1/7. Hangman's fracture caused by suspected child abuse. A case report.This report highlights the difficulties associated with diagnosing cervical spine injuries in children especially as the history and mechanism of injury may often be unclear and the normal variations in roentgenographic appearance may be confusing. As far as we are aware this is only the second case of traumatic Hangman's fracture in a child under the age of 3 years and the only case where there is a strong probability of child abuse. A female child aged 23 months was admitted with a 5-day history of irritability and general malaise. Her father reported noticing that she was reluctant to move her neck. He denied any possibility of trauma. On admission she had neck stiffness with a temperature of 37 degrees C and supported her neck with her hands. There was evidence of otitis media of her right ear. Her physical examination was otherwise normal. A full blood count and lumbar puncture were within normal limits. Cervical spine x rays suggested a Hangman's fracture of C2 with slight anterior subluxation of C2 on C3 and a kyphus at that level. Computerized tomography demonstrated no significant canal encroachment. An isotope bone scan was non-diagnostic. She was treated in a moulded cervical collar with neck held in slight extension. Her symptoms resolved and further radiographs showed improved alignment. Repeat CT scans seven weeks post admission showed callus formation. At follow-up at one year she remains asymptomatic. Hangman's fracture is very rare in children under 3 years and the considerable normal variations further complicate diagnosis. Swischuk described the posterior cervical line connecting the spinous process of C1-C3 vertebrae on the lateral projection to differentiate a true fracture dislocation from physiological anterior displacement. A detailed history, roentgenograms, bone scans, CT scans and MRI scans are often required for accurate diagnosis.- - - - - - - - - - ranking = 1keywords = physical examination, physical (Clic here for more details about this article) |
2/7. 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 = 1keywords = physical examination, physical (Clic here for more details about this article) |
3/7. Aortic flap valve presenting as neurogenic claudication: a case report.STUDY DESIGN: A case report of a patient who presented with pain in both lower limbs related with walking and standing as a result of an unusual vascular etiology. OBJECTIVES: To describe the pathology and treatment of an unusual case of vascular claudication. SUMMARY OF BACKGROUND DATA: Symptoms of neurogenic claudication may be mimicked by intermittent vascular claudication. Not infrequently, arterial disease coexists with spinal canal stenosis. Determination of correct diagnosis is the prerequisite for effective treatment. methods: The patient was a 64-year-old woman who presented with bilateral buttock pain spreading to the calves. The symptom was related to walking and climbing stairs and relieved by sitting down. MRI of the lumbosacral spine corroborated severe spinal stenosis at L3-L4 and L4-L5. Based on findings on physical examination of the peripheral pulses, an aortogram revealed a flap in the lumen functioning like a valve as the cause of her lower limb ischemic pain. RESULTS: The patient was managed by insertion of a self-expandable metallic stent with complete resolution of her symptoms. CONCLUSIONS: We report a case that was diagnosed as neurogenic claudication on clinical features and MRI evidence. However, subsequent to an aortogram the diagnosis was revised. intermittent claudication is often difficult to distinguish from neurogenic claudication. There are no sensitive discriminators based on history alone. In the presence of poor or absent peripheral pulses, an arteriogram is necessary to ascertain the relative importance of the peripheral arterial circulation.- - - - - - - - - - ranking = 1keywords = physical examination, physical (Clic here for more details about this article) |
4/7. 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 = 0.19766407537969keywords = physical (Clic here for more details about this article) |
5/7. spondylolysis of the axis. A case report and review of the literature.Bilateral congenital defects in the pedicles of the second cervical vertebra were noted on conventional x-rays and tomography of a 42-year-old male. He had been assaulted after which he suffered upper neck and occipital pain. Subsequent CT scanning demonstrated the incomplete nature of the axis defects. This is felt to be important in prognosticating the likelihood of spondylolisthesis formation and counselling the patient with regard to acceptable future physical activity. The role of CT examination for this purpose has not been stressed before. The importance of differentiation from old trauma is emphasized.- - - - - - - - - - ranking = 0.19766407537969keywords = physical (Clic here for more details about this article) |
6/7. Traumatic spondylolisthesis of the axis in a patient presenting with torticollis. A case report.In a 34-year-old man with an acute traumatic spondylolisthesis (ATS) of the axis, the presenting physical sign was severe torticollis associated with reactive spasm of the right sternomastoid muscle. Computed axial tomography (CAT) was useful both in assessing the nature of ATS (which involved more displacement of the axis fracture and adjacent soft-tissues on the right side of the neck) and in ascertaining reduction, realignment, and healing. The reduction was sustained by halo-vest immobilization.- - - - - - - - - - ranking = 0.19766407537969keywords = physical (Clic here for more details about this article) |
7/7. Treatment of lumbo-ischialgias of different origins by intradiscal injection of chymopapain (discolysis). Analysis of literature and personal experiences.An analysis is given of a series of 25 patients suffering from lumboischialgic pain of different causes, which have been treated by discolysis. literature reports are taken into consideration. As a result of analysis, the following statements seem justified: In no kind of lumbar disc prolapse are the results of discolysis superior to those of modern operative treatment. Discolysis results are indisputably worse in cases with the usual operative indication, which consists of neurological deficit and large disc prolapse. Favourable results by discolysis can be obtained in cases with disc protrusion or small prolapse, but these cases can mostly be cured also by consequent conservative treatment. Contraindications are marked neurological deficit, demonstration of a large disc prolapse by contrast methods, Verbiest's stenosis of the lumbar spinal canal, low back pain and ischialgia without possible proof of a disc protrusion, cases with low back pain as the main or only feature, spondylolisthesis. Disc prolapse recurrences after discolysis often occur about one month afterwards. Structural instability at this stage is likely. Therefore, as with postoperative treatment, it is advisable to avoid major physical stress for the first weeks after discolysis. Major complications after discolysis are possible, and have occurred. Because discolysis offers no real advantages but some shortcomings compared to conservative treatment for disc protrusions, and to operative treatment in real disc prolapses, its justification seems more than questionable.- - - - - - - - - - ranking = 0.19766407537969keywords = physical (Clic here for more details about this article) |