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International Journal of Surgery Case... Jul 2024Traumatic lower cervical dislocation with spinal cord injury (SCI) can cause long-lasting dysfunction in many organ systems resulting in significant financial burden and...
INTRODUCTION AND IMPORTANCE
Traumatic lower cervical dislocation with spinal cord injury (SCI) can cause long-lasting dysfunction in many organ systems resulting in significant financial burden and functional disability. The patient may come with complete or incomplete neurological deficit. However, there is also possibility of no neurological deficit.
CASE PRESENTATION
This case reports presented two cases of a 68-year-old man and a 54-year-old man that came to the emergency department after a traffic accident and fell from a height. Surprisingly there was no neurological deficit found on both patients. The patient underwent emergency open reduction and posterior stabilization. Several months later, the neurological function was still excellent, and the pain was absent.
CLINICAL DISCUSSION
Traumatic cervical dislocation without neurological deficit is rare. Enlargement of the spinal canal is significant when the vertebral body and the shattered posterior arch separate, which may play a protective role on the spinal cord. The neurological deficit did not happen in the first case due to a widening spinal canal. Still, in the second case, the patient's neurological condition remained excellent despite no disruption on the posterior arch after cervical dislocation.
CONCLUSION
Neurological deficit may not occur in the cervical dislocation with disruption of the posterior arch due to the widening of the spinal canal. This injury should be treated properly to prevent other morbidities and even mortality. The posterior technique for stabilization gives various benefits, such as the safety and familiarity of the procedure and the high success rate.
PubMed: 38851073
DOI: 10.1016/j.ijscr.2024.109814 -
Skeletal Radiology Jun 2024A new axial loading device was used to investigate the effects of axial loading and positions on lumbar structure and lumbar spinal stenosis.
OBJECTIVE
A new axial loading device was used to investigate the effects of axial loading and positions on lumbar structure and lumbar spinal stenosis.
METHODS
A total of 40 patients sequentially underwent 4 examinations: (1) the psoas-relaxed position MRI, (2) the extended position MRI, (3) the psoas-relaxed position axial loading MRI, (4) the extended position axial loading MRI. The dural sac cross-sectional area, sagittal vertebral canal diameter, disc height and ligamentum flavum thickness of L3-4, L4-5, L5-S1 and lumbar lordosis angle were measured and compared. A new device with pneumatic shoulder-hip compression mode was used for axial loading.
RESULTS
In the absence of axial loading, there was a significant reduction in dural sac cross-sectional area with extension only seen at the L3-4 (p = 0.033) relative to the dural sac area in the psoas-relaxed position. However, with axial loading, there was a significant reduction in dural sac cross-sectional area at all levels in both psoas-relaxed (L3-4, p = 0.041; L5-S1, p = 0.005; L4-5, p = 0.002) and extension (p < 0.001) positions. The sagittal vertebral canal diameter and disc height were significantly reduced at all lumbar levels with axial loading and extension (p < 0.001); however, in psoas-relaxed position, the sagittal vertebral canal diameter was only reduced with axial loading at L3-4 (p = 0.018) and L4-5 (p = 0.011), and the disc height was reduced with axial-loading at all levels (L3-4, p = 0.027; L5-S1, p = 0.001; L4-5, p < 0.001). The ligamentum flavum thickness and lumbar lordosis in extension position had a statistically significant increase compared to psoas-relaxed position with or without axial loading (p < 0.001).
CONCLUSION
Both axial loading and extension of lumbar may exacerbate lumbar spinal stenosis. Axial loading in extension position could maximally aggravate lumbar spinal stenosis, but may cause some patients intolerable. For those patients, axial loading MRI in psoas-relaxed position may be a good choice.
PubMed: 38849534
DOI: 10.1007/s00256-024-04720-5 -
JBJS Case Connector Apr 2024A 37-year-old man American Society of Anesthesiologists grade 1 patient with lumbar canal stenosis at the L4-L5 level underwent endoscopic decompression. Toward the end...
CASE
A 37-year-old man American Society of Anesthesiologists grade 1 patient with lumbar canal stenosis at the L4-L5 level underwent endoscopic decompression. Toward the end of the procedure, the patient developed sudden-onset bradycardia, followed by ventricular arrhythmia and acute pulmonary edema. The patient was successfully managed with resuscitation and supportive management and recovered uneventfully thereafter. A diagnosis of perioperative stress cardiomyopathy was subsequently made after evaluation of the patient.
CONCLUSION
The possibility of takotsubo cardiomyopathy should be considered in cases of acute perioperative cardiac decompensation and pulmonary edema in patients undergoing spinal surgery.
Topics: Humans; Takotsubo Cardiomyopathy; Adult; Male; Spinal Stenosis; Endoscopy; Lumbar Vertebrae; Decompression, Surgical; Intraoperative Complications
PubMed: 38848407
DOI: 10.2106/JBJS.CC.24.00031 -
Child's Nervous System : ChNS :... Jun 2024A subset of children with Chiari 1 malformation (CM-1) have a 4th ventricle arachnoid veil-a thin membrane covering the outlet of the 4th ventricle. Studies suggest that...
INTRODUCTION
A subset of children with Chiari 1 malformation (CM-1) have a 4th ventricle arachnoid veil-a thin membrane covering the outlet of the 4th ventricle. Studies suggest that failure to disrupt this veil during posterior fossa decompression can reduce the likelihood of syringomyelia resolution. However, there is no reliable method for predicting the presence of the veil without direct surgical exploration. This study aims to evaluate the association between pre-operative symptoms, radiographic measurements, and the arachnoid veil.
METHODS
A retrospective review of an institutional database of children evaluated for CM-I was conducted. For patients treated with surgery, operative notes were reviewed to determine if an arachnoid veil was present. Logistic regression was used to test for relationship of clinical variables and radiographic measurements with the presence of an arachnoid veil.
RESULTS
Out of 997 children with CM-1, 226 surgical patients were included in the analysis after excluding those with inadequate documentation. An arachnoid veil was found in 23 patients (10.2%). Larger syrinx, spinal canal, and thecal sac diameters were significantly associated with the presence of a veil, with odds ratios of 1.23 (95% CI 1.2-1.48; p = 0.03), 1.27 (95% CI 1.02-1.59; p = 0.03), and 1.35 (95% CI 1.03-1.77; p = 0.03), respectively. No significant associations were found with any signs or symptoms.
CONCLUSIONS
Arachnoid veil was present in 10% of cases. Radiographic measurements indicating larger syrinx size were the only variables found to be significantly associated with an arachnoid veil. Exploration of the 4th ventricular outlet is recommended for CM-I decompression in the setting of expansile syringomyelia.
PubMed: 38847880
DOI: 10.1007/s00381-024-06482-w -
Medicine Jun 2024Percutaneous epidural adhesiolysis (PEA) is an effective treatment for patients with lumbar radiculopathy unresponsive to single steroid injections. Various approaches... (Observational Study)
Observational Study
Percutaneous epidural adhesiolysis (PEA) is an effective treatment for patients with lumbar radiculopathy unresponsive to single steroid injections. Various approaches and instruments have been developed to access these lesions. This study aimed to evaluate the utility of a retrodiscal approach for epidural adhesiolysis using a WHIP catheter®. This retrospective study was conducted at Bundang Seoul National University Hospital, reviewing cases from January to December 2022. Forty-seven patients diagnosed with lumbar radiculopathy, aged 20 to 80 years, who underwent PEA with the WHIP catheter® were included. Outcomes assessed Numeric Rating Scale (NRS) for pain, Patients' Global Impression of Change (PGIC) scores, and the incidence of procedure-related complications. Follow-up evaluations occurred at 1, 3, and 6 months post-procedure. Among 47 patients, 41 completed the study, showing significant pain reduction at all follow-up points: 1 month (N = 41, 1.32 ± 1.68, P < .001), 3 months (N = 31, 1.90 ± 2.14, P < .001), and 6 months (N = 30, 2.50 ± 2.30, P < .001). PGIC scores indicated that 40% of the patients reported substantial improvement at one-month post-procedure. The complications were minimal, with only one case of intradiscal injection and 2 cases of vascular uptake. The retrodiscal approach PEA using the WHIP catheter® demonstrated significant efficacy in pain reduction with minimal safety concerns for patients with lumbar radiculopathy. These findings suggest that this procedure is a viable option for patients who are unresponsive to conservative treatment. However, the retrospective nature of this study and its small sample size necessitate further prospective controlled studies to confirm our results and establish long-term outcomes.
Topics: Humans; Retrospective Studies; Radiculopathy; Male; Middle Aged; Female; Adult; Aged; Catheters; Lumbar Vertebrae; Treatment Outcome; Aged, 80 and over; Pain Measurement; Epidural Space; Tissue Adhesions; Young Adult; Injections, Epidural
PubMed: 38847700
DOI: 10.1097/MD.0000000000038452 -
Operative Neurosurgery (Hagerstown, Md.) Jun 2024Neurocysticercosis is a notorious-albeit relatively rare-parasitic infection of the nervous system caused by ingestion of embryonated eggs or gravid proglottids of the...
Neurocysticercosis is a notorious-albeit relatively rare-parasitic infection of the nervous system caused by ingestion of embryonated eggs or gravid proglottids of the pork tapeworm Taenia solium.1 Most cases appear intracranially and can present with seizures and/or headache; far fewer affect the spinal canal alone.1-6 We describe a case of a 66-year-old Hispanic man with isolated spinal cysticercosis presenting to the emergency department initially with axial back pain. After lumbar x-rays and a computed tomography scan failed to find any pathology, he was discharged home without neurosurgical consultation. A week later he would re-present to the same emergency department with worsening back pain and new neurologic deficits, prompting an MRI revealing pathology within the lumbar spinal canal. After consultation, the neurosurgical team discussed management strategies and eventually opted for surgical exploration of the patient's lumbar spine. This exploration eventually culminated in an intradural exploration, revealing an impressive string of interconnected larval cysts of the T. solium tapeworm within the cauda equina. The patient's neurologic condition improved immediately after surgery, and final pathologic examination supported a diagnosis of spinal cysticercosis, prompting the appropriate workup and medical treatment. He would ultimately make a full recovery and continues to follow-up with infectious disease at our institution. The patient consented to the surgical intervention described herein after a discussion of its risks, benefits, and alternatives. Institutional review board and ethics committee approval was not sought because the intervention did not constitute experimental surgery, but rather represented standard of care given the patient's condition on presentation.
PubMed: 38847526
DOI: 10.1227/ons.0000000000001231 -
Radiology Case Reports Aug 2024Ventricular meningiomas are neoplastic cells originating from the ependymal lining of the central canal of the spinal cord and the ventricles of the brain. These...
Ventricular meningiomas are neoplastic cells originating from the ependymal lining of the central canal of the spinal cord and the ventricles of the brain. These tumorigenic cells predominantly manifest in the fourth ventricle, followed by the spinal cord. Most intraparenchymal ventricular meningiomas are located within the brain tissue, exhibiting a higher degree of malignancy compared to their intracerebroventricular counterparts. While intracranial dissemination and metastasis to the spinal cord can occur, extra-neurologic metastasis is an exceedingly rare phenomenon that lacks a clear elucidation regarding its underlying mechanism. The authors presented a case of supratentorial brain parenchymal type ventricular meningioma surgical treatment in a young female patient, occurring two years after the development of multiple metastases in both lungs, pleura, and mediastinum. This may be attributed to the high malignancy degree and strong invasiveness of this lesion, as well as its proximity to the dura mater and venous sinus. The craniotomy provided an opportunity for tumor cells to invade the adjacent venous sinus, leading to dissemination through the blood system. Additionally, postoperative radiation and chemotherapy were administered to inhibit tumor angiogenesis; however, these treatments also increased the likelihood of tumor cell invasion into neighboring brain tissues and distant metastasis.
PubMed: 38845628
DOI: 10.1016/j.radcr.2024.04.092 -
Frontiers in Public Health 2024Spondylitis caused by infection is a rare but challenging condition, and its successful management depends on timely diagnosis and appropriate treatment. This study...
BACKGROUND
Spondylitis caused by infection is a rare but challenging condition, and its successful management depends on timely diagnosis and appropriate treatment. This study reports two typical cases of thoracic and lumbar brucellosis spondylitis, highlighting the pivotal roles of real-time polymerase chain reaction (real-time PCR) detection and surgical intervention.
CASE PRESENTATION
Case 1 involved a 49-year-old male shepherd who presented with a 6-month history of fever (40°C), severe chest and back pain, and 2-week limited lower limb movement with night-time exacerbation. Physical examination revealed tenderness and percussion pain over the T9 and T10 spinous processes, with grade 2 muscle strength in the lower limbs. CT showed bone destruction of the T9 and T10 vertebrae with narrowing of the intervertebral space, whereas MRI demonstrated abnormal signals in the T9-T10 vertebrae, a spinal canal abscess, and spinal cord compression. The Rose Bengal plate agglutination test was positive. Case 2 was a 59-year-old man who complained of severe thoracolumbar back pain with fever (39.0°C) and limited walking for 2 months. He had a 2.5 kg weight loss and a history of close contact with sheep. The Rose Bengal test was positive, and the MRI showed inflammatory changes in the L1 and L2 vertebrae. Diagnosis and treatment: real-time PCR confirmed infection in both cases. Preoperative antimicrobial therapy with doxycycline, rifampicin, and ceftazidime-sulbactam was administered for at least 2 weeks. Surgical management involved intervertebral foraminotomy-assisted debridement, decompression, internal fixation, and bone grafting under general anesthesia. Postoperative histopathological examination with HE and Gram staining further substantiated the diagnosis. Outcomes: both patients experienced significant pain relief and restored normal lower limb movement at the last follow-up (4-12 weeks) after the intervention.
CONCLUSION
Real-time PCR detection offers valuable diagnostic insights for suspected cases of brucellosis spondylitis. Surgical treatment helps in infection control, decompression of the spinal cord, and restoration of stability, constituting a necessary and effective therapeutic approach. Prompt diagnosis and comprehensive management are crucial for favorable outcomes in such cases.
Topics: Humans; Male; Brucellosis; Middle Aged; Spondylitis; Real-Time Polymerase Chain Reaction; Lumbar Vertebrae; Thoracic Vertebrae; Brucella; Anti-Bacterial Agents; Magnetic Resonance Imaging
PubMed: 38841672
DOI: 10.3389/fpubh.2024.1396152 -
The Journal of the Canadian... Apr 2024Spinal epidural lipomatosis (SEL) is a rare contributor of low back pain (LBP) that can present with or without radicular symptoms.
BACKGROUND
Spinal epidural lipomatosis (SEL) is a rare contributor of low back pain (LBP) that can present with or without radicular symptoms.
CASE PRESENTATION
A 51-year-old and 65-year-old male presented with chronic LBP to the Veterans Affairs chiropractic clinic for a trial of care. One had a moderate degree of lumbar spinal stenosis with known SEL and the other had severe. The patient with moderate grade stenosis responded favorably with weeks of transient benefit after visits and the patient with severe grade did not find benefit with care.
SUMMARY
SEL is a condition that conservative care providers should be aware of as a potential cause of central canal stenosis or neuroforaminal narrowing. Chiropractic management of SEL has been scarcely reflected in the published literature, but may be a viable option for transient symptom management.
PubMed: 38840968
DOI: No ID Found