: This report extends the potential use of infliximab to patients with more chronic sciatica and to those who have had prior epidural steroids. Larger, randomized trials are warranted.- - - - - - - - - - ranking = 7.7589189621414keywords = physical examination, physical (Clic here for more details about this article) |
7/15. A thoracolumbar epidural hematoma simulating a disc syndrome.Epidural hematoma, a rare entity, may occur spontaneously, although a factor such as anticoagulation therapy is more frequently the cause. Epidural hematomas most commonly manifest with pain and neurologic deficit. Only six cases of lumbar hematoma simulating a herniated disc syndrome have been reported in the literature. In this article a thorough knowledge of the natural history and the differential diagnosis of disc disease as well as the importance of a complete physical examination are emphasized. Sagittal MRI imaging, as shown here, has proved to be an important adjunct in the evaluation of multilevel spinal disorders.- - - - - - - - - - ranking = 7.7589189621414keywords = physical examination, physical (Clic here for more details about this article) |
8/15. Chronic fentanyl application induces adrenocortical insufficiency.We report a case of a 64-year-old man with secondary adrenocortical insufficiency who has been on a chronic transdermal fentanyl treatment because of sciatic pain syndrome. Shortly before admission to our hospital, the patient had discontinued his hydrocortisone medication. Adrenal crisis was assumed and during therapy with hydrocortisone infusion, the patient recovered. We suspected an opiate-induced suppression of the hypothalamus-pituitary-adrenal (HPA) axis. Therefore, we gradually reduced the opiate dosage. After 1 week, HPA axis function was markedly improved. We conclude that opiate medication may inhibit - in a life-threatening way - the organism's ability to respond to physical, emotional or metabolic stressors.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
9/15. Resolution of a synovial cyst of the lumbar spine without surgical therapy -- a case report.Synovial cysts originating from the facet joint of the lumbar spine are a rare cause of radiculopathy. Surgical resection is considered to be the treatment of choice, although very little is known about the natural history of spinal synovial cysts. Only six cases have been published up to now concerning the spontaneous regression of a cyst without invasive therapy. We present the history of a patient suffering from sciatic pain caused by a synovial cyst at the level of L4/5, and we describe the spontaneous remission of the cyst, discussing the radiological and clinical findings and comparing our findings with respect to the current literature. CLINICAL PRESENTATION: The patient suffered from sciatic pain for 5 months without neurological deficits. Magnetic resonance tomography revealed a cystic structure adjacent to the facet joint L4/5. Presuming a synovial cyst, we scheduled surgery and at the same time started conservative treatment, including physical therapy and analgesic medication. The patient's condition improved significantly during conservative treatment, so that surgery was cancelled. A second magnetic resonance tomography showed that the cyst had dramatically shrunken, without any narrowing of the spinal canal. CONCLUSIONS: Up to now, synovial cysts of the lumbar spine have usually been treated operatively, but we and others have shown that spontaneous resolution of the cyst seems possible, so that extensive conservative treatment should always be considered as the first therapeutic option, provided that there are no severe neurological deficits.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
10/15. sciatica in a patient with unusual peripheral nerve sheath tumors.BACKGROUND: Other causes such as peripheral schwannomas can mimic lumbar disk disease. CASE DESCRIPTION: We present an unusual case of multiple nerve sheath tumors in a patient with left radicular leg pain accompanied by a Tinel sign. Initial lumbar MR imaging revealed a mass in the right lumbar plexus, side opposite the patient's symptoms. Magnetic resonance neurography subsequently revealed a compressive mass of the sciatic nerve proximal to the popliteal fossa, histologically identified as a schwannoma. CONCLUSION: This case emphasizes the importance of continued investigation when the radiographic findings do not correlate with the patient's history in the presence of localizing signs on physical examination.- - - - - - - - - - ranking = 7.7589189621414keywords = physical examination, physical (Clic here for more details about this article) |
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